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4641. Bridging The Health Gap. An incentivised Scheme for Primary Care GP’s

scheme was introduced in England in 2008-09 to encourage annual GP health checks Methods The study being reviewed is a longitudinal cohort study to determine whether the incentivised opt in scheme (LD-DES) was successful at improving the healthcare of individuals with a known learning disability in England within its first three years. Electronic data gathered by the Health Improvement Network Primary Care Database (THIN) was collected and assessed using a multifunctional logistical regression (...) with a “known” learning disability. GP practices also had to demonstrate a pre-established rate of data recording per annum before being included in the study. These included the following data per patent, per year before the 1st January 2009 (thus cut off was set as it coincides with the introduction of the LD-DES): One medical record One additional health data record Two prescription records In addition to this data, a measure of deprivation of liberty had to be completed for at least 80% of patients

2015 The Learning Disabilities Elf

4642. Hand held health records increased awareness of health issues but no evidence of improvements in short-term health care activity

of health care Alongside the health action plan derived from a health check, the use of hospital ‘passports’ has also developed to improve communication of important information to hospital staff. Ideally such passports are produced with the person and will contain information that is important to them (such as preferences) as well as information about them that might be supplied by health professionals (e.g. a record of health problems, prescribed medication, health risks). Use of hospital passports (...) some relevant studies. Their search terms did not include ‘health action plan’, for example. They excluded electronic records on the grounds that these are not “physically located with the individual”. It is not clear whether this may have resulted in the exclusion of studies involving records that the individual might hold on a device such as tablet computer. It is notable that the studies selected for inclusion did not include the CIPOLD report, which was published within the timeframe and did

2015 The Learning Disabilities Elf

4643. What influences adherence to exercise programs for older people?

Online (MEDLINE), Excerpta Medica Database (EMBASE), Scientific Electronic Library (SciELO), Latin American Literature in Health Sciences (LILACS) and Physiotherapy Evidence Database (PEDro) the date range was not reported. The included studies involving older people undertaking exercise programs and including measures of adherence, adherence rates and factors associated with adherence. Two reviewers independently extracted the relevant data but no information was given on how studies were quality (...) -based and self-supervised. The development of digital health and mobile technology such as smart phones and apps may help with this in the future. Exercise prescribers should be more aware of some of the person-level factors identified in this review when developing, delivering and monitoring exercise programmes for older people. What do you think? Do you monitor adherence to exercise programmes? What method do you use? Do you take into account the person level factors identified in this review

2015 The Musculoskeletal Elf

4644. Is aquatic exercise training effective for fibromyalgia?

This updated Cochrane review review examined the effects of supervised group aquatic training programs (led by an instructor). The authors defined aquatic training as exercising in a pool while standing at waist, chest, or shoulder depth. They searched a wide range of electronic databases for Randomised Controlled Trials (RCT’s) to Oct 2013 in adults diagnosed with fibromyalgia based on published criteria,comparing aquatic intervention and a control or other intervention. They excluded studies if exercise (...) documentation of adverse effects and adherence to exercise prescriptions. Further issues stem from inadequate sample sizes and inappropriate designs for assessing mixed exercise programs. What do you think? Do you recommend aqautic exercise for people with fibromyalgia? Do you recommend land-based exercise for people with fibromyalgia? What types of exercise do you recommend for improving muscle strength in people with fibromyalgia? Send us your views on this blog and become part of the ever expanding

2015 The Musculoskeletal Elf

4645. NICE challenging behaviour guidelines stress person centred proactive support but barriers to achievement still exist

with: , , After qualifying as a social worker, John worked in community learning disability teams before getting involved in a number of long-stay hospital closure programmes, working to develop individual plans for people moving into their own homes. He worked for BILD, helping to develop the Quality Network and was editorial lead for the NHS electronic library learning disabilities specialist collection. This led him to found the Learning Disabilities Elf site with Andre Tomlin as a way of making (...) on challenging behaviour Fawn Harrad View Does anyone know of any work that is being done / planned that will look at the way in which these guidelines are implemented ‘on the ground’? Particularly outside of the NHS, such as supported living environments? replied: View Hi Fawn, although not looking strictly at the implementation on the NICE Guidelines, there has just been an ‘urgent call to action’ on the over-prescribing of anti-psychotic medication. IHAL have produced a report as well as one from NHS-IQ

2015 The Learning Disabilities Elf

4646. NICE challenging behaviour guidelines stress person centred proactive support but barriers to achievement still exist

with: , , After qualifying as a social worker, John worked in community learning disability teams before getting involved in a number of long-stay hospital closure programmes, working to develop individual plans for people moving into their own homes. He worked for BILD, helping to develop the Quality Network and was editorial lead for the NHS electronic library learning disabilities specialist collection. This led him to found the Learning Disabilities Elf site with Andre Tomlin as a way of making (...) on challenging behaviour Fawn Harrad View Does anyone know of any work that is being done / planned that will look at the way in which these guidelines are implemented ‘on the ground’? Particularly outside of the NHS, such as supported living environments? replied: View Hi Fawn, although not looking strictly at the implementation on the NICE Guidelines, there has just been an ‘urgent call to action’ on the over-prescribing of anti-psychotic medication. IHAL have produced a report as well as one from NHS-IQ

2015 The Learning Disabilities Elf

4647. Does opioid antagonist medication improve the core features of autism spectrum conditions in children?

reductions in SIB. This paper reviews 10 studies that have tested Naltrexone with children with autism spectrum conditions. Opioid antagonist drugs like Naltrexone are thought to prevent the body’s response to endorphins Method The authors systematically reviewed the available evidence on Naltrexone, examining whether those who took this medication showed improved behaviour and/or any side effects. The collection of the articles involved 4 elements: the search of four electronic databases; the cross (...) exhibited problem behaviour (PB) Studies where there were participants with and without intellectual disability, including those with or without autism spectrum disorder Symptoms – any behaviour problem or a symptom related to ASC Any orally taken opioid antagonist which had been prescribed for the management of problem behaviour (excluding the drug Naloxone) Outcome measure where there was a pre and post intervention (these included behavioural measures and measures of side effects) Papers written

2015 The Learning Disabilities Elf

4648. Effects of a patient oriented decision aid for prioritising treatment goals in diabetes: pragmatic randomised controlled trial. Full Text available with Trip Pro

the consultation. Four different formats of the decision aid were included for additional explorative analyses.The primary outcome was the effects on patient empowerment for setting and achieving goals. The secondary outcomes were changes in the prescribing of drugs to regulate glucose, blood pressure, lipids, and albuminuria. Data were collected through structured questionnaires and automated data extraction from electronic health records during six months before and after the intervention.Of all intervention

2014 BMJ Controlled trial quality: predicted high

4649. WITHDRAWN. Interventions for treating plantar heel pain. (Abstract)

-intensity laser therapy, exposure to an electron generating device or insoles with magnetic foil. No randomised trials evaluating surgery, or radiotherapy against a randomly allocated control population were identified. There was limited evidence for the superiority of corticosteroid injections over orthotic devices.Although there is limited evidence for the effectiveness of local corticosteroid therapy, the effectiveness of other frequently employed treatments in altering the clinical course of plantar (...) heel pain has not been established in randomised controlled trials.At the moment there is limited evidence upon which to base clinical practice. Treatments that are used to reduce heel pain seem to bring only marginal gains over no treatment and control therapies such as stretching exercises. Steroid injections are a popular method of treating the condition but only seem to be useful in the short term and only to a small degree. Orthoses should be cautiously prescribed for those patients who stand

2010 Cochrane

4650. Comparative effectiveness of generic and brand-name statins on patient outcomes: a cohort study. Full Text available with Trip Pro

Comparative effectiveness of generic and brand-name statins on patient outcomes: a cohort study. Statins are effective in preventing cardiovascular events, but patients do not fully adhere to them.To determine whether patients are more adherent to generic statins versus brand-name statins (lovastatin, pravastatin, or simvastatin) and whether greater adherence improves health outcomes.Observational, propensity score-matched, new-user cohort study.Linked electronic data from medical and pharmacy (...) claims.Medicare beneficiaries aged 65 years or older with prescription drug coverage between 2006 and 2008.Initiation of a generic or brand-name statin.Adherence to statin therapy (measured as the proportion of days covered [PDC] up to 1 year) and a composite outcome comprising hospitalization for an acute coronary syndrome or stroke and all-cause mortality. Hazard ratios (HRs) and absolute rate differences were estimated.A total of 90,111 patients who initiated a statin during the study was identified

2014 Annals of Internal Medicine

4651. Stelara (ustekinumab (genetical recombination))

name] Stelara Subcutaneous Injection 45 mg Syringe [Non-proprietary name] Ustekinumab (Genetical Recombination) [Name of applicant] Janssen Pharmaceutical K.K. [Date of application] January 21, 2010 [Dosage form/Strength] A solution for injection in a prefilled syringe. Each prefilled syringe (0.5 mL) contains 45 mg of Ustekinumab (Genetical Recombination). [Application classification] Prescription drug (1) Drug with a new active ingredient [Chemical structure] See Figure 1 and Figure 2 below (...) Negative Negative NT S + L - focus assay b) Report results only Negative Negative Negative NT XC plaque assay c) Report results only Negative Negative Negative NT Co-cultivation assay for ERV a) Report results only ERV detected ERV detected ERV detected ERV detected Mink cell focus assay c) Report results only Negative Negative Negative Negative Electron microscopy Report results only A-type and C-type retrovirus-like particles observed A-type and C-type retrovirus-like particles observed A-type and C

2010 Pharmaceuticals and Medical Devices Agency, Japan

4652. Bridion (sugammadex sodium)

[Name of applicant] Schering-Plough K.K. (Nippon Organon K.K. at the time of submission) [Date of application] December 20, 2007 [Dosage form/Strength] A solution for injection containing sugammadex sodium equivalent to 200 mg or 500 mg sugammadex per vial [Application classification] Prescription drug (1) Drug with a new active ingredient [Chemical structure] Molecular formula: C 72 H 104 O 48 S 8 Na 8 Molecular mass: 2178.01 3 Chemical name: Cyclooctakis-(1 ?4)-{6-S-[2-(sodium carboxylato)ethyl]-6 (...) stored in the upright position were tested only for bacterial endotoxins, sterility, and container/closure integrity at 12, 24, and 36 months. 12 2.B Outline of the review by PMDA 2.B.(1) Polymorphism of the drug substance PMDA asked the applicant to explain polymorphism of the drug substance and its effects on stability and solubility. The applicant explained as follows: The solid state properties (X-ray powder diffraction, solid state NMR, electron microscopy, specific surface area

2010 Pharmaceuticals and Medical Devices Agency, Japan

4653. Soliris (eculizumab (genetical recombination))

300 mg of Eculizumab (Genetical Recombination). [Application classification] Prescription drug (1) Drug with a new active ingredient [Entity] Eculizumab is a recombinant humanized monoclonal antibody composed of the variable regions consisting of complementarity-determining regions derived from mouse anti-human complement C5 a-chain monoclonal antibody and human framework regions and human IgG constant regions. The L-chain constant region is derived from a human ?-chain. The CH1, hinge and a part (...) ) Negative (MRC-5, NIH/3T3, Vero) In vitro bovine virus assay Negative (BT, MA104) Negative (BT, Vero) NT In vivo assay to reveal latent viruses (inoculation into suckling and adult mice and guinea pigs, and in embryonated eggs) Negative NT Negative Mouse antibody production test * Negative NT Negative Quantitative PCR Negative (bovine polyoma virus, bovine and porcine circovirus, MVM ) NT Negative (MVM) Tests for retroviruses Transmission electron microscopy Examination of cell sections A-type and C

2010 Pharmaceuticals and Medical Devices Agency, Japan

4654. Orencia (abatacept (genetical recombination))

and Medical Devices Agency on the following pharmaceutical product submitted for registration are as follows. [Brand Name] Orencia for I.V. Infusion 250 mg [Non-proprietary name] Abatacept (Genetical Recombination) [Applicant] Bristol-Myers K.K. [Date of application] September 18, 2008 [Dosage form/Strength] Lyophilized product for intravenous infusion containing 250 mg abatacept in each 15-mL vial. [Application classification] Prescription drug (1) Drug with a new active ingredient [Chemical structure (...) parvovirus was detected in *** **. NT Not detected. Index cell line: **** Murine minute virus (MMV) free test Not detected by PCR NT Not detected by in vitro test Infectious retrovirus test Transmission electron microscopy Cell culture No virus-like particles other than retrovirus-like particles were observed. NT No virus-like particles other than retrovirus-like particles were observed. Cell culture supernatant NT NT No virus-like particles other than retrovirus-like particles of ***×***/mL were

2010 Pharmaceuticals and Medical Devices Agency, Japan

4655. Preventing Alzheimer's Disease and Cognitive Decline

moderate scientific quality exists to support the association of any modifiable factor (such as nutritional supplements, herbal preparations, dietary factors, prescription or nonprescription drugs, social or economic factors, medical conditions, toxins, or environmental exposures) with reduced risk of Alzheimer’s disease. What We Know Genetic factors, particularly the apolipoprotein E (ApoE) gene variation, are associated with risk of Alzheimer’s disease. Although better understanding of genetic risk (...) healthcare delivery systems with defined populations and well-developed electronic health records could serve as a cost-effective research platform for studies of cognitive decline and Alzheimer’s disease. A Web site should be established to continually update the American public in an ongoing way about preventive interventions for Alzheimer’s disease and cognitive decline with proven efficacy. Future research into the basic mechanisms of normal and pathological aging is critical to identify additional

2010 NIH Consensus Statements

4656. National retinoblastoma strategy Canadian guidelines for care

years of publication of this version and will establish a 5-year cycle of guideline reassessment, in terms of new literature and studies, and renewed consensus. Updates may be published in the event of signi?cant changes in evidence supporting the recommendations. Notes to Readers These guidelines are based on the best available evidence and expert opinion, and are intended to optimize patterns of clinical practice. They are not to be prescriptive or replace clinical judgement, 6 nor restrict

2010 CPG Infobase

4657. Antiviral medications provide no benefit over placebo treament in the treatment of Bell's palsy.

palsy, treatment with antivirals alone does not appear to have any benefit over placebo treatment. Evidence Quality Rating Limited Evidence Structured Abstract Clinical Questions: For patients with Bell's palsy, does treatment with antiviral agents decrease risk for incomplete recovery and does treatment with antivirals plus corticosteroids further decrease the risk for incomplete recovery over treatment with corticosteroids alone? Review Methods: The researchers searched four electronic databases (...) in this review. Antiviral therapy commonly is prescribed to treat Bell’s palsy based on an assumption that herpes simplex may be implicated in this condition. In 2009 two systemic review articles (4, 5) compared corticosteroid treatment alone with corticosteroid plus antiviral treatment for Bell's palsy. Their published findings conflicted, with one review suggesting that combination treatment improved the rate of full recovery while the second did not. The contradictory findings of those reviews

2011 ADA Center for Evidence-Based Dentistry

4658. Studies suggest suboptimal compliance of bisphosphonate therapy for osteoporosis increases fracture risk.

patient not to discontinue medication unless directed by physician. Evidence Quality Rating Limited Evidence Structured Abstract Clinical Questions: In postmenopausal women with osteoporosis, does noncompliance (compared to compliance) with bisphosphonate therapy result in more bone fractures? Review Methods: The authors of this systematic review, utilizing six electronic databases, evaluated studies up to March 2009. They conducted a comprehensive search with defined inclusion and exclusion criteria (...) . Two authors independently assessed quality (Newcastle-Ottawa Scale) and extracted data, with disagreements resolved through consensus. The 15 included studies were seven studies, one study and seven observational retrospective studies without control. The authors defined “persistence” as drug discontinuation greater than 30 days in one year, and “compliance” as the medication possession ratio (MPR), proportion of doses dispensed compared to doses prescribed. Main Results: The 15 included studies

2011 ADA Center for Evidence-Based Dentistry

4659. Evidence suggests that over-the-counter analgesics are efficacious in relieving pain from fixed orthodontic appliances.

(acetaminophen, aspirin, naproxen and ibuprofen), prescription nonsteroidal anti-inflammatory agents (NSAIDs) and low level laser therapy (LLLT) are efficacious for relief from orthodontic-associated pain. Evidence Quality Rating Limited Evidence Structured Abstract Clinical Questions: Do analgesics or LLLT compared to placebo, effectively relieve orthodontic pain in adolescents and adults after fixed orthodontic appliance adjustments? Review Methods: The authors searched three electronic databases (...) ), lowered pain perception scores from visual analog scale (VAS). One RCT (76 subjects) suggested reported LLLT is an approach to lower pain response with VAS scores of 3.30 compared to 7.25 in control group. Conclusion: Limited evidence suggests over-the-counter analgesics (ibuprofen, naproxen, acetaminophen, and aspirin) prescription NSAIDs (tenoxicam and valdecoxib) and low level laser therapy reduce orthodontic pain without evidence showing a preferred analgesic. Preemptive use of NSAIDs may

2011 ADA Center for Evidence-Based Dentistry

4660. Evidence suggests that over-the-counter analgesics are efficacious in relieving pain from fixed orthodontic appliances.

(acetaminophen, aspirin, naproxen and ibuprofen), prescription nonsteroidal anti-inflammatory agents (NSAIDs) and low level laser therapy (LLLT) are efficacious for relief from orthodontic-associated pain. Evidence Quality Rating Limited Evidence Structured Abstract Clinical Questions: Do analgesics or LLLT compared to placebo, effectively relieve orthodontic pain in adolescents and adults after fixed orthodontic appliance adjustments? Review Methods: The authors searched three electronic databases (...) ), lowered pain perception scores from visual analog scale (VAS). One RCT (76 subjects) suggested reported LLLT is an approach to lower pain response with VAS scores of 3.30 compared to 7.25 in control group. Conclusion: Limited evidence suggests over-the-counter analgesics (ibuprofen, naproxen, acetaminophen, and aspirin) prescription NSAIDs (tenoxicam and valdecoxib) and low level laser therapy reduce orthodontic pain without evidence showing a preferred analgesic. Preemptive use of NSAIDs may

2011 ADA Center for Evidence-Based Dentistry

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