Muñoz-Hernando, Leticia; Muñoz-Gonzalez, Jose L; Marqueta-Marques, Laura; Alvarez-Conejo, Carmen; Tejerizo-García, Álvaro; Lopez-Gonzalez, Gregorio; Villegas-Muñoz, Emilia; Martin-Jimenez, Angel; Jiménez-López, Jesús S
Endometriosis is an inflammatory estrogen-dependent disease defined by the presence of endometrial glands and stroma at extrauterine sites. The main purpose of endometriosis management is alleviating pain associated to the disease. This can be achieved surgically or medically, although in most women a combination of both treatments is required. Long-term medical treatment is usually needed in most women. Unfortunately, in most cases, pain symptoms recur between 6 months and 12 months once treatment is stopped. The authors conducted a literature search for English original articles, related to new medical treatments of endometriosis in humans, including articles published in PubMed, Medline, and the Cochrane Library. Keywords included “endometriosis” matched with “medical treatment”, “new treatment”, “GnRH antagonists”, “Aromatase inhibitors”, “selective progesterone receptor modulators”, “anti-TNF α”, and “anti-angiogenic factors”. Hormonal treatments currently available are effective in the relief of pain associated to endometriosis. Among new hormonal drugs, association to aromatase inhibitors could be effective in the treatment of women who do not respond to conventional therapies. GnRH antagonists are expected to be as effective as GnRH agonists, but with easier administration (oral). There is a need to find effective treatments that do not block the ovarian function. For this purpose, antiangiogenic factors could be important components of endometriosis therapy in the future. Upcoming researches and controlled clinical trials should focus on these drugs. PMID:26089705
Brenyo, Andrew; Aktas, Mehmet K
Complementary and alternative medical (CAM) therapies are commonly used by patients for the treatment of medical conditions spanning the full spectrum of severity and chronicity. The use of alternative remedies, both herbal and others, for conditions lacking effective medical treatment, is on the increase. Included within this categorization, arrhythmic disease-absent effective catheter-based therapy or with medical therapy limited by the toxicities of contemporary antiarrhythmic agents is frequently managed by patients with CAM therapies without their practitioner's knowledge and in the face of potential herb-drug toxicities. This study reviews 9 CAM therapies: 7 individual herbal therapies along with acupuncture and yoga that have been studied and reported as having an antiarrhythmic effect. The primary focuses are the proposed antiarrhythmic mechanism of each CAM agent along with interactions between the CAM therapies and commonly prescribed medical therapy for arrhythmia patients. We stress persistent vigilance on the part of the provider in discussing the use of herbal or other CAM agents within the arrhythmia population. PMID:24528618
Anagnostou, Evdokia; Hansen, Robin
Purpose of review Up to 35% of children and youth with autism spectrum disorder (ASD) receive at least one psychotropic medication. 50–70% of this population also receives biologically based complementary and alternative medicine (CAM). The data evaluating such practices are being reviewed. Recent findings There are accumulating data to suggest that atypical antipsychotics and stimulants may be useful for the treatment of irritability and hyperactivity in children and youth with ASD. The data for the use of selective serotonin reuptake inhibitors are less promising. New avenues of pharmacologic research targeting molecular targets identified by genomics, animal models and neuropathology are being evaluated. Areas of interest include glutamate/gamma-aminobutyric acid systems, neuropeptides such as oxytocin, and immune dysfunction, among others. In the case of biologically based CAM, a few compounds have been shown to be well tolerated, although efficacy is still being evaluated, such as melatonin, certain vitamins, and omega 3 fatty acids. Others have safety concerns without demonstrated efficacy, such as chelation therapies. Summary Accumulating data suggest a series of existing medications may be useful in ASD and large randomized clinical trials are necessary to evaluate safety and efficacy of both pharmaceuticals and alternative treatments. PMID:22001766
Hume, Anne L; Quilliam, Brian J; Goldman, Roberta; Eaton, Charles
Objective To describe the development of evidence-based electronic prescribing (e-prescribing) triggers and treatment algorithms for potentially inappropriate medications (PIMs) for older adults. Design Literature review, expert panel and focus group. Setting Primary care with access to e-prescribing systems. Participants Primary care physicians using e-prescribing systems receiving medication history. Interventions Standardised treatment algorithms for clinicians attempting to prescribe PIMs for older patients. Main outcome measure Development of 15 treatment algorithms suggesting alternative therapies. Results Evidence-based treatment algorithms were well received by primary care physicians. Providing alternatives to PIMs would make it easier for physicians to change decisions at the point of prescribing. Conclusion Prospectively identifying older persons receiving PIMs or with adherence issues and providing feasible interventions may prevent adverse drug events. PMID:21719560
Barry, Declan T.; Beitel, Mark; Cutter, Christopher J.; Garnet, Brian; Joshi, Dipa; Schottenfeld, Richard S.; Rounsaville, Bruce J.
We surveyed 150 methadone maintenance treatment program (MMTP) patients about pain, pain treatment utilization, perceived efficacy of prior pain treatment, and interest in pursuing pain treatment at the MMTP. Respondents with chronic severe pain (CSP) (i.e., pain lasting at least 6 months with moderate to severe pain intensity or significant pain interference) and “some pain” (i.e., pain reported in the previous week but not CSP) endorsed similar rates of past-week and lifetime allopathic or standard medical (with the exception of lifetime medical use of non-opiate medication) and complementary and alternative medicine (CAM) utilization for pain reduction. Prior pain treatments were perceived to be less effective by CSP than SP patients but both groups had equivalent high rates of interest in pain treatment associated with the MMTP. These findings may have implications for resource and program planning in MMT programs. PMID:19874157
... marketed as a “medical food” called Axona®) and coconut oil Caprylic acid is the active ingredient of ... a medium-chain triglyceride (fat) produced by processing coconut oil or palm kernel oil. The body breaks ...
Asare, Fredrick; Störsrud, Stine; Simrén, Magnus
Complimentary alternative treatment regimens are widely used in irritable bowel syndrome (IBS), but the evidence supporting their use varies. For psychological treatment options, such as cognitive behavioral therapy, mindfulness, gut-directed hypnotherapy, and psychodynamic therapy, the evidence supporting their use in IBS patients is strong, but the availability limits their use in clinical practice. Dietary interventions are commonly included in the management of IBS patients, but these are primarily based on studies assessing physiological function in relation to dietary components, and to a lesser degree upon research examining the role of dietary components in the therapeutic management of IBS. Several probiotic products improve a range of symptoms in IBS patients. Physical activity is of benefit for health in general and recent data implicates its usefulness also for IBS patients. Acupuncture does not seem to have an effect beyond placebo in IBS. A beneficial effect of some herbal treatments has been reported. PMID:22661301
Alternative disinfestant water treatments are disinfestants not as commonly used by the horticultural industry. Chlorine products that produce hypochlorous acid are the main disinfestants used for treating irrigation water. Chlorine dioxide will be the primary disinfestant discussed as an alternativ...
... Clinical Trials Resources and Publications Medical Treatments for Fibroids Skip sharing on social media links Share this: ... suggest medical treatments to reduce the symptoms of fibroids or to stop the growth of fibroids. These ...
McGlasson, Terry D.
For many years now, Cognitive Behavioral Therapy and anti-depressant medications have been the primary treatments for adolescent depression. However, there are many youth today with mild to moderate depressive symptoms for whom these treatments are not necessary. This article briefly summarizes several alternative therapeutic approaches for…
Sarac, Aysegul Jale; Gur, Ali
This article describes the studies that have been performed evaluating complementary or alternative medical (CAM) therapies for efficacy and some adverse events fibromyalgia (FM). There is no permanent cure for FM; therefore, adequate symptom control should be goal of treatment. Clinicians can choose from a variety of pharmacologic and nonpharmacologic modalities. Unfortunately, controlled studies of most current treatments have failed to demonstrate sustained, clinically significant responses. CAM has gained increasing popularity, particularly among individuals with FM for which traditional medicine has generally been ineffective. Some herbal and nutritional supplements (magnesium, S- adenosylmethionine) and massage therapy have the best evidence for effectiveness with FM. Other CAM therapies such as chlorella, biofeedback, relaxation have either been evaluated in only one randomised controlled trials (RCT) with positive results, in multiple RCTs with mixed results (magnet therapies) or have positive results from studies with methodological flaws (homeopathy, botanical oils, balneotherapy, anthocyanidins and dietary modifications). Another CAM therapy such as chiropractic care has neither well-designed studies nor positive results and is not currently recommended for FM treatment. Once CAM therapies have been better evaluated for safety and long-term efficacy in randomised, placebo-controlled trials, they may prove to be beneficial in treatments for FM. It would then be important to assess studies assessing cost-benefit analyses comparing conventional therapies and CAM. PMID:16454724
Martins e Silva, J
This article briefly reviews the impact of regularly promoted alternative therapies within portuguese society. The origins, attractions and acceptance of alternative therapies, homeopathic included, are discussed. Recent homeopathic studies published in renowned scientific journals provoked comments and reports claiming for more objective explanations and better criticism. Accordingly, homeopathy is presently an unacceptable system with no physical basis, supported by inexplicable observations and a mixture of magic effects. Also alternatives therapies may provide an area of conflict with health and medical care, particularly in most severe diseases that require advanced resources of orthodox medicine. Improved education of the population, more qualified medical personal, and better understanding of medical problems, difficulties and progress by the media are final recommendations. PMID:2077840
Salvi, M; Campi, I
The medical treatment of Graves' orbitopathy (GO) is usually reserved to moderate to severe disease. Steroids have been widely employed and possess anti-inflammatory activity, but about 20-30% of patients are not responsive and about 20% present with disease recurrence. Immunosuppressive therapy alternative to corticosteroids may target the different antigens involved in pathogenic mechanisms of GO. Some have already been employed in clinical studies and showed interesting results, although the lack of randomized and controlled trials suggests caution for their use in clinical practice. Potential targets for therapy in GO are the TSH receptor and the IGF-1 receptor on the fibroblasts, inflammatory cytokines, B and T cells. Most promising results are obtained by interacting with the PIK3/mTORC1 signaling cascades for adipogenesis and the anti-IGF-1R with the monoclonal antibody teprotumumab. A recent open study has shown that tocilizumab, an anti-sIL-6R antibody, inactivates GO. Consistent reports on the efficacy of rituximab have recently been challenged by randomized controlled trials. Clinical practice will greatly benefit from the use of disease modifying agents in GO, as compared to steroids, currently standard treatment for GO. Among these, rituximab may be useful, especially in patients resistant to steroid or with contraindications to steroids. However, larger randomized controlled trials are needed for definitive data on the potential disease-modifying role of rituximab in GO. Direct targeting of the orbital fibroblast via immunosuppression or nonimmunosuppressive drugs is emerging as a promising alternative. PMID:26361263
Cornel, Stefan; Mihaela, Timaru Cristina; Adriana, Iliescu Daniela; Mehdi, Batras; Algerino, De Simone
The purpose of this study is to review the current medical treatment and the new and better alternatives for patients with glaucoma. Glaucoma refers to a group of related eye disorders that have in common an optic neuropathy associated with visual function loss. It is one of the leading causes of irreversible blindness worldwide. Glaucoma can damage vision gradually so it may not be noticed until the disease is at an advanced stage. Early diagnosis and treatment can minimize or prevent optic nerve damage and limit glaucoma-related vision loss. Nowadays, research continues for the improvement of current medical treatment. PMID:26978866
Haldane, J J
Contemporary medical ethics is generally concerned with the application of ethical theory to medico-moral dilemmas and with the critical analysis of the concepts of medicine. This paper presents an alternative programme: the development of a medical philosophy which, by taking as its starting point the two questions: what is man? and, what constitutes goodness in life? offers an account of health as one of the primary concepts of value. This view of the subject resembles that implied by ancient theories of goodness, and in later sections of the paper it is shown how Aristotle points us towards a coherent theory of human nature as psycho-physical, which overcomes the inadequacies of dualism and physicalist reductionism. What is on offer therefore, is the prospect of an integrated account of human nature and of what constitutes its flourishing: to be healthy is to be an active unity-of-parts in equilibrium. PMID:3761336
Alternative and complementary therapies differ importantly, and the distinction between the two is crucial for clinical oncologists. "Alternative" or unproven therapies are treatments used independent of surgery, radiation and chemotherapy. They can be dangerous directly and also by delaying patients' receipt of mainstream care. In contrast, complementary therapies typically are adjuncts to mainstream medicine. They can provide symptom control and noninvasive palliation with minimal side effects, improve patients' well-being and enhance cancer medicine. Complementary therapies represent a desired addition and balance to technologically sophisticated cancer care. PMID:10387984
... Incontinence Managing Incontinence: A Survey The Patient's Perspective Barriers on Diagnosis and Treatment Personal Stories Contact Us ... Incontinence Managing Incontinence: A Survey The Patient's Perspective Barriers on Diagnosis and Treatment Personal Stories Contact Us ...
Learn how INL researchers are increasing world supplies of Bismuth 213 to help with cancer treatments. For more information about INL research projects, visit http://www.facebook.com/idahonationallaboratory.
Learn how INL researchers are increasing world supplies of Bismuth 213 to help with cancer treatments. For more information about INL research projects, visit http://www.facebook.com/idahonationallaboratory.
Four therapeutic classes can be used for the treatment of BPH: alphablockers, 5 alpha reductase inhibitors (5ARI), muscrinic receptor antagonists, and plant extracts. Two combination therapies have been proven to be efficient: 5ARI - alphablockers, and muscarinic receptor antagonists - alphablockers. Alphablockers have the advantage to be efficient quickly. 5ARI decrease prostate volume. Efficacy of plant extracts is still discussed, but their tolerance is excellent. Muscrinic receptor antagonists can be a viable treatment option for men with predominantly bladder storage symptoms but without bladder outlet obstruction. PMID:19963186
... Ask about Your Treatment Research Complementary and Alternative Medicine for Patients Complementary and alternative medicine (CAM) is ... based on scientific evidence from research studies. Complementary medicine refers to treatments that are used with standard ...
Abbott, Ryan B; Hui, Ka-Kit; Hays, Ron D; Mandel, Jess; Goldstein, Michael; Winegarden, Babbi; Glaser, Dale; Brunton, Laurence
While the use of complementary, alternative and integrative medicine (CAIM) is substantial, it continues to exist at the periphery of allopathic medicine. Understanding the attitudes of medical students toward CAIM will be useful in understanding future integration of CAIM and allopathic medicine. This study was conducted to develop and evaluate an instrument and assess medical students' attitudes toward CAIM. The Complementary, Alternative and Integrative Medicine Attitudes Questionnaire (CAIMAQ) was developed by a panel of experts in CAIM, allopathic medicine, medical education and survey development. A total of 1770 CAIMAQ surveys (51% of US medical schools participated) were obtained in a national sample of medical students in 2007. Factor analysis of the CAIMAQ revealed five distinct attitudinal domains: desirability of CAIM therapies, progressive patient/physician health care roles, mind-body-spirit connection, principles of allostasis and a holistic understanding of disease. The students held the most positive attitude for the "mind-body-spirit connection" and the least positive for the "desirability of CAIM therapies". This study provided initial support for the reliability of the CAIMAQ. The survey results indicated that in general students responded more positively to the principles of CAIM than to CAIM treatment. A higher quality of CAIM-related medical education and expanded research into CAIM therapies would facilitate appropriate integration of CAIM into medical curricula. The most significant limitation of this study is a low response rate, and further work is required to assess more representative populations in order to determine whether the relationships found in this study are generalizable. PMID:21826186
Abbott, Ryan B.; Hui, Ka-Kit; Hays, Ron D.; Mandel, Jess; Goldstein, Michael; Winegarden, Babbi; Glaser, Dale; Brunton, Laurence
While the use of complementary, alternative and integrative medicine (CAIM) is substantial, it continues to exist at the periphery of allopathic medicine. Understanding the attitudes of medical students toward CAIM will be useful in understanding future integration of CAIM and allopathic medicine. This study was conducted to develop and evaluate an instrument and assess medical students' attitudes toward CAIM. The Complementary, Alternative and Integrative Medicine Attitudes Questionnaire (CAIMAQ) was developed by a panel of experts in CAIM, allopathic medicine, medical education and survey development. A total of 1770 CAIMAQ surveys (51% of US medical schools participated) were obtained in a national sample of medical students in 2007. Factor analysis of the CAIMAQ revealed five distinct attitudinal domains: desirability of CAIM therapies, progressive patient/physician health care roles, mind-body-spirit connection, principles of allostasis and a holistic understanding of disease. The students held the most positive attitude for the “mind-body-spirit connection” and the least positive for the “desirability of CAIM therapies”. This study provided initial support for the reliability of the CAIMAQ. The survey results indicated that in general students responded more positively to the principles of CAIM than to CAIM treatment. A higher quality of CAIM-related medical education and expanded research into CAIM therapies would facilitate appropriate integration of CAIM into medical curricula. The most significant limitation of this study is a low response rate, and further work is required to assess more representative populations in order to determine whether the relationships found in this study are generalizable. PMID:21826186
Carlson, Peggy, Ed.
The technology explosion in medical education has led to the use of computer models, videotapes, interactive videos, and state-of-the-art simulators in medical training. This booklet describes alternatives to using animals in medical education. Although it is mainly intended to describe products applicable to medical school courses, high-quality,…
Rinke, Anja; Michl, Patrick; Gress, Thomas
Treatment of the clinically and prognostically heterogeneous neuroendocrine neoplasms (NEN) should be based on a multidisciplinary approach, including surgical, interventional, medical and nuclear medicine-based therapeutic options. Medical therapies include somatostatin analogues, interferon-α, mTOR inhibitors, multikinase inhibitors and systemic chemotherapy. For the selection of the appropriate medical treatment the hormonal activity, primary tumor localization, tumor grading and growth behaviour as well as the extent of the disease must be considered. Somatostatin analogues are mainly indicated in hormonally active tumors for symptomatic relief, but antiproliferative effects have also been demonstrated, especially in well-differentiated intestinal NET. The efficacy of everolimus and sunitinib in patients with pancreatic neuroendocrine tumors (pNET) has been demonstrated in large placebo-controlled clinical trials. pNETs are also chemosensitive. Streptozocin-based chemotherapeutic regimens are regarded as current standard of care. Temozolomide in combination with capecitabine is an alternative that has shown promising results that need to be confirmed in larger trials. Currently, no comparative studies and no molecular markers are established that predict the response to medical treatment. Therefore the choice of treatment for each pNET patient is based on individual parameters taking into account the patient’s preference, expected side effects and established response criteria such as proliferation rate and tumor load. Platin-based chemotherapy is still the standard treatment for poorly differentiated neuroendocrine carcinomas. Clearly, there is an unmet need for new systemic treatment options in patients with extrapancreatic neuroendocrine tumors. PMID:24213230
Atan, Ali; Balcandı, Melih
The frequency of stone disease in childhood ranges between 0.1-5 percent. Stone disease occurs as a result of enviromental, metabolic, anatomical, infectious and nutritional factors. Percutaneous nephrolitotomy, uretherorenoscopy, laparoscopic surgery, open surgery and extracorporeal shock wave lithothripsy are treatment alternatives for stone disease during childhood. However, these methods are not completely innocent. Some complications may occur after these procedures. These procedures are generally not cost- effective. Even invasive procedures have high success rates, so medical expulsive treatment modalities have become an alternative for a group of patients. Nonsteroidal anti- inflammatory drugs, antimuscarinic drugs, phospodiesterase type 5 inhibitors, steroids, calcium channel blockers and alpha blockers are treatment alterneatives used for this modality in the literature. The drug is chosen according to the location, size, and composition of the stone, recent technology, cost, surgeon's experience and surgeon's and the parents' preferences. In this review article the following topics will be discussed such as "Why medical expulsive treatment is needed during childhood? Which drug should be chosen for which stone type? How long should a treatment of urolithiasis last? PMID:26328197
Atan, Ali; Balcι, Melih
The frequency of stone disease in childhood ranges between 0.1–5 percent. Stone disease occurs as a result of enviromental, metabolic, anatomical, infectious and nutritional factors. Percutaneous nephrolitotomy, uretherorenoscopy, laparoscopic surgery, open surgery and extracorporeal shock wave lithothripsy are treatment alternatives for stone disease during childhood. However, these methods are not completely innocent. Some complications may occur after these procedures. These procedures are generally not cost- effective. Even invasive procedures have high success rates, so medical expulsive treatment modalities have become an alternative for a group of patients. Nonsteroidal anti- inflammatory drugs, antimuscarinic drugs, phospodiesterase type 5 inhibitors, steroids, calcium channel blockers and alpha blockers are treatment alterneatives used for this modality in the literature. The drug is chosen according to the location, size, and composition of the stone, recent technology, cost, surgeon’s experience and surgeon’s and the parents’ preferences. In this review article the following topics will be discussed such as “Why medical expulsive treatment is needed during childhood? Which drug should be chosen for which stone type? How long should a treatment of urolithiasis last? PMID:26328197
Kottow, M H
Classical medicine operates in a climate of rational discourse, scientific knowledge accretion and the acceptance of ethical standards that regulate its activities. Criticism has centred on the excessive technological emphasis of modern medicine and on its social strategy aimed at defending exclusiveness and the privileges of professional status. Alternative therapeutic approaches have taken advantage of the eroded public image of medicine, offering treatments based on holistic philosophies that stress the non-rational, non-technical and non-scientific approach to the unwell, disregarding traditional diagnostic categories and concentrating on enhancing subjective comfort and well-being, but remaining oblivious to the organic substrate of disease. This leads to questionable ethics in terms of false hopes and lost opportunities for effective therapy. PMID:1573644
Cuevas-Ramos, Daniel; Fleseriu, Maria
Cushing's Syndrome (CS) is a serious endocrine disease that results from the adverse clinical consequences of chronic exposure to high levels of glucocorticoids. Most patients with endogenous CS have an adrenocorticotropin (ACTH)-secreting pituitary corticotroph adenoma, i.e. Cushing's Disease (CD). The first-line therapy for CD is transsphenoidal pituitary surgery. If tumor removal is incomplete or unsuccessful, persistent hypercortisolism will require further treatment. Repeat surgery, medical therapy, radiation and bilateral adrenalectomy are all second line therapy options; however, medical therapy can be also used as first line therapy in patients who cannot undergo surgery, or to decrease cortisol values and/or improve co-morbidities. Medications used in the treatment of CD, classified into three groups: pituitary directed drugs, adrenal steroidogenesis inhibitors and glucocorticoid receptor blockers, are reviewed. Future 'on the horizon' treatment options are also discussed. PMID:26977887
Longo, Leonardo; Postiglione, Marco
Today, laser resurfacing technique is codified. The purpose of our study is to reduce the post-intervention discomfort and the clinical signs. We tested a combination of pharmacological substances, applied as spray lotion and gel during and immediately after the intervention and the days after. We used this substances after laser resurfacing done with CO2 laser, Er:YAG laser and both. We noted a reduction statistically significant of the signs up described, with reduction of the recovery time. It is our opinion that this medical treatment must be done always, during and post laser resurfacing treatment.
Novack, Thomas A.; And Others
Discusses treatment alternatives which may alleviate problems in recovery following mild head injury, including providing education, cognitive stimulation, stress management training, individual counseling, group discussion, and physical activity in a day treatment setting. (Author/ABL)
Qiu, Juan; Grine, Kristen
This article explains the proposed pathophysiology, evidence of efficacy, and adverse effects of several complementary and alternative medicine modalities, for the treatment of allergic conditions, such as traditional Chinese medicine formula, herbal treatments, acupuncture, and homeopathy. PMID:27545740
Godin, Gaston; Beaulieu, Dominique; Touchette, Jean-Sebastien; Lambert, Leo-Daniel; Dodin, Sylvie
The authors' goal was to identify factors explaining intention to encourage a patient to follow complementary and alternative medicine (CAM) treatment among general practitioners (GPs), fourth-year medical students, and residents in family medicine. They surveyed 500 GPs and 904 medical students via a self-administered mailed questionnaire that…
Friese, K H
In this review, the most important complementary und alternative therapies are discussed, focusing particularly on their use in otorhinolaryngology. These therapies include balneology, Kneipp therapy, microbiological therapy, fasting, excretion therapy, different oxygen therapies, hydro-colon therapy, urine therapy, own-blood therapy, Bach therapy, orthomolecular therapy, order therapy, environmental medicine, phytotherapy, homeopathy, complex homeopathy, anthroposophy, neural therapy, electroaccupuncture according to Voll and similar therapies, nasal reflex therapy, reflex-zone massage, manual therapy, massage, lymph drainage, aroma therapy, thermotherapy, bioresonance, kinesiology, hopi candles, and dietetics. Some of these methods and regimens can be recommended, but others should be rejected. In universities, these methods are only represented to a minor extend, but are more accepted by otorhinolaryngologists in practice. This paper provides a guide to which alternative therapies are sensible and possible in otorhinolaryngology. The aim is to stimulate interest in these methods. It is necessary to discuss these alternative methods reasonably and credibly with patients. PMID:9378666
Cowen, Virginia S; Cyr, Vicki
An analysis of complementary and alternative medicine (CAM) in US medical school curriculum was undertaken. Websites for 130 US medical schools were systematically analyzed for course listings and content. Half of the schools (50.8%) offered at least one CAM course or clerkship. A total of 127 different course listings were identified, embracing a range of topics and methods of instruction. The most frequently listed topics were traditional medicine, acupuncture, spirituality, and herbs, along with the general topic of CAM. Nearly 25.0% of the courses referenced personal growth or self-care through CAM practices, while only 11.0% referenced inter-professional education activities involving interaction with CAM providers. The most frequently reported instructional methods were lectures, readings, and observation of, or receiving a CAM treatment. The findings of this analysis indicated fewer medical schools offered instruction in CAM than previously reported and a wide range of approaches to the topic across the schools where CAM is taught. PMID:25709517
Chamberlain, Marc C; Barnholtz-Sloan, Jill S
Meningiomas are the second most common primary brain tumor and are primarily treated with surgery (with or without embolization) and radiotherapy. Increasingly today, meningiomas undergo multiple resections and two radiotherapy treatments (either stereotactic or conventional external beam) before consideration for hormonal, chemotherapy or targeted therapy. The failure of hormonal and cytotoxic chemotherapy in the treatment of recurrent meningioma and increasing understanding of potential molecular targets in meningioma has resulted in multiple studies utilizing single-agent targeted therapy directed at biologically relevant signaling pathways, such as somatostatin (Sandostatin(®) LAR, SOM230c), PDGF (imatinib), EGF (erlotinib) and VEGF (sunitinib and vatalanib). Early results using a targeted approach have been modest at best and are often associated with significant toxicity. Consequently and at present, the brain tumor guidelines recognize only three medical therapies for inoperable and radiation-refractory meningiomas: hydroxyurea, IFN-α and Sandostatin LAR, a somatostatin analogue. Clearly, there remains an unmet need in neuro-oncology with respect to the medical treatment of recurrent meningiomas. PMID:21955199
Assar, A N
Conventional open repair or endovascular aneurysm repair is indicated for infrarenal abdominal aortic aneurysm (AAA) when the diameter of the latter is ≥ 5.5 cm. This therapeutic strategy is based on results of randomized trials of open repair versus ultrasound surveillance of small AAA (<5.5 cm). Studies of screening for AAA have shown that >90% of aneurysms detected are small aneurysms (<5.5 cm). Despite the low annual risk of rupture of these aneurysms, patients with small AAA are left with a potentially life-threatening disease for which no immediate treatment is available. Hence, medical treatment directed at limiting the expansion of small AAA has emerged as an alternative therapeutic strategy. Randomized trials of doxycycline, roxithromycin, and propranolol in patients with small AAA have been published. The results of the doxycycline and roxithromycin trials suggest that both medications can limit AAA expansion, especially during the first year of treatment. Propranolol did not limit AAA expansion, and the trials were stopped because of its serious side effects. In other studies, statins and indomethacin have also been shown to limit AAA expansion. However, these studies were observational with relatively small numbers of patients. Thus, large randomized controlled trials with long follow-up are needed to objectively assess the efficacy of medications that have shown potential in limiting AAA expansion. In addition, recent evidence of regression of AAA in experimental animal models is likely to change our concepts of the molecular pathogenesis of AAA, and could make medical treatment of small AAA a possibility. PMID:22854530
Although osteoporosis is a systemic disease, vertebral fractures due to spinal bone loss are a frequent, sometimes early and often neglected complication of the disease, generally associated with considerable disability and pain. As osteoporotic vertebral fractures are an important predictor of future fracture risk, including at the hip, medical management is targeted at reducing fracture risk. A literature search for randomized, double-blind, prospective, controlled clinical studies addressing medical treatment possibilities of vertebral fractures in postmenopausal Caucasian women was performed on the leading medical databases. For each publication, the number of patients with at least one new vertebral fracture and the number of randomized patients by treatment arm was retrieved. The relative risk (RR) and the number needed to treat (NNT, i.e. the number of patients to be treated to avoid one radiological vertebral fracture over the duration of the study), together with the respective 95% confidence intervals (95%CI) were calculated for each study. Treatment of steroid-induced osteoporosis and treatment of osteoporosis in men were reviewed separately, based on the low number of publications available. Forty-five publications matched with the search criteria, allowing for analysis of 15 different substances tested regarding their anti-fracture efficacy at the vertebral level. Bisphosphonates, mainly alendronate and risedronate, were reported to have consistently reduced the risk of a vertebral fracture over up to 50 months of treatment in four (alendronate) and two (risedronate) publications. Raloxifene reduced vertebral fracture risk in one study over 36 months, which was confirmed by 48 months' follow-up data. Parathormone (PTH) showed a drastic reduction in vertebral fracture risk in early studies, while calcitonin may also be a treatment option to reduce fracture risk. For other substances published data are conflicting (calcitriol, fluoride) or insufficient
Sabry, Mohamed; Al-Hendy, Ayman
Uterine leiomyomas (also called myomata or fibroids) are the most common gynecologic tumors in the United States. The prevalence of leiomyomas is at least 3 to 4 times higher among African American women than in white women. Pathologically, uterine leiomyomas are benign tumors that arise in any part of the uterus under the influence of local growth factors and sex hormones, such as estrogen and progesterone. These common tumors cause significant morbidity for women and they are considered to be the most common indication for hysterectomy in the world; they are also associated with a substantial economic impact on health care systems that amounts to approximately $2.2 billion/year in the United States alone. Uterine myomas cause several reproductive problems such as heavy or abnormal uterine bleeding, pelvic pressure, infertility, and several obstetrical complications including miscarriage and preterm labor. Surgery has traditionally been the gold standard for the treatment of uterine leiomyomas and has typically consisted of either hysterectomy or myomectomy. In recent years, a few clinical trials have evaluated the efficacy of orally administered medications for the management of leiomyoma-related symptoms. In the present review, we will discuss these promising medical treatments in further detail. PMID:22378865
The technology assessment provides an introduction to the use of several alternative energy sources at wastewater treatment plants. The report contains fact sheets (technical descriptions) and data sheets (cost and design information) for the technologies. Cost figures and schema...
Situating the contemporary medical treatment of transgender young people--children and adolescents--in the longer history of engagement between transgender activists and the medical community, this article analyzes the World Professional Association for Transgender Health's (WPATH) Standards of Care (SOC) concerning the medical treatment of transgender young people. It traces how the SOC both achieves medical treatment for children and adolescents and reinforces a normative gender system by cleaving to a developmental approach. Without rejecting the value of developmentally-based medical treatment for now, it offers some preliminary thoughts on queer theory's valuation of developmental failure as a potential future alternative to an emergent medico-technological transgender normativity. PMID:25641206
Fernández-Hinojosa, E; Murillo-Cabezas, F; Puppo-Moreno, A; Leal-Noval, S R
Massive hemorrhage is the main cause of mortality and morbidity in trauma patients, and is one of the most important causes in any patient following major surgery. Conventional treatment consists of volume replacement, including the transfusion of blood products, so that tissue perfusion and oxygenation may be maintained. Associated hypothermia, acidosis and coagulopathy is a lethal triad. This review focuses on the latest therapeutic management of massive hemorrhage. The authors advocate the use of crystalloids as per protocol (controlled volumes) in order to achieve a systolic blood pressure of 85mmHg. The administration of the three blood products (red cells, plasma, and platelets) should be on a 1:1:1 basis. Where possible, this in turn should be guided by thromboelastography performed at point of care near the patient. Coagulopathy can occur early and late. With the exception of tranexamic acid, the cost-benefit relationships of the hemostatic agents, such as fibrinogen, prothrombin complex, and recombinant F VII, are subject to discussion. PMID:22321860
Den Houtter, Kathryn
Results from recent studies on the effectiveness of Ritalin for "hyperactivity" show that this treatment is dubious at best. This article presents an alternative treatment approach, placing emphasis on devising an appropriate learning situation that meets the needs of the so-called hyperactive child. (Author)
Vickers, Andrew J; Cassileth, Barrie R
Michael Gearin-Tosh was an English professor at Oxford University who was diagnosed with multiple myeloma in 1994. He rejected conventional chemotherapeutic approaches and turned to a variety of alternative cancer treatments, particularly those involving nutritional supplements and dietary change. In 2002, Dr. Gearin-Tosh published a book, Living Proof: A Medical Mutiny, recounting his experiences. The book gained significant public and media attention. One chapter was written by Carmen Wheatley, an advocate of alternative cancer treatments. In distinction to Dr. Gearin-Tosh's personal story, Dr. Wheatley makes general claims about cancer treatment that are supposedly based on the research literature. This appears to provide scientific validation for a highly unconventional program of cancer care. However, the scientific case made for alternative cancer treatments in Living Proof does not bear serious examination. There are numerous inaccuracies, omissions, and misrepresentations. Many important claims are either entirely unsubstantiated or not supported by the literature cited. In conclusion, a highly publicized book gives the impression that alternative cancer treatments are supported by scientific research. It also suggests that little progress has been made in the conventional treatment of myeloma. This is highly misleading and may lead to cancer patients rejecting effective treatments. PMID:18302909
Takacs, T.J.; Johnson, M.E.
Sodium-potassium alloy (NaK) is currently treated at the Y-12 Plant by open burning. Due to uncertainties with future permits for this process alternative treatment methods were investigated, revealing that two treatment processes are feasible. One process reacts the NaK with water in a highly concentrated molten caustic solution (sodium and potassium hydroxide). The final waste is a caustic that may be used elsewhere in the plant. This process has two safety concerns: Hot corrosive materials used throughout the process present handling difficulties and the process must be carefully controlled (temperature and water content) to avoid explosive NaK reactions. To avoid these problems a second process was developed that dissolves NaK in a mixture of propylene glycol and water at room temperature. While this process is safer, it generates more waste than the caustic process. The waste may possibly be used as a carbon food source in biological waste treatment operations at the Y-12 Plant. Experiments were conducted to demonstrate both processes, and they showed that both processes are feasible alternatives for NaK treatment. Process flow sheets with mass balances were generated for both processes and compared. While the caustic process generates less waste, the propylene glycol process is safer in several ways (temperature, material handling, and reaction control). The authors recommend that the propylene glycol alternative be pursued further as an alternative for NaK treatment. To optimize this process for a larger scale several experiments should be conducted. The amount of NaK dissolved in propylene glycol and subsequent waste generated should be optimized. The offgas processes should be optimized. The viability of using this waste as a carbon food source at one of the Y-12 Plant treatment facilities should be investigated. If the state accepts this process as an alternative, design and construction of a pilot-scale treatment system should begin.
Wynn, Gary H
Complementary and alternative medicine is a diverse set of practices and treatments that has seen a significant increase among Americans over the past decade. These approaches have been applied to a myriad of medical and mental health disorders with varying levels of efficacy. Recent years have seen an increased interest in the use of complementary and alternative medicine to address the growing numbers of individuals suffering from post-traumatic stress disorder and other trauma-related disorders. These approaches include pharmacologic and non-pharmacologic modalities. This article will review some of the most widely used non-pharmacologic complementary and alternative medicine practices used to treat post-traumatic stress disorder such as recreational therapy, animal-assisted therapy, yoga, and acupuncture as well as alternative delivery methods for psychotherapy. PMID:26073362
Johnson, G. S.
Universal sized vest, with specially tailored pockets designed to hold medical supplies, provides first aid/first care medical teams with broadened on-site capability. Vest is made of nylon, tough fibrous materials, and polyvinyl chloride. Design facilitates rapid donning, doffing, and adjustment.
Background The rise of authorized marijuana use in the U.S. means that many individuals are using cannabis as they concurrently engage in other forms of treatment, such as substance abuse counseling and psychotherapy. Clinical and legal decisions may be influenced by findings that suggest marijuana use during treatment serves as an obstacle to treatment success, compromises treatment integrity, or increases the prevalence or severity of relapse. In this paper, the author reviews the relationship between authorized marijuana use and substance abuse treatment utilizing data from a preliminary pilot study that, for the first time, uses a systematic methodology to collect data examining possible effects on treatment. Methods Data from the California Outcomes Measurement System (CalOMS) were compared for medical (authorized) marijuana users and non-marijuana users who were admitted to a public substance abuse treatment program in California. Behavioral and social treatment outcomes recorded by clinical staff at discharge and reported to the California Department of Alcohol and Drug Programs were assessed for both groups, which included a sample of 18 reported medical marijuana users. Results While the findings described here are preliminary and very limited due to the small sample size, the study demonstrates that questions about the relationship between medical marijuana use and involvement in drug treatment can be systematically evaluated. In this small sample, cannabis use did not seem to compromise substance abuse treatment amongst the medical marijuana using group, who (based on these preliminary data) fared equal to or better than non-medical marijuana users in several important outcome categories (e.g., treatment completion, criminal justice involvement, medical concerns). Conclusions This exploratory study suggests that medical marijuana is consistent with participation in other forms of drug treatment and may not adversely affect positive treatment outcomes
ADHD is a syndrome that can be treated effectively, safely, and economically with stimulant medications. There is no equal alternative to these agents in short-term treatment of ADHD symptoms. However, many families seek alternatives to stimulants and other drug treatments for a variety of reasons. Alternative approaches reflect the complexity and heterogeneity of the disorder by being equally manifold, complex, and often obscure in their modus operandi. Scientific evidence suggests that individualized dietary management may be effective in some children. Trace element supplementation also may be beneficial when specific deficiencies are present. At this point, nootropics, herbs, and homeopathy are being seriously researched regarding their role in neurologic functioning, but evidence to support their role in the specific treatment of ADHD is inconsistent or lacking. Self-regulatory techniques such as hypnotherapy and biofeedback do not alter the core symptoms of ADHD but may be helpful in controlling secondary symptoms. These methods are unique in ADHD treatment because children can become active agents of their own coping strategies. There is no scientific evidence to support the validity of vision therapy, oculovestibular treatment, or sound training (Tomatis method) as treatment modalities for ADHD. However, auditory stimulation with individualized music may help to improve situational performance in cognitive tasks. Regardless of the treatment approach, the diagnosis of ADHD and other comorbidities first must be established through a standard medical evaluation. The standard treatment options always should be presented and discussed carefully. If alternative approaches are sought, the merits of available options should be reiterated. If the primary care provider is not comfortable or knowledgeable about an acceptable method, referral to capable and responsible practitioners in the community who are experienced in these areas should be considered. The primary
Jimerson, D C; Wolfe, B E; Brotman, A W; Metzger, E D
Effective planning for medication treatment in patients with bulimia nervosa and anorexia nervosa is based on a comprehensive clinical assessment, including a careful review of comorbid psychiatric disorders and response to treatments for previous episodes of the disorder. Although most patients with bulimia nervosa are offered a trial of psychotherapy, significant results of controlled trials have contributed to an increased role for medications in the treatment of patients with this disorder. Pharmacologic treatment of anorexia nervosa has similarities to that of treatment-resistant depression, with the clinician turning to open trials and clinical reports for clues to rational management. As described in this article, considerations of potential side effects and medical complications are likely to play an important role in guiding the choice of medication used for treatment of patients with eating disorders. PMID:8933605
Burns-Cox, N.; Gingell, C.
There has been a tremendous increase in demand for the treatment of erectile dysfunction in the last 10 years. This has occurred partly because of a greater understanding and awareness by both the general public and clinicians, and also because there now exists a range of effective treatments. The choice of treatments is increasing rapidly and novel delivery systems which may be more patient-friendly than intracavernosal injections are now becoming available. We review the published data on effectiveness and safety of the currently available treatments and discuss recent advances in oral therapy, as these drugs are likely to become available in the near future. Images Figure 1 Figure 2 PMID:9799886
Cohen, Brandon E; Elbuluk, Nada; Mu, Euphemia W; Orlow, Seth J
Vitiligo is a common, acquired disorder of skin pigmentation that can significantly impact quality of life. It often represents a therapeutic challenge, which has resulted in interest in alternative treatments such as herbal and vitamin supplements. In this review, we provide an overview of the most commonly studied complementary agents, describe proposed mechanisms of action, identify potential adverse effects, and discuss the primary evidence supporting their use. Our discussion focuses on L-phenylalanine, Polypodium leucotomos, khellin, Ginkgo biloba, and vitamins and minerals, including vitamins B12, C, and E, folic acid, and zinc used as monotherapy or in combination with other treatments for the management of vitiligo. PMID:26329814
Satora, Leszek; Gawlikowski, Tomasz
Expositions to fish venoms should be treated as a separate group of intoxications because of their different diagnostic procedure. Until now, there are over 220 venomous fish species described, but skin excretions are potentially toxic for humans. Cases of fish envenomations (37), consulted by Poison Information Centres in Poland, as well as described in literature and contained in Micromedex database were analyzed. The course of envenomation, medical management during exposition to venomous of Chondrichthyes and Osteichthyes, freshwater and marine fishes were resolved. Injuries caused by venoms fishes were similarly treated, usually symptomatic. Specific antivenoms are available only for two fish species. Each patient exposed to sting or bite should be examined and observed. If characteristic sings and symptoms of envenomation are present, proper medical management should be proceed. PMID:19788131
Bar-Cohen, Y.; Siegel, R.; Grandia, W.
In parallel to the industrial application of NDE to flaw detection and material property determination, the medical community has succesfully adapted such methods to the noninvasaive diagnostics and treatment of many conditions and disorders of the human body.
Chapman, M. J.
At this point in our settlement of the planet Earth, with over seven billion human inhabitants, there are very few unallocated sources of fresh water. We are turning slowly toward "alternatives" such as municipal and industrial wastewater, saline groundwater, the sea, irrigation return flow, and produced water that comes up with oil and gas deposits from deep beneath the surface of the earth. Slowly turning, not because of a lack in technological ability, but because it takes a large capital investment to acquire and treat these sources to a level at which they can be used. The regulatory system is not geared up for alternative sources and treatment processes. Permitting can be circular, contradictory, time consuming, and very expensive. The purpose for the water, or the value of the product obtained using the water, must be such that the capital and ongoing expense seem reasonable. There are so many technological solutions for recovering water quality that choosing the most reliable, economical, and environmentally sound technology involves unraveling the "best" weave of treatment processes from a tangled knot of alternatives. Aside from permitting issues, which are beyond the topic for this presentation, the "best" weave of processes will be composed of four strands specifically fitted to the local situation: energy, pretreatment, driving force for separation processes, and waste management. A range of treatment technologies will be examined in this presentation with a focus on how the quality of the feed water, available power sources, materials, and waste management opportunities aid in choosing the best weave of treatment technologies, and how innovative use of a wide variety of driving forces are increasing the efficiency of treatment processes.
Lobel, B; Cipolla, B; Labrador, J
Hormone dependence of prostate cancer is well known. In 80% of cases with metastases, hormone suppression leads to the reduction of tumour volume and related disorders. However the treatment is generally palliative because malignant process recurs after about around 16 months. Mean survival is less than 3 years in these forms. Lack of response come always together with a poor prognosis, and there is 90% mortality at 2 years. Advanced prostatic cancer should not be treated with hormones if the patient has few symptoms and his quality of life is satisfactory. Symptomatic forms require hormone manipulation. Orchidectomy or LH-RH are recommended. Total androgen ablation (combined treatment) leads rapidly to more relief of symptoms, but its drawbacks and especially high cost indicate that its use should be weighed individually. Estramustine is not a first-lune treatment. Presently, there is no criteria to predict response to treatment. PMID:8066398
Yuvanc, Ercan; Yilmaz, Erdal; Tuglu, Devrim; Batislam, Ertan
Nephrolithiasis is a serious problem for both patients and the health system. Recurrence stands out as a significant problem in urinary system stone disease, the prevalence of which is increasing gradually. If recurrence is not prevented, patients may go through recurrent operations due to nephrolithiasis. While classical therapeutic options are available for all stone types, the number of randomized controlled studies and extensive meta-analyses focusing on their efficiency are inadequate. Various alternative therapeutic options to these medical therapies also stand out in recent years. The etiology of urolithiasis is multifactorial and not always related to nutritional factors. Nutrition therapy seems to be useful, either along with pharmacological therapy or as a monotherapy. General nutrition guidelines are useful in promoting public health and developing nutrition plans that reduce the risk or attenuate the effects of diseases affected by nutrition. Nutrition therapy involves the evaluation of a patient’s nutritional state and intake, the diagnosis of nutrition risk factors, and the organization and application of a nutrition program. The main target is the reduction or prevention of calculus formation and growth via decreasing lithogenic risk factors and increasing lithogenic inhibitors in urine. This review focuses briefly on classical medical therapy, along with alternative options, related diets, and medical expulsive therapy. PMID:26558186
Hanlon, Joseph T.; Semla, Todd P.; Schmader, Kenneth E.
The National Committee for Quality Assurance (NCQA) and the Pharmacy Quality Alliance (PQA) use the American Geriatrics Society (AGS) Beers Criteria to designate the quality measure Use of High-Risk Medications in the Elderly (HRM). The Centers for Medicare and Medicaid Services (CMS) use the HRM measure to monitor and evaluate the quality of care provided to Medicare beneficiaries. NCQA additionally uses the AGS Beers Criteria to designate the quality measure Potentially Harmful Drug–Disease Interactions in the Elderly. Medications included in these measures may be harmful to elderly adults, negatively affect a health care plan’s quality ratings, and be denied as a health care plan drug benefit. Prescribers, pharmacists, patients, and health care plans may benefit from evidence-based alternative medication treatments to avoid these problems. Therefore the goal of this work was to develop a list of alternative medications to those included in the two measures. The authors conducted a comprehensive literature review for 2000 to 2014 and a search of their personal files. From the evidence, they prepared a list of drug-therapy alternatives with supporting references. A reference list of non-pharmacological approaches was also provided when appropriate. NCQA, PQA, the 2015 AGS Beers Criteria panel, and the Executive Committee of the AGS reviewed the drug therapy alternatives and nonpharmacological approaches. Recommendations by these groups were incorporated into the final list of alternatives. The final product of drug-therapy alternatives to medications included in the two quality measures and some nonpharmacological resources will be useful to health professionals, consumers, payers, and health systems that care for older adults. PMID:26447889
Rajput, Ali H; Rajput, Alex
Essential tremor (ET) is the most common pathological tremor characterized by upper limb action—postural tremor (PT)/kinetic tremor (KT). There are no specific neuropathological or biochemical abnormalities in ET. The disability is consequent to amplitude of KT, which may remain mild without handicap or may become disabling. The most effective drugs for sustained tremor control are propranolol and primidone. Symptomatic drug treatment must be individualized depending on the circumstances that provoke the tremor-related disability. Broad guidelines for treatment are discussed in this review. Patients may be treated intermittently only on stressful occasions with propranolol, clonazepam, or primidone monotherapy, or an alcoholic drink. Those with persistently disabling tremor need continued treatment. PMID:24812533
Sieben, Robert L.
The author presents a critical review of popular medical treatments for children with learning disabilities, including dietary treatment (food additives theories, brain allergies, hypoglycemia, megavitamin therapy, and trace mineral tests) and neurophysiologic retraining (patterning, sensory integrative therapy, and optometric training). (IM)
Panzuto, F; Nasoni, S; Delle Fave, G
Surgery is the only therapy able to cure patients with digestive neuroendocrine tumor. However, due to the presence of diffuse metastases, radical surgery is often not feasible. In these cases, medical treatment plays a critical role, because of its ability to control symptoms in functioning tumors and to inhibit tumor growth. Different therapeutic approaches, such as chemotherapy, hepatic artery chemoembolization and targeted radio-nuclide therapy can be used alone or combined to the biologic treatment with somatostatin analogues and interferon. However, an accurate staging by imaging procedures plus a histological, immunohistochemical and biomolecular examination must be performed before planning an optimal medical treatment. PMID:11753237
Robinson, Cassandra L.
Psychopharmacological treatment has been the mainstay in long-term maintenance of bipolar disorder (BD) patients for the last 60 years. Conventionally accepted treatment options are primarily based on expert opinion rather than on well-executed, independently funded research. Investigation of maintaining patients without medications using treatment alternatives has been neglected. This clinical case series examines the outcomes of 7 BD patients who experienced a poor response or significant side effects with conventional treatment modalities. Patients were gradually and safely withdrawn from all medications. Treatment strategies were based on an individualized holistic approach using herbs, nutritional supplements, vitamins, amino acids, acupuncture, dietary recommendations, and behavioral modifications. Multiple treatment modalities were combined addressing the etiological causes for BD symptoms. Upon withdrawal from psychotropic medications, patients were free of medication-induced side effects and obtained psychiatric stability for at least 10 months. Further research is needed to investigate the long-term outcomes of BD treatment modalities based on well-defined successful outcome criteria, such as reduction in symptoms, improvement in quality of life, overall health outcomes, and cost effectiveness. PMID:25984407
The diagnosis of ankylosing spondylitis is often delayed due to ambiguous clinical manifestations and strict diagnostic criteria. However, imaging techniques such as magnetic resonance imaging have been found effective for the early diagnosis of non-radiographic sacroiliitis. New tumor necrosis factor alpha (TNF-α) inhibitors have good efficacy for patients with persistently high disease activity despite conventional nonsteroidal anti-inflammatory drug treatment. Thus, early diagnosis and aggressive treatments are essential for ankylosing spondylitis patients. Because many patients complain of musculoskeletal pains, especially around the sacroiliac joint area, hip specialists should be informed of up-to-date knowledge. In this review, we discuss new diagnostic criteria for ankylosing spondylitis, administration methods of TNF-α inhibitors, and the long-term follow-up results for patients treated with TNF-α inhibitors.
Akol, Achier D; Weeks, Andrew D
The standard treatment for retained placenta is manual removal whatever its subtype (adherens, trapped or partial accreta). Although medical treatment should reduce the risk of anesthetic and surgical complications, they have not been found to be effective. This may be due to the contrasting uterotonic needs of the different underlying pathologies. In placenta adherens, oxytocics have been used to contract the retro-placental myometrium. However, if injected locally through the umbilical vein, they bypass the myometrium and perfuse directly into the venous system. Intravenous injection is an alternative but exacerbates a trapped placenta. Conversely, for trapped placentas, a relaxant could help by resolving cervical constriction, but would worsen the situation for placenta adherens. This confusion over medical treatment will continue unless we can find a way to diagnose the underlying pathology. This will allow us to stop treating the retained placenta as a single entity and to deliver targeted treatments. PMID:26765548
Ibrahim, Joseph E; Ranson, David L; O'Brien, Adam; Charles, Amanda; Young, Carmel
Patients suffer preventable harm from their medical treatment. The traditional approaches to investigating medical treatment related deaths are the 'hospital mortality audit' and legal or coroners investigation. The aim is to describe how the patient safety movement in the late 1990s is changing traditional approaches to the investigation. The prevention of medical treatment related death involves an investigation as one of five major stages. These are Stage I Preparedness; Stage II Recognition and reporting; Stage III Investigation and analysis; Stage IV Findings and recommendations; and Stage V Response. The influence of the patient safety approach is considered at each stage with a particular focus on Stage I. It is at this stage that the concepts of clinical governance, culture and systems of care have a major influence on the nature of an investigation. The genesis of the modern forensic investigation into medical treatment related deaths in Victoria, Australia is described. The formation of the Clinical Liaison Service incorporates concepts from the patient safety approach with clinical staff to transform the traditional Coroner's investigation. Benefits of a modern forensic investigation include improving appropriateness of cases proceeding to investigation and a focus on prevention. Achieving a reduction in medical treatment related death requires substantial shifts towards an approach consistent with the patient safety. PMID:19278889
Surgical removal of nasal polyps is associated with discomfort and risks for the patient, but is the treatment of choice to most otorhinolaryngologists. Medical treatment alone has been little investigated. In a prospective clinical trial surgical removal followed by continuous topical steroid treatment has been compared with a single dose of steroid deposit followed by continuous topical steroid treatment. During a study period of one year, expiratory nasal peak flow and sense of smell were monitored. In general, the course in the two groups was alike, with a tendency favouring the medically treated group. In another study the clinical efficacy of this medical regimen was further documented experimentally. By acoustic rhinometry the square area of the nasal passages was measured before and a few days after the injection of the steroid deposit. Increased volume was found, corresponding to the instant clinical improvement. It is concluded that primary treatment of nasal polyps should be medical. Surgery is only recommended in cases, resistant to medical therapy. PMID:2672276
Mahvi-Shirazi, Majid; Rasoolzade-Tabatabaei, Sayed-Kazem; Amini, Mohsen
Introduction The study aims to investigate two kinds of treatment in patients suffering from irritable bowel syndrome (IBS) and consequently compares its efficacy on improving the symptoms and mental health of patients; one with just medical treatment and another through a combination of psychotherapy and medical treatment. Material and methods Applying general sampling, 50 IBS patients were selected from among those who used to refer to a Gastroenterology Clinic. After physical and mental evaluations based on ROME-II scale and SCL-90-R questionnaires, the subjects were randomly superseded into: the control group with medical treatment and, the case group with a combination of medical and psychological treatments. The acquired data were then analyzed through t-test and Mann-Whitney U-test. Results The findings show that the mental health of patients receiving cognitive behavioral therapy along with the medical treatment was higher than those of the control group at post-test level. It was observed that the therapy reduces the disability caused by IBS. Comparatively, while the cognitive therapy and medical treatments cured 80% of the patients, those receiving cognitive therapy alone showed an extensive reduction of symptoms. Conclusions Considering the role of cognitive behavioral therapy, it is therefore recommend that such patients be managed by a combined team of gastroenterologists and psychologists. PMID:22457686
Li, I-Chuan; Kuo, Huai-Ting; Sin, Mo-Kyung; Liu, Chien-Ting
Older adults are at risk of problems of medication use including underuse, overuse, and misuse. The purposes of this study were to investigate the prevalence of the use of conventional and complementary and alternative medications (CAM) in older adults and to explore which factors related to their medication use. For this descriptive correlational study, 1,427 citizens who were 65 years old or older from two towns in Yilan County, Taiwan were interviewed by ten trained public health nurses between June and September, 2013. Instruments in this study were physical functional capacity, depressive symptoms, and medication use. Pearson product-moment correlation analysis and the Chi-square test were used to detect relationships among research variables. Of the 1,427 participants, 75.4 % used at least one type of conventional medication, and the average number of medications used was 2.9 (SD = 2.1). Polypharmacy (the use of five or more medications) was identified in 20.1 % of participants. Significant factors related to conventional medications use were older age (χ(2) = 41.7***), female (χ(2) = 7.6**), bad memory (χ(2) = 11.2**), defect cognition status (χ(2) = 7.8**), lost the interest to do anything depressive symptoms (χ(2) = 7.2**), and independent in their daily activities (χ(2) = 41.3***). We found that sociodemographic characteristics and factors pertaining to health status determine the difference between the use of conventional medications and CAM by rural older adults. Our study results suggested that health professionals in Taiwan must be educated and trained in how to integrate CAM into current conventional treatment. PMID:25120230
Seng, Elizabeth K; Rains, Jeanetta A; Nicholson, Robert A; Lipton, Richard B
Medication adherence is integral to successful treatment of migraine and other headache. The existing literature examining medication adherence in migraine is small, and the methodologies used to assess adherence are limited. However, these studies broadly suggest poor adherence to both acute and preventive migraine medications, with studies using more objective monitoring reporting lower adherence rates. Methods for improving medication adherence are described, including organizational strategies, provider-monitoring and self-monitoring of adherence, regimen strategies, patient education, self-management skills training (e.g., stimulus control, behavioral contracts), and cognitive-behavioral therapy techniques. The article concludes by discussing the future of research regarding adherence to medications for migraine and other headaches. PMID:26040703
Machtei, Eli E.
Peri-implant diseases are becoming a major health issue in dentistry. Despite the magnitude of this problem and the potential grave consequences, commonly acceptable treatment protocols are missing. Hence, the present paper reviews the literature treatment of peri-implantitis in order to explore their benefits and limitations. Treatment of peri-implantitis may include surgical and nonsurgical approaches, either individually or combined. Nonsurgical therapy is aimed at removing local irritants from the implants' surface with or without surface decontamination and possibly some additional adjunctive therapies agents or devices. Systemic antibiotics may also be incorporated. Surgical therapy is aimed at removing any residual subgingival deposits and additionally reducing the peri-implant pockets depth. This can be done alone or in conjunction with either osseous respective approach or regenerative approach. Finally, if all fails, explantation might be the best alternative in order to arrest the destruction of the osseous structure around the implant, thus preserving whatever is left in this site for future reconstruction. The available literature is still lacking with large heterogeneity in the clinical response thus suggesting possible underlying predisposing conditions that are not all clear to us. Therefore, at present time treatment of peri-implantitis should be considered possible but not necessarily predictable. PMID:26556414
Akın, Yiğit; Uçar, Murat; Yücel, Selçuk
Although the prevalence of urolithiasis is nearly 2–3% in childhood, the risk of recurrence may range from 6.5–54%. There has been an increase in urinary stone disease among pediatric age groups, and stone disease has a multifactorial etiology. After the diagnosis, detailed metabolic evaluation is required. High recurrence rates, therapeutic irregularities and deficiency in diagnosis may lead to comorbidities such as loss of kidney function. Following diagnosis, the requirement for surgery, such as stone extraction and correction of anatomical anomalies, is determined. Medical and supportive treatments are also needed to prevent recurrence and urinary tract infections and to preserve renal function. Supportive care includes increased fluid intake and dietary modifications. Medical treatment is dependent on the cause of the urinary stone disease. The morbidities associated with pediatric urolithiasis can be prevented by early diagnosis, detailed metabolic analysis, regular follow-up and medical treatment protocols. PMID:26328120
Fieni, F; Topie, E; Gogny, A
Pyometra is a reproductive disorder very common in bitches over 8 years of age in which physiological effects of progesterone on the uterus play a major role. The traditional therapy for pyometra is ovariohysterectomy. The main advantage of ovariohysterectomy over medical management is that it is both curative and preventive for recurrence of pyometra. However, surgery is associated with the risk of anaesthesia and renders the bitch sterile. During the last 10 years, numerous medical treatments have been proposed to treat both open and closed cervix pyometra. The most effective medical treatment with minor side effects seems to be the repeated administration of aglepristone with or without the additional treatment with low doses of prostaglandins. PMID:24947858
Lildholdt, T; Fogstrup, J; Gammelgaard, N; Kortholm, B; Ulsoe, C
A randomized comparison of the usual surgical removal of nasal polyps versus systemic steroid treatment was performed in 53 patients. In all, continuous topical steroid treatment was given during the one year period of observation. In both groups the initial treatment resulted in a continuous increase in mean nasal expiratory peak flow as well as in the sense of smell; these two parameters showed a temporary statistically significant difference in favour of the medically treated group. In general though, the results in the two treatment groups were alike. Therefore medical treatment is recommended for routine use. Surgical removal should be reserved for those few cases in which the presence of residual or recurrent polyps justifies the inherent risks and discomfort for the patient. PMID:3341154
López-Torres Hidalgo, Jesús; López Gallardo, Yolanda; Párraga Martínez, Ignacio; Del Campo Del Campo, José María; Villena Ferrer, Alejandro; Morena Rayo, Susana
This study sought to assess treatment satisfaction among patients on antidepressants, ascertaining whether there might be an association with depressive symptomatology and other variables. Cross-sectional study conducted on 564 adult patients taking antidepressant medication. Satisfaction with antidepressant treatment was assessed using the Assessment of Satisfaction with Antidepressant Treatment Questionnaire (ESTA/Evaluación de la Satisfacción con el Tratamiento Antidepresivo). A moderate negative correlation was observed between satisfaction and intensity of depressive symptoms, as assessed with the Montgomery-Asberg scale. A weak negative correlation was observed between greater satisfaction and less favourable views about taking medication. Satisfaction scale scores were higher among those who took antidepressant medication for 1 year or more versus shorter periods. Most patients reported being satisfied with the antidepressant treatment but the level of satisfaction was higher among those who presented with less marked depressive symptoms, received longer-term treatment and viewed drug treatments favourably. Treatment satisfaction is one of the patient-reported outcome measures that can serve to complement clinical evaluation of depressive disorders. PMID:25833726
... stop the progression of the disease and thereby prolong life. MEDICAL ANGINA TREATMENT — Medical treatment for coronary ... be recommended. Stenting has not been shown to prolong life compared with medical therapy. It is used ...
Ayala, Guadalupe; Escobedo-Hinojosa, Wendy Itzel; de la Cruz-Herrera, Carlos Felipe; Romero, Irma
Helicobacter pylori (H. pylori) is a successful pathogen that can persist in the stomach of an infected person for their entire life. It provokes chronic gastric inflammation that leads to the development of serious gastric diseases such as peptic ulcers, gastric cancer and Mucosa associated lymphoid tissue lymphoma. It is known that these ailments can be avoided if the infection by the bacteria can be prevented or eradicated. Currently, numerous antibiotic-based therapies are available. However, these therapies have several inherent problems, including the appearance of resistance to the antibiotics used and associated adverse effects, the risk of re-infection and the high cost of antibiotic therapy. The delay in developing a vaccine to prevent or eradicate the infection has furthered research into new therapeutic approaches. This review summarises the most relevant recent studies on vaccine development and new treatments using natural resources such as plants, probiotics and nutraceuticals. In addition, novel alternatives based on microorganisms, peptides, polysaccharides, and intragastric violet light irradiation are presented. Alternative therapies have not been effective in eradicating the bacteria but have been shown to maintain low bacterial levels. Nevertheless, some of them are useful in preventing the adverse effects of antibiotics, modulating the immune response, gastroprotection, and the general promotion of health. Therefore, those agents can be used as adjuvants of allopathic anti-H. pylori eradication therapy. PMID:24587621
Ross, W.A.; Clark, L.L.; Oma, K.H.
This evaluation compared four alternatives for the treatment or processing of non-fuel bearing hardware (NFBH) to reduce its volume and prepare it for disposal. These treatment alternatives are: shredding; shredding and low pressure compaction; shredding and supercompaction; and melting. These alternatives are compared on the basis of system costs, waste form characteristics, and process considerations. The study recommends that melting and supercompaction alternatives be further considered and that additional testing be conducted for these two alternatives.
A portable medical status and treatment system is discussed. The vital signs monitor includes electrocardiogram, respiration, temperature, blood pressure, alarm, and power subsystems, which are described. A DC defibrillator module, a radio module, and their packaging are also described. These subsystems were evaluated and the results and recommendations are presented.
Marom, Tal; Marchisio, Paola; Tamir, Sharon Ovnat; Torretta, Sara; Gavriel, Haim; Esposito, Susanna
Abstract Otitis media (OM) has numerous presentations in children. Together with conventional medical therapies aimed to prevent and/or treat OM, a rising number of complementary and alternative medicine (CAM) treatment options can be offered. Since OM is common in children, parents may ask healthcare professionals about possible CAM therapies. Many physicians feel that their knowledge is limited regarding these therapies, and that they desire some information. Therefore, we conducted a literature review of CAM therapies for OM, taking into account that many of these treatments, their validity and efficacy and have not been scientifically demonstrated. We performed a search in MEDLINE (accessed via PubMed) using the following terms: “CAM” in conjunction with “OM” and “children. Retrieved publications regarding treatment of OM in children which included these terms included randomized controlled trials, prospective/retrospective studies, and case studies. The following CAM options for OM treatment in children were considered: acupuncture, homeopathy, herbal medicine/phytotherapy, osteopathy, chiropractic, xylitol, ear candling, vitamin D supplement, and systemic and topical probiotics. We reviewed each treatment and described the level of scientific evidence of the relevant publications. The therapeutic approaches commonly associated with CAM are usually conservative, and do not include drugs or surgery. Currently, CAM is not considered by physicians a potential treatment of OM, as there is limited supporting evidence. Further studies are warranted in order to evaluate the potential value of CAM therapies for OM. PMID:26871802
Kahn, Robert B.; And Others
In May, 1974, Fresno County's Narcotic Abuse Treatment Program began a twenty-one-day outpatient methadone detoxification treatment modality. The results of the evaluation suggested an alternative treatment modality. The purpose of this paper is to examine this alternative treatment modality, its characteristics, its therapeutic outcomes and the…
Levy, Susan E.; Hyman, Susan L.
This article reviews common complementary or alternative medicine (CAM) treatments used to address symptoms of autistic spectrum disorders, including vitamin supplements, medications, antibiotics, antifungals, diet strategies, chelation/mercury detoxification, and nonbiologic treatments. Strategies that professionals may use in assessing the…
Liakakos, Theodore; Karamanolis, George; Patapis, Paul; Misiakos, Evangelos P.
Background. Gastroesophageal reflux disease is a common condition with increasing prevalence worldwide. The disease encompasses a broad spectrum of clinical symptoms and disorders from simple heartburn without esophagitis to erosive esophagitis with severe complications, such as esophageal strictures and intestinal metaplasia. Diagnosis is based mainly on ambulatory esophageal pH testing and endoscopy. There has been a long-standing debate about the best treatment approach for this troublesome disease. Methods and Results. Medical treatment with PPIs has an excellent efficacy in reversing the symptoms of GERD, but they should be taken for life, and long-term side effects do exist. However, patients who desire a permanent cure and have severe complications or cannot tolerate long-term treatment with PPIs are candidates for surgical treatment. Laparoscopic antireflux surgery achieves a significant symptom control, increased patient satisfaction, and complete withdrawal of antireflux medications, in the majority of patients. Conclusion. Surgical treatment should be reserved mainly for young patients seeking permanent results. However, the choice of the treatment schedule should be individualized for every patient. It is up to the patient, the physician and the surgeon to decide the best treatment option for individual cases. PMID:20069112
... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Medical treatment, care... Certain New Pension Recipients Medical and Related Services § 21.6240 Medical treatment, care and services... be furnished medical treatment, care and services which VA determines are necessary to develop,...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Medical treatment, care... Certain New Pension Recipients Medical and Related Services § 21.6240 Medical treatment, care and services... be furnished medical treatment, care and services which VA determines are necessary to develop,...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Medical treatment, care... 38 U.S.C. Chapter 31 Medical and Related Services § 21.240 Medical treatment, care and services. (a) General. A Chapter 31 participant shall be furnished medical treatment, care and services which...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Medical treatment, care... 38 U.S.C. Chapter 31 Medical and Related Services § 21.240 Medical treatment, care and services. (a) General. A Chapter 31 participant shall be furnished medical treatment, care and services which...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Medical treatment, care... 38 U.S.C. Chapter 31 Medical and Related Services § 21.240 Medical treatment, care and services. (a) General. A Chapter 31 participant shall be furnished medical treatment, care and services which...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Medical treatment, care... 38 U.S.C. Chapter 31 Medical and Related Services § 21.240 Medical treatment, care and services. (a) General. A Chapter 31 participant shall be furnished medical treatment, care and services which...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Medical treatment, care... Certain New Pension Recipients Medical and Related Services § 21.6240 Medical treatment, care and services... be furnished medical treatment, care and services which VA determines are necessary to develop,...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Medical treatment, care... Certain New Pension Recipients Medical and Related Services § 21.6240 Medical treatment, care and services... be furnished medical treatment, care and services which VA determines are necessary to develop,...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Medical treatment, care... 38 U.S.C. Chapter 31 Medical and Related Services § 21.240 Medical treatment, care and services. (a) General. A Chapter 31 participant shall be furnished medical treatment, care and services which...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Medical treatment, care... Certain New Pension Recipients Medical and Related Services § 21.6240 Medical treatment, care and services... be furnished medical treatment, care and services which VA determines are necessary to develop,...
Wentzell, Emily; Salmerón, Jorge
The pharmaceutically focused clinical and epidemiological literature on erectile dysfunction (ED) treatment has paid little attention to men's non-medical responses to changing erectile function. This study explores the relationship of erectile function change, resulting use of medical or alternative treatments, and Mexican men's understandings of masculinity and aging, through a mixed method approach utilizing both quantitative survey and ethnographic interview data. A survey of 750 men undertaken at the Instituto Méxicano del Seguro Social hospital in Cuernavaca, Mexico in April to June 2008 showed that only about half of those who experienced erectile function changes sought treatment for these changes; treatment users were far more likely to seek alternative treatment than medical treatment, especially preferring lifestyle change and vitamins. Ethnographic data from interviews with 250 male urology patients undertaken from October 2007 to August 2008 at the same site reveal that treatment users' preferences were linked to fears about the safety and situational inappropriateness of medical ED treatment. These findings suggest that by focusing on patients' use of pharmaceuticals, biomedically oriented research has overlooked the most common responses to changing erectile function. Broadening the focus of ED treatment research to include analysis of men's rejection of pharmaceutical treatment - either in favor of alternative treatment, or because they do not see their erectile function changes as requiring medical intervention - would correct this imbalance in the literature. Further, the knowledge that even men who seek treatment may prefer alternatives to pharmaceutical interventions will help physicians to offer treatments, such as lifestyle change, that their patients might find more acceptable. Such measures would simultaneously help to mitigate the chronic illnesses, like diabetes and hypertension, which frequently co-occur with diminished erectile function
Pandian, Jeyaraj Durai; Liu, Ming; Misbach, Jusuf; Venketasubramanian, N
Patients seek alternative therapies for stroke in Asia due to dissatisfaction with poststroke recovery. Most alternative therapies are of unproven benefit in rehabilitation. Well-conducted trials are needed to better define the role of alternative therapies in the process of poststroke recovery; the CHInese Medicine Neuroaid Efficacy on Stroke recovery is ongoing. However, further studies, better health education and rehabilitation services and centers are also required. PMID:22111799
Weber, Wendy; Newmark, Sanford
Complementary and alternative medical (CAM) therapies are commonly used by parents for their children who have attention deficit hyperactivity disorder (ADHD) or autism spectrum disorders. The use of these therapies is well documented, yet the evidence of the safety and efficacy of these treatments in children is limited. This article describes the current evidence-based CAM therapies for ADHD and autism, focusing on nutritional interventions; natural health products, including essential fatty acids, vitamins, minerals, and other health supplements; biofeedback; and reducing environmental toxins. The CAM evidence in ADHD is addressed, as is the CAM literature in autism. PMID:18061787
This report addresses the economics of wastewater treatment alternatives as a guide for minimizing the costs of meeting water pollution control requirements. Initially, operating and investment costs are presented for conventional wastewater treatment systems employed by the elec...
Thaipisuttikul, Papan; Galvin, James E
SUMMARY Alzheimer’s disease, the most common cause of dementia, has a high global economic impact. To date, there is no curative treatment; therefore, many efforts are directed not only at novel potential disease-modifying treatments and interventions, but also to develop alternative symptomatic and supportive treatments. Examples of these efforts include the medical foods. There are three medical foods that claim to offer symptomatic benefits: Axona®, Souvenaid® and CerefolinNAC®. Axona supplies ketone bodies as alternative energy source to neurons. Souvenaid provides precursors thought to enhance synaptic function. CerefolinNAC addresses the role of oxidative stress related to memory loss. The current scientific evidence on these medical foods is reviewed in this article. Furthermore, we also review the concept and evidence supporting use of the Mediterranean diet, a possible alternative to medical foods that, if implemented correctly, may have lower costs, fewer side effects and stronger epidemiological health outcomes. PMID:23362453
Thaipisuttikul, Papan; Galvin, James E
Alzheimer's disease, the most common cause of dementia, has a high global economic impact. To date, there is no curative treatment; therefore, many efforts are directed not only at novel potential disease-modifying treatments and interventions, but also to develop alternative symptomatic and supportive treatments. Examples of these efforts include the medical foods. There are three medical foods that claim to offer symptomatic benefits: Axona(®), Souvenaid(®) and CerefolinNAC(®). Axona supplies ketone bodies as alternative energy source to neurons. Souvenaid provides precursors thought to enhance synaptic function. CerefolinNAC addresses the role of oxidative stress related to memory loss. The current scientific evidence on these medical foods is reviewed in this article. Furthermore, we also review the concept and evidence supporting use of the Mediterranean diet, a possible alternative to medical foods that, if implemented correctly, may have lower costs, fewer side effects and stronger epidemiological health outcomes. PMID:23362453
... medication. 549.43 Section 549.43 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT MEDICAL SERVICES Administrative Safeguards for Psychiatric Treatment and Medication § 549.43 Involuntary psychiatric treatment and medication. Title 18 U.S.C. 4241-4247 and federal...
Botha, John; Tiruvoipati, Ravindranath; Goldberg, David
Intensive care provides support for acute reversible organ failure and most patients who receive intensive care recover from their illness. In some patients organ failure may become irreversible and in these patients further treatment or organ support may be considered futile. Emerging technologies and expertise can enable the medical profession to prolong life / death indefinitely without curing or controlling the underlying disease process. Introduction of ultramodern organ supports such as extracorporeal life-support systems, ventricular assist devices and organ transplantation surgeries have introduced some degree of ambiguity in defining futility of care. Furthermore medico legal implications of futility of care introduce further complexities in defining and instituting futile treatments. In this review we discuss the evolution of the concept of futility of care, review the various meanings of the term "futility of care", explore the complexities of management when care is considered futile, offer suggestions as to how such patients and their families could be managed. We also review the legal framework when consensus is not achieved. PMID:24157992
Wiley-Exley, Elizabeth K; Mielenz, Thelma J; Norton, Edward C; Callahan, Leigh F
Medical skepticism is the reservation about the ability of conventional medical care to significantly improve health. Individuals with musculoskeletal disorders seeing specialists usually experience higher levels of disability; therefore it is expected they might be more skeptical of current treatment and thus more likely to try Complementary and Alternative Medicine (CAM). The goal of this study was to define these relationships. These data were drawn from a cross-sectional survey from two cohorts: those seeing specialists (n=1,344) and non-specialists (n=724). Site-level fixed effects logistic regression models were used to test associations between medical skepticism and 10 CAM use categories. Some form of CAM was used by 88% of the sample. Increased skepticism was associated with one CAM category for the non-specialist group and six categories for the specialist group. Increased medical skepticism is associated with CAM use, but medical skepticism is more often associated with CAM use for those seeing specialists. PMID:19088894
Ozsu, Savas; Cinarka, Halit
Chronic thromboembolic pulmonary hypertension (CTEPH) is responsible for significant levels of morbidity and mortality. The estimated cumulative incidence of CTEPH is 2-4% among patients presenting with acute pulmonary thromboembolism. Currently, at the time of CTEPH diagnosis, 37.9% of the patients in an international registry were receiving at least one pulmonary arterial hypertension (PAH)-targeted therapy. Advanced medical therapy is considered in patients with inoperable disease, as a bridge to pulmonary endarterectomy or in those with persistent or recurrent pulmonary hypertension. PAH-specific medical therapies include endothelin receptor antagonists, phosphodiesterase inhibitors, and prostacyclin analogues. The present article will focus on recent developments in the pharmacological treatment of CTEPH. PMID:24015333
Rey, Joseph M.; Walter, Garry; Soh, Nerissa
Children and adolescents often use complementary and alternative medicine (CAM) treatments outside their indications, particularly to lose weight. Some of the herbal remedies and dietary supplements that may of relevance for psychopharmacological practice are discussed with respect to CAM treatments.
Under current Federal regulations (40 CFR 503), municipal sludge must be treated prior to land application. The regulations identify two classes of treatment with respect to pathogen reduction: Class B (three alternatives) which provides a minimum acceptable level of treatment;...
Bedford, Linda; Hybertson, Larry D.
Describes the Treatment Alternatives Project (TAP) which provides caseworker aid and supportive services that allow problem children to undergo treatment while remaining in their own homes or foster homes. (SDH)
... 20 Employees' Benefits 1 2014-04-01 2012-04-01 true Furnishing of medical treatment. 61.204..., Disability or Death § 61.204 Furnishing of medical treatment. All medical services, appliances, drugs and supplies which in the opinion of the Office are necessary for the treatment of an injury coming within...
... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Furnishing of medical treatment. 61.204..., Disability or Death § 61.204 Furnishing of medical treatment. All medical services, appliances, drugs and supplies which in the opinion of the Office are necessary for the treatment of an injury coming within...
Levy, Susan E; Hyman, Susan L
There are many treatments in current use for core and associated symptoms of autism spectrum disorders (ASD). This review discusses the complementary and alternative medical (CAM) treatments commonly added to conventional interventions for children with ASD, including natural products, mind and body practices, and other biomedical treatments. The article focuses on factors associated with use of CAM, the empirical evidence for the most frequently used treatments, and how clinicians work with families who choose CAM treatments. Some treatments have been ineffective, some have unacceptable potential side effects, and others require more study in depth. PMID:25455579
In 1977, the Supreme Judicial Court of Massachusetts held in the Saikewicz case that the probate court is the proper tribunal for making decisions whether to give or withhold "life-prolonging treatment" for terminally ill incompetent patients. This ruling provoked debate in the medical and legal communities. Dr. Arnold Relman, Editor of The New England Journal of Medicine, argues that Saikewicz encroaches on existing sound medical practice and requires decision-making machinery that is impractical and inhumane. Relman contends that treatment decision for terminally ill incompetents in Saikewicz-type cases should be made by the physician in consultation with the patient's family. Law professor Charles Baron, in contrast, defends Saikewicz's judicialization approach, arguing that such decision must bemade in an adversary framework that approximates the ideal of the rule of law. In the present Article, Professor Buchanan argues that Relman's criticism of Saikewicz rests on a defective, medical paternalist view of the physician-patient relationship, and that Baron's support of Saikewicz is based on an unjustifiable, legal imperalist view of decision making for incompetents. In Buchanan's view, Relman's approach fails to distinguish appropriately between the making of medical judgments and the making of moral judgments and wrongly assumes that the patient's family typically cannot understand the elements of the decision, while Baron's approach unjustifiably extends the sphere of the legal process by ignoring the special moral relationship that usually exists between the family and its incompetent member. Buchanan proposes an alternative decision-making approach that he believes incorporates the merits, while remedying the defects, of both Baron's and Relman's approaches. The alternative is based on three propositions. (1) The proper presumption in Saikewicz-type cases is that the family of an incompetent is to make decisions concerning treatment. (2) This presumption of
Yamauchi, Mika; Sugimoto, Toshitsugu
Although various osteoporosis medications have become available with proven effects for protecting against bone fracture, such osteoporosis treatment is only given to 20 to 25% of those eligible in Japan. The most urgent task at present is to increase the treatment rate. The guidelines for prevention and treatment of osteoporosis were revised in 2015 and now include criteria for commencing medical treatment. However, guidelines for management of osteoporosis, including the duration of medical treatment for osteoporosis, are still under discussion. PMID:26529921
Greef, Basma; Eisen, Tim
Renal cell carcinoma (RCC) makes up 2-3% of adult cancers. The introduction of tyrosine kinase inhibitors (TKIs) and mammalian target of rapamycin inhibitors in the mid-2000s radically changed the management of RCC. These targeted treatments superseded immunotherapy with interleukin-2 and interferon. The pendulum now appears to be shifting back towards immunotherapy, with the evidence of prolonged overall survival of patients with metastatic RCC on treatment with the anti-programmed cell death 1 ligand monoclonal antibody, nivolumab. Clinical prognostic criteria aid prediction of relapse risk for resected localised disease. Unfortunately, for patients at high risk of relapse, no adjuvant treatment has yet shown benefit, although further trials are yet to report. Clinical prognostic models also have a role in the management of advanced disease; now there is a pressing need for predictive biomarkers to direct therapy. Treatment selection for metastatic disease is currently based on histology, prognostic group and patient preference based on side effect profile. In this article, we review the current medical and surgical management of localised, oligometastatic and advanced RCC, including side effect management and the evidence base for management of poor-risk and non-clear cell disease. We discuss recent results from clinical trials and how these are likely to shape future practice and a renaissance of immunotherapy for renal cell cancer. PMID:27490806
Greef, Basma; Eisen, Tim
Renal cell carcinoma (RCC) makes up 2–3% of adult cancers. The introduction of tyrosine kinase inhibitors (TKIs) and mammalian target of rapamycin inhibitors in the mid-2000s radically changed the management of RCC. These targeted treatments superseded immunotherapy with interleukin-2 and interferon. The pendulum now appears to be shifting back towards immunotherapy, with the evidence of prolonged overall survival of patients with metastatic RCC on treatment with the anti-programmed cell death 1 ligand monoclonal antibody, nivolumab. Clinical prognostic criteria aid prediction of relapse risk for resected localised disease. Unfortunately, for patients at high risk of relapse, no adjuvant treatment has yet shown benefit, although further trials are yet to report. Clinical prognostic models also have a role in the management of advanced disease; now there is a pressing need for predictive biomarkers to direct therapy. Treatment selection for metastatic disease is currently based on histology, prognostic group and patient preference based on side effect profile. In this article, we review the current medical and surgical management of localised, oligometastatic and advanced RCC, including side effect management and the evidence base for management of poor-risk and non-clear cell disease. We discuss recent results from clinical trials and how these are likely to shape future practice and a renaissance of immunotherapy for renal cell cancer. PMID:27490806
Dong, Jie; Cui, Yanhua; Li, Song; Le, Weidong
Over the decades, pharmaceutical treatments, particularly dopaminergic (DAergic) drugs have been considered as the main therapy against motor symptoms of Parkinson's disease (PD). It is proposed that DAergic drugs in combination with other medications, such as monoamine oxidase type B inhibitors, catechol-O-methyl transferase inhibitors, anticholinergics and other newly developed non-DAergic drugs can make a better control of motor symptoms or alleviate levodopa-induced motor complications. Moreover, non-motor symptoms of PD, such as cognitive, neuropsychiatric, sleep, autonomic and sensory disturbances caused by intrinsic PD pathology or drug-induced side effects, are gaining increasing attention and urgently need to be taken care of due to their impact on quality of life. Currently, neuroprotective therapies have been investigated extensively in pre-clinical studies, and some of them have been subjected to clinical trials. Furthermore, non-pharmaceutical treatments, including deep brain stimulation (DBS), gene therapy, cell replacement therapy and some complementary managements, such as Tai chi, Yoga, traditional herbs and molecular targeted therapies have also been considered as effective alternative therapies to classical pharmaceutics. This review will provide us updated information regarding the current drugs and non-drugs therapies for PD. PMID:26585523
Atchley, Megan Danielle; Shah, Nima M.
The diagnosis and treatment of interstitial cystitis/bladder pain syndrome (IC/BPS) has shifted from organ-specific to a multifactorial, multidisciplinary and individualized approach. Patients with refractory and debilitating symptoms may respond to complementary and alternative medical treatments (CAM). Through CAM therapies, practitioners assist the patient to be at the center of their care, empowering them to be emotionally and physically involved. Multi-disciplinary care, including urology, gynecology, gastroenterology, neurology, psychology, physiotherapy and pain medicine, is also identified to be the crux of adequate management of patients with chronic pelvic pain because of its variable etiology. The purpose of this review is to emphasize these changes and discuss management strategies. PMID:26816868
During a one-yr study at Jefferson Parish, La., the chemical, microbiological, and mutagenic effects os using the major drinkgin water disinfectants (chlorine, chlorine dioxide, chloramine, ozone) were evaluated. Tests were performed on samples collected from various treatment s...
... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Medical treatment following release. 301... INMATE ACCIDENT COMPENSATION Compensation for Work-Related Physical Impairment or Death § 301.317 Medical treatment following release. Federal Prison lndustries, Inc., may not pay the cost of medical,...
... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false Furnishing of medical treatment. 61.204..., Disability or Death § 61.204 Furnishing of medical treatment. All medical services, appliances, drugs and... the same manner and under the same regulations, as are prescribed for the furnishing of...
... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Medical treatment following release. 301... INMATE ACCIDENT COMPENSATION Compensation for Work-Related Physical Impairment or Death § 301.317 Medical treatment following release. Federal Prison lndustries, Inc., may not pay the cost of medical,...
... 20 Employees' Benefits 1 2012-04-01 2012-04-01 false Furnishing of medical treatment. 61.204..., Disability or Death § 61.204 Furnishing of medical treatment. All medical services, appliances, drugs and... the same manner and under the same regulations, as are prescribed for the furnishing of...
... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Medical treatment following release. 301... INMATE ACCIDENT COMPENSATION Compensation for Work-Related Physical Impairment or Death § 301.317 Medical treatment following release. Federal Prison lndustries, Inc., may not pay the cost of medical,...
... 20 Employees' Benefits 1 2013-04-01 2012-04-01 true Furnishing of medical treatment. 61.204..., Disability or Death § 61.204 Furnishing of medical treatment. All medical services, appliances, drugs and... the same manner and under the same regulations, as are prescribed for the furnishing of...
Kahn, Robert B.; And Others
In May 1974, Fresno County's Narcotic Abuse Treatment Program began a 21-day outpatient methadone detoxification treatment modality. The purpose of this paper is to examine this alternative treatment modality, its characteristics, its therapeutic outcomes and the rationale for its use. (Author)
Alternatives to antibiotics in animal agriculture are urgently needed but present a complex problem because of their various uses: disease treatment, disease prevention, and feed efficiency improvement. Numerous antibiotic alternatives, such as feed amended with pre- and probiotics, have been propos...
This report was prepared as an issue paper for the EPA Engineering Forum, summarizes experiences with proven aboveground treatment alternatives for arsenic in groundwater, and provides information on their relative performance and cost. The four technologies reviewed are: preci...
Maria-Engler, S S; Mares-Guia, M; Correa, M L; Oliveira, E M; Aita, C A; Krogh, K; Genzini, T; Miranda, M P; Ribeiro, M; Vilela, L; Noronha, I L; Eliaschewitz, F G; Sogayar, M C
In the 70's, pancreatic islet transplantation arose as an attractive alternative to restore normoglycemia; however, the scarcity of donors and difficulties with allotransplants, even under immunosuppressive treatment, greatly hampered the use of this alternative. Several materials and devices have been developed to circumvent the problem of islet rejection by the recipient, but, so far, none has proved to be totally effective. A major barrier to transpose is the highly organized islet architecture and its physical and chemical setting in the pancreatic parenchyma. In order to tackle this problem, we assembled a multidisciplinary team that has been working towards setting up the Human Pancreatic Islets Unit at the Chemistry Institute of the University of São Paulo, to collect and process pancreas from human donors, upon consent, in order to produce purified, viable and functional islets to be used in transplants. Collaboration with the private enterprise has allowed access to the latest developed biomaterials for islet encapsulation and immunoisolation. Reasoning that the natural islet microenvironment should be mimicked for optimum viability and function, we set out to isolate extracellular matrix components from human pancreas, not only for analytical purposes, but also to be used as supplementary components of encapsulating materials. A protocol was designed to routinely culture different pancreatic tissues (islets, parenchyma and ducts) in the presence of several pancreatic extracellular matrix components and peptide growth factors to enrich the beta cell population in vitro before transplantation into patients. In addition to representing a therapeutic promise, this initiative is an example of productive partnership between the medical and scientific sectors of the university and private enterprises. PMID:11378656
Arndt, G. Dickey (Inventor); Ngo, Phong H. (Inventor); Carl, James R. (Inventor); George, W. Rflfoul (Inventor)
Methods, simulations, and apparatus are provided that may be utilized for medical treatments which are especially suitable for treatment of benign prostatic hyperplasia (BPH). In a preferred embodiment, a plurality of separate microwave antennas are utilized to heat prostatic tissue to promote necrosing of the prostatic tissue that relieves the pressure of the prostatic tissue against the urethra as the body reabsorbs the necrosed or dead tissue. By utilizing constructive and destructive interference of the microwave transmission, the energy can be deposited on the tissues to be necrosed while protecting other tissues such as the urethra. Saline injections to alter the conductivity of the tissues may also be used to further focus the energy deposits. A computer simulation is Provided that can be used to Predict the resulting temperature profile produced in the prostatic tissue. By changing the various control features of one or more catheters and the methods of applying microwave energy, a temperature profile can be predicted and produced that is similar to the temperature profile desired for the particular patient.
Niesel, T; Moore, R G; Hofmann, R; Kavoussi, L R
Advances in endoscopic instrumentation and techniques offer new alternatives for safe and effective treatment of urethral strictures. Visual internal urethrotomy, the standard treatment modality, is associated with new scar formation with stricture recurrence. This experience has led to the investigation of alternative techniques which would avoid or ameliorate this result. This article reviews the current literature and discusses these newer approaches, including balloon dilatation, laser urethrotomy, endoscopic urethroplasty, "cut to the light" and "core through" procedures, and urethral wallstent implantation. PMID:9540185
Ralevski, Elizabeth; Olivera-Figueroa, Lening A; Petrakis, Ismene
Background Although posttraumatic stress disorder (PTSD) and alcohol use disorders (AUD) frequently co-occur there are no specific treatments for individuals diagnosed with these comorbid conditions. The main objectives of this paper are to review the literature on pharmacological options for PTSD and comorbid AUD, and to summarize promising behavioral and alternative interventions for those with these dual diagnoses. Methods We conducted a comprehensive search on PsycINFO and MEDLINE/PubMed databases using Medical Subject Headings terms in various combinations to identify articles that used pharmacotherapy for individuals with dual diagnoses of PTSD and AUD. Similar strategies were used to identify articles on behavioral and alternative treatments for AUD and PTSD. We identified and reviewed six studies that tested pharmacological treatments for patients with PTSD and comorbid AUD. Results The literature on treatment with US Food and Drug Administration approved medications for patients with dual diagnosis of PTSD and AUD is very limited and inconclusive. Promising evidence indicates that topiramate and prazosin may be effective in reducing PTSD and AUD symptoms in individuals with comorbidity. Seeking safety has had mixed efficacy in clinical trials. The efficacy of other behavioral and alternative treatments (mindfulness-based, yoga, and acupuncture) is more difficult to evaluate since the evidence comes from small, single studies without comparison groups. Conclusion There is a clear need for more systematic and rigorous study of pharmacological, behavioral, and alternative treatments for patients with dual diagnoses of PTSD and AUD. PMID:24648794
... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Medical treatment following release. 301... treatment following release. Federal Prison lndustries, Inc., may not pay the cost of medical, hospital treatment, or any other related expense incurred after release from confinement unless such cost...
... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Medical treatment following release. 301... treatment following release. Federal Prison lndustries, Inc., may not pay the cost of medical, hospital treatment, or any other related expense incurred after release from confinement unless such cost...
... 33 Navigation and Navigable Waters 1 2014-07-01 2014-07-01 false Medical treatment and... GENERAL COAST GUARD AUXILIARY § 5.59 Medical treatment and hospitalization. When any member of the... other specific duty to which they have been assigned shall be entitled to the same hospital treatment...
Foster, Patricia H.; Whitworth, J. M.
Describes a program model, Medical Foster Care, which uses registered nurses as foster parents who work closely with biological parents of abused and neglected children with acute health problems. The program reunites families, improves parenting skills, and saves money in long-term hospitalization. (Author/BB)
Winnick, Terri A
Consumers, health care financing, external and internal competition are factors identified in the medical literature as prompting change within medicine. I test these factors to determine if they also prompt regular doctors to define themselves as 'holistic MDs' and align themselves with complementary and alternative medicine (CAM). State-level regression analyses on the number of MDs advertising in referral directories for CAM therapies find holistic practice a function of practice locale. The proportion of holistic MDs increases in states with an older population, where more patients survive despite serious disabilities, and where non-physician providers pose a competitive threat. Consumer demand, specialization and licensing do not significantly influence adoption of CAM treatments in these analyses. Health care financing has disparate effects. Indemnity insurance constrains holistic practice while HMO penetration enhances it. These results suggest that holistic practice may be an integral part of the regular profession's ongoing professionalization project. PMID:16513658
Jecker, N S; Berg, A O
In national debates concerning the allocation of medical resources rural America is a neglected topic, and the voices of rural health professionals are seldom heard. This paper highlights the special problems encountered in allocating medical resources within the rural setting and indicates the strategies that rural residents compose for dealing with them. Our findings are based on a study consisting of in-depth open-ended interviews with family physicians in the rural northwest United States. We contrast the approach to justice expressed by these rural physicians with the conception of justice that dominates Western philosophy and bioethics. In the course of our discussion, the diversity within Western culture becomes apparent. We discuss strategies for incorporating different perspectives into local and national allocation debates, clarify the reasons why a more encompassing approach to justice is necessary, and review the implications of our work for future research. PMID:1604352
Taylor, W I
The aim of this article is to provoke dialogue and to initiate change. Costs of health care are alarming. Our inability to respond effectively to the demand for total health care is frustrating. Some drastic changes are required. This article, the first of a series that will enquire into our present methods for providing health care, suggests that in group medical practice some satisfactory solutions may be found. PMID:20468486
With the justification that the treatment and medical liability act suffers from a lack of transparency and reliability due to being characterized by many isolated decisions, in 2013 this was made into statute law in the form of the patients rights act in the German Civil Code (BGB). It was considered that "currently existing comprehensive rights of patients" would be strengthened through clarity and "legal transparency" and that the practical "implementation" would be improved. That this target will be achieved with these new statutory provisions is doubtful. Instead of more clarity, transparency and legal security, there now exists substantial need for interpretation of many aspects which will keep courts and lawyers occupied for many years. Furthermore, this has given rise to more bureaucratization of medicine with the compulsion to fulfil new formalities in clinics and doctors' offices. In this article the most important regulations for physicians will be presented and explained. Due to limited space and with due respect to the readership a subtle legal analysis of the regulations will be dispensed with. PMID:24499957
... grant a variance from any treatment technique requirement of a national primary drinking water... 40 Protection of Environment 23 2011-07-01 2011-07-01 false Alternative treatment techniques. 142.46 Section 142.46 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED)...
... grant a variance from any treatment technique requirement of a national primary drinking water... 40 Protection of Environment 22 2010-07-01 2010-07-01 false Alternative treatment techniques. 142.46 Section 142.46 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED)...
... grant a variance from any treatment technique requirement of a national primary drinking water... 40 Protection of Environment 24 2012-07-01 2012-07-01 false Alternative treatment techniques. 142.46 Section 142.46 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED)...
... grant a variance from any treatment technique requirement of a national primary drinking water... 40 Protection of Environment 23 2014-07-01 2014-07-01 false Alternative treatment techniques. 142.46 Section 142.46 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED)...
... grant a variance from any treatment technique requirement of a national primary drinking water... 40 Protection of Environment 24 2013-07-01 2013-07-01 false Alternative treatment techniques. 142.46 Section 142.46 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED)...
Zarzycka, Maja; Rozek, Karina; Zarzycki, Michał
Scoliosis is a deformity of the spine known since Hippocrates times. The value of certain methods of conservative treatment remains controversial. Some of them have only a psychological value both for the physician and his or her caregivers. Based on current literature and the Scoliosis Research Society Report of Alternative Methods of Treatment of Idiopathic Scoliosis, we describe the effectiveness of various alternative methods, such as exercise, Dobosiewicz technique, Karski method, SEAS 02, acupuncture, Alexander technique, aromatherapy, ayurveda, ASCO treatment, biofeedback, chiropractic, Yoga, Feldenkrais method, Pilates method, massage therapy, rolfing, magnet therapy, surface electrical stimulation, PNF, Copes system, and bracing. PMID:19920282
Roy, Angkana; Lurslurchachai, Linda; Halm, Ethan A.; Li, Xiu-Min; Wisnivesky, Juan P.
Background Complementary and alternative medicines (CAM) are used widely by patients with chronic diseases such as asthma. However, it is unclear whether use of CAM is associated with decreased adherence to inhaled corticosteroids (ICS), a key component of asthma management. Methods We surveyed 326 adults with persistent asthma receiving care at two inner-city outpatient clinics. Patients were asked about CAM use for treatment of asthma in the prior six months. Medication adherence was assessed using the Medication Adherence Report Scale, a validated self-report measure. Univariate and multiple regression analyses were used to assess the relationship between CAM use, adherence to ICS, and medication and disease beliefs. Results Overall, 25% (95% CI: 20–30%) of patients reported CAM use. Of those who used CAM, 39% (95% CI: 19–59%) discussed it with their physician, and 21% (95% CI: 12–31%) used CAM in place of prescribed asthma therapy. Univariate analyses showed that CAM use was associated with decreased ICS adherence and increased asthma morbidity. In multivariable analysis, CAM use was associated with lower ICS adherence (odds ratio [OR]: 0.5, 95% CI: 0.3–0.9) after adjusting for age, gender, race/ethnicity, education, years since diagnosis, language, and co-morbidities. CAM users were also more likely to worry about side effects of ICS (p=0.01). Conclusion CAM use was associated with decreased ICS adherence among inner-city asthmatics. Medication beliefs such as worry about ICS side effects may in part mediate this relationship. CAM use may be a marker for decreased adherence to ICS, particularly among patients with poor asthma control. PMID:20306816
Salomonsen-Sautel, Stacy; Sakai, Joseph T.; Thurstone, Christian; Corley, Robin; Hopfer, Christian
Objective: To assess the prevalence and frequency of medical marijuana diversion and use among adolescents in substance abuse treatment and to identify factors related to their medical marijuana use. Method: This study calculated the prevalence and frequency of diverted medical marijuana use among adolescents (n = 164), ages 14-18 years (mean age…
Feingold, Benjamin F.
The author replies to the article titled "Controversial Medical Treatments of Learning Disabilities" (R. Sieben), and discusses research on the relationship between food additives and hyperactivity, and dietary treatments for learning disabled children. (IM)
synergistic effect in the inactivation of coliphage MS-2 and poliovirus. Other techniques: There are a number of other techniques. We have conducted trials of most of these in the control of Legionella sp., but these fall out of the scope of this article, and as such less emphasis has been placed on them here. Ozonation: Ozone [O3] is an oxidising gas, generated electrically from oxygen [O2]. L. pneumophila can be killed at < 1 mg/L of ozone [Edelstien et al 1982]. Muraca et al  found that 1-2 mg/L of continuous ozone over a six hour contact time, produced a 5 logarithm decrease of L. pneumophila. The effectiveness of ozone treatment against a range of bacteria and coliphages has been studied Botzenhart et al . E. coli was least resistant to ozone, followed by MS 2-coliphage and PhiX 174-coliphage, with L. pneumophila and Bacillus subtilis spores being the most resistant. (ABSTRACT TRUNCATED) PMID:11447890
Blackwell, Barry; And Others
To demonstrate poor patient compliance, medical students who preregistered for a conference on patient compliance were asked to adopt the role of "patient" and to take "medication" (Vitamin C) for one week, to observe certain dietary restrictions, and to complete an attitude and health beliefs questionnaire. Student attitudes resembled those of…
National Association for Search and Rescue, Fairfax, VA.
This paper offers a brief outline of the training curriculum developed by the National Association for Search and Rescue (NASAR) for its Wilderness Medicine Programs. The training modules are designed for wilderness search and rescue units, rural emergency medical services (EMS) squads, military medics, backcountry rangers, epedition leaders,…
Bartel, Nettie R.; Thurman, S. Kenneth
The miracles of modern medical technology are sometimes accompanied by unanticipated costs affecting survivors' quality of life. This article considers the educational implications for three groups of children who could not survive without medical intervention: children treated for cancer, low birth-weight and premature infants, and the medically…
... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Medical treatment and hospitalization. 5.59 Section 5.59 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY GENERAL COAST GUARD AUXILIARY § 5.59 Medical treatment and hospitalization. When any member of...
... 33 Navigation and Navigable Waters 1 2013-07-01 2013-07-01 false Medical treatment and hospitalization. 5.59 Section 5.59 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY GENERAL COAST GUARD AUXILIARY § 5.59 Medical treatment and hospitalization. When any member of...
... 33 Navigation and Navigable Waters 1 2012-07-01 2012-07-01 false Medical treatment and hospitalization. 5.59 Section 5.59 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY GENERAL COAST GUARD AUXILIARY § 5.59 Medical treatment and hospitalization. When any member of...
... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Medical treatment and hospitalization. 5.59 Section 5.59 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY GENERAL COAST GUARD AUXILIARY § 5.59 Medical treatment and hospitalization. When any member of...
Levy, Susan E.
SYNOPSIS Complementary and alternative medical treatments are commonly used for children with autism spectrum disorders. This review discusses the evidence supporting the most frequently used treatments, including categories of mind-body medicine, energy medicine, biologically based, manipulative and body-based practices, with the latter two the most commonly selected by families. It is important for clinical providers to understand the evidence for efficacy (or lack thereof) and potential side effects. Some CAM practices have evidence to reject their use, such as secretin, others have emerging evidence to support their use, like melatonin. Most treatments, however, have not been adequately studied and do not have evidence to support their use. PMID:18775371
Salomonsen-Sautel, Stacy; Sakai, Joseph T.; Thurstone, Christian; Corley, Robin; Hopfer, Christian
Objective To assess the prevalence and frequency of medical marijuana diversion and use among adolescents in substance abuse treatment and to identify factors related to their medical marijuana use. Method This study calculated the prevalence and frequency of diverted medical marijuana use among adolescents (N = 164), ages 14–18 (x□ age = 16.09, SD = 1.12), in substance abuse treatment in the Denver metropolitan area. Bivariate and multivariate analyses were completed to determine factors related to adolescents' use of medical marijuana. Results Approximately 74% of the adolescents had used someone else's medical marijuana and they reported using diverted medical marijuana a median of 50 times. After adjusting for gender and race/ethnicity, adolescents who used medical marijuana had an earlier age of regular marijuana use, more marijuana abuse and dependence symptoms, and more conduct disorder symptoms compared to those who did not use medical marijuana. Conclusions Medical marijuana use among adolescent patients in substance abuse treatment is very common, implying substantial diversion from registered users. These results support the need for policy changes that protect against diversion of medical marijuana and reduce adolescent access to diverted medical marijuana. Future studies should examine patterns of medical marijuana diversion and use in general population adolescents. PMID:22721592
Kazdin, A E
The acceptability of alternative treatments for deviant child behavior was evaluated in two experiments. In each experiment, clinical cases were described to undergraduate students along with four different treatments in a Replicated Latin Square Design. The treatments included reinforcement of incomparible behavior, time out from reinforcement, drug therapy, and electric shock and the treatments were described as they were appliedto children with problem behaviors. Experiment 1 developed an assessment device to evaluate treatment acceptability and examined whether treatments were rated as differentially acceptable. Experiment 2 replicated the first experiment and examined whether the severity of the presenting clinical problem influenced ratings of acceptability. The results indicated that treatments were sharply distinguished in overall acceptability. Reinforcement of incompatible behavior was more acceptable than other treatments which followed, in order, time out from reinforcement, drug therapy, and electric shock. Case severity influenced acceptability of alternative treatments with all treatments being rated as more acceptable with more severe cases. However, the strength of case severity was relatively small in relation to the different treatment conditions themselves which accounted for large portions of variance. PMID:7380752
Barry, Declan T.; Savant, Jonathan D.; Beitel, Mark; Cutter, Christopher J.; Moore, Brent A.; Schottenfeld, Richard S.; Fiellin, David A.
Previous studies have not examined patterns of pain treatment use among patients seeking office-based buprenorphine-naloxone treatment (BNT) for opioid dependence. Objectives To examine, among individuals with pain seeking BNT for opioid dependence, the use of pain treatment modalities, perceived efficacy of prior pain treatment, and interest in pursuing pain treatment while in BNT. Methods 244 patients seeking office-based BNT for opioid dependence completed measures of demographics, pain status (i.e. “chronic pain (CP)” [pain lasting at least 3 months] vs. “some pain (SP)” [pain in the past week not meeting the duration criteria for chronic pain]), pain treatment use, perceived efficacy of prior pain treatment, and interest in receiving pain treatment while in BNT. Results In comparison to the SP group (N = 87), the CP group (N = 88) was more likely to report past-week medical use of opioid medication (AOR 3.2, 95% CI 1.2–8.4), lifetime medical use of non-opioid prescribed medication (AOR 2.2, 95% CI 1.1–4.7), and lifetime use of prayer (AOR 2.8, 95% CI 1.2–6.5), and was less likely to report lifetime use of yoga (AOR 0.2, 95% CI 0.1–0.7) to treat pain. While the two pain groups did not differ on levels of perceived efficacy of prior lifetime pain treatments, in comparison to the SP group, the CP group was more likely to report interest in receiving pain treatment while in BNT (P < 0.001). Conclusions Individuals with pain seeking BNT for opioid dependence report a wide range of conventional, complementary, and alternative pain-related treatments and are interested (especially those with CP) in receiving pain management services along with BNT. PMID:23041680
Heunis, T. D. J.; Dicks, L. M. T.
Injury to the skin causes a breach in the protective layer surrounding the body. Many pathogens are resistant to antibiotics, rendering conventional treatment less effective. This led to the use of alternative antimicrobial compounds, such as silver ions, in skin treatment. In this review nanofibers, and the incorporation of natural antimicrobial compounds in these scaffolds, are discussed as an alternative way to control skin infections. Electrospinning as a technique to prepare nanofibers is discussed. The possibility of using these structures as drug delivery systems is investigated. PMID:20798871
Pieterse, Reneé; Todorov, Svetoslav D.
Mastitis is considered to be the most costly disease affecting the dairy industry. Management strategies involve the extensive use of antibiotics to treat and prevent this disease. Prophylactic dosages of antibiotics used in mastitis control programmes could select for strains with resistance to antibiotics. In addition, a strong drive towards reducing antibiotic residues in animal food products has lead to research in finding alternative antimicrobial agents. In this review we have focus on the pathogenesis of the mastitis in dairy cows, existing antibiotic treatments and possible alternative for application of bacteriocins from lactic acid bacteria in the treatment and prevention of this disease. PMID:24031528
Liberato, Ana Carolina Sauer; Rodrigues, Roberta Cunha Matheus; São-João, Thaís Moreira; Alexandre, Neusa Maria Costa; Gallani, Maria Cecília Bueno Jayme
Abstract Objective: to psychometrically test the Brazilian version of the Treatment Satisfaction Questionnaire for Medication - TSQM (version 1.4), regarding ceiling and floor effect, practicability, acceptability, reliability and validity. Methods: participants with coronary heart disease (n=190) were recruited from an outpatient cardiology clinic at a university hospital in Southeastern Brazil and interviewed to evaluate their satisfaction with medication using the TSQM (version 1.4) and adherence using the Morisky Self-Reported Measure of Medication Adherence Scale and proportion of adherence. The Ceiling and Floor effect were analyzed considering the 15% worst and best possible TSQM scores; Practicability was assessed by time spent during TSQM interviews; Acceptability by proportion of unanswered items and participants who answered all items; Reliability through the Cronbach's alpha coefficient and Validity through the convergent construct validity between the TSQM and the adherence measures. Results: TSQM was easily applied. Ceiling effect was found in the side effects domain and floor effect in the side effects and global satisfaction domains. Evidence of reliability was close to satisfied in all domains. The convergent construct validity was partially supported. Conclusions: the Brazilian TSQM presents evidence of acceptability and practicability, although its validity was weakly supported and adequate internal consistency was observed for one domain. PMID:27276018
Neugebauer, Maria Gertrudes Fernandes Pereira; Neugebauer, Samuel Antônio; Almeida Junior, Hiram Larangeira; Mota, Laís Marques
Skin infections by Mycobacterium marinum are quite rare in our environment and, therefore, little studied. The majority of the lesions appear three weeks after traumas in aquariums, beaches and fish tanks. Lymph node drainage and systematization of the disease are rare and most lesions disappear in about three years. This case aims to show the effectiveness of the treatment used (lymecycline 150 mg/orally/day). This medication may be a new therapeutic option for the treatment of Mycobacterium marinum. PMID:25672310
Neilson, James P; Gyte, Gillian ML; Hickey, Martha; Vazquez, Juan C; Dou, Lixia
. Overall, there were fewer surgical evacuations with misoprostol (average RR 0.07, 95% CI 0.03 to 0.18; eight studies, 1538 women) but more unplanned procedures (average RR 6.32, 95% CI 2.90 to 13.77; six studies, 1158 women). There were few data on ‘deaths or serious complications’. Limited evidence suggests that women generally seem satisfied with their care. Long-term follow up from one included study identified no difference in subsequent fertility between the three approaches. Authors’ conclusions The available evidence suggests that medical treatment, with misoprostol, and expectant care are both acceptable alternatives to routine surgical evacuation given the availability of health service resources to support all three approaches. Women experiencing miscarriage at less than 13 weeks should be offered an informed choice. [Note: the 34 citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.] PMID:20091626
The report gives results of an evaluation of the effectiveness of two treatment alternatives in achieving best available technology (BAT) standards: (1) direct filtration, using a dual media filter; and (2) hydroxide precipitation with lime, followed by dual media filtration. Wit...
Hogue, Aaron; Bobek, Molly; Tau, Gregory Z.; Levin, Frances R.
Attention-Deficit/Hyperactivity Disorder (ADHD) is highly prevalent among adolescents enrolled in behavioral health services but remains undertreated in this age group. Also the first-line treatment for adolescent ADHD, stimulant medication, is underutilized in routine practice. This article briefly describes three behavioral interventions designed to promote stronger integration of medication interventions into treatment planning for adolescent ADHD: family ADHD psychoeducation, family-based medication decision-making, and behavior therapist leadership in coordinating medication integration. It then introduces the Medication Integration Protocol (MIP), which incorporates all three interventions into a five-task protocol: ADHD Assessment and Medication Consult; ADHD Psychoeducation and Client Acceptance; ADHD Symptoms and Family Relations; ADHD Medication and Family Decision-Making; and Medication Management and Integration Planning. The article concludes by highlighting what behavior therapists should know about best practices for medication integration across diverse settings and populations: integrating medication interventions into primary care, managing medication priorities and polypharmacy issues for adolescents with multiple diagnoses, providing ADHD medications to adolescent substance users, and the compatibility of MIP intervention strategies with everyday practice conditions. PMID:25505817
Clark, Glenn T; Padilla, Mariela; Dionne, Raymond
Chronic pain in the orofacial region has always been a vexing problem for dentists to diagnose and treat effectively. For trigeminal neuropathic pain, there are 3 medications (gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors) to use plus topical anesthetics that have therapeutic efficacy. For chronic daily headaches (often migraine in origin), 3 prophylactic medications have reasonable therapeutic efficacy (β-blockers, tricyclic antidepressants, and antiepileptic drugs). The 3 Food and Drug Administration-approved drugs for fibromyalgia (pregabalin, duloxetine, and milnacipran) are not robust, with poor efficacy. For osteroarthritis, nonsteroidal anti-inflammatory drugs have therapeutic efficacy and when gastritis contraindicates them, corticosteriod injections are helpful. PMID:27475515
Fox, Daniel J; Tharp, David F; Fox, Lydia C
Current research has shown that neurofeedback, or EEG biofeedback as it is sometimes called, is a viable alternative treatment for Attention Deficit Hyperactivity Disorder (ADHD). The aim of this article is to illustrate current treatment modalities(s), compare them to neurofeedback, and present the benefits of utilizing this method of treatment to control and potentially alleviate the symptoms of ADHD. In addition, this article examines the prevalence rates and possible etiology of ADHD, the factors associated with ADHD and brain dysfunction, the current pharmacological treatments of ADHD, Ritalin, and the potential risks and side effects. Behavior modification and cognitive behavioral treatment for ADHD is discussed as well. Lastly, a brief history of the study of neurofeedback, treatment successes and clinical benefits, comparisons to medication, and limitations are presented. PMID:16385424
Freeborn, D K; Polen, M R; Mullooly, J P
Research on adults has documented that use of medical services decreases after initiation of treatment for alcohol problems, but little is known about this relationship among adolescents. We studied utilization and costs of care following participation in the Adolescent Chemical Health Program (ACHP) of Kaiser Permanente, Northwest Region, in 1986-88. Three groups of adolescents (and their parents) were identified: adolescents who were assessed and initiated treatment in ACHP (n = 561), adolescents who were assessed and recommended for treatment but did not return for treatment (n = 278), and adolescents with no known substance use problems (n = 381). Medical records were reviewed for 1 year pre- and 1.5 years postassessment. After adjusting for preassessment medical visits, severity of alcohol and drug use, gender, and age, analyses suggested that substance user treatment was not associated with reduced use of medical services or costs by either adolescents or parents. PMID:7558471
Leeuwenburgh-Pronk, Wendela G; Miller-Smith, Laura; Forman, Vicki; Lantos, John D; Tibboel, Dick; Buysse, Corinne
One of the most difficult ethical dilemmas in pediatrics today arises when a child has complex chronic conditions that are not curable and cause discomfort with no prospect of any improvement on quality of life. In the context of medical futility, it is harmful to prolong medical treatment. The question is: How can medical treatment be discontinued when the child is not dependent on mechanical ventilation or ICU treatment? What is the appropriate palliative care and does it justify the use of sedatives or analgesics if this also might shorten life? PMID:25647670
Peintinger, Christa; Hartmann, Wolfgang
Pain--which can have a variety of causes--constitutes a severe problem for patients in need of palliative care, because this pain usually dramatically impairs their quality of life. Thus, the more advanced a terminal illness has become, the more hospital staff should focus on holistic treatment, encompassing body, mind and soul of the patient. Apart from conventional medication-based pain therapy, there is also a variety of non-medicinal treatments for pain. One of these methods is hypnosis, an imaginative treatment that activates available resources; it is not only an effective way of alleviating pain, but it also can ease psychological problems at the same time. PMID:19165446
Jaranson, James M.
This paper is an overview of issues and findings in the use of medication to treat mentally ill refugees. The introductory background section briefly discusses the development of interest in ethnic differences in response to psychotropic drugs. The second section highlights the results of research literature on the use of the following kinds of…
Metts, Julius; Wright, Steven; Sundaram, Jawahar; Hashemi, Nastran
With medical marijuana available in more and more states, family physicians need to know what the evidence says about its use. This review includes a step-by-step guide and a list of red flags to watch for. PMID:27158689
Ryan, Joseph B.; Katsiyannis, Antonis; Hughes, Elizabeth M.
Attention deficit hyperactivity disorder (ADHD) has become the most commonly diagnosed psychiatric disorder among school-age children. For more than half a century, physicians have prescribed medications to help manage behaviors such as hyperactivity, impulsivity, and inattention. Today, there is a growing consensus that ADHD is a biologically…
Charles M. Barnes; James B. Bosley; Clifford W. Olsen
The purpose of this document is to discuss issues related to the implementation of each of the five down-selected INEEL/INTEC radioactive liquid waste (sodium-bearing waste - SBW) treatment alternatives and summarize information in three main areas of concern: process/technical, environmental permitting, and schedule. Major implementation options for each treatment alternative are also identified and briefly discussed. This report may touch upon, but purposely does not address in detail, issues that are programmatic in nature. Examples of these include how the SBW will be classified with respect to the Nuclear Waste Policy Act (NWPA), status of Waste Isolation Pilot Plant (WIPP) permits and waste storage availability, available funding for implementation, stakeholder issues, and State of Idaho Settlement Agreement milestones. It is assumed in this report that the SBW would be classified as a transuranic (TRU) waste suitable for disposal at WIPP, located in New Mexico, after appropriate treatment to meet transportation requirements and waste acceptance criteria (WAC).
Mehler, Philip S; Krantz, Mori J; Sachs, Katherine V
Inherent to anorexia nervosa and bulimia nervosa are a plethora of medical complications which correlate with the severity of weight loss or the frequency and mode of purging. Yet, the encouraging fact is that most of these medical complications are treatable and reversible with definitive care and cessation of the eating-disordered behaviours. Herein, these treatments are described for both the medical complications of anorexia nervosa and those which are a result of bulimia nervosa. PMID:25874112
Taghipour, Hassan; Mohammadyarei, Taher; Asghari Jafarabadi, Mohamad; Asl Hashemi, Ahmad
Treating hazardous-infectious medical waste can be carried out on-site or off-site of health-care establishments. Nevertheless, the selection between on-site and off-site locations for treating medical waste sometimes is a controversial subject. Currently in Iran, due to policies of Health Ministry, the hospitals have selected on-site-treating method as the preferred treatment. The objectives of this study were to assess the current condition of on-site medical waste treatment facilities, compare on-site medical waste treatment facilities with off-site systems and find the best location of medical waste treatment. To assess the current on-site facilities, four provinces (and 40 active hospitals) were selected to participate in the survey. For comparison of on-site and off-site facilities (due to non availability of an installed off-site facility) Analytical Hierarchy Process (AHP) was employed. The result indicated that most on-site medical waste treating systems have problems in financing, planning, determining capacity of installations, operation and maintenance. AHP synthesis (with inconsistency ratio of 0.01 < 0.1) revealed that, in total, the off-site treatment of medical waste was in much higher priority than the on-site treatment (64.1% versus 35.9%). According to the results of study it was concluded that the off-site central treatment can be considered as an alternative. An amendment could be made to Iran's current medical waste regulations to have infectious-hazardous waste sent to a central off-site installation for treatment. To begin and test this plan and also receive the official approval, a central off-site can be put into practice, at least as a pilot in one province. Next, if it was practically successful, it could be expanded to other provinces and cities. PMID:24739145
Byers, K.R.; Johnston, J.W.; Bennett, C.A.; Brouns, R.J.; Mullen, M.F.; Roberts, F.P.
This document presents an analysis of alternatives to correct deficiencies in the statistical treatment of inventory differences in the NRC guidance documents and licensee practice. Pacific Northwest Laboratory's objective for this study was to assess alternatives developed by the NRC and a panel of safeguards statistical experts. Criteria were developed for the evaluation and the assessment was made considering the criteria. The results of this assessment are PNL recommendations, which are intended to provide NRC decision makers with a logical and statistically sound basis for correcting the deficiencies.
Plummer, Nancy; Michael, Nancy, Ed.
This module on medications used in the treatment of ischemic heart disease is intended for use in inservice or continuing education programs for persons who administer medications in long-term care facilities. Instructor information, including teaching suggestions, and a listing of recommended audiovisual materials and their sources appear first.…
Gerrity, Deborah A.
Explores the marital happiness, state/trait anxiety, coping techniques, and types of support received for a national sample of men and women experiencing the infertility medical process. Suggests that counselors should be aware that medical treatment affects the distress level of the individual and couple and the types of coping used. Further…
Agrawal, Shantanu; Everett, Worth W.; Sharma, Sonali
Purpose: This study examined the impact of medical education on students' views of substance abuse treatment, public policy options and training. Method: A longitudinal survey was conducted on a single-class cohort of 101 students in a major American, urban medical school. The survey was administered in the Spring semesters of the first to third…
This paper examines biomedicine's contemporary overture to complementary and alternative medicine (CAM) in the move toward an integrated medical system. The paper argues that a major challenge of our increasingly integrating medical culture is raising commensurate personnel to grapple with the changing ethical landscape, especially with regard to understanding the methodologies and philosophies of CAM's therapeutic paradigms. Such personnel is required to tackle realistically the critical ethical challenge of our amalgamating medical system, namely an acceptable framework for evaluating the efficacy of CAM's plural therapeutic paradigms. PMID:16884349
Pulmonary arterial hypertension is a chronic, progressive disease of the pulmonary vasculature resulting in poor outcomes if left untreated. The management of group 1 pulmonary arterial hypertension has included the use of prostanoids, phosphodiesterase-5 inhibitors, and endothelin receptor antagonists targeting the prostacyclin, endothelin-1, and nitric oxide pathways. Three new medications have been approved by the US Food and Drug Administration over the past couple of years. Macitentan is the newest endothelin receptor antagonist, riociguat is a soluble guanylate cyclase stimulator, and treprostinil diolamine is the first oral prostanoid. This review will focus on the key trials leading to their approval, special considerations for each medication, and their potential place in therapy. The use of combination therapy as initial therapy in pulmonary arterial hypertension will also be discussed. PMID:26336595
Bowker, L H; Maurer, L
Knowledge gained from a literature summary was tested against data obtained from a national volunteer sample of 1,000 battered women recruited primarily through solicitation by an advertisement in Woman's Day magazine. In comparison with other help-sources (social service agencies, the clergy, the police, lawyers, women's groups, shelters), medical personnel were found to have been used fairly frequently, but they were seen by the battered women as less effective than any other group. Quotes taken from indepth interviewers with 146 of the battered wives are used to bring life to the comparative statistics. Specific reasons for the low effectiveness ratings of the medical profession are considered, and ways to improve service delivery ratings are discussed. PMID:3577197
Matlow, A.; Vellend, H.
We describe four cases of multiple, cryptogenic, and streptococcal liver abscesses which were cured with antibiotic therapy. Two of the patients were referred for medical management as a last resort after open surgical drainage failed to eradicate the suppurative process. The other two patients were treated from the time of diagnosis with antimicrobial agents alone. Blood cultures or needle aspirates of the abscesses yielded a pure growth of streptococci in all instances. All isolates were susceptible to penicillin G. Cryptogenic streptococcal abscesses may represent a subset of multiple hepatic abscesses particularly amenable to successful medical therapy consisting of a minimum of 6 weeks parenteral antibiotic therapy followed by a period of oral antibiotics until clinical, biochemical, and radiological resolution of the abscesses has occurred.
Lunt, Neil; Horsfall, Daniel; Hanefeld, Johanna
The scoping review focuses on medical tourism, whereby consumers elect to travel across borders or to overseas destinations to receive their treatment. Such treatments include: cosmetic and dental surgery; cardio, orthopaedic and bariatric surgery; IVF; and organ and tissue transplantation. The review assesses the emerging focus of research evidence post-2010. The narrative review traverses discussion on medical tourism definitions and flows, consumer choice, clinical quality and outcomes, and health systems implications. Attention is drawn to gaps in the research evidence. PMID:27105695
Litten, Raye Z; Wilford, Bonnie B; Falk, Daniel E; Ryan, Megan L; Fertig, Joanne B
Alcohol use disorder (AUD), as currently defined in the Diagnostic and Statistical Manual, 5th Edition (DSM-5), is a heterogeneous disorder stemming from a complex interaction of neurobiological, genetic, and environmental factors. As a result of this heterogeneity, there is no one treatment for AUD that will work for everyone. During the past 2 decades, efforts have been made to develop a menu of medications to give patients and clinicians more choices when seeking a therapy that is both effective and which has limited side effects. To date, 3 medications have been approved by the US Food and Drug Administration (FDA) to treat alcohol dependence: disulfiram, naltrexone, and acamprosate. In addition to these approved medications, researchers have identified new therapeutic targets and, as a result, a number of alternative medications are now being evaluated for treatment of AUD in human studies. Although not approved by the FDA for the treatment of AUD, in some cases, these alternative medications are being used off-label by clinicians for this purpose. These potential medications are reviewed here. They include nalmefene, varenicline, gabapentin, topiramate, zonisamide, baclofen, ondansetron, levetiracetam, quetiapine, aripiprazole, and serotonin reuptake inhibitors. The effectiveness of these medications has been mixed-some show good efficacy with side effects that are mild to moderate in intensity; others have mixed or promising results but are awaiting findings from ongoing studies; and still others show poor efficacy, despite promising preliminary results. Medications development remains a high priority. Key initiatives for the National Institute on Alcohol Abuse and Alcoholism (NIAAA) include supporting the discovery and development of more effective and safer medications, advancing the field of personalized medicine, and forging public and private partnerships to investigate new and more effective compounds. PMID:26928397
Saxon, Dale W; Tunnicliff, Godfrey; Brokaw, James J; Raess, Beat U
Reflecting society's interest in complementary and alternative medicine (CAM), most allopathic medical schools in the United States offer instruction in CAM. Pertinent information about the teaching of CAM at osteopathic medical schools is lacking. The authors therefore sought to document the form and content of CAM instruction at osteopathic medical schools and compare their findings with those reported for allopathic medical schools in a recently published survey. Phone conversations with academic officials at each of the 19 colleges of osteopathic medicine revealed that only one school did not teach CAM. With the help of these officials, the authors identified 25 CAM instructors at 18 osteopathic medical schools and sent them questionnaires. All returned a completed form with details about CAM instruction at their schools. The authors found that CAM material was usually presented in required courses sponsored by clinical departments, was most likely taught in the first 2 years of medical school, and involved fewer than 20 contact hours of instruction. The topics most often taught were acupuncture (68%), herbs and botanicals (68%), spirituality (56%), dietary therapy (52%), and homeopathy (48%). Most (72%) CAM instructors were also practitioners of CAM modes of therapy. Few (12%) of the instructors taught CAM from an evidence-based perspective. The authors conclude that the form and content of CAM instruction at osteopathic medical schools is similar to that offered at allopathic medical schools and that both osteopathic and allopathic medical schools should strive to teach CAM with less advocacy and more reliance on evidence-based medicine. PMID:15083987
The Jewish principle concerning a decision with regard to a dangerous treatment is as following: A patient who is estimated to die within 12 months because of a fatal illness is permitted to undergo a treatment that on the one hand may extend his life beyond 12 months, but on the other hand may hasten his death. There are, however, several limitations to this ruling related to the chances of success with the proposed treatment, the nature of the treatment, whether it is intended to be curative or merely to postpone the danger and death, whether the treatment is absolutely necessary, and others. One is not obligated to undergo a dangerous treatment, but one is permitted to do so. The permissibility to forfeit a short life expectancy in order to achieve more prolonged life applies only with the patient’s consent. That consent is valid and is not considered a form of attempted suicide. Neither is a refusal to submit to treatment considered an act of suicide; the patient has the right to refuse a dangerous procedure. In all situations where a permissive ruling is granted for a patient to endanger his short life expectancy, the ruling should be arrived at after careful reflection and with the approval of the rabbinic authorities acting on the recommendation of the most expert physicians. PMID:26241221
Stanley, J M
Several misunderstandings regarding the question of when to stop treatment are examined by considering two frameworks for sorting out the different dimensions of the question. One framework addresses what is meant, and what is not meant, by 'stopping treatment'. The other plots various strategies of stopping treatment on a continuum of increasing degrees of invasiveness. While significant disagreements remain at important points, there is evidence of an emerging consensus in Western medicine: (1) that palliative care and counselling through the dying process should be increased whenever curative or life-sustaining treatment is curtailed; (ii) that any treatment that is not curative, but merely life-sustaining, should be stopped whenever a patient makes an authentic request to have it stopped; (iii) that genuinely futile treatment should not be offered even if requested; (iv) that much more thought and discussion is required to achieve a workable agreement about the definitions of 'futile' and 'inappropriate' treatment; and (v) that assistance in dying, although profoundly problematic, is no longer unthinkable. PMID:9422041
Marcus, Donald M.
Analyzes alleged deficiencies in medical education and concludes they are based on misrepresentations (for example, that physicians ignore mind-body interactions). Examines fundamental differences between traditional and alternative medicine and asserts that physicians need additional education in order to provide guidance to patients, but that…
Wong, Helen H. L.; Smith, Ronald G.
Previous studies suggest that complementary and alternative medical (CAM) therapy use in children with chronic illnesses is higher than in children in the general population. In this study, we investigated patterns of CAM therapy use in children diagnosed with autism spectrum disorders (ASD, n = 50) as compared to a control population of children…
Kamata, Arimichi; Kano, Tsunehisa; Hagiwara, Hideyuki; Sarukawa, Hideki; Wada, Yudai; Miyamae, Taku; Koizumi, Masaki; Takahashi, Kazuhiro; Abe, Yutaka; Natori, Joji; Uchiyama, Kiichiro
The recommended regimen for S-1 internal use is 4 weeks of daily medication and 2 weeks of drug holiday. However, we experience many cases where changing the regimen is ineffective because of adverse events. This time, we report a favorable case of alternate-day treatment with S-1 in an elderly patient with multiple lung metastases of colon cancer. An 84-year-old woman, performance status 2, was diagnosed as having colon cancer and multiple lung metastases. After operation of the colon, she received chemotherapy with the S-1 alternate-day treatment. The lung metastases decreased remarkably, and she was able to continue the treatment without significant adverse events. She has been receiving the treatment without progression for more than 18 months now. The alternate-day treatment with S-1 is reported as a cure with anticancer efficacy and few adverse events. This treatment seems to be a useful chemotherapy for elderly patients with colon cancer. PMID:27067859
Armstrong, Terri S; Gilbert, Mark R
The use of complementary and alternative medicine (CAM) is increasing. CAM includes mind-body interventions, biologically based therapies, energy therapies, and body-based methods. Primary brain tumors arise within the brain and have a poor prognosis when malignant. Even patients with benign tumors suffer neurologic and systemic symptoms as a result of the tumor or its treatment. CAM is used by 30% of brain tumor patients, who often do not report its use to their physician. Herbal medicines may affect the metabolism of prescribed medications or produce adverse effects that may be attributed to other causes. In patients with systemic cancer, mind-body modalities such as meditation and relaxation therapy have been shown to be helpful in reducing anxiety and pain; acupuncture and hypnotherapy may also reduce both pain and nausea. Recent preclinical studies have reported that ginseng, Scutellaria baicalensis, and Angelica sinensis may promote apoptosis of tumor cells or exercise antiangiogenic effects. Further studies are needed to evaluate the impact of CAM on symptom control or tumor growth in this vulnerable patient population. PMID:18541122
Loquai, Carmen; Dechent, Dagmar; Garzarolli, Marlene; Kaatz, Martin; Kaehler, Katharina C; Kurschat, Peter; Meiss, Frank; Stein, Annette; Nashan, Dorothee; Micke, Oliver; Muecke, Ralph; Muenstedt, Karsten; Stoll, Christoph; Schmidtmann, Irene; Huebner, Jutta
Complementary and alternative medicine (CAM) is used widely among cancer patients. Beside the risk of interaction with cancer therapies, interactions with treatment for comorbidities are an underestimated problem. The aim of this study was to assess prevalence of interactions between CAM and drugs for comorbidities from a large CAM usage survey on melanoma patients and to classify herb-drug interactions with regard to their potential to harm. Consecutive melanoma outpatients of seven skin cancer centers were asked to complete a standardized CAM questionnaire including questions to their CAM use and their taken medication for comorbidities and cancer. Each combination of conventional drugs and complementary substances was evaluated for their potential of interaction. 1089 questionnaires were eligible for evaluation. From these, 61.6 % of patients reported taking drugs regularly from which 34.4 % used biological-based CAM methods. Risk evaluation for interaction was possible for 180 CAM users who listed the names or substances they took for comorbidities. From those patients, we found 37.2 % at risk of interaction of their co-consumption of conventional and complementary drugs. Almost all patients using Chinese herbs were at risk (88.6 %). With a high rate of CAM usage at risk of interactions between CAM drugs and drugs taken for comorbidities, implementation of a regular assessment of CAM usage and drugs for comorbidities is mandatory in cancer care. PMID:27090799
Chang, Julietta; Brethauer, Stacy
Obesity continues to be a growing epidemic worldwide. Although bariatric surgery remains the most effective and durable treatment of obesity and its comorbidities, there is a need for less invasive yet efficacious weight loss therapies. Currently the Food and Drug Administration has approved two endoscopically placed intragastric balloon devices and a surgically placed vagal blockade device. Another device that holds promise, particularly for the treatment of type 2 diabetes, is the endoscopically placed duodenojejunal bypass sleeve. This article reviews the indications and current data regarding results for these devices. PMID:27519137
Rezende, Karla Mayra; Moraes, Paulo de Camargo; Oliveira, Luciana Butini; Thomaz, Luiz Alexandre; Junqueira, José Luiz Cintra; Bönecker, Marcelo
Children can exhibit a wide variety of oral pathologies, such as oral lesions, bone lesions, tumors, cysts and cutaneous lesions. Different techniques have been described for the treatment of these lesions, but all of them are invasive. This paper presents a series of cases that demonstrate the clinical efficacy of cryosurgery as an alternative to invasive surgical treatments of the most common oral lesions in children. This technique has been well tolerated by patients due to the absence of anesthesia, rapid healing and minimal bleeding. Cryotherapy has many applications in oral medicine and is an extremely useful alternative in patients to whom surgery is contraindicated due to age or medical history. It is a simple procedure to perform, minimally invasive, low-cost and very effective in pediatric dentistry clinic. PMID:25250502
... 41 Public Contracts and Property Management 4 2011-07-01 2011-07-01 false May any travel costs be reimbursed if the employee travels to an alternate location for medical treatment? 301-70.505 Section 301-70.505 Public Contracts and Property Management Federal Travel Regulation System TEMPORARY DUTY...
Graff, Andrew E; Thomas, Andrew S; Reed, Aaron D; Skinner, William K
Classic trigeminal neuralgia (TN) causes severe facial pain. Several treatment options exist for classic TN refractory to medical therapy, including stereotactic radiosurgery (SRS). Most studies in the medical literature used a frame-based SRS technique. Improvements in linear accelerator-based treatment systems and image guidance have led to the use of frameless SRS as a safe and feasible alternative to the frame-based technique for the treatment of refractory TN. We present a case of refractory TN successfully treated with frameless SRS. PMID:27186453
Thomas, Andrew S; Reed, Aaron D; Skinner, William K
Classic trigeminal neuralgia (TN) causes severe facial pain. Several treatment options exist for classic TN refractory to medical therapy, including stereotactic radiosurgery (SRS). Most studies in the medical literature used a frame-based SRS technique. Improvements in linear accelerator-based treatment systems and image guidance have led to the use of frameless SRS as a safe and feasible alternative to the frame-based technique for the treatment of refractory TN. We present a case of refractory TN successfully treated with frameless SRS. PMID:27186453
Ballard, Brenda D.; Gipson, Martin
The nature of children's distress reactions to medical treatment is examined in terms of age and sex differences and initial normative data are provided. Predominately white, middle class children, ages 1 to 11, were observed while receiving allergy treatment injections. Males were observed on 453 injection occasions while females were observed on…
Friedmann, Peter D; Zhang, Zhiwei; Hendrickson, James; Stein, Michael D; Gerstein, Dean R
OBJECTIVE To examine whether the availability of primary medical care on-site at addiction treatment programs or off-site by referral improves patients' addiction severity and medical outcomes, compared to programs that offer no primary care. DESIGN Secondary analysis of a prospective cohort study of patients admitted to a purposive national sample of substance abuse treatment programs. SETTING Substance abuse treatment programs in major U.S. metropolitan areas eligible for demonstration grant funding from the federal Substance Abuse and Mental Health Services Administration. RESPONDENTS Administrators at 52 substance abuse treatment programs, and 2,878 of their patients who completed treatment intake, discharge, and follow-up interviews. MEASUREMENTS Program administrators reported whether the program had primary medical care available on-site, only off-site, or not at all. Patients responded to multiple questions regarding their addiction and medical status in intake and 12-month follow-up interviews. These items were combined into multi-item composite scores of addiction and medical severity. The addiction severity score includes items measuring alcohol and drug use, employment, illegal activities, legal supervision, family and other social support, housing, physical conditions, and psychiatric status. The medical severity score includes measures of perceived health, functional limitations, and comorbid physical conditions. MAIN RESULTS After controlling for treatment modality, geographic region, and multiple patient-level characteristics, patients who attended programs with on-site primary medical care experienced significantly less addiction severity at 12-month follow-up (regression coefficient, −25.9; 95% confidence interval [95% CI], −43.2 to −8.5), compared with patients who attended programs with no primary medical care. However, on-site care did not significantly influence medical severity at follow-up (coefficient, −0.28; 95% CI, −0.69 to 0
Cancelo Hidalgo, María Jesús
The main objective of treatment in women with uterine fibroids is the control of associated symptoms such as abnormal uterine bleeding, pain and pressure. Although the cost and potential adverse effects of the long-term use of medical treatment may limit its use for a long time, this alternative should be considered before indicating surgical treatment. At present, we have a considerable variety of drugs that, although not specific treatments for fibroids, may be used for the short to medium-term management of bleeding; however, we have still not found an alternative that eliminates the need for invasive treatments. Further research in this field is therefore warranted. Given the heterogeneity of fibroids and the lack of effective treatments in controlling their growth, the identification of signals that stimulate the onset and growth of these fibroids opens doors to the development of new therapies. In the future we may be able to differentiate classes of fibroids by molecular techniques and thereby implement specific treatments that control their development and their associated symptoms. PMID:24314565
Lué, Alberto; Laredo, Viviana; Lanas, Angel
Diverticular disease (DD) of the colon represents the most common disease affecting the large bowel in western countries. Its prevalence is increasing. Recent studies suggest that changes in gut microbiota could contribute to development of symptoms and complication. For this reason antibiotics play a key role in the management of both uncomplicated and complicated DD. Rifaximin has demonstrated to be effective in obtaining symptoms relief at 1 year in patients with uncomplicated DD and to improve symptoms and maintain periods of remission following acute colonic diverticulitis (AD). Despite absence of data that supports the routine use of antibiotic in uncomplicated AD, they are recommended in selected patients. In patients with AD that develop an abscess, conservative treatment with broad-spectrum antibiotics is successful in up to 70% of cases. In patients on conservative treatment where percutaneous drainage fails or peritonitis develops, surgery is considered the standard therapy. In conclusion antibiotics seem to remain the mainstay of treatment in symptomatic uncomplicated DD and AD. Inpatient management and intravenous antibiotics are necessary in complicated AD, while outpatient management is considered the best strategy in the majority of uncomplicated patients. PMID:27622367
Simpson, Barabara Sherman
Urine spraying (urine marking) is one of the most prevalent feline behavior disorders and a common reason for veterinarian consultation. Although urine spraying is a normal feline communication signal, it is unacceptable behavior for house cats, and, if untreated can lead to relinquishment, relegation outside, or even euthanasia. Urine spraying is associated with a medical disorder in up to 25% of cats that present for treatment; hence all cats that spray should undego clinical examination by a veterinarian to rule out physical causes before a psychogenic cause can be presumed. Behavioral treatment involves litter box management and medication. A variety of psychotropic medications have proven safe and effective for the long-term treatment of psychogenic feline urine spraying, but only if they are prescribed appropriately, monitored judiciously, and coupled therapeutically with environmental management. The goal of such therapy is to reduce the incidence of urine marking to a level acceptable to the owner. Compounding pharmacists perform an essential function in modifying doses of manufactured anxiolytic and antidepressant medications for use in cats whose spraying is psychogenic in origin. In this article, the case is reported of a cat successfully treated with psychotropic medication to reduce the incidence of urine marking, and medications compounded for that purpose are briefly reviewed. The role of the compounding pharmacist in ensuring the success of treatment is also discussed. PMID:23974483
El Alili, Mohamed; Vrijens, Bernard; Demonceau, Jenny; Evers, Silvia M; Hiligsmann, Mickael
Different methods are available for measuring medication adherence. In this paper, we conducted a scoping review to identify and summarize evidence of all studies comparing the Medication Event Monitoring System (MEMS) with alternative methods for measuring medication adherence. A literature search was performed using the open database www.iAdherence.org that includes all original studies reporting findings from the MEMS. Papers comparing methods for measuring adherence to solid oral formulations were included. Data was extracted using a standardized extraction table. A total of 117 articles fulfilled the inclusion criteria, including 251 comparisons. Most frequent comparisons were against self-report (n = 119) and pill count (n = 59). Similar outcome measures were used in 210 comparisons (84%), among which 78 used dichotomous variables (adherent or not) and 132 used continuous measures (adherence expressed as percentage). Furthermore, 32% of all comparisons did not estimate adherence over the same coverage period and 44% of all comparisons did not use a statistical method or used a suboptimal one. Only eighty-seven (35%) comparisons had similar coverage periods, similar outcome measures and optimal statistical methods. Compared to MEMS, median adherence was grossly overestimated by 17% using self-report, by 8% using pill count and by 6% using rating. In conclusion, among all comparisons of MEMS versus alternative methods for measuring adherence, only a few used adequate comparisons in terms of outcome measures, coverage periods and statistical method. Researchers should therefore use stronger methodological frameworks when comparing measurement methods and be aware that non-electronic measures could lead to overestimation of medication adherence. PMID:27005306
Gökalp, Mehmet Ata; Gözen, Abdurrahim; Ünsal, Seyyid Şerif; Önder, Haci; Güner, Savaş
Background An osteoid osteoma is a benign bone tumor that tends to be <1 cm in size. The tumor is characterized by night-time pain that may be relieved by aspirin or other non-steroidal anti-inflammatory drugs. Osteoid osteoma can be treated with various conservative and surgical methods, but these have some risks and difficulties. The purpose of the present study was to present an alternative treatment method for osteoid osteoma and the results we obtained. Material/Methods In the period from 2010 to 2014, 10 patients with osteoid osteoma underwent nidus excision by using a safe alternative method in an operating room (OR) with no computed tomography (CT). The localization of the tumor was determined by use of a CT-guided Kirschner wire in the radiology unit, then, in the OR the surgical intervention was performed without removing the Kirschner wire. Results Following the alternative intervention, all the patients were completely relieved of pain. In the follow-up, no recurrence or complication occurred. Conclusions The presented alternative method for treating osteoid osteoma is an efficient and practical procedure for surgeons working in clinics that lack specialized equipment. PMID:26898923
Shen, Yi-Hao A.; Nahas, Richard
Abstract OBJECTIVE To review the evidence supporting selected complementary and alternative medicine approaches used in the treatment of irritable bowel syndrome (IBS). QUALITY OF EVIDENCE MEDLINE (from January 1966), EMBASE (from January 1980), and the Cochrane Database of Systematic Reviews were searched until March 2008, combining the terms irritable bowel syndrome or irritable colon with complementary therapies, alternative medicine, acupuncture, fiber, peppermint oil, herbal, traditional, yoga, massage, meditation, mind, relaxation, probiotic, hypnotherapy, psychotherapy, cognitive therapy, or behavior therapy. Results were screened to include only clinical trials, systematic reviews, and meta-analyses. Level I evidence was available for most interventions. MAIN MESSAGE Soluble fibre improves constipation and global IBS symptoms. Peppermint oil alleviates IBS symptoms, including abdominal pain. Probiotic trials show overall benefit for IBS but there is little evidence supporting the use of any specific strain. Hypnotherapy and cognitive-behavioural therapy are also effective therapeutic options for appropriate patients. Certain herbal formulas are supported by limited evidence, but safety is a potential concern. All interventions are supported by systematic reviews or meta-analyses. CONCLUSION Several complementary and alternative therapies can be recommended as part of an evidence-based approach to the treatment of IBS; these might provide patients with satisfactory relief and improve the therapeutic alliance. PMID:19221071
Whitmore, Kristene E
The management of interstitial cystitis (IC) is predominantly the reduction of the symptoms of frequency, urgency, and pain. Multimodal treatment approaches for IC are helpful in customizing therapy for individual patients. Complementary and alternative therapies are a quintessential addition to the therapeutic armamentarium and frequently include dietary modification, nutraceuticals, bladder training, neuromodulation, stress reduction, and sex therapy. Dietary modification involves elimination of bladder irritants, fluid regulation, and a bowel regimen. Nutraceuticals studied for the treatment of IC include calcium glycerophosphate, L-arginine, mucopolysaccharides, bioflavinoids, and Chinese herbs. Bladder training is effective after pain reduction. The neuromodulation of high-tone pelvic-floor muscle dysfunction is achieved with physical therapy and acupuncture. Stress reduction and sex therapy are best administered by a qualified stress manager and sex therapist. Multimodal, nonconventional management may add efficacy to the treatment of IC. PMID:16986031
Buoli, Massimiliano; Serati, Marta; Cahn, Wiepke
Adult Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent psychiatric condition associated with high disability and frequent comorbidity. Current standard pharmacotherapy (methylphenidate and atomoxetine) improves ADHD symptoms in the short-term, but poor data were published about long-term treatment. In addition a number of patients present partial or no response to methylphenidate and atomoxetine. Research into the main database sources has been conducted to obtain an overview of alternative pharmacological approaches in adult ADHD patients. Among alternative compounds, amphetamines (mixed amphetamine salts and lisdexamfetamine) have the most robust evidence of efficacy, but they may be associated with serious side effects (e.g. psychotic symptoms or hypertension). Antidepressants, particularly those acting as noradrenaline or dopamine enhancers, have evidence of efficacy, but they should be avoided in patients with comorbid bipolar disorder. Finally metadoxine and lithium may be particularly suitable in case of comorbid alcohol misuse or bipolar disorder. PMID:26693882
Jerry, Jason M; Collins, Gregory B
People addicted to opiates are more likely to avoid returning to these drugs if they participate in a program that includes taking maintenance doses of methadone or buprenorphine than with an abstinence program. Although medical opinion has long been divided on the issue of abstinence vs medication-assisted treatment, the latter seems to be gaining respect as an evidence-based approach. PMID:23733899
Roy, A Kenison; Miller, Michael M
In a previous article, the authors described the changes initiated by recent health care legislation, and how those changes might affect the practice of medicine and the delivery of addiction services. This article reviews the same changes with respect to how they have the potential to change the practice activities of addiction physicians, addiction therapists, addiction counselors and addiction nurses, as well as the activities of administrators and service delivery financial personnel. Developments in delivery systems and the impact of those developments on professionals who work in addiction treatment are considered; current problems, potential solutions, and opportunities for clinicians under health reform are addressed. The goals envisioned for health system reform and the potential for realization of those goals via changes in addiction service delivery design and clinical practice are discussed. PMID:22880538
Wicks, George G.; Schulz, Rebecca L.; Clark, David E.
The invention discloses a tandem microwave system consisting of a primary chamber in which hybrid microwave energy is used for the controlled combustion of materials. A second chamber is used to further treat the off-gases from the primary chamber by passage through a susceptor matrix subjected to additional hybrid microwave energy. The direct microwave radiation and elevated temperatures provide for significant reductions in the qualitative and quantitative emissions of the treated off gases. The tandem microwave system can be utilized for disinfecting wastes, sterilizing materials, and/or modifying the form of wastes to solidify organic or inorganic materials. The simple design allows on-site treatment of waste by small volume waste generators.
Nasri-Heir, Cibele; Khan, Junad; Heir, Gary M
Understanding mechanisms of neuropathic orofacial pain, targets of treatment, and basic pharmacology and working with informed compounding pharmacists may result in significant benefit for patients. The clinical significance of topical medications is improvement of quality of life for patients by providing a unique medication delivery system for neuropathic orofacial pain and other dental and extraoral conditions. The use of this route of administration has decreased or minimized side effects compared with other methods and is especially useful in medically compromised and elderly patients. These innovations, supported and improved by ongoing research, will augment the armamentarium of the clinician treating orofacial pain disorders. PMID:23809308
Oosterlinck, W; Derie, A
A review of the literature of the last 5 years on retroperitoneal fibrosis is given. MRT seems to add to the exact extend of the disease and galliumscintigraphy can give new information on the activity of the process and the usefulness of medical therapy. The use of corticosteroid or other immunosuppressive drugs such a azathioprine, again is confirmed. Other drugs mentioned in the medical therapy are methotrexate, cyclophosfamide and penicillamine. A few cases responded well to tamoxifen, a drug which was already used in therapy of desmoid tumours. Medical treatment is anyhow superior to surgery alone. PMID:9287431
The shared medication treatment plan is a key element for supporting the continuity of care. Indeed a substantial amount of emergency hospitalization is linked to medication - 5% to 10% according to some studies. Methods and tools helping all healthcare providers to have a better knowledge of the complete medication plan are therefore required in order to limit side effects linked to an insufficient knowledge of what the patient is taking. The workshop intends to present various initiatives and open the discussion about the limits, pros and cons of various initiatives. PMID:27332315
Sheinman, Victor; Rudnitsky, Arkady; Toichuev, Rakhmanbek; Eshiev, Abdyrakhman; Abdullaeva, Svetlana; Egemkulov, Talantbek; Zalevsky, Zeev
An evolving area of biomedical research is related to the creation of implantable units that provide various possibilities for imaging, measurement, and the monitoring of a wide range of diseases and intrabody phototherapy. The units can be autonomic or built-in in some kind of clinically applicable implants. Because of specific working conditions in the live body, such implants must have a number of features requiring further development. This topic can cause wide interest among developers of optical, mechanical, and electronic solutions in biomedicine. We introduce preliminary clinical trials obtained with an implantable pill and devices that we have developed. The pill and devices are capable of applying in-body phototherapy, low-level laser therapy, blue light (450 nm) for sterilization, and controlled injection of chemicals. The pill is also capable of communicating with an external control box, including the transmission of images from inside the patient’s body. In this work, our pill was utilized for illumination of the sinus-carotid zone in dog and red light influence on arterial pressure and heart rate was demonstrated. Intrabody liver tissue laser ablation and nanoparticle-assisted laser ablation was investigated. Sterilization effect of intrabody blue light illumination was applied during a maxillofacial phlegmon treatment. PMID:25279540
Sheinman, Victor; Rudnitsky, Arkady; Toichuev, Rakhmanbek; Eshiev, Abdyrakhman; Abdullaeva, Svetlana; Egemkulov, Talantbek; Zalevsky, Zeev
An evolving area of biomedical research is related to the creation of implantable units that provide various possibilities for imaging, measurement, and the monitoring of a wide range of diseases and intrabody phototherapy. The units can be autonomic or built-in in some kind of clinically applicable implants. Because of specific working conditions in the live body, such implants must have a number of features requiring further development. This topic can cause wide interest among developers of optical, mechanical, and electronic solutions in biomedicine. We introduce preliminary clinical trials obtained with an implantable pill and devices that we have developed. The pill and devices are capable of applying in-body phototherapy, low-level laser therapy, blue light (450 nm) for sterilization, and controlled injection of chemicals. The pill is also capable of communicating with an external control box, including the transmission of images from inside the patient's body. In this work, our pill was utilized for illumination of the sinus-carotid zone in dog and red light influence on arterial pressure and heart rate was demonstrated. Intrabody liver tissue laser ablation and nanoparticle-assisted laser ablation was investigated. Sterilization effect of intrabody blue light illumination was applied during a maxillofacial phlegmon treatment.
Objective: To explore factors important to patients considering medical antiaging treatments. Design: Ten-minute online survey using a global opinion panel. Setting: Survey of existing and prospective patients cosponsored by the American Society for Dermatologic Surgery and Dermik Laboratories, a business of Sanofi-Aventis U.S. LLC. Participants: 383 women aged 35 to 69 years (mean, 52 years; 91% Caucasian) with an annual household income of at least $50,000, who were considering undergoing medical antiaging treatments within the next two years (“medical antiaging treatment considerers”). Of these, 100 had used an injectable product such as dermal fillers, collagen replacers, or muscle relaxants in the past two years (“injectable users”); a subset of 64 had specifically used an injectable dermal filler or collagen replacer in the past two years (“filler users”). Measurements: Maximum difference analysis of factors most important to respondents when considering medical antiaging treatments, safety, and potential for side effects. Results: Medical antiaging treatment considerers, injectable users, and filler users all identified physician training and expertise as the most important factor (93–95% of respondents); other key factors included duration of effect, cost, how the product works, and recommendation by the physician. In paired comparisons, women were more interested in results that last a long time versus immediate results (89–91% of respondents), and gradual results that last for two years versus immediate results that last for six months (85–89% of respondents). Conclusion: Physician experience and training is very important to patients who are considering medical antiaging treatments, and should therefore be addressed during the counseling of prospective patients. PMID:20877522
Ciolina, Federica; Manganaro, Lucia; Scipione, Roberto; Napoli, Alessandro
Uterine fibroids are benign neoplasms that can cause distressing symptoms in women during their reproductive age. They are often associated with menorrhagia that can determine anemia or bulk-related symptoms. Different treatment options are available: medical therapy has the goal to treat related symptoms, while semi-invasive or non-invasive uterus-sparing procedures aim to treat symptoms and eventually to determine a reduction in fibroids size. In this review we illustrate the current semi-invasive and totally non-invasive most frequently used uterus sparing procedures available. A review of the literature along with personal experience will offer the readers a panoramic view of these up-to-date treatments to be considered as different possibilities to treat women affected by uterine fibroids looking for uterus conserving non-surgical approach. PMID:26824505
Park, Seung Woon; Um, Soon Ho; Lee, Han Ah; Kim, Sang Hyun; Sim, Yura; Yim, Sun Young; Seo, Yeon Seok; Ryu, Ho Sang
Autoimmune hepatitis (AIH) is an immune-mediated chronic liver disease characterized by hepatocellular inflammation, necrosis, and fibrosis, which can progress to cirrhosis and fulminant hepatic failure. The standard treatment for AIH includes corticosteroids alone or in combination with azathioprine. Although most patients achieve remission using the standard regimen, some patients do not respond due to either drug intolerance or refractory disease; in such cases alternative immunosuppressive agents should be explored. The second-line therapies are cyclophilin inhibitors such as cyclosporine A or tacrolimus, and nowadays mycophenolate mofetil (MMF) is widely used if azathioprine-based therapies are not tolerated. Although these are recommended as an alternative to the first-line regimen, there is insufficient evidence for the efficacy of second-line therapies, with the evidence based mainly on expert opinion. Therefore, we report an AIH patient receiving the standard regimen in whom remission did not occur due to side effects to azathioprine, but was successfully treated with MMF in combination with corticosteroids as an alternative to the standard regimen. PMID:27246353
Bugshan, Amr; Patel, Harsh; Garber, Karen; Meiller, Timothy F.
Pyogenic granulomas (PGs) in the oral cavity present as an inflammatory hyperplasia usually caused by trauma, hormonal imbalance, chronic irritation, or as the response to a wide variety of drugs. PGs with atypical presentation and behavior may clinically mimic malignant tumors. Thus, histological examination is required to rule out cancer development. Lesions in the oral cavity have been described to be either an isolated entity or present in multiple forms and with multiple recurrences. Conservative surgical excision is the standard choice of treatment in almost every scenario. However, the severity of the lesions and the affected sites often challenge surgical treatment. In this report, we describe the clinical scenario of a recurrent PG, where surgical excision of the lesion was questioned. As an alternative, we describe a noninvasive approach with lesional steroid injections. PMID:26668570
Niesel, T; Moore, R G; Alfert, H J; Kavoussi, L R
Advances in endoscopic instrumentation and techniques have expanded our armamentarium for safe and effective treatment of urethral strictures. Endoscopic incision or dilation should remain the preferred treatment for uncomplicated primary strictures. Balloon dilation can be useful in the treatment of dense strictures. Incision using laser energy has yet to provide better results than procedures employing a cold knife. As such, it would be difficult to justify the added expense of laser urethrotomy. Endoscopic placement of free skin grafts into the bed of the urethra after transurethral resection or deep incision of the stricture is a novel approach that has shown a great deal of promise. Endourethroplasty is a reasonable alternative to open urethroplasty when treating long strictures, as more than 90% of the reported patients have had a successful outcome with no recurrence. However, larger experience with this procedure is necessary to verify its efficacy and for greater acceptance. The placement of indwelling stents is another new promising treatment option. Overall short-term success rates range from 75% to 100%, but the follow-up period is short, and little is known about the long-term risks of an indwelling foreign body in the urethra. Endoscopic incision via "cut-to-the-light" or "core-through" procedures is an excellent alternative in patients with obliterative strictures. Data from several centers reveal that the majority of patients gain relief of obstruction while maintaining continence and erectile potency. However, at least 25% of these patients will need further endoscopic management to maintain urethral patency. PMID:7780428
One of the most challenging scenarios in obstetric care occurs when a pregnant patient refuses recommended medical treatment that aims to support her well-being, her fetus's well-being, or both. In such circumstances, the obstetrician-gynecologist's ethical obligation to safeguard the pregnant woman's autonomy may conflict with the ethical desire to optimize the health of the fetus. Forced compliance-the alternative to respecting a patient's refusal of treatment-raises profoundly important issues about patient rights, respect for autonomy, violations of bodily integrity, power differentials, and gender equality. The purpose of this document is to provide obstetrician-gynecologists with an ethical approach to addressing a pregnant woman's decision to refuse recommended medical treatment that recognizes the centrality of the pregnant woman's decisional authority and the interconnection between the pregnant woman and the fetus. PMID:27214186
One of the most challenging scenarios in obstetric care occurs when a pregnant patient refuses recommended medical treatment that aims to support her well-being, her fetus's well-being, or both. In such circumstances, the obstetrician-gynecologist's ethical obligation to safeguard the pregnant woman's autonomy may conflict with the ethical desire to optimize the health of the fetus. Forced compliance-the alternative to respecting a patient's refusal of treatment-raises profoundly important issues about patient rights, respect for autonomy, violations of bodily integrity, power differentials, and gender equality. The purpose of this document is to provide obstetrician-gynecologists with an ethical approach to addressing a pregnant woman's decision to refuse recommended medical treatment that recognizes the centrality of the pregnant woman's decisional authority and the interconnection between the pregnant woman and the fetus. PMID:27214192
Iorno, V; Burani, R; Bianchini, B; Minelli, E; Martinelli, F; Ciatto, S
We evaluated the effect of acupuncture on NSAID resistant dysmenorrhea related pain [measured according to Visual Analogue Scale (VAS)] in 15 consecutive patients. Pain was measured at baseline (T1), mid treatment (T2), end of treatment (T3) and 3 (T4) and 6 months (T5) after the end of treatment. Substantial reduction of pain and NSAID assumption was observed in 13 of 15 patients (87%). Pain intensity was significantly reduced with respect to baseline (average VAS = 8.5), by 64, 72, 60 or 53% at T2, T3, T4 or T5. Greater reduction of pain was observed for primary as compared with secondary dysmenorrhea. Average pain duration at baseline (2.6 days) was significantly reduced by 62, 69, 54 or 54% at T2, T3, T4 or T5. Average NSAID use was significantly reduced by 63, 74, 58 or 58% at T2, T3, T4 or T5, respectively, and ceased totally in 7 patients, still asymptomatic 6 months after treatment. Our findings suggest that acupuncture may be indicated to treat dysmenorrhea related pain, in particular in those subjects in whom NSAID or oral contraceptives are contraindicated or refused. PMID:18604253
Pedersen, M; Beranova, A; Møller, S
For many years all patients with dysphonia referred to in the literature as resulting from non-organic (functional) voice disorders were sent to speech therapy. Medical diagnoses were not taken into account. In our earlier Cochrane review on vocal cord nodules we discovered that evidence-based research in the area of benign voice disorders with dysphonia, and with or without slight benign swellings including nodules on the vocal cords, was lacking at that time. Therefore, a prospective randomised pilot study based on our Cochrane review has been made on dysphonic patients with non-organic (function provoked?) voice disorders as the basis for further evidence-based studies. Medical treatment was based on the scientific approach that once a micro-organic disorder caused by reflux, infection, allergy or environmental irritatants (e.g., dust or noise in the workplace) was discovered by very careful anamnesis and systematic objective routine analyses and was treated effectively, with documentation, the non-organic voice disorder disappeared, as, e.g., in the case of a diagnosis and treatment of helicobakter pylori. The reason is that the mucosal swelling/dysfunction of the vocal cords is secondary. In order to try to understand why the recommendation to all these patients for many years was only voice therapy, which the speech therapists "felt to be effective", updated voice-hygiene advice (for posture, accents of the diaphragm, intonation pattern and resonance) was given by experienced laryngologists, randomised with the updated medical diagnosis/therapy in order to elucidate what effect the training might have. No evidence-based studies in the literature document any effect. The crucial point seemed to be that doctors mostly did not examine any other diagnoses other than the "dysphonia" and did not dig down to any of the medical reasons when the vocal fold diagnosis of "non- organic disorders" was made. This should be changed in the future. This pilot study was based
Everhart, Kelly; Lacy, Brian E.
Constipation is a highly prevalent disorder that affects people regardless of age, race, gender, or socioeconomic status. For many patients, constipation is a chronic condition that reduces quality of life. Chronic constipation also imposes a significant economic burden on the health care system. The treatment of constipation remains problematic for both patients and providers for a variety of reasons, including a lack of specificity of symptoms, an inconsistent relationship between underlying pathophysiology and symptom generation, and different and unpredictable patient responses to medications. A large number of over-the-counter agents are used to treat symptoms of constipation, although many of these agents are not effective, and data to support their use are limited and generally of poor quality. Patients referred for consultation typically have failed therapy with over-the-counter agents and require prescription medications or possibly even surgical therapy. This article discusses medical treatments and surgical options for chronic idiopathic constipation. PMID:27099579
Hussain, Zilla H; Everhart, Kelly; Lacy, Brian E
Constipation is a highly prevalent disorder that affects people regardless of age, race, gender, or socioeconomic status. For many patients, constipation is a chronic condition that reduces quality of life. Chronic constipation also imposes a significant economic burden on the health care system. The treatment of constipation remains problematic for both patients and providers for a variety of reasons, including a lack of specificity of symptoms, an inconsistent relationship between underlying pathophysiology and symptom generation, and different and unpredictable patient responses to medications. A large number of over-the-counter agents are used to treat symptoms of constipation, although many of these agents are not effective, and data to support their use are limited and generally of poor quality. Patients referred for consultation typically have failed therapy with over-the-counter agents and require prescription medications or possibly even surgical therapy. This article discusses medical treatments and surgical options for chronic idiopathic constipation. PMID:27099579
Bucolo, Claudio; Platania, Chiara Bianca Maria; Reibaldi, Michele; Bonfiglio, Vincenza; Longo, Antonio; Salomone, Salvatore; Drago, Filippo
Elevated eye pressure is the main risk factor for glaucoma; intraocular pressure rises when the ratio between aqueous humor formation (inflow) and its outflow is unbalanced. Currently, the main goal of medical treatment is the reduction of intraocular pressure. Five main classes of topical drugs are available; they include betablockers, carbonic anhydrase inhibitors, prostaglandin derivatives, sympathomimetics and miotics. Beta-blockers and carbonic anhydrase inhibitors slow the formation of aqueous humor and may be considered as "inflow" drugs; the other three classes reduce the resistance to the drainage of aqueous humor and may be considered as "outflow" drugs. Despite the variety of drugs accessible in the market, there is a real need for ophthalmologists to have more potent medications for this disease. This review focuses on medical treatment of glaucoma with particular attention to novel molecules in pre-clinical or clinical development. PMID:26350532
Bhide, V V
The ancient Vedic texts Provides us with valuable information and guide lines on various multi-faced aspects of human life. The present discussion is limited to the medical treatment and medicinal charms mentioned in the Atharvanic literature with specific consideration to Kausikasutra for better understanding of the rites and actions mentioned in Atharvanaveda. PMID:22556455
Harvey, Geralyn L.
Children with laryngeal pathologies or alterations in laryngeal structure and/or function often present with complex medical profiles. This article presents case studies for the speech-language pathologist that provide information regarding management decisions and specific treatment options. (Author/DB)
Rush, A J; Rago, W V; Crismon, M L; Toprac, M G; Shon, S P; Suppes, T; Miller, A L; Trivedi, M H; Swann, A C; Biggs, M M; Shores-Wilson, K; Kashner, T M; Pigott, T; Chiles, J A; Gilbert, D A; Altshuler, K Z
This article provides an overview of the issues involved in developing, using, and evaluating specific medication guidelines for patients with psychiatric disorders. The potential advantages and disadvantages, as well as the essential elements in the structure of algorithms, are illustrated by experience to date with the Texas Medication Algorithm Project, a public-academic collaboration. Phase 1 entailed assembling research findings on the efficacy of medications for schizophrenic, bipolar, and major depressive disorders. This knowledge was evaluated for its quality and relevance, integrated with expert clinical judgment as well as input by practicing clinicians, family advocates, and patients. Phase 1 (the design and development of the algorithms) was followed by a feasibility test (Phase 2). Phase 3 is an ongoing evaluation comparing the clinical and economic effects of using specific medication guidelines (algorithms) versus treatment as usual in public sector patients with severe and persistent mental illnesses. PMID:10362434
van Dam, P A; van Dam, V C N; Altintas, S; Papadimitriou, K; Rolfo, C; Trinh, X B
During the last decade neoadjuvant endocrine therapy (NET) has moved from being reserved for elderly and frail non-chemotherapy candidates to a primary systemic modality in selected patients with hormone sensitive breast cancer. Neoadjuvant hormonal treatment in patients with hormone receptor positive, HER-2 negative early breast cancer is proven to be an effective and safe option; it is associated with a higher rate of breast conserving surgery (BCS), may reduce the need for adjuvant chemotherapy and enables a delay of surgery for medical or practical reasons. Clinical responses range from 13% to 100% with at least 3 months of NET. Methods of assessing response should include MRI of the breast, particularly in lobular tumours. In studies comparing tamoxifen with aromatase inhibitors (AI), AI proved to be superior in terms of tumour response and rates of BCS. Change in Ki67 is accepted as a validated endpoint for comparing endocrine neoadjuvant agents. Levels of Ki67 during treatment are more closely related to long-term prognosis than pretreatment Ki67. Neoadjuvant endocrine therapy provides a unique opportunity for studies of endocrine responsiveness and the development of new experimental drugs combined with systemic hormonal treatment. PMID:26776766
Sternieri, Emilio; Coccia, Ciro Pio Rosario; Pinetti, Diego; Guerzoni, Simona; Ferrari, Anna
The present part II review highlights pharmacokinetic drug-drug interactions (excluding those of minor severity) of medications used in prophylactic treatment of the main primary headaches (migraine, tension-type and cluster headache). The principles of pharmacokinetics and metabolism, and the interactions of medications for acute treatment are examined in part I. The overall goal of this series of two reviews is to increase the awareness of physicians, primary care providers and specialists regarding pharmacokinetic drug-drug interactions (DDIs) of headache medications. The aim of prophylactic treatment is to reduce the frequency of headache attacks using beta-blockers, calcium-channel blockers, antidepressants, antiepileptics, lithium, serotonin antagonists, corticosteroids and muscle relaxants, which must be taken daily for long periods. During treatment the patient often continues to take symptomatic drugs for the attack, and may need other medications for associated or new-onset illnesses. DDIs can, therefore, occur. As a whole, DDIs of clinical relevance concerning prophylactic drugs are a limited number. Their effects can be prevented by starting the treatment with low dosages, which should be gradually increased depending on response and side effects, while frequently monitoring the patient and plasma levels of other possible coadministered drugs with a narrow therapeutic range. Most headache medications are substrates of CYP2D6 (e.g., beta-blockers, antidepressants) or CYP3A4 (e.g., calcium-channel blockers, selective serotonin re-uptake inhibitors, corticosteroids). The inducers and, especially, the inhibitors of these isoenzymes should be carefully coadministered. PMID:17125412
Pettinati, Helen M; Rabinowitz, Amanda R
In the past decade, scientists have made important progress toward understanding the neurobiology underlying an alcohol disorder. This knowledge has led to the development of promising pharmacotherapies that target the neural pathways involved in the brain's reward center in such a way that the usual treatment response (via counseling) is substantially improved upon. There are now four US Food and Drug Administration (FDA)-approved pharmacotherapies for the treatment of alcohol dependence: disulfiram (Antabuse; Odyssey Pharmaceuticals, East Hanover, NJ), oral naltrexone (ReVia; Barr Pharmaceuticals, Inc., Pomona, NY), acamprosate (Campral; Forest Laboratories, Inc., New York, NY), and, as of April 2006, an extended-release (30-day) injectable suspension formulation of naltrexone (Vivitrol; Alkermes, Inc., Cambridge, MA). Other types of medications (eg, topiramate and quetiapine) are currently under investigation for the treatment of alcohol dependence. Research also has provided insights into best practices for prescribing the available medications. This report reviews the latest innovations in pharmacotherapy for the treatment of alcohol dependence, focusing on FDA-approved medications presently available to the treatment community. PMID:16968619
Nolan, Justin M; Schneider, Mary Jo
Tourists travel to Arkansas' mountain regions to experience, appreciate, and consume multiple aspects of otherness, including sacred sites and pristine and authentic peoples and environments. A largely unexplored aspect of this consumption of authenticity is alternative medicine, provided to tourists and day travelers in search of physical and emotional restoration. Traditional forms of medicine are deeply rooted in women's social roles as community healers in the region and are perpetuated in part because of the lack of readily accessible forms of so-called modern medicine. Contemporary medical tourism in Arkansas has promoted access to folk health systems, preserving them by incorporating them into tourists' health care services, and also has attracted new and dynamic alternative medical practices while encouraging the transformation of existing forms of traditional medicine. Ultimately, the blend of alternative, folk, and conventional medicine in the Arkansas highlands is evidence of globalizing forces at work in a regional culture. It also serves to highlight a renewed appreciation for the historic continuity and the efficacy of traditional knowledge in the upper South. PMID:21114077
Levy, J K
Cardiovascular rehabilitation is the process of restoring functional abilities degraded by a serious cardiovascular event or by a surgical procedure to preempt such an event. Cardiovascular rehabilitation also includes attempts to reverse risk factors that have contributed initially to the disease process. Rehabilitation programs generally comprise disease-related educational components, supervised prescriptive physical exercise, diet counseling and modification, cessation of tobacco use, psychoeducational interventions aimed at adjustment and coping, and relaxation and stress management to lower nonexertion-related sympathetic drive. The presence of so-called coronary-prone behavior patterns can be detected, and special behavioral modifications may be indicated to mitigate these putative risk factors. This paper reviews the roles of these behavioral adjuncts in treating cardiovascular disease and its aftermath, and notes new and unusual approaches to these components of treatment, such as alternative exercises, biofeedback, yoga, and other relaxation methods. Barriers to compliance are acknowledged, and enhancement of compliance is discussed briefly. PMID:8219823
Alkatheri, Abdulmalik A; Albekairy, Abdulkareem M; Jarab, Anan; Bustami, Rami; Khalidi, Nabil; Alshaya, Abdulrahman; Bin Saleh, Khalid; Alraddadi, Sultan; Alharbi, Shmeylan; Vasudevan, Senthilvel; Alsayyari, Abdullah; Qandil, Amjad M
BACKGROUND Evidence suggests that patients who are more satisfied with their treatment show better adherence with the prescribed therapy. Although there is valuable data about medication adherence among renal transplant recipients (RTRs), there is a limited literature about their treatment satisfaction and its relation to adherence. The aim of the present study was to investigate factors that can predict medication adherence and to explore the relationship between treatment satisfaction and medication adherence in renal transplant recipients. MATERIAL AND METHODS Adult RTRs were included in the study using convenient sampling. The participants were asked to complete the 8-item Morisky Medication Adherence Scale (MMAS-8) and Treatment Satisfaction Scale TSQM 1.4 in addition to several socio-demographic and treatment-related data. The results were statistically analyzed using univariate and multivariate logistic regression modelling in a stepwise procedure. RESULTS A total of 151 RTRs were included in the study, of which 52 were classified as adherent (34%). Univariate analysis showed that, in comparison with non-adherent RTRs, the adherent group demonstrated significantly higher satisfaction scores in the domains of convenience (96.6±8.7 vs. 85.3±19.3), side effects (95.9±14.1 vs. 82.6±24.1), and global satisfaction (93.4±9.8 vs. 86.7±16.7), while they had marginally higher satisfaction scores in the effectiveness domain (90.4±11.6 vs. 86.5±14.5). Results from multiple logistic regression showed that higher likelihood of adherence was significantly associated with increased satisfaction score in the convenience domain [AOR=1.76, 95% CI=(1.21, 2.55); p=0.003] and marginally related to increased satisfaction scores in the side effects domain [AOR=1.31, 95% CI=(0.99, 1.74); p=0.061]. Male RTRs were significantly more likely to be adherent than female RTRs [AOR=2.23, 95% CI=(1.02, 4.84); p=0.043]. CONCLUSIONS Although the adherence rate among RTRs is relatively
Saxon, Andrew J; Hser, Yih-Ing; Woody, George; Ling, Walter
Among agents for treatment of opioid addiction, methadone is a full mu-opioid receptor agonist, whereas buprenorphine is a partial agonist. Both are long-acting. Buprenorphine has a superior safety profile. Methadone is formulated for oral administration and buprenorphine for sublingual administration. A subdermal buprenorphine implant with a 6-month duration of action is being considered for approval by the U.S. Food and Drug Administration. Both medications reduce mortality rates and improve other outcomes. Data from a recent randomized controlled comparison of both medications (N = 1269) show better treatment retention with methadone but reduced illicit opioid use early in treatment with buprenorphine. Human immunodeficiency virus (HIV) risk behaviors were measured using the Risk Behavior Survey at baseline, 12 weeks, and 24 weeks for study completers. In the 30 days prior to treatment entry, 14.4% of the completers randomized to treatment with buprenorphine (n = 340) and 14.1% of the completers randomized to methadone treatment (n = 391) shared needles. The percent sharing needles decreased to 2.4% for buprenorphine and 4.8 for methadone in the 30 days prior to Week 24 (p < 0.0001). In the 30 days prior to treatment entry, 6.8% of the completers randomized to buprenorphine and 8.2% of the completers randomized to methadone had multiple sexual partners, with only 5.2% and 5.1%, respectively, reporting multiple partners at Week 24 (p < 0.04). PMID:24436573
Buitelaar, Jan; Asherson, Philip; Soutullo, Cesar; Colla, Michael; Adams, David H; Tanaka, Yoko; Haynes, Virginia S; Escobar, Rodrigo; Upadhyaya, Himanshu
The attention-deficit/hyperactivity disorder (ADHD) treatment literature has been focused on onset-of-effect and short-term effect size, with little exploration of ADHD symptoms upon medication discontinuation. The objective of this narrative review and analysis was to better understand the relapse of ADHD symptoms upon discontinuation of medication treatment in children, adolescents, and adults with ADHD who have responded to medication treatment and to explore differences among different medications in maintaining treatment response. Randomized withdrawal studies of dexmethylphenidate hydrochloride (d-MPH), methylphenidate modified-release (MPH-LA), lisdexamphetamine dimesylate (LDX), guanfacine extended-release (GXR), and atomoxetine (ATX) in both children/adolescents and adults with ADHD were reviewed. The percentage of relapse was significantly higher and the time-to-relapse significantly shorter with placebo compared to active treatment in patients who were previously stable on 5 weeks to 1 year of active treatment, suggesting clinically significant benefit with continued long-term pharmacotherapy. However, percentage of relapse at each time point studied after discontinuing stimulants and GXR appears substantially higher than observed when discontinuing ATX, suggesting longer maintenance of response after discontinuing ATX than after stimulants and GXR. Additionally, slope of relapse percentages over time appears to be more rapid with stimulants or GXR than with ATX. These differences in maintenance of response among ATX, GXR, and stimulants may reflect differences in mechanisms of action and persistence of the medication effect. Alternatively, they may be due to methodological differences, including study design and response/relapse definitions. Continued investigation is needed regarding factors that affect risk of symptom relapse upon discontinuation of pharmacotherapy. PMID:26169574
Ameade, Evans Paul Kwame; Amalba, Anthony; Helegbe, Gideon Kofi; Mohammed, Baba Sulemana
Interest, use of and research into Complementary and Alternative Medicine (CAM; bǔ chōng yǔ tì dài yī xué) is on the increase in recent times even in developed countries. It may therefore be appropriate if medical students who would become future physicians possess adequate knowledge and better attitude towards CAMS. This study assessed medical students' knowledge of, attitude towards, and usage of CAM as well as their opinion about integrating CAMs into the medical curriculum. In a cross-sectional study, 203 medical students in 2nd, 3rd and 4th year classes completed a questionnaire. Data was analyzed using SPSS 18 and GraphPad 5.01. Association between different variables was tested. The overall mean knowledge score was 19.6%. Students in higher years of study were significantly more knowledgeable in CAMs (p = 0.0006). The best known CAM was herbal medicine (63.6%), with relatives and friends being their main source of information. Students' attitude towards CAM was good (75.1%) with majority (71.5%) favouring introduction of CAM into the medical curriculum; preferably at the preclinical level (67.5%). Year of study, gender and locality where student grew up did not significantly affect attitude towards CAM use. Up to 117 (59.0%) of the students had ever used CAM especially herbal medicine. Although students in this study were deficient in knowledge on CAMs, their attitude and usage was good. Herbal medicine was the best known and used CAM. Majority of the students believed knowledge on CAM would be beneficial to their practice hence, desirous of its introduction into their medical curriculum. PMID:27419086
Fraser, J J
The purpose of this technical report is to provide pediatricians with an understanding of past crises within the professional liability insurance industry, the difficulties of the tort system, and alternative strategies for resolving malpractice disputes that have been applied to medical malpractice actions. Through this report, pediatricians will gain a technical understanding of common alternative dispute resolution (ADR) strategies. The report explains the distinctions between various ADR methods in terms of process and outcome, risks and benefits, appropriateness to the nature of the dispute, and long-term ramifications. By knowing these concepts, pediatricians faced with malpractice claims will be better-equipped to participate in the decision-making with legal counsel on whether to settle, litigate, or explore ADR options. PMID:11230609
Stroke is the third leading cause of mortality. Approximately 80 to 85% strokes are ischemic due to carotid artery stenosis (CAS). The prevalence of significant CAS is 7% in women and 9% in men. Severe asymptomatic CAS varies from 0 to 3.1%. Prevalence of symptomatic CAS is high in patients with peripheral arterial disease. CAS is due to atherosclerosis, the major risk factors for which include dyslipidemia, hypertension, diabetes, obesity, cigarette smoking, advanced glycation end products (AGEs) and its receptors (RAGE, soluble RAGE [sRAGE]), lack of exercise and C-reactive protein (CRP). This article discusses the basic mechanism of atherosclerosis and the mechanisms by which these risk factors induce atherosclerosis. The role of AGEs and its receptors in the development and progression of CAS has been discussed in detail. Lifestyle changes and medical treatment of CAS such as lifestyle changes, lipid-lowering agents, antihypertensive agents, antidiabetic drugs, anti-AGE therapy, measures to elevate soluble receptors of AGE (sRAGE, esRAGE). CRP-lowering agents have been discussed in detail. The drugs especially lipid-lowering agents, and antihypertensive and antidiabetic drugs suppress, regress, and slow the progression of CAS. The possible role of lowering the levels of AGEs and raising the levels of sRAGE in the treatment of CAS has been proposed. Lifestyle changes besides medical treatment have been stressed. Lifestyle changes and medical treatment not only would slow the progression of CAS but would also regress the CAS. PMID:26417183
Medication-overuse headache (MOH) is one of the most common chronic headache disorders and a public health problem with a worldwide prevalence of 1–2%. It is a condition characterized by chronic headache and overuse of different headache medications, and withdrawal of the overused medication is recognised as the treatment of choice. However, the strategy for achieving withdrawal is, at present, based on expert opinion rather than scientific evidence, partly due to the lack of randomised controlled studies. This narrative review investigates different aspects of epidemiology, diagnosis, risk factors and pathogenesis as well as management for MOH. We suggest that the first step in the treatment of MOH should be carried out in general practice and should focus primarily on detoxification. For most patients, both prevention and follow up after detoxification can also be performed in general practice, thus freeing resources for referral of more complicated cases to headache clinics and neurologists. These suffering patients have much to gain by an earlier treatment-focused approach lower down on the treatment ladder. PMID:25083264
Vlyssides, A; Barampouti, E M; Mai, S; Stamatoglou, A; Tsimas, E
This work studied alternative treatment schemes for the vinasse wastewater from wine distilleries aiming at overcoming the problems caused by the high nitrogen and sulfur concentrations. A plexiglas laboratory-scale upflow anaerobic sludge blanket (UASB) reactor of 20 L volume that was operated at 45°C and hydraulic retention time 1 d, was included in all the examined systems. System 1 was the conventional UASB reactor, system 2 was the UASB reactor supplemented with iron. System 3 consisted of the UASB reactor supplemented with iron and a CSTR reactor that operated under the following conditions: Diluted Oxygen 1.2 mg/L, Hydraulic Retention Time 1 d, pH 6.7 and Temperature 45°C. System 3 aimed at converting ammonium directly to dinitrogen gas under anaerobic conditions but it needed to be preceeded by a first partial nitrification step. All systems had high COD efficiencies over 75%. Ferrous iron addition apart from enhancing the performance of systems 2 and 3, it was able to retain all sulphur content of the wastewater as ferrous sulfide stripping the biogas from hydrogen sulfide. System 3 also managed to meet its goal, since it achieved an 86% nitrogen reduction. Conclusively, system 3 seems to be a very promising environmental technology for the treatment of distillery and winery byproducts, as well as industrial wastewater with high sulfur and nitrogen content. PMID:21123920
Milani, Andrea; Geuna, Elena; Zucchini, Giorgia; Aversa, Caterina; Martinello, Rossella; Montemurro, Filippo
About 10% of breast cancers are associated with the inheritance of autosomal dominant breast cancer susceptibility alleles BRCA1 and BRCA2. Until recently, the medical management of BRCA mutation-associated breast cancer has not differed from that of the sporadic breast cancer counterpart. However, there is mounting evidence that this molecular alteration confers sensitivity or resistance to systemic therapies that can be exploited in terms of medical management. For example, studies support the use of platinum salts chemotherapy in BRCA mutated cancers. Moreover, a number of targeted therapies are showing activity in BRCA mutation carriers. Above all, BRCA defective tumor cells are particularly sensitive to Poly(ADP-ribose) polymerase (PARP) inhibitors. This review will summarize the state of the art of the medical treatment of breast cancer in BRCA mutation carriers, with a particular focus on chemotherapies and targeted therapies. PMID:26799758
Marom, Tal; Marchisio, Paola; Tamir, Sharon Ovnat; Torretta, Sara; Gavriel, Haim; Esposito, Susanna
Otitis media (OM) has numerous presentations in children. Together with conventional medical therapies aimed to prevent and/or treat OM, a rising number of complementary and alternative medicine (CAM) treatment options can be offered. Since OM is common in children, parents may ask healthcare professionals about possible CAM therapies. Many physicians feel that their knowledge is limited regarding these therapies, and that they desire some information. Therefore, we conducted a literature review of CAM therapies for OM, taking into account that many of these treatments, their validity and efficacy and have not been scientifically demonstrated.We performed a search in MEDLINE (accessed via PubMed) using the following terms: "CAM" in conjunction with "OM" and "children. Retrieved publications regarding treatment of OM in children which included these terms included randomized controlled trials, prospective/retrospective studies, and case studies.The following CAM options for OM treatment in children were considered: acupuncture, homeopathy, herbal medicine/phytotherapy, osteopathy, chiropractic, xylitol, ear candling, vitamin D supplement, and systemic and topical probiotics. We reviewed each treatment and described the level of scientific evidence of the relevant publications.The therapeutic approaches commonly associated with CAM are usually conservative, and do not include drugs or surgery. Currently, CAM is not considered by physicians a potential treatment of OM, as there is limited supporting evidence. Further studies are warranted in order to evaluate the potential value of CAM therapies for OM. PMID:26871802
Yakir, Segev; Riskin-Mashiah, Shlomit; Lavie, Ofer; Auslender, Ron
The aim of modern obstetrics is to bring a healthy child to a healthy mother. Preconception counseling is a form of preventive medicine that consists of three main components: risk assessment, health promotion and intervention, in order to improve pregnancy outcome. A large proportion of women, who need assisted reproductive technologies (ART) due to infertility, are older than the average pregnant women. The risk for chronic maternal disease such as obesity, diabetes mellitus, chronic hypertension, cardiovascular diseases and malignant disease greatly increases with maternal age. Chronic maternal illness might increase the risk of in vitro fertilization procedure and is also associated with increased obstetrics risk and even death. A previous study has shown that most maternal deaths in the USA, due to chronic maternal disease, are potentially preventable through better medical care from preconception, yet most studies that deal with preconception care in infertility patients only address the problems of infertility. Therefore, similar to the recommendations of the American Heart Association before non-competitive physical activity, and the American Society of Anesthesiologists before an elective surgery, we suggest a pre-ART medical assessment. Our objective is to outline the potential risks for older women who undergo ART procedure and potentially, pregnancy, and to characterize guidelines for evaluation prior to enrolling them in ART programs. Pre-ART assessment should include a thorough medical questionnaire and medical examination. Appropriate treatment for women with medical conditions prior to ART procedure and optimizing disease control in preparation for pregnancy including changing a potentially teratogenic treatment, can improve women's health status prior to pregnancy and reduce pregnancy related complications. At the end of the evaluation, and before ART treatment, the women should be consulted, based on the results of tests, on the possible risks
Pinho, Sílvia C; Nunes, Olga C; Lobo-da-Cunha, Alexandre; Almeida, Manuel F
Although alkaline hydrolysis treatment emerges as an alternative disinfection/sterilization method for medical waste, information on its effects on the inactivation of biological indicators is scarce. The effects of alkaline treatment on the resistance of Geobacillus stearothermophilus spores were investigated and the influence of temperature (80 °C, 100 °C and 110 °C) and NaOH concentration was evaluated. In addition, spore inactivation in the presence of animal tissues and discarded medical components, used as surrogate of medical waste, was also assessed. The effectiveness of the alkaline treatment was carried out by determination of survival curves and D-values. No significant differences were seen in D-values obtained at 80 °C and 100 °C for NaOH concentrations of 0.5 M and 0.75 M. The D-values obtained at 110 °C (2.3-0.5 min) were approximately 3 times lower than those at 100 °C (8.8-1.6 min). Independent of the presence of animal tissues and discarded medical components, 6 log10 reduction times varied between 66 and 5 min at 100 °C-0.1 M NaOH and 110 °C-1 M NaOH, respectively. The alkaline treatment may be used in future as a disinfection or sterilization alternative method for contaminated waste. PMID:26150372
Background Health consumers have moved away from a reliance on medical practitioner advice to more independent decision processes and so their information search processes have subsequently widened. This study examined how persons with back pain searched for alternative treatment types and service providers. That is, what information do they seek and how; what sources do they use and why; and by what means do they search for it? Methods 12 persons with back pain were interviewed. The method used was convergent interviewing. This involved a series of semi-structured questions to obtain open-ended answers. The interviewer analysed the responses and refined the questions after each interview, to converge on the dominant factors influencing decisions about treatment patterns. Results Persons with back pain mainly search their memories and use word of mouth (their doctor and friends) for information about potential treatments and service providers. Their search is generally limited due to personal, provider-related and information-supply reasons. However, they did want in-depth information about the alternative treatments and providers in an attempt to establish apriori their efficacy in treating their specific back problems. They searched different sources depending on the type of information they required. Conclusions The findings differ from previous studies about the types of information health consumers require when searching for information about alternative or mainstream healthcare services. The results have identified for the first time that limited information availability was only one of three categories of reasons identified about why persons with back pain do not search for more information particularly from external non-personal sources. PMID:24725300