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Global Initiative (global + initiative)
Selected AbstractsA clinical pharmacological study of the potential beneficial effects of a propolis food product as an adjuvant in asthmatic patientsFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 1 2003M. T. Khayyal Abstract The aqueous extract of propolis has been formulated as a nutritional food product and administered, as an adjuvant to therapy, to patients with mild to moderate asthma daily for 2 months in the framework of a comparative clinical study in parallel with a placebo preparation. The diagnosis of asthma was made according to the criteria of patient classification of the National Institutes of Health and Global Initiative for Asthma Management. At inclusion, the pulmonary forced expiratory volume in the first second (FEV1) as a percentage of the forced vital capacity (FVC) was more than 80% in mild persistent cases, and between 60 and 80% in moderate persistent cases, showing an increase in the degree of reversibility of >,15% in FEV1. All patients were on oral theophylline as controller therapy, none was receiving oral or inhaled corticosteroids, none had other comorbidities necessitating medical treatment, and all were from a middle-class community and had suffered from asthma for the last 2,5 years. Twenty-four patients received the placebo, with one drop-out during the study, while 22 received the propolis extract, with no drop-outs. The age range of the patients was 19,52 years; 36 were male and 10 female. The number of nocturnal attacks was recorded on a weekly basis, while pulmonary function tests were performed on all patients at the beginning of the trial, 1 month later and at the termination of the trial. Immunological parameters, including various cytokines and eicosanoids known to play a role in asthma, were measured in all patients at the beginning of the trial and 2 months later. Analysis of the results at the end of the clinical study revealed that patients receiving propolis showed a marked reduction in the incidence and severity of nocturnal attacks and improvement of ventilatory functions. The number of nocturnal attacks dropped from an average of 2.5 attacks per week to only 1. The improvement in pulmonary functions was manifested as a nearly 19% increase in FVC, a 29.5% increase in FEV1, a 30% increase in peak expiratory flow rate (PEFR), and a 41% increase in the forced expiratory flow rate between 25 and 75% of the vital capacity (FEF25-75). The clinical improvement was associated with decreases by 52, 65, 44 and 30%, respectively, of initial values for the pro-inflammatory cytokines tumor necrosis factor (TNF)-,, ICAM-1, interleukin (IL)-6 and IL-8, and a 3-fold increase in the ,protective' cytokine IL-10. The levels of prostaglandins E2 and F2, and leukotriene D4 were decreased significantly to 36, 39, and 28%, respectively, of initial values. Patients on the placebo preparation showed no significant improvement in ventilatory functions or in the levels of mediators. The findings suggest that the aqueous propolis extract tested is potentially effective as an adjuvant to therapy in asthmatic patients. The benefits may be related to the presence in the extract of caffeic acid derivatives and other active constituents. [source] A review of the GOLD guidelines for the diagnosis and treatment of patients with COPDINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 8 2008L. Fromer Summary Chronic obstructive pulmonary disease (COPD) is a leading cause of death in the USA, and represents a major health, social and economic burden. COPD is underdiagnosed and often misdiagnosed, which likely contributes to the continuing increases in the prevalence, morbidity and mortality associated with this disease. This is unfortunate because whereas COPD cannot be cured, it can be treated effectively, particularly during the earlier stages of the disease. Evidence-based guidelines, developed to assist in the prevention, diagnosis and management of COPD, are available to healthcare professionals interested in learning more about COPD. These guidelines are updated and revised on a regular basis to reflect recent advances in our understanding of the pathophysiology of and treatments available for COPD. Nevertheless, primary-care physicians have reported a lack of awareness of the fundamental concepts underpinning the optimal treatment and management of COPD presented in the guidelines. Thus, the objective of this article is to summarise key physiologic, diagnostic and management concepts provided in the most recent update of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, which were published in November 2006. [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] Inhospital management of COPD exacerbations: a systematic review of the literature with regard to adherence to international guidelinesJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 6 2009Cathy Lodewijckx RN MSc PhD Cand Abstract Rationale, Chronic obstructive pulmonary disease (COPD) exacerbations are a leading cause of hospitalization. Suboptimal inhospital management is expected to lead to more frequent exacerbations and recurrent hospital admission, and is associated with increased mortality. Aims, To explore inhospital management of COPD and to compare the results with recommendations from international guidelines. Methods, A literature search was carried out for relevant articles published 2000,2009 in the databases Medline, Cochrane Library, Cumulative Index for Nursing and Allied Health Literature and Invert. In addition, the reference lists of the selected articles were examined. Main inclusion criteria were as follows: COPD, exacerbation, hospitalization, description of inpatient management, and clinical trials. Assessment and treatment strategies in different studies were analysed and compared with American Thoracic Society-European Respiratory Society and Global Initiative for Chronic Obstructive Lung Disease guidelines. Outcomes were analysed. Results, Seven eligible studies were selected. Non-pharmacological treatment was infrequently explored. When compared with international guidelines, diagnostic assessment and therapy were suboptimal, especially non-pharmacological treatment. Respiratory physicians were more likely to perform recommended interventions than non-respiratory physicians. Conclusions, Adherence to international guidelines is low for inhospital management of COPD exacerbations, especially in terms of non-pharmacological treatment. Further investigation is recommended to explore strategies like care pathways that improve performance of recommended interventions. [source] Chronic obstructive pulmonary disease: Diagnosis and managementJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 3 2007Acute, CCRN (Adjunct Faculty, Charles A. Downs MSN, Continuing Care Nurse Practitioner Program, Nurse Practitioner) Abstract Purpose: The purpose of this article is to provide a comprehensive review of the current modalities employed in diagnosing and treating chronic obstructive pulmonary disease (COPD). Special emphasis is placed on current guidelines, as defined by the Global Initiative for Chronic Obstructive Lung Disease. Data source: A comprehensive literature review for COPD serves as the basis for this article. Conclusions: According to the National COPD Coalition (2004), there are nearly 24 million Americans who suffer from COPD. The incidence of COPD is rising globally and is associated with increased morbidity and mortality. COPD is characterized by progressive decline in function, resulting in concomitant diseases, which increase healthcare dollar expenditures, thus making COPD a concern for healthcare providers in the United States and abroad. Implications for practice: Once a diagnosis of COPD is made, healthcare providers should explore multiple treatment options in an effort to find the most beneficial regimen. It is only when the treatments are individualized, including physiological therapies and cognitive approaches to lessen risks as well as to reduce exacerbations, that the patient with COPD is able to potentially experience a reasonable quality of life. [source] Health economics of asthma: assessing the value of asthma interventionsALLERGY, Issue 12 2008J. D. Campbell The aim of this systematic review was to summarize and assess the quality of asthma intervention health economic studies from 2002 to 2007, compare the study findings with clinical management guidelines, and suggest avenues for future improvement of asthma health economic studies. Forty of the 177 studies met our inclusion criteria. We assessed the quality of studies using The Quality of Health Economic Studies validated instrument (total score range: 0,100). Six studies (15%) had quality category 2, 26 studies (65%) achieved quality category 3, and the remaining eight (20%) studies were scored as the highest quality level, category 4. Overall, the findings from this review are in line with the Global Initiative for Asthma clinical guidelines. Many asthma health economic studies lacked appropriate long term time horizons to match the chronic nature of the disease and suffered from using effectiveness measures that did not capture all disease related risks and benefits. We recommend that new asthma simulation models: be flexible to allow for long term time horizons, focus on using levels of asthma control in their structure, and estimate both long term asthma specific outcomes like well-controlled time as well as generic outcomes such as quality adjusted survival. [source] Asthma control or severity: that is the questionALLERGY, Issue 2 2007M. Humbert In the first National Heart Lung and Blood Institute and Global Initiative for Asthma (GINA) guidelines, the level of symptoms and airflow limitation and its variability allowed asthma to be subdivided by severity into four subcategories (intermittent, mild persistent, moderate persistent, and severe persistent). It is important to recognize, however, that asthma severity involves both the severity of the underlying disease and its responsiveness to treatment. Thus, the first update of the GINA guidelines defined asthma severity depending on the clinical features already proposed as well as the