摘要:

Disease management strategies, which seek to integrate care around the needs of various stakeholders - providers, drug and device makers, physicians, patients, managed care organisations and employers - have the potential to markedly change how healthcare services are delivered. To support this transition, information technologies are needed to facilitate the collection, integration, analysis, real-time presentation and secure storage of clinical data.This article reviews the needs of the various stakeholders in disease management and links these needs to healthcare delivery information technologies, both currently existing and planned. It summarises the status of the core information technologies that support healthcare delivery and disease management. The article focuses on the principles of evaluating the costs and benefits of information technology with respect to the business plan for the clinical organisation and of successfully implementing information technology in the healthcare setting.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

Meningococcal disease is a much-feared infectious disease with high mortality, unpredictable epidemiology and a predilection for the young. Primary prevention by vaccination cannot yet be fully achieved, so control of the disease must focus on the prevention of secondary cases among contacts of patients. Three strategies are possible: information, vaccination and chemoprophylaxis. This article focuses on the latter.Chemoprophylaxis aims to prevent secondary cases by eliminating the bacterium from the throats of carriers and thus interrupting the chain of transmission and protecting susceptible individuals from invasive infection. The drugs of choice for chemoprophylaxis are the antibacterials rifampicin (rifampin), ceftriaxone and ciprofloxacin. Sulphonamides and penicillins, traditionally used to control meningococcal disease, are of little benefit. Aside from chemoprophylaxis, vaccination can offer protection from certain meningococcal strains, while good public information prevents panic and helps to ensure that new cases are recognised and treated at the earliest possible stage.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

The main consequence of osteoporosis is fracture, which is due to loss of bone mass and microarchitecture upon which mechanical integrity depends. The management of osteoporosis care focuses either on preventing bone loss (and thereby preserving mechanical integrity) or targets those who have lost a significant amount of bone and have had, or are at imminent risk of, a fracture.The prevention of osteoporosis is centred on primary care where the opportunities to identify those at risk should be included in normal clinical practice. For many patients, treatment can be started in primary care without recourse to hospital referral.Hormone replacement therapy (HRT) is the mainstay of treatment. Introduction early in the menopause is good for compliance but this wanes with time and few women will take treatment for more than 10 years. Protection from osteoporosis will then decline as they reach later life when major fractures have their peak incidence. It may be that HRT or other agents like the selective estrogen receptor modulators should be introduced for the first time in later life but this will require different strategies to achieve compliance.Treatment of established bone loss also requires the identification in primary care of those most at risk in both primary prevention and treatment of osteoporosis, bone mineral density measurements are critical to the evaluation of risk. Since bone loss is an inevitable consequence of aging, osteoporosis is so common in the elderly that treatment must be directed at those most at risk of a fracture. The bisphosphonates which are potent inhibitors of bone resorption have been shown to increase bone mass and reduce major fractures and play a key role in management. Unfortunately none of the bisphosphonates, nor any of the other agents used for treating osteoporosis (HRT, vitamin D, calcitriol, calcitonin) have been directly compared in fracture prevention studies and the relative merits of these agents have to be derived from individual trials which often differ in major respects.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

Epilepsy is a common condition with multiple potential causes that may present as a variety of types of seizure. Drug therapy is the mainstay of treatment, with seizures being controlled by monotherapy in approximately 60% of patients. In a minority of patients, seizures are controlled by combinations of antiepileptic drugs. Approximately 20% of patients have treatment-resistant epilepsy which, in some cases, will respond to surgical treatment.The management of epilepsy with drugs requires a clear diagnosis of the type of epilepsy. One or several individual drugs are then tested initially as monotherapy and in combination if necessary until efficacy is established.The use of older drugs (e.g. phenytoin, carbamazepine, etc.) is generally well established in the treatment of different types of epilepsy. Although other agents have their place, valproic acid (sodium valproate) appears to be the only agent with a sufficiently broad spectrum of activity to allow its use in all types of epilepsy. Valproic acid and carbamazepine are often used as first-line treatment for patients with partial epilepsy. However, adverse effects or drug interactions often dictate the choice between older antiepileptic drugs. In assessing newer agents, differences in efficacy, tolerability, drug interactions and contraindications often make treatment choices clear. Furthermore, several newer drugs are licensed only for add-on therapy, which restricts their use.Lamotrigine is a newer antiepileptic drug with efficacy in most seizure types. It has been demonstrated to be effective and well tolerated when added to established antiepileptic drug regimens in adults and children, and as monotherapy in adults. Although it must be introduced slowly to minimise the possibility of skin rash, once at maintenance dosages it may be administered once or twice daily. The tolerability and drug interaction profiles of lamotrigine are well characterised. Thus, lamotrigine provides an effective and generally well tolerated alternative to older and newer antiepileptic drugs in the treatment of a variety of types of epilepsy.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS