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 Since then, tegaserod has been withdrawn from the Canadian market.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 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.

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.

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.

scholarly journals Traction Therapy for Cervical Radicular Syndrome is Statistically Significant but not Clinically Relevant for Pain Relief. A Systematic Literature Review with Meta-Analysis and Trial Sequential Analysis

2020 ◽  
Vol 9 (11) ◽  
pp. 3389
Author(s):  
Claudio Colombo ◽  
Stefano Salvioli ◽  
Silvia Gianola ◽  
Greta Castellini ◽  
Marco Testa
Keyword(s):  
Sequential Analysis ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Treatment Modalities ◽  
Trial Sequential Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Quality Of Evidence ◽  
Radicular Syndrome

Aim: We aimed to investigate the effectiveness of traction therapy in reducing pain by performing a systematic review with meta-analysis. We also explore the best modality for administering traction to patients with cervical radicular syndrome (CRS). Methods: We searched the Medline, Physiotherapy Evidence Database (PEDro), Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) electronic databases. Two reviewers independently selected randomized controlled trials (RCTs) that compared traction in addition to other treatments versus the effectiveness of other treatments alone for pain outcome. We calculated the mean differences (MDs) and 95% confidence intervals (CIs). We used Cochrane’s tool to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to evaluate the quality of evidence and summarize the study conclusions. Results: A total of seven studies (589 patients), one with low risk of bias, were evaluated. An overall estimate of treatment modalities showed low evidence that adding traction to other treatments is statistically significant (MD −5.93 [95% CI, −11.81 to −0.04] P = 0.05 and I2 = 57%) compared to other treatments alone. The subgroup analyses were still statistically significant only for mechanical and continuous modalities. Conclusions: Overall analysis showed that, compared to controls, reduction in pain intensity after traction therapy was achieved in patients with cervical radiculopathy. However, the quality of evidence was generally low and none of these effects were clinically meaningful.

scholarly journals New Treatment Options for Chronic Constipation: Mechanisms, Efficacy and Safety

2011 ◽  
Vol 25 (suppl b) ◽  
pp. 29B-35B ◽  
Author(s):  
Michael Camilleri
Keyword(s):  
Bile Acid ◽  
Serotonin Receptor ◽  
Treatment Options ◽  
Chloride Ion ◽  
New Drugs ◽  
Receptor Subtype ◽  
Efficacy And Safety ◽  
Guanylate Cyclase C ◽  
Patient Responsiveness ◽  
New Treatment

The present review has several objectives, the first of which is to review the pharmacology and selectivity of serotonergic agents to contrast the older serotonergic agents (which were withdrawn because of cardiac or vascular adverse effects) with the newer generation serotonin receptor subtype 4 agonists. Second, the chloride ion secretagogues that act through the guanylate cyclase C receptor are appraised and their pharmacology is compared with the approved medication, lubiprostone. Third, the efficacy and safety of the application of bile acid modulation to treat constipation are addressed. The long-term studies of surgically induced excess bile acid delivery to the colon are reviewed to ascertain the safety of this therapeutic approach. Finally, the new drugs for opiate-induced constipation are introduced. Assuming these drugs are approved, practitioners will have a choice; however, patient responsiveness will be based on trial and error. Nevertheless, the spectrum of mechanisms and demonstrated efficacy and safety augur well for satisfactory treatment outcomes.

scholarly journals European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia

2021 ◽  
pp. 239698732110397
Author(s):  
Rainer Dziewas ◽  
Emilia Michou ◽  
Michaela Trapl-Grundschober ◽  
Avtar Lal ◽  
Ethem Murat Arsava ◽  
...  
Keyword(s):  
Treatment Options ◽  
Standard Operating Procedure ◽  
Dietary Interventions ◽  
Stroke Patients ◽  
Pharmacological Agents ◽  
Quality Of Evidence ◽  
Post Stroke ◽  
Moderate Quality ◽  
Grade Approach

Post-stroke dysphagia (PSD) is present in more than 50% of acute stroke patients, increases the risk of complications, in particular aspiration pneumonia, malnutrition and dehydration, and is linked to poor outcome and mortality. The aim of this guideline is to assist all members of the multidisciplinary team in their management of patients with PSD. These guidelines were developed based on the European Stroke Organisation (ESO) standard operating procedure and followed the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. An interdisciplinary working group identified 20 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence and wrote evidence-based recommendations. Expert opinion was provided if not enough evidence was available to provide recommendations based on the GRADE approach. We found moderate quality of evidence to recommend dysphagia screening in all stroke patients to prevent post-stroke pneumonia and to early mortality and low quality of evidence to suggest dysphagia assessment in stroke patients having been identified at being at risk of PSD. We found low to moderate quality of evidence for a variety of treatment options to improve swallowing physiology and swallowing safety. These options include dietary interventions, behavioural swallowing treatment including acupuncture, nutritional interventions, oral health care, different pharmacological agents and different types of neurostimulation treatment. Some of the studied interventions also had an impact on other clinical endpoints such as feedings status or pneumonia. Overall, further randomized trials are needed to improve the quality of evidence for the treatment of PSD.

scholarly journals Music Therapy and Dance as Gait Rehabilitation in Patients With Parkinson Disease: A Review of Evidence

2018 ◽  
Vol 32 (1) ◽  
pp. 49-56 ◽  
Author(s):  
Ana Paula S. Pereira ◽  
Victor Marinho ◽  
Daya Gupta ◽  
Francisco Magalhães ◽  
Carla Ayres ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Music Therapy ◽  
Parkinson Disease ◽  
Cognitive Abilities ◽  
Treatment Options ◽  
Music Performance ◽  
Well Being ◽  
The Elderly ◽  
Treatment Modalities

Parkinson disease causes several changes in gait, such as postural stability, which consequently induces fall risk factors and loss of quality of life. Alternative forms of treatment through rhythmic and dance stimuli have been used to minimize the Parkinson disease effects, which have been shown to be effective in improving gait and providing social well-being and quality of life in the patient. Aim: This review aims to demonstrate the efficiency of music and dance for gait improvement and symptom alleviation in Parkinson disease. Methodology: Studies that analyzed sound stimuli and dance in gait improvement in Parkinson disease were searched through PubMed, Scopus, Doaj, MEDLINE, and ScienceDirect databases from November 2017 to April 2018 and repeated in September 2018. Results and Discussion: Forty-five studies met the inclusion criteria to synthesize the findings on dance and music performance as a treatment for classical symptoms of Parkinson disease. Five reviews and 40 experimental papers have shown that rhythmic stimulation and dance provide the motor, cognitive, and quality of life benefits for participants with Parkinson disease. Thus, sound stimuli and dance offer satisfactory effects for gait, improving cognitive abilities such as motor control and adjustment and spatial memory. In addition, these new treatment modalities stimulate the elderly population to practice physical exercise, generating well-being and helping self-esteem. Conclusion: Dance and music therapy interventions are noninvasive, simple treatment options, which promote gait and cognition.

Treatment of painful diabetic peripheral neuropathy

2015 ◽  
Vol 39 (1) ◽  
pp. 17-28 ◽  
Author(s):  
Casandra J Rosenberg ◽  
James C Watson
Keyword(s):  
Quality Of Life ◽  
Peripheral Neuropathy ◽  
Side Effects ◽  
Diabetic Peripheral Neuropathy ◽  
Pain Control ◽  
Treatment Options ◽  
Mechanisms Of Action ◽  
Treatment Modalities ◽  
Painful Diabetic Peripheral Neuropathy

