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Biventricular pacing (cardiac resynchronization therapy): an evidence-based analysis.

ISSUE: In 2002, (before the establishment of the Ontario Health Technology Advisory Committee), the Medical Advisory Secretariat conducted a health technology policy assessment on biventricular (BiV) pacing, also called cardiac resynchronization therapy (CRT). The goal of treatment with BiV pacing is to improve cardiac output for people in heart failure (HF) with conduction defect on ECG (wide QRS interval) by synchronizing ventricular contraction. The Medical Advisory Secretariat concluded that there was evidence of short (6 months) and longer-term (12 months) effectiveness in terms of cardia

Anabolic steroids for treating pressure ulcers.

BACKGROUND: Pressure ulcers, also known as bed sores, pressure sores or decubitus ulcers develop as a result of a localised injury to the skin or underlying tissue, or both. The ulcers usually arise over a bony prominence, and are recognised as a common medical problem affecting people confined to a bed or wheelchair for long periods of time. Anabolic steroids are used as off-label drugs (drugs which are used without regulatory approval) and have been used as adjuvants to usual treatment with dressings, debridement, nutritional supplements, systemic antibiotics and antiseptics, which are consi

Interventions for preventing silent cerebral infarcts in people with sickle cell disease.

BACKGROUND: Sickle cell disease (SCD) is one of the commonest severe monogenic disorders in the world, due to the inheritance of two abnormal haemoglobin (beta globin) genes. SCD can cause severe pain, significant end-organ damage, pulmonary complications, and premature death. Silent cerebral infarcts are the commonest neurological complication in children and probably adults with SCD. Silent cerebral infarcts also affect academic performance, increase cognitive deficits and may lower intelligence quotient. OBJECTIVES: To assess the effectiveness of interventions to reduce or prevent silent c

Blood transfusion for preventing primary and secondary stroke in people with sickle cell disease.

BACKGROUND: Sickle cell disease is one of the commonest severe monogenic disorders in the world, due to the inheritance of two abnormal haemoglobin (beta globin) genes. Sickle cell disease can cause severe pain, significant end-organ damage, pulmonary complications, and premature death. Stroke affects around 10% of children with sickle cell anaemia (HbSS). Chronic blood transfusions may reduce the risk of vaso-occlusion and stroke by diluting the proportion of sickled cells in the circulation. This is an update of a Cochrane Review first published in 2002, and last updated in 2017. OBJECTIVES

Interventions for preventing silent cerebral infarcts in people with sickle cell disease.

BACKGROUND: Sickle cell disease (SCD) is one of the commonest severe monogenic disorders in the world, due to the inheritance of two abnormal haemoglobin (beta globin) genes. SCD can cause severe pain, significant end-organ damage, pulmonary complications, and premature death. Silent cerebral infarcts are the commonest neurological complication in children and probably adults with SCD. Silent cerebral infarcts also affect academic performance, increase cognitive deficits and may lower intelligence quotient. OBJECTIVES: To assess the effectiveness of interventions to reduce or prevent silent c

[Expert consensus on the diagnosis and treatment of severe pulmonary tuberculosis].

Patients with pulmonary tuberculosis (PTB) progressing severe conditions have a poor prognosis and high mortality. To enhance the scientificity and standardization of the diagnosis and treatment of severe PTB, the Chinese Society of Tuberculosis of Chinese Medical Association organized domestic experts to formulate the "Expert Consensus on the Diagnosis and Treatment of Severe Pulmonary Tuberculosis". The consensus presents 19 recommendation statements across the following 12 aspects, aiming to provide a decision-making basis for improving the management of severe PTB.The recommendations are l

The ultra-long study: a randomized controlled trial evaluating long-term GnRH downregulation prior to ART in women with endometriosis.

STUDY QUESTION: Does ultra-long downregulation with a GnRH agonist (triptorelin depot) in previously operated patients with endometriosis improve the rate of clinical pregnancy with positive fetal heart beat (CPHB) in the subsequent initiated fresh ART cycle? SUMMARY ANSWER: Ultra-long downregulation with a GnRH agonist prior to ART did not improve the rate of CPHB in the subsequent fresh ART cycle in previously completely operated patients but the trial was underpowered due to early termination. WHAT IS KNOWN ALREADY: Administration of GnRH agonists for a period of 3-6 months prior to ART i

Two-year efficacy and safety of relugolix combination therapy in women with endometriosis-associated pain: SPIRIT open-label extension study.

STUDY QUESTION: What is the efficacy and safety of long-term treatment (up to 2 years) with relugolix combination therapy (CT) in women with moderate to severe endometriosis-associated pain? SUMMARY ANSWER: For up to 2 years, treatment with relugolix CT improved menstrual and non-menstrual pain, dyspareunia, and function in women with endometriosis; after an initial decline of <1%, the mean bone mineral density (BMD) remained stable with continued treatment. WHAT IS KNOWN ALREADY: Endometriosis is a chronic condition characterized by symptoms of dysmenorrhea, non-menstrual pelvic pain (NMPP)

Home Treatment of Older People with Symptomatic SARS-CoV-2 Infection (COVID-19): A structured Summary of a Study Protocol for a Multi-Arm Multi-Stage (MAMS) Randomized Trial to Evaluate the Efficacy and Tolerability of Several Experimental Treatments to Reduce the Risk of Hospitalisation or Death in outpatients aged 65 years or older (COVERAGE trial).

OBJECTIVES: To assess the efficacy of several repurposed drugs to prevent hospitalisation or death in patients aged 65 or more with recent symptomatic SARS-CoV-2 infection (COVID-19) and no criteria for hospitalisation. TRIAL DESIGN: Phase III, multi-arm (5) and multi-stage (MAMS), randomized, open-label controlled superiority trial. Participants will be randomly allocated 1:1:1:1:1 to the following strategies: Arm 1: Control arm Arms 2 to 5: Experimental treatment arms Planned interim analyses will be conducted at regular intervals. Their results will be reviewed by an Independent Data and S

Paracervical block as pain treatment during second-trimester medical termination of pregnancy: an RCT with bupivacaine versus sodium chloride.

STUDY QUESTION: Can paracervical block (PCB) administered before the onset of pain decrease women's pain experience during second-trimester medical termination of pregnancy (MToP)? SUMMARY ANSWER: There were no clinically significant differences between groups receiving PCB with bupivacaine or saline with regard to the highest and lowest pain intensity, morphine consumption or induction-to abortion interval. WHAT IS KNOWN ALREADY: The most common side effect of misoprostol is pain; nevertheless, there are sparse studies in pain and pain treatment during MToP, especially in second-trimester a

Convalescent plasma or hyperimmune immunoglobulin for people with COVID-19: a living systematic review.

BACKGROUND: Convalescent plasma and hyperimmune immunoglobulin may reduce mortality in patients with viral respiratory diseases, and are currently being investigated in trials as potential therapy for coronavirus disease 2019 (COVID-19). A thorough understanding of the current body of evidence regarding the benefits and risks is required.  OBJECTIVES: To continually assess, as more evidence becomes available, whether convalescent plasma or hyperimmune immunoglobulin transfusion is effective and safe in treatment of people with COVID-19. SEARCH METHODS: We searched the World Health Organizatio

Convalescent plasma or hyperimmune immunoglobulin for people with COVID-19: a living systematic review.

BACKGROUND: Convalescent plasma and hyperimmune immunoglobulin may reduce mortality in patients with viral respiratory diseases, and are currently being investigated in trials as potential therapy for coronavirus disease 2019 (COVID-19). A thorough understanding of the current body of evidence regarding the benefits and risks is required.  OBJECTIVES: To continually assess, as more evidence becomes available, whether convalescent plasma or hyperimmune immunoglobulin transfusion is effective and safe in treatment of people with COVID-19. SEARCH METHODS: We searched the World Health Organizatio

Recurrent Angiolymphoid Hyperplasia with Eosinophilia of the Parotid.

Mitochondrial fusion plays an essential role in mitochondrial calcium homeostasis, bioenergetics, autophagy and quality control. Fusion is quantified in living cells by photo-conversion of matrix targeted photoactivatable GFP (mtPAGFP) in a subset of mitochondria. The rate at which the photoconverted molecules equilibrate across the entire mitochondrial population is used as a measure of fusion activity. Thus far measurements were performed using a single cell time lapse approach, quantifying the equilibration in one cell over an hour. Here, we scale up and automate a previously published live

Effectiveness of ondansetron as an adjunct to lidocaine intravenous regional anesthesia on tourniquet pain and postoperative pain in patients undergoing elective hand surgery: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this quantitative systematic review is to determine the effects of ondansetron as an adjunct to lidocaine on the tourniquet pain and postoperative pain of American Society of Anesthesiologists (ASA) class 1 or 2 adult patients undergoing elective hand surgery with intravenous regional anesthesia. BACKGROUND: Both injury and deformity of the upper extremity can result in dysfunction to nerves, tendons and bones which can lead to disability and pain. Hand injuries and deformities encompass an area of upper extremity surgery, wherein isolation and acce

Interventions for the eradication of meticillin-resistant Staphylococcus aureus (MRSA) in people with cystic fibrosis.

RATIONALE: Cystic fibrosis (CF) is a genetic disorder characterised by recurrent and persistent pulmonary infections from resistant organisms, resulting in deterioration of lung function and early mortality. Meticillin-resistant Staphylococcus aureus (MRSA) is an important infection in hospital patients and harmful to people with CF (pwCF). Chronic pulmonary MRSA infection may confer a worse clinical outcome on pwCF and result in a faster decline in lung function. Robust evidence clearly guiding MRSA eradication in CF is urgently needed. This is an updated review. OBJECTIVES: To evaluate the

Advanced electrophysiologic mapping systems: an evidence-based analysis.

OBJECTIVE: To assess the effectiveness, cost-effectiveness, and demand in Ontario for catheter ablation of complex arrhythmias guided by advanced nonfluoroscopy mapping systems. Particular attention was paid to ablation for atrial fibrillation (AF). CLINICAL NEED: Tachycardia Tachycardia refers to a diverse group of arrhythmias characterized by heart rates that are greater than 100 beats per minute. It results from abnormal firing of electrical impulses from heart tissues or abnormal electrical pathways in the heart because of scars. Tachycardia may be asymptomatic, or it may adversely affect

Abstracts for the Eighth Congress of the European Association for Neuro-Oncology (EANO) : September 12–14, 2008 Barcelona, Spain

Background: Standard treatment consisting of surgery, irradiation plus concomitant and following T is established in GBM with median survival of 15.6 months, indicating the need for further effective treatment. In several phase II studies B plus I showed impressive objective response rates (>50%) in pre-treated GBM pts with low toxicity rate, duration of response, however, was moderate. Therefore, B plus I might be an effective induction regimen for T resistant GBM patients as basis for further treatments. In colo-rectal cancer a lower dose of B plus I was effective, therefore B and I dose was

End-of-life Care, Comfort Care, and Hospice: Terms and Concepts

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Подход к оказанию паллиативной помощи взрослым пациентам, не являющимся ракерами, страдающим заболеваниями, ограничивающими жизнь, обеспечивает экономию средств или нейтральность с точки зрения затрат: систематический обзор РХТ.

В мире большинство пациентов, нуждающихся в паллиативном уходе, составляют лица, живущие с болезнями, ограничивающими жизнь, помимо рака, однако большинство предыдущих систематических обзоров последствий паллиативного ухода с точки зрения затрат не были сосредоточены исключительно на этой категории населения. Анализы, проведенные по касательной в отношении пациентов, не являющихся ракерами, выявили неопровержимые доказательства. Случайные контролируемые испытания (РСТ) являются золотым стандартом эффективности лечения, в то время как общие расходы на медицинское обслуживание являются всеобъемл

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… care; terminally ill | health care costs; health expenditures; financ*; economic; cost* | Primary research NHS Evidence | “Palliative Care”; “Hospice Care”; “Palliative Medicine”; “Terminal Care”; “Terminally Ill” | “Health Care Costs”; “Health Expenditures”; “Costs and Cost Analysis”; “Cost Benefit … Care; TOPIC “Terminally Ill”; TITLE “Palliative Care”; TITLE “Hospice Care”; TITLE “Palliative Medicine”; TITLE “Terminal Care”; TITLE “Terminally Ill” | TOPIC “Health Care Costs”; TOPIC “Health Expenditures”; TOPIC “Costs and Cost Analysis”; TOPIC “Cost–Benefit”; TOPIC “Cost”; TOPIC “Economic”; TITLE …

Comparing Perceptions, Determinants, and Needs of Patients, Family Members, Nurses, and Physicians When Making Life-Sustaining Treatment Decisions for Patients with Hematologic Malignancies.

PurposeThis descriptive study compared the perceptions, determinants, and needs of patients, family members, nurses, and physicians regarding life-sustaining treatment decisions for patients with hematologic malignancies in the hematology-oncology department of a tertiary hospital in Seoul, Korea.MethodsIn total, 147 subjects were recruited, gave written consent, and provided data by completing a structured questionnaire. Data were analyzed using analysis of variance, the chi-square test, and the Fisher exact test.ResultsNurses (F=3.35) and physicians (F=3.57) showed significantly greater fami