13 research outputs found
Sex and gender differences in the treatment of Alzheimer's disease: A systematic review of randomized controlled trials
No full texttIn recent years, epidemiological, clinical, and biological evidence has drawn the attention on the influenceof sex and gender on Alzheimer’s disease (AD). Nevertheless, not enough attention has been paid totheir impact on treatment outcomes. The present study is aimed at systematically retrieve, review anddiscuss data coming from available randomized placebo-controlled trials (RCTs) on currently marketedtreatments for AD (i.e., cholinesterase inhibitors [ChEIs] and memantine) in order to describe possiblesex and gender differences in their efficacy, safety and tolerability.A systematic review of literature was performed. None of the retrieved studies reported data on theefficacy, safety and tolerability of considered medications separately in male and female patients withAD. We thus analyzed 48 excluded studies of potential interest, that is, almost all of the currently availabletrials on the four considered drugs. Nearly all the considered RCTs recruited a larger number of femaleparticipants to mirror the sexually unbalanced prevalence of AD. Only two studies took into account thepotential influence of sex and gender on treatment efficacy, reporting no significant differences betweenmen and women. None of the studies investigated potential sex and gender differences in the safety andtolerability of the four considered treatments.The existence of sex and gender differences in the efficacy and tolerability of ChEIs and memantine inAD has, to date, drawn limited to no attention. However, a considerable amount of data, with an adequaterepresentativeness in terms of sex/gender distribution, seem to be already available for dedicated anal-yses on this topic. A greater effort should be made to collect and report data on those factors interactingwith sex and gender that may significantly influence clinical manifestations, outcomes, and trajectoriesover time of AD patients
Multimodal analgesic strategies in polytraumatized patients
No full textIn recent years, the resuscitation of trauma patients has improved; however, pain related to trauma remains associated with systemic complications. In trauma patients, pain should be considered a vital sign, and its control is crucial for reducing complications, improving patient satisfaction, and enhancing the quality of life. The multimodal analgesia approach is the mainstay in pain control, and growing evidence in the literature supports a greater role of regional anesthesia in the management of trauma casualties. In this review, we offer the reader an updated general framework of the various approaches available for pain treatment in polytraumatized patients, with a focus on the opportunities presented by regional anesthesia. We will examine different types of locoregional anesthesia blocks and describe ultrasonographic execution techniques
Promoting the Assessment of Frailty in the Clinical Approach to Cognitive Disorders
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Agreement between diseases-centered and multidimensional models of care in disadvantaged settings
No full textSpontaneous Reversion of Clinical Conditions Measuring the Risk Profile of the Individual: From Frailty to Mild Cognitive Impairment
No full textThe number of people living with disabilities worldwide is rapidly growing due to a longer life expectancy and the subsequent increasing burden of chronic diseases. The need of developing and implementing effective strategies aimed at delaying or preventing disability has been repeatedly underlined and is currently the main focus of several health-care policies. In this scenario, a special attention is addressed to the identification of specific clinical conditions measuring the risk profile of the individual of developing an overt disability and other negative outcomes. These risk profiles can indeed become promising targets for developing and implementing preventive interventions. When the disabling cascade is fully established, in fact, the reversing/attenuating the process becomes more challenging. However, the exact nature of these relatively new constructs is not yet sufficiently clear, and several related issues remain poorly explored. In particular, these entities tend to be considered as unequivocally prodromal stages of a future disease, neglecting and underestimating their fluctuations/transitions over time and their potential to clinically improve/revert. This unbalanced judgment did probably contribute to an ambiguous and biased use of these conditions. Considering them as an early stage of an unavoidable future disease, in fact, determined a tendency to start a targeted intervention as if in presence of the disease itself, with the subsequent risk of over-diagnosis and over-treatment. In the present article, we discuss the dynamics underlying the reversion from a clinical at-risk condition to normality and its implications, specifically focusing on the examples of frailty and mild cognitive impairment
U-CHANGE Project: a multidimensional consensus on how clinicians, patients and caregivers may approach together the new urothelial cancer scenario
No full textIntroduction: Advanced urothelial carcinoma remains aggressive and very hard to cure, while new treatments will pose a challenge for clinicians and healthcare funding policymakers alike. The U-CHANGE Project aimed to redesign the current model of care for advanced urothelial carcinoma patients to identify limitations ("as is" scenario) and recommend future actions ("to be" scenario). Methods: Twenty-three subject-matter experts, divided into three groups, analyzed the two scenarios as part of a multidimensional consensus process, developing statements for specific domains of the disease, and a simplified Delphi methodology was used to establish consensus among the experts. Results: Recommended actions included increasing awareness of the disease, increased training of healthcare professionals, improvement of screening strategies and care pathways, increased support for patients and caregivers and relevant recommendations from molecular tumor boards when comprehensive genomic profiling has to be provided for appropriate patient selection to ad hoc targeted therapies. Discussion: While the innovative new targeted agents have the potential to significantly alter the clinical approach to this highly aggressive disease, the U-CHANGE Project experience shows that the use of these new agents will require a radical shift in the entire model of care, implementing sustainable changes which anticipate the benefits of future treatments, capable of targeting the right patient with the right agent at different stages of the disease
The last of the simple remainders
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Race reporting and disparities in clinical trials on Alzheimer's disease : A systematic review
No full textIntroduction: Race is an important health determinant and should adequately be considered in research and drug development protocols targeting Alzheimer's disease (AD).Methods: A systematic review of available randomized controlled trials (RCTs) on the currently marketed treatments for AD was conducted with the aim of 1) documenting the reporting of race, and 2) exploring the impact of race on the efficacy and safety/tolerability of the considered medications.Results: Overall, 59.2% of the 49 retained RCTs reported information concerning the race of participants. Only a striking minority of enrolled patients was constituted of blacks and Hispanics. None on the retained studies reported results on the efficacy and safety/tolerability of the tested treatment separately for racial groups nor performed sensitivity analyses accounting for the race of participants.Discussion: Race has insufficiently been reported in previous interventional studies on AD. Its potential association with the effectiveness and safety/tolerability of the tested medications has completely been neglected.</p
Management of bleeding in acquired hemophilia A: Results from the European Acquired Haemophilia (EACH2) registry
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