Eva Pietrzak

How well does B-type natriuretic peptide predict death and cardiac events in patients with heart failure: systematic review

Abstract Objective To assess how well B-type natriuretic peptide (BNP) predicts prognosis in patients with heart failure. Design Systematic review of studies assessing BNP for prognosis in patients with heart failure or asymptomatic patients. Data sources Electronic searches of Medline and Embase from January 1994 to March 2004 and reference lists of included studies. Study selection and data extraction We included all studies that estimated the relation between BNP measurement and the risk of death, cardiac death, sudden death, or cardiovascular event in patients with heart failure or asymptomatic patients, including initial values and changes in values in response to treatment. Multivariable models that included both BNP and left ventricular ejection fraction as predictors were used to compare the prognostic value of each variable. Two reviewers independently selected studies and extracted data. Data synthesis 19 studies used BNP to estimate the relative risk of death or cardiovascular events in heart failure patients and five studies in asymptomatic patients. In heart failure patients, each 100 pg/ml increase was associated with a 35% increase in the relative risk of death. BNP was used in 35 multivariable models of prognosis. In nine of the models, it was the only variable to reach significance—that is, other variables contained no prognostic information beyond that of BNP. Even allowing for the scale of the variables, it seems to be a strong indicator of risk. Conclusion Although systematic reviews of prognostic studies have inherent difficulties, including the possibility of publication bias, the results of the studies in this review show that BNP is a strong prognostic indicator for both asymptomatic patients and for patients with heart failure at all stages of disease.

Using Commercial Video Games for Upper Limb Stroke Rehabilitation: Is This the Way of the Future?

Abstract Background: The increasing number of people living with poststroke sequelae has stimulated the search for novel ways of providing poststroke rehabilitation without putting additional stress on overburdened health care systems. One of them is the use of commercially available technology and off-the-shelf video games for hemiparetic upper limb rehabilitation. Methods: The MEDLINE, EMBASE, and Cochrane Library databases were searched using key word synonyms for stroke, upper limb, and video games. Included studies investigated upper limb stroke rehabilitation using commercially available consoles and video games, reported outcomes that included measures of upper limb functionality, and were published in a peer-reviewed journal written in English. Results: Thirteen studies were identified - 6 published as full articles and 7 as abstracts. Studies were generally small and only 3 were randomized. The gaming systems investigated were the Nintendo Wii (n = 10), EyeToy PlayStation (n = 2), and CyWee Z (n = 1). The Nintendo Wii appears to provide the greatest benefits to patients, with improvements seen in upper extremity function measures such as joint range of motion, hand motor function, grip strength, and dexterity. Three studies indicate that video therapy appears to be safe and that long-term improvements continue at follow-up. Conclusions: At present, the evidence that the use of commercial video games in rehabilitation improves upper limb functionality after stroke is very limited. However, this approach has the potential to provide easily available and affordable stroke rehabilitation therapy in settings where access to therapy is limited by geographical or financial constraints.

Using commercial video games for falls prevention in older adults: The way for the future?

Background and Purpose:Falls in older adults are an increasingly costly public health issue. There are many fall prevention strategies that are effective. However, with an increasing population of older people and ever-decreasing availability of health practitioners and health funding, novel modes of intervention are being developed, including those relying on computer technologies.The aim of this article was to review the literature on the use of exergaming to prevent falls in older adult persons living in the community. Methods:The Cochrane, Medline, and Embase databases were searched using prespecified search terms. To be included, studies had to investigate the effect of using commercially available consoles and video games on outcome measures such as a decrease in falls, improvements in balance control or gait parameters, decreased fear of falling, and attitude to exercise in older adult persons living in the community. All study designs with the exception of single-person case studies were included. Articles had to be published in peer-reviewed journals in the English language. Results:Nineteen studies fulfilled the inclusion criteria. The following outcomes were observed: (1) using computer-based virtual reality gaming for balance training in older adults was feasible; (2) the majority of studies showed a positive effect of exergaming on balance control; (3) some studies showed a positive effect on balance confidence and gait parameters; (4) the effect was seen across the age and sex spectrum of older adults, including those with and without balance impairment. Conclusions:There is as yet no evidence that using virtual reality games will prevent falls, but there is an indication that their use in balance training may improve balance control, which in turn may lead to falls prevention.

Plasticity of brain muscarinic receptors in aging rats: The adaptative response to scopolamine and ethanol treatment

Young and aged rats were treated chronically with ethanol or scopolamine. Muscarinic receptors were measured in cerebral cortex, hippocampus and striatum. Following scopolamine treatment muscarinic receptor density in cerebral cortex, hippocampus and striatum of young rats increased by 34, 57 and 27%, respectively; in brains of aged rats the increase was 41% in cerebral cortex, 43% in hippocampus and nil in striatum. Affinity of muscarinic receptors was not changed by scopolamine treatment. Following chronic ethanol administration there was a 48% increase in cortical muscarinic receptor density in young, but not aged rats. The density of muscarinic receptors in hippocampus and striatum of both young and aged rats was not affected by ethanol treatment. Affinity of receptors in hippocampus of aged, ethanol-treated rats was increased compared to age-matched controls. Adaptative responses of the muscarinic receptor/transducer system to neurotransmitter availability are present in both young and aged rats, both the ethanol-induced response is present only in young animals. This suggests differences in the mechanism of action of ethanol and receptor agonists and antagonists in modulating receptor plasticity.

Are N-of-1 Trials an Economically Viable Option to Improve Access to Selected High Cost Medications? The Australian Experience

OBJECTIVE To explore the economic viability of N-of-1 trials for improving access to selected high cost medications in Australia. METHODS Cost and effectiveness estimates were derived from two N-of-1 trials conducted by The University of Queensland from 2003 to 2005-celecoxib versus sustained-release paracetamol for osteoarthritis in a general practice setting and gabapentin versus placebo for chronic neuropathic pain in a hospital setting. Effectiveness was determined by the proportion of responders to each medication. The costs of trials were offset against the savings generated by subsequent changes in prescribing. Decision analysis models with semi-Markov processes were used to compare different scenarios of N-of-1 trials versus usual care. RESULTS The fixed cost of performing N-of-1 trials was approximately AUS

Primary and secondary prevention of cardiovascular disease: is there a place for Internet-based interventions?

23,000 for each trial and the variable cost was approximately AUS

The effect of chronic ethanol consumption on [14C]deoxyglucose uptake in rat brain in vivo

1300 per participant. Clinical outcomes favored celecoxib over paracetamol in 17% of participants and gabapentin over placebo in 24% of participants. Modeling these results showed that the cost-offsets from efficient use of medications were less than the cost of running a trial; however, the incremental costs per quality-adjusted life-year gained were AUS

Effects of chronic ethanol treatment and aging on brain phosphoinositide turnover and adenylate cyclase activity

6,896 and AUS

A feeding regime for the study of the interaction of ethanol and aging

29,550 for the gabapentin/placebo and celecoxib/paracetamol trials, respectively, over a 5-year horizon. Key factors affecting the viability were the time horizon modeled, the variable cost per participant, the probability of response to the intervention medication, and rates of use in nonresponders and the usual care alternative. CONCLUSIONS The N-of-1 strategy offers a realistic and viable option for increasing access to selected high cost medications where the medications are used for the symptomatic treatment of chronic disease, have rapid onset of action, and clinical response is unpredictable without a trial.

Chronic ethanol administration alters binding of [35S]t-butylbicyclophosphorothionate to the GABA-benzodiazepine receptor complex in rat brain

PURPOSE:Internet-based interventions to manage and prevent chronic diseases are becoming increasingly popular, especially for those with limited access to health services. This article reviews Internet-based interventions for the prevention of cardiovascular disease (CVD) and reduction of cardiovascular risk factors. METHODS:MEDLINE, EMBASE, and Cochrane databases were searched using terms for telemedicine and CVD (heart disease* OR myocardial infarction OR cardiac event* OR heart attack* OR cardiovascular disease* OR cardiovascular risk factor* OR blood pressure OR hypertension OR cholesterol OR LDL-C OR HDL-C OR cardiac rehabilitation) AND (telemonitor* OR tele-monitor* OR teleconsult* OR tele-consult* OR telemanagement OR tele-management OR telerehab* OR tele-rehab* OR Internet-based intervention OR internet based intervention OR Internet intervention* OR web based or web-based). Studies that investigated Internet-based interventions delivered directly to patients and resulted in improvement of cardiovascular-related health outcomes were included. RESULTS:Studies were identified (N = 23) investigating the reduction of cardiovascular risk factors. Five studies investigated patients diagnosed with CVD, 6 targeted participants with diabetes, 6 targeted participants with increased cardiovascular risk, and 6 investigated the general population. The majority of studies reported improvement in blood pressure and HbA1c levels in participants diagnosed with type 2 diabetes. Other outcomes included a decreased number of cardiovascular events, improved lipid profile and eating habits, decreased weight, and increased physical activity. CONCLUSIONS:There is emerging evidence that Internet-based interventions may reduce cardiovascular risk in cardiac patients and in populations with a heightened risk of CVD. Such interventions may also represent an alternative method of providing CVD prevention strategies.