scholarly journals Headache Worsening after COVID-19 Vaccination: An Online Questionnaire-Based Study on 841 Patients with Migraine

2021 ◽  
Vol 10 (24) ◽  
pp. 5914
Author(s):  
Marcello Silvestro ◽  
Alessandro Tessitore ◽  
Ilaria Orologio ◽  
Pasquale Sozio ◽  
Giuseppe Napolitano ◽  
...  
Keyword(s):  
Health Care ◽  
General Population ◽  
Vaccine Dose ◽  
Controlled Trials ◽  
Clinical Parameters ◽  
Online Questionnaire ◽  
Headache Attack ◽  
Randomized Controlled ◽  
High Prevalence ◽  
Headache Patients

Vaccines have represented the breakthrough in the fight against COVID-19. Based on reported headache attacks after vaccination in randomized controlled trials, we focused on the effects of COVID-19 vaccine administration on the migraine population, using an online questionnaire published on Italian Facebook groups oriented to headache patients. We collected data about the demographics and clinical parameters of migraine severity, COVID-19 infection, vaccination, and characteristics of headaches following vaccination. Out of 841 migraine patients filling in the questionnaire, 66.47% and 60.15% patients experienced a headache attack (from 1 hour to 7 days) after the first and the second vaccine dose, respectively. The main finding concerns headaches perceived by 57.60% of patients: attacks following vaccination were referred to as more severe (50.62% of patients), long-lasting (52.80% of patients) and hardwearing (49.69% of patients) compared to the usually experienced migraine attacks. This could be related to the production of inflammatory mediators such as type Iβ interferon. Considering the high prevalence of migraine in the general population, awareness of the possibility of headaches worsening following COVID-19 vaccination in these patients may allow both patients and clinicians to face this clinical entity with conscious serenity, and to reduce the waste of resources towards inappropriate health-care.

Reactive Arthritis: Modern Aspects of Diagnosis and Treatment

2020 ◽  
Vol 65 (7-8) ◽  
pp. 63-70
Author(s):  
B. S. Belov ◽  
R. M. Balabanova
Keyword(s):  
Russian Federation ◽  
Clinical Picture ◽  
Reactive Arthritis ◽  
Epidemiological Data ◽  
Controlled Trials ◽  
Antimicrobial Drugs ◽  
Randomized Controlled ◽  
Laboratory Techniques ◽  
High Prevalence ◽  
The Russian Federation

Currently, the problem of reactive arthritis (ReA) retains its importance due to the fairly high prevalence of the disease, primarily in Russia. Analysis of epidemiological data allows us to put forward a number of possible reasons explaining the different frequency of ReA in certain regions of the Russian Federation and in other countries. The lecture describes the clinical picture of the disease, as well as analyzes the significance of various laboratory techniques aimed at identifying the causative agent of ReA. The Russian diagnostic criteria for ReA are presented. The main approaches to the therapy of ReA are outlined with an emphasis on the use of antimicrobial drugs. The effectiveness and safety of drug immunocorrection (inducers of interferon, polyoxidonium, immunofan, etc.) in the treatment of urogenital chlamydia in patients with ReA have not been confirmed by data from randomized controlled trials.

scholarly journals Randomized, double-blinded, controlled non-inferiority trials evaluating the immunogenicity and safety of fractional doses of Yellow Fever vaccines in Kenya and Uganda

2019 ◽  
Vol 4 ◽  
pp. 182 ◽  
Author(s):  
Derick Kimathi ◽  
Aitana Juan ◽  
Philip Bejon ◽  
Rebecca F. Grais ◽  
George M. Warimwe ◽  
...  
Keyword(s):  
Immune Response ◽  
Randomized Controlled Trials ◽  
Yellow Fever ◽  
Vaccine Dose ◽  
World Health ◽  
Yellow Fever Vaccine ◽  
Controlled Trials ◽  
Post Vaccination ◽  
Randomized Controlled ◽  
Link Type

Introduction: Yellow fever is endemic in specific regions of sub-Saharan Africa and the Americas, with recent epidemics occurring on both continents. The yellow fever vaccine is effective, affordable and safe, providing life-long immunity following a single dose vaccination. However, the vaccine production process is slow and cannot be readily scaled up during epidemics. This has led the World Health Organization (WHO) to recommend the use of fractional doses as a dose-sparing strategy during epidemics, but there are no randomized controlled trials of fractional yellow fever vaccine doses in Africa. Methods and analysis: We will recruit healthy adult volunteers, adults living with HIV, and children to a series of randomized controlled trials aiming to determine the immunogenicity and safety of fractional vaccine doses in comparison to the standard vaccine dose. The trials will be conducted across two sites; Kilifi, Kenya and Mbarara, Uganda. Recruited participants will be randomized to receive fractional or standard doses of yellow fever vaccine. Scheduled visits will include blood collection for serum and peripheral blood mononuclear cells (PBMCs) before vaccination and on various days – up to 2 years – post-vaccination. The primary outcome is the rate of seroconversion as measured by the plaque reduction neutralization test (PRNT50) at 28 days post-vaccination. Secondary outcomes include antibody titre changes, longevity of the immune response, safety assessment using clinical data, the nature and magnitude of the cellular immune response and post-vaccination control of viremia by vaccine dose. Ethics and dissemination: The clinical trial protocols have received approval from the relevant institutional ethics and regulatory review committees in Kenya and Uganda, and the WHO Ethics Review Committee. The research findings will be disseminated through open-access publications and presented at relevant conferences and workshops. Registration: ClinicalTrials.gov NCT02991495 (registered on 13 December 2016) and NCT04059471 (registered on 15 August 2019).

scholarly journals The Effect of Noninvasive Telemonitoring for Chronic Heart Failure on Health Care Utilization: Systematic Review (Preprint)

2020 ◽  
Author(s):  
Stefan L Auener ◽  
Toine E P Remers ◽  
Simone A van Dulmen ◽  
Gert P Westert ◽  
Rudolf B Kool ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Chronic Heart Failure ◽  
Health Care Utilization ◽  
Health Care Costs ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Care Costs

BACKGROUND Chronic heart failure accounts for approximately 1%-2% of health care expenditures in most developed countries. These costs are primarily driven by hospitalizations and comorbidities. Telemonitoring has been proposed to reduce the number of hospitalizations and decrease the cost of treatment for patients with heart failure. However, the effects of telemonitoring on health care utilization remain unclear. OBJECTIVE This systematic review aims to study the effect of telemonitoring programs on health care utilization and costs in patients with chronic heart failure. We assess the effect of telemonitoring on hospitalizations, emergency department visits, length of stay, hospital days, nonemergency department visits, and health care costs. METHODS We searched PubMed, Embase, and Web of Science for randomized controlled trials and nonrandomized studies on noninvasive telemonitoring and health care utilization. We included studies published between January 2010 and August 2020. For each study, we extracted the reported data on the effect of telemonitoring on health care utilization. We used <i>P</i>&lt;.05 and CIs not including 1.00 to determine whether the effect was statistically significant. RESULTS We included 16 randomized controlled trials and 13 nonrandomized studies. Inclusion criteria, population characteristics, and outcome measures differed among the included studies. Most studies showed no effect of telemonitoring on health care utilization. The number of hospitalizations was significantly reduced in 38% (9/24) of studies, whereas emergency department visits were reduced in 13% (1/8) of studies. An increase in nonemergency department visits (6/9, 67% of studies) was reported. Health care costs showed ambiguous results, with 3 studies reporting an increase in health care costs, 3 studies reporting a reduction, and 4 studies reporting no significant differences. Health care cost reductions were realized through a reduction in hospitalizations, whereas increases were caused by the high costs of the telemonitoring program or increased health care utilization. CONCLUSIONS Most telemonitoring programs do not show clear effects on health care utilization measures, except for an increase in nonemergency outpatient department visits. This may be an unwarranted side effect rather than a prerequisite for effective telemonitoring. The consequences of telemonitoring on nonemergency outpatient visits should receive more attention from regulators, payers, and providers. This review further demonstrates the high clinical and methodological heterogeneity of telemonitoring programs. This should be taken into account in future meta-analyses aimed at identifying the effective components of telemonitoring programs.

scholarly journals Prevention of Lateral Ankle Sprains

2019 ◽  
Vol 54 (6) ◽  
pp. 650-661 ◽  
Author(s):  
Thomas W. Kaminski ◽  
Alan R. Needle ◽  
Eamonn Delahunt
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Athletic Trainers ◽  
Current Evidence ◽  
Controlled Trials ◽  
Ankle Sprains ◽  
Lateral Ankle ◽  
Athletic Population ◽  
Randomized Controlled ◽  
Critical Interpretation

Context Given the frequency of ankle sprains, especially in the athletic population, prevention is a primary task of athletic trainers and other sports health care professionals. Objective To discuss the current evidence as it relates to prophylactic programs for the prevention of ankle sprains and to provide critical interpretation of the evidence supporting and refuting the implementation of preventive programs. Conclusions External prophylactic supports and preventive exercise programs are effective for reducing the risk of ankle sprains in both uninjured and previously injured populations. Ankle bracing appears to offer the best outcomes in terms of cost and risk reduction. However, there remains a paucity of well-designed, prospective randomized controlled trials relevant to the primary prevention of lateral ankle sprains, especially across a range of sport settings.

Randomized Controlled Trials and Comparative Effectiveness Research

2012 ◽  
Vol 30 (34) ◽  
pp. 4194-4201 ◽  
Author(s):  
Olwen M. Hahn ◽  
Richard L. Schilsky
Keyword(s):  
Health Care ◽  
Randomized Controlled Trials ◽  
Comparative Effectiveness Research ◽  
Comparative Effectiveness ◽  
Cost Effective ◽  
Health Care Research ◽  
Controlled Trials ◽  
Effectiveness Research ◽  
Randomized Controlled

Comparative effectiveness research (CER) has been promoted as a way to improve the translation gap between clinical research and everyday clinical practice as well as to deliver more cost-effective health care. CER will account for a significant portion of funding allocated by the US government for health care research. Oncology has a rich history of improving clinical outcomes and advancing research through randomized controlled trials (RCTs). In this article, we review the role of RCTs in achieving the goals of CER, with particular emphasis on the role of publicly funded clinical trials.

scholarly journals The origins, evolution, and future of The Cochrane Database of Systematic Reviews

2009 ◽  
Vol 25 (S1) ◽  
pp. 182-195 ◽  
Author(s):  
Mark Starr ◽  
Iain Chalmers ◽  
Mike Clarke ◽  
Andrew D. Oxman
Keyword(s):  
Health Care ◽  
Systematic Reviews ◽  
Medical Profession ◽  
Relevant Information ◽  
Controlled Trials ◽  
Electronic Publication ◽  
Randomized Controlled ◽  
Cochrane Reviews ◽  
New Information ◽  
Cochrane Database

The Cochrane Database of Systematic Reviews (CDSR) evolved in response to Archie Cochrane's challenge to the medical profession to assemble “a critical summary, adapted periodically, of all . . . relevant randomized controlled trials”. CDSR has been an electronic publication from its inception and this has meant that Cochrane reviews (i) need not be constrained by lack of space; (ii) can be updated as new information becomes available and when mistakes or other ways of improving them are identified; and (iii) can be cross-linked to other, related sources of relevant information. Although CDSR has become widely cited, it must continue to evolve in the light of technological and methodological developments, and in response to the needs of people making decisions about health care.

scholarly journals Evidence-Based Practice and Chiropractic Care

2012 ◽  
Vol 18 (1) ◽  
pp. 75-79 ◽  
Author(s):  
Ron LeFebvre ◽  
David Peterson ◽  
Mitchell Haas
Keyword(s):  
Health Care ◽  
Research Evidence ◽  
Evidence Based Practice ◽  
Chiropractic Care ◽  
Therapeutic Interventions ◽  
Controlled Trials ◽  
Evidence Based ◽  
Randomized Controlled ◽  
Chiropractic Education ◽  
Growing Body

Evidence-based practice has had a growing impact on chiropractic education and the delivery of chiropractic care. For evidence-based practice to penetrate and transform a profession, the penetration must occur at 2 levels. One level is the degree to which individual practitioners possess the willingness and basic skills to search and assess the literature. Chiropractic education received a significant boost in this realm in 2005 when the National Center for Complementary and Alternative Medicine awarded 4 chiropractic institutions R25 education grants to strengthen their research/evidence-based practice curricula. The second level relates to whether the therapeutic interventions commonly employed by a particular health care discipline are supported by clinical research. A growing body of randomized controlled trials provides evidence of the effectiveness and safety of manual therapies.

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