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Cushing Response

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261. Special Endocrine Testing

testing, with rare exception, is indicated for the investigation of hypercalcemia with concomitantly low parathyroid hormone (PTH) only and is not indicated for monitoring patients receiving calcitriol. Insulin testing is primarily useful for investigation of spontaneous hypoglycemia or to help distinguish type I diabetes from type II diabetes, but not for establishment of insulin resistance. The utility of salivary hormone testing in any clinical context is limited to Cushing Syndrome screening using (...) and plasma renin activity after 1-2 hours ambulation and before 10 AM. Numerous physiological states and medications interfere with sensitivity and specificity of screening. Renin MSP cost: $63.87 – $98.11 Indications Non-Indications Investigation of secondary causes of hypertension: primary aldosteronism and renal artery stenosis. Monitoring of CAH and mineralocorticoid supplementation in Addison’s Disease. Cortisol, 24-hour urine free Indications Non-Indications Used for targeted screening for Cushing

2016 Clinical Practice Guidelines and Protocols in British Columbia

262. Osteoporosis: assessing the risk of fragility fracture

Osteoporosis: assessing the risk of fragility fracture Osteoporosis: assessing the risk of Osteoporosis: assessing the risk of fr fragility fr agility fracture acture Clinical guideline Published: 8 August 2012 nice.org.uk/guidance/cg146 © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Y Y our responsibility our responsibility The recommendations in this guideline represent the view of NICE, arrived at after careful (...) consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian

2012 National Institute for Health and Clinical Excellence - Clinical Guidelines

263. Saxenda - liraglutide

. Pharmacokinetics 24 2.4.3. Pharmacodynamics 27 2.4.4. Discussion on clinical pharmacology 30 2.4.5. Conclusions on clinical pharmacology 32 2.5. Clinical efficacy 33 2.5.1. Dose response study 33 2.5.2. Dose response and main studies 33 2.5.3. Discussion on clinical efficacy 59 2.5.4. Conclusions on the clinical efficacy 63 2.6. Clinical safety 63 2.6.1. Discussion on clinical safety 75 2.6.2. Conclusions on the clinical safety 78 2.7. Pharmacovigilance 79 2.8. Risk Management Plan 79 2.9. Product information (...) Denmark Novo Nordisk A/S Novo Alle, 2880 Bagsvaerd Denmark Manufacturers responsible for batch release Novo Nordisk A/S Novo Alle 2880 Bagsvaerd DENMARK 1.3. Steps taken for the assessment of the product The Rapporteur and Co-Rapporteur appointed by the CHMP were: Rapporteur: Pieter de Graeff Co-Rapporteur: Jens Heisterberg CHMP Peer reviewer:Ondrej Slanar • The application was received by the EMA on 20 December 2013. • The procedure started on 22 January 2014. • The Rapporteur's first Assessment

2015 European Medicines Agency - EPARs

264. Corluxin - mifepristone

). In addition reductions in fasting blood glucose, 2 hour post prandial glucose and insulin reflect the changes in AUC and are strongly supportive of the efficacy of Corluxin in managing hyperglycaemia in those with Cushing’s syndrome with DM or impaired glucose tolerance. The applicant has recalculated response rates for the primary endpoint in the DM population using the ITT population and two sided 95% confidence intervals. The lower bound for the 95% CI in the ITT population is 32.5% which is above (...) and symptoms of endogenous Cushing’s syndrome in adults is not approvable since "major objections" have been identified to which the applicant has not responded at the time of withdrawal of the application, which preclude a recommendation for marketing authorisation at the present time. The major objections precluding a recommendation of marketing authorisation pertain to the following principal deficiencies: Quality 1. Clear documentary evidence confirming inspection of the site of finished product

2015 European Medicines Agency - EPARs

265. Anesthesia Information Management Systems for Patients Undergoing Surgery

Anesthesia Information Management Systems for Patients Undergoing Surgery Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should (...) be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found

2015 Canadian Agency for Drugs and Technologies in Health - Rapid Review

266. Effect of Oxytocin on Stress Response in Cocaine-dependent Individuals

. Subjects with Addison's disease, Cushing's disease or other diseases of the adrenal cortex likely to affect hormonal/neuroendocrine status. Subjects with a history of or current psychotic disorder or bipolar affective disorder as these may interfere with subjective measurements. Subjects with current major depressive disorder or post-traumatic stress disorder as these disorders are associated with characteristic changes in stress response. Subjects receiving synthetic glucocorticoid therapy, any (...) Effect of Oxytocin on Stress Response in Cocaine-dependent Individuals Effect of Oxytocin on Stress Response in Cocaine-dependent Individuals - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Effect

2011 Clinical Trials

267. Neurosteroidogenesis is required for the physiological response to stress: role of neurosteroid-sensitive GABAA receptors Full Text available with Trip Pro

Neurosteroidogenesis is required for the physiological response to stress: role of neurosteroid-sensitive GABAA receptors The hypothalamic-pituitary-adrenal (HPA) axis, which mediates the body's response to stress, is largely under GABAergic control. Here we demonstrate that corticotropin-releasing hormone (CRH) neurons are modulated by the stress-derived neurosteroid, tetrahydrodeoxycorticosterone (THDOC), acting on δ subunit-containing GABA(A) receptors (GABA(A)Rs). Under normal conditions (...) conditions. Interestingly, blocking neurosteroidogenesis with finasteride is sufficient to block the stress-induced elevations in corticosterone and prevent stress-induced anxiety-like behaviors in mice. These data demonstrate that positive feedback of neurosteroids onto CRH neurons is required to mount the physiological response to stress. Further, GABA(A)R δ subunit-containing receptors and phosphorylation of KCC2 residue Ser940 may be novel targets for control of the stress response, which has

2011 The Journal of Neuroscience

268. The Effect of Vitamin D Supplementation on Calcium Excretion in Thalassemia: a Dose Response Study

The Effect of Vitamin D Supplementation on Calcium Excretion in Thalassemia: a Dose Response Study The Effect of Vitamin D Supplementation on Calcium Excretion in Thalassemia: a Dose Response Study - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove (...) one or more studies before adding more. The Effect of Vitamin D Supplementation on Calcium Excretion in Thalassemia: a Dose Response Study The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT01323608 Recruitment Status : Unknown Verified April 2011 by Weill Medical College of Cornell University

2011 Clinical Trials

269. Late Effects of Treatment for Childhood Cancer (PDQ®): Health Professional Version

for Childhood Cancer During the past five decades, dramatic progress has been made in the development of curative therapy for pediatric malignancies. Long-term survival into adulthood is the expectation for more than 80% of children with access to contemporary therapies for pediatric malignancies.[ , ] The therapy responsible for this survival can also produce adverse long-term health-related outcomes, referred to as late effects , which manifest months to years after completion of cancer treatment (...) exposure-based medical evaluation 2 or more years after completion of therapy. Health Links. Patient education materials called Health Links provide detailed information on guideline-specific topics to enhance health maintenance and promotion among this population of cancer survivors.[ ] Comprehensive reviews. Multidisciplinary system-based (e.g., cardiovascular, neurocognitive, and reproductive) task forces who are responsible for monitoring the literature, evaluating guideline content, and providing

2018 PDQ - NCI's Comprehensive Cancer Database

270. Unusual Cancers of Childhood Treatment (PDQ®): Health Professional Version

of EBV-specific cytotoxic T-lymphocyte therapy in patients with refractory disease, response rates were observed in 33.3% of patients, and long-term remissions were obtained in 62% of patients treated in their second or subsequent remission.[ ] Anti–programmed death-ligand 1 (PD-L1) monoclonal antibodies have been studied in two phase II trials in adults with refractory nasopharyngeal carcinoma, with response rates of 20.5% to 25.9% (33% in patients with PD-L1–positive tumors) and evidence of long (...) on for more information.) The risk increases after exposure to a mean dose of more than 0.05 Gy to 0.1 Gy (50–100 mGy), and follows a linear dose-response pattern up to 30 Gy and then declines, which is greater at younger age of exposure and persists more than 45 years after exposure.[ , ] Papillary thyroid carcinoma is the most frequent form of thyroid carcinoma diagnosed after radiation exposure.[ ] Molecular alterations, including intrachromosomal rearrangements, are frequently found; among them, RET

2018 PDQ - NCI's Comprehensive Cancer Database

271. Adrenocortical Carcinoma Treatment (PDQ®): Health Professional Version

. [ ] Allolio B, Fassnacht M: Clinical review: Adrenocortical carcinoma: clinical update. J Clin Endocrinol Metab 91 (6): 2027-37, 2006. [ ] Cellular Classification of Adrenocortical Carcinoma Adrenocortical carcinoma (ACC) can be classified into functioning and nonfunctioning tumors by clinical and biochemical assessment. Approximately 60% of ACCs produce hormones.[ ] The associated clinical syndromes include the following: Hypercortisolism (Cushing syndrome). Hirsutism/virilization. Feminization (...) are appropriate for newly diagnosed patients when possible. Radiation therapy (approximately 50 to 70 Gy given over a period of 4 weeks) may be given to patients with localized but unresectable tumors.[ ] For patients unable to undergo complete resection, mitotane in doses as high as 10 to 12 g per day to achieve a blood level of 14 to 20 mg/L should be considered. This adrenolytic drug produces useful clinical responses in about 20% to 30% of patients with measurable tumor burden.[ , ] Two other cytotoxic

2018 PDQ - NCI's Comprehensive Cancer Database

272. Small Cell Lung Cancer Treatment (PDQ®): Health Professional Version

, approximately 30% of patients with SCLC will have tumors confined to the hemithorax of origin, the mediastinum, or the supraclavicular lymph nodes. These patients are designated as having limited-stage disease (LD).[ ] Patients with tumors that have spread beyond the supraclavicular areas are said to have extensive-stage disease (ED). SCLC is more responsive to chemotherapy and radiation therapy than other cell types of lung cancer; however, a cure is difficult to achieve because SCLC has a greater tendency (...) and include neurological defect or personality change from brain metastases or pain from bone metastases. Infrequently, patients with SCLC may present with symptoms and signs of one of the following paraneoplastic syndromes: Inappropriate antidiuretic hormone secretion. Cushing syndrome from secretion of adrenocorticotropic hormone. Paraneoplastic cerebellar degeneration. Lambert-Eaton myasthenic syndrome.[ ] Physical examination may identify enlarged supraclavicular lymphadenopathy, pleural effusion

2018 PDQ - NCI's Comprehensive Cancer Database

273. Genetics of Kidney Cancer (Renal Cell Cancer) (PDQ®): Health Professional Version

.[ ] Cell cycle control pVHL reintroduction induces cell cycle arrest and p27 upregulation after serum withdrawal in VHL null cell lines.[ ] Additionally, pVHL destabilizes Skp2, and upregulates p27 in response to damage.[ ] Nuclear localization and intensity of p27 is inversely associated with tumor grade.[ ] pVHL binds to [ ] and facilitates phosphorylation of p53 in an ATM-dependent fashion.[ ] Extracellular matrix control Functional pVHL is needed for appropriate assembly of an extracellular

2018 PDQ - NCI's Comprehensive Cancer Database

274. Oncogenetic testing for persons with hereditary endocrine cancer syndromes

, psychologists (indicative and non- exhaustive list). a The KCE has sole responsibility for the recommendations. COLOPHON Title: Oncogenetic testing for persons with hereditary endocrine cancer syndromes – Abstract Authors: Joan Vlayen (KCE), Marie Bex (UZ Leuven), Bert Bravenboer (UZ Brussel), Kathleen Claes (UZ Gent), Bruno Lapauw (UZ Gent), Alexandre Persu (Cliniques universitaires Saint-Luc), Kris Poppe (CHU Saint-Pierre), Urielle Ullman (Institut de Pathologie de Gosselies), Tom Van Maerken (UZ Gent (...) investigator or researcher: Marie Bex (somatostatine analogen in acromegalie and cushing, NOVARTIS), Kris Poppe (Takeda “L. Thyroxine” study) Layout: Ine Verhulst Disclaimer: The external experts were consulted about a (preliminary) version of the scientific report. Their comments were discussed during meetings. They did not co-author the scientific report and did not necessarily agree with its content. Subsequently, a (final) version was submitted to the validators. The validation of the report results

2015 Belgian Health Care Knowledge Centre

275. Towards a better managed off-label use of drugs

access to the pharmaceutical, unless the non-industrial sponsor finances it himself. 4 ‘Off-label’ drugs KCE Report 252Cs LIABILITY ? The choice of therapy is primarily the physician’s responsibility. The off- label use of medicines is covered by the legally recognized principle of the therapeutic freedom. Off-label use is lawful if the medication is prescribed with the care, skill and forethought of a medical practitioner in the same circumstances. To evaluate this, the scientific basis plays (...) to which it could reasonably be expected that the product would be put”. It is unlikely, however, that the producer will be held liable if the patient was sufficiently informed on the possible risks by the package leaflet and by the physician and if the injury was not caused by a defect inherent to the product or an error in the leaflet. ? Pharmacists can be held liable for damage caused by a defective magistral formula. They are responsible for the quality of the magistral formula: correct weighing

2015 Belgian Health Care Knowledge Centre

276. Erectile dysfunction

satisfactory sexual performance. It is a complicated disorder with several possible organic and/or psychogenic causes. It can also be drug induced. Organic causes may be vasculogenic (for example cardiovascular disease [CVD], hypertension, hyperlipidaemia, diabetes mellitus); neurogenic (for example multiple sclerosis, Parkinson’s disease); anatomical (for example Peyronie’s disease, hypospadias, prostate cancer), or hormonal (for example hypogonadism, hyper-and hypothyroidism, Cushing’s disease (...) with erectile dysfunction should receive 6–8 doses of a PDE-5 inhibitor at a maximum dose with sexual stimulation before being classified as a non-responder. Referral should be arranged: To urology — for young men who have always had erectile dysfunction and for all men with a history of trauma to genital area, pelvis or spine; abnormality of the penis or testicles; or no response to maximum dose of at least two PDE-5 inhibitors. To endocrinology — if hypogonadism is suspected (abnormal serum testosterone

2018 NICE Clinical Knowledge Summaries

277. Corticosteroids - topical (skin), nose, and eyes: Scenario: Topical treatment

, instead of treating flares as they arise, in people with frequent flares. Review people receiving intermittent treatment every 3–6 months depending on the potency and site of application. Once a clinical response has been seen, long-term topical corticosteroid treatment should be gradually in a stepwise manner. For more information on managing eczema and psoriasis, see the CKS topics on and . Basis for recommendation These recommendations are based on the National Institute for Health and Care (...) be applied? A thin layer of topical corticosteroid should be applied once or twice daily, adjusting the potency to control symptoms. For many conditions, once daily application is usually sufficient. Increase to twice daily application only if the condition does not respond adequately. Avoid the use of the phrase 'use sparingly' to avoid undertreatment. Topical corticosteroids should typically be used in bursts of 3–7 days in order to achieve control. Once a clinical response is seen, the corticosteroid

2018 NICE Clinical Knowledge Summaries

278. Corticosteroids - oral: Scenario: Corticosteroids

that an appropriate protective immune response may occur [ ]. What contraindications and cautions are associated with oral corticosteroids? Oral corticosteroids are contraindicated in: People with acute infections uncontrolled by appropriate antimicrobial therapy — they may mask the symptoms of infection. Oral corticosteroids should be used with caution in people with: Hepatic impairment — plasma concentrations of oral corticosteroids may be increased in hepatic impairment. Psychoses or severe affective disorders (...) . Cerebrovascular — benign intracranial hypertension. Endocrine — adrenal suppression, diabetes mellitus (new onset or worsening of blood glucose control in existing diabetes mellitus), Cushing's syndrome (this is usually reversible on withdrawal of treatment). Gastrointestinal — peptic ulceration with perforation and haemorrhage, dyspepsia, abdominal distension, and oesophageal ulceration; especially in . Immunological — immunosuppression, increased susceptibility to infection, aggravation of existing

2018 NICE Clinical Knowledge Summaries

279. Recovery: care of the child/young person

spontaneous movement or deterioration in reflexive posturing purposeful movement deteriorates decorticate posturing, and then decerebrate posturing, and then flaccid response to pain 4. Cushing’s triad (hypertension, bradycardia, apnoea) may occur only as a late sign ( ). Routinely measure intracranial pressure on patients who have monitoring devices in situ ( ). Immediately report to the surgeon and anaesthetist any fluctuations in intracranial pressure outside of normal parameters ( ) ( ). Liaise (...) ( ). Neurological assessment Evaluate the patient’s alertness and responsiveness to the environment ( ). Perform a rapid but thorough neurological assessment for all patients who have undergone neurological/neurosurgical procedures ( ). This must incorporate an assessment of eye opening, verbal responsiveness, motor function and reflexes, and pupil size and response to light, as per GOSH clinical procedure guideline. Continue neurological observations at 10 minute intervals alongside the recording of vital

2015 Publication 1593

280. Clinical Practice Guidelines on Obesity

and patterns of care evolve. The contents of this publication are guidelines to clinical practice, based on the best available evidence at the time of development. Adherence to these guidelines may not ensure a successful outcome in every case. These guidelines should neither be construed as including all proper methods of care, nor exclude other acceptable methods of care. Each physician is ultimately responsible for the management of his/her unique patient, in the light of the clinical data presented (...) • Fasting plasma glucose • Alanine transaminase / aspartate transaminase • ECG (if > 50 years)3 Assessment for secondary causes: • Thyroid function tests: Thyroid stimulating hormone / free thyroxine • Cushing’s syndrome: Screen only if clinically suspected • Hypogonadism: Screen only if clinically suspected BMI: body mass index; ECG: electrocardiography; HDL: high-density lipoprotein; LDL: low-density lipoprotein GPP C Patient motivation – an important prerequisite in weight loss management – should

2016 Ministry of Health, Singapore

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