摘要:

Increasing healthcare expenditures and other economic pressures mandate fundamental reforms of the healthcare system in Germany. The overall goal is restraint of costs while at the same time maintaining a high standard of medical care. Among all options, managed care represents a potential solution, since it combines financing mechanisms and a care delivery system under the control and direction of a single management entity. A core element of managed care is cost containment through structured guidance of healthcare providers and patients. This has the potential to provide a higher level of control and promote greater transparency in the healthcare system. However, it remains to be seen if it is possible to adapt elements of managed care from other countries to the German healthcare system.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

The impact of migraine is substantial for both the individual who suffers from it and society in general in terms of lost work hours, medication costs and healthcare usage. Many different forms of treatment are available for migraine, including biobehavioural approaches such as relaxation training and biofeedback.Research regarding the efficacy of these nonpharmacological treatments has been extensive and consistently demonstrates lasting success with the use of the skills taught in treatment. Such treatment approaches have demonstrated effectiveness even when delivered in as few as 2 or 3 sessions with a therapist, thus substantially reducing the cost of treatment. Other treatment formats such as group and no-contact therapies have demonstrated success as well.This article reviews the efficacy and cost efficiency of minimal-contact biobehavioural treatments for migraine as outlined in the research literature. Strictly self-help approaches are also reviewed, and resources for self-help information are discussed. The research indicates that such time-limited and focused treatment approaches are highly effective with select patients; however, there is a lack of research specifying the specific types of patients with migraine who benefit the most from these approaches. Future research needs to address this issue in order to provide the most efficacious and cost-effective treatments for all patients with migraine.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

Development of self-management skills for the people with epilepsy is important to maintain optimum health. Self-management has been primarily conceptualised in the research literature as compliance. A conceptual analysis of self-management provided a framework for this literature review and suggested that self-management encompasses 3 domains. The first domain, prescription management, may best be understood as compliance. The second domain is seizure management, and includes both strategies to control seizures and strategies to control the consequences of seizures. The third domain, life management, includes techniques to manage situations that arise as a result of having epilepsy.A study that focused on the perception of self-management by people with epilepsy provided expanded information about the importance of self-management to these persons. Two management profiles emerged from the study − a proactive management profile and a reactive management profile. Those with a proactive management style scored higher on the quality-of-life scale than those with a reactive style. There was no difference in their percentage of compliance. A conceptual framework for self-management is introduced that suggests that the 3 domains of self-management are interactive and that a natural outcome of self-management is quality of life.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

Growing concern about the rapid emergence of penicillin-resistantStreptococcus pneumoniae, as well as β-lactamase-mediated resistance amongHaemophilus influenzaeandMoraxella catarrhalis, has lead to reconsideration of the management of acute otitis media in children. Acute otitis media is the most common disorder diagnosed by paediatricians and among the most common indications for which antibacterial agents are prescribed in children.Although there is little consensus regarding the optimal management of children with acute otitis media, the need for judicious use of antibacterial agents is generally recognised. Several initiatives have been undertaken in an attempt to improve the management practices for this infection. One recent example is the recommendations of the US Drug-ResistantS. pneumoniae(DRSP) Therapeutic Working Group which advocate an accurate diagnosis of acute otitis media, a step-wise approach to treatment and a role for diagnostic tympanocentesis in children who do not respond to therapy. Based on pharmacokinetic and efficacy data, amoxicillin is recommended as first-line treatment. Cefuroxime axetil, amoxicillin/clavulanic acid and ceftriaxone are recommended as second-line options.ConclusionsCefuroxime axetil is one of very few oral agents which has proven clinical efficacy againstS. pneumoniae, as well as β-lactamase-producingH. influenzaeandM. catarrhalis. Although not as palatable as some other oral paediatric formulations, it has significantly better gastrointestinal tolerability than amoxicillin/clavulanic acid, another oral agent with a similar activity profile, and can be administered conveniently in 2 divided daily doses. Cefuroxime axetil is, therefore, an important oral treatment option for children with acute otitis media.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

Acute repetitive seizures, more commonly known as cluster, crescendo or sequential seizures, are defined as episodes of increased seizure activity occurring in patients with refractory epilepsy who are already receiving stable regimens of anticonvulsants. They lie in the seizure spectrum between isolated seizures and status epilepticus. If acute repetitive seizures are left untreated, they may progress to status epilepticus.Acute repetitive seizures and prolonged seizures are rated as a neurological emergency and treatment must be prompt. The primary goals of therapy are cessation of the seizure and prevention of recurrence. The use of traditional intravenous agents such as phenytoin, phenobarbital (phenobarbitone), lorazepam and diazepam is well established in the first-line treatment of acute seizures. However, adverse effects and the time to onset of effect often dictate the choice between older anticonvulsants. Newer agents (such as fosphenytoin) and alternative routes of administration (such as rectal administration of diazepam solution) have been developed in an effort to reduce adverse effects, decrease the time to onset of effect, reduce acute care facility costs and investigate the possibility of home treatment.Diazepam rectal gel, a newer formulation of diazepam intended for rectal administration, effectively terminates acute seizures and prevents recurrence within the first 12 hours after administration. Diazepam rectal gel is available for use by a trained caregiver in a home setting and, therefore, emergency room treatment and hospitalisation may not be required and could be avoided. This may result in reductions in financial and emotional costs associated with acute repetitive seizures, but broader clinical experience is needed to assess this. Diazepam rectal gel is not associated with respiratory depression and most adverse effects appear to be mild to moderate in severity.At present, diazepam rectal gel is a valuable addition to the current anticonvulsant armamentarium for first-line therapy of acute repetitive seizures. Wider clinical experience will better determine the place of this formulation in the treatment of this debilitating disorder.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS