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Jeremy R Parr - One of the best experts on this subject based on the ideXlab platform.
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drooling reduction intervention randomised trial dri comparing the efficacy and acceptability of Hyoscine patches and glycopyrronium liquid on drooling in children with neurodisability
Archives of Disease in Childhood, 2018Co-Authors: Jeremy R Parr, Emma Todhunter, Lindsay Pennington, Deborah Stocken, Jill Cadwgan, Anne Ohare, Catherine Tuffrey, Jane WilliamsAbstract:Objective Investigate whether Hyoscine patch or glycopyrronium liquid is more effective and acceptable to treat drooling in children with neurodisability. Design Multicentre, single-blind, randomised controlled trial. Setting Recruitment through neurodisability teams; treatment by parents. Participants Ninety children with neurodisability who had never received medication for drooling (55 boys, 35 girls; median age 4 years). Exclusion criteria: medication contraindicated; in a trial that could affect drooling or management. Intervention Children were randomised to receive a Hyoscine skin patch or glycopyrronium liquid. Dose was increased over 4 weeks to achieve optimum symptom control with minimal side-effects; steady dose then continued to 12 weeks. Primary and secondary outcomes Primary outcome: Drooling Impact Scale (DIS) score at week-4. Secondary outcomes: change in DIS scores over 12 weeks, Drooling Severity and Frequency Scale and Treatment Satisfaction Questionnaire for Medication; adverse events; children’s perception about treatment. Results Both medications yielded clinically and statistically significant reductions in mean DIS at week-4 (25.0 (SD 22.2) for Hyoscine and 26.6 (SD 16) for glycopyrronium). There was no significant difference in change in DIS scores between treatment groups. By week-12, 26/47 (55%) children starting treatment were receiving Hyoscine compared with 31/38 (82%) on glycopyrronium. There was a 42% increased chance of being on treatment at week-12 for children randomised to glycopyrronium relative to Hyoscine (1.42, 95% CI 1.04 to 1.95). Conclusions Hyoscine and glycopyrronium are clinically effective in treating drooling in children with neurodisability. Hyoscine produced more problematic side effects leading to a greater chance of treatment cessation. Trial registration numbers ISRCTN 75287237; EUDRACT: 2013-000863-94; Medicines and Healthcare Products Regulatory Agency: 17136/0264/001-0003
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the drooling reduction intervention trial dri a single blind trial comparing the efficacy of glycopyrronium and Hyoscine on drooling in children with neurodisability
Trials, 2014Co-Authors: Jeremy R Parr, Emma Weldon, Lindsay Pennington, Anne Ohare, Jane Williams, Nick Steen, Charlie Fairhurst, Raj Lodh, Af ColverAbstract:Background: Drooling saliva is a common problem in children with neurodevelopmental disorders. The negative consequences of drooling include skin breakdown, dehydration, and damage to clothing and equipment. Children and families often suffer social embarrassment due to drooling. There is no evidence about the relative effectiveness, side effect profiles or patient acceptability of the two medications most commonly used to reduce drooling - glycopyrronium and Hyoscine. Consequently, there is no consensus or guideline to aid clinical decisions about which drug to use, and at what dose. Methods/design: A multi-centre, randomised trial of treatment with glycopyrronium or Hyoscine in children with problematic drooling and non-progressive neurodisability. Ninety children aged between 3 and 15 years who have never received medication for drooling will be stratified by severity of drooling and care centre. Randomisation to receive treatment with glycopyrronium or Hyoscine will be computer generated from the trial randomisation website. Dose adjustment and side effect monitoring will occur via telephone consultation. Medication arm will be known to participants and clinicians but not the Trial Outcome Assessor. The primary outcome measure is the Drooling Impact Scale score at four weeks, at which time all children will be on the maximum tolerated dose of their medication. Secondary outcome measures include change in Drooling Impact Scale score between baseline, 4, 12 and 52 weeks, change in Drooling Severity and Frequency Scale score and difference between groups in the Treatment Satisfaction Questionnaire for Medication score. A structured interview with children and young people of sufficient age, cognitive and communication ability will explore their perceptions of drooling and the effectiveness and acceptability of the medications. Discussion: The primary objective of the study is to identify whether glycopyrronium or Hyoscine is more effective in treating drooling in children with non-progressive neurodisability. The study will also determine which medications at what doses are most acceptable and have fewest side effects. This information will be used to develop evidence based guidance to inform the medical treatment of drooling.
Atef Kamel Salama - One of the best experts on this subject based on the ideXlab platform.
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comparison between ketamine and Hyoscine for the management of postoperative catheter related bladder discomfort a randomized controlled double blind study
Journal of Anaesthesiology Clinical Pharmacology, 2017Co-Authors: Atef Kamel SalamaAbstract:Background and Aim: Postoperative catheter-related bladder discomfort (CRBD) can be a distressing complication for patients in whom a urinary catheter was inserted intraoperatively and is accompanied with patients' dissatisfaction. This trial investigated the efficacy of Hyoscine and ketamine on treatment of postoperative CRBD in patients undergoing various surgeries. Material and Methods: This was a prospective randomized, double-blind study, which included 60 American Society of Anesthesiologists Class I-II male patients undergoing elective nonurological operations requiring intraoperative urinary catheterization under general anesthesia after ethical approval and written informed consent. Patients were allocated randomly into two groups: The Hyoscine group (H group) (n = 30) received 20 mg of Hyoscine intravenously and ketamine group (K group) (n = 30) received 0.25 mg/kg of ketamine intravenously immediately after the occurrence of CRBD. The severity of CRBD was assessed at 0, 1, 2, and 4 h postoperatively. Adverse effects of Hyoscine and ketamine were also examined. Data were summarized using mean ± standard deviation, and comparisons between groups were done by unpaired t-test. For comparison of serial measurements within each group, ANOVA was used. Results: There was a significant difference between the two groups in the severity of CRBD measured by visual analog scale score only 30 min after drug administration where it was higher in ketamine group (44.50 ± 7.70) compared to Hyoscine group (36.00 ± 8.55) (P Conclusion: Intravenous Hyoscine 20 mg is more effective in control of CRBD than ketamine (0.25 mg/kg) in the first 30 min; later on they have the same effect.
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Comparison between ketamine and Hyoscine for the management of postoperative catheter-related bladder discomfort: A randomized controlled double-blind study
Wolters Kluwer Medknow Publications, 2017Co-Authors: Atef Kamel SalamaAbstract:Background and Aim: Postoperative catheter-related bladder discomfort (CRBD) can be a distressing complication for patients in whom a urinary catheter was inserted intraoperatively and is accompanied with patients' dissatisfaction. This trial investigated the efficacy of Hyoscine and ketamine on treatment of postoperative CRBD in patients undergoing various surgeries. Material and Methods: This was a prospective randomized, double-blind study, which included 60 American Society of Anesthesiologists Class I-II male patients undergoing elective nonurological operations requiring intraoperative urinary catheterization under general anesthesia after ethical approval and written informed consent. Patients were allocated randomly into two groups: The Hyoscine group (H group) (n = 30) received 20 mg of Hyoscine intravenously and ketamine group (K group) (n = 30) received 0.25 mg/kg of ketamine intravenously immediately after the occurrence of CRBD. The severity of CRBD was assessed at 0, 1, 2, and 4 h postoperatively. Adverse effects of Hyoscine and ketamine were also examined. Data were summarized using mean ± standard deviation, and comparisons between groups were done by unpaired t-test. For comparison of serial measurements within each group, ANOVA was used. Results: There was a significant difference between the two groups in the severity of CRBD measured by visual analog scale score only 30 min after drug administration where it was higher in ketamine group (44.50 ± 7.70) compared to Hyoscine group (36.00 ± 8.55) (P < 0.001), otherwise there was no significant difference at other time points between the two groups, also there was a significant rise in heart rate in Hyoscine group but no significant difference in mean arterial pressure. Conclusion: Intravenous Hyoscine 20 mg is more effective in control of CRBD than ketamine (0.25 mg/kg) in the first 30 min; later on they have the same effect
Brian R Leaker - One of the best experts on this subject based on the ideXlab platform.
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the effects of the selective muscarinic m3 receptor antagonist darifenacin and of Hyoscine scopolamine on motion sickness skin conductance cognitive function
British Journal of Clinical Pharmacology, 2018Co-Authors: John F Golding, Keith Wesnes, Brian R LeakerAbstract:Aims: The aim of this study was to compare the effects of the selective M3 muscarinic acetylcholine receptor antagonist Darifenacin, oral Hyoscine hydrobromide and Placebo on motion sickness induced by cross-coupled stimulation. Methods: The effects of Darifenacin 10 mg or 20 mg, Hyoscine hydrobromide 0.6 mg and Placebo were assessed in a randomised, double-blind, 4-way cross over trial of 16 healthy subjects. Motion sickness, skin conductance (a measure of sweating) and psychomotor cognitive function tests were investigated. Results: Hyoscine hydrobromide produced significantly increased tolerance to motion versus Placebo (P<0.05 to P<0.01). The motion protection effect of Darifenacin (10 or 20 mg) was approximately one third of that of Hyoscine hydrobromide, but was not significant versus Placebo. Darifenacin and Hyoscine hydrobromide both significantly reduced skin conductance versus Placebo. Darifenacin produced either no effect or an enhanced effect on cognitive function in contrast to Hyoscine hydrobromide where there was significant impairment of psychomotor performance. Conclusion: The results suggest that selective antagonism of the M3 receptor may not be important in the prevention of motion sickness. However selective M3 antagonism does not impair cognitive function. These observations may be important given that long term treatment with non-selective anti-muscarinic agents such as Oxybutynin may lead to an increased incidence of dementia.
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The effects of the selective muscarinic M3 receptor antagonist darifenacin, and of Hyoscine (scopolamine), on motion sickness, skin conductance & cognitive function.
British journal of clinical pharmacology, 2018Co-Authors: John F Golding, Keith Wesnes, Brian R LeakerAbstract:Aims: The aim of this study was to compare the effects of the selective M3 muscarinic acetylcholine receptor antagonist Darifenacin, oral Hyoscine hydrobromide and Placebo on motion sickness induced by cross-coupled stimulation. Methods: The effects of Darifenacin 10 mg or 20 mg, Hyoscine hydrobromide 0.6 mg and Placebo were assessed in a randomised, double-blind, 4-way cross over trial of 16 healthy subjects. Motion sickness, skin conductance (a measure of sweating) and psychomotor cognitive function tests were investigated. Results: Hyoscine hydrobromide produced significantly increased tolerance to motion versus Placebo (P
Jane Williams - One of the best experts on this subject based on the ideXlab platform.
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drooling reduction intervention randomised trial dri comparing the efficacy and acceptability of Hyoscine patches and glycopyrronium liquid on drooling in children with neurodisability
Archives of Disease in Childhood, 2018Co-Authors: Jeremy R Parr, Emma Todhunter, Lindsay Pennington, Deborah Stocken, Jill Cadwgan, Anne Ohare, Catherine Tuffrey, Jane WilliamsAbstract:Objective Investigate whether Hyoscine patch or glycopyrronium liquid is more effective and acceptable to treat drooling in children with neurodisability. Design Multicentre, single-blind, randomised controlled trial. Setting Recruitment through neurodisability teams; treatment by parents. Participants Ninety children with neurodisability who had never received medication for drooling (55 boys, 35 girls; median age 4 years). Exclusion criteria: medication contraindicated; in a trial that could affect drooling or management. Intervention Children were randomised to receive a Hyoscine skin patch or glycopyrronium liquid. Dose was increased over 4 weeks to achieve optimum symptom control with minimal side-effects; steady dose then continued to 12 weeks. Primary and secondary outcomes Primary outcome: Drooling Impact Scale (DIS) score at week-4. Secondary outcomes: change in DIS scores over 12 weeks, Drooling Severity and Frequency Scale and Treatment Satisfaction Questionnaire for Medication; adverse events; children’s perception about treatment. Results Both medications yielded clinically and statistically significant reductions in mean DIS at week-4 (25.0 (SD 22.2) for Hyoscine and 26.6 (SD 16) for glycopyrronium). There was no significant difference in change in DIS scores between treatment groups. By week-12, 26/47 (55%) children starting treatment were receiving Hyoscine compared with 31/38 (82%) on glycopyrronium. There was a 42% increased chance of being on treatment at week-12 for children randomised to glycopyrronium relative to Hyoscine (1.42, 95% CI 1.04 to 1.95). Conclusions Hyoscine and glycopyrronium are clinically effective in treating drooling in children with neurodisability. Hyoscine produced more problematic side effects leading to a greater chance of treatment cessation. Trial registration numbers ISRCTN 75287237; EUDRACT: 2013-000863-94; Medicines and Healthcare Products Regulatory Agency: 17136/0264/001-0003
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the drooling reduction intervention trial dri a single blind trial comparing the efficacy of glycopyrronium and Hyoscine on drooling in children with neurodisability
Trials, 2014Co-Authors: Jeremy R Parr, Emma Weldon, Lindsay Pennington, Anne Ohare, Jane Williams, Nick Steen, Charlie Fairhurst, Raj Lodh, Af ColverAbstract:Background: Drooling saliva is a common problem in children with neurodevelopmental disorders. The negative consequences of drooling include skin breakdown, dehydration, and damage to clothing and equipment. Children and families often suffer social embarrassment due to drooling. There is no evidence about the relative effectiveness, side effect profiles or patient acceptability of the two medications most commonly used to reduce drooling - glycopyrronium and Hyoscine. Consequently, there is no consensus or guideline to aid clinical decisions about which drug to use, and at what dose. Methods/design: A multi-centre, randomised trial of treatment with glycopyrronium or Hyoscine in children with problematic drooling and non-progressive neurodisability. Ninety children aged between 3 and 15 years who have never received medication for drooling will be stratified by severity of drooling and care centre. Randomisation to receive treatment with glycopyrronium or Hyoscine will be computer generated from the trial randomisation website. Dose adjustment and side effect monitoring will occur via telephone consultation. Medication arm will be known to participants and clinicians but not the Trial Outcome Assessor. The primary outcome measure is the Drooling Impact Scale score at four weeks, at which time all children will be on the maximum tolerated dose of their medication. Secondary outcome measures include change in Drooling Impact Scale score between baseline, 4, 12 and 52 weeks, change in Drooling Severity and Frequency Scale score and difference between groups in the Treatment Satisfaction Questionnaire for Medication score. A structured interview with children and young people of sufficient age, cognitive and communication ability will explore their perceptions of drooling and the effectiveness and acceptability of the medications. Discussion: The primary objective of the study is to identify whether glycopyrronium or Hyoscine is more effective in treating drooling in children with non-progressive neurodisability. The study will also determine which medications at what doses are most acceptable and have fewest side effects. This information will be used to develop evidence based guidance to inform the medical treatment of drooling.
Andreas Gutzeit - One of the best experts on this subject based on the ideXlab platform.
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Evaluation of the anti-peristaltic effect of glucagon and Hyoscine on the small bowel: comparison of intravenous and intramuscular drug administration
European Radiology, 2012Co-Authors: Andreas Gutzeit, Christoph A Binkert, Dowmu Koh, Klaus Hergan, Nicole Graf, Michael A Patak, Justus E Roos, M Horstmann, Constantin Weymarn, Sebastian KosAbstract:Purpose To evaluate prospectively duration and effectiveness of aperistalsis achieved by glucagon(GLU) or Hyoscine N-butylbromide(HBB) following various administration routes. Materials and methods Six volunteers underwent Magnetic Resonance Imaging (MRI) after standardized oral preparation in random order five separate MR examinations with both spasmolytic agents (HBB intravenous(i.v.) or intramuscular(i.m.), GLU i.v. or i.m., and a combined scheme). The MR protocol included a sagittal 2D cross-section of the small bowel with a temporal resolution of 0.55 s acquired over 60 to 90 min. To quantify bowel motility, small bowel cross-sectional areas were summated over time. Results The anti-peristaltic i.v. effects of HBB and glucagon started on average after 85 s/65 s and ended after 21 min/23.3 min, respectively. By comparison, the anti-peristaltic effects of i.m. HBB and glucagon started significantly later 5.1/11.6 min ( P = 0.001; Wilcoxon signed ranks test) and lasted for 17.7/28.2 min with greater inter-individual differences ( P = 0.012; Brown-Forsythe test). The combined scheme resulted in a rapid onset after 65 s with effect duration of 31 min. Conclusion Anti-peristaltic effects on the small bowel are drug dependant, i.e., their onset is faster and more reliable when administering i.v. than i.m.. Combining i.v. GLU with i.m. HBB provides an early onset of effect, sustained spasmolysis and the highest degree of motility impairment. Key Points • Anti-persitaltic agents are widely used before various diagnostic procedures of the abdomen . • The combination of iv-glucagon with im-Hyoscine provides reliable spasmolysis with early onset . • Intravenous spasmolysis is more reliable compared to intramuscular administration . • Intravenous glucagon has a prolonged spasmolytic effect compared to intravenous Hyoscine .
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evaluation of the anti peristaltic effect of glucagon and Hyoscine on the small bowel comparison of intravenous and intramuscular drug administration
European Radiology, 2012Co-Authors: Andreas Gutzeit, Christoph A Binkert, Dowmu Koh, Klaus Hergan, Constantin Von Weymarn, Nicole Graf, Michael A Patak, Justus E Roos, M HorstmannAbstract:Purpose To evaluate prospectively duration and effectiveness of aperistalsis achieved by glucagon(GLU) or Hyoscine N-butylbromide(HBB) following various administration routes.
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evaluation of the anti peristaltic effect of glucagon and Hyoscine on the small bowel comparison of intravenous and intramuscular drug administration
European Radiology, 2012Co-Authors: Andreas Gutzeit, Christoph A Binkert, Dowmu Koh, Klaus Hergan, Constantin Von Weymarn, Nicole Graf, Michael A Patak, Justus E Roos, M HorstmannAbstract:To evaluate prospectively duration and effectiveness of aperistalsis achieved by glucagon(GLU) or Hyoscine N-butylbromide(HBB) following various administration routes. Six volunteers underwent Magnetic Resonance Imaging (MRI) after standardized oral preparation in random order five separate MR examinations with both spasmolytic agents (HBB intravenous(i.v.) or intramuscular(i.m.), GLU i.v. or i.m., and a combined scheme). The MR protocol included a sagittal 2D cross-section of the small bowel with a temporal resolution of 0.55 s acquired over 60 to 90 min. To quantify bowel motility, small bowel cross-sectional areas were summated over time. The anti-peristaltic i.v. effects of HBB and glucagon started on average after 85 s/65 s and ended after 21 min/23.3 min, respectively. By comparison, the anti-peristaltic effects of i.m. HBB and glucagon started significantly later 5.1/11.6 min (P = 0.001; Wilcoxon signed ranks test) and lasted for 17.7/28.2 min with greater inter-individual differences (P = 0.012; Brown-Forsythe test). The combined scheme resulted in a rapid onset after 65 s with effect duration of 31 min. Anti-peristaltic effects on the small bowel are drug dependant, i.e., their onset is faster and more reliable when administering i.v. than i.m.. Combining i.v. GLU with i.m. HBB provides an early onset of effect, sustained spasmolysis and the highest degree of motility impairment. • Anti-persitaltic agents are widely used before various diagnostic procedures of the abdomen. • The combination of iv-glucagon with im-Hyoscine provides reliable spasmolysis with early onset. • Intravenous spasmolysis is more reliable compared to intramuscular administration. • Intravenous glucagon has a prolonged spasmolytic effect compared to intravenous Hyoscine.
