How to Choose the Best Cross-linking Procedure in 2016

2015 ◽  
Vol 09 (02) ◽  
pp. 98
Author(s):  
Nikki Hafezi ◽  
◽  
◽  
Farhad Hafezi ◽  
◽  
...  
Keyword(s):  
Solid Body ◽  
Research Evidence ◽  
Scientific Evidence ◽  
Standard Of Care ◽  
Cross Linking ◽  
Common Pathway ◽  
Corneal Ectasia ◽  
The Past ◽  
Final Common Pathway

Ever since cross-linking (CXL) technology was introduced into clinical ophthalmology in 1999, the technique has established itself as a standard of care in the treatment of corneal ectasia. The original protocol, referred to as the ‘Dresden protocol’, consisted of 30 minutes of iso-osmolaric riboflavin instillation on a de-epithelialised cornea, followed by irradiation at 365 nm and 3 mW/cm2for 30 minutes. These settings correspond to a fluence of 5.4 J/cm2. A large variety of modifications of this original protocol have emerged in the past years: some of these modifications are backed up by a solid body of research evidence, both clinically and experimentally, whereas other modifications are based on little to no scientific evidence. Navigating through this ‘sea of new protocols’ is becoming increasingly difficult for the treating ophthalmologist. The two most important modifications are transepithelial (epi-on) CXL and accelerated CXL. Most interestingly, they seem to share a final common pathway, which determines efficacy: oxygen dependency.

The Past: What We Have Learned in the Last Decade

Hematology ◽  
2010 ◽  
Vol 2010 (1) ◽  
pp. 101-107 ◽  
Author(s):  
Peter Borchmann ◽  
Andreas Engert
Keyword(s):  
Early Stage ◽  
Scientific Evidence ◽  
Standard Of Care ◽  
Treatment Recommendations ◽  
Individual Treatment ◽  
Advanced Stage ◽  
First Line ◽  
The Past ◽  
Preliminary Information ◽  
Definite Treatment

AbstractHodgkin lymphoma (HL) has become a curable malignancy for most patients during the last decades. However, many controversies still exist on the optimal strategy of how to cure our patients. The key question is how to balance the risks and toxicities of chemotherapy and radiotherapy against the need for a definite treatment for early or advanced-stage HL patients. However, although many studies have been conducted and reported during the past decade, interpretation of their results and treatment recommendations might vary significantly in different countries. For example, early-stage HL might be divided into two different subgroups: early favorable and early unfavorable or not. Treatment of early-stage HL might include radiotherapy (“combined modality”) or not. Depending on the extent of radiotherapy, the schedule and number of chemotherapy cycles are also questioned. For advanced-stage HL, the situation is not much different. Compared with ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine), the more aggressive escalated BEACOPP regimen (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, and prednisone) is highly effective, but also raises concern due to excessive toxicity. Thus, there is a controversy about the standard of care for advanced HL patients. Because no mature results comparing these approaches with each other are currently available, it remains our duty to share the preliminary information with our patients and to figure out the most appropriate individual treatment strategy. Of course, the discussion of these issues is influenced by experiences and preferences. In contrast, in this article, we will try to focus on the available scientific evidence regarding the first-line treatment of HL. Of course, focusing on the last decade necessarily exclude the most recent results from ongoing studies. Thus, even though this article comprises treatment recommendations for HL patients, the best treatment certainly still is within properly designed prospective clinical trials.

The Prescription as Final Common Pathway

1995 ◽  
Vol 11 (3) ◽  
pp. 384-390 ◽  
Author(s):  
Jerry Avorn
Keyword(s):  
Decision Making ◽  
Cost Effectiveness ◽  
Health Economics ◽  
Medical Care ◽  
Clinical Medicine ◽  
Decision Science ◽  
Therapeutic Decision ◽  
Common Pathway ◽  
Final Common Pathway ◽  
Therapeutic Decision Making

AbstractThere is an informational void about Pharmaceuticals in the training of most doctors, despite the importance of the prescription in medical care. The writing of the prescription is the final common pathway in therapeutic decision making, which involves such diverse forces and disciplines as anthropology, decision science, health economics, ethics, and politics, as well as pharmacology and clinical medicine. Programs to improve the precision and cost-effectiveness of doctors' prescribing must consider all of these factors if pharmacotherapeutics are to be used optimally.

scholarly journals Beyond Mindfulness

Open Theology ◽  
2016 ◽  
Vol 2 (1) ◽  
Author(s):  
Thomas G. Plante
Keyword(s):  
Research Evidence ◽  
State Of The Art ◽  
Empirical Studies ◽  
Religion And Spirituality ◽  
Spiritual Values ◽  
Quality Research ◽  
The Past ◽  
Enormous Amount ◽  
Consulting Psychology ◽  
Areas Of Interest

AbstractSince the publication of Bergin’s classic 1980 paper “Psychotherapy and Religious Values” in the Journal of Clinical and Consulting Psychology, an enormous amount of quality research has been conducted on the integration of religious and spiritual values and perspectives into the psychotherapy endeavor. Numerous empirical studies, chapters, books, blogs, and specialty organizations have emerged in the past 35 years that have helped researchers and clinicians alike come to appreciate the value of religion and spirituality in the psychotherapeutic process. While so much has been accomplished in this area of integration, so much more needs to occur in order for the psychotherapeutic world to benefit from the wisdom of the great religious and spiritual traditions and values. While state-of-the-art quality research has and continues to demonstrate how religious and spiritual practices and values can be used effectively to enhance the benefits of behavioral and psychological interventions, too often the field either gets overly focused on particular and perhaps trendy areas of interest (e.g., mindfulness) or fails to appreciate and incorporate the research evidence supporting (or not supporting) the use of certain religiously or spiritually informed assessments and interventions. The purpose of this article is to reflect on where the field integrating religion, spirituality and psychotherapy has evolved through the present and where it still needs to go in the future. In doing so I hope to reflect on the call for integration that Bergin highlights in his classic 1980 paper.

(Uncontrolled) Donation after Cardiac Determination of Death: A Note of Caution

2008 ◽  
Vol 36 (4) ◽  
pp. 760-765 ◽  
Author(s):  
Christopher James Doig ◽  
David A. Zygun
Keyword(s):  
Organ Failure ◽  
Organ Transplant ◽  
Standard Of Care ◽  
Determination Of Death ◽  
The Past ◽  
The World ◽  
Tissue Recovery ◽  
End Stage

“I think there’s a big strong belief in [...] the community … and maybe it’s in the world at large that somehow the doctors are more concerned about harvesting the organs than what’s best for the patient.”1 In the past 45 years, organ and tissue recovery and transplantation have moved from the occasional and experimental to a standard of care for end-stage organ failure; receiving an organ transplant is for many the only opportunity for increased quantity and/or quality of life. The increasing prevalence of diseases such as viral hepatitis, diabetes, and hypertension has significantly increased the incidence of end-organ failure. Additionally, surgical advances have permitted less stringent qualification criteria, so that people of advanced age or patients who may be in a physiologically fragile state are now eligible to be organ recipients. These changes have created a significant demand for organs.

scholarly journals Glioblastoma Multiforme—A Look at the Past and a Glance at the Future

Pharmaceutics ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1053
Author(s):  
Jasmine L. King ◽  
Soumya Rahima Benhabbour
Keyword(s):  
Glioblastoma Multiforme ◽  
Immune Surveillance ◽  
Standard Of Care ◽  
Current Standard ◽  
Comprehensive Overview ◽  
Therapeutic Delivery ◽  
The Past ◽  
Adults And Children ◽  
The Central Nervous System ◽  
Delivery Strategies

Gliomas are the most common type of brain tumor that occur in adults and children. Glioblastoma multiforme (GBM) is the most common, aggressive form of brain cancer in adults and is universally fatal. The current standard-of-care options for GBM include surgical resection, radiotherapy, and concomitant and/or adjuvant chemotherapy. One of the major challenges that impedes success of chemotherapy is the presence of the blood–brain barrier (BBB). Because of the tightly regulated BBB, immune surveillance in the central nervous system (CNS) is poor, contributing to unregulated glioma cell growth. This review gives a comprehensive overview of the latest advances in treatment of GBM with emphasis on the significant advances in immunotherapy and novel therapeutic delivery strategies to enhance treatment for GBM.

