2009 January 01

Corticotropin tests for hypothalamic-pituitary- adrenal insufficiency: a metaanalysis.

J Clin Endocrinol Metab Start a Discussion »

Jan 012009

Corticotropin tests for hypothalamic-pituitary- adrenal insufficiency: a metaanalysis.

J Clin Endocrinol Metab. 2008 Nov;93(11):4245-53

Authors: Kazlauskaite R, Evans AT, Villabona CV, Abdu TA, Ambrosi B, Atkinson AB, Choi CH, Clayton RN, Courtney CH, Gonc EN, Maghnie M, Rose SR, Soule SG, Tordjman K,

CONTEXT: The diagnostic value of tests for detecting hypothalamic-pituitary adrenal insufficiency (HPAI) is controversial. OBJECTIVE: Our objective was to compare standard-dose and low-dose corticotropin tests for diagnosing HPAI. DATA SOURCES: We searched the PubMed database from 1966-2006 for studies reporting diagnostic value of standard-dose or low-dose corticotropin tests, with patient-level data obtained from original investigators. STUDY SELECTION: Eligible studies had more than 10 patients. All subjects were evaluated because of suspicion for chronic HPAI, and patient-level data were available. We excluded studies with no accepted reference standard for HPAI (insulin hypoglycemia or metyrapone test) if test subjects were in the intensive care unit or if only normal healthy subjects were used as controls. DATA EXTRACTION: We constructed receiver operator characteristic (ROC) curves using patient-level data from each study and then merged results to create summary ROC curves, adjusting for study size and cortisol assay method. Diagnostic value of tests was measured by calculating area under the ROC curve (AUC) and likelihood ratios. DATA SYNTHESIS: Patient-level data from 13 of 23 studies (57%; 679 subjects) were included in the metaanalysis. The AUC were as follows: low-dose corticotropin test, 0.92 (95% confidence interval 0.89-0.94), and standard-dose corticotropin test, 0.79 (95% confidence interval 0.74-0.84). Among patients with paired data (seven studies, 254 subjects), diagnostic value of low-dose corticotropin test was superior to standard-dose test (AUC 0.94 and 0.85, respectively; P<0.001). CONCLUSIONS: Low-dose corticotropin test was superior to standard-dose test for diagnosing chronic HPAI, although it has technical limitations.

PMID: 18697868 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Dysphagia in the elderly.

Phys Med Rehabil Clin N Am Start a Discussion »

Jan 012009

Dysphagia in the elderly.

Phys Med Rehabil Clin N Am. 2008 Nov;19(4):853-66, ix-x

Authors: Humbert IA, Robbins J

The capacity to swallow or eat is a basic human need and can be a great pleasure. Older adults look forward to sharing mealtimes and participating in social interactions. The loss of capacity to swallow and dine can have far-reaching implications. With age, the ability to swallow undergoes changes that increase the risk for disordered swallowing, with devastating health implications for older adults. With the growth in the aging population, dysphagia is becoming a national health care burden and concern. Upward of 40% of people in institutionalized settings are dysphagic. There is a need to address dysphagia in ambulatory, acute care, and long-term care settings.

PMID: 18940645 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Treatment of oral and pharyngeal dysphagia.

Phys Med Rehabil Clin N Am Start a Discussion »

Jan 012009

Treatment of oral and pharyngeal dysphagia.

Phys Med Rehabil Clin N Am. 2008 Nov;19(4):803-16, ix

Authors: Logemann JA

Research on treatment of oropharyngeal dysphagia has supported several treatment approaches. Treatment can include postural changes, heightening preswallow sensory input, voluntary swallow maneuvers, and exercises. Evidence to support the efficacy of these procedures is variable. An instrumental study of a patient's oropharyngeal swallow forms the basis for treatment selection.

PMID: 18940642 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

The bedside examination in dysphagia.

Phys Med Rehabil Clin N Am Start a Discussion »

Jan 012009

The bedside examination in dysphagia.

Phys Med Rehabil Clin N Am. 2008 Nov;19(4):747-68, viii

Authors: Carnaby-Mann G, Lenius K

The evaluation of swallowing disorders currently uses a variety of methods. The most common dichotomy is between instrumental and noninstrumental or clinical examinations. The clinical bedside assessment often is considered the mainstay of dysphagia management. As the first line of assessment, it frequently defines the process and requisites of the task. This article reviews the available methods of noninstrumental bedside swallowing assessment and considers the issues surrounding the use of these approaches today.

PMID: 18940639 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Pexelizumab in ischemic heart disease: a systematic review and meta-analysis on 15,196 patients.

J Thorac Cardiovasc Surg Start a Discussion »

Jan 012009

Pexelizumab in ischemic heart disease: a systematic review and meta-analysis on 15,196 patients.

J Thorac Cardiovasc Surg. 2008 Oct;136(4):884-93

Authors: Testa L, Van Gaal WJ, Bhindi R, Biondi-Zoccai GG, Abbate A, Agostoni P, Porto I, Andreotti F, Crea F, Banning AP

OBJECT: Pexelizumab is a humanized monoclonal antibody inhibiting C5 complement. It has been postulated to improve outcomes in patients undergoing coronary artery bypass surgery and urgent reperfusion therapy for ST elevation myocardial infarction. We aimed at evaluating the risk/benefit profile of pexelizumab (bolus + infusion) versus placebo on top of current approaches in the management of patients with ST elevation myocardial infarction or undergoing coronary artery bypass. METHODS: We conducted a search of BioMedCentral, CENTRAL, mRCT, and PubMed without language restrictions (updated October 2007) for randomized controlled trials. Outcomes of interest were the risk of major adverse events (the composite of all-cause death, myocardial infarction, and thromboembolic stroke), the risk of single end points, and heart failure. RESULTS: Seven trials were included (15,196 patients: 7019 patients with ST elevation myocardial infarction and 8177 undergoing coronary bypass surgery). No benefit of adding pexelizumab was found in the overall analysis for major adverse events (OR 0.91 [0.76-1.09]; P = .29], death (OR 0.79 [0.61-1.03], P = .11], myocardial infarction (OR 1.04 [0.89-1.22]; P = .14), stroke (OR 0.95 [0.66-1.38]; P = .8), heart failure (OR1.0 [0.82-1.22]; P = .99), nor in the settings of patients with ST elevation myocardial infarction treated with mechanical or pharmacologic reperfusion therapy. Pexelizumab was associated with a 26% reduction of the risk of death in the setting of coronary artery bypass (OR 0.74 [0.58-0.94]; P = .01). The number needed to treat was 100. CONCLUSION: Our data ruled out the hypothesis of any benefit of adding pexelizumab on top of currently available therapies for ST elevation myocardial infarction. However, pexelizumab reduces the risk of death in patients undergoing coronary artery bypass grafting.

PMID: 18954626 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Intensive versus conventional insulin therapy: a randomized controlled trial in medical and surgical critically ill patients.

Crit Care Med Start a Discussion »

Jan 012009

Intensive versus conventional insulin therapy: a randomized controlled trial in medical and surgical critically ill patients.

Crit Care Med. 2008 Dec;36(12):3190-7

Authors: Arabi YM, Dabbagh OC, Tamim HM, Al-Shimemeri AA, Memish ZA, Haddad SH, Syed SJ, Giridhar HR, Rishu AH, Al-Daker MO, Kahoul SH, Britts RJ, Sakkijha MH

OBJECTIVE: The role of intensive insulin therapy in medical surgical intensive care patients remains unclear. The objective of this study was to examine the effect of intensive insulin therapy on mortality in medical surgical intensive care unit patients. DESIGN: Randomized controlled trial. SETTINGS: Tertiary care intensive care unit. PATIENTS: Medical surgical intensive care unit patients with admission blood glucose of > 6.1 mmol/L or 110 mg/dL. INTERVENTION: A total of 523 patients were randomly assigned to receive intensive insulin therapy (target blood glucose 4.4-6.1 mmol/L or 80-110 mg/dL) or conventional insulin therapy (target blood glucose 10-11.1 mmol/L or 180-200 mg/dL). MEASUREMENTS AND MAIN OUTCOMES: The primary end point was intensive care unit mortality. Secondary end points included hospital mortality, intensive care unit and hospital length of stay, mechanical ventilation duration, the need for renal replacement therapy and packed red blood cells transfusion, and the rates of intensive care unit acquired infections as well as the rate of hypoglycemia (defined as blood glucose < or = 2.2 mmol/L or 40 mg/dL). There was no significant difference in intensive care unit mortality between the intensive insulin therapy and conventional insulin therapy groups (13.5% vs. 17.1%, p = 0.30). After adjustment for baseline characteristics, intensive insulin therapy was not associated with mortality difference (adjusted hazard ratio 1.09, 95% confidence interval 0.70-1.72). Hypoglycemia occurred more frequently with intensive insulin therapy (28.6% vs. 3.1% of patients; p < 0.0001 or 6.8/100 treatment days vs. 0.4/100 treatment days; p < 0.0001). There was no difference between the intensive insulin therapy and conventional insulin therapy in any of the other secondary end points. CONCLUSIONS: Intensive insulin therapy was not associated with improved survival among medical surgical intensive care unit patients and was associated with increased occurrence of hypoglycemia. Based on these results, we do not advocate universal application of intensive insulin therapy in intensive care unit patients. TRIAL REGISTRATION: Current Controlled Trials registry (ISRCTN07413772) http://www.controlled-trials.com/ISRCTN07413772/07413772; 2005.

PMID: 18936702 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Older Entries

January 2009
M	T	W	T	F	S	S
« Dec				Feb »
			1	2	3	4
5	6	7	8	9	10	11
12	13	14	15	16	17	18
19	20	21	22	23	24	25
26	27	28	29	30	31