• ARTICLE_TITLE


    By A. Sigmor. New Brunswick Theological Seminary. 2018.

    Types of chronic urticaria that occur in response to physical stimuli include dermatographism (urticaria in response to stroking generic viagra super active 25mg with visa, friction cheap viagra super active 50mg with amex, or rubbing), cholinergic urticaria (where stimuli that raise the core temperature of the body elicit urticaria), cold urticaria (where wheals occur after exposure to 22 cold; this condition is rarely associated with underlying diseases), solar urticaria (provoked by ultraviolet light), and aquagenic urticaria (precipitated by contact of the skin with water of any temperature). So-called “idiopathic urticaria” may be due to an autoimmune process in 40% to 23 50% of patients. Chronic idiopathic urticaria is self-limited for most patients; 50% undergo Antihistamines Page 8 of 72 Final Report Update 2 Drug Effectiveness Review Project spontaneous remissions within 1 year. Twenty percent, however, have intermittent symptoms for 22 years. Acute urticaria is much more common than the chronic form in both adults and children, 22 accounting for 70% of cases. Acute urticaria is idiopathic in greater than 50% of cases. It can, however, occur as a hypersensitivity reaction to food, wasp or bee stings, as a response to blood products, infection, or febrile illness, or as a response to various drugs. A variety of drugs can cause acute as well as chronic urticaria, most commonly antimicrobial agents, anti-inflammatory 22 drugs, analgesics, angiotensin-converting enzyme inhibitors, and blood products. Purpose and Limitations of Systematic Reviews Systematic reviews, also called evidence reviews, are the foundation of evidence-based practice. They focus on the strength and limits of evidence from studies about the effectiveness of a clinical intervention. Systematic reviews begin with careful formulation of research questions. The goal is to select questions that are important to patients and clinicians then to examine how well the scientific literature answers those questions. Terms commonly used in systematic reviews, such as statistical terms, are provided in Appendix A and are defined as they apply to reports produced by the Drug Effectiveness Review Project. Systematic reviews emphasize the patient’s perspective in the choice of outcome measures used to answer research questions. Studies that measure health outcomes (events or conditions that the patient can feel, such as fractures, functional status, and quality of life) are preferred over studies of intermediate outcomes (such as change in bone density). Reviews also emphasize measures that are easily interpreted in a clinical context. Specifically, measures of absolute risk or the probability of disease are preferred to measures such as relative risk. The difference in absolute risk between interventions depends on the number of events in each group, such that the difference (absolute risk reduction) is smaller when there are fewer events. In contrast, the difference in relative risk is fairly constant between groups with different baseline risk for the event, such that the difference (relative risk reduction) is similar across these groups. Relative risk reduction is often more impressive than absolute risk reduction. Another useful measure is the number needed to treat (or harm). The number needed to treat is the number of patients who would need be treated with an intervention for 1 additional patient to benefit (experience a positive outcome or avoid a negative outcome). The absolute risk reduction is used to calculate the number needed to treat. Systematic reviews weigh the quality of the evidence, allowing a greater contribution from studies that meet high methodological standards and, thereby, reducing the likelihood of biased results. In general, for questions about the relative benefit of a drug, the results of well- executed randomized controlled trials are considered better evidence than results of cohort, case- control, and cross-sectional studies. In turn, these studies provide better evidence than uncontrolled trials and case series. For questions about tolerability and harms, observational study designs may provide important information that is not available from controlled trials. Within the hierarchy of observational studies, well-conducted cohort designs are preferred for assessing a common outcome.

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    Effects of nebulized 4 beta 2-adrenergic agonists on pulmonary mechanics in anesthetized patients with chronic obstructive pulmonary disease purchase viagra super active 100 mg on line. Vidgren M viagra super active 50mg with visa, Silvasti M, Korhonen P, Kinkelin A, Frischer B, Stern K. Vidgren P, Silvasti M, Vidgren M, Paronen P, Tukiainen H, Lehti H. In 6-DELIVERY vitro inhalation behaviour and therapeutical response of salbutamol particles administered from two metered dose aerosols. SHORT exercise-induced bronchoconstriction while on regular treatment with Oxis. Quick-relief medications for asthma Page 111 of 113 Final Report Update 1 Drug Effectiveness Review Project Citation Exclusion Code Vizel AA, Vizel I, Vizel EA. Comparison of acute bronchodilator tests in 1 patients with chronic obstructive lung disease and bronchial asthma. Volcheck GW, Kelkar P, Bartemes KR, Gleich GJ, Kita H. Effects of (R)- 6 and (S)-isomers of beta-adrenergic agonists on eosinophil response to interleukin-5. Variability of short-term responses 1 to beta -adrenoceptor agonists in chronic airways obstruction. Formoterol and salbutamol metered aerosols: 6-LONG VS. SHORT comparison of a new and an established beta -agonist for their2 bronchodilating efficacy in the treatment of childhood bronchial asthma. Wallin A, Melander B, Rosenhall L, Sandstrom T, Wahlander L. SHORT Formoterol, a new long acting beta -agonist for inhalation twice daily,2 compared with salbutamol in the treatment of asthma. SHORT duration of bronchodilatation with formoterol dry powder in patients with stable asthma. Wang SW, Liu X, Wiener DJ, Sennett C, Bowers BW, Legorreta AP. Bronchodilation subsensitivity to salbutamol after 6-LONG VS. Correspondence regarding levalbuterol and racemic 5 albuterol, July 2004 Supplement. SHORT quality of life of salmeterol versus albuterol in patients with mild to moderate persistent asthma. Clinical comparative 1 efficacy trial of pirbuterol in the autohaler and salbutamol in a customary metered-dose aerosol in children with asthma aged 6-12 years. Quick-relief medications for asthma Page 112 of 113 Final Report Update 1 Drug Effectiveness Review Project Citation Exclusion Code Wilcke JT, Iversen ET, Kok-Jensen A. SHORT independent of previously inhaled salbutamol: a clinical controlled study. Willaert W, Daenen M, Bomans P, Verleden G, Decramer M. What is 3 the optimal treatment strategy for chronic obstructive pulmonary disease exacerbations? Williamson IJ, Reid A, Monie RD, Fennerty AG, Rimmer EM. Generic 6-DESIGN inhaled salbutamol versus branded salbutamol. Comparison of powder and 6-POWDER aerosol formulations of salmeterol in the treatment of asthma. SHORT acting and short-acting beta-agonists on methacholine dose-response curves in asthmatics.

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    Efficacy and safety of atomoxetine in adolescents with attention deficit hyperactivity disorder and major depression buy viagra super active 100 mg with amex. Attention deficit hyperactivity disorder 149 of 200 Final Update 4 Report Drug Effectiveness Review Project 382 effective viagra super active 50 mg. Lisdexamfetamine dimesylate for the treatment of attention deficit hyperactivity disorder in adults with a history of depression or history of substance use disorder. Randomized, placebo-controlled trial of mixed amphetamine salts for symptoms of comorbid ADHD in pediatric bipolar disorder after mood stabilization with divalproex sodium. Methylphenidate in the treatment of children and adolescents with bipolar disorder and attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry. Zeni CP, Tramontina S, Ketzer CR, Pheula GF, Rohde LA. Methylphenidate combined with aripiprazole in children and adolescents with bipolar disorder and attention- deficit/hyperactivity disorder: a randomized crossover trial. Gadow KD, Paolicelli LM, Nolan EE, Schwartz J, et al. Indirect effects of medication treatment on peer behavior. School observations of children with attention- deficit hyperactivity disorder and comorbid tic disorder: effects of methylphenidate treatment. Stimulant medication withdrawal during long-term therapy in children with comorbid attention-deficit hyperactivity disorder and chronic multiple tic disorder. Journal of the American Academy of Child & Adolescent Psychiatry. Atomoxetine treatment in children and adolescents with ADHD and comorbid tic disorders. Gadow KD, Sverd J, Nolan EE, Sprafkin J, Schneider J. Immediate-release methylphenidate for ADHD in children with comorbid chronic multiple tic disorder. Journal of the American Academy of Child & Adolescent Psychiatry. Atomoxetine treatment of ADHD in children with comorbid Tourette syndrome. Methylphenidate and comorbid anxiety disorder in children with both chronic multiple Tic disorder and ADHD. Gadow KD, Sverd J, Sprafkin J, Nolan EE, Grossman S. Long-term methylphenidate therapy in children with comorbid attention-deficit hyperactivity disorder and chronic multiple tic disorder. Attention deficit hyperactivity disorder 150 of 200 Final Update 4 Report Drug Effectiveness Review Project 396. A randomized crossover clinical study showing that methylphenidate-SODAS improves attention-deficit/hyperactivity disorder symptoms in adolescents with substance use disorder. Thurstone C, Riggs PD, Salomonsen-Sautel S, Mikulich-Gilbertson SK. Randomized, controlled trial of atomoxetine for attention-deficit/hyperactivity disorder in adolescents with substance use disorder. Journal of the American Academy of Child & Adolescent Psychiatry. Atomoxetine treatment of adults with ADHD and comorbid alcohol use disorders. Williams RJ, Goodale LA, Shay-Fiddler MA, Gloster SP, Chang SY. Methylphenidate and dextroamphetamine abuse in substance-abusing adolescents. Table 4: Annual Estimates of the Population by Race Alone and Hispanic or Latino Origin for the United States and States: Population Division, U. Attention Deficit Hyperactivity Disorder: Effectiveness of Treatment in At-Risk Preschoolers; Long-Term Effectiveness in All Ages; and Variability in Prevalence, Diagnosis, and Treatment.

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    Beta blockers Page 97 of 122 Final Report Update 4 Drug Effectiveness Review Project 68 purchase viagra super active 25 mg. Campo C purchase viagra super active 25mg amex, Segura J, Fernandez ML, Guerrero L, Christiansen H, Ruilope LM. A prospective comparison of four antihypertensive agents in daily clinical practice. Carroll JD, Reidy M, Savundra PA, Cleave N, McAinsh J. Long-acting propranolol in the prophylaxis of migraine: a comparative study of two doses. Carruthers G, Dessain P, Fodor G, Newman C, Palmer W, Sim D. Comparative trial of doxazosin and atenolol on cardiovascular risk reduction in systemic hypertension. Metoprolol and hydrochlorothiazide in a fixed combination once daily in the treatment of hypertension. Current Therapeutic Research, Clinical & Experimental. Effect of partial agonist activity on the side effects of beta-blockade in patients with chronic stable angina. A comparison of atenolol with controlled release diltiazem in chronic stable angina. Hypertension and alpha-adrenergic blockers: Preliminary ALLHAT results. Early intravenous then oral metoprolol in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. The seventh report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure. A comparison of the effects of beta-blockers with and without intrinsic sympathomimetic activity on hemodynamics and left ventricular function at rest and during exercise in patients with coronary artery disease. Clausen J, Felsby M, Jorgensen FS, Nielsen BL, Roin J, Strange B. Absence of prophylactic effect of propranolol in myocardial infarction. Improving patient outcomes in heart failure: evidence and barriers. Cleophas TJ, van der Mey N, van der Meulen J, Niemeyer MG. Quality of life before and during antihypertensive treatment: a comparative study of celiprolol and atenolol. International Journal of Clinical Pharmacology & Therapeutics. Celiprolol vs propranolol in unstable angina pectoris: a double-blind, randomized, parallel-group study. Celiprolol and propranolol for unstable angina pectoris. Beta blockers Page 98 of 122 Final Report Update 4 Drug Effectiveness Review Project 84. Quality of life before and during antihypertensive treatment: a comparative study of celiprolol and atenolol. The effects of angiotensin receptor antagonists on mortality and morbidity in heart failure--and an interaction with beta blockade. Therapeutic effects of pindolol and nifedipine in patients with stable angina pectoris and asymptomatic resting ischemia. Cohn JN, Tognoni G, Valsartan Heart Failure Trial I. A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. A comparison of the effects of the slow release formulations of metoprolol and oxprenolol in hypertension. Double-blind, placebo-controlled, randomized trial of prophylactic metoprolol for reduction of hospital length of stay after heart surgery: The β-Blocker Length Of Stay (BLOS) study.

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    In EuroSIDA 50 mg viagra super active for sale, the greatest mean increase in CD4 count of 100 cells/µl per year was seen in the year after starting ART discount viagra super active 25mg line. Significant, but lower, increases, around 50 CD4 T cells/µl per years, were seen even at 5 years after start- ing ART in patients whose current CD4 T cell count was less than 500 cells/µl (Mocroft 2007). If you start relatively late in the disease, CD4 T cell recovery will be more blighted than if you start closer to transmission. It is still under debate whether the immune system is restored continuously after a long period of viral load suppression or whether a plateau is reached after three to 148 ART four years beyond which there is little or no expected improvement (Smith 2004, Mocroft 2007, Lok 2010). There are patients showing immunological improvement even 6-8 years after initiation and there are patients in which CD4 T cells remain stable at a low level. The lower the CD4 count at baseline, the less likely it is to normalize completely (Kaufmann 2005, Robbins 2009). The immune system often does not recover completely. In the Swiss Cohort, only 39% of 2,235 patients who had begun ART in 1996-97 reached a CD4 T cell count above 500/µl (Kaufmann 2003). However, it appears that the increase within the first 3–6 months provides certain clues as to how well the immune system will be restored (Kaufmann 2005). Negative consequences of a low CD4 T cell count at the time of ART initiation are often present for a long time. In one study, 25% of patients who started an ART at lower levels of CD4 T cell count did not reach normal levels of 500 CD4 T cells/µl, even after a decade of otherwise effective ART with good viral suppression (Kelley 2009, Lok 2010). Immunological treatment success is not necessarily linked to maximal viral suppression; even partial suppression can result in improved CD4 T cell count (Kaufmann 1998, Ledergerber 2004). The initial level of viral load is also not signif- icant. What seems to be important is that the viral load remains lower than before treatment (Deeks 2002, Ledergerber 2004). In view of the numerous factors that occur independent of ART that are able to influence therapy success and individual immuno-regeneration (see below), it is generally not wise to look at the CD4 T cell count alone as the deciding criterion for the success of ART. Virological success is more appropriate for judging the efficacy of specific regimens. Once CD4 T cells have “normalized” and plasma viremia remains undetectable, it is unlikely that they will significantly change (Phillips 2002). In a newer study, patients infected with less than <200 copies/mL and CD4 T cell counts 300 cells/µl had a 99. With good CD4 T cells, immunological treatment success therefore does not require constant monitoring. Discordant response Failure to achieve therapeutic goals – in terms of immunologic and virologic success – is referred to as a discordant response. The frequencies of such discordant responses in adults are outlined in Table 4. Virological response: <1000 copies/ml (Grabar 2000) or <500 copies/ml (Moore 2005) or <50 copies (Tan 2008) Therapies can be virologically successful without immunological improvement; despite undetectable viral load, CD4 T cell counts remain low (Piketty 1998, Grabar 2000, Moore 2005, Tan 2007). Conversely, ART may be extremely effective immuno- logically and induce significant increases in the CD4 T cell count, while viral load remains detectable. Although therapies have constantly improved, discordant responses appear in one fourth of all treatment-naïve patients. Goals and principles of therapy 149 groups showing virological success but little immunological improvement, it is often not clear how to continue therapy. Mortality seems to be slightly higher in this patient group, but has not been related to AIDS diseases (Gilson 2010). If there is any increase of AIDS incidence in the setting of discordant response, this is restricted to the first six months (Zoufaly 2011). Different CD4 T cell response kinetics are shown in Figures 1a-1d. The risk factors for a lack of immunologic response can often not be influenced and are also heterogenic (Review: Aiuti 2006). Low CD4 counts at baseline, as well as a low viral load at treatment initiation are only two factors (Florence 2003, Kaufmann 2005, Moore 2005, Kelley 2009). In older patients, immuno- logic response is often only moderate, mainly due to thymic degeneration (Lederman 2000, Grabar 2004).

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