摘要:

During the twentieth century, chronic health conditions (which include both chronic diseases and impairments), became the major cause of illness, disability and death in developed countries. The high prevalence of chronic conditions among the elderly, combined with a rapidly growing population of elderly people, is expected to dramatically increase the absolute numbers of people with chronic care needs in the twenty-first century.This article provides a comprehensive analysis of recent technological developments which have stimulated the use of telecommunication technologies in healthcare delivery to persons with chronic illnesses. Although the potential of this approach has been well recognised since the early 1960s, limitations of early telecommunication technologies (such as absence of common protocols), restricted accessibility, and high cost prevented their widespread use. The Internet and World Wide Web technologies, deployment of high-speed telecommunications networks coupled with a decline in their operating costs, and invention of devices capable of capturing and transmitting data from patients' homes are discussed in terms of their impact on chronic disease care. Healthcare delivery applications in 3 major areas (primary prevention and early disease detection, chronic disease control and symptom management, personal and social support) where use of telecommunication systems in the management of chronic medical conditions have been shown to be effective are reviewed.We conclude that the use of telecommunication technologies in the management of chronic diseases will likely expand rapidly during the early twenty-first century with the expectation that these systems will have a significant impact on quality of life and healthcare costs of patients with chronic conditions.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

Aggressive lipid disorder therapy in both primary and secondary prevention has been shown to reduce progression of coronary heart disease, reduce mortality and clinical events and ultimately reduce healthcare costs. Outpatient cardiac centres, diabetic treatment clinics, multispecialty medical groups, primary care medicine, and health management organisations currently have a unique opportunity to establish cost-effective lipid management programmes.Lipid clinics involve more than drug therapy and formulary management. Lipid clinics fit well within the genre of disease management; they target algorithmically driven therapy to high risk populations using intensive patient education, frequent follow-up and proven behaviour change strategies. Properly planned and organised, lipid clinics significantly enhance therapeutic compliance and lipid goal achievement compared with usual care. Successful lipid clinic operation also requires judicious staffing, sufficient patient volume, efficient referral mechanisms, tracking of outcomes measures, business development skills, and eventual integration with more comprehensive cardiovascular disease risk reduction services.This systematic approach to lipid management and cardiovascular disease risk reduction will afford meaningful opportunities for physician groups and integrated healthcare systems who aspire to reduce the unnecessary burden of premature cardiovascular disease.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

Influenza remains a significant cause of worldwide morbidity and mortality. With the availability of new effective antivirals for the treatment of influenza, early diagnosis of the disease will become increasingly important for effective disease management.Although investigators are generally in broad agreement about the symptoms of influenza, there are currently no agreed guidelines for the clinical diagnosis of influenza during annual outbreaks. This paper outlines the recommendations of a Working Party (comprising virologists and family practitioners) who met to construct criteria that could be used by primary healthcare professionals to aid early clinical diagnosis of influenza, i.e. before the development of any complications.A virologically confirmable diagnosis of influenza is likely when an otherwise healthy adult presents, during a known local influenza outbreak, with rapid onset of the symptom complex of fever, feverishness or chills plus myalgia, cough or malaise. Guidelines for the diagnosis of influenza in children, in patients with chronic diseases and in the elderly require further refinement.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

Clinical studies in patients with rheumatoid arthritis (RA) provide valuable information on the course and outcome of the disease whereas clinical trials provide information on optimal treatment for patients. This paper discusses measurement concepts and most frequently used measures in RA.To optimise the information that can be obtained from clinical studies, uniform measures are essential. Therefore, the international rheumatology community has made an effort to propose uniform end-points for clinical studies in RA. Measurement in RA is traditionally divided into the measurement of ‘the process’ and measurement of ‘outcome’. Current measures in use include:disease activity measures − global assessments, symptoms (e.g. morning stiffness), health status/ physical function, physical signs (e.g. joint counts) and laboratory assessments; andmeasures of damage − radiography of affected joints and physical function.Several Outcome Measures in Rheumatology (OMERACT) conferences have resulted in a core set of end-points to be used in RA clinical trials, which are supported by the World Health Organization and International League of Associations for Rheumatology (WHO/ILAR).In addition, the OMERACT conferences focused on minimum important differences for patients and in trials, resulting in recommendations for improvement criteria. Improvement criteria were further developed and validated by both the American College of Rheumatology (ACR) and European League Against Rheumatology (EULAR). The ACR criteria use the WHO/ILAR core set of end-points to define minimum improvement in each of the measures. The EULAR criteria define improvement using the Disease Activity Score.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

Narcolepsy is a chronic sleep disorder characterised by excessive daytime sleepiness, with or without cataplexy, sleep paralysis and hypnagogic hallucinations, with an estimated prevalence of 0.02 to 0.05% worldwide.The goal of managing narcolepsy is to keep patients as alert as possible during daytime hours and to minimise the incidence of cataplexy. A combination of nonpharmacological (lifestyle and behavioural modifications) and pharmacological treatments may be used to alleviate excessive daytime sleepiness. Stimulants such as amphetamines and methylphenidate have been the mainstay of pharmacological treatment, although a range of different agents have been used over several decades.Modafinil, a benzohydrylsulfinyl-acetamide derivative, has demonstrated good efficacy in the treatment of excessive daytime sleepiness, but has limited anticataplectic effects. In clinical studies modafinil 200 to 400 mg/day significantly improved subjective and objective measures of sleepiness and alertness compared with placebo. A long term study of up to 10 years' duration showed modafinil to have good to excellent efficacy in 64% of patients. Use of modafinil does not appear to be associated with the development of tolerance or dependence, and it is considered to have limited potential for abuse. Modafinil is generally well tolerated with few adverse effects, the most common being headache, nausea, nervousness and anxiety. It may be coadministered with drugs for treating cataplexy. The efficacy and the cost effectiveness of modafinil in the treatment of narcolepsy have not been compared with other available agents.ConclusionsModafinil provides a useful alternative to traditional stimulants for the treatment of excessive daytime sleepiness associated with narcolepsy. It is well tolerated, may be taken in combination with medications for cataplexy, and shows long term efficacy without development of tolerance.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS