#46
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Öèòàòà:
Áóêâàëüíî ñëåäóþùåå: The American Pain Society recommends that adults with osteoarthritis be encouraged to take 1,500 mg of glucosamine daily as a dietary supplement but does not specifically recommend it as pharmacologic management for pain. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Ïîýòîìó òàêàÿ ðåêîìåíäàöèÿ ïîòåíöèàëüíî âîçìîæíà: Patients should be advised to take 1,500 mg of glucosamine daily, either once daily or in divided doses three times daily, and to continue therapy for at least four to eight weeks to allow for onset of benefit. Am Fam Physician. 2006 Apr 1;73(7):1245-6 [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#47
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Òàê ýòî æå èìåííî òî, óâàæàåìûé Âàäèì Âàëåðüåâè÷, î ÷åì ÿ çäåñü âñå âðåìÿ ïèøó: õîíäðîïðîòåêòîðû - ýòî ÁÀÄû, è ðåêîìåíäàöèè ïî èõ ïðèìåíåíèþ äàþòñÿ òàê æå, êàê è ïî îòíîøåíèþ êî âñÿêèì áèîäîáàâêàì, íå ñ÷èòàÿ ýòî ëåêàðñòâåííîé òåðàïèåé!
[Èçîáðàæåíèÿ äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì] |
#48
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[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
Results: A total of 212 patients were enrolled in the study (106 assigned to each group). The baseline characteristics were similar for the 2 groups. The mean age of the patients was 66 years, and about 80% were women. Only 71 patients (67%) in the glucosamine group and 68 (64%) in the placebo group completed the 3 years of follow-up. Intention-to-treat analysis revealed that the mean joint-space narrowing was –0.06 mm in the glucosamine group and –0.31 mm in the placebo group, for a difference of 0.24 mm (95% confidence interval [CI] 0.01 to 0.48, p = 0.043). The minimum joint-space narrowing was –0.07 mm with glucosamine, as compared with –0.40 mm with placebo, for a similar difference of 0.33 mm (95% CI 0.12 to 0.54, p = 0.003). A preservation of about 0.3 mm in joint-space width over 3 years may not seem clinically significant, but the authors cite a rate of natural joint-space narrowing of –0.1 mm per year in other studies. The change in overall symptom score using visual analogue scales was –11.7% with glucosamine and 9.8% with placebo, for a difference of –21.6% (p = 0.02). Glucosamine was well tolerated. Commentary: Although this was described as a double-blind study, there were no data on the success of allocation concealment, a criticism of earlier studies of glucosamine.2 If patients knew their treatment assignment, then the subjective perception of symptom relief with glucosamine may have been exaggerated. The measurements of joint-space narrowing, however, were objective and raise the possibility of a disease-modifying effect. |
#49
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Óâàæàåìûé Ìèõàèë Âëàäèìèðîâè÷! ß ëå÷ó ïàöìåíòîâ ñ ðåôðàêòåðíîé ÀÃ, îò êîòîðûõ óæå îòêàçàëèñü äðóãèå âðà÷è. È êîíòðîëü äàâëåíèÿ íà ðåêîìåíäóåìîì óðîâíå ìíîþ ó íèõ äîñòèãàåòñÿ. Ôàêòè÷åñêè ÿ ïîëó÷àþ ðåçóëüòàò, ðåêîìåíäóåìûé îôèöèàëüíûìè ãàéäàìè. Êàê ÿ ïîëó÷àþ ýòîò ðåçóëüòàò ïðàêòè÷åñêè íå èìååò çíà÷åíèÿ (÷òî òîæå îãîâîðåíî ãàéäàìè). ß òàê ïîíèìàþ, åäèíñòâåííîå ìîå ðàñõîæäåíèå ñ ãàéäàìè ýòî ìåòîä äîñòèæåíèÿ öåëè (êîòîðûé êñòàòè îòñóòñòâóåò â êëàññå ðåêîìåíäàöèé III âî âñåõ ãàéäàõ). Èç ëè÷íûõ áåñåä ìíå èçâåñòíî, ÷òî àìåðèêàíñêèå âðà÷è òàêæå ïðèìåíÿþò ýòîò ìåòîä, íå ðèñêóÿ ëèöåíçèåé. È åùå. ÍÏÂÑ è ÕÏ íå âûëå÷èâàþò àðòðîç. Âñå-òàêè ÷òî ãóìàííåå, ñíèìàòü áîëü ñóáñòàíöèåé íåèçâåñòíîãî äåéñòâèÿ, íå èìåþùåé ïðàêòè÷åñêè ïîáî÷íûõ äåéñòâèé, èëè îêàçûâàòü ïðîòèâîâîñïàëèòåëüíîå äåéñòâèå, ðèñêóÿ ñåðúåçíûìè îñëîæíåíèÿìè, î êîòîðûõ óæå ãîâîðèëîñü. Åñëè êòî óñìîòðèò â ìîèõ âûñêàçûâàíèÿõ ðåêëàìó èëè ñàìîðåêëàìó - òî ýòî íå òàê.
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#50
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[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
Öèòàòà:
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#51
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Åñòü äàííûå ïî âëèÿíèþ õîíäðîïðîòåêòîðîâ íà ñòðóêòóðó ïîðàæåííûõ ñóñòàâîâ. Ñ ðàçíîé ñòåïåíüþ óáåäèòåëüíîñòè èññëåäîâàíèÿ äîêàçàëè çàìåäëåíèå ïðîãðåññèðîâàíèÿ îñòåîàðòðîçà.
Âîò ñâåæàéøèé îáçîð ïî ãëþêîçàìèíó - [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Jean-Yves Reginster, Olivier Bruyere and Audrey Neuprez. Rheumatology (Oxford). 2007 Mar 31 Öèòàòà:
Öèòàòà:
Öèòàòà:
Èññëåäîâàíèå ýòî èìååò ðÿä îãðàíè÷åíèé - 1. Àñòðîíîìè÷åñêè âûñîêèé ýôôåêò ïëàöåáî – 60%. Íå êàæäîå ýôôåêòèâíîå ëåêàðñòâî ìîæåò ïðåîäîëåòü ýòîò áàðüåð. 2.  äàííîì èññëåäîâàíèè èñïîëüçîâàëñÿ ãëþêîçàìèíà ãèäðîõëîðèä, ÷òî âåñüìà ñòðàííî, ò.ê. íàèáîëåå çíà÷èìàÿ äîêàçàòåëüíàÿ áàçà èìååòñÿ ïî ñóëüôàòó ãëþêîçàìèíà. 3. Áîëüøèíñòâî ïàöèåíòîâ (78%) èìåëè ñëàáîâûðàæåííûé áîëåâîé ñèíäðîì. Öèòàòà:
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#52
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Õîðîøî, ÷òî æå ìîæíî íàéòè â ïåðå÷èñëåííûõ ñòàòüÿõ íîâîãî?
 òîì, ÷òî âñå èññëåäîâàòåëè ïðèõîäÿò ê âûâîäó "Ýôôåêò, âðîäå åñòü, òîëüêî êàêîé-òî òðóäíîóëîâèìûé" è "Íàäî ïðîäîëæàòü èññëåäîâàíèÿ - òîãäà, ãëÿäèøü, ñêîðî äîêàæåì ýôôåêòèâíîñòü" - òàê ýòî ñòàíäàðòíàÿ ñèòóàöèÿ âî âñåõ èññëåäîâàíèÿõ, ïîñâÿùåííûõ ÁÀÄàì. Êñòàòè, íå âèæó áîëüøîé ðàçíèöû ìåæäó ôðàçàìè "Õîíäðîïðîòåêòîðû, ïî êðàéíåé ìåðå, ãëþêîçàìèí è õîíäðîèòèí – ýòî ëåêàðñòâà (drugs), êîòîðûå â íåêîòîðûõ ñòðàíàõ äîñòóïíû òîëüêî êàê ÁÀÄû" è "Õîíäðîïðîòåêòîðû - ýòî ÁÀÄû, ñ÷èòàþùèåñÿ â íåêîòîðûõ ñòðàíàõ ëåêàðñòâàìè". Ïîëàãàþ, ÷òî âçÿâ íàóãàä ëþáîé ÁÀÄ, ìû âñåãäà ñìîæåì íàéòè íà ãëîáóñå ñòðàíó, â êîòîðîé îíûé ïðåïàðàò ñ÷èòàåòñÿ ëåêàðñòâîì (drug). Ìåæäó ïðî÷èì, â áåëüãèéñêîì èññëåäîâàíèè ÿ ïî÷åìó-òî íå íàøåë ãðóïïû ñðàâíåíèÿ (íàâåðíîå, íåâíèìàòåëüíî ÷èòàë...). Ò.å., ïðåòåíçèè ê äèçàéíó òàêè åñòü... ×òî êàñàåòñÿ ðåêîìåíäàöèé Åâðîïåéñêîé Àíòèðåâìàòè÷åñêîé ëèãè (íà ñàìîì äåëå ýòî âñåãî ëèøü ëèòîáçîð ïî êîëåííûì àðòðîçàì), òî â íèõ ïðîñòî ñîáðàíî âñå, ÷òî êîãäà-ëèáî èñïîëüçîâàëîñü â ëå÷åíèè ÎÀ. Êñòàòè, EULAR äåëàåò åäèíñòâåííûé âûâîä - êàæäàÿ ñòðàíà ìîæåò ñàìà âûáðàòü èç ïðèâåäåííîãî ñïèñêà ìåòîäîâ ëå÷åíèÿ òî, ÷òî åé íðàâèòñÿ (êîìó õîíäðîïðîòåêòîðû, êîìó - ëàçåðîòåðàïèÿ ). Ìåæäó ïðî÷èì , ðàáî÷àÿ ãðóïïà ïî ñîñòàâëåíèþ ýòîãî äîêóìåíòà çàñåäàëà â Âåëèêîáðèòàíèè - ðåçóëüòàò â ñòðàíå ïóáëèêàöèè âñåì óæå èçâåñòåí. Ò.î., äàííûå "ðåêîìåíäàöèè" íå ìîãóò ñ÷èòàòüñÿ îôèöèàëüíûì äîêóìåíòîì, íà îñíîâàíèè êîòîðîãî âðà÷è äîëæíû âûáèðàòü òàêòèêó ëå÷åíèÿ. |
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#53
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Öèòàòà:
Áåëüãèéñêîå èññëåäîâàíèå íàóãàä âçÿòî è ýòî êàæåòñÿ íå ôóë òåêñò, èõ ïîëíî èññëåäîâàíèé òî ýòèõ..è åùå áóäóò.Òàì îíè ïðîñòî íå çíàëè, ÷òî òåìà óæå çàêðûòà è ïåðâûé ýòàï çàêîí÷èëñÿ.Èëè ìîæåò ïàöèåíòîâ ðåøèëè ðàçâëå÷ü, íå âñå æ ïëàöåáî òî ïèòü... È, êñòàòè, åùå ïî ýòîìó èññëåäîâàíèþ, êîòîðîå ìû òóò çàìóñîëèëè, ïðî 1358 ÷åëîâåê.Òàì âïîëíå íîðìàëüíàÿ ïîäâûáîðêà, êîððåêòíî ïîäåëåííàÿ íà 5 ãðóïï ïî 70 ÷åëîâåê áîëåå òÿæåëûõ, òî åñòü ýòî ìîæíî êàê èññëåäîâàíèå âûâîäèòü. ýòîé ãðóïïå ñêà÷îê ïî ãõ äî 79%.Âûáîðêà 354 ÷åëîâåê.È ïî ïëàöåáî òàì 54%.( òî åñòü íà áîëåå òÿæåëûõ ïëàöåáî, âèäèìî íå ïîäåéñòâîâàëî) |
#54
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Ýòî Âû âåðíî çàìåòèëè. Ïîñëå ðàññìîòðåíèÿ óêàçàííîãî Âàìè ñëàéäà #44 âîïðîñîâ óæå íå îñòàåòñÿ. Ñëåäóåò ñìîòðåòü ïðåæäå âñåãî íà îáùèé ðåçóëüòàò â ãðóïïå All patients (N=1538): ÍÏÂÑ äàåò âåñüìà ñëàáûé ýôôåêò, à óæ õîíäðîïðîòåêòîðû - ýòè âîâñå íè÷åì íå îòëè÷àþòñÿ îò ïëàöåáî.
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#55
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Öèòàòà:
̲ͲÑÒÅÐÑÒÂÎ ÎÕÎÐÎÍÈ ÇÄÎÐÎÂ'ß ÓÊÐÀ¯ÍÈ "Ïðèêàç îò 05.05.2003 ¹191 Îá óòâåðæäåíèè âðåìåííûõ ãîñóäàðñòâåííûõ ñîöèàëüíûõ íîðìàòèâîâ ïðåäîñòàâëåíèÿ ìåäïîìîùè ïî ñïåöèàëüíîñòè îáùàÿ ïðàêòèêà-ñåìåéíàÿ ìåäèöèíà. " Öèòàòà:
Åñòü äîêàçàòåëüíàÿ áàçà ïî õîäðîïðîòåêòîðàì, õîòü è ñëàáàÿ. Åñòü äîêàçàòåëüñòâà, êàê ñèìïòîìàòè÷åñêîãî ýôôåêòà, òàê è âëèÿíèÿ íà ïðîãðåññèðîâàíèå çàáîëåâàíèÿ (îñîáåííî äëÿ ãëþêîçàìèíà ñóëüôàòà). Áåçîïàñíîñòü äîêàçàíà íåïëîõî.  ðåêîìåíäàöèÿõ àìåðèêàíñêèõ è áðèòàíñêèõ, â «Õàððèñîíå» îíè óïîìèíàþòñÿ êàê ñðåäñòâà äîïóñòèìûå ê ïðèìåíåíèþ. Ñïåêòð ìåòîäîâ ëå÷åíèÿ îñòåîàðòðîçà êðàéíå óçîê â ìîåé ïðàêòèêå (ÿ ïðîñòîé ó÷àñòêîâûé òåðàïåâò). Âíóòðèñóñòàâíûå èíúåêöèè ÿ íå äåëàþ, ïðîòåçèðîâàíèå ñóñòàâîâ ìîèì ïàöèåíòàì íå äîñòóïíî, íàðêîòèêè òàêèì ïàöèåíòàì ÿ íå íàçíà÷ó (òðàìàäîë ó íàñ â ñïèñêå íàðêîòèêîâ). ×òî îñòàåòñÿ? ×åì ëå÷èòü îñòåîàðòðîç? Òîëüêî ÍÏÂÑ? ß ïðèìåíÿë, ïðèìåíÿþ, è áóäó ïðèìåíÿòü õîíäðîïðîòåêòîðû (ãëþêîçàìèí, õîíäðîèòèí). ß äëÿ ýòîãî âèæó äîñòàòî÷íûå îñíîâàíèÿ.  ñåãîäíÿøíåì íîìåðå Annals of internal medicine îïóáëèêîâàí ìåòààíàëèç, ñîäåðæàùèé ïëîõèå íîâîñòè äëÿ ñòîðîííèêîâ õîíäðîïðîòåêòîðîâ - [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Öèòàòà:
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#56
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Öèòàòà:
Ïîñìîòðåëè âñå òàêè? È ïðÿì âîò òàê âîò íàäî ýòî ñìîòðåòü äà?Íó ÿ ïîïðîáóþ.... |
#57
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Öèòàòà:
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#58
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Óâàæàåìûé Àëåêñàíäð Þðüåâè÷! Ñàìûì ãëàâíûì ðèñêîì Àà ÿâëÿåòñÿ ñàìà ÀÃ. È ñíèæåíèå ÀÄ íèæå 140/90 (130/80) ýòî ïåðâàÿ è ãëàâíàÿ çàäà÷à. È ïîòîì íåóæåëè Âû äóìàåòå, ÷òî ÿ òîëüêî ñóáñòàíöèåé ëå÷ó. Ãèïåðòîíèÿ-òî ðåôðàêòåðíàÿ. ÁÊÊ+òèàçèäû+èÀÏÔ+ ÁÁ. Íîëü ýôôåêòà (ò.å ãëàâíàÿ çàäà÷à íå ðåøåíà). Äîáàëÿåì ñóáñòàíöèþ - åñòü ýôôåêò. ×òî ÿ ýòèì íàðóøàþ?
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#59
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Ñäåëàéòå îòäåëüíóþ òåìó è äàâàéòå ðàññìîòðèì ýòîò âûäàþùèéñÿ ñëó÷àé âî âñåõ åãî ïîäðîáíîñòÿõ Ó íàñ â áîëüíèöå òîæå íå ïðèíÿòî îòêàçûâàòüñÿ îò áîëüíûõ, ðåçèñòåíòíûå ãèïåðòîíèè áûâàåò, íî áåç øàìàíñòâà ïîòèõîíüêó îáõîäèìñÿ.  ìèðå êàê-òî òîæå
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#60
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Ïîïðîáóþ óãàäàòü, êàê ó Âàñ, Óâàæàåìûé Àëåêñàíäð, â áîëüíèöå îáõîäÿòñÿ áåç øàìàíñòâà. 5-10 êàïåëüíèö ñ êàâèíòîíîì, 5-10 êàïåëüíèö ñ ïåíòèëèíîì... è åùå ìàãíåçèÿ, ìèëäðîíàò, ïèðàöåòàì. Äàéòå-êà äîêàçàòåëüíóþ áàçó íà ýòè ïðåïàðàòû, èëè ýòî íå øàìàíñòâî?
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