摘要:

With emerging access to the Internet and valuable healthcare resources online, healthcare consumers have quickly adopted the World Wide Web as a resource for healthcare information. Because growing numbers of consumers are accessing healthcare information online, it is important to explore how they are using this information in healthcare decision-making, and the eventual outcomes for their health.All English-language articles indexed in Medline related to the use of Internet technology in healthcare education, and published in peer-reviewed journals between 1998 and 2000, were screened for review. 37 studies met the eligibility criteria. Although demographics remain uneven, with a distinct Internet access gap existing between the economically advantaged and disadvantaged, results of studies described in this paper support the effectiveness of Internet-delivered healthcare information in changing clinical outcomes. Electronic mail and telehealth applications hold promise as a new mode of communication and information transfer for patients and providers, while at the same time raising issues related to inaccurate and misleading information.The findings of this review support Internet-delivered technologies as an effective strategy for the transfer of data and knowledge as well as support for the patient-provider interaction. From the patient's perspective, the Internet provides information, a new mode of connection to the healthcare environment, and access to virtual support groups. Additional research is needed to assess the impact and best approaches for use of the Internet as a link to the clinical environment for communication and sharing of patient-centered clinical information.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

The National Lung Health Education Program (NLHEP) is a new healthcare initiative which encourages the early diagnosis of and intervention in patients who are in the process of developing chronic obstructive pulmonary disease (COPD) and related disorders. COPD is primarily a smoker's disease. Lung injury is due to proteolytic and oxidative damage early in the course of disease and results in premature loss of lung function, as measured by forced expiratory volume in 1 second (FEV1). Smoking cessation will retard this rate of decline and improve prognosis.The most common cause of death in patients with early stage COPD is lung cancer. Thus, the possibility of lung cancer should be investigated in patients with early degrees of airflow obstruction. The NLHEP Spirometry Statement encourages testing of all smokers aged over 45 years, and anyone with cough, dyspnea, mucus hypersecretion, or wheeze. The spirometry industry has responded to the NLHEP by developing simple, accurate, reliable, and inexpensive office spirometers for screening purposes. It is hoped that the widespread use of spirometry will begin to reduce the socioeconomic impact of COPD and related lung cancer. Managed care should endorse the goals and objectives of the NLHEP for the benefit of their patients, and to help contain costs.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

ObjectiveThe purpose of this study was to evaluate the use of antidepressants through use of mutually exclusive disease indications using a managed care database.Design and settingA claims database from a 225 000 member managed care organisation was used for the study. A hierarchy of mutually exclusive antidepressant indications was developed: ‘Depression’, ‘Other Approved Indication’, ‘Mental Health’, ‘Surrogate Diagnosis’, ‘Other Uses’, ‘Chronic Disease’, and a residual ‘Unclassified’ hierarchical indication group.Main outcome measures and resultsPatients in the Depression and Other Approved Indication hierarchical groups likely received the antidepressant drugs primarily for these indications and frequently received selective serotonin reuptake inhibitors (SSRIs). Use of antidepressants in the Mental Health Disorders hierarchical group may have been for a related disease. The patients in the Surrogate Diagnosis, Other Uses, Chronic Diseases, and Unclassified hierarchical groups were significantly older than those patients in the Depression group and tricyclic antidepressant (TCA) use was more frequent than the SSRIs. The patients in the Unclassified diagnosis group may represent antidepressant use that is not adequately documented or not indicated. The Surrogate Diagnosis and Chronic Diseases hierarchical groups total healthcare costs were significantly higher than those observed in patients with a Depression diagnosis.ConclusionsUse of mutually exclusive hierarchical diagnosis groups proved to be a useful strategy for assessing antidepressant drug use. SSRI use was more common in the Depression and Other Approved Indication hierarchical groups. Patients in the Surrogate Diagnosis, Other Uses, Chronic Diseases, and Unclassified hierarchical groups used TCAs more frequently.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

In Europe and the US >300 000 cases of advanced colorectal cancer are diagnosed each year, and it is the third most common type of cancer after breast/ prostate and lung cancers. The lifetime risk of developing colorectal cancer increases with genetic predisposition or a family history of colorectal cancer. The 5-year survival rate varies depending on the stage at which colorectal cancer is diagnosed. Advanced colorectal cancer (stage IV, Duke's D) has a 5-year survival rate of <5%.Screening and early detection can significantly increase the likelihood of survival. Treatment of early colorectal cancer relies on surgery and/or chemotherapy. Patients with stage I to II (Duke's A to B) colorectal cancer have a good prognosis, with a >70% survival rate at 5 years. While the management of advanced colorectal cancer also encompasses these options, treatment is largely palliative. Fluorouracil is currently the gold standard for treatment of advanced colorectal cancer. However, despite its widespread use it is associated with a relatively low tumor response rate (<15%), drug regimens are complex and toxicities are significant.Raltitrexed, a specific thymidylate synthase inhibitor, has been approved for the treatment of advanced colorectal cancer. As first-line therapy it has similar efficacy to fluorouracil in terms of tumor response rates (approximately 14 to 19%) and overall survival duration (approximately 10 to 11 months), although disease progression may be sooner with raltitrexed. However, in an effort to further increase survival duration, raltitrexed has been administered concomitantly with fluorouracil or oxaliplatin therapy as first- or second-line therapy, with promising preliminary results.In comparative clinical trials, leukopenia and mucositis were more commonly associated with fluorouracil than with raltitrexed monotherapy. In contrast, elevated transaminase levels, which were not clinically significant, and anemia were more common with the raltitrexed regimen.Higher drug acquisition costs for raltitrexed than for fluorouracil are partially offset by reduced pharmacy resource utilization, lower drug administration costs and reduced costs relating to the management of chemotherapy-induced adverse events. Overall treatment-related costs were slightly higher for raltitrexed than for fluorouracil administered according to the Mayo regimen, but lower than either the Lokich or De Gramont regimens.Early comparative quality-of-life assessments favoured raltitrexed over fluorouracil; however, comparisons at 15 weeks failed to show any clear preference in favor of either treatment. Palliative improvements occurred in patients who responded to treatment or those who had disease stabilization in both treatment groups.ConclusionsRaltitrexed is a first-line treatment option for the management of advanced colorectal cancer and offers a more convenient administration regimen than traditional fluorouracil infusion regimens. Available data suggest that it may have lower overall treatment costs than some but not all fluorouracil regimens; however, formal cost-effectiveness comparisons (in terms of cost per clinical outcome) are not available. Preliminary results from trials of combination therapy with raltitrexed and either fluorouracil or oxaliplatin are promising; however, further data on raltitrexed combination therapy are necessary to better determine its place in the management of advanced colorectal cancer.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS