scholarly journals Non-pharmacological Treatment Options in the Management of Diabetes Mellitus

2018 ◽  
Vol 14 (2) ◽  
pp. 31 ◽  
Author(s):  
Arkiath V Raveendran
Keyword(s):  
Diabetes Mellitus ◽  
Treatment Options ◽  
Evidence Base ◽  
Pharmacological Therapy ◽  
Current Evidence ◽  
Effective Management ◽  
Pharmacological Interventions ◽  
Current Evidence Base ◽  
Control Of Diabetes

The global prevalence of diabetes, especially type 2 diabetes mellitus, has reached epidemic proportions in the last few decades of the 20th century because of the obesity pandemic resulting from adverse lifestyles. Diabetes as a consequence of obesity (diabesity), continues to increase exponentially in the 21st century. Although there are a multitude of drugs for the effective management of diabesity with modest benefits, most patients will require insulin for control of diabetes at some stage that would worsen obesity, and thereby diabesity. Therefore, effective non-pharmacological therapy needs to be expedited in all patients with diabesity. These measures include medical nutrition interventions, change of lifestyles and bariatric surgery. Non-pharmacological interventions are also useful for the effective management of even type 1 diabetes mellitus when used along with insulin therapy especially in those with obesity. This review summarises the current evidence base for the non-pharmacological interventions in the management of diabetes.

scholarly journals Against the stream: early diagnosis of dementia, is it so desirable?

2019 ◽  
Vol 43 (3) ◽  
pp. 123-125 ◽  
Author(s):  
Carol Brayne ◽  
Sarah Kelly
Keyword(s):  
Clinical Practice ◽  
Early Diagnosis ◽  
Empirical Evidence ◽  
Treatment Options ◽  
Evidence Base ◽  
Current Evidence ◽  
Dementia Diagnosis ◽  
Case Identification ◽  
Current Evidence Base ◽  
Diagnosis Of Dementia

SummaryThe Prime Minister's challenge on dementia called for improved dementia diagnosis rates, based on assumptions of benefit to individuals and those who care for them. Subsequent policies have led to increased target drives for clinical practice to achieve early diagnosis of dementia through intense case identification. However, the current evidence base and treatment options do not support screening for dementia, and there is little empirical evidence that such intensive case identification and early diagnosis for dementia is justified without a better understanding of the benefits, costs and potential harms to individuals and services.Declaration of interestNone.

Management of feline carpal injuries: What are the options and when is arthrodesis indicated?

2019 ◽  
Vol 21 (9) ◽  
pp. 809-823 ◽  
Author(s):  
Rachel M Basa ◽  
Kenneth A Johnson
Keyword(s):  
Treatment Options ◽  
Case Series ◽  
Evidence Base ◽  
Careful Examination ◽  
Current Evidence ◽  
Collateral Ligament ◽  
Retrospective Case ◽  
Radial Collateral Ligament ◽  
Current Evidence Base ◽  
Direct Extrapolation

Practical relevance: Feline carpal injuries are usually caused by falls from a height that result in hyperextension injury or antebrachiocarpal luxation or subluxation. Isolated ligamentous damage or fracture of the carpus is unusual; it is more common to have a combination of both in the cat. These injuries can be debilitating since cats climb and jump from great heights, and have a greater range of antebrachial pronation and supination than dogs. Anatomy: There are differences in the anatomy of the feline and canine carpus. In particular, cats only have a single short radial collateral ligament, also known as the medial collateral ligament. This means that, in the cat, antebrachiocarpal subluxation is possible with rupture of the dorsal joint capsule and short radial collateral ligament alone. Clinical challenges: Many feline carpal injuries can be treated without performing pancarpal arthrodesis. However, determining which ligaments and joint levels are affected requires careful examination and often stress radiography. When pancarpal arthrodesis is performed in the cat, it has been reported to reduce the height of jumping and to increase reluctance to climb. This is speculated to be due to reduced pronation and supination movement of the carpus. Evidence base: The current evidence base for management of feline carpal injuries is grade III or IV, with most of the studies being retrospective case series involving cadaveric dissection or direct extrapolation from published information about the dog. There are few guidelines regarding the optimal treatment options for carpal injuries in the cat.

Pharmacotherapy of Anxiety Disorders

2013 ◽  
pp. 636-639
Author(s):  
James W. Murrough ◽  
Dan V. Iosifescu ◽  
Dennis S. Charney
Keyword(s):  
Anxiety Disorders ◽  
Treatment Options ◽  
The United States ◽  
Evidence Base ◽  
Current Evidence ◽  
Generalized Anxiety ◽  
Pharmacological Agents ◽  
Current Evidence Base ◽  
High Degree ◽  
Monoaminergic Agents

Anxiety disorders are among the most prevalent mental disorders in the United States and are associated with a high degree of morbidity and public health costs. This chapter will present a general approach to the diagnosis and treatment of these disorders and summarize the current evidence base for pharmacotherapeutic treatment options in individual disorders, including panic disorder, social phobia, posttraumatic stress disorder, generalized anxiety disorder.The serotonin-selective and serotonin norepinephrine reuptake inhibitors are generally considered first-line treatment while older monoaminergic agents are often efficacious but are limited by safety and tolerability issues. The benzodiazepines play an important role in the treatment of some anxiety disorders, however these agents also possess important limitations. Other pharmacological agents have a more limited evidence base. Continued progress in basic and translational neuroscience is expected to meet the need for new, more effective treatments for patients suffering from these disorders.

scholarly journals CONGENITAL CHYLOTHORAX: CURRENT EVIDENCE-BASED PRENATAL AND POST-NATAL DIAGNOSIS AND MANAGEMENT

Lymphology ◽  
2020 ◽  
Vol 52 (3) ◽  
Author(s):  
LC De Angelis ◽  
T Bellini ◽  
MH Witte ◽  
RI Kylat ◽  
M Bernas ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Therapeutic Approach ◽  
Neonatal Period ◽  
Treatment Options ◽  
Evidence Base ◽  
Current Evidence ◽  
Treatment Timing ◽  
Current Evidence Base ◽  
Uncommon Condition ◽  
Congenital Chylothorax

Congenital chylothorax is an uncommon condition but represents the main cause of congenital pleural effusion during the neonatal period. It usually appears before birth, both as an isolated disorder or in association with hydrops fetalis, negatively affecting the subsequent neonatal outcome. Prenatal treatment is usually considered to ensure a satisfactory lung development in case of moderate to severe pleural effusion or in the presence of hydrops, although consensus on treatment timing and modalities has not been reached to date. Both medical and surgical therapeutic strategies are available to treat this condition and novel treatment options have been recently attempted with acceptable results in both prenatal and post-natal setting. The heterogeneous clinical presentation of congenital chylothorax together with its rarity, its numerous etiologies and the absence of a highly effective treatment renders the diagnostic and therapeutic approach difficult to standardize. In addition, adequate visualization of the lymphatic system is complex, especially in small neonates, although new promising techniques have been developed lately and may contribute to improved management of this serious but infrequent condition. This review focuses on the current evidence base for the diagnosis and treatment options for congenital chylothorax, suggesting a rational diagnostic and therapeutic approach both in the prenatal and in the neonatal period.

Care for patients with multiple endocrine neoplasia type 1: the current evidence base

2010 ◽  
Vol 10 (1) ◽  
pp. 157-171 ◽  
Author(s):  
C. R. C. Pieterman ◽  
M. R. Vriens ◽  
K. M. A. Dreijerink ◽  
R. B. van der Luijt ◽  
G. D. Valk
Keyword(s):  
Multiple Endocrine Neoplasia ◽  
Multiple Endocrine Neoplasia Type ◽  
Evidence Base ◽  
Current Evidence ◽  
Endocrine Neoplasia ◽  
Endocrine Neoplasia Type ◽  
Current Evidence Base

scholarly journals Polyphenols and Cognition In Humans: An Overview of Current Evidence from Recent Systematic Reviews and Meta-Analyses

