摘要:

The utility of antibacterials in the management of acute exacerbations of chronic bronchitis (AECB) and the related lung pathology, chronic obstructive pulmonary disease (COPD), has been debated for decades. Data presented in this article document that more expensive antimicrobials may be favored in AECB treatment to prevent adverse outcomes to patients, namely antimicrobial failure and hospitalization. Identified patient-specific variables that may lead to treatment failure include right- or left-sided heart failure and ≥4 exacerbations/year. Risk factors for hospitalization include age ≥65 years and severe pulmonary and nonpulmonary dysfunction. However, these risk factors have never been formally validated in a prospective, randomized trial. Drug-resistant organisms have not been documented to cause antimicrobial failure or hospitalization, however, more data are needed in this growing area.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

Health promotion programs that are offered in the general community often present physical, attitudinal and knowledge barriers that limit participation by those with disabilities. These environmental barriers and the lack of information on how to overcome them make it difficult for individuals with disabilities to engage in health-promoting behaviors. This paper presents a brief overview of health promotion for individuals with disabilities in the areas of exercise, nutrition and health education, and describes a service delivery model that addresses the needs of this important subgroup. The primary emphasis of the model is to provide instructional guidance to those with disabilities in the supportive transitional setting that will assist them in overcoming environmental barriers to participation in their community (i.e. home or wellness facility). The supportive transitional setting is used to empower people with disabilities to adopt healthier lifestyles and manage various secondary conditions related to their disability (e.g. fatigue, weakness, and pain). A sample program conducted in this setting is described.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

Lymphedema remains a relatively common, and often under-recognized, complication of breast cancer therapy. When present, arm edema can engender significant morbidity and psychological distress in survivors of breast cancer. Therapeutic approaches to post-mastectomy lymphedema further compromise mental health because of the unrelenting demands on patient time and energies. It is proposed that psychoeducational interventions, including supportive group therapy, would be helpful. Although formal outcomes studies are lacking, extrapolation from studies of more broadly defined groups of people surviving cancer suggest that this approach might be useful to further acceptance of preventive strategies, diminish social isolation, and provide more effective coping skills.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

Palliative care has been through a difficult development process, but now has the evidence and experience base to make a contribution in the changing health environment. There has now been a great deal of experience with different types of care, and research has shown that patients strongly prefer home-based care. Research on outcomes has inevitably proved difficult, but the evidence on patient perspectives is strong. The aim of ensuring privacy, dignity and control in the last phase of life is a very positive one and is attainable for most patients. Health funders should be keen to drive forward advances in this field.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

ObjectiveTo develop a method of value analysis which would facilitate an objective comparison of available angiotensin II antagonists as antihypertensive agents, in order to provide an adaptable framework which would allow for future developments in new product introduction and changes in evidence base.MethodsSix angiotensin II antagonists were available for review at the time of the study: candesartan, eprosartan, irbesartan, losartan, telmisartan and valsartan. A team comprised of a cardiologist, a physician and a pharmacist conducted the evaluation. A nine-point selection criteria set was developed as a comparison framework. Each criterion was assigned a relative weighted value by the panel. Each drug product was systematically evaluated against each criterion to generate a series of product-criterion scores.ResultsA total score for each product was derived by combining product-criterion scores and the respective weighted values. The results obtained were presented to the hospital's Drug and Therapeutics committee. Analysis of these scores ranked losartan highest (707), followed by valsartan (611) and candesartan (610). The agents most recently introduced on to the UK market scored the lowest.ConclusionThe formulary analysis was accepted by the therapeutics committee as a viable method of comparison and consequently the previous formulary selections of candesartan and losartan was deemed to be justified.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

Type 2 diabetes mellitus is a progressive disease with an insidious onset. It is thought to affect up to 10% of European and North American populations with a significantly higher incidence in non-White than in White populations. Complications of the disease are associated with considerable morbidity and mortality and their management consumes significant healthcare resources.Data from the United Kingdom Prospective Diabetes Study have shown that intensive glycemic control reduces the microvascular complications of type 2 disease and that intensive management of fasting plasma glucose (FPG) levels is insufficient over time to provide such control. Recent studies have demonstrated that lowering postprandial plasma (PPG) glucose levels provides some additional glycemic control and recent epidemiologic data suggest reducing PPG levels may be associated with a reduction in mortality.In patients with type 2 diabetes mellitus inadequately controlled by diet and exercise, nateglinide significantly improved glycemic control compared with placebo; a beneficial effect on both FPG and PPG levels was observed. In active comparator studies, nateglinide has been shown to be as effective as metformin (in pharmacotherapy-naïve patients), acarbose and troglitazone in reducing glycosylated hemoglobin (HbA1c) levels.When used in combination with metformin (in patients inadequately controlled on maximum dosages of metformin monotherapy) nateglinide significantly improves glycemic control compared with placebo. In addition, nateglinide has been shown to display pronounced additive effects when added to troglitazone or metformin in patients inadequately controlled by diet and exercise alone.Nateglinide was generally well tolerated in clinical trials. The most common adverse event was hypoglycemia, although the incidence was low in comparison with sulfonylureas. The incidence of hypoglycemia was increased in patients using nateglinide in combination with metformin.By controlling HbA1cand PPG, nateglinide has the potential to provide substantial health and quality-of-life benefits; however, long-term outcome data and validated quality-of-life assessments are lacking. In economic modelling studies, the estimated cost-effectiveness ratios observed with nateglinide were well within the range for therapies considered to be cost-effective.In conclusion, nateglinide is a useful addition to the available treatments for type 2 diabetes mellitus. It significantly improved glycemic control in pharmacotherapy-naïve patients as well as in patients not adequately controlled by metformin alone; however, until long-term clinical data become available, nateglinide can only be considered as an adjunct to metformin in patients inadequately controlled on metformin alone in whom PPG levels are elevated. Nateglinide is well tolerated and has low potential to cause hypoglycemia and bodyweight gain.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS