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Important Treatment Option (important + treatment_option)
Selected AbstractsOnce-daily OROSŪ,hydromorphone for the management of chronic nonmalignant pain: a dose-conversion and titration studyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 10 2007M. Wallace Summary Background:, The use of opioid analgesics for patients with chronic nonmalignant pain is becoming more widely accepted, and long-acting formulations are an important treatment option. Aim:, To assess conversion to extended-release OROSŪ hydromorphone from previous stable opioid agonist therapy in patients with chronic nonmalignant pain of moderate-to-severe intensity. Methods:, In this open-label multicentre trial, patients were stabilised on their previous opioid therapy before being switched to OROSŪ hydromorphone at a ratio of 5 : 1 (morphine sulphate equivalent to hydromorphone hydrochloride). The OROSŪ hydromorphone dose was titrated over 3,16 days to achieve effective analgesia, and maintenance treatment continued for 14 days. Results:, Study medication was received by 336 patients; 66% completed all study phases. Stabilisation of OROSŪ hydromorphone was achieved by 94.6% of patients, the majority in two or fewer titration steps (mean time, 4.2 days). Mean pain intensity scores, as determined by the Brief Pain Inventory, decreased during OROSŪ hydromorphone treatment (p , 0.001). The percentage of patients rating their pain relief as ,good' or ,complete' increased, and the use of rescue analgesics for breakthrough pain decreased. The interference of pain with everyday activities (e.g. walking or work), and the effects on mood and enjoyment of life, also improved during the study (all p < 0.001). OROSŪ hydromorphone was well tolerated, and adverse events were those expected for opioid agonist therapy. Conclusion:, Patients with chronic nonmalignant pain who had been receiving opioid therapy easily underwent conversion to OROSŪ hydromorphone, with no loss of efficacy or increase in adverse events. [source] Angiotensin-Converting Enzyme Inhibitors in the Treatment of Hypertension: An UpdateJOURNAL OF CLINICAL HYPERTENSION, Issue 11 2007William B. White MD Angiotensin-converting enzyme inhibitors are an important treatment option for hypertension, especially when elevated blood pressure exists in the presence of diabetes mellitus, chronic kidney disease, or congestive heart failure. This article reviews some of the pathophysiologic mechanisms involved in patients with hypertension and these comorbidities and how they relate to the renin-angiotensin system (RAS). Inhibition of the RAS when utilized along with other antihypertensive medications has been particularly effective in hypertensive patients with type 2 diabetes, chronic kidney disease, and vascular disorders; consensus group guidelines have reflected this in their treatment recommendations. Clinical trial data demonstrate that the effectiveness of RAS blockers is enhanced by maximizing the daily dose and combining these medications with thiazide diuretics. [source] Argon Plasma Coagulation (APC) in Palliative Surgery of Head and Neck MalignanciesTHE LARYNGOSCOPE, Issue 7 2002Ulrich Hauser MD Abstract Objectives Surgical reduction of bulky disease is an important treatment option in patients with incurable head and neck malignancies. In general, conventional tumor ablation is associated with significant hemorrhage, and the resulting tumorous wound surface entails aftercare problems. Argon plasma coagulation (APC) represents a novel technique providing effective hemostasis and wound sealing. Thus, APC features requirements of particular interest in palliative surgery of the head and neck. Study Design Using APC, we performed 18 palliative tumor resections in a series of 8 consecutive patients with recurrent head and neck lesions. Five patients received repeated APC treatment up to five times. Methods APC as non-contact, high-frequency electrosurgery under inert argon plasma atmosphere allows dissection, hemostasis, and desiccation of tumor tissue in a one-step procedure. In consideration of the limited and heterogeneous group of patients, results are interpreted descriptively. Results In every case of palliative surgery, APC caused efficient hemostasis, which helped significantly to reduce both time exposure of the operation and intraoperative loss of blood. Only one APC-unrelated complication occurred (transient rhino-liquorrhea), and none of the patients developed postoperative hemorrhage. Finally, APC produced dry and clean wound surfaces facilitating surgical aftercare. The achieved esthetic and functional improvements strengthened the patient's autonomy and social acceptance. Conclusion APC is highly recommended for palliative surgery of head and neck malignancies. [source] Chronic Obstructive Pulmonary Disease Diagnosis and Management in Older AdultsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2010Nalaka S. Gooneratne MD Chronic obstructive pulmonary disease (COPD) in older adults is a complex disorder with several unique age-related aspects. Underlying changes in pulmonary lung function and poor sensitivity to bronchoconstriction and hypoxia with advancing age can place older adults at greater risk of mortality or other complications from COPD. The establishment of the Global Initiative for Obstructive Lung Disease criteria, which can be effectively applied to older adults, has more rigorously defined the diagnosis and management of COPD. An important component of this approach is the use of spirometry for disease staging, a procedure that can be performed in most older adults. The management of COPD includes smoking cessation, influenza and pneumococcal vaccinations, and the use of short- and long-acting bronchodilators. Unlike with asthma, corticosteroid inhalers represent a third-line option for COPD. Combination therapy is frequently required. When using various inhaler designs, it is important to note that older adults, especially those with more-severe disease, may have inadequate inspiratory force for some dry-powder inhalers, although many older adults find the dry-powder inhalers easier to use than metered-dose inhalers. Other important treatment options include pulmonary rehabilitation, oxygen therapy, noninvasive positive airway pressure, and depression and osteopenia screening. Clinicians caring for older adults with an acute COPD exacerbation should also guard against prognostic pessimism. Although COPD is associated with significant disability, there is a growing range of treatment options to assist patients. [source] | ||||||||||