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Conventional Management (conventional + management)

Distribution by Scientific Domains

Medical Sciences	53%

Selected Abstracts

The role of the intestine in the pathophysiology and management of severe acute pancreatitis

HPB, Issue 2 2003
RS Flint
Background The outcome of severe acute pancreatitis has scarcely improved in 10 years. Further impact will require new paradigms in pathophysiology and treatment. There is accumulating evidence to support the concept that the intestine has a key role in the pathophysiology of severe acute pancreatitis which goes beyond the notion of secondary pancreatic infection. Intestinal ischaemia and reperfusion and barrier failure are implicated in the development of multiple organ failure. Discussion Conventional management of severe acute pancreatitis has tended to ignore the intestine. More recent attempts to rectify this problem have included 1) resuscitation aimed at restoring intestinal blood flow through the use of appropriate fluids and splanchnic-sparing vasoconstrictors or inotropes; 2) enteral nutrition to help maintain the integrity of the intestinal barrier; 3) selective gut decontamination and prophylactic antibiotics to reduce bacterial translocation and secondary infection. Novel therapies are being developed to limit intestinal injury, and these include antioxidants and anti-cytokine agents. This paper focuses on the role of the intestine in the pathogenesis of severe acute pancreatitis and reviews the implications for management. [source]

Comprehensive review of conventional and non-conventional methods of management of recurrent vulvovaginal candidiasis

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2007
Cathy WATSON
Abstract Recurrent vulvovaginal candidiasis (VVC) is a condition what causes women a great deal of discomfort, inconvenience, and sometimes has psychological sequelae.1 This condition is notoriously difficult to manage. Conventional management is generally favoured by medical practitioners. Some practitioners prefer not to offer other options because of significant possible side-effects and the lack of research supporting alternative treatments. There are many studies and much available information surrounding uncomplicated VVC, including two systematic reviews.2,3 In the area of recurrent VVC however, quality conclusive studies are scarce, and recurrent VVC is featured infrequently in randomised controlled trials (RCTs). Systematic reviews that strongly support a particular pharmacological method of conventional management of recurrent VVC over another are absent from medical literature. Recommendations are largely formed on the basis of scanty RCTs and expert opinion. There is even less conclusive evidence in the area of alternative therapies; yet despite this, anecdotally many practitioners (both alternative and mainstream) continue to advocate certain treatments in the absence of any reliable cure that can be confidently prescribed. As the use of methods other than mainstream medicine becomes more widespread, it is important to be aware of both conventional and non-conventional management of recurrent vulvovaginal candidiasis. Practitioners need to ascertain their patient's preference and treatment history. It is difficult to find comprehensive literature assessing both approaches. Giving women the most up-to-date and relevant information, and different management options, is essential in allowing them to make informed decisions. This review critically assesses both mainstream and less conventional approaches in the management of recurrent VVC. [source]

Contribution of N2O to the greenhouse gas balance of first-generation biofuels

GLOBAL CHANGE BIOLOGY, Issue 1 2009
EDWARD M. W. SMEETS
Abstract In this study, we analyze the impact of fertilizer- and manure-induced N2O emissions due to energy crop production on the reduction of greenhouse gas (GHG) emissions when conventional transportation fuels are replaced by first-generation biofuels (also taking account of other GHG emissions during the entire life cycle). We calculate the nitrous oxide (N2O) emissions by applying a statistical model that uses spatial data on climate and soil. For the land use that is assumed to be replaced by energy crop production (the ,reference land-use system'), we explore a variety of options, the most important of which are cropland for food production, grassland, and natural vegetation. Calculations are also done in the case that emissions due to energy crop production are fully additional and thus no reference is considered. The results are combined with data on other emissions due to biofuels production that are derived from existing studies, resulting in total GHG emission reduction potentials for major biofuels compared with conventional fuels. The results show that N2O emissions can have an important impact on the overall GHG balance of biofuels, though there are large uncertainties. The most important ones are those in the statistical model and the GHG emissions not related to land use. Ethanol produced from sugar cane and sugar beet are relatively robust GHG savers: these biofuels change the GHG emissions by ,103% to ,60% (sugar cane) and ,58% to ,17% (sugar beet), compared with conventional transportation fuels and depending on the reference land-use system that is considered. The use of diesel from palm fruit also results in a relatively constant and substantial change of the GHG emissions by ,75% to ,39%. For corn and wheat ethanol, the figures are ,38% to 11% and ,107% to 53%, respectively. Rapeseed diesel changes the GHG emissions by ,81% to 72% and soybean diesel by ,111% to 44%. Optimized crop management, which involves the use of state-of-the-art agricultural technologies combined with an optimized fertilization regime and the use of nitrification inhibitors, can reduce N2O emissions substantially and change the GHG emissions by up to ,135 percent points (pp) compared with conventional management. However, the uncertainties in the statistical N2O emission model and in the data on non-land-use GHG emissions due to biofuels production are large; they can change the GHG emission reduction by between ,152 and 87 pp. [source]

Ethanol lock therapy for the treatment of catheter-related infections in haemophilia patients

HAEMOPHILIA, Issue 6 2009
M. RAJPURKAR
Summary., Central venous access devices (CVAD) are increasingly being used for optimal delivery of clotting factor concentrates in patients with haemophilia with poor peripheral venous access. The utility of CVAD is particularly well recognized in young patients starting factor prophylaxis and in patients with inhibitors undergoing immune tolerance induction (ITI). A catheter-related infection (CRI) remains the most common complication of CVAD in haemophilia patients and is the most frequent indication for its removal. Additionally, in some patients the infection results in significant morbidity and mortality and also contributes to failure of the ITI regimen. Ethanol-lock therapy (ELT) is a treatment modality that has been used to treat CRI in patients with indwelling catheters for home parenteral nutrition and chemotherapy. The aim of this study was to report the success in treating CRI in haemophilia patients using ELT. Three severe haemophilia A patients undergoing ITI regimen who developed CVAD infections resistant to conventional management with antibiotics were treated by ELT according to the institutional technique. All three patients responded well to ELT with clearance of the CVAD infection. There were no adverse side effects. To our knowledge, this is the first report of ELT in patients with haemophilia. The role of ELT needs to be investigated in larger studies for treatment of CRI in patients with bleeding disorders. [source]

Organic versus conventional management in an apple orchard: effects of fertilization and tree-row management on ground-dwelling predaceous arthropods

AGRICULTURAL AND FOREST ENTOMOLOGY, Issue 2 2009
M. Miñarro
Abstract 1,Organic and conventional management of apple orchards may have a different effect on arthropod communities. 2,We conducted a 3-year study to assess the effect of two strategies of fertilizer treatment (organic versus chemical) and three tree-row management systems (straw mulching, tillage and herbicide) on activity-density and biodiversity of epigeic predators. Ground beetles (Carabidae), rove beetles (Staphylinidae), ants (Formicidae) and spiders (Araneae) were sampled monthly with pitfall traps in the same apple orchard during 2003, 2004 and 2005. 3,A total of 4978 individuals were collected. Carabids (56.8% of the total catches) were the most abundant taxonomic group, followed by spiders (20.7%), ants (14.8%) and rove beetles (7.7%). Tree-row management had a greater influence on predator catches than fertilizer treatment. Total predator catches were lower under the mulch. Mulching also reduced carabid abundance, but increased staphylinid catches. 4,Tree row management also had a significant effect on biodiversity parameters. Species richness did not significantly differ among treatments for ants, spiders or the total catches, but was higher on herbicide-treated plots for carabids and on mulched plots for staphylinids. Shannon,Wiener's diversity index was significantly greater in the mulched and herbicide treated plots for total predators and carabids. For staphylinids, this index was significantly greater on the mulched plots. Fertilizer application strategy only influenced the species richness of rove beetles, which was greater in the chemically-treated plots. 5,The results showed that a change from conventional to organic fertilizer treatment of apple trees may be performed without differential effects on predator activity-density or biodiversity. However, a change from herbicide treatment to mulching or mechanical weed control may be significant, depending on the taxonomic group. [source]

Management, Theology and Moral Points of View: Towards an Alternative to the Conventional Materialist-Individualist Ideal-Type of Management*

JOURNAL OF MANAGEMENT STUDIES, Issue 4 2005
Bruno Dyck
abstract Weber's (1958) argument suggests that there are four ideal-types of management, and that conventional management is underpinned by a moral-point-of-view associated with a secularized Protestant Ethic, which can be characterized by its relatively high emphasis on materialism (e.g. productivity, efficiency and profitability) and individualism (e.g. competitiveness). Weber calls on management scholars and practitioners to become aware of their own moral-points-of-view, and to develop management theory and practice that de-emphasizes materialism and individualism. Our paper responds to this challenge, as we draw from an Anabaptist-Mennonite moral-point-of-view to develop a radical ideal-type of management that is characterized by its emphasis on servant leadership, stakeholding, job crafting and sustaincentrism. Implications for management theory and practice are discussed. [source]

Grain mineral concentrations and yield of wheat grown under organic and conventional management

JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE, Issue 3 2004
MH Ryan
Abstract On the low-P soils in southeastern Australia, organic crops differ from conventional ones primarily in the use of relatively insoluble, as opposed to soluble, P fertilisers and in the non-use of herbicides. As organic management, particularly elimination of soluble fertilisers, is often claimed to enhance grain mineral concentrations, we examined grain from wheat on paired organic and conventional farms in two sets of experiments: (1) four pairs of commercial crops (1991,1993); and (2) fertiliser experiments on one farm pair where nil fertiliser was compared with 40 kg ha,1 of P as either relatively insoluble reactive phosphate rock or more soluble superphosphate (1991 and 1992). All wheat was grown following a 2,6 year legume-based pasture phase. Both conventional management and the superphosphate treatment greatly increased yields but reduced colonisation by mycorrhizal fungi. While only minor variations occurred in grain N, K, Mg, Ca, S and Fe concentrations, conventional grain had lower Zn and Cu but higher Mn and P than organic grain. These differences were ascribed to: soluble P fertilisers increasing P uptake but reducing mycorrhizal colonisation and thereby reducing Zn uptake and enhancing Mn uptake; dilution of Cu in heavier crops; and past lime applications on the organic farm decreasing Mn availability. These variations in grain minerals had nutritional implications primarily favouring the organic grain; however, organic management and, specifically, elimination of soluble fertilisers did not induce dramatic increases in grain mineral concentrations. In addition, organic management was coupled with yield reductions of 17,84 per cent due to P limitation and weeds. The impact of large regional variations in the characteristics of organic and conventional systems on the general applicability of the results from this study and other similar studies is discussed. Copyright © 2004 Society of Chemical Industry [source]

Airway function in infants treated with inhaled nitric oxide for persistent pulmonary hypertension

PEDIATRIC PULMONOLOGY, Issue 3 2008
Aparna U. Hoskote MD
Abstract Rationale Inhaled nitric oxide (iNO), used for treatment of persistent pulmonary hypertension of newborn (PPHN), is an oxygen free radical with potential for lung injury. Deferring ECMO with iNO in these neonates could potentially have long-term detrimental effects on lung function. We studied respiratory morbidity (defined as occurrence of respiratory infections requiring treatment, episodes of wheezing, and/or need for ongoing medications following discharge) and airway function at 1 year postnatal age in term neonates treated with iNO but not ECMO for PPHN, and compared data from similar infants recruited to the UK ECMO Trial randomized to receive ECMO or conventional management (CM). Methods Maximal expiratory flow at FRC (V'maxFRC) was measured in infants treated with iNO for PPHN (oxygenation index ,25) at birth. Results V'maxFRC was measured in 23 infants and expressed as z -scores, to adjust for sex and body size and compared to data from 71 (46 ECMO, 25 CM) infants studied at a similar age in the ECMO Trial. Respiratory morbidity was low in iNO group. V'maxFRCz -score was lower than predicted in all groups (P,<,0.001), with no significant difference between those treated with iNO [mean (SD) z -score: ,1.65 (1.2)] and those treated with ECMO [,1.59 (1.2)] or CM [,2.1(1.0)]. Within iNO, ECMO and CM groups; 26%, 37% and 56%, respectively, had V'maxFRCz -scores below normal. Conclusions Respiratory outcome at 1 year in iNO treated neonates with moderately severe PPHN is encouraging, with no apparent increase in respiratory morbidity when compared to the general population. Sub-clinical reductions in airway function are evident at 1 year, suggesting that continuing efforts to minimize lung injury in the neonatal period are warranted to maximize lung health in later life. Pediatr Pulmonol. 2008; 43:224,235. © 2008 Wiley-Liss, Inc. [source]

Latest news and product developments

PRESCRIBER, Issue 4 2008
Article first published online: 20 MAR 200
Suicide warning for all antidepressants All antidepressants are to include a warning of the risk of suicide in their product information, the MHRA says. The requirement formerly applied only to SSRIs but, following a US review of safety data, the Agency says the risk is similar for all classes of antidepressants. Patients at increased risk include young people with psychiatric morbidity and those with a history of suicidal ideation. Patients are at increased risk of suicide until remission occurs, and clinical experience shows that the risk is increased during the early stages of recovery. Confusion over type 2 diabetes management Contradictory findings have been reported from two studies of intensive management of type 2 diabetes. The STENO-2 study (N Engl J Med 2008;358:580-91) found that tight control of blood glucose, blood pressure and lipids plus low-dose aspirin in 160 patients with type 2 diabetes and microalbuminuria significantly reduced all-cause mortality, cardiovascular events, cardiovascular death and microvascular complications by 40-60 per cent. The US National Heart, Blood and Lung Institute has announced the end of the intensive treatment arm of the ACCORD study (unpublished). This study was comparing intensive lowering of blood glucose below currently recommended levels (target HbA1C <6 per cent) with conventional management in adults with type 2 diabetes at especially high risk for heart attack and stroke. Although mortality was reduced in both arms compared with other populations, intensive treatment was associated with increased mortality equivalent to three deaths per 1000 patients per year over four years. Another antibiotics campaign The Government has launched another campaign to promote public awareness that antibiotics are not appropriate for viral infections causing coughs, colds and sore throats. Get Well Soon , Without Antibiotics is supported by a national advertising campaign and leaflets and posters encouraging the public to ask advice rather than demand a prescription. Details are available at www.dh.gov.uk. Episenta: once-daily sodium valproate Following a launch to specialists last year, a new once-daily modified-release formulation of sodium valproate is being promoted more widely to GPs. Episenta is licensed for the treatment of all forms of epilepsy and is formulated as modified-release capsules of 150mg and 300mg and sachets of modified-release granules of 500mg and 1000mg. The dose may be administered once or twice daily. Patients may be switched from enteric-coated tablets of valproate to the same dose given as Episenta. Episenta costs £5.70 or £10.90 for 100 × 150mg or 300mg capsules, and £18 or £35.50 for 100 × 500mg or 1000mg sachets. Latest NICE agenda The Department of Health has referred a new batch of topics for appraisal by NICE. Six of seven technology appraisals are for cancer drugs; the last is for dabigatran etexilate for venous thromboembolism. There will be four new clinical guidelines: autism spectrum disorders, hypertension in pregnancy, bed-wetting in children and severe mental illness with substance abuse. Two combined public health and clinical guidelines will address alcohol misuse. Varenicline vs NRT Varenicline (Champix) offers slightly greater smoking cessation rates than nicotine replacement therapy (NRT) in the long term and better symptom improvement, an international study has shown (Thorax 2008; published online:10.1136/ thx.2007.090647). A total of 746 smokers were randomised to treatment with varenicline 1mg twice daily for 12 weeks or transdermal NRT (21mg reducing to 7mg per day) for 10 weeks. Continuous abstinence rates for the last four weeks of treatment were 56 vs 43 per cent. The corresponding rates for one year were 26 and 20 per cent. Varenicline was associated with greater reductions in cravings, withdrawal symptoms and smoking satisfaction, but more nausea (37 vs 10 per cent). Adverse reactions class effect of statins The MHRA has identified several adverse effects that it says are class effects of the statins (Drug Safety Update 2008;1:Issue 7). Following a review of clinical trials and spontaneous reports, it is now apparent that any statin may be associated with sleep disturbance, depression, memory loss and sexual dysfunction; interstitial lung disease has been reported rarely. Product information is being updated to include the new information. Depression, including suicidal ideation, has also been associated with varenicline (Champix), the MHRA says; affected patients should stop treatment immediately. The combination of transdermal nicotine replacement therapy (NRT) and varenicline appears to be associated with a higher incidence of nausea, headache, vomiting, dizziness, dyspepsia and fatigue than NRT alone. The MHRA has also announced that, following the suspension of marketing authorisation for carisoprodol (Carisoma), it is considering a phased withdrawal of the closely-related meprobamate , the main active metabolite of carisoprodol. Following a successful pilot study, the public are being encouraged to report adverse reactions on yellow cards; the MHRA notes that health professionals provide more complete reports but patients include more information about quality of life. The scheme will be promoted via community pharmacies throughout the UK from February 2008. Cochrane: evidence on back pain interventions The latest release of Cochrane reviews includes three meta-analyses assessing interventions for back pain. Overall, NSAIDs were found to be effective as short-term treatment for acute or chronic back pain but the effect size was small. They were comparable with paracetamol but associated with more adverse effects; COX-2 selective NSAIDs were similarly effective, with slightly fewer adverse effects. There was no evidence that antidepressants reduced back pain but intensive individual patient education (lasting 2.5 hours) was effective for acute and subacute back pain and comparable with manipulation and physiotherapy; its effects on chronic pain were unclear. Copyright © 2008 Wiley Interface Ltd [source]

Prevention and management of hypotension during spinal anaesthesia for elective Caesarean section: a survey of practice

ANAESTHESIA, Issue 8 2001
S. M. Burns
Hypotension during obstetric spinal anaesthesia has traditionally been managed by such measures as fluid preloading, positioning of the patient and the use of vasoconstrictors. However, studies and reports have regularly appeared in the literature disputing the value of conventional management, in particular, the fluid preload. With this in mind, we surveyed UK consultant obstetric anaesthetists to determine current practice in this area. Of the 558 respondents, 486 (87.1%) stated that they routinely give a fluid preload. The fluid chosen by 405 (83.3%) of the preloaders was Hartmann's solution and the usual volume, chosen by 194 (39.9%), was 1000 ml. A simple left lateral position was preferred by 221 respondents (39.6%) overall and in the treatment of hypotension, ephedrine was the sole vasoconstrictor selected by 531 (95.2%). Heavy bupivacaine 0.5% was the local anaesthetic chosen by 545 (97.7%) and 407 (72.9%) respondents indicated the use of additional spinal drugs. [source]