Current medical research and opinion
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Meta Analysis Comparative Study
Retrograde versus antegrade intramedullary nailing for femoral fractures: a meta-analysis of randomized controlled trials.
To conduct a meta-analysis of randomized controlled trials assessing the effect on clinical outcomes of intramedullary nailing for femoral fractures via a retrograde or antegrade approach. ⋯ Both retrograde and antegrade intramedullary nailing produced high union rates. We found no significant difference in union rate between the retrograde nailing group and the antegrade nailing group for femoral fractures (RR 1.02, 95% CI: 0.94-1.11, p = 0.59, I (2 )= 0%).
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The risk of stroke in atrial fibrillation (AF) increases with number of risk factors (RFs). However, the combined effect from multiple RFs on the incidence of ischemic stroke and transient ischemic attack (TIA) among US patients without AF has not been fully examined. ⋯ In a large cohort of elderly patients without AF, the risk of ischemic stroke/TIA increased substantially in the presence of multiple RFs, highlighting potentially unmet medical needs. This observation implies that future studies may be warranted to investigate the effect of prophylactic anticoagulation in high risk non-AF patients.
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Observational Study
Adherence to denosumab in the treatment of osteoporosis and its utilization in the Czech Republic.
The objective was to analyze adherence and current trends in utilization and prescription practice patterns of the anti-RANKL monoclonal antibody denosumab in the treatment of postmenopausal osteoporosis (OP). ⋯ Despite relatively high MPR and persistence rate observed in denosumab treatment, adherence enhancing strategies, focused on persistence in particular, are still needed. The uptake of denosumab has been rapid, its utilization keeps rising swiftly, and denosumab already represents a significant part of the osteoporosis therapy budget.
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To provide an overview of the drug profile of the orally active, selective endothelin A receptor antagonist ambrisentan, and its efficacy and safety in the treatment of patients with pulmonary arterial hypertension (PAH). ⋯ The long-term efficacy and safety profile of ambrisentan in patients with PAH is supported by data from a comprehensive clinical trial program and real-life, post-marketing observations.
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Review
A holistic approach to chronic pain management that involves all stakeholders: change is needed.
Chronic pain affects a large proportion of the population, imposing significant individual distress and a considerable burden on society, yet treatment is not always instituted and/or adequate. Comprehensive multidisciplinary management based on the biopsychosocial model of pain has been shown to be clinically effective and cost-efficient, but is not widely available. A literature review of stakeholder groups revealed many reasons for this, including: i) many patients believe healthcare professionals lack relevant knowledge, and consultations are rushed, ii) general practitioners consider that pain management has a low priority and is under-resourced, iii) pain specialists cite non-adherence to evidence-based treatment, sub-optimal prescribing, and chronic pain not being regarded as a disease in its own right, iv) nurses', pharmacists' and physiotherapists' skills are not fully utilized, and v) psychological therapy is employed infrequently and often too late. ⋯ Equally important measures include the widespread adoption of a patient-centered approach, chronic pain being recognized as a disease in its own right, and the development of universal guidelines for managing chronic non-cancer pain. Perhaps the greatest barrier to improvement is lack of political will at both national and international level. Some powerful initiatives and collaborations are currently lobbying policy-making bodies to raise standards and reduce unnecessary pain - it is vital they continue.