2020 ◽  
pp. 1-15
Author(s):  
Daniel Joseph Lamport ◽  
Claire Michelle Williams
Keyword(s):  
Systematic Reviews ◽  
Evidence Base ◽  
Epidemiological Studies ◽  
Cognitive Outcome ◽  
Current Evidence ◽  
Duration Of Treatment ◽  
Current Evidence Base ◽  
Cognitive Benefits ◽  
Meta Analyses ◽  
The Impact

There is increasing interest in the impact of dietary influences on the brain throughout the lifespan, ranging from improving cognitive development in children through to attenuating ageing related cognitive decline and reducing risk of neurodegenerative diseases. Polyphenols, phytochemicals naturally present in a host of fruits, vegetables, tea, cocoa and other foods, have received particular attention in this regard, and there is now a substantial body of evidence from experimental and epidemiological studies examining whether their consumption is associated with cognitive benefits. The purpose of this overview is to synthesise and evaluate the best available evidence from two sources, namely meta-analyses and systematic reviews, in order to give an accurate reflection of the current evidence base for an association between polyphenols and cognitive benefits. Four meta-analyses and thirteen systematic reviews published between 2017–2020 were included, and were categorised according to whether they reviewed specific polyphenol-rich foods and classes or all polyphenols. A requirement for inclusion was assessment of a behavioural cognitive outcome in humans. A clear and consistent theme emerged that whilst there is support for an association between polyphenol consumption and cognitive benefits, this conclusion is tentative, and by no means definitive. Considerable methodological heterogeneity was repeatedly highlighted as problematic such that the current evidence base does not support reliable conclusions relating to efficacy of specific doses, duration of treatment, or sensitivity in specific populations or certain cognitive domains. The complexity of multiple interactions between a range of direct and indirect mechanisms of action is discussed. Further research is required to strengthen the reliability of the evidence base.

scholarly journals P-26 Challenging the pressure on nhs resources: could 48-hour continuous subcutaneous infusions (CSCIS) help? a systematically-structured review of the current evidence base

2017 ◽  
Vol 7 (Suppl 1) ◽  
pp. A9.3-A10
Author(s):  
James Baker ◽  
Andrew Dickman ◽  
Stephen Mason ◽  
John Ellershaw ◽  
Paul Skipper ◽  
...  
Keyword(s):  
Evidence Base ◽  
Current Evidence ◽  
Current Evidence Base

scholarly journals Rates of violence in patients classified as high risk by structured risk assessment instruments

2014 ◽  
Vol 204 (3) ◽  
pp. 180-187 ◽  
Author(s):  
Jay P. Singh ◽  
Seena Fazel ◽  
Ralitza Gueorguieva ◽  
Alec Buchanan
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Risk Groups ◽  
Evidence Base ◽  
Assessment Tools ◽  
Current Evidence ◽  
Assessment Instruments ◽  
Individual Liberty ◽  
Current Evidence Base ◽  
Study Heterogeneity

BackgroundRates of violence in persons identified as high risk by structured risk assessment instruments (SRAIs) are uncertain and frequently unreported by validation studies.AimsTo analyse the variation in rates of violence in individuals identified as high risk by SRAIs.MethodA systematic search of databases (1995–2011) was conducted for studies on nine widely used assessment tools. Where violence rates in high-risk groups were not published, these were requested from study authors. Rate information was extracted, and binomial logistic regression was used to study heterogeneity.ResultsInformation was collected on 13 045 participants in 57 samples from 47 independent studies. Annualised rates of violence in individuals classified as high risk varied both across and within instruments. Rates were elevated when population rates of violence were higher, when a structured professional judgement instrument was used and when there was a lower proportion of men in a study.ConclusionsAfter controlling for time at risk, the rate of violence in individuals classified as high risk by SRAIs shows substantial variation. In the absence of information on local base rates, assigning predetermined probabilities to future violence risk on the basis of a structured risk assessment is not supported by the current evidence base. This underscores the need for caution when such risk estimates are used to influence decisions related to individual liberty and public safety.

Sign in / Sign up

Export Citation Format

Share Document