scholarly journals Nebulized Colistin in Ventilator-Associated Pneumonia and Tracheobronchitis: Historical Background, Pharmacokinetics and Perspectives

2021 ◽  
Vol 9 (6) ◽  
pp. 1154
Author(s):  
Yinggang Zhu ◽  
Antoine Monsel ◽  
Jason Roberts ◽  
Konstantinos Pontikis ◽  
Olivier Mimoz ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Experimental Studies ◽  
Multidrug Resistant ◽  
Historical Background ◽  
Future Research ◽  
Controlled Trials ◽  
Ventilator Associated Pneumonia ◽  
Randomized Controlled ◽  
High Doses ◽  
Tract Infections

Clinical evidence suggests that nebulized colistimethate sodium (CMS) has benefits for treating lower respiratory tract infections caused by multidrug-resistant Gram-negative bacteria (GNB). Colistin is positively charged, while CMS is negatively charged, and both have a high molecular mass and are hydrophilic. These physico-chemical characteristics impair crossing of the alveolo-capillary membrane but enable the disruption of the bacterial wall of GNB and the aggregation of the circulating lipopolysaccharide. Intravenous CMS is rapidly cleared by glomerular filtration and tubular excretion, and 20–25% is spontaneously hydrolyzed to colistin. Urine colistin is substantially reabsorbed by tubular cells and eliminated by biliary excretion. Colistin is a concentration-dependent antibiotic with post-antibiotic and inoculum effects. As CMS conversion to colistin is slower than its renal clearance, intravenous administration can lead to low plasma and lung colistin concentrations that risk treatment failure. Following nebulization of high doses, colistin (200,000 international units/24h) lung tissue concentrations are > five times minimum inhibitory concentration (MIC) of GNB in regions with multiple foci of bronchopneumonia and in the range of MIC breakpoints in regions with confluent pneumonia. Future research should include: (1) experimental studies using lung microdialysis to assess the PK/PD in the interstitial fluid of the lung following nebulization of high doses of colistin; (2) superiority multicenter randomized controlled trials comparing nebulized and intravenous CMS in patients with pandrug-resistant GNB ventilator-associated pneumonia and ventilator-associated tracheobronchitis; (3) non-inferiority multicenter randomized controlled trials comparing nebulized CMS to intravenous new cephalosporines/ß-lactamase inhibitors in patients with extensive drug-resistant GNB ventilator-associated pneumonia and ventilator-associated tracheobronchitis.

The effects of aquatic therapy on mobility of individuals with neurological diseases: a systematic review

2014 ◽  
Vol 29 (8) ◽  
pp. 741-751 ◽  
Author(s):  
Andresa R Marinho-Buzelli ◽  
Alison M Bonnyman ◽  
Mary C Verrier
Keyword(s):  
Randomized Controlled Trials ◽  
Gait Speed ◽  
Neurological Diseases ◽  
Dynamic Balance ◽  
Experimental Studies ◽  
Controlled Trials ◽  
Aquatic Therapy ◽  
Randomized Controlled ◽  
Randomized Studies ◽  
Before And After

Objective:To summarize evidence on the effects of aquatic therapy on mobility in individuals with neurological diseases.Data sources:MEDLINE, EMBASE, PsycInfo, CENTRAL, CINAHL, SPORTDiscus, PEDro, PsycBITE and OT Seeker were searched from inception to 15 September 2014. Hand-searching of reference lists was performed in the selected studies.Review methods:The search included randomized controlled trials and quasi-experimental studies that investigated the use of aquatic therapy and its effect on mobility of adults with neurological diseases. One reviewer screened titles and abstracts of retrieved studies from the search strategy. Two reviewers independently examined the full texts and conducted the study selection, data extraction and quality assessment. A narrative synthesis of data was applied to summarize information from included studies. The Downs and Black Scale was used to assess methodological quality.Results:A total of 116 articles were obtained for full text eligibility. Twenty studies met the specified inclusion criteria: four Randomized Controlled Trials (RCTs), four non-randomized studies and 12 before-and-after tests. Two RCTs (30 patients with stroke in the aquatic therapy groups), three non-randomized studies and three before-and-after studies showed “fair” evidence that aquatic therapy increases dynamic balance in participants with some neurological disorders. One RCT (seven patients with stroke in the aquatic therapy group) and two before-and-after tests (20 patients with multiple sclerosis) demonstrated “fair” evidence on improvement of gait speed after aquatic therapy.Conclusion:Our synthesis showed “fair” evidence supporting the use of aquatic therapy to improve dynamic balance and gait speed in adults with certain neurological conditions.

Registry-based randomized controlled trials- what are the advantages, challenges, and areas for future research?

2016 ◽  
Vol 80 ◽  
pp. 16-24 ◽  
Author(s):  
Guowei Li ◽  
Tolulope T. Sajobi ◽  
Bijoy K. Menon ◽  
Lawrence Korngut ◽  
Mark Lowerison ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Future Research ◽  
Controlled Trials ◽  
Randomized Controlled

scholarly journals Improving Cardiovascular Health through Nudging Healthier Food Choices: A Systematic Review

Nutrients ◽  
2019 ◽  
Vol 11 (10) ◽  
pp. 2520 ◽  
Author(s):  
Christine Tørris ◽  
Hilde Mobekk
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Dietary Habits ◽  
Negative Impact ◽  
Experimental Studies ◽  
Food Choices ◽  
Overweight And Obesity ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
The Impact

Obesity and metabolic syndrome are considered major public health problems, and their negative impact on cardiovascular disease (CVD) and diabetes mellitus type 2 (DM2) is profound. Targeting modifiable risk factors such as dietary habits is therefore of great importance. Many of today’s health challenges with overweight and obesity may have behavioral roots, and traditional methods such as regulations and campaigns are often insufficient to improve dietary choices. Nudging or choice architecture might be a viable tool to influence people’s everyday choices and behaviors to better outcomes. This paper reviews the current state of the rapidly expanding number of experimental field studies that investigate the effects/associations of nudging on healthy food choices. A systematic literature search was conducted in PubMed, where 142 citations were identified. Based on selection criteria, six randomized controlled trials and 15 non-randomized controlled trials were ultimately included. The results of this systematic review show that many of the studies included traffic-light labeling, which may be a promising strategy. The reviewed findings, however, also highlight the challenges that confront experimental studies examining the impact of nudging on diet.

Psychotherapy for Psychopathology During Pregnancy and the Postpartum Period

2015 ◽  
Author(s):  
Amy Wenzel ◽  
Scott Stuart ◽  
Hristina Koleva
Keyword(s):  
Randomized Controlled Trials ◽  
Large Scale ◽  
Behavioral Therapy ◽  
Treatment Retention ◽  
Future Research ◽  
Controlled Trials ◽  
Depression And Anxiety ◽  
Randomized Controlled ◽  
Medication Exposure ◽  
Perinatal Women

Psychotherapy is often the treatment of choice for perinatal women who wish to limit their fetus’s or infant’s medication exposure. The vast majority of empirical research that has examined psychotherapy for perinatal women has focused on depression. Interpersonal psychotherapy (IPT) and cognitive behavioral therapy (CBT) have been examined in several studies to determine their efficacy in perinatal depression and anxiety. Recent research has begun to examine the manner in which psychotherapies can be delivered in alternative formats (e.g., teletherapy) in order to overcome problems with treatment retention and compliance. Suggestions for future research include large-scale randomized controlled trials that compare two active approaches to psychotherapy, mediation studies to uncover the mechanisms of change associated with the successful treatment of perinatal women, and randomized controlled trials evaluating the efficacy of psychotherapy for mental health disorders other than depression.

The Impact of ARC in Human Service Organizations

2018 ◽  
Author(s):  
Anthony L. Hemmelgarn ◽  
Charles Glisson
Keyword(s):  
Randomized Controlled Trials ◽  
Experimental Studies ◽  
Empirical Support ◽  
Controlled Trials ◽  
Evidence Based ◽  
Client Outcomes ◽  
Service Effectiveness ◽  
Randomized Controlled ◽  
Arc Model ◽  
The Impact

This chapter describes empirical support for the ARC model from multiple randomized controlled trials. These trials describe the effects of ARC on organizational culture and climate, organizational priorities, clinicians’ work attitudes, clinicians’ evidence-based practice behaviors, and most importantly, client outcomes. Both the ARC model and the validity of the OSC measurement system are also supported by a number of non-experimental and quasi-experimental studies. Collectively, these studies describe linkages with OSC and related criteria using regional and nationwide samples that are fundamental to explaining the value of the ARC model. Much of this work is referenced throughout the book. In this chapter, the authors focus on the randomized controlled trials to support causal inferences about the effects of ARC, including impact on client outcomes, staff outcomes such as turnover and engagement, as well as impact on evidence-based practices. The evidence also highlights the implications for using ARC strategies in planned efforts to improve service effectiveness.

scholarly journals Non-Immersive Virtual Reality for Rehabilitation of the Older People: A Systematic Review into Efficacy and Effectiveness

2019 ◽  
Vol 8 (11) ◽  
pp. 1882 ◽  
Author(s):  
Bevilacqua ◽  
Maranesi ◽  
Riccardi ◽  
Donna ◽  
Pelliccioni ◽  
...  
Keyword(s):  
Systematic Review ◽  
Virtual Reality ◽  
Older People ◽  
Randomized Controlled Trials ◽  
Cognitive Abilities ◽  
Positive Impact ◽  
Data Extraction ◽  
Future Research ◽  
Controlled Trials ◽  
Randomized Controlled

: Objective: the objective of this review is to analyze the advances in the field of rehabilitation through virtual reality, while taking into account non-immersive systems, as evidence have them shown to be highly accepted by older people, due to the lowest “cibersikness” symptomatology. Data sources: a systematic review of the literature was conducted in June 2019. The data were collected from Cochrane, Embase, Scopus, and PubMed databases, analyzing manuscripts and articles of the last 10 years. Study selection: we only included randomized controlled trials written in English aimed to study the use of the virtual reality in rehabilitation. We selected 10 studies, which were characterized by clinical heterogeneity. Data extraction: quality evaluation was performed based on the Physioterapy Evidence Database (PEDro) scale, suggested for evidence based review of stroke rehabilitation. Of 10 studies considered, eight were randomized controlled trials and the PEDro score ranged from four to a maximum of nine. Data synthesis: VR (Virtual Reality) creates artificial environments with the possibility of a patient interaction. This kind of experience leads to the development of cognitive and motor abilities, which usually positively affect the emotional state of the patient, increasing collaboration and compliance. Some recent studies have suggested that rehabilitation treatment interventions might be useful and effective in treating motor and cognitive symptoms in different neurological disorders, including traumatic brain injury, multiple sclerosis, and progressive supranuclear palsy. Conclusions: as it is shown by the numerous studies in the field, the application of VR has a positive impact on the rehabilitation of the most predominant geriatric syndromes. The level of realism of the virtual stimuli seems to have a crucial role in the training of cognitive abilities. Future research needs to improve study design by including larger samples, longitudinal designs, long term follow-ups, and different outcome measures, including functional and quality of life indexes, to better evaluate the clinical impact of this promising technology in healthy old subjects and in neurological patients.

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