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Current Indications (current + indication)
Selected AbstractsCritical considerations for future action during the second commitment period: A small islands' perspectiveNATURAL RESOURCES FORUM, Issue 2 2007Leonard Nurse Abstract If the objective of the United Nations Framework Convention on Climate Change (UNFCCC) is to be achieved, Parties must commit themselves to meeting meaningful long-term targets that, based on current knowledge, would minimize the possibility of irreversible climate change. Current indications are that a global mean temperature rise in excess of 2,3 °C would enhance the risk of destabilizing the climate system as we know it, and possibly lead to catastrophic change such as a shutdown of the deep ocean circulation, and the disintegration of the West Arctic Ice Sheet. Observations have shown that for many small island developing States (SIDS), life-sustaining ecosystems such as coral reefs, already living near the limit of thermal tolerance, are highly climate-sensitive, and can suffer severe damage from exposure to sea temperatures as low as 1 °C above the seasonal maximum. Other natural systems (e.g., mangroves) are similarly susceptible to relatively low temperature increases, coupled with small increments of sea level rise. Economic and social sectors, including agriculture and human health, face similar challenges from the likely impacts of projected climate change. In light of known thresholds, this paper presents the view that SIDS should seek support for a temperature cap not exceeding 1.5,2.0 °C above the pre-industrial mean. It is argued that a less stringent post-Kyoto target would frustrate achievement of the UNFCCC objective. The view is expressed that all countries which emit significant amounts of greenhouse gases should commit to binding reduction targets in the second commitment period, but that targets for developing countries should be less stringent than those agreed for developed countries. Such an arrangement would be faithful to the principles of equity and would ensure that the right of Parties to attain developed country status would not be abrogated. [source] CURRENT TECHNIQUES AND DEVICES FOR SAFE AND CONVENIENT ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) AND KOREAN EXPERIENCE OF ESDDIGESTIVE ENDOSCOPY, Issue 3 2008Sang-Yong Seol Conventional endoscopic mucosal resection (EMR) technique has limitations in its capacity of achieving en bloc resection and, for lesions greater than 20 mm, removal in a piecemeal resection is often required. This leads to uncertainty as to whether or not the lesion has been completely removed and to an increase in local recurrence. To overcome this limitation, a new technique using specifically designed cutting devices, termed endoscopic submucosal dissection (ESD) has been developed. The present article discuss the current indication, new diagnostic, cutting and hemostatic devices and long-term outcomes of EMR and ESD in early gastric cancer in Korea. [source] A review of the benefits of whole body exercise during and after treatment for breast cancerJOURNAL OF CLINICAL NURSING, Issue 1 2007Marilyn N Kirshbaum PhD RN (NY) RGN DipAdultOnc Aim., A current critical review of the literature was deemed necessary to evaluate the strength of evidence to inform clinical practice. Background., Recently, there has been a noticeable increase in empirical literature surrounding the benefits of exercise for breast cancer patients. Methods., A systematic search strategy was used to identify relevant literature. Twenty-nine articles were retained for critical review, appraised for quality and synthesized. Results., Many early studies had limited internal and external validity. Recent studies were considerably more rigorous and robust. Consistent support for all types of aerobic exercise was most evident in studies of patients during adjuvant cancer treatments (chemotherapy and radiotherapy), compared with post-treatment studies. The evidence which suggested that aerobic exercise limits cancer-related fatigue was particularly strong. For other patient concerns, the empirical support was less robust, however, the potential for beneficial and measurable patient outcomes was indicated for cardiopulmonary function, overall quality of life, global health, strength, sleep, self-esteem and reduced weight gain, depression, anxiety and tiredness. Conclusions., Additional studies with higher methodological quality are required in this clinically relevant area to substantiate current indications particularly for patient subgroups (e.g. older people, those with advanced cancer and the disadvantaged). Relevance to clinical practice., It is important for all healthcare professionals involved in the care of individuals affected by breast cancer to be aware of the evidence surrounding the benefits of exercise and to encourage patients to increase physical activity and improve their overall health and well-being. [source] Predictors of Early Mortality in Patients Age 80 and Older Receiving Implantable DefibrillatorsPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2010DREW ERTEL M.D. Background: There are no upper age restrictions for implantable defibrillators (ICDs) but their benefit may be limited in patients , 80 years with strong competing risks of early mortality. Risk factors for early (1-year) mortality in ICD recipients , 80 years of age have not been established. Methods: Two-center retrospective cohort study to assess predictors of one-year mortality in ICD recipients , 80 years of age. Results: Of 2,967 ICDs implanted in the two centers from 1990,2006, 225 (7.6%) patients were ,80 years of age and followed-up at one of the two centers. Mean age was 83.3 ± 3.1 years and follow-up time 3.3 ± 2.6 years. Median survival was 3.6 years (95% confidence interval 2.3,4.9). Multivariate predictors of 1-year mortality included ejection fraction (EF) , 20% and the absence of beta-blocker use. Actuarial 1-year mortality of ICD recipients , 80 with an EF , 20% was 38.2% versus 13.1% in patients 80+ years with an EF > 20% and 10.6% for patients < 80 years with an EF , 20% (P < 0.001 for both). There was no significant difference in the risk of appropriate ICD therapy between those patients 80+ years with EF above and below 20%. Conclusion: In general, patients , 80 years of age who meet current indications for ICD implantation live sufficiently long to warrant device implantation based on anticipated survival alone. However, those with an EF , 20% have a markedly elevated 1-year mortality with no observed increase in appropriate ICD therapy, thus reducing the benefit of device implantation in this population. (PACE 2010; 981,987) [source] Impact of Renal Function on Survival in Patients with Implantable Cardioverter-DefibrillatorsPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2007MINTU P. TURAKHIA M.D. Background:Although chronic renal insufficiency (CRI) is associated with increased cardiac and noncardiac mortality, there is limited data on the relationship between CRI and survival in patients with implantable cardioverter-defibrillators (ICDs), particularly across a wide range of renal function. Methods:We studied 507 consecutive patients receiving first-time ICDs from 1993,2003 at a single center. Preimplant serum creatinine measurements were used to determine glomerular filtration rate (GFR) and stage of chronic kidney disease (CKD). The primary outcome was time to death. Results:During a mean follow-up of 4 years, all-cause mortality through completion of follow-up increased stepwise by GFR stage (I: 16%, II: 20%, III: 35%; IV: 40%; V: 50%; P < 0.001 for trend). After multivariate adjustment, CRI was independently associated with death (HR = 1.7, P = 0.02), as were a serum creatinine ,2.0 mg/dL (HR 2.5, P = 0.003) and the presence of end-stage renal disease (HR 6.8; P < 0.001). For every 10-unit decrease in GFR, the adjusted hazard of death increased 12% (P = 0.04). Conclusion:The presence of CRI prior to implant is independently associated with increased mortality in patients receiving ICDs. The risk is proportional to the degree of renal dysfunction and is apparent even when GFR is only mildly reduced. Differences in mortality are observed within the first year of implant, and patients on dialysis are at highest risk. Because randomized trials of ICDs have not included large numbers of patients with moderate or severe renal disease, our findings may have important implications in prognosis and case selection of patients who otherwise meet current indications for ICD implantation. [source] History and Current Practice of TonsillectomyTHE LARYNGOSCOPE, Issue S100 2002Ramzi T. Younis MD Abstract Objective To review important developments in the history of adenotonsillectomy and describe current methods and results for the operation. Study Design Review. Methods Tonsillectomy practices since antiquity were reviewed, with emphasis on introductions of new surgical tools and procedures, anesthesia methods, and patient care practices. Past and current indications for and complications associated with tonsillectomy were also reviewed. Results Devices used for adenotonsillectomy have included snares, forceps, guillotines, various kinds of scalpels, lasers, ultrasonic scalpels, powered microdebriders, and bipolar scissors. General anesthesia, the Crowe-Davis mouth gag, and methods for controlling bleeding have contributed greatly to success with the operation. Past and current indications for adenotonsillectomy are similar, although the relative importance of some indications has changed. The complication rate has declined, but the problems that do occur remain the same. Currently, cost-effectiveness is a principal concern. Conclusion The instruments and procedures used for adenotonsillectomy have evolved to render it a precise operation. Today, the procedure is a safe, effective method for treating breathing obstruction, throat infections, and recurrent childhood ear disease. [source] Open mini-access ureterolithotomy: the treatment of choice for the refractory ureteric stone?BJU INTERNATIONAL, Issue 6 2003D.M. Sharma OBJECTIVE To report the experience in one centre of the efficacy and safety of open mini-access ureterolithotomy (MAU) and to discuss relevant current indications. PATIENTS AND METHODS MAU was undertaken in 112 patients (mean age 38 years, range 26,57) between 1991 and 2001; the details and outcomes are reviewed. The mean (range) stone size was 12 (8,22) mm, with 30 stones in the upper, 69 in the mid- and 13 in the lower ureter. In 15 cases the stones were impacted and there were signs of infection in the proximal ureter. RESULTS MAU was successful in 111 patients; the one failure was caused by proximal stone migration early in the series. The mean (range) operative duration was 28 (10,44) min and the hospital stay 42 (24,72) h; 33 patients were in hospital for 24 h, 72 for 48 h and seven for 72 h. The blood loss was minimal, at 50 (30,150) mL. The drain was removed after 5 (5,7) days. Patients reported using opioid or nonsteroidal anti-inflammatory analgesia for a mean of 4 (1,7) days after surgery. The mean time to resumption of work was 16 (8,35) days. CONCLUSIONS MAU is a safe and reliable minimally invasive procedure; its role is mainly confined to salvage for failed first-line stone treatments but in selected cases, where a poor outcome can be predicted from other methods, it is an excellent first-line treatment. [source] | ||||||||||