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  1. Article ; Online: Evidence-based management of systemic sclerosis: Navigating recommendations and guidelines.

    Pellar, Russell Edward / Pope, Janet Elizabeth

    Seminars in arthritis and rheumatism

    2017  Volume 46, Issue 6, Page(s) 767–774

    Abstract: Objectives: Systemic sclerosis (SSc) is a rare heterogeneous connective tissue disease. Recommendations addressing the major issues in the management of SSc including screening and treatment of organ complications are needed.: Methods: The updated ... ...

    Abstract Objectives: Systemic sclerosis (SSc) is a rare heterogeneous connective tissue disease. Recommendations addressing the major issues in the management of SSc including screening and treatment of organ complications are needed.
    Methods: The updated European League Against Rheumatism/European Scleroderma Trial and Research (EULAR/EUSTAR) and the British Society of Rheumatology (BSR) and British Health Professionals in Rheumatology (BHPR) guidelines were compared and contrasted.
    Results: The updated EULAR/EUSTAR guidelines focus specifically on the management of SSc features and include data on newer therapeutic modalities and mention a research agenda. These recommendations are pharmacologic, with few guidelines regarding investigations and non-pharmacologic management. Recommendations from BSR/BHPR are similar to the organ manifestations mentioned in the EULAR/EUSTAR recommendations, and expand on several domains of treatment, including general measures, non-pharmacologic treatment, cardiac involvement, calcinosis, and musculoskeletal features. The guidelines usually agree with one another. Limitations include the lack of guidance for combination or second-line therapy, algorithmic suggestions, the absence of evidence-based recommendations regarding the treatment of specific complications (i.e., gastric antral ectasia and erectile dysfunction). Consensus for when to treat interstitial lung disease in SSc is lacking. There are differences between Europe and North American experts due to access and indications for certain therapies.
    Conclusions: Care gaps in SSc have been demonstrated so the EULAR/EUSTAR and BSR/BHP guidelines can promote best practices. Certain complications warrant active investigation to further improve outcomes in SSc and future updates of these recommendations. Care gaps in SSc have been demonstrated so the EULAR/EUSTAR and BSR/BHP guidelines can promote best practices. Certain complications warrant active investigation to further improve outcomes in SSc.
    Language English
    Publishing date 2017-06
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 120247-9
    ISSN 1532-866X ; 0049-0172
    ISSN (online) 1532-866X
    ISSN 0049-0172
    DOI 10.1016/j.semarthrit.2016.12.003
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  2. Article ; Online: Raynaud's phenomenon (primary).

    Pope, Janet Elizabeth

    BMJ clinical evidence

    2011  Volume 2011

    Abstract: Introduction: Raynaud's phenomenon is an episodic vasospasm of the peripheral arteries, causing pallor, followed by cyanosis and redness with pain, and sometimes paraesthesia. On rare occasions it can lead to ulceration of the fingers and toes (and in ... ...

    Abstract Introduction: Raynaud's phenomenon is an episodic vasospasm of the peripheral arteries, causing pallor, followed by cyanosis and redness with pain, and sometimes paraesthesia. On rare occasions it can lead to ulceration of the fingers and toes (and in some cases of the ears or nose). This review focuses on primary (idiopathic) Raynaud's phenomenon, occurring in the absence of an underlying disease. The prevalence of primary Raynaud's phenomenon varies by sex, country, and exposure to workplace vibration.
    Methods and outcomes: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for primary Raynaud's phenomenon? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
    Results: We found 16 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
    Conclusions: In this systematic review we present information relating to the effectiveness and safety of the following interventions: amlodipine, diltiazem, exercise, inositol nicotinate, keeping warm, moxisylyte (thymoxamine), naftidrofuryl oxalate, nicardipine, nifedipine, prazosin, and smoking cessation.
    MeSH term(s) Administration, Oral ; Humans ; Nifedipine/therapeutic use ; Prevalence ; Raynaud Disease/drug therapy ; Ulcer ; Vibration
    Chemical Substances Nifedipine (I9ZF7L6G2L)
    Language English
    Publishing date 2011-03-14
    Publishing country England
    Document type Journal Article ; Review ; Systematic Review
    ZDB-ID 2393858-4
    ISSN 1752-8526 ; 1757-0816 ; 1475-9225
    ISSN (online) 1752-8526
    ISSN 1757-0816 ; 1475-9225
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  3. Article ; Online: Phosphodiesterase 5 inhibitors (PDE5i) for the treatment of Raynaud's phenomenon.

    Maltez, Nancy / Maxwell, Lara J / Rirash, Fadumo / Tanjong Ghogomu, Elizabeth / Harding, Sarah E / Tingey, Paul C / Wells, George A / Tugwell, Peter / Pope, Janet

    The Cochrane database of systematic reviews

    2023  Volume 11, Page(s) CD014089

    Abstract: Background: Raynaud's phenomenon is a vasodilatory phenomenon characterised by digital pallor, cyanosis, and pain of the extremities. Primary Raynaud's phenomenon has no underlying disease associated with it, while secondary Raynaud's phenomenon is ... ...

    Abstract Background: Raynaud's phenomenon is a vasodilatory phenomenon characterised by digital pallor, cyanosis, and pain of the extremities. Primary Raynaud's phenomenon has no underlying disease associated with it, while secondary Raynaud's phenomenon is associated with connective tissue disorders such as systemic sclerosis. Systemic sclerosis causes fibrosis and commonly affects the skin and internal organs such as the gastrointestinal tract, lungs, kidney, and heart. Phosphodiesterase 5 inhibitors (PDE5i) are a class of drugs that increases blood flow to the extremities and may be beneficial in the treatment of Raynaud's phenomenon.
    Objectives: To assess the benefits and harms of PDE5i compared to placebo for the treatment of Raynaud's phenomenon.
    Search methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and clinical trial registries up to June 2022. We did not apply any language restrictions. We searched the bibliographies of retrieved articles and contacted key experts in the field for additional and unpublished data.
    Selection criteria: Randomised controlled trials (RCTs) comparing PDE5i to placebo in people with primary and secondary Raynaud's phenomenon.
    Data collection and analysis: We used standard methodological procedures expected by Cochrane.
    Main results: This review included nine RCTs which ranged in duration from four to eight weeks and included a total of 411 participants. The majority had Raynaud's phenomenon secondary to systemic sclerosis. Tadalafil was assessed in four studies, sildenafil in three studies, vardenafil in one study, and a new PDE5 inhibitor known as "PF-00489791" in one study. Three studies were parallel design and six studies were cross-over. The frequency of attacks per week was 24 with placebo and PDE5i reduced the frequency of attacks by an average of three attacks per week (mean difference (MD) -3.07, 95% confidence interval (CI) -5.15 to -1.00; 8 studies; low-certainty evidence). The duration of attacks per day was 55 minutes with placebo and PDE5i reduced the duration of attacks by an average of five minutes (MD -5.31, 95% CI -8.90 to -1.71; 8 studies; low-certainty evidence). Very low-certainty evidence from one study with eight participants showed severity of Raynaud's attacks (assessed on a 10 cm visual analogue scale with lower scores indicating less severity) was 20% lower with a PDE5i (3.7 with placebo compared to 1.6 with treatment; MD -2.1, 95% CI -2.7 to 1.4; very low-certainty evidence). Pain and patient global assessment were assessed on a 10 cm visual analogue scale with lower scores indicating improvement. Low-certainty evidence showed that the use of PDE5i may result in little to no difference compared to placebo in reducing the average pain of Raynaud's attacks (3 to 2.9; MD -0.10, 95% CI -0.78 to 0.57; 4 studies). Global scores were 36% lower with the use of a PDE5i compared to placebo (9.2 to 5.6; MD -3.59, 95% CI -4.45 to -2.73; 1 study, 24 participants; low-certainty evidence). The rate of withdrawals during treatment with PDE5i ranged from 4% to 20% compared with 2% in the placebo group in five studies. Four studies reported no withdrawals due to adverse events. Seven studies reported no serious adverse events. The rate of serious adverse events reported in two studies ranged from 2% during treatment to 4% with placebo. The majority of the studies were judged as low or unclear risk of bias for selection, performance, and detection bias. Almost half were judged at high risk of attrition bias and unclear risk for selective reporting bias. We downgraded frequency of attacks, duration of attacks, pain intensity, and patient global assessment for small sample sizes and concerns about inconsistency and graded each as low certainty of evidence. We downgraded severity of attacks to very low certainty due to serious concerns about imprecision and publication bias. We downgraded withdrawals due to adverse events and serious adverse events to moderate certainty of evidence due to a low number of reported events.
    Authors' conclusions: Based on low-certainty evidence, PDE5i may reduce the frequency of attacks of Raynaud's phenomenon by a small amount per week, result in a small reduction in the duration of attack, improve patients' global assessment of their disease, and result in little to no difference in pain. PDE5i probably result in little or no difference in serious adverse events but slightly increase the likelihood of withdrawing from treatment due to an adverse event.
    MeSH term(s) Humans ; Pain ; Phosphodiesterase 5 Inhibitors/therapeutic use ; Sample Size ; Scleroderma, Systemic/complications ; Scleroderma, Systemic/drug therapy
    Chemical Substances Phosphodiesterase 5 Inhibitors
    Language English
    Publishing date 2023-11-06
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ISSN 1469-493X
    ISSN (online) 1469-493X
    DOI 10.1002/14651858.CD014089
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Patient-Reported Outcome Measures in Systemic Sclerosis (Scleroderma).

    Pellar, Russell E / Tingey, Theresa M / Pope, Janet Elizabeth

    Rheumatic diseases clinics of North America

    2016  Volume 42, Issue 2, Page(s) 301–316

    Abstract: Scleroderma (systemic sclerosis) is a rare autoimmune connective tissue disease that can damage multiple organs and reduce quality of life. Patient-reported outcome measures capture the patient's perspective. Some measures are specific to systemic ... ...

    Abstract Scleroderma (systemic sclerosis) is a rare autoimmune connective tissue disease that can damage multiple organs and reduce quality of life. Patient-reported outcome measures capture the patient's perspective. Some measures are specific to systemic sclerosis and others are general. Patient-reported outcomes in systemic sclerosis are important to aid in understanding the impact of systemic sclerosis on patients.
    MeSH term(s) Activities of Daily Living ; Humans ; Mental Health ; Patient Reported Outcome Measures ; Quality of Life ; Scleroderma, Systemic/physiopathology ; Social Participation ; Surveys and Questionnaires
    Language English
    Publishing date 2016-05
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 92118-x
    ISSN 1558-3163 ; 0889-857X
    ISSN (online) 1558-3163
    ISSN 0889-857X
    DOI 10.1016/j.rdc.2016.01.003
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  5. Article ; Online: Raynaud's phenomenon (primary).

    Pope, Janet Elizabeth

    BMJ clinical evidence

    2008  Volume 2008

    Abstract: Introduction: Raynaud's phenomenon is an episodic vasospasm of the peripheral arteries, causing pallor followed by cyanosis and redness with pain and sometimes paraesthesia. On rare occasions it can lead to ulceration of the fingers and toes (and in ... ...

    Abstract Introduction: Raynaud's phenomenon is an episodic vasospasm of the peripheral arteries, causing pallor followed by cyanosis and redness with pain and sometimes paraesthesia. On rare occasions it can lead to ulceration of the fingers and toes (and in some cases of the ears or nose). This review focuses on primary (idiopathic) Raynaud's phenomenon occurring in the absence of an underlying disease. The prevalence of primary Raynaud's phenomenon varies by sex, country, and exposure to workplace vibration.
    Methods and outcomes: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for primary Raynaud's phenomenon? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2008 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
    Results: We found 15 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
    Conclusions: In this systematic review we present information relating to the effectiveness and safety of the following interventions: amlodipine, diltiazem, exercise, inositol nicotinate, keeping warm, moxisylyte (thymoxamine), naftidrofuryl oxalate, nicardipine, nifedipine, prazosin, and smoking cessation.
    MeSH term(s) Administration, Oral ; Humans ; Nifedipine/therapeutic use ; Prevalence ; Raynaud Disease/drug therapy ; Ulcer ; Vibration
    Chemical Substances Nifedipine (I9ZF7L6G2L)
    Language English
    Publishing date 2008-12-16
    Publishing country England
    Document type Journal Article ; Review ; Systematic Review
    ZDB-ID 2393858-4
    ISSN 1752-8526 ; 1757-0816 ; 1475-9225
    ISSN (online) 1752-8526
    ISSN 1757-0816 ; 1475-9225
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  6. Article ; Online: Cooking Education Improves Cooking Confidence and Dietary Habits in Veterans.

    Dexter, Ashley S / Pope, Janet F / Erickson, Dawn / Fontenot, Catherine / Ollendike, Elizabeth / Walker, Emily

    The Diabetes educator

    2019  Volume 45, Issue 4, Page(s) 442–449

    Abstract: Purpose: The purpose of the study was to evaluate a 12-week cooking education class on cooking confidence, dietary habits, weight status, and laboratory data among veterans with prediabetes and diabetes.: Methods: The sample for this study included ... ...

    Abstract Purpose: The purpose of the study was to evaluate a 12-week cooking education class on cooking confidence, dietary habits, weight status, and laboratory data among veterans with prediabetes and diabetes.
    Methods: The sample for this study included 75 veterans within the Overton Brooks Veteran Affairs Medical Center who completed the 12-week class in an in-person group setting in Shreveport, Louisiana, or via Clinical Video Telehealth (CVT) in Longview, Texas. Veterans were referred to the Healthy Teaching Kitchen by their primary care provider or primary care dietitian. Enrollment in the class was on a volunteer basis. The cooking and nutrition education classes included topics such as carbohydrate counting, safety and sanitation, meal planning, and creating budget-friendly recipes. Participants completed 2 questionnaires for assessment of healthy dietary habits and confidence related to cooking. Changes in body weight, lipid panel, and hemoglobin A1C were assessed. Differences in class settings were tested via independent samples
    Results: Subjects lost a mean 2.91 ± 5.8 lbs (
    Conclusions: Cooking and nutrition education can increase cooking confidence and dietary quality. These results provide support for the need for further research on the long-term effects of nutrition cooking education and for the benefits of using CVT software to provide education to remote facilities.
    MeSH term(s) Adult ; Aged ; Blood Glucose/analysis ; Cooking/methods ; Diabetes Mellitus/blood ; Diabetes Mellitus/psychology ; Feeding Behavior/psychology ; Female ; Glycated Hemoglobin A/analysis ; Health Education/methods ; Health Knowledge, Attitudes, Practice ; Humans ; Louisiana ; Male ; Middle Aged ; Outcome Assessment, Health Care ; Prediabetic State/blood ; Prediabetic State/psychology ; Program Evaluation ; Retrospective Studies ; Self Concept ; Texas ; Veterans/education ; Veterans/psychology
    Chemical Substances Blood Glucose ; Glycated Hemoglobin A ; hemoglobin A1c protein, human
    Language English
    Publishing date 2019-05-10
    Publishing country United States
    Document type Evaluation Study ; Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 603168-7
    ISSN 1554-6063 ; 0145-7217
    ISSN (online) 1554-6063
    ISSN 0145-7217
    DOI 10.1177/0145721719848429
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  7. Article: Cooking Education Improves Cooking Confidence and Dietary Habits in Veterans

    Dexter, Ashley S / Pope, Janet F / Erickson, Dawn / Fontenot, Catherine / Ollendike, Elizabeth / Walker, Emily

    Diabetes educator. 2019 Aug., v. 45, no. 4

    2019  

    Abstract: The purpose of the study was to evaluate a 12-week cooking education class on cooking confidence, dietary habits, weight status, and laboratory data among veterans with prediabetes and diabetes. The sample for this study included 75 veterans within the ... ...

    Abstract The purpose of the study was to evaluate a 12-week cooking education class on cooking confidence, dietary habits, weight status, and laboratory data among veterans with prediabetes and diabetes. The sample for this study included 75 veterans within the Overton Brooks Veteran Affairs Medical Center who completed the 12-week class in an in-person group setting in Shreveport, Louisiana, or via Clinical Video Telehealth (CVT) in Longview, Texas. Veterans were referred to the Healthy Teaching Kitchen by their primary care provider or primary care dietitian. Enrollment in the class was on a volunteer basis. The cooking and nutrition education classes included topics such as carbohydrate counting, safety and sanitation, meal planning, and creating budget-friendly recipes. Participants completed 2 questionnaires for assessment of healthy dietary habits and confidence related to cooking. Changes in body weight, lipid panel, and hemoglobin A1C were assessed. Differences in class settings were tested via independent samples t tests. Paired samples t tests were completed to compare changes in mean laboratory results, weight, and questionnaire responses. Subjects lost a mean 2.91 ± 5.8 lbs (P < .001). There was no significant difference in percent change in laboratory data and weight between subjects participating via CVT and subjects in the live class. Overall, there was significant improvement in the confidence questionnaire ratings and Healthy Habits Questionnaire responses. Cooking and nutrition education can increase cooking confidence and dietary quality. These results provide support for the need for further research on the long-term effects of nutrition cooking education and for the benefits of using CVT software to provide education to remote facilities.
    Keywords body weight ; carbohydrates ; computer software ; cooking ; diabetes ; dietitians ; eating habits ; glycohemoglobin ; health behavior ; health education ; lipids ; long term effects ; meal planning ; medical facilities ; nutrition education ; nutritional adequacy ; questionnaires ; recipes ; sanitation ; veterans
    Language English
    Dates of publication 2019-08
    Size p. 442-449.
    Publishing place SAGE Publications
    Document type Article
    ZDB-ID 2173745-9
    ISSN 1554-6063 ; 0145-7217
    ISSN (online) 1554-6063
    ISSN 0145-7217
    DOI 10.1177/0145721719848429
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  8. Article: Measuring the Rheumatology Workforce in Canada: A Literature Review.

    Brophy, Julie / Marshall, Deborah A / Badley, Elizabeth M / Hanly, John G / Averns, Henry / Ellsworth, Janet / Pope, Janet E / Barber, Claire E H

    The Journal of rheumatology

    2016  Volume 43, Issue 6, Page(s) 1121–1129

    Abstract: Objective: The number of rheumatologists per capita has been proposed as a performance measure for arthritis care. This study reviews what is known about the rheumatologist workforce in Canada.: Methods: A systematic search was conducted in EMBASE ... ...

    Abstract Objective: The number of rheumatologists per capita has been proposed as a performance measure for arthritis care. This study reviews what is known about the rheumatologist workforce in Canada.
    Methods: A systematic search was conducted in EMBASE and MEDLINE using the search themes "rheumatology" AND "workforce" AND "Canada" from 2000 until December 2014. Additionally, workforce databases and rheumatology websites were searched. Data were abstracted on the numbers of rheumatologists, demographics, retirement projections, and barriers to healthcare.
    Results: Twenty-five sources for rheumatology workforce information were found: 6 surveys, 14 databases, 2 patient/provider resources, and 3 epidemiologic studies. Recent estimates say there are 398 to 428 rheumatologists in Canada, but there were limited data on allocation of time to clinical practice. Although the net number of rheumatologists has increased, the mean age was ≥ 47.7 years, and up to one-third are planning to retire in the next decade. There is a clustering of rheumatologists around academic centers, while some provinces/territories have suboptimal ratios of rheumatologists per capita (range 0-1.1). Limited information was found on whether rural areas are receiving adequate services. The most consistent barrier reported by rheumatologists was lack of allied health professionals.
    Conclusion: In Canada there are regional disparities in access to rheumatologist care and an aging rheumatologist workforce. To address these workforce capacity issues, better data are needed including information on clinical full-time equivalents, delivery of care to remote communities, and use of alternative models of care to increase clinical capacity.
    Language English
    Publishing date 2016-06
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 194928-7
    ISSN 1499-2752 ; 0315-162X
    ISSN (online) 1499-2752
    ISSN 0315-162X
    DOI 10.3899/jrheum.151174
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  9. Article ; Online: Calcium channel blockers for primary and secondary Raynaud's phenomenon.

    Rirash, Fadumo / Tingey, Paul C / Harding, Sarah E / Maxwell, Lara J / Tanjong Ghogomu, Elizabeth / Wells, George A / Tugwell, Peter / Pope, Janet

    The Cochrane database of systematic reviews

    2017  Volume 12, Page(s) CD000467

    Abstract: Background: Raynaud's phenomenon is a vasospastic disease characterized by digital pallor, cyanosis, and extremity pain. Primary Raynaud's phenomenon is not associated with underlying disease, but secondary Raynaud's phenomenon is associated with ... ...

    Abstract Background: Raynaud's phenomenon is a vasospastic disease characterized by digital pallor, cyanosis, and extremity pain. Primary Raynaud's phenomenon is not associated with underlying disease, but secondary Raynaud's phenomenon is associated with connective tissue disorders such as systemic sclerosis, systemic lupus erythematosus, and mixed connective tissue disease. Calcium channel blockers promote vasodilation and are commonly used when drug treatment for Raynaud's phenomenon is required.
    Objectives: To assess the benefits and harms of calcium channel blockers (CCBs) versus placebo for treatment of individuals with Raynaud's phenomenon with respect to Raynaud's type (primary vs secondary) and type and dose of CCBs.
    Search methods: We searched the Cochrane Central Register of Controlled Trials (May 19, 2017), MEDLINE (1946 to May 19, 2017), Embase (1947 to May 19, 2017), clinicaltrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Portal. We applied no language restrictions. We also searched bibliographies of retrieved articles and contacted key experts for additional and unpublished data.
    Selection criteria: All randomized controlled trials (RCTs) comparing calcium channel blockers versus placebo.
    Data collection and analysis: Two review authors independently assessed search results and risk of bias and extracted trial data. We used the GRADE approach to assess the quality of evidence.
    Main results: This review contains 38 RCTs (33 cross-over RCTs) with an average duration of 7.4 weeks and 982 participants; however, not all trials reported all outcomes of interest. Nine of the identified trials studied patients with primary Raynaud's phenomenon (N = 365), five studied patients with secondary Raynaud's phenomenon (N = 63), and the rest examined a mixture of patients with primary and secondary Raynaud's phenomenon (N = 554). The most frequently encountered risk of bias types were incomplete outcome data and poor reporting of randomization and allocation methods.When researchers considered both primary and secondary Raynaud's phenomenon, evidence of moderate quality (downgraded for inconsistency) from 23 trials with 528 participants indicates that calcium channel blockers (CCBs) were superior to placebo in reducing the frequency of attacks. CCBs reduced the average number of attacks per week by six ( weighted mean difference (WMD) -6.13, 95% confidence interval (CI) -6.60 to - 5.67; I² = 98%) compared with 13.7 attacks per week with placebo. When review authors excluded Kahan 1985C, a trial showing a very large reduction in the frequency of attacks, data showed that CCBs reduced attack frequency by 2.93 per week (95% CI -3.44 to -2.43; I² = 77%).Low-quality evidence (downgraded for imprecision and inconsistency) from six trials with 69 participants suggests that the average duration of attacks did not differ in a statistically significant or clinically meaningful way between CCBs and placebo (WMD -1.67 minutes, 95% CI -3.29 to 0); this is equivalent to a -9% difference (95% CI -18% to 0%).Moderate-quality evidence (downgraded for inconsistency) based on 16 trials and 415 participants showed that CCBs reduced attack severity by 0.62 cm (95% CI -0.72 to - 0.51) on a 10-cm visual analogue scale (lower scores indicate less severity); this was equivalent to absolute and relative percent reductions of 6% (95% CI -11% to -8%) and 9% (95% CI -11% to -8%), respectively, which may not be clinically meaningful.Improvement in Raynaud's pain (low-quality evidence; downgraded for imprecision and inconsistency) and in disability as measured by a patient global assessment (moderate-quality evidence; downgraded for imprecision) favored CCBs (pain: WMD -1.47 cm, 95% CI -2.21 to -0.74; patient global: WMD -0.37 cm, 95% CI -0.73 to 0, when assessed on a 0 to 10 cm visual analogue scale, with lower scores indicating less pain and less disability). However, these effect estimates were likely underpowered, as they were based on limited numbers of participants, respectively, 62 and 92. For pain assessment, absolute and relative percent improvements were 15% (95% -22% to -7%) and 47% (95% CI -71% to -24%), respectively. For patient global assessment, absolute and relative percent improvements were 4% (95% CI -7% to 0%) and 9% (95% CI -19% to 0%), respectively.Subgroup analyses by Raynaud's type, CCB class, and CCB dose suggest that dihydropyridine CCBs in higher doses may be more effective for primary Raynaud's than for secondary Raynaud's, and CCBs likely have a greater effect in primary than in secondary Raynaud's. However, differences were small and were not found for all outcomes. Dihydropyridine CCBs were studied as they are the subgroup of CCBs that are not cardioselective and are traditionally used in RP treatment whereas other CCBs such as verapamil are not routinely used and diltiazem is not used as first line subtype of CCBs. Most trial data pertained to nifedipine.Withdrawals from studies due to adverse effects were inconclusive owing to a wide CI (risk ratio [RR] 1.30, 95% CI 0.51 to 3.33) from two parallel studies with 63 participants (low-quality evidence downgraded owing to imprecision and a high attrition rate); absolute and relative percent differences in withdrawals were 6% (95% CI -14% to 26%) and 30% (95% CI -49% to 233%), respectively. In cross-over trials, although a meta-analysis was not performed, withdrawals were more common with CCBs than with placebo. The most common side effects were headache, dizziness, nausea, palpitations, and ankle edema. However, in all trials, no serious adverse events (death or hospitalization) were reported.
    Authors' conclusions: Randomized controlled trials with evidence of low to moderate quality showed that CCBs (especially the dihydropyridine class) may be useful in reducing the frequency, duration, severity of attacks, pain and disability associated with Raynaud's phenomenon. Higher doses may be more effective than lower doses and these CCBs may be more effective in primary RP. Although there were more withdrawals due to adverse events in the treatment groups, no serious adverse events were reported.
    MeSH term(s) Calcium Channel Blockers/administration & dosage ; Calcium Channel Blockers/therapeutic use ; Dihydropyridines/administration & dosage ; Dihydropyridines/therapeutic use ; Humans ; Nifedipine/administration & dosage ; Nifedipine/therapeutic use ; Pain Management ; Placebos/therapeutic use ; Publication Bias ; Randomized Controlled Trials as Topic ; Raynaud Disease/drug therapy ; Raynaud Disease/etiology ; Severity of Illness Index
    Chemical Substances Calcium Channel Blockers ; Dihydropyridines ; Placebos ; 1,4-dihydropyridine (7M8K3P6I89) ; Nifedipine (I9ZF7L6G2L)
    Language English
    Publishing date 2017-12-13
    Publishing country England
    Document type Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Review ; Systematic Review
    ISSN 1469-493X
    ISSN (online) 1469-493X
    DOI 10.1002/14651858.CD000467.pub2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Overweight, Obesity, and the Likelihood of Achieving Sustained Remission in Early Rheumatoid Arthritis: Results From a Multicenter Prospective Cohort Study.

    Schulman, Elizabeth / Bartlett, Susan J / Schieir, Orit / Andersen, Kathleen M / Boire, Gilles / Pope, Janet E / Hitchon, Carol / Jamal, Shahin / Thorne, J Carter / Tin, Diane / Keystone, Edward C / Haraoui, Boulos / Goodman, Susan M / Bykerk, Vivian P

    Arthritis care & research

    2018  Volume 70, Issue 8, Page(s) 1185–1191

    Abstract: Objective: Obesity is implicated in rheumatoid arthritis (RA) development, severity, outcomes, and treatment response. We estimated the independent effects of overweight and obesity on ability to achieve sustained remission (sREM) in the 3 years ... ...

    Abstract Objective: Obesity is implicated in rheumatoid arthritis (RA) development, severity, outcomes, and treatment response. We estimated the independent effects of overweight and obesity on ability to achieve sustained remission (sREM) in the 3 years following RA diagnosis.
    Methods: Data were from the Canadian Early Arthritis Cohort, a multicenter observational trial of early RA patients treated by rheumatologists using guideline-based care. sREM was defined as Disease Activity Score in 28 joints (DAS28) <2.6 for 2 consecutive visits. Patients were stratified by body mass index (BMI) as healthy (18.5-24.9 kg/m
    Results: Of 982 patients, 315 (32%) had a healthy BMI, 343 (35%) were overweight, and 324 (33%) were obese; 355 (36%) achieved sREM within 3 years. Initial treatment did not differ by BMI category. Compared to healthy BMI, overweight patients (hazard ratio [HR] 0.75 [95% confidence interval (95% CI) 0.58-0.98]) and obese patients (HR 0.53 [95% CI 0.39-0.71]) were significantly less likely to achieve sREM.
    Conclusion: Rates of overweight and obesity were high (69%) in this early RA cohort. Overweight patients were 25% less likely, and obese patients were 47% less likely, to achieve sREM in the first 3 years, despite similar initial disease-modifying antirheumatic drug treatment and subsequent biologic use. This is the largest study demonstrating the negative impact of excess weight on RA disease activity and supports a call to action to better identify and address this risk in RA patients.
    MeSH term(s) Adult ; Age Distribution ; Aged ; Antirheumatic Agents/therapeutic use ; Arthritis, Rheumatoid/diagnosis ; Arthritis, Rheumatoid/drug therapy ; Arthritis, Rheumatoid/epidemiology ; Body Mass Index ; Canada/epidemiology ; Cohort Studies ; Comorbidity ; Disability Evaluation ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Multivariate Analysis ; Obesity/epidemiology ; Overweight/epidemiology ; Prevalence ; Prognosis ; Proportional Hazards Models ; Prospective Studies ; Remission Induction ; Severity of Illness Index ; Sex Distribution ; Survival Analysis ; Treatment Outcome ; Young Adult
    Chemical Substances Antirheumatic Agents
    Language English
    Publishing date 2018-07-13
    Publishing country United States
    Document type Journal Article ; Multicenter Study ; Observational Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 645059-3
    ISSN 2151-4658 ; 0893-7524 ; 2151-464X
    ISSN (online) 2151-4658
    ISSN 0893-7524 ; 2151-464X
    DOI 10.1002/acr.23457
    Database MEDical Literature Analysis and Retrieval System OnLINE

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