Corneal Tomographic Changes After UV Cross-Linking for Corneal Ectasia (1-Year Results)

Cornea ◽  
2017 ◽  
Vol 36 (12) ◽  
pp. 1498-1502
Author(s):  
Zainab Baksoellah ◽  
Itay Lavy ◽  
Lamis Baydoun ◽  
Hilde C. M. Hooijmaijers ◽  
Korine van Dijk ◽  
...  
Keyword(s):  
Cross Linking ◽  
Corneal Ectasia

The 2016 RANZCP Guidelines for the Management of Schizophrenia and Related Disorders – what’s next?

2017 ◽  
Vol 25 (6) ◽  
pp. 600-602 ◽  
Author(s):  
Assen Jablensky ◽  
David J Castle ◽  
Frances Dark ◽  
Verity Humberstone ◽  
Eoin Killackey ◽  
...  
Keyword(s):  
Mental Health ◽  
Scientific Evidence ◽  
Standard Of Care ◽  
Mental Health Research ◽  
Response To Treatment ◽  
Clinical Expertise ◽  
The Public ◽  
Measuring Outcomes ◽  
Treatment Plans ◽  
Personalised Treatment

Objectives: The recently published RANZCP guidelines for schizophrenia and related disorders reviewed recent scientific evidence, and, where lacking, referred to clinical expertise to supply a template for raising the standard of care. This paper builds on the guidelines and recommends how they might be used to improve outcomes. Methods: The guidelines call for evidence-based mental health policies, inclusive of mobilising affected families, communities and the public in support of policies that ensure better care and protect the wellbeing of people with severe mental disorders. The process of preparing the guidelines highlighted the limits of our scientific understanding of schizophrenia and shortcomings in the care currently provided. Results: Writing the guidelines evinced the need for a culture of measuring outcomes and response to treatment, and harnessing such data to monitoring and optimising patient care. Conclusions: We recommend creation of a national case cohort for mental health research involving a collaborative network of clinical research centres, using the guidelines and generating scientific evidence for translation into clinical practice protocols that enable personalised treatment plans for patients and criteria for the performance of clinical services.

scholarly journals Drug information update. Lithium and chronic kidney disease: Debates and dilemmas

2017 ◽  
Vol 41 (4) ◽  
pp. 216-220 ◽  
Author(s):  
Sumeet Gupta ◽  
Udayan Khastgir
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Research Evidence ◽  
Evidence Base ◽  
Current Evidence ◽  
Treatment Resistant ◽  
The Past ◽  
Current Evidence Base ◽  
Information Update ◽  
Resistant Depression

SummaryLithium is an established treatment for bipolar disorder and an augmenting agent for treatment-resistant depression. Despite awareness of renal adverse effects, including chronic kidney disease, for the past five decades, there has been a lack of research evidence. This has led to debates around the existence and magnitude of the risk. This article discusses the current evidence base regarding the link between lithium and chronic kidney disease, monitoring of renal functions and its clinical implications.

scholarly journals Echinacea: a Miracle Herb against Aging and Cancer? EvidenceIn vivoin Mice

2005 ◽  
Vol 2 (3) ◽  
pp. 309-314 ◽  
Author(s):  
Sandra C. Miller
Keyword(s):  
Life Span ◽  
Scientific Evidence ◽  
Formal Proof ◽  
Daily Consumption ◽  
The Past ◽  
Arduous Task

Echinaceahas been viewed as an immunoenhancing herb since it became commercially available several years ago. Indeed, its medicinal significance is responsible for billions of dollars in worldwide sales annually. Unfortunately, most of the ‘evidence’ for the purported medicinal efficacy ofEchinaceahas been anecdotal and, moreover, to this day, there is no formal proof on how to achieve the best results—whether it should be consumed daily throughout life as a prophylactic; consumed by either young or old; or consumed after diseases, such as cancer, have taken hold. Our work over the past 5 years has led to conclusive answers to some of these questions, at least in mice. Our results have shown that daily consumption ofEchinaceais indeed prophylactic, extends the life span of aging mice, significantly abates leukemia and extends the life span of leukemic mice. Given that humans are 97% genetically common with mice and that virtually all our basic physiology is identical, it is neither unjustified to extrapolate these observations to humans nor would it be an arduous task to perform many of these studies in humans, thus establishing viable scientific evidence replacing the anecdotal.

Sign in / Sign up

Export Citation Format

Share Document