scholarly journals MANAGEMENT OF ENDOCRINE DISEASE: Critical review of the evidence underlying management of glucocorticoid-induced hyperglycaemia

2018 ◽  
Vol 179 (4) ◽  
pp. R207-R218 ◽  
Author(s):  
Anjana Radhakutty ◽  
Morton G Burt
Keyword(s):  
Low Dose ◽  
Randomized Clinical Trials ◽  
Chronic Inflammatory Disease ◽  
Hospitalized Patients ◽  
Isophane Insulin ◽  
Wide Range ◽  
Clinical Benefits ◽  
High Doses ◽  
Bolus Insulin

Glucocorticoids are frequently prescribed to patients with a wide range of inflammatory and autoimmune diseases. The semi-synthetic glucocorticoid prednisolone is most commonly prescribed and in two main patterns. Prednisolone is prescribed short term at medium-high doses to treat an acute inflammatory illness or long term at lower doses to attenuate chronic inflammatory disease progression. In hospitalized patients with acute prednisolone-induced hyperglycaemia, there is a distinct circadian pattern of glucose elevation, which occurs predominantly in the afternoon and evening. As a morning dose of isophane insulin has a pharmacokinetic pattern that matches this pattern of glucose elevation, treatment comprising a basal dose of morning isophane insulin in combination with short-acting insulin boluses is generally recommended. However, evidence is lacking that isophane-based basal bolus insulin is more efficacious than other insulin regimens. In outpatients, low-dose prednisolone causes a small increase in post glucose-load glucose concentration but no change in overall glycaemic control as measured by glycosylated haemoglobin. If treatment is indicated, metformin has been shown to be effective and may attenuate other adverse effects of long-term prednisolone therapy. Further studies are necessary in order to identify factors underlying the variability in response to insulin therapy and clinical benefits of treatment in hospitalized patients with prednisolone-induced hyperglycaemia. In outpatients prescribed low-dose prednisolone, the cardiovascular risk associated with postprandial hyperglycaemia and efficacy of hypoglycaemic therapies should be evaluated in future randomized clinical trials.

Cognitive impairment in long-term benzodiazepine users

1988 ◽  
Vol 18 (2) ◽  
pp. 365-374 ◽  
Author(s):  
Susan Golombok ◽  
Parimala Moodley ◽  
Malcolm Lader
Keyword(s):  
Neuropsychological Tests ◽  
Matched Control ◽  
Control Group ◽  
Therapeutic Practice ◽  
The Past ◽  
Visual Spatial ◽  
Wide Range ◽  
High Doses ◽  
One Year

SynopsisIn view of the very extensive and often prolonged use of benzodiazepines in therapeutic practice, this study was designed to investigate whether or not cognitive ability is impaired in longterm benzodiazepine users, and to determine the nature and extent of any deficit. Fifty patients currently taking benzodiazepines for at least one year, thirty-four who had stopped taking benzodiazepines, and a matched control group of subjects who had never taken benzodiazepines or who had taken benzodiazepines in the past for less than one year were administered a battery of neuropsychological tests designed to measure a wide range of cognitive functions. It was found that patients taking high doses of benzodiazepines for long periods of time perform poorly on tasks involving visual-spatial ability and sustained attention. This is consistent with deficits in posterior cortical cognitive function.

Effects of long-term continuous GnRH administration on the pituitary–gonadal axis in Eld's deer stags (Cervus eldi thamin)

1995 ◽  
Vol 73 (9) ◽  
pp. 1609-1619 ◽  
Author(s):  
S. L. Monfort ◽  
J. L. Brown ◽  
T. C. Wood ◽  
M. Bush ◽  
L. R. Williamson ◽  
...  
Keyword(s):  
Dose Group ◽  
Low Dose ◽  
High Dose ◽  
Fertile Period ◽  
Nonbreeding Season ◽  
Testosterone Secretion ◽  
High Doses ◽  
Seasonal Decline ◽  
Seasonally Breeding

Eld's deer stags (Cervus eldi thamin) (in groups of three) were continuously administered gonadotropin-releasing hormone (GnRH) in control, low, medium, or high doses (0, 20.1 ± 0.7, 83.3 ± 2.6, and 292.9 ± 4.9 ng∙kg−1∙d−1, respectively) via osmotic minipumps for ~80 d to investigate the potential for precociously reactivating the pituitary–testicular axis during the nonbreeding season. Secretory patterns of LH, FSH, and testosterone concentrations were qualitatively similar among treatments. However, in the low-dose group, basal LH and FSH concentrations were both increased (p < 0.05) and pituitary responsiveness to a superimposed GnRH challenge was augmented (p < 0.05) after 12 weeks of treatment compared with all other groups. Despite these endocrine changes, continuous low-dose GnRH administration was not effective for precociously inducing testicular activity in this seasonally breeding species. High-dose GnRH administration initially induced a transient increase in LH, FSH, and testosterone secretion and delayed, but did not prevent, the seasonal decline in spermatogenesis. After 6–12 weeks of high-dose GnRH administration, however, attenuated pituitary responsiveness appeared to delay the normal seasonal reactivation of the pituitary–gonadal axis. In conclusion, prolonged, continuous low-dose GnRH administration did not effectively translate into a precocious onset of testicular activity; therefore, this specific approach is unlikely to be useful for prolonging the fertile period in this seasonally breeding species.

scholarly journals Lavender aromatherapy for sleep in hospitalized patients: A scoping review

2021 ◽  
Vol 11 (10) ◽  
pp. 41
Author(s):  
Ani Jacob ◽  
Jane H. White
Keyword(s):  
Scoping Review ◽  
Clinical Evidence ◽  
Randomized Clinical Trials ◽  
The United States ◽  
Hospitalized Patients ◽  
Surgical Patients ◽  
Health And Wellness ◽  
Wide Range ◽  
Sample Characteristics ◽  
Administration Methods

Background and objective: The importance of promoting sleep for hospitalized patients is vital especially because sleep has been shown to promote healing. Complementary and alternative medicine approaches for health and wellness have been widely used in the United States. However, for hospitalized patients, while aromatherapy such as lavender is often used by nurses for comfort and sleep, the evidence for specific dosage and administration methods are unclear, even though its effectiveness has been shown and published.  The purpose of this scoping review is to highlight the significant issues surrounding the evidence to date for lavender aromatherapy’s clinical use for hospitalized patients.Methods: This review utilized the PRISMA steps to identify literature important to the study’s purpose.Results: After the initial search using specific keywords yielded 588 articles, further steps in the process resulted in 8 studies whose purpose was to test the effectiveness of lavender aromatherapy for sleep in hospitalized patients. Three major categories that resulted from the review addressed the clinical evidence limitations associated with lavender’s use for sleep: the wide range of sample characteristics and counties, mixed variables for study purposes, and disparate dosage and administration methods. Most significant for clinical practice was the disparate dosages and methods of lavender aromatherapy administration across the studies reviewed for effectiveness.Conclusion and implications: Nurses should proceed with caution when using lavender aromatherapy for hospitalized patients. This review highlighted the need for nurses to conduct and disseminate findings from randomized clinical trials utilizing hospitalized general medical-surgical patients. Testing dosages and administration methods that have shown to be effective for medical surgical hospitalized patients is warranted.

scholarly journals The Potential of Virtual Reality for Inducing Neuroplasticity in Children with Amblyopia

2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
Author(s):  
María B. Coco-Martin ◽  
David P. Piñero ◽  
Luis Leal-Vega ◽  
Carlos J. Hernández-Rodríguez ◽  
Joaquin Adiego ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Randomized Clinical Trials ◽  
Cortical Reorganization ◽  
Visual Rehabilitation ◽  
Wide Range ◽  
Head Mounted Displays ◽  
Neuronal Connections ◽  
Definition Of ◽  
And Control

In recent years, virtual reality (VR) has emerged as a new safe and effective tool for neurorehabilitation of different childhood and adulthood conditions. VR-based therapies can induce cortical reorganization and promote the activation of different neuronal connections over a wide range of ages, leading to contrasted improvements in motor and functional skills. The use of VR for the visual rehabilitation in amblyopia has been investigated in the last years, with the potential of using serious games combining perceptual learning and dichoptic stimulation. This combination of technologies allows the clinician to measure, treat, and control changes in interocular suppression, which is one of the factors leading to cortical alterations in amblyopia. Several clinical researches on this issue have been conducted, showing the potential of promoting visual acuity, contrast sensitivity, and stereopsis improvement. Indeed, several systems have been evaluated for amblyopia treatment including the use of different commercially available types of head mounted displays (HMDs). These HMDs are mostly well tolerated by patients during short exposures and do not cause significant long-term side effects, although their use has been occasionally associated with some visual discomfort and other complications in certain types of subjects. More studies are needed to confirm these promising therapies in controlled randomized clinical trials, with special emphasis on the definition of the most adequate planning for obtaining an effective recovery of the visual and binocular function.

scholarly journals Lack of evidence for the effectiveness or safety of over-the-counter cannabidiol products

2020 ◽  
Vol 10 ◽  
pp. 204512532095499
Author(s):  
Edward Chesney ◽  
Philip McGuire ◽  
Tom P. Freeman ◽  
John Strang ◽  
Amir Englund
Keyword(s):  
Public Interest ◽  
Low Dose ◽  
Health Benefits ◽  
Controlled Trials ◽  
Over The Counter ◽  
Potential Health ◽  
Beneficial Effects ◽  
The Past ◽  
Wide Range ◽  
High Doses

Over the past 5 years, public interest in the potential health benefits of cannabidiol (CBD) has increased exponentially, and a wide range of over-the-counter (OTC) preparations of CBD are now available. A substantial proportion of the population appears to have used these products, yet the extent to which they are effective or safe is unclear. We reviewed the evidence for whether CBD has significant pharmacological and symptomatic effects at the doses typically found in OTC preparations. We found that most of the evidence for beneficial effects is derived from studies of pure, pharmaceutical grade CBD at relatively high doses. Relatively few studies have examined the effect of OTC CBD preparations, or of CBD at low doses. Thus, at present, there is little evidence that OTC CBD products have health benefits, and their safety has not been investigated. Controlled trials of OTC and low-dose CBD preparations are needed to resolve these issues.

scholarly journals Ticagrelor in patients with stable coronary artery disease: a role in improving prognosis

2020 ◽  
Vol 25 ◽  
pp. 4094
Author(s):  
T. N. Novikova
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Acetylsalicylic Acid ◽  
Low Dose ◽  
Randomized Clinical Trials ◽  
Stable Coronary Artery Disease ◽  
Evidence Base ◽  
Actual Clinical Practice ◽  
Artery Disease

The aim of this review was to study the evidence base for the efficacy and safety of the P2Y12 receptor blocker ticagrelor in combination with acetylsalicylic acid in patients with stable coronary artery disease and high and moderate risk of adverse cardiovascular events. Currently, the mortality rate of this category of patients remains high. Long-term dual antithrombotic therapy allows to improve the prognosis. Ticagrelor at a low dose (60 mg 2 times a day) in combination with acetylsalicylic acid in randomized clinical trials and an actual clinical practice has shown a beneficial effect on prognosis in stable coronary artery disease.

Is Continuous Low-Dose Prophylaxis Superior to On-Demand Treatment for Patients with Hemophilia?

2016 ◽  
Vol 42 (05) ◽  
pp. 533-540 ◽  
Author(s):  
Jerzy Windyga
Keyword(s):  
Low Dose ◽  
Randomized Clinical Trials ◽  
Venous Access ◽  
Convincing Evidence ◽  
Clotting Factor ◽  
High Dose ◽  
Optimal Dosage ◽  
On Demand ◽  
Related Quality

Long-term (or continuous) prophylaxis is generally accepted as the best form of treatment for patients with severe hemophilia A and B. Results of recent prospective, randomized clinical trials, as well as observational studies performed in the last decades, have provided strong and convincing evidence that continuous prophylaxis leads to reduction in the number of bleeding episodes, better joint status and improved health-related quality of life as compared with on-demand (or episodic) treatment. Nevertheless, many questions regarding long-term prophylaxis still remain open, for instance: when should prophylaxis be started (before or after the first joint bleeding), what is the optimal dosage to replace the missing factor, when should discontinuation of long-term prophylaxis be considered, what is the best way to measure the outcome of prophylaxis, etc. Moreover, there are numerous obstacles to widespread use of prophylactic therapy. The most challenging seem to be adequate venous access (particularly in younger patients) and patients' adherence. The crucial barrier to long-term prophylaxis is, however, the remarkably high cost of clotting factor concentrates. For most countries high-dose or intermediate-dose prophylaxis regimens are not affordable due to lack of economic resources. So, is continuous prophylaxis reserved exclusively for wealthy societies? Fortunately, there is an increasing body of evidence to suggest that low-dose prophylaxis offers significant benefits over on-demand treatment with comparable amounts of factor concentrate (and much lower amounts if compared with intermediate or high-dose prophylaxis regimens). The aim of this article is to discuss the clinical and economical aspects of continuous prophylaxis in hemophilia with emphasis on the low-dose regimens.

Combination therapy for obesity

2017 ◽  
Vol 31 (11) ◽  
pp. 1503-1508 ◽  
Author(s):  
John PH Wilding
Keyword(s):  
Bariatric Surgery ◽  
Combination Therapy ◽  
Low Dose ◽  
Lifestyle Modification ◽  
Gut Hormones ◽  
First Line ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1 ◽  
High Doses

Obesity is a chronic disease with serious consequences and although lifestyle modification is considered first line treatment, it is often ineffective, especially in the long term. Relatively few people with obesity will undergo the most effective currently available treatment of bariatric surgery. Pharmacotherapy can bridge the gap between lifestyle modification and surgery, but many monotherapies have only modest efficacy or require high doses with unacceptable side effects. As with many other areas of medicine, combination therapy is now becoming accepted as a way of optimising efficacy for weight management, whilst minimising adverse effects. Combinations may use different medications with complementary modes of action. Currently available combination therapies are low-dose phentermine and sustained release topiramate and naltrexone/bupropion. Many other possibilities exist and promising options include combination of phentermine with a sodium glucose co-transporter 2 inhibitor or combination of a glucagon-like peptide 1 agonist with other gut hormones or with a sodium glucose co-transporter 2 inhibitor. The ultimate aim is to match the efficacy of bariatric surgery with a combination of medicines, but this remains an elusive goal.

Sign in / Sign up

Export Citation Format

Share Document