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Wiete Westerhof - One of the best experts on this subject based on the ideXlab platform.
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Quantitative and objective evaluation of wound debriding properties of collagenase and fibrinolysin/desoxyribonuclease in a necrotic ulcer animal model
Archives of Dermatological Research, 1998Co-Authors: Jan R. Mekkes, James E Zeegelaar, Wiete WesterhofAbstract:Proteolytic enzymes have been used for wound debridement for many years. The two enzymes most widely used in Europe are fibrinolysin/desoxyribonuclease and collagenase. Despite their frequent use, very few Placebo-controlled studies comparing the enzymes with vehiculum only, or with each other, are available. In a specially developed necrotic ulcer animal model, combined with a computer image analysis technique to measure necrotic and total wound surface areas quantitatively, we assessed the wound-cleansing properties of fibrinolysin/DNase oleogel, collagenase ointment, saline-soaked gauze control treatment, and new galenic formulations of collagenase, including Placebos. The average relative area of necrotic tissue present in the wound after 1 week was 31% for collagenase ointment and 56% for fibrinolysin/DNAse oleogel (P = 0.0037). Collagenase gel was significantly (P = 0.0007) better in removing necrosis than Placebo (gel only). Fibrinolysin/DNAse was not significantly more effective than the three Placebo or control treatments (Placebo film, Placebo gel, saline-soaked gauzes). We conclude that collagenase is a suitable enzyme for wound debridement, but we were not able to detect clinical efficacy of fibrinolysin/DNAse in this model.
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Quantitative and objective evaluation of wound debriding properties of collagenase and fibrinolysin/desoxyribonuclease in a necrotic ulcer animal model
Archives of Dermatological Research, 1998Co-Authors: Jan R. Mekkes, James E Zeegelaar, Wiete WesterhofAbstract:Proteolytic enzymes have been used for wound debridement for many years. The two enzymes most widely used in Europe are fibrinolysin/desoxyribonuclease and collagenase. Despite their frequent use, very few Placebo-controlled studies comparing the enzymes with vehiculum only, or with each other, are available. In a specially developed necrotic ulcer animal model, combined with a computer image analysis technique to measure necrotic and total wound surface areas quantitatively, we assessed the wound-cleansing properties of fibrinolysin/DNase oleogel, collagenase ointment, saline-soaked gauze control treatment, and new galenic formulations of collagenase, including Placebos. The average relative area of necrotic tissue present in the wound after 1 week was 31% for collagenase ointment and 56% for fibrinolysin/DNAse oleogel (P = 0.0037). Collagenase gel was significantly (P = 0.0007) better in removing necrosis than Placebo (gel only). Fibrinolysin/DNAse was not significantly more effective than the three Placebo or control treatments (Placebo film, Placebo gel, saline-soaked gauzes). We conclude that collagenase is a suitable enzyme for wound debridement, but we were not able to detect clinical efficacy of fibrinolysin/DNAse in this model.
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quantitative and objective evaluation of wound debriding properties of collagenase and fibrinolysin desoxyribonuclease in a necrotic ulcer animal model
Archives of Dermatological Research, 1998Co-Authors: Jan R. Mekkes, James E Zeegelaar, Wiete WesterhofAbstract:Proteolytic enzymes have been used for wound debridement for many years. The two enzymes most widely used in Europe are fibrinolysin/desoxyribonuclease and collagenase. Despite their frequent use, very few Placebo-controlled studies comparing the enzymes with vehiculum only, or with each other, are available. In a specially developed necrotic ulcer animal model, combined with a computer image analysis technique to measure necrotic and total wound surface areas quantitatively, we assessed the wound-cleansing properties of fibrinolysin/DNase oleogel, collagenase ointment, saline-soaked gauze control treatment, and new galenic formulations of collagenase, including Placebos. The average relative area of necrotic tissue present in the wound after 1 week was 31% for collagenase ointment and 56% for fibrinolysin/DNAse oleogel (P = 0.0037). Collagenase gel was significantly (P = 0.0007) better in removing necrosis than Placebo (gel only). Fibrinolysin/DNAse was not significantly more effective than the three Placebo or control treatments (Placebo film, Placebo gel, saline-soaked gauzes). We conclude that collagenase is a suitable enzyme for wound debridement, but we were not able to detect clinical efficacy of fibrinolysin/DNAse in this model.
Jan R. Mekkes - One of the best experts on this subject based on the ideXlab platform.
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Quantitative and objective evaluation of wound debriding properties of collagenase and fibrinolysin/desoxyribonuclease in a necrotic ulcer animal model
Archives of Dermatological Research, 1998Co-Authors: Jan R. Mekkes, James E Zeegelaar, Wiete WesterhofAbstract:Proteolytic enzymes have been used for wound debridement for many years. The two enzymes most widely used in Europe are fibrinolysin/desoxyribonuclease and collagenase. Despite their frequent use, very few Placebo-controlled studies comparing the enzymes with vehiculum only, or with each other, are available. In a specially developed necrotic ulcer animal model, combined with a computer image analysis technique to measure necrotic and total wound surface areas quantitatively, we assessed the wound-cleansing properties of fibrinolysin/DNase oleogel, collagenase ointment, saline-soaked gauze control treatment, and new galenic formulations of collagenase, including Placebos. The average relative area of necrotic tissue present in the wound after 1 week was 31% for collagenase ointment and 56% for fibrinolysin/DNAse oleogel (P = 0.0037). Collagenase gel was significantly (P = 0.0007) better in removing necrosis than Placebo (gel only). Fibrinolysin/DNAse was not significantly more effective than the three Placebo or control treatments (Placebo film, Placebo gel, saline-soaked gauzes). We conclude that collagenase is a suitable enzyme for wound debridement, but we were not able to detect clinical efficacy of fibrinolysin/DNAse in this model.
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Quantitative and objective evaluation of wound debriding properties of collagenase and fibrinolysin/desoxyribonuclease in a necrotic ulcer animal model
Archives of Dermatological Research, 1998Co-Authors: Jan R. Mekkes, James E Zeegelaar, Wiete WesterhofAbstract:Proteolytic enzymes have been used for wound debridement for many years. The two enzymes most widely used in Europe are fibrinolysin/desoxyribonuclease and collagenase. Despite their frequent use, very few Placebo-controlled studies comparing the enzymes with vehiculum only, or with each other, are available. In a specially developed necrotic ulcer animal model, combined with a computer image analysis technique to measure necrotic and total wound surface areas quantitatively, we assessed the wound-cleansing properties of fibrinolysin/DNase oleogel, collagenase ointment, saline-soaked gauze control treatment, and new galenic formulations of collagenase, including Placebos. The average relative area of necrotic tissue present in the wound after 1 week was 31% for collagenase ointment and 56% for fibrinolysin/DNAse oleogel (P = 0.0037). Collagenase gel was significantly (P = 0.0007) better in removing necrosis than Placebo (gel only). Fibrinolysin/DNAse was not significantly more effective than the three Placebo or control treatments (Placebo film, Placebo gel, saline-soaked gauzes). We conclude that collagenase is a suitable enzyme for wound debridement, but we were not able to detect clinical efficacy of fibrinolysin/DNAse in this model.
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quantitative and objective evaluation of wound debriding properties of collagenase and fibrinolysin desoxyribonuclease in a necrotic ulcer animal model
Archives of Dermatological Research, 1998Co-Authors: Jan R. Mekkes, James E Zeegelaar, Wiete WesterhofAbstract:Proteolytic enzymes have been used for wound debridement for many years. The two enzymes most widely used in Europe are fibrinolysin/desoxyribonuclease and collagenase. Despite their frequent use, very few Placebo-controlled studies comparing the enzymes with vehiculum only, or with each other, are available. In a specially developed necrotic ulcer animal model, combined with a computer image analysis technique to measure necrotic and total wound surface areas quantitatively, we assessed the wound-cleansing properties of fibrinolysin/DNase oleogel, collagenase ointment, saline-soaked gauze control treatment, and new galenic formulations of collagenase, including Placebos. The average relative area of necrotic tissue present in the wound after 1 week was 31% for collagenase ointment and 56% for fibrinolysin/DNAse oleogel (P = 0.0037). Collagenase gel was significantly (P = 0.0007) better in removing necrosis than Placebo (gel only). Fibrinolysin/DNAse was not significantly more effective than the three Placebo or control treatments (Placebo film, Placebo gel, saline-soaked gauzes). We conclude that collagenase is a suitable enzyme for wound debridement, but we were not able to detect clinical efficacy of fibrinolysin/DNAse in this model.
James E Zeegelaar - One of the best experts on this subject based on the ideXlab platform.
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Quantitative and objective evaluation of wound debriding properties of collagenase and fibrinolysin/desoxyribonuclease in a necrotic ulcer animal model
Archives of Dermatological Research, 1998Co-Authors: Jan R. Mekkes, James E Zeegelaar, Wiete WesterhofAbstract:Proteolytic enzymes have been used for wound debridement for many years. The two enzymes most widely used in Europe are fibrinolysin/desoxyribonuclease and collagenase. Despite their frequent use, very few Placebo-controlled studies comparing the enzymes with vehiculum only, or with each other, are available. In a specially developed necrotic ulcer animal model, combined with a computer image analysis technique to measure necrotic and total wound surface areas quantitatively, we assessed the wound-cleansing properties of fibrinolysin/DNase oleogel, collagenase ointment, saline-soaked gauze control treatment, and new galenic formulations of collagenase, including Placebos. The average relative area of necrotic tissue present in the wound after 1 week was 31% for collagenase ointment and 56% for fibrinolysin/DNAse oleogel (P = 0.0037). Collagenase gel was significantly (P = 0.0007) better in removing necrosis than Placebo (gel only). Fibrinolysin/DNAse was not significantly more effective than the three Placebo or control treatments (Placebo film, Placebo gel, saline-soaked gauzes). We conclude that collagenase is a suitable enzyme for wound debridement, but we were not able to detect clinical efficacy of fibrinolysin/DNAse in this model.
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Quantitative and objective evaluation of wound debriding properties of collagenase and fibrinolysin/desoxyribonuclease in a necrotic ulcer animal model
Archives of Dermatological Research, 1998Co-Authors: Jan R. Mekkes, James E Zeegelaar, Wiete WesterhofAbstract:Proteolytic enzymes have been used for wound debridement for many years. The two enzymes most widely used in Europe are fibrinolysin/desoxyribonuclease and collagenase. Despite their frequent use, very few Placebo-controlled studies comparing the enzymes with vehiculum only, or with each other, are available. In a specially developed necrotic ulcer animal model, combined with a computer image analysis technique to measure necrotic and total wound surface areas quantitatively, we assessed the wound-cleansing properties of fibrinolysin/DNase oleogel, collagenase ointment, saline-soaked gauze control treatment, and new galenic formulations of collagenase, including Placebos. The average relative area of necrotic tissue present in the wound after 1 week was 31% for collagenase ointment and 56% for fibrinolysin/DNAse oleogel (P = 0.0037). Collagenase gel was significantly (P = 0.0007) better in removing necrosis than Placebo (gel only). Fibrinolysin/DNAse was not significantly more effective than the three Placebo or control treatments (Placebo film, Placebo gel, saline-soaked gauzes). We conclude that collagenase is a suitable enzyme for wound debridement, but we were not able to detect clinical efficacy of fibrinolysin/DNAse in this model.
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quantitative and objective evaluation of wound debriding properties of collagenase and fibrinolysin desoxyribonuclease in a necrotic ulcer animal model
Archives of Dermatological Research, 1998Co-Authors: Jan R. Mekkes, James E Zeegelaar, Wiete WesterhofAbstract:Proteolytic enzymes have been used for wound debridement for many years. The two enzymes most widely used in Europe are fibrinolysin/desoxyribonuclease and collagenase. Despite their frequent use, very few Placebo-controlled studies comparing the enzymes with vehiculum only, or with each other, are available. In a specially developed necrotic ulcer animal model, combined with a computer image analysis technique to measure necrotic and total wound surface areas quantitatively, we assessed the wound-cleansing properties of fibrinolysin/DNase oleogel, collagenase ointment, saline-soaked gauze control treatment, and new galenic formulations of collagenase, including Placebos. The average relative area of necrotic tissue present in the wound after 1 week was 31% for collagenase ointment and 56% for fibrinolysin/DNAse oleogel (P = 0.0037). Collagenase gel was significantly (P = 0.0007) better in removing necrosis than Placebo (gel only). Fibrinolysin/DNAse was not significantly more effective than the three Placebo or control treatments (Placebo film, Placebo gel, saline-soaked gauzes). We conclude that collagenase is a suitable enzyme for wound debridement, but we were not able to detect clinical efficacy of fibrinolysin/DNAse in this model.
Jens Gaab - One of the best experts on this subject based on the ideXlab platform.
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Effects and Components of Placebos with a Psychological Treatment Rationale – Three Randomized-Controlled Studies
Nature Publishing Group, 2019Co-Authors: Jens Gaab, Joe Kossowsky, Ulrike Ehlert, Cosima LocherAbstract:Abstract In recent years, Placebos have evolved from a mean to control for ‘therapeutic chaff’ to something that has clinically relevant effects with biological underpinning and that is considered to have clinical as well as scientific potential. However, the wealth of scientific Placebo research is conceptualized in a biomedical context, i.e. based on Placebos provided with a biomedical treatment rationale, whereas little is known about effects and mechanisms of Placebos provided with a psychological treatment rationale. This has important repercussions not only on Placebo research, but also on attempts to establish specificity of psychological interventions, such as psychotherapy. Therefore, we set out to assess the effects and possible components of Placebos provided with a psychological treatment rationale in three experiments on healthy subjects. We show that Placebos provided with a psychological treatment rationale are effective in short- as well as mid-term, but only when provided by a trustworthy, friendly and empathetic experimenter. These findings indicate that Placebos are effective outside the medical context and thus need be controlled for in non-medical trials. Furthermore, it highlights and confirms the importance of a plausible psychological treatment rationale in the context of a therapeutic alliance for psychological interventions, such as psychotherapy
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is the rationale more important than deception a randomized controlled trial of open label Placebo analgesia
Pain, 2017Co-Authors: Cosima Locher, Irving Kirsch, Antje Frey Nascimento, Joe Kossowsky, A Meyer, Jens GaabAbstract:Research on open-label Placebos questions whether deception is a necessary characteristic of Placebo effects. Yet, comparisons between open-label and deceptive Placebos (DPs) are lacking. We therefore assessed effects of open-label Placebos and DPs in comparison with no treatment (NT) with a standardized experimental heat pain paradigm in a randomized controlled trial in healthy participants. Participants (N = 160) were randomly assigned to NT, open-label Placebo without rationale (OPR-), open-label Placebo with rationale (OPR), and DP. We conducted baseline and posttreatment measurements of heat pain threshold and tolerance. Apart from the NT, all groups received an application of a Placebo cream. Primary outcomes were planned comparisons of heat pain tolerance and the corresponding intensity and unpleasantness ratings. Objective posttreatment pain tolerance did not differ among groups. However, for subjective heat pain ratings at the posttreatment tolerance level, groups with a rationale (OPR and DP) reported diminished heat pain intensity (t(146) = -2.15, P = 0.033, d = 0.43) and unpleasantness ratings (t(146) = -2.43, P = 0.016, d = 0.49) compared with the OPR-group. Interestingly, the OPR and the DP groups did not significantly differ in heat pain intensity (t(146) = -1.10, P = 0.272) or unpleasantness ratings (t(146) = -0.05, P = 0.961) at the posttreatment tolerance level. Our findings reveal that Placebos with a plausible rationale are more effective than without a rationale. Even more, open-label Placebos did not significantly differ in their effects from DPs. Therefore, we question the ubiquitously assumed necessity of concealment in Placebo administration.
Ted J. Kaptchuk - One of the best experts on this subject based on the ideXlab platform.
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Placebo-induced somatic sensations: a multi-modal study of three different Placebo interventions.
PloS one, 2015Co-Authors: Florian Beissner, Ted J. Kaptchuk, Franziska S. Brunner, Maria Cristina Domingues Da Silva Fink, Karin Meissner, Vitaly NapadowAbstract:Somatic sensations induced by Placebos are a frequent phenomenon whose etiology and clinical relevance remains unknown. In this study, we have evaluated the quantitative, qualitative, spatial, and temporal characteristics of Placebo-induced somatic sensations in response to three different Placebo interventions: (1) Placebo irritant solution, (2) Placebo laser stimulation, and (3) imagined laser stimulation. The quality and intensity of evoked sensations were assessed using the McGill pain questionnaire and visual analogue scales (VAS), while subjects’ sensation drawings processed by a geographic information system (GIS) were used to measure their spatial characteristics. We found that all three interventions are capable of producing robust sensations most frequently described as “tingling” and “warm” that can reach consider-able spatial extent (≤ 205mm²) and intensity (≤ 80/100 VAS). Sensations from Placebo stimulation were often referred to areas remote from the stimulation site and exhibit considerable similarity with referred pain. Interestingly, there was considerable similarity of qualitative features as well as spatial patterns across subjects and Placebos. However, Placebo laser stimulation elicited significantly stronger and more widespread sensations than Placebo irritant solution. Finally, novelty seeking, a character trait assessed by the Temperament and Character Inventory and associated with basal dopaminergic activity, was less pronounced in subjects susceptible to report Placebo-induced sensations. Our study has shown that Placebo-induced sensations are frequent and can reach considerable intensity and extent. As multiple somatosensory subsystems are involved despite the lack of peripheral stimulus, we propose a central etiology for this phenomenon.
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The Placebo effect in asthma.
Current allergy and asthma reports, 2014Co-Authors: Stefanie Dutile, Ted J. Kaptchuk, Michael E. WechslerAbstract:The Placebo effect is a complex phenomenon occurring across a variety of clinical conditions. While much Placebo research has been conducted in diseases defined by self-report such as depression, chronic pain, and irritable bowel syndrome (IBS), asthma has been proposed as a useful model because of its easily measured objective outcomes. Studies examining the Placebo response in asthma have not only contributed to an understanding of the mechanisms behind the Placebo response but also shed an interesting light on the current treatment and diagnosis of asthma. This paper will review current literature on Placebos in general and specifically on the Placebo response in asthma. It focuses on what we know about the mechanisms behind the Placebo effect, whether there is a specific portion of the population who responds to Placebos, which patient outcomes are influenced by the Placebo effect, and whether the effect can be augmented.
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Placebos without deception a randomized controlled trial in irritable bowel syndrome
PLOS ONE, 2010Co-Authors: Ted J. Kaptchuk, Elizabeth Friedlander, John M Kelley, Norma M Sanchez, Efi Kokkotou, Joyce P Singer, Magda Kowalczykowski, Franklin G MillerAbstract:Background: Placebo treatment can significantly influence subjective symptoms. However, it is widely believed that response to Placebo requires concealment or deception. We tested whether open-label Placebo (non-deceptive and nonconcealed administration) is superior to a no-treatment control with matched patient-provider interactions in the treatment of irritable bowel syndrome (IBS). Methods: Two-group, randomized, controlled three week trial (August 2009-April 2010) conducted at a single academic center, involving 80 primarily female (70%) patients, mean age 47618 with IBS diagnosed by Rome III criteria and with a score $150 on the IBS Symptom Severity Scale (IBS-SSS). Patients were randomized to either open-label Placebo pills presented as ‘‘Placebo pills made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body self-healing processes’’ or no-treatment controls with the same quality of interaction with providers. The primary outcome was IBS Global Improvement Scale (IBS-GIS). Secondary measures were IBS Symptom Severity Scale (IBS-SSS), IBS Adequate Relief (IBS-AR) and IBS Quality of Life (IBS-QoL). Findings: Open-label Placebo produced significantly higher mean (6SD) global improvement scores (IBS-GIS) at both 11day midpoint (5.261.0 vs. 4.061.1, p,.001) and at 21-day endpoint (5.061.5 vs. 3.961.3, p=.002). Significant results were also observed at both time points for reduced symptom severity (IBS-SSS, p=.008 and p=.03) and adequate relief (IBS-AR, p=.02 and p=.03); and a trend favoring open-label Placebo was observed for quality of life (IBS-QoL) at the 21-day endpoint (p=.08). Conclusion: Placebos administered without deception may be an effective treatment for IBS. Further research is warranted in IBS, and perhaps other conditions, to elucidate whether physicians can benefit patients using Placebos consistent with informed consent. Trial Registration: ClinicalTrials.gov NCT01010191
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biological clinical and ethical advances of Placebo effects
The Lancet, 2010Co-Authors: Damien G Finniss, Ted J. Kaptchuk, Franklin G Miller, Fabrizio BenedettiAbstract:For many years, Placebos have been defined by their inert content and their use as controls in clinical trials and treatments in clinical practice. Recent research shows that Placebo effects are genuine psychobiological events attributable to the overall therapeutic context, and that these effects can be robust in both laboratory and clinical settings. There is also evidence that Placebo effects can exist in clinical practice, even if no Placebo is given. Further promotion and integration of laboratory and clinical research will allow advances in the ethical use of Placebo mechanisms that are inherent in routine clinical care, and encourage the use of treatments that stimulate Placebo effects.
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Placebos and Placebo effects in medicine: historical overview.
Journal of the Royal Society of Medicine, 1999Co-Authors: A. J. M. De Craen, Ted J. Kaptchuk, Jan G.p. Tijssen, Jos KleijnenAbstract:some experimental intervention. Although the most frequently used Placebo is the 'sugar pill' in drug trials, Placebos can be and have been used for all kinds of interventions, ranging from Placebo ultrasound in the treatment of pressure ulcers and Placebo surgery in the treatment of osteoarthritis to sham traction in the treatment of low back pain and Placebo oestrogen implants in the prevention of menopause symptoms.
