Routine Pharmacotherapy Research Articles

Systematic review and meta-analysis of repetitive transcranial magnetic stimulation (rTMS) for activities of daily living in Alzheimer's disease.

This systematic review of randomised controlled trials (RCTs) was conducted to assess the effect of repetitive transcranial magnetic stimulation (rTMS) on activities of daily living (ADLs) in Alzheimer's disease (AD) patients. Ten databases were retrieved for pertinent Chinese and English literatures published up until January 2024. All RCTs of rTMS for ADLs in AD were included in this meta-analysis. Two researchers independently selected the literatures, retrieved the data of included literatures, accessed risk-of-bias of literatures with the Cochrane Collaboration's quality criteria and then cross-checked. Meta-analysis was carried out with Cochrane's Review Manager (RevMan, version 5.4). The PRISMA guidelines were followed in this systematic review. The 37 literatures involving 2461 patients with AD were included in this study. Compared with the control groups received the interventions such as routine pharmacotherapy, cognitive training, ect., with/without sham-rTMS, the experiment groups received the interventions of the control groups and rTMS. The findings were as follows: ADL scale [mean difference (MD) = -3.92, 95%CI (-4.93, -2.91), P < 0.00001]; Barthel Index (BI) [MD = 9.75, 95% CI (6.66, 12.85), P < 0.00001]; Modified Barthel Index (MBI) [MD = 5.43, 95% CI (3.13, 7.73), P < 0.00001]. The differences were statistically significant for all indicators. In 29 studies, rTMS stimulation sites were located in the dorsolateral prefrontal cortex (DLPFC). The rTMS could improve the ADLs in AD patients, and the DLPFC was a frequently used stimulation site of the rTMS for AD treatment.

Impact of Botoulinum Toxin-A on Complex Regional Pain Syndrome Type-2; A Case Report

CRPS is a very debilitating disorder. Pain (sensory) motor &amp; autonomic changes are the main stream manifestation of this disorder. In this case study we employed Botoulinum Toxin-A along with routine pharmacotherapy to observe its Impact on patient’s pain intensity along with quality of life. On McGill pain scale and SF-36 QoL result showed improvement after 2nd week till 12th week. Change in each variable was significant over 12 weeks interval.

Perceived social support and clinical characteristics in males with opioid use disorder on maintenance therapy

ABSTRACT Objective Perceived social support (PSS) is an important factor affecting the treatment outcomes in substance use disorders. The aim of this study was to determine the level of PSS among males with opioid use disorder receiving treatment. Method The population of this cross-sectional study consisted of 70 adult males diagnosed with opioid use disorder on maintenance therapy. Participants completed a semi-structured socio-demographic form, the Multidimensional Scale of Perceived Social and the Beck Depression Inventory (BDI). Results Levels of PSS among participants were found as follows: 41.4% had low PSS, 47.1% had moderate PSS, and 11.4% had high PSS. 41.4% of the participants had a history of injection opioid use; this group reported significantly lower PSS scores than non-injection opioid users. PSS scores were found to be significantly lower in patients with depressive scores above the cut-off score of BDI. There was a negative correlation between number of relapse and PSS. Conclusion Our findings suggest that males with opioid use disorder in Turkey reported lower PSS and PSS was associated with depressive symptoms and frequency of relapse. Aside from routine pharmacotherapy programs, PSS should be taken into consideration for patients with opioid use disorder and patient-specific strategies should be planned.

The Association of Medication Complexity with COVID-19 Severity and its Impact on Pharmacotherapy Evaluation

Published on:August 2022Journal of Young Pharmacists, 2022; 14(3):322-326Original Article | doi:10.5530/jyp.2022.14.63 Authors: Yogendra Shrestha*, Rajesh Venkataraman, Jeet Bahadur Moktan, Sonakshi Mallikarjuna, Sindhu Shree Narayan, Manisha Hemmige Madappa, Priyanka Anekere SatyaDepartment of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, Adichunchanagiri University, BG Nagara, Nagamangala, Karnataka, INDIA. Abstract: Background: Off-level medicines do not provide adequate health outcomes since there is insufficient efficacy and/or toxicity evidence. Offlevel medicines are more vulnerable to adverse drug reactions (ADRs), which are a prominent cause of morbidity and mortality. Objective of the study is to determine the relationship between the medication complexity and severity of COVID-19 and its impact on pharmacotherapy evaluation. Materials and Methods: A prospective, cross-sectional study was conducted in the COVID ward where medication complexity was assessed for all prescriptions on admission using the Medical Regimen Complexity Index’s guidelines and subjected to pharmacotherapy evaluation. Results: Overall, the patients spent an average of 7.55 ± 3.60 days in the hospital. Each prescription contained an average of 6.54 ± 2.51 drugs. Polypharmacy was found in 82.70% (263) of the prescriptions, while medication duplication was found in 17.29% (55), severe drug interactions accounted for 83.01% (264), and drug dosage adjustment was performed in 10.06% (32). The mean medication complexity was 26.86 ± 7. 58. When comparing medication complexity concerning the severity of COVID-19, we found that the average medication complexity score for mild was 24.62 ± 6.04, moderate was 31.65 ± 8.39, severe was 35.19 ± 6.81, and critical was 28.59 ± 8.60. we found a statistically significant positive correlation between the medical complexity and the hospital stay (P-value, 0.000), and there was an association between the medication complexity and the Covid-19 severity (p <0.001). Conclusion: The assessment of the medication complexity in routine pharmacotherapy evaluations could be beneficial in alerting potential risks, suggesting additional focus wherever required, and decreasing the financial burden by reducing hospital stay. It demonstrated an association between medication complexity and the severity of COVID-19.Keywords: Pharmacotherapy Evaluation, Medication Complexity, Drug Interaction, Polypharmacy, Medication Duplication, Dosage Adjustment.

The Role of Acupoint Application of Herbal Medicine for Asthma: Meta-Analysis of Randomized Double-Blind Placebo-Controlled Trials.

Background Acupoint application of herbal medicine (AAHM) has been widely used in China. At present, there is no systematic review of AAHM versus placebo in the treatment of asthma. This systematic review aims to assess the efficacy of AAHM for asthma. Methods Searches were conducted in five English databases and four Chinese databases from their inceptions until December 2020. Randomized double-blind placebo-controlled trials were screened, and included studies evaluated routine pharmacotherapy (RP) plus AAHM versus RP plus placebo or AAHM versus placebo. The Cochrane risk of bias tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE) were performed to evaluate the methodological quality and quality of evidence separately. Results Sixteen studies involving 1,730 participants were included in this review. Compared with placebo plus RP, participants receiving long-term AAHM plus RP showed improvement in asthma quality of life questionnaire (AQLQ) with moderate-quality evidence (MD 6.53 points, 95% CI 2.70 to 10.36). Low-quality evidence indicated that AAHM plus RP was associated with improved FEV1 (%) compared with placebo plus RP, whether long- or short-term use (MD 11.80%, 95% CI 2.84 to 20.76; MD 10.57%, 95% CI 8.40 to 12.74; respectively). Moderate-quality evidence showed that participants receiving short-term AAHM were associated with a higher AQLQ score (MD 6.57 points, 95% CI 3.76 to 9.38) and a lower frequency of acute exacerbations (MD –1.84, 95% CI –2.32 to –1.36) compared with placebo. Low-quality evidence also indicated that AAHM was associated with improved FEV1 (L) compared with placebo, whether long- or short-term use (MD 0.35 litres, 95% CI 0.03 to 0.67; MD 0.66 litres, 95% CI 0.59 to 0.73; respectively). Conclusions Moderate-quality evidence is promising that AAHM can improve the quality of life and reduce acute exacerbations in patients with asthma. AAHM also shows a positive role in improving lung function, but the evidence is so indefinite due to low quality.

ГАМКергические препараты в терапии начальных форм дисциркуляторной энцефалопатии

В настоящее время все большее значение приобретают функциональные расстройства при цереброваскулярных заболеваниях: тревога, ларвированная депрессия, когнитивные нарушения, инсомния и др. Это и нейрокардиальная проблема, и психосоматическая патология, требующая пересмотра существующих рутинных схем фармакотерапии, более многовекторного патогенетического подхода к лечению. В статье приведены результаты открытого пилотного когортного проспективного клинического исследования среди пациентов с дисциркуляторной энцефалопатией 1–2-й стадии. У пациентов с цереброваскулярной патологией применяли препарат Гамалате В6, нормализующий психоэмоциональные и мнестические функции — краткосрочную и долговременную память, снижающий уровень личностной и ситуативной тревожности. Под влиянием курсового приема Гамалате В6 улучшается мозговое крово­обращение: увеличивается скорость кровотока и снижается периферическое сопротивление в экстракраниальных сосудах каротидного бассейна. Гамалате В6 гармонизирует активность таламокортикальных структур (увеличивает мощность альфа-ритма на фоне снижения ЭЭГ-мощности подкорковых структур, генерирующих медленные ритмы) и симпатико-парасимпатический баланс вегетативной нервной системы по оценкам вариабельности ритма сердца.

Chinese Medicine for Chronic Obstructive Pulmonary Disease: A Pilot Study on Patient Preferences.

PurposeThe patient’s preference plays an important role in clinical practice. There currently is no available evidence regarding the perception and attitudes of patients with chronic obstructive pulmonary disease (COPD) towards the use of Chinese medicine (CM) approaches. This study was designed to explore preferences and factors associated with CM among COPD patients.Patients and MethodsA pilot survey was conducted among COPD patients using a structured, pre-tested questionnaire. The perceptions of CM therapies (including herbal medicine, non-pharmacotherapies), and expected clinical outcomes were investigated based on patient preference. Factors associated with preference of treatment scenarios were estimated in order of importance.ResultsThirty patients were enrolled in the survey, including 27 males and 3 females. Two-thirds of the patients preferred integrative Chinese and Western medicine for the treatment of COPD. Chinese patent medicines and CM decoction therapy were more popular than CM injections. The preferred non-drug therapy was point application, followed by acupuncture, Tai chi, or Qigong. More than 70% of patients reported that important clinical outcomes were improvements in lung function (77%) and dyspnea, cough, and sputum symptoms (73%), followed by exercise endurance (50%). Besides clinical efficacy, costs and side effects were also important factors for treatment selection.ConclusionThis pilot study showed that Chinese patent medicine and CM decoctions were preferred options for complementary medicines to combine with routine pharmacotherapy for COPD treatment according to the patients’ preferences. The improvement of dyspnea, cough symptoms, and lung function was the most desired clinical outcomes for patients. Quicker symptom relief, lower costs, and fewer side effects were key attributes for the treatment selection. Further research with a larger sample size is needed to definitively address the comprehensive conclusion.

Effects of probiotic, cinnamon, and synbiotic supplementation on glycemic control and antioxidant status in people with type 2 diabetes; a randomized, double-blind, placebo-controlled study.

The aim of this study was to investigate the effect of probiotic bacteria of Lactobacillus acidophilus, cinnamon powder and their combinations on the glycemic and antioxidant indices in patients with type 2 diabetes. A total of 136 patients randomized with type 2 diabetes entered the study and were randomly divided into four groups who were matched for age and gender. Thereafter, alongside their routine pharmacotherapy, each group followed one of the following diets: Group A: Lactobacillus acidophilus 108cfu and 0.5g of powdered cinnamon (synbiotic). Group B: Lactobacillus acidophilus (probiotic), Group C: powdered cinnamon. Group D: rice flour powder as placebo. At the beginning and end of the intervention, fasting blood sugar (FBS), HbA1c, advance glycation end products (AGE), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and antioxidant enzymes of superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT) were measured. Following 3months of treatment, the mean FBS level was decreased significantly in probiotic, cinnamon, and synbiotic supplementation groups compared with control (P < 0.01). FBS levels in probiotic, cinnamon, and synbiotic groups were significantly decreased compared with the control group (P = 0.001, P = 0.063 and P =0.001, respectively). The mean HbA1C in probiotic, cinnamon, and synbiotic groups were also decreased (P =0.001, P = 0.001 and P = 0.04, respectively). The mean AGE in synbiotic group was significantly decreased (P = 0.037). Probiotic, cinnamon and synbiotic all could improve antioxidant enzyme activity modestly. However, the most significant effect was seen in probiotic group. According to the current results, the use of probiotic supplements (individually or in combination with cinnamon) leads to a reduction in blood glucose and an increase in antioxidant enzymes in people with type 2 diabetes.

Comparative effectiveness of six Chinese herb formulas for acute exacerbation of chronic obstructive pulmonary disease: a systematic review and network meta-analysis

BackgroundSix Chinese herb formulas, namely, the Weijing decoction (WJ), the Maxingshigan decoction (MXSG), the Yuebijiabanxia decoction (YBBX), the Qingqihuatan decoction (QQHT), the Dingchuan decoction (DC) and the Sangbaipi decoction (SBP), are commonly used, along with routine pharmacotherapy, to manage the acute exacerbation of chronic obstructive pulmonary disease (AECOPD). In this study, we conducted a systematic review to summarize the efficacy of these six formulas, and we also conducted a network meta-analysis (NMA) to rank these formulas.MethodsWe searched five English databases and four Chinese databases, with dates ranging from the starting dates of these databases to December 2016. Randomized controlled trials that evaluated any of the six Chinese herb formulas combined with the use of pharmacotherapy for AECOPD were identified.ResultsFifty-five studies involving 4560 participants were included. The pairwise meta-analyses showed that WJ and QQHT had superior effects on the improvement of lung function (forced expiratory volume in 1 seconds; FEV1) (mean difference (MD): 0.25, 95% confidence interval (CI): 0.19–0.30 and 0.34, 95%CI: 0.10–0.58). MXSG, WJ and QQHT were found to be more effective for improving arterial blood gases (PaO2 and PaCO2). In terms of effective rates, all of these formulas had additional favourable effects compared to routine pharmacotherapy. The results of the NMA analyses indicated that only MXSG showed superior add-on effects for the improvement of FEV1 (MD: 0.37, 95% credible interval (CrI): 0.03–0.72). Most of the formulas combined with routine pharmacotherapy were superior to pharmacotherapy alone for the improvement of arterial blood gases and effective rates. The ranking tests suggested that QQHT and MXSG combined with routine pharmacotherapy might be optimal options for the treatment of AECOPD.ConclusionsThis NMA indicated that QQHT and MXSG might be more effective treatment regimens for AECOPD. Further well-designed studies that specifically examine the direct comparisons of these formulas are needed to support our conclusions.

The Effect of a Selective Exercise Program on Motor Competence and Pulmonary Function of Asthmatic Children: A Randomized Clinical Trial

Background Physical activity in asthmatic children may be useful. But there is not adequate knowledge about it. In present study the effect of selective exercise on motor competency and pulmonary function in asthmatic pediatrics was evaluated. Materials and Methods In a randomized clinical trial study,fifteen asthmatic children aged 6 to 18 years were included. Patients were randomly divided into the experimental or control group. There was no difference in the routine pharmacotherapy. The aerobic group had an exercise program consisting of 45-minute sessions three times per week for 8 weeks. The outcome measures were the difference between the pre- and post-exercise program and also the experimental and control groups. Spirometry parameters (such as FEV1and FVC) were measured. Motor competency was measured by the Ozeretski test. Quality of life was evaluated by St. George's questionnaire. The data were analyzed using SPSS software (version 16.0). Results: A significant effect was observed for spirometry parameters, quality of life and the Ozeretski test in two studied groups. Aerobic exercise had a significant effect in improving FEF 25-75%, quality of life and the fine and gross motor performance in the experimental group (P< 0.05). A significant difference was observed between two groups for FEF, FEF25-75% and quality of life (P< 0.05). Conclusion Regular exercise improves the spirometric parameters and quality of life in studied asthmatic children. In present study, aerobic exercise and strength training were useful complementary means for the treatment of asthmatic children.

The Effect of Aerobic Indoor Exercise Compared with Green Exercise on Different Symptoms of Depression: An Investigation of Psychological Mediators of Stress and Coping

Objectives: Considering the growing need for using a variety of new nonpharmacological methods in treating depression, this quasi experimental study was conducted to investigate the effect of aerobic indoor exercise in a gym compared with green exercise in an outdoor green environment of an urban park on triple categories of affective, cognitive and somatic symptoms of depression and to examine its psychological mediators of perceived stress and coping strategies. Methods: Forty six female outpatients with major depressive disorder were divided into 3 conditions of indoor exercise + routine pharmacotherapy (n = 15), green exercise + routine pharmacotherapy (n = 15), and a routine pharmacotherapy alone as the control group (n = 16). The exercise used for both indoor and green exercise conditions consisted of 36 one hour sessions (three times per week) with an intensity of 50% - 70% of the maximum heart rate. The participants completed the pre- and post-intervention depression, stress and coping questionnaires including Beck Depression Inventory-II, Perceived Stress Scale and Coping Inventory for Stressful Situations. Results: The findings indicated a significant decrease in the post-intervention scores of all three categories of affective, cognitive and somatic symptoms of depression and perceived stress in both exercise groups compared with the control group, but there was no significant difference between two exercise groups. With respect to the use of problem-focused, emotion-focused and avoidant-focused coping methods, there was no significant difference between post-intervention scores of all groups. Conclusion: In the clinical settings, both of the indoor exercise and green exercise programs can help to further improvement in all three categories of affective, cognitive and somatic symptoms of depression as an adjunct (or independent) treatment to the same degree, especially mediated by reducing the amount of perceived stress, but not through any significant changes in cognitive-behavioral coping strategies.

Can Chinese Herbal Medicine Adjunctive Therapy Improve Outcomes of Senile Vascular Dementia? Systematic Review with Meta-analysis of Clinical Trials.

Many publications have reported the growing application of complementary and alternative medicine, particularly the use of Chinese herbal medicine (CHM) in combination with routine pharmacotherapy (RP) for senile vascular dementia (SVD), but its efficacy remains largely unexplored. The purpose of this study is to evaluate the efficacy of CHM adjunctive therapy (CHMAT), which is CHM combined with RP, in the treatment of SVD. Publications in seven electronic databases were searched extensively, and 27 trials with a total of 1961 patients were included for analysis. Compared with RP alone, CHMAT significantly increased the effective rate [odds ratio (OR) 2.98, 95% confidence interval (CI) 2.30, 3.86]. In addition, CHMAT showed benefits in detailed subgroups of the Mini-Mental State Exam (MMSE) score from time of onset to 4 weeks (WMD 3.01, 95% CI 2.15, 3.87), 8 weeks (weighted mean difference (WMD) 2.30, 95% CI 1.28, 3.32), 12 weeks (WMD 2.93, 95% CI 2.17, 3.69), and 24 weeks (WMD 3.25, 95% CI 2.61, 3.88), and in the activity of daily living scale score from time of onset to 4 weeks (WMD -4.64, 95% CI -6.12, -3.17), 8 weeks (WMD -4.30, 95% CI -6.04, -2.56), 12 weeks (WMD -3.89, 95% CI -4.68, -3.09), and 24 weeks (WMD -4.04, 95% CI -6.51, -1.57). Moreover, CHMAT had positive effects on changes in the Hasegawa dementia scale, National Institutes of Health Stroke Scale, Clinical Dementia Rating, and Montreal Cognitive Assessment scores, as well as blood fat levels (total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and apolipoprotein E), platelet aggregation rate (1-min platelet aggregation rate, 5-min platelet aggregation rate, and maximal platelet aggregation rate), and blood rheology (whole-blood viscosity and hematocrit). No serious or frequently occurring adverse effects were reported. Weaknesses of methodological quality in most trials were assessed using the Cochrane risk of bias tool, while the quality level of Grades of Recommendations Assessment Development and Evaluation (GRADE) evidence classification indicated 'very low'. This systematic review suggests that CHM as an adjunctive therapy can improve cognitive impairment and enhance immediate response and quality of life in SVD patients. However, because of limitations of methodological quality in the included studies, further research of rigorous design is needed.

24 Short-Term Effectiveness and Safety Profile of Ranolazine in Patients with Refractory Angina

Introduction Refractory angina describes those patients with persistence of symptoms despite revascularisation and routine pharmacotherapy with β-blockers, calcium channel antagonists and nitrates. Ranolazine offers adjunct therapy in such cohorts, by providing anti-ischaemic effects complementary to existing agents. It is thought to be well-tolerated, without significant effects on haemodynamic parameters including heart rate and blood pressure. This prospective study aimed to establish the short-term effectiveness and safety profile of ranolazine in patients with refractory angina. Methods Bradford Royal Infirmary has a specialised cardiology service to manage refractory angina (BRAS). From their database, 50 consecutive patients were selected for inclusion between May 2013 and February 2014. All patients were commenced on ranolazine 375 mg twice daily at initial review, and therapy was continued for 1 month. Those who required up-titration of anti-anginals or revascularisation on clinical grounds were excluded from the study. Results of 6 min walks, Canadian Cardiovascular Society (CCS) grading of angina severity and QTc interval on resting ECG was tabulated, both pre-intervention and at 1 month. Wilcoxon signed rank sum testing was applied to measure differences in outcome. Patients were surveyed to assess for tolerability and adverse events. Results 45 patients were eligible for inclusion. 87% (39/45) were male, with a mean age of 65.2 years (SD 12.3). At 1 month, there was a median increase in 6 min walk of 30 metres (95% CI: 25 – 60; p = 0.0002). CCS grading class for angina severity reduced by 0.5 (95% CI: 0 – 0.86; p Conclusions These findings suggest that ranolazine offers effective additive therapy in patients with persistent anginal symptoms who have been otherwise optimised. Despite our small sample size, results demonstrated a statistically significant improvement in performance on 6 min walk, CCS grading score and usage of GTN spray. Overall, ranolazine was well-tolerated without QTc prolongation or overt side-effects. Further studies are indicated to establish whether effects are maintained in the longer term.

Addressing phenoconversion: the Achilles' heel of personalized medicine.

Phenoconversion is a phenomenon that converts genotypic extensive metabolizers (EMs) into phenotypic poor metabolizers (PMs) of drugs, thereby modifying their clinical response to that of genotypic PMs. Phenoconversion, usually resulting from nongenetic extrinsic factors, has a significant impact on the analysis and interpretation of genotype-focused clinical outcome association studies and personalizing therapy in routine clinical practice. The high phenotypic variability or genotype-phenotype mismatch, frequently observed due to phenoconversion within the genotypic EM population, means that the real number of phenotypic PM subjects may be greater than predicted from their genotype alone, because many genotypic EMs would be phenotypically PMs. If the phenoconverted population with genotype-phenotype mismatch, most extensively studied for CYP2D6, is as large as the evidence suggests, there is a real risk that genotype-focused association studies, typically correlating only the genotype with clinical outcomes, may miss clinically strong pharmacogenetic associations, thus compromising any potential for advancing the prospects of personalized medicine. This review focuses primarily on co-medication-induced phenoconversion and discusses potential approaches to rectify some of the current shortcomings. It advocates routine phenotyping of subjects in genotype-focused association studies and proposes a new nomenclature to categorize study populations. Even with strong and reliable data associating patients' genotypes with clinical outcome(s), there are problems clinically in applying this knowledge into routine pharmacotherapy because of potential genotype-phenotype mismatch. Drug-induced phenoconversion during routine clinical practice remains a major public health issue. Therefore, the principal challenges facing personalized medicine, which need to be addressed, include identification of the following factors: (i) drugs that are susceptible to phenoconversion; (ii) co-medications that can cause phenoconversion; and (iii) dosage amendments that need to be applied during and following phenoconversion.

TCM Zheng Classification and Clinical Trials 2014.

TCM Zheng Classification and Clinical Trials 2014.

Oral Chinese Herbal Medicine Combined with Pharmacotherapy for Stable COPD: A Systematic Review of Effect on BODE Index and Six Minute Walk Test

This systematic review evaluated the effects of Chinese herbal medicine (CHM) plus routine pharmacotherapy (RP) on the objective outcome measures BODE index, 6-minute walk test (6MWT), and 6-minute walk distance (6MWD) in individuals with stable chronic obstructive pulmonary disease (COPD). Searches were conducted of six English and Chinese databases (PubMed, EMBASE, CENTRAL, CINAHL, CNKI and CQVIP) from their inceptions until 18th November 2013 for randomized controlled trials involving oral administration of CHM plus RP compared to the same RP, with BODE Index and/or 6MWT/D as outcomes. Twenty-five studies were identified. BODE Index was used in nine studies and 6MWT/D was used in 22 studies. Methodological quality was assessed using the Cochrane Risk of Bias tool. Weaknesses were identified in most studies. Six studies were judged as ‘low’ risk of bias for randomisation sequence generation. Twenty-two studies involving 1,834 participants were included in the meta-analyses. The main meta-analysis results showed relative benefits for BODE Index in nine studies (mean difference [MD] −0.71, 95% confidence interval [CI] −0.94, −0.47) and 6MWT/D in 17 studies (MD 54.61 meters, 95%CI 33.30, 75.92) in favour of the CHM plus RP groups. The principal plants used were Astragalus membranaceus, Panax ginseng and Cordyceps sinensis. A. membranaceus was used in combination with other herbs in 18 formulae in 16 studies. Detailed sub-group and sensitivity analyses were conducted. Clinically meaningful benefits for BODE Index and 6MWT were found in multiple studies. These therapeutic effects were promising but need to be interpreted with caution due to variations in the CHMs and RPs used and methodological weakness in the studies. These issues should be addressed in future trials.

Chinese herbal medicine (weijing decoction) combined with pharmacotherapy for the treatment of acute exacerbations of chronic obstructive pulmonary disease.

Objective. To evaluate the efficacy and safety of Weijing decoction combined with routine pharmacotherapy (RP) for the treatment of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Methods. Randomized controlled trials (RCT) evaluating Weijing decoction for AECOPD were included. English, Chinese, and Japanese databases were searched from their respective inceptions to June 2013. The methodological quality was assessed according to the Cochrane Collaboration's risk of bias tool. All data were analyzed and synthesized using RevMan 5.2 software. Results. Fifteen (15) studies involving 986 participants were included. Participants were diagnosed with COPD in the acute exacerbation stage. In addition, most of studies reported that they included participants with the Chinese medicine syndrome, phlegm-heat obstructing the Lung. Weijing decoction combined with RP improved lung function (forced expiratory volume in one second; FEV1), arterial blood gases (PaO2 and PaCO2), clinical effective rate, and reduced inflammatory biomarkers (TNF-α and IL-8) when compared with RP alone. No severe adverse events were reported in these studies. Conclusions. Weijing decoction appeared to be beneficial for AECOPD and well-tolerated when taken concurrently with RP, such as antibiotics, bronchodilators (oral and inhaled), and mucolytics.

GW24-e1145 The effects of Shensongyangxin capsule on heart rate turbulence and heart rate variability in chronic heart failure

ObjectivesAlthough the use of β blockers, angiotensin converting enzyme inhibitors (ACEI)/angiotensin II receptor blockers (ARB), the malignant arrhythmia and cardiac sudden death remainsMethodsSixty-six patients with CHF were randomly divided into...

Oral Chinese Herbal Medicine for Improvement of Quality of Life in Patients with Stable Chronic Obstructive Pulmonary Disease: A Systematic Review

This study evaluates published clinical trials of Chinese herbal medicine (CHM) for chronic obstructive pulmonary disease (COPD) that employ a health-related quality of life (HRQoL) outcome measure. Searches were conducted in April 2011 on MEDLINE, Embase, the Cochrane Controlled Trials Register, CINAHL, Scopus, and Chinese databases (CNKI, CQVIP, WANFANG). Randomized controlled trials involving oral administration of CHM formulae or single herb, with or without blinding, compared to placebo, no treatment, routine pharmacotherapy control, or CHM plus routine pharmacotherapy versus routine pharmacotherapy, with a HRQoL questionnaire as an outcome measure were identified. The methodological quality was assessed using the Cochrane risk of bias assessment. A total of 27 studies involving 1966 patients were identified. St. George Respiratory Questionnaire (SGRQ) or Cai's QoLQ were used in 13 and 14 studies, respectively. Assessment of the Cochrane risk of bias revealed adequate sequence of generation in 10 studies and adequate allocation concealment in 1 study; double blinding was not described adequately in any studies. Seventeen (17) studies addressed incomplete outcome data, and 17 studies were free of selective reporting. The main results of meta-analysis showed improvement of total HRQoL scores (SGRQ and Cai's QoLQ) when CHM was compared to no treatment (-6.07 [-9.21, -2.93] and -0.20 [-32, -0.07], respectively) and for CHM plus routine pharmacotherapy versus routine pharmacotherapy (-5.15 [-7.26, -3.05]) and (-0.25 [-0.37, -0.13]). While the results of CHM on HRQoL for stable COPD sufferers were promising, they need to be interpreted with caution due to methodological problems, which should be addressed in future trials.

Adjunctive cognitive remediation for schizophrenia using yoga: an open, non-randomised trial

BACKGROUND: Yoga therapy (YT) improves cognitive function in healthy individuals, but its impact on cognitive function among persons with schizophrenia (SZ) has not been investigated. AIMS: Evaluate adjunctive YT for cognitive domains impaired in SZ. METHODS: Patients with SZ received YT or treatment as usual (TAU; n = 65, n = 23, respectively). Accuracy and speed for seven cognitive domains were assessed using a computerized neurocognitive battery (CNB), thus minimizing observer bias. Separately, YT was evaluated among patients with Bipolar I disorder (n = 40), Major Depressive Disorder (n = 37), and cardiology outpatients (n = 68). All patients also received routine pharmacotherapy. Patients were not randomized to YT or TAU. RESULTS: Compared with the SZ/TAU group, the SZ/YT group showed significantly greater improvement with regard to measures of attention following corrections for multiple comparisons; the changes were more prominent among the men. In the other diagnostic groups, differing patterns of improvements were noted with small to medium effect sizes. CONCLUSIONS: Our initial analyses suggest nominally significant improvement in cognitive function in schizophrenia with adjunctive therapies such as YT. The magnitude of the change varies by cognitive domain and may also vary by diagnostic group.