Background: Painful diabetic peripheral neuropathy impairs quality of life and can be difficult to treat. Objective: To discuss current treatment recommendations for painful diabetic peripheral neuropathy. Study design: Literature review. Methods: Systematic review of the literature discussing treatment of painful diabetic peripheral neuropathy. Existing treatment guidelines were studied and compared. Results: Painful diabetic peripheral neuropathy occurs in about one in six people with diabetes. This condition impairs quality of life and increases healthcare costs. Treatment recommendations exist, but individual patient therapy can require a trial-and-error approach. Many treatment options have adjuvant benefits or side effects which should be considered prior to initiating therapy. Often, a combination of treatment modalities with various mechanisms of action is required for adequate pain control. Adequate medication titration and a reasonable trial period should be allowed. Conclusion: The treatment of painful diabetic peripheral neuropathy can be challenging, but effective management can improve patient’s quality of life. Clinical relevance Painful diabetic peripheral neuropathy impairs quality of life and can be difficult to treat. Many treatment options have adjuvant benefits or side effects which should be considered prior to initiating therapy. Often, a combination of treatment modalities with various mechanisms of action is required for adequate pain control.

Developing Clinical Recommendations for Breast, Colorectal, and Lung Cancer Adjuvant Treatments Using the GRADE System: A Study From the Programma Ricerca e Innovazione Emilia Romagna Oncology Research Group

2008 ◽  
Vol 26 (7) ◽  
pp. 1033-1039 ◽  
Author(s):  
Rossana De Palma ◽  
Alessandro Liberati ◽  
Giovannino Ciccone ◽  
Elena Bandieri ◽  
Maurizio Belfiglio ◽  
...  
Keyword(s):  
Anticancer Drugs ◽  
Evaluation System ◽  
Risk Profile ◽  
Grade System ◽  
Quality Of Evidence ◽  
Assessment Development ◽  
Oncology Research ◽  
Course Of Action ◽  
Effective Interventions

Purpose In the area of anticancer drugs, the legitimate search for effective interventions can be jeopardized by the strong pressure for accelerated approval, which may hinder the full assessment of their benefit-risk profile. We aimed to produce drug-specific recommendations using an explicit approach that separates the judgments on quality of evidence from the judgment about strength of recommendations. Materials and Methods We used the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) system to develop recommendations for the use of specific anticancer drugs/regimens; 12 clinical questions relevant to adjuvant treatment of breast (three), colorectal (four) and lung (five) cancer have been assessed by multidisciplinary panels supported by a group of methodologists. Results For nine of 12 questions, recommendations were produced (one strong and six weak in favor and one weak and one strong against the index treatment); for the remaining three questions no specific course of action could be recommended. The perceived benefits to risk balance of the treatment was the most important and statistically significant (P < .01) predictor of panels’ recommendations and of their strength, whereas panelists’ personal (age, sex) and professional (specialty) characteristics were not statistically associated. Conclusion Because the GRADE system sets out an explicit process going from evaluation of the quality of evidence and benefit-risk profile to the judgment of the strength of recommendations, in this experience, it proved very useful to combine methodologic rigor with the interdisciplinary participation that is important in the definition of evidence based clinical policies.

scholarly journals Rare cases of appendicitis presented in KIMS Amalapuram, India: a clinical study

2017 ◽  
Vol 4 (11) ◽  
pp. 3779
Author(s):  
M. Uday Kiran ◽  
B. Rakesh ◽  
L. Hari Prasad Rao ◽  
P. Avinash ◽  
D. Amrita Manjusha ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Acute Appendicitis ◽  
Carcinoid Tumour ◽  
Treatment Options ◽  
Treatment Modalities ◽  
Current Standard ◽  
Rare Presentation ◽  
Omental Patch ◽  
Perforated Appendix

RIF pain is a hall mark of acute appendicitis until proven otherwise decision making in a case of acute appendicitis may be difficult for junior surgeons hence we aimed at analysis in RIF pain. Out of 120 cases we found 3 rare entities they are PMP, CT of appendix and perforated appendix in LIF. Pseudomyxomaperinei and carcinoid tumour are rare presentations. Despite the current standard of treatment modalities as extensive surgical resection combined with chemotherapy, PMP and CT frequently recurs with treatment options being limited at recurrence and with severe impact on quality of life. Perforated appendix in LIF is also a rare presentation which needs appendicectomy, perforation closer with omental patch.

Sign in / Sign up

Export Citation Format

Share Document