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Treatment Thresholds (treatment + threshold)

Distribution by Scientific Domains

Medical Sciences	60%
Life Sciences	40%

Selected Abstracts

The value of a specialist lipid clinic

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 6 2008
S. C. Martin
Summary Aims:, To establish the value of the first 3 years of a cardiovascular risk factor clinic in tackling the major risk factors for cardiovascular disease (CVD). Methods:, A database review of all 339 patients referred to the clinic. Results:, Blood pressure levels in the hypertensive patients were significantly reduced and 9% of the smokers managed to quit for 12 months, half of them subsequently relapsing. Ninety-eight oral glucose tolerance tests were performed and 40% were abnormal yielding 10 patients with hitherto unsuspected diabetes and 29 with impaired glucose tolerance. Sixty-four of the 97 referrals of patients in the primary prevention group (no evidence of CVD) were found to have calculated Framingham coronary heart disease risk estimates of < 15% per decade, the lowest being 0.3%. Lipid levels were significantly reduced in both the hypercholesterolaemic (n = 290) and hypertriglyceridaemic (n = 49) patient groups through the use of more potent statins, extensive use of combination therapy and appropriate use of fibrates and omega-3 fish oil supplements. The annual drug cost per patient treated only increased from £310.72 to £398.08, yet there was a 3.5-fold increase in the number of patients achieving the General Medical Services 2 target of a total cholesterol < 5 mmol/l and a 4.5-fold increase in patients achieving the Joint British Societies 2 target of a low-density lipoprotein (LDL) cholesterol < 2 mmol/l. Conclusion:, The need for a specialist clinic was demonstrated by the 66% of primary prevention referrals who did not meet the current NICE treatment threshold. Additionally, the clinic was able to diagnose and treat 39 patients with undiagnosed diabetes mellitus/impaired glucose tolerance and 12 with hypothyroidism. LDL cholesterol was reduced overall by 36% implying a greater than one-third reduction in future cardiovascular events before the improvements in blood pressure control and smoking cessation are included and this was achieved at marginal extra cost to the mean drug bill at referral. [source]

The treatment of CIN: what are the risks?

CYTOPATHOLOGY, Issue 3 2009
W. Prendiville
The treatment of squamous cervical intraepithelial neoplasia is to remove or destroy the transformation zone (TZ). It is likely that no method of treatment is superior to another if it is performed properly and the limited available evidence supports this view. The significant advantages of excision (simplicity, cost, outpatient procedure, histological examination of the entire TZ) mean that treatment thresholds may have lowered over the last decade. Long-term pregnancy-related morbidity associated with excision has been reported recently. The evidence would suggest that this increase equates to a genuine increase in serious adverse outcome for cone biopsy but not large loop excision of the transformation zone (LLETZ). The available data also point to an increase in both incomplete excision and premature labour associated with the excision of large endocervical TZs. The clinical implications arising from this are firstly that women with large type 2 and 3 TZs need appropriate counselling before treatment and that the threshold for treating young women with mild abnormalities needs review. [source]

Review of carrot fly control in Northern Europe , 2009,

EPPO BULLETIN, Issue 2 2009
R. Collier
In February 2009, the European and Mediterranean Plant Protection Organization (EPPO) held a workshop to discuss the management of carrot fly (Psila rosae) within Europe. Prior to the workshop, participants completed a questionnaire about carrot fly and current control methods and some of the information is summarised in this paper. In general, this pest is controlled adequately at present, but there is a heavy reliance on insecticides. The responses to the questionnaire highlighted a number of issues, in particular: the limited range and efficacy of the insecticides available at present, concerns about the availability of effective control measures in the future and a need for improvements in the targeting of treatments through forecasting and monitoring and the use of treatment thresholds. [source]

Osteoporosis and the Global Competition for Health Care Resources,

JOURNAL OF BONE AND MINERAL RESEARCH, Issue 7 2004
L Joseph Melton III
Abstract Global aging superimposed on existing infectious diseases and trauma will aggravate competition for health care resources to diagnose and treat osteoporosis. Efforts to implement public health measures are needed, but the targeted approach to assessment and treatment of high-risk individuals must also be refined. Increases in the elderly population worldwide will cause a dramatic rise in osteoporotic fractures, but other age-related diseases will increase as well. Changes will be superimposed on existing public health problems (e.g., malaria, alcoholism), and these acute health care needs will take priority in some areas. Societies in most parts of the world may have to limit osteoporosis control to broad public health measures, and such efforts (e.g., calcium and vitamin D supplementation) should be supported. In these regions, clinical decision-making will generally be limited to treating patients with fractures (who presumably have already failed any public health measures in place), or in a few wealthy countries, to patients with low bone density identified by case-finding. Case-finding approaches will vary with the resources available, although unselective (mass) screening by bone densitometry is largely ineffective and unaffordable anywhere. The key to clinical decision-making on behalf of individuals will be an assessment of absolute fracture risk, and the tools needed to predict the risk of an osteoporotic fracture over the next 10 years are now being developed. These include bone density measures, but also incorporate other risk factors (e.g., fracture history, corticosteroid use), which may allow extension of fracture risk prediction to nonwhite populations and to men. Even with a universal risk prediction tool, cost-effective treatment thresholds will vary by country based on the level of fracture risk in the region and on the resources available for health care. To better compete for these resources, efforts should be made to lower the cost of osteoporosis interventions. Additionally, evidence is needed that these interventions are really effective in reducing fractures in the community. [source]

Seasonal dynamics, dispersion, sequential sampling plans and treatment thresholds for the citrus leafminer, Phyllocnistis citrella Stainton (Lepidoptera: Gracillariidae), in a mature lemon block in coastal New South Wales, Australia

AUSTRALIAN JOURNAL OF ENTOMOLOGY, Issue 3 2008
Zhong Min Liu
Abstract, Studies of citrus leafminer in a coastal orchard in NSW, Australia indicated that an increase in abundance to about one mine per flush was followed during the midseason flush by a rapid increase in population that was related to an increase in the percentage of leaves infested within flushes and the number of mines per leaf. The fits of frequency distributions and Iwao's patchiness regression indicated that populations were highly contagious initially, and as the exponent k of the negative binomial distribution increased with increasing population density, the distribution approached random. Concurrently, the coefficient of variation of mines per flush (which was strongly related to the proportion of un-infested flushes) decreased to about unity as the proportion of un-infested flushes reached zero and fell further as the number of mines per flush increased. Both numerative and binomial sequential sampling plans were developed using a decision threshold based on 1.2 mines per flush. The binomial sampling plan was based on a closely fitting model of the functional relationship between mean density and proportion of infested flushes. Functional relationships using the parameters determined from Iwao's patchiness regression and Taylor's power law were equally satisfactory, and one based on the negative binomial model also fitted well, but the Poisson model did not. The three best fitting models indicated that a decision threshold of 1.2 mines per flush was equivalent to 50% of flushes infested. From a practical point of view, the transition from 25% infestation of flushes through 50% is so rapid that it may be prudent to take action when the 25% level is reached; otherwise, the 50% may be passed before the crop is checked again. For valuable nursery stock should infestation be detected in spring, it may be advisable to apply prophylactic treatment as the midseason flush starts. [source]