Severe disease — Patients with severe ulcerative colitis usually have a large region of the colon involved, often the entire colon. Symptoms of severe ulcerative colitis include Diagram of the colon and rectum Ulcerative Colitis (UC) is a disease in which the lining of the colon (the large intestine) becomes inflamed. The immune system mistakenly targets the lining of the colon, causing inflammation, ulceration, bleeding and diarrhea. The inflammation almost always affects the rectum and lower part of the colon, but it can also effect the entire colon
Lizards are ideal organisms for ecological studies, largely because of their basic traits and remarkable diversity. Because lizards are ectotherms, they are often abundant, making them relatively easy to locate, observe, and capture. This chapter highlights lizards as model subjects for basic ecological studies. It examines variations in their morphology, behavior, physiology, and ecology.
In the late 1999 concern over the inadequacies of social research prompted a group of academics and nongovernmental organization (NGO)-based researchers and activists to plan a conference. It was held at the University of the Witwatersrand in April 2001 entitled "Aids in Context: Explaining the Social Cultural and Historical Roots of the Epidemic in southern Africa". Key objectives were to cross-fertilize existing work to create new organizational and intellectual linkages (particularly between NGOs and universities) and to stimulate new research initiatives. The conference attracted broad participation from academics NGOs and research organizations. There was also some representation from government. The media took a strong interest and a number of leading journalists delivered papers and played an important role in panel discussions. More than a hundred papers were presented offering rich and sometimes novel insights into the causes context and course of the pandemic. It is impossible in the space available to us here to do justice to this material. One outcome of the conference will be a book presently nearing completion which will make key insights available to a wide audience. And a number of special issues of journals are being prepared drawing on the papers presented on particular themes. (excerpt)
Article AbstractBackground: While postpartum depression is a common mental condition with significant burden, it often remains undiagnosed and untreated. The objective of this article is to critically review the literature to determine the current state of scientific knowledge related to the treatment of postpartum depression from a nonbiological perspective. Data Sources: Databases searched for this review included Medline, PubMed, CINAHL, PsycINFO, EMBASE, ProQuest, the Cochrane Library, and the WHO Reproductive Health Library from 1966 to 2003. The search terms used were postpartum/postnatal depression and randomized controlled/clinical trials. Published peer-reviewed articles in English from 1990 to 2003 were included in the review, although select earlier studies were also included based on good methodological quality and/or the absence of more recent work. Method: The criteria used to evaluate the interventions were based on the standardized methodology developed by the U.S. Preventive Services Task Force and the Canadian Task Force on Preventive Health Care. Results: Twenty-one studies that met inclusion criteria were examined. These studies included interpersonal psychotherapy, cognitive-behavioral therapy, peer and partner support, nondirective counseling, relaxation/massage therapy, infant sleep interventions, infant-mother relationship therapy, and maternal exercise. Although some of these interventions have been better studied for depression unrelated to childbirth, methodological limitations render their efficacy equivocal for postpartum depression. Conclusions: Definite conclusions cannot be reached about the relative effectiveness of most of the nonbiological treatment approaches due to the lack of well-designed investigations. Randomized controlled trials are needed to compare different treatment modalities, examine the effectiveness of individual treatment components, and determine which treatments are most useful for women with different risk factors or clinical presentations of postpartum depression.
Blood pressure lowering is an established strategy for preventing microvascular and macrovascular complications of diabetes, but its role in the prevention of diabetes itself is unclear. We aimed to examine this question using individual participant data from major randomised controlled trials.We performed a one-stage individual participant data meta-analysis, in which data were pooled to investigate the effect of blood pressure lowering per se on the risk of new-onset type 2 diabetes. An individual participant data network meta-analysis was used to investigate the differential effects of five major classes of antihypertensive drugs on the risk of new-onset type 2 diabetes. Overall, data from 22 studies conducted between 1973 and 2008, were obtained by the Blood Pressure Lowering Treatment Trialists’ Collaboration (Oxford University, Oxford, UK). We included all primary and secondary prevention trials that used a specific class or classes of antihypertensive drugs versus placebo or other classes of blood pressure lowering medications that had at least 1000 persons-years of follow-up in each randomly allocated arm. Participants with a known diagnosis of diabetes at baseline and trials conducted in patients with prevalent diabetes were excluded. For the one-stage individual participant data meta-analysis we used stratified Cox proportional hazards model and for the individual participant data network meta-analysis we used logistic regression models to calculate the relative risk (RR) for drug class comparisons.145 939 participants (88 500 [60·6%] men and 57 429 [39·4%] women) from 19 randomised controlled trials were included in the one-stage individual participant data meta-analysis. 22 trials were included in the individual participant data network meta-analysis. After a median follow-up of 4·5 years (IQR 2·0), 9883 participants were diagnosed with new-onset type 2 diabetes. Systolic blood pressure reduction by 5 mm Hg reduced the risk of type 2 diabetes across all trials by 11% (hazard ratio 0·89 [95% CI 0·84–0·95]). Investigation of the effects of five major classes of antihypertensive drugs showed that in comparison to placebo, angiotensin-converting enzyme inhibitors (RR 0·84 [95% 0·76–0·93]) and angiotensin II receptor blockers (RR 0·84 [0·76–0·92]) reduced the risk of new-onset type 2 diabetes; however, the use of β blockers (RR 1·48 [1·27–1·72]) and thiazide diuretics (RR 1·20 [1·07–1·35]) increased this risk, and no material effect was found for calcium channel blockers (RR 1·02 [0·92–1·13]).Blood pressure lowering is an effective strategy for the prevention of new-onset type 2 diabetes. Established pharmacological interventions, however, have qualitatively and quantitively different effects on diabetes, likely due to their differing off-target effects, with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers having the most favourable outcomes. This evidence supports the indication for selected classes of antihypertensive drugs for the prevention of diabetes, which could further refine the selection of drug choice according to an individual's clinical risk of diabetes.British Heart Foundation, National Institute for Health Research, and Oxford Martin School.
Patient adherence is an essential goal of pharmaceutical care and can be an initial focus for cognitive services in a traditional pharmacy. Pharmacists are well placed to manage adherence programs. Activities associated with adherence include screening or assessment, follow-up monitoring, and use of memory aids or refill reminders. Technology is available in many forms to assist pharmacists in this role. The pharmacist's role in adherence should focus on achieving desirable patient outcomes. Services associated with adherence programs need not be attached to distribution activities. Producing cost-effective drug therapy outcomes will continue to be of critical value to patients, health care systems, and third party providers.
RZs, like ASO agents, are several years from approval by the Food and Drug Administration. Although many problems must be solved before they can be used effectively as therapeutic agents, results from a wide variety of in vitro and in vivo experiments are encouraging. The advantages of RZs are their very high specificity of action, their catalytic mechanism, their potential for targeted therapy, and the lack of side effects with their use. These advantages, coupled with the wide applicability of ribozyme technology, will continue to drive the research necessary to develop RZs into useful therapeutic agents.
Les hôpitaux sont désormais confrontés à des contraintes économiques fortes et à des exigences de plus en plus élevées en termes de qualité et de sécurité des soins. Pour faire face à ces contraintes, l’une des solutions pourrait être l’adoption d’approches issues de l’industrie. Certaines de ces approches, comme la gestion des risque a priori, font depuis l’arrêté du 6 avril 2011 relatif au management de la qualité de la prise en charge médicamenteuse, partie intégrante du quotidien des professionnels de santé. D’autres, comme les approches d’amélioration des processus métiers, sont encore peu développées à l’hôpital. Nous proposons dans cette revue générale de revenir sur les principales approches d’améliorations des processus métiers ayant été utilisées en milieu hospitalier en nous focalisant plus particulièrement sur l’une des plus récentes et des plus utilisées actuellement : le Lean.Hospitals have to deal strong with economic constraints and increasing requirements in terms of quality and safety of care. To address these constraints, one solution could be the adoption of approaches from the industry sector. Following the decree of April 6, 2011 on the quality management of the medication use process, some of these approaches, such as risk management, are now part of the everyday work of healthcare professionals. However, other approaches, such as business process improvement, are still poorly developed in the hospital setting. In this general review, we discuss the main approaches of business process improvements that have been used in hospitals by focusing specifically on one of the newest and most currently used: Lean.
