Home About us Contact
|
Home About us Contact | ||
|
|
||
Adequate Response (adequate + response)
Selected AbstractsStressful but rewarding: Norwegian personnel mobilised for the 2004 tsunami disasterDISASTERS, Issue 3 2009Siri Thoresen Adequate responses to disasters and emergency situations rely, among other factors, on coping abilities in disaster workers and emergency personnel. In this study, different aspects of disaster-related stressors and training/experience were investigated in Norwegian personnel (n = 581) mobilised for the 2004 tsunami disaster. The level of stress reactions, measured nine to ten months after the tsunami, was relatively low in this sample, indicating that the personnel coped well with the challenges of the disaster. The level of intrusive memories was higher in disaster-area personnel (n = 335) than in home-base personnel (n = 246). Stress reactions were significantly associated with witnessing experiences (disaster-area group) and with having to reject victims in need of help (both groups). Specific preparation for the mission was associated with a lower level of stress reactions in disaster-area personnel. Such factors may be considered in training and preparation programmes for disaster workers. [source] Randomized controlled trial comparing the effectiveness and safety of intranasal and intramuscular naloxone for the treatment of suspected heroin overdoseADDICTION, Issue 12 2009Debra Kerr ABSTRACT Aims Traditionally, the opiate antagonist naloxone has been administered parenterally; however, intranasal (i.n.) administration has the potential to reduce the risk of needlestick injury. This is important when working with populations known to have a high prevalence of blood-borne viruses. Preliminary research suggests that i.n. administration might be effective, but suboptimal naloxone solutions were used. This study compared the effectiveness of concentrated (2 mg/ml) i.n. naloxone to intramuscular (i.m.) naloxone for suspected opiate overdose. Methods This randomized controlled trial included patients treated for suspected opiate overdose in the pre-hospital setting. Patients received 2 mg of either i.n. or i.m. naloxone. The primary outcome was the proportion of patients who responded within 10 minutes of naloxone treatment. Secondary outcomes included time to adequate response and requirement for supplementary naloxone. Data were analysed using multivariate statistical techniques. Results A total of 172 patients were enrolled into the study. Median age was 29 years and 74% were male. Rates of response within 10 minutes were similar: i.n. naloxone (60/83, 72.3%) compared with i.m. naloxone (69/89, 77.5%) [difference: ,5.2%, 95% confidence interval (CI) ,18.2 to 7.7]. No difference was observed in mean response time (i.n.: 8.0, i.m.: 7.9 minutes; difference 0.1, 95% CI ,1.3 to 1.5). Supplementary naloxone was administered to fewer patients who received i.m. naloxone (i.n.: 18.1%; i.m.: 4.5%) (difference: 13.6%, 95% CI 4.2,22.9). Conclusions Concentrated intranasal naloxone reversed heroin overdose successfully in 82% of patients. Time to adequate response was the same for both routes, suggesting that the i.n. route of administration is of similar effectiveness to the i.m. route as a first-line treatment for heroin overdose. [source] Generic Products of Antiepileptic Drugs (AEDs): Is It an Issue?EPILEPSIA, Issue 10 2007Meir Bialer Summary:, The availability of generic products of antiepileptic drugs (AEDs) has raised the following concerns: (1) Do generic AEDs work as well as brand AEDs in terms of their efficacy, safety and quality? (2) Can generic AEDs be used as substitutions for brand AEDs? and (3) Can generic products of AEDs be used interchangeably? The traditional average bioequivalence analysis addresses concern 1 but does not provide a complete adequate response to concerns 2 and 3. Drug interchangeability can be classified as drug prescribability or drug switchability. Drug prescribability refers to the situation where a patient is treated for the first time so that either a brand or a bioequivalent generic AED can be chosen. Drug switchability refers to the situation in which a brand AED is switched to a bioequivalent generic product of the same AED. The traditional average bioequivalence approach is sufficient to evaluate the prescribability of generic products, but does not ensure the switchability between prescribable formulations. The necessity of assuring switchability of two formulations can be addressed by individual bioequivalence. While the switch to generic AEDs is well tolerated by many patients and in general cost-effective, seizure control should not be sacrificed on the basis of cost alone, as the major end point in treating epilepsy with AEDs is seizure control without side effects. Until we have individual (within patient) bioequivalence data on generic AEDs and/or the tools to a priori identify the subset of patients susceptible to the generic switch, a switch of AED products in seizure-free patients is not recommended. [source] PACIFIC NORTHWEST REGIONAL ASSESSMIENT: THE IMPACTS OF CLIMATE VARIABILITY AND CLIMATE CHANGE ON THE WATER RESOURCES OF TEE COLUMBIA RWER BASIN,JOURNAL OF THE AMERICAN WATER RESOURCES ASSOCIATION, Issue 2 2000Edward L. Miles ABSTRACT: The Pacific Northwest (PNW) regional assessment is an integrated examination of the consequences of natural climate variability and projected future climate change for the natural and human systems of the region. The assessment currently focuses on four sectors: hydrology/water resources, forests and forestry, aquatic ecosystems, and coastal activities. The assessment begins by identifying and elucidating the natural patterns of climate vanability in the PNW on interannual to decadal timescales. The pathways through which these climate variations are manifested and the resultant impacts on the natural and human systems of the region are investigated. Knowledge of these pathways allows an analysis of the potential impacts of future climate change, as defined by IPCC climate change scenarios. In this paper, we examine the sensitivity, adaptability and vulnerability of hydrology and water resources to climate variability and change. We focus on the Columbia River Basin, which covers approximately 75 percent of the PNW and is the basis for the dominant water resources system of the PNW. The water resources system of the Columbia River is sensitive to climate variability, especially with respect to drought. Management inertia and the lack of a centralized authority coordinating all uses of the resource impede adaptability to drought and optimization of water distribution. Climate change projections suggest exacerbated conditions of conflict between users as a result of low summertime streamfiow conditions. An understanding of the patterns and consequences of regional climate variability is crucial to developing an adequate response to future changes in climate. [source] Vaccination against hepatitis B virus in cirrhotic patients on liver transplant waiting listLIVER TRANSPLANTATION, Issue 4 2000Mercedes Domínguez Patients with cirrhosis may fail to respond to anti,hepatitis B vaccine. An adequate response would be especially interesting when patients are on a liver transplant waiting list. Posttransplantation de novo hepatitis B has been well documented. One possible source is the grafting of organs from hepatitis B surface antigen (HBsAg),negative, antibody to HBsAg (anti-HBs),positive, antibody to hepatitis B core antigen,positive donors. The achievement of high titers of anti-HBs could be protective in this setting. We studied prospectively the response rate to recombinant hepatitis B vaccine (3 40-,g doses administered at 0, 1, and 2 months) in 62 patients with end-stage liver disease awaiting liver transplantation. Twenty-two patients showed antibody response (44%). A further 3 doses were administered in 15 of 28 nonresponders and were effective in 9 patients. Thus, the response rate reached 62% (31 of 50 patients completing 1 or 2 vaccination schedules before liver transplantation). Classic hepatitis B vaccination studies of patients with cirrhosis yield lower response rates. Vaccination with this double-dose schedule should be considered in such patients before liver transplantation. [source] Excessive dopamine neuron loss in progressive supranuclear palsyMOVEMENT DISORDERS, Issue 4 2008Karen E. Murphy BSc(Hons) Abstract Progressive supranuclear palsy (PSP) and Parkinson's disease (PD) differ in their response to dopaminergic replacement therapies, despite having a similar degree of neuronal degeneration in the dopaminergic substantia nigra. We observed more widespread dopamine neuron loss in the extranigral A10 midbrain cell groups in PSP compared with PD. These cell groups innervate subcortical and cortical regions and may be required for adequate response to levodopa therapy. © 2007 Movement Disorder Society [source] Communitarian Citizenship and Civil DisobediencePOLITICS & POLICY, Issue 2 2001Brent L. Pickett Perhaps the most frequent criticism of communitarianism is that it is too sympathetic to community, and too hostile to individualism. It is alleged that the community and its agent, the state, are given too much power, and hence the important role of dissent is dangerously marginalized. To evaluate and respond to this criticism, this paper expounds the communitarian understanding of citizenship and addresses communitarians' critics, in part through a close reading of Charles Taylor's essay, "Atomism". Some forms of communitarianism, especially those that put an emphasis upon citizen participation, have an adequate response to the critics. Moreover, in some ways communitarianism has a better understanding of, and a more central role for, dissent and civil disobedience. [source] Bioactive polyurethanes in clinical applications,POLYMERS FOR ADVANCED TECHNOLOGIES, Issue 9-10 2006G. Ciardelli Abstract Biomaterials play an important role in most tissue engineering strategies. They can serve as substrates on which cell populations can attach and migrate, can be used as cell delivery vehicles and as bioactive factor carriers to activate specific cellular functions. A series of biodegradable polyurethanes (PUs) with tunable chemical, physical and degradation properties, showing an adequate response to in vitro tests was proposed for applications in soft tissue engineering. Three-dimensional scaffolds of superimposed square meshed grids were prepared by using a rapid prototyping technique (pressure activated microsyringe, PAM) and tested in vivo. Functionalization of PU systems was performed in order to control the chemistry of the materials for the promotion of highly specific binding interactions between materials and biological environments. Two different approaches were used for the coupling of bioactive molecules such as gelatin. The first involved the modification of the polymer chain through a novel monomer and the second one consisted in a surface modification by plasma-induced graft copolymerization of acrylic acid. Copyright © 2006 John Wiley & Sons, Ltd. [source] Latest news and product developmentsPRESCRIBER, Issue 22 2007Article first published online: 28 DEC 200 Glitazones: benefits outweigh the risks Following a review of the safety of rosiglitazone and pioglitazone, the European Medicines Agency (EMEA) has concluded that their benefits outweigh their risks in the approved indications. The review was prompted by reports of an increased risk of fractures in women and, in patients taking rosiglitazone, ischaemic heart disease. The EMEA concluded that prescribing information for rosiglitazone should now include a warning that, in patients with ischaemic heart disease, it should only be used after careful evaluation of each patient's individual risk, and the combination of rosiglitazone and insulin should only be used in exceptional cases and under close supervision. No change was considered necessary to the prescribing information for pioglitazone. Modern dressings no better? A systematic review has found only weak evidence that modern dressings are better than saline gauze or paraffin gauze for healing acute and chronic wounds (Arch Dermatol 2007;143: 1297-304). The analysis, which included 99 studies, found that only hydrocolloids were demonstrably better than older dressings for healing chronic wounds, and alginates were superior to other modern dressings for debriding necrotic wounds. There was no evidence that modern dressings offered superior overall performance to the older alternatives. Hospital inflation twice primary care level The cost of drugs prescribed in secondary care but dispensed in the community increased by 6.4 per cent in 2006 - twice the rate of inflation in primary care - according to the latest statistics on hospital prescribing in England. The increase follows a reduction in costs in 2005 after the introduction of the new PPRS scheme. Data from The Information Centre (www.ic.nhs.uk) show that hospital medicines make up about 24 per cent of the NHS drugs budget. Secondary care has a consistently better record than primary care in prescribing lower-cost alternatives within therapeutic categories, eg simvastatin and pravastatin among the statins, omeprazole and lansoprazole among PPIs, and ACE inhibitors among drugs acting on the renin angiotensin system. The most expensive drug prescribed by hospital specialists and dispensed in the community is interferon beta. MHRA limits the use of fibrates The Medicines and Healthcare products Regulatory Agency (MHRA) has advised that fibrates should now be reserved for the treatment of isolated severe hypertriglyceridaemia. They should be considered for hypercholesterolaemia only when a statin or other treatment is contraindicated or not tolerated. In the latest Drug Safety Update, the MHRA says there is insufficient evidence of long-term benefits from fibrates, and first-line use is no longer justified because the evidence for the benefits of statins is robust. The MHRA also warns that some breastfeeding infants have increased susceptibility to the adverse effects of codeine taken by their mother, and that St John's wort may affect the hepatic metabolism of any anticonvulsant. Annual zoledronic acid infusion cuts mortality after hip fracture Once-yearly infusion of zoledronic acid (Aclasta) after hip fracture reduces deaths over a two-year period by 28 per cent compared with placebo, US investigators say (N Engl J Med 2007;357:1799-809). The HORIZON Recurrent Fracture Trial randomised 2127 men and women (mean age 75) within 90 days of surgery for hip fracture to zoledronic acid 5mg yearly or placebo. Mortality over 1.9 years of follow-up was 9.6 per cent with zoledronic acid and 13.3 per cent with placebo. Zoledronic acid also significantly reduced the rate of any new clinical fractures (by 35 per cent) and new clinical vertebral fractures(by 45 per cent),but the lower rate of hip fracture (2.0 vs 3.5 per cent with placebo) was not statistically significant. Rivastigmine patch for mild to moderate AD Rivastigmine (Exelon) is now available as a transdermal patch for the treatment of mild to moderate Alzheimer's disease. Applied once daily, the patch delivers 9.5mg per 24 hours and, says manufacturer Novartis, is associated with a lower incidence of nausea and vomiting than a comparable oral dose. The patch is available in two strengths: 4.6mg per 24hr is equivalent to oral doses of 3 or 6mg per day, and the 9.5mg per 24hr patch is equivalent to 9 or 12mg per day orally. The recommended dose of the patch is 9.5mg per day; both strengths cost £83.84 for 30 patches. Women more aspirin resistant than men? The cardioprotective effect of low-dose aspirin may be lower in women than men, say Canadian investigators (BMC Medicine 2007;5:29 doi: 10.1186/1741-70155-29). Their meta-analysis of 23 randomised trials involving a total of 113 494 participants found that aspirin significantly reduced the risk of nonfatal but not fatal myocardial infarction (MI). About one-quarter of the variation in its effects on nonfatal MI was accounted for by the sex mix of the trial population. Separating the results by sex showed the reduction in risk with aspirin use was statistically significant in men (relative risk, RR, 0.62) but not in women (RR 0.87). Look after physical health of mentally ill GPs and other primary care workers should take more responsibility for the physical health of their mentally ill patients, say advocacy groups. Mind and Body: Preventing and Improving Physical Health Problems in Patients With Schizophrenia points out that the mental health needs of patients with schizophrenia are met in secondary care, but their physical health needs should be met in primary care. In particular, the metabolic effects of antipsychotics may lead to obesity, diabetes and cardiovascular disease, and weight gain in particular is a frequent reason for nonadherence to treatment. The Mind and Body Manifesto was developed by SANE, The Mental Health Nurses Association, The National Obesity Forum and The Disability Rights Commission and sponsored by Bristol-Myers Squibb Pharmaceuticals Limited and Otsuka Pharmaceuticals (UK) Ltd. Copies are available from elizabeth.green@ ogilvyhealthworld.com. Health eCard costs Some costs quoted in our article on the Health eCard (The Health eCard: the way ahead for medical records?,5 October issue, pages 28-9) have been revised: the card and initial download will cost patients £39.50, and GPs will be entitled to charge patients £10 per annum for subsequent downloads. NICE appraisals of cytokine inhibitors in RA NICE has endorsed the use of the anti-TNF agents adalimumab (Humira), etanercept (Enbrel) and infliximab (Remicade), normally in conjunction with methotrexate, for the treatment of active RA when methotrexate and another DMARD have failed (also see New from NICE below). NICE has provisionally concluded, subject to consultation, that abatacept (Orencia) should not be recommended for the treatment of RA. Boots and BMJ launch health advice site www.askbootshealth.com is a new website providing information about health and medicines for the public produced by Boots using information provided by the BMJ Publishing Group. The website covers many of the topics already available from NHSDirect, with perhaps more information about available treatments. Diabetes care shows small improvement The third National Diabetes Audit in England and Wales has found that more people with diabetes were achieving the targets set by NICE for cholesterol levels, glycaemic control and blood pressure in 2005/06 - but younger patients were doing less well. Overall, the HbA1C target of ,7.5 per cent was achieved in 60 per cent of people with diabetes compared with 58 per cent in 2004/05. However, HbA1C was >9.5 per cent in 30 per cent of children and young people, of whom 9 per cent experienced at least one episode of ketoacidosis. More topics for NICE New topics referred to NICE include clinical guidelines on ovarian cancer, coeliac disease and stable angina, public health guidance on preventing cardiovascular disease, and technology appraisals on insulin detemir (Levemir) for type 1 diabetes, several treatments for cancer and hepatic and haematological disorders, and biological therapies for juvenile arthritis. New from NICE NICE appraisal on anti-TNFs for RA Since NICE published its first appraisal of agents acting against tumour necrosis factor-alpha (anti-TNFs) for the treatment of RA in 2002, the product licences for etanercept (Enbrel) and infliximab (Remicade) have changed and a new agent, adalimumab (Humira), has been introduced. The anti-TNFs act in different ways. Infliximab is a chimeric monoclonal antibody that binds to TNF-alpha, neutralising its activity. Etanercept, a recombinant human TNF-alpha receptor fusion protein, and adalimumab, a human-sequence antibody, both bind to TNF-alpha and block its interaction with cell surface receptors. Adalimumab also modulates some biological responses induced or regulated by TNF-alpha. These agents are recommended for adults with severe active RA (defined as a disease activity score - DAS28 - greater than 5.1) who have already tried two disease-modifying drugs, including methotrexate (if not contraindicated). Prior treatment should have been of at least six months' duration, including two months at the standard dose (unless limited by toxicity). Anti-TNFs should normally be prescribed with methotrexate; when this is not appropriate, etanercept and adalimumab may be prescribed as monotherapy. Treatment with an anti-TNF should be continued beyond six months only if there is an adequate response (defined as an improvement in DAS28 of at least 1.2). Data from the British Rheumatology Society Biologics register show that, after six months, 67 per cent of patients met NICE criteria for an adequate response; this declined to 55 per cent at 18 months. The basic annual cost of treatment is £9295 for adalimumab 40mg on alternate weeks or etanercept 25mg twice weekly; infliximab costs £3777 for a loading dose, then £7553-£8812 depending on dose. Assuming no progression of disability, the incremental costs per QALY (compared with sequential DMARDs) were £30 200 for adalimumab, £24 600 for etanercept and £39 400 for infliximab. There are no direct comparative trials of the anti-TNFs, and their clinical trial findings are not directly comparable. Unless other factors determine treatment choice, NICE therefore recommends the least expensive. If the first anti-TNF is withdrawn within six months due to an adverse event, a second may be tried. [source] Are Terrorists Mentally Deranged?ANALYSES OF SOCIAL ISSUES & PUBLIC POLICY, Issue 1 2002Charles L. Ruby Recent terrorist attacks on the World Trade Center towers and the Pentagon have accentuated the threat of terrorism. However, it appears that the attackers are popularly thought of as mentally deranged individuals who are evil. This article suggests that such an understanding is a misperception of these people and may interfere with an adequate response to prevent future attacks. The article reviews the extant literature on psychological theories of terrorism and concludes that terrorists are not dysfunctional or pathological; rather, it suggests that terrorism is basically another form of politically motivated violence that is perpetrated by rational, lucid people who have valid motives. The only real difference between terrorism and conventional military action is one of strategy. Terrorists lack the necessary resources to wage war in furtherance of their political goals. [source] REVISITING CHILD-BASED OBJECTIONS TO COMMERCIAL SURROGACYBIOETHICS, Issue 7 2010JASON K.M. HANNA ABSTRACT Many critics of commercial surrogate motherhood argue that it violates the rights of children. In this paper, I respond to several versions of this objection. The most common version claims that surrogacy involves child-selling. I argue that while proponents of surrogacy have generally failed to provide an adequate response to this objection, it can be overcome. After showing that the two most prominent arguments for the child-selling objection fail, I explain how the commissioning couple can acquire parental rights by paying the surrogate only for her reproductive labor. My explanation appeals to the idea that parental rights are acquired by those who have claims over the reproductive labor that produces the child, not necessarily by those who actually perform the labor. This account clarifies how commercial surrogacy differs from commercial adoption. In the final section of the paper, I consider and reject three further child-based objections to commercial surrogacy: that it establishes a market in children's attributes, that it requires courts to stray from the best interests standard in determining custodial rights, and that it requires the surrogate to neglect her parental responsibilities. Since each of these objections fails, children's rights probably do not pose an obstacle to the acceptability of commercial surrogacy arrangements. [source] GENOCIDE AND THE MORAL AGENCY OF ETHNIC GROUPSMETAPHILOSOPHY, Issue 3-4 2006KAREN KOVACH Abstract: Genocide is the deliberate destruction, in whole or in part, of a people. Typically, it is a crime that is committed by a people. In this essay, I propose an analysis of the concept of an ethnic identity group, which is, I argue, the concept of ethnicity at issue in many important discussions of group rights, group acts, and the moral responsibility of group members for the acts of the groups to which they belong. I develop the account of collective agency presupposed by this analysis and explore its implications for assessments of individual moral responsibility for genocide. I argue, further, that among other advantages over culturalist approaches to questions about group rights, the approach that follows from the concept of an ethnic identity group sheds light on the specific moral wrong of genocide. I reply to individualist objections to the idea that ethnic group membership may be morally significant and argue that morally adequate responses to genocide presuppose acknowledgment of the fact that groups act and are acted upon in morally significant ways. [source] "New Governance" and Associative Pluralism: The Case of Drug Policy in Swiss CitiesPOLICY STUDIES JOURNAL, Issue 4 2003Sonja Wälti Throughout the 1990s, hierarchical administrative governance structures have been replaced by self-governing networks for various motives, one of which is to improve the authenticity and democratic quality of public decisions. Thus, "new governance" has been praised for its propensity to provide a plurality of civil society organizations with access to the decision process. This article explores these claims based on the case of drug policy in Swiss cities. We show that self-governing networks indeed seem to have increased the involvement of civil society organizations in the policy process. However, we also find evidence that self-governing networks may in the longer run induce state control over civil society organizations, thus ultimately reducing associative pluralism. They do so either by imposing a policy paradigm or by excluding actors who do not comply with the dominant paradigm from the networks. We conclude by arguing that self-organizing networks should not be dismissed, given that former hierarchical bureaucratic approaches to drug-related problems have failed even worse. Rather, their long-term effects should be subject to further examination aimed at developing adequate responses to their shortcomings. [source] | |||||||||||||