摘要:

Asthma disease management (DM) programmes often focus on patients who are considered to be high resource users, such as those with recent emergency department visits and/or hospitalisations, or patients who have been diagnosed with severe persistent asthma. These programmes often focus on a few patients who have acute needs, but may not identify the populations with the highest future resource use. A population-based approach to disease management focuses on identifying deficiencies in asthma management across the population diagnosed with the disease and establishes a partnership between the patient, provider and healthcare plan to improve the overall quality of asthma care. The disease management approach described in this article is population-based, and is intended to raise the standard of medical care across a spectrum of patients with asthma.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

Telemedicine is a communications technology that can be expected to influence investment in equipment, the delivery and organisation of health services and outcomes of healthcare. Analysis of the economic impact of telemedicine has so far been limited and has focused on cost studies for individual applications. Telemedicine initiatives should be compared with conventional alternatives. A search of recent literature revealed 20 such studies that included, usually limited, economic analyses. It is important to note, however, that such assessments apply to localised situations and may not be generalisable. Overall, the potential impact of telemedicine on healthcare systems remains unclear.The challenges that lie ahead for telemedicine, and its economic assessment, include technological change, sustainability of applications, availability of outcomes and other data, and generalisability of evaluation results.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

Depression remains under-recognised and under-treated despite it being more disabling than any other medical disorder and the availability of effective protocol-based psychotherapy and pharmacotherapy treatments. Prevailing psychotherapy seldom employs evidence-based treatments, continuing instead the use of idiosyncratic psychotherapies of dubious value.Computer interview programs have been developed and evaluated that have the potential to make protocol-based psychotherapy of proven efficacy available over the Internet. Interactive voice response (IVR) makes these programs even more accessible through any touch-tone telephone.COPE™ is a self-help program for patients with depression that combines a series of booklets, videotapes and IVR telephone calls. One trial reported significant reductions in Hamilton Depression Rating Scale scores in patients with depression who completed a 12-week COPE™ program.Impediments to dissemination of these computer tools that complement, supplement and reinforce best practice values include developer's limited knowledge of business practices and the slow change of practice paradigms.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

Most breast and ovarian cancers occur sporadically, but an estimated 5 to 10% of cases occur in women with hereditary predisposition to these cancers. Two genes,BRCA1andBRCA2, have been identified, which, when altered, are thought to be responsible for most cases of hereditary breast and ovarian cancer. Testing for mutations in these genes is now available for women who are at risk. At present, only a small percentage of women have been tested, and identification of high risk women is dependent on pedigree analysis and application of empiric models.In the general population, the level of risk of hereditary cancer ranges from nonexistent to highly likely. A disease management approach requires identification of the level of risk of each individual in the population, and the development of a specific management strategy of screening and consideration of chemoprevention and prophylactic surgery commensurate with risk. Therefore, risk identification takes on an important role in the allocation of health resources.This article presents an approach to categorising women who are at increased risk of experiencing hereditary breast or ovarian cancer, whether or not testing is accepted or feasible. An evidence-based approach to screening and measures for prevention are outlined according to level of risk. Occasions when genetic testing would appreciably enhance decisions regarding management are noted.Clinically useful guidelines for risk assessment and management are intended to reduce the incidence of and morbidity associated with hereditary breast and ovarian cancer. Ongoing research with regard to clinical outcomes of carriers of theBRCA1orBRCA2mutation will help refine these strategies.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

ObjectiveBritish Thoracic Society guidelines advocate the use of oral steroid therapy as a means of controlling symptoms in patients with severe asthma. However, it is well established that there are a number of undesirable adverse effects associated with this form of treatment. The aim of this study was to determine whether the addition of nebulised budesonide reduced oral steroid usage in oral steroid-dependent patients.DesignA 21- to 35-day run-in period allowed asthma stability to be assessed before patients were randomised in a double-blind manner to receive nebulised budesonide or placebo. At the end of the 15-week treatment period, all patients were given nebulised budesonide and followed for a further 4 weeks. Oral steroid reduction was also studied throughout the treatment period.Participants118 patients (aged 16 to 65 years) with severe oral steroid-dependent asthma (5 mg/day oral prednisolone and ≥800 µg/day inhaled steroid) were enrolled into the study. Of these, 76 were randomised to receive nebulised budesonide or placebo.Interventions: Eligible patients were randomised to receive either nebulised budesonide 2mg twice daily or nebulised placebo in addition to their existing oral steroid medication.ResultsThe addition of nebulised budesonide to existing oral steroid therapy provided a significant reduction in the number of asthma exacerbations experienced over the 15-week treatment period compared with placebo (1.1vs0.35; p < 0.05). Moreover, this seemed to be coupled with a marked decrease in the severity of asthma symptoms such as cough (nebulised budesonide group: mean change −0.16; nebulised placebo group: +0.23; p < 0.05) breathlessness (−0.34 vs +0.06; p < 0.05) and sleep disturbance (−0.05 nights per weekvs+0.93 nights per week; p < 0.01). Notably, these benefits were achieved without any deterioration in lung function and in conjunction with patients attempting to reduce their dosage of oral steroid. 68% of patients in the nebulised budesonide group were able to achieve a reduction in oral steroid dosage, compared with 53% in the placebo group, although this was not a significant difference.ConclusionsThe addition of nebulised budesonide to regular oral steroid treatment can help to improve symptoms in patients with severe asthma. Moreover, this is achieved without an increase in steroid-related adverse effects. However, the percentage reduction in oral steroid usage between the nebulised budesonide group and the placebo group was not found to be significant (68 versus 53%).

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS