Osteoarthritis (OA) is a major cause of pain and disability in the elderly. The perspective of OA as a dynamic process triggered by diverse insults is increasingly accepted. Objectives of management are patient educat...
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Osteoarthritis (OA) is a major cause of pain and disability in the elderly. The perspective of OA as a dynamic process triggered by diverse insults is increasingly accepted. Objectives of management are patient education, relief of pain, optimization of function and modification of the OA process. management should be individualized and should take into account factors relating to the person as well as the OA joint. There is a reasonable evidence base for several key elements of management. Recent review of the research evidence shows a skewed distribution in favour of drugs, particularly NSAIDs, and important gaps in clinically relevant knowledge. The restricted generalizability of the research data could be improved by improvements in study design and methods of reporting. Current published guidelines on management of OA are critically reviewed and compared.
The prevalence of asthma has been increasing in Japan, like in other parts of the world. Asthma management guidelines were developed in Japan in 1993 and 1998. These guidelines have been shown to contribute to the imp...
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The prevalence of asthma has been increasing in Japan, like in other parts of the world. Asthma management guidelines were developed in Japan in 1993 and 1998. These guidelines have been shown to contribute to the improvement of asthma management in Japan. Most allergists know the guidelines and make use of them. However, only half the non-specialists surveyed knew the guidelines in 1996-97, although the awareness of the guidelines increased over the next 3 years. Further efforts are required to implement the guidelines widely.
Antihypertensive drug treatment has been unequivocally shown to exert favourable cardiovascular effects by reducing the incidence of (and delaying the occurrence of) major complications of hypertension, i.e. stroke, c...
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Antihypertensive drug treatment has been unequivocally shown to exert favourable cardiovascular effects by reducing the incidence of (and delaying the occurrence of) major complications of hypertension, i.e. stroke, coronary atherosclerosis, congestive heart failure and renal insufficiency. Evidence has also been provided that the benefits of antihypertensive treatment (1) can be observed not only in diastolic or systo-diastolic hypertensive states but also in isolated systolic hypertensions and (2) are not related to a specific antihypertensive drug regimen but rather to the blood pressure lowering per se. The latter statement has been confirmed by the results of recently published clinical trials, demonstrating the ability of ACE inhibitors and calcium antagonists to exert cardioprotective properties similar to those induced by conventional antihypertensive drug treatment. Recent clinical trials have also shown that further advantages in patient protection can be achieved by lowering diastolic blood pressure values to well below 90 mmHg, particularly when high blood pressure is accompanied by diabetes and renal insufficiency.
Objective: To determine the factors influencing general practitioners' prescribing for patients with moderate hypertension, and to investigate their ability to assess patients' absolute risk of cardiovascular ...
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Objective: To determine the factors influencing general practitioners' prescribing for patients with moderate hypertension, and to investigate their ability to assess patients' absolute risk of cardiovascular disease, Design: Decision-making was assessed by a postal questionnaire involving five standardised example patients, send to all general practitioners in the CB-postcode area (Cambridge, UK). Patients varied in age, gender, diabetic and smoking status, blood pressure and total cholesterol, giving 5-year absolute risks ranging from less than 5% to greater than 20%. GP treatment decisions and risk factor influence, age bias, absolute risk calculations and cost-awareness were analysed with SPSS. Absolute risk was calculated using the New Zealand Core Services Committee (NZCSC) guidelines, 1995. Results: GP response rate was 66%. Sample demographics (mean age 42 years, 39% female) did not differ statistically from local health authority data, High blood pressure alone was the most common reason for instituting therapy (67%), independent of other risk factors. Drug choices did not differ statistically from Prescription Pricing Authority data. This supports the validity of the questionnaire. GP estimations of absolute risk were inconsistent, and there was a significant association between underestimation of elderly patient risk and overestimation of younger patient risk (p = 0.05). Conclusions: The Cambridge GPs more frequently based treatment decisions on patients' blood pressure level alone, rather than considering absolute risk as recommended by NZCSC and WHO guidelines. The relationship between patient age and risk estimations map indicate a "young age premium" influencing treatment. The data support the need for risk-based guidelines and education in treatment of hypertension.
The 1999 hypertension management guidelines issued by the World Health Organization and the International Society of Hypertension emphasize the importance of blood pressure reduction in the prevention of cardiovascula...
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The 1999 hypertension management guidelines issued by the World Health Organization and the International Society of Hypertension emphasize the importance of blood pressure reduction in the prevention of cardiovascular events. Furthermore, they conclude that the benefits of treatment are due to blood pressure lowering per sc, rather than to any specific antihypertensive therapy. The results of the second Swedish Trial in Old Patients with Hypertension (STOP-Hypertension-2) are consistent with these recommendations, since in this trial angiotensin converting enzyme (ACE) inhibitors and calcium antagonists reduced blood pressure to the same extent as conventional therapy with beta-blockers and diuretics in elderly hypertensive patients, and the three treatments produced similar reductions in the risk of cardiovascular events. Furthermore, a first subgroup analysis of cardiovascular mortality showed that the three treatments seemed equally effective in diabetic patients. The STOP-Hypertension-2 data, therefore, are fully consistent with the 1999 hypertension management guidelines, and underline the advantages offered by both older and newer antihypertensive therapies.
In 1989 the European Endangered Species Programme (EEP) for the Hyacinth macaw Anodorhynchus hyacinthinus was founded following concerns about the status of the wild population and the lack of breeding success in capt...
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Introduction: Herpes zoster is a common disease which may cause serious ocular sequelae when it affects the trigeminal nerve. Although involvement of the nasociliary branch of the first division of the trigeminal nerv...
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COPD guidelines provide advice about the appropriate use of various medications in treating patients with this condition. Comparisons of drug therapy as recommended by these guidelines with what is actually prescribed...
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COPD guidelines provide advice about the appropriate use of various medications in treating patients with this condition. Comparisons of drug therapy as recommended by these guidelines with what is actually prescribed by both primary care physicians and specialist pulmonologists in a number of European countries can be examined in a variety of ways. Nonadherence to guidelines and differences between countries are caused by a number of factors, including varying degrees of misdiagnosis and different national attitudes to various classes of drugs.
The introduction of guidelines for the management of asthma has led to standardization of management and better care of patients with the condition. Many national and international respiratory societies have developed...
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The introduction of guidelines for the management of asthma has led to standardization of management and better care of patients with the condition. Many national and international respiratory societies have developed guidelines for COPD. The World Health Organization and the National Heart, Lung, and Blood Institute are jointly developing guidelines that will present evidence-based recommendations for the management of COPD. The guidelines will discuss the definition, epidemiology, natural history, risk factors, pathology, and diagnosis of COPD. There will be guidance on the management of chronic disease and acute exacerbations, education, prevention, and socioeconomics.
The present guidelines were prepared by the guidelines Sub-Committee of the World Health Organization-International Society of Hypertension (WHO-ISH) Mild Hypertension Liaison Committee, the members of which are liste...
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The present guidelines were prepared by the guidelines Sub-Committee of the World Health Organization-International Society of Hypertension (WHO-ISH) Mild Hypertension Liaison Committee, the members of which are listed at the end of the text. These guidelines represent the fourth revision of the WHO-ISH guidelines and were finalised after presentation and discussion at the 7th WHO-ISH Meeting on Hypertension, Fukuoka, Japan, 29thSept–1stOct, 1998. Previous versions of the guidelines were published in Bull WHO 1993, 71:503–517 and J Hypertens 1993 11:905–918.
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