Patient perceptions and experiences of stereotactic radiotherapy for wet age-related macular degeneration.

PURPOSE Wet age-related macular degeneration (ARMD) is a leading cause of visual impairment. Anti-vascular endothelial growth factor (VEGF) injections are the mainstay of treatment but require monthly injections and frequent hospital visits. A novel approach to treatment with the use of stereotactic radiotherapy (Oraya IRay) as an adjunct to ranibizumab injections has shown promising results. We explored patients' experiences of receiving Oraya therapy for wet ARMD. METHODS We present a consecutive case series with objective and detailed reporting of the personal experiences of 5 patients with active wet ARMD treated with Oraya radiotherapy in our unit. We provided all patients who had received one Oraya treatment with a standardized survey composed of 10 questions addressing the experience of receiving this treatment. RESULTS Generally, patients reported positive experiences of receiving Oraya treatment and perceived this treatment as a better option in comparison with anti-VEGF injections. However, the patients' perceptions of Oraya treatment varied according to patients' previous experiences of anti-VEGF injections and expectations of treatment. CONCLUSIONS Patients mainly justified their decision to receive Oraya treatment by expecting fewer intravitreal injections, but more research on this topic is needed to suggest new evidence-based treatment protocols for patients with wet ARMD

Ketamine and other glutamate receptor modulators for depression in adults

Considering the ample evidence of involvement of the glutamate system in the pathophysiology of depression, pre-clinical and clinical studies have been conducted to assess the antidepressant efficacy of glutamate inhibition, and glutamate receptor modulators in particular. This review focuses on the use of glutamate receptor modulators in unipolar depression. This review is an abridged version of a Cochrane review previously published in the Cochrane Database of Systematic Reviews, 2015, Sept 23, Issue 9: CD011612.</p

Ketamine and other glutamate receptor modulators for depression in bipolar disorder in adults

There is emerging evidence that glutamatergic system dysfunction might play an important role in the pathophysiology of bipolar depression. This review focuses on the use of glutamate receptor modulators for depression in bipolar disorder. This review is an abridged version of a Cochrane review previously published in the Cochrane Database of Systematic Reviews, 2015, Sep 29, Issue 9, CD011611</p

Ketamine and other glutamate receptor modulators for depression in bipolar disorder in adults

There is emerging evidence that glutamatergic system dysfunction might play an important role in the pathophysiology of bipolar depression. This review focuses on the use of glutamate receptor modulators for depression in bipolar disorder. This review is an abridged version of a Cochrane review previously published in the Cochrane Database of Systematic Reviews, 2015, Sep 29, Issue 9, CD011611</p

Ketamine and other glutamate receptor modulators for depression in bipolar disorder in adults

There is emerging evidence that glutamatergic system dysfunction might play an important role in the pathophysiology of bipolar depression. This review focuses on the use of glutamate receptor modulators for depression in bipolar disorder. This review is an abridged version of a Cochrane review previously published in the Cochrane Database of Systematic Reviews, 2015, Sep 29, Issue 9, CD011611</p

Randomised controlled trial to determine the efficacy and safety of prescribed water intake to prevent kidney failure due to autosomal dominant polycystic kidney disease (PREVENT-ADPKD)

Introduction Maintaining fluid intake sufficient to reduce arginine vasopressin (AVP) secretion has been hypothesised to slow kidney cyst growth in autosomal dominant polycystic kidney disease (ADPKD). However, evidence to support this as a clinical practice recommendation is of poor quality. The aim of the present study is to determine the long-term efficacy and safety of prescribed water intake to prevent the progression of height-adjusted total kidney volume (ht-TKV) in patients with chronic kidney disease (stages 1-3) due to ADPKD. Methods and analysis A multicentre, prospective, parallel-group, open-label, randomised controlled trial will be conducted. Patients with ADPKD (n=180; age ≤65 years, estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m 2) will be randomised (1:1) to either the control (standard treatment+usual fluid intake) or intervention (standard treatment+prescribed fluid intake) group. Participants in the intervention arm will be prescribed an individualised daily fluid intake to reduce urine osmolality to ≤270 mOsmol/kg, and supported with structured clinic and telephonic dietetic review, self-monitoring of urine-specific gravity, short message service text reminders and internet-based tools. All participants will have 6-monthly follow-up visits, and ht-TKV will be measured by MRI at 0, 18 and 36 months. The primary end point is the annual rate of change in ht-TKV as determined by serial renal MRI in control vs intervention groups, from baseline to 3 years. The secondary end points are differences between the two groups in systemic AVP activity, renal disease (eGFR, blood pressure, renal pain), patient adherence, acceptability and safety. Ethics and dissemination The trial was approved by the Human Research Ethics Committee, Western Sydney Local Health District. The results will inform clinicians, patients and policy-makers regarding the long-term safety, efficacy and feasibility of prescribed fluid intake as an approach to reduce kidney cyst growth in patients with ADPKD. Trial registration number ANZCTR12614001216606