Several Guidelines (several + guideline)

Distribution by Scientific Domains

Selected Abstracts

Vignettes in Osteoporosis: A Road Map to Successful Therapeutics,

Clifford J Rosen
Abstract The diagnosis and management of osteoporosis have become increasingly more complex as new drugs enter the marketplace and meta-analyses of randomized trials with "other" agents become more prolific. We describe five common clinical scenarios encountered in the practice of osteoporosis medicine and various road maps that could lead to successful therapy. Introduction: The diagnosis and treatment of osteoporosis have changed dramatically in the last decade. Advances in diagnostic technologies and a range of newer treatment options have provided the clinician with a wide array of choices for treating this chronic disease. Despite the issuance of several "guidelines" and practice recommendations, there still remains confusion among clinicians about basic approaches to the management of osteoporosis. This paper should be used as a case-based approach to define optimal therapeutic choices. Materials and Methods: Five representative cases were selected from two very large clinical practices (Bangor, ME; Pittsburgh, PA). Diagnostic modalities and treatment options used in these cases were selected on an evidence-based analysis of respective clinical trials. Subsequent to narrative choices by two metabolic bone disease specialists (SG and CR), calculation of future fracture risk and selection of potential alternative therapeutic regimens were reviewed and critiqued by an epidemiologist (DB). Results: A narrative about each case and possible management choices for each of the five cases are presented with references to justify selection of the various therapeutic options. Alternatives are considered and discussed based on literature and references through July 2003. The disposition of the individual patient is noted at the end of each case. Conclusions: A case-based approach to the management of osteoporosis provides a useful interface between guidelines, evidence-based meta-analyses, and clinical practice dilemmas. [source]

Sustaining economic expansion in Pakistan in an era of energy shortfalls: growth options to 20351

Robert Looney
Pakistan's recent economic acceleration together with rapid rates of population growth is having a significant impact on the country's energy supply/demand balances. Energy supplies in turn affect the pace and pattern of the country's economic expansion. Drawing on the empirically-based complex links between energy and the economy, several alternative scenarios of growth and energy needs are developed in an attempt to answer several key questions. In particular, what are some of the key interrelationships between sources of energy demand and supply? What are the economic growth consequences of alternative energy availabilities and, in turn, how do these growth patterns affect the subsequent energy supply and demand patterns? What energy strategies are suggested by the interconnection between the country growth requirements and energy needs? Are these significantly modified under rising or falling energy prices? Based on this analysis, several guidelines are drawn for the country's future energy policy. [source]

Legal and ethical considerations for genetic clinical research

Judith E. Beach
Abstract From the trend in modern medicine toward the study of genes and their contribution to the development of disease has evolved an increased awareness of ,the diversity of genetic fingerprints among individuals' [1]. The incorporation of this knowledge into the technologies of the pharmaceutical industry has led to the emerging field of ,pharmacogenomics'; that is, the process of identifying the differences in genetic sequences between individuals and developing therapies [2] as ,personal medicines' [3]. For example, a drug used as a muscle relaxant during surgery, suxamethonium, was found to be lethal to patients who possessed a rare version of a gene involved in nerve transmission so that now those who receive this drug are tested for this specific gene [4]. Although pharmacogenomics promises great possibilities for the future of medicine, it does involve ethical and legal considerations that must be considered. Indeed, potential misuses of genetic information, such as discrimination in obtaining health insurance and in the workplace, need to be addressed. Genetic testing practices remain more advanced than the national and international laws governing the appropriate use of genetics. Although there is no national law in the United States that specifically addresses DNA and genetic privacy, several federal regulations would apply indirectly to the protection of this information and state legislators have successfully passed numerous state laws. Professional associations and private organizations have issued several guidelines for genetic testing practices. The purpose of this report is to provide a picture of the legal and ethical ramifications of genetic testing in clinical research. The genetic testing issue is presented herein in the categories of national, international, and state laws, policies, regulations and guidelines. Copyright 2003 John Wiley & Sons, Ltd. [source]

Conscientious Objection in Medicine

BIOETHICS, Issue 3 2000
Mark R. Wicclair
Recognition of conscientious objection seems reasonable in relation to controversial and contentious issues, such as physician assisted suicide and abortion. However, physicians also advance conscience-based objections to actions and practices that are sanctioned by established norms of medical ethics, and an account of their moral force can be more elusive in such contexts. Several possible ethical justifications for recognizing appeals to conscience in medicine are examined, and it is argued that the most promising one is respect for moral integrity. It is also argued that an appeal to conscience has significant moral weight only if the core ethical values on which it is based correspond to one or more core values in medicine. Finally, several guidelines pertaining to appeals to conscience and their ethical evaluation are presented. [source]

ARIA: impact of compliance

P. Van Cauwenberge
Summary Epidemiological studies show that the prevalence of asthma and allergic rhinitis (AR) has increased progressively over the past two to three decades. Similarly, there is increasing evidence that asthma and rhinitis frequently co-exist in the same patients and that rhinitis is a risk factor for asthma. Although several guidelines are currently available for the diagnosis and management of AR, the earlier guidelines and their successors were not evidence based, and were developed primarily on the basis of expert opinion, but of course based on the available literature. More recently, the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines were published in co-operation with the World Health Organization. These guidelines are evidence based and directed towards managing co-morbid rhinitis and asthma as different manifestations of a single airway disease, rather than as two separate diseases of the nose and the lung. They recommend treatment of AR in a step-wise manner (using a combination of allergen avoidance, pharmacotherapy and immunotherapy), based on the duration and severity of disease, rather than on the basis of type of exposure (i.e seasonal, perennial, occupational), as recommended by previous guidelines. The ARIA guidelines recognize that both the availability and the cost of a particular intervention are likely to determine patient compliance, and therefore recommends a flexible approach based on availability and cost of specific interventions in different countries. Despite the availability of treatment guidelines, there is evidence that the severity of disease is often diagnosed and treated inappropriately by general practitioners (GPs), who frequently do not use a guided treatment strategy, leading to low patient satisfaction and compliance. This suggests a clear need to implement the guidelines among GPs, especially since the vast majority of patients generally trust their GPs to provide appropriate information and optimal medication for the management of their disease. [source]