Clinical therapeutics
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Clinical therapeutics · May 2004
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialEffects of QD insulin detemir or neutral protamine Hagedorn on blood glucose control in patients with type I diabetes mellitus using a basal-bolus regimen.
The purpose of this trial was to compare the effects of QD basal insulin replacement using insulin detemir versus neutral protamine Hagedorn (NPH) insulin in basal-bolus therapy in combination with regular human insulin (HI) in patients with type 1 diabetes mellitus (DM). ⋯ In this study, QD administration of insulin detemir at bedtime resulted in lower fasting blood glucose levels with less day-to-day variability and less fluctuation from ean blood glucose levels over 24 hours than NPH insulin, combined with an overall reduction in the risk of nocturnal hypoglycemia. These findings suggest that evening administration of insulin detemir may provide an opportunity to further improve fasting blood glucose targets.
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Clinical therapeutics · May 2004
Randomized Controlled Trial Comparative Study Clinical TrialComparison of rofecoxib and oxycodone plus acetaminophen in the treatment of acute pain: a randomized, double-blind, placebo-controlled study in patients with moderate to severe postoperative pain in the third molar extraction model.
Opiates, acetaminophen, nonselective nonsteroidal anti-inflammatory drugs (NSAIDs), and cyclooxygenase-2-selective inhibitors such as rofecoxib are used in the treatment of acute pain because of their anti-inflammatory and/or analgesic properties. Rofecoxib has demonstrated an improved gastrointestinal safety profile compared with nonselective NSAIDs. ⋯ In study patients with moderate to severe pain after dental surgery, rofecoxib 50 mg had a greater analgesic effect than oxycodone/acetaminophen 5/325 mg and was associated with less nausea and vomiting.
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Clinical therapeutics · May 2004
Randomized Controlled Trial Comparative Study Clinical TrialEtoricoxib in acute pain associated with dental surgery: a randomized, double-blind, placebo- and active comparator-controlled dose-ranging study.
Patients experiencing acute pain after surgery, including dental surgery, often require analgesia. Ideally, the chosen analgesic should have a rapid onset and sustained effect. Etoricoxib is a new cyclooxygenase-2-selective inhibitor that has demonstrated analgesic efficacy in the treatment of acute pain with a rapid onset and long-lasting pain relief. ⋯ In this dose-ranging study, etoricoxib 120 mg was determined to be the minimum dose that had maximal efficacy in patients with moderate to severe acute pain associated with dental surgery. Both etoricoxib and ibuprofen were generally well tolerated.
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Clinical therapeutics · May 2004
ReviewPrevention and treatment of stroke in patients with hypertension.
Each year, stroke occurs in 30.9 million individuals worldwide and is responsible for approximately 4 million deaths. In the United States, it is the third leading cause of death, occurring with greater frequency than myocardial infarction in patients with hypertension. The greatest burden of stroke, apart from death, is serious long-term physical and mental disability. Stroke survivors often experience physical handicap, depression, and cognitive dysfunction, which together affect their daily functioning, quality of life, and survival. The treatment of stroke is associated with extremely high costs, with stroke-related illnesses responsible for >$49 billion in the United States in 2002. Despite intensive research efforts, few effective treatments are available once stroke has occurred; thus, stroke prevention should be a primary focus for all health care providers. ⋯ Identifying and modifying key risk factors is crucial to reducing the morbidity and mortality of stroke. Hypertension is one of the most important risk factors for stroke, and treatment with a variety of antihypertensive agents reduces the risk. Recent evidence suggests that the angiotensin II (ATII)-receptor antagonist losartan may offer advantages beyond blood pressure lowering, including attenuation of the central aortic reflected pressure wave, molecule-specific properties, and neural protective influences on brain ATII type 2 receptors.
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Clinical therapeutics · May 2004
Do evidence-based treatments provide incremental benefits to patients with congestive heart failure already receiving angiotensin-converting enzyme inhibitors? A secondary analysis of one-year outcomes from the Assessment of Treatment with Lisinopril and Survival (ATLAS) study.
In patients with congestive heart failure (CHF), use of submaximal doses of angiotensin-converting enzyme (ACE) inhibitors (ie, low-dose ACE inhibitors) represents usual care in routine clinical practice, whereas high-dose ACE inhibitors, beta-blockers, and digoxin have each been shown to improve outcomes. ⋯ Compared with usual care for patients with CHF, in this analysis, an evidence-based strategy that incorporated high-dose ACE inhibitors plus beta-blockers plus digoxin was associated with incrementally greater reductions in morbidity and mortality. These findings support treatment guidelines that recommend the concurrent use of all available proven efficacious treatment in patients with advanced CHF.