current treatment of the patient. In addition, severity is not a fixed feature of asthma, but may change over months or years, whereas the classification by severity suggests a static feature. Moreover, using severity as an outcome measure has limited value in predicting what treatment will be required and what the response to that treatment might be. Because of these considerations, the classification of asthma severity is no longer recommended as the basis for treatment decisions, a periodic assessment of asthma control being more relevant and useful. [source] Asthma Control Test correlates well with the treatment decisions made by asthma specialistsRESPIROLOGY, Issue 4 2009Fanny W.S. KO ABSTRACT Background and objective: Poor assessment of asthma control results in suboptimal treatment. Identifying parameters that accurately assess control will benefit treatment decisions. The Asthma Control Test (ACT) is a five-item questionnaire for the assessment of asthma control. This study evaluated its correlation with the treatment decisions made by asthma specialists in an outpatient clinic setting, and compared its performance with other conventional parameters including spirometry, PEF rate (PEFR), fractional exhaled nitric oxide (FeNO) and BHR. Methods: The 383 (122 men) study subjects completed a 1-month diary on symptoms and PEFR before the assessment. All subjects then completed the ACT together with same-day spirometry and FeNO measurement. BHR to methacholine was performed in 73 subjects in the week before assessment. Asthma specialists, blinded to the results of the ACT, FeNO and BHR (but not spirometry and PEFR), assessed the patients' level of control according to the 2006 version of the Global Initiative for Asthma guidelines and made appropriate treatment decision. Results: The group mean (SD) age was 46.1 (13.4) years with pre-bronchodilator FEV1 84.72 (20.81) % predicted. Receiver operating characteristic (ROC) curve analysis found that an ACT score of ,20 best correlated with uncontrolled asthma (area under curve (AUC) = 0.76) with a sensitivity of 70.5%, specificity 76.0%, positive predictive value 76.2% and negative predictive value 70.2% for predicting step-up of asthma therapy. On ROC analysis, the ACT score had the highest AUC (0.81 (P < 0.001)) for changing asthma therapy when compared with FeNO, spirometry, PEFR and BHR parameters Conclusions: The ACT correlated better with treatment decisions made by asthma specialists than spirometry, PEFR and FeNO. [source] Sputum bacteriology in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease in Taiwan with an emphasis on Klebsiella pneumoniae and Pseudomonas aeruginosaRESPIROLOGY, Issue 1 2007Sheng-Hsiang LIN Background and objective: Bacterial infection is one of the major causes of acute exacerbation of COPD (AECOPD). This study was undertaken to investigate the microbiology of AECOPD. Methods: Medical records from 494 episodes of AECOPD in patients admitted to the National Taiwan University Hospital from January 2000 to June 2004 were reviewed. Severity of COPD was classified according to the 2003 Global Initiative for Chronic Obstructive Lung Disease guideline. Results: Potential pathogenic microorganisms were isolated from patients in 328 (66.4%) episodes of AECOPD. The predominant bacteria were Klebsiella pneumoniae (19.6%), Pseudomonas aeruginosa (16.8%) and Haemophilus influenzae (7.5%), followed by Acinetobacter baumannii (6.9%), Enterobacter species (6.1%) and Staphylococcus aureus (6.1%). The incidence of Streptococcus pneumoniae was 2.4%. Spirometry results obtained within 1 year of the exacerbation were available in 186 cases. K. pneumoniae was more frequently isolated in stage I COPD (39.1%) than stage II (16.6%), III (13.8%) and IV (9.4%). No glucose non-fermentative Gram-negative bacilli were isolated in stage I patients. Multivariate logistic regression analysis revealed that P. aeruginosa (odds ratio (OR) 3.19; 95% confidence interval (CI): 1.21,8.38), intubation (OR 14.81; 95% CI: 5.08,43.12) and age (OR 1.1; 95% CI: 1.03,1.17) were independent risk factors for mortality. Conclusions: Klebsiella pneumoniae and P. aeruginosa are the most common sputum pathogens in hospitalized patients with AECOPD in Taiwan, with the former being more commonly isolated from mild COPD and the latter associated with poor clinical outcome. These results should be considered when deciding which antibiotics should initially be used to treat patients with AECOPD. [source] Factors Associated with Hospital Admission among Emergency Department Patients with Chronic Obstructive Pulmonary Disease ExacerbationACADEMIC EMERGENCY MEDICINE, Issue 1 2007Chu-Lin Tsai MD Abstract Objectives To determine the patient factors associated with hospital admission among adults who present to the emergency department (ED) with acute exacerbations of chronic obstructive pulmonary disease (COPD) and to determine whether admissions were concordant with recommendations in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Methods The authors performed a prospective multicenter cohort study involving 29 EDs in the United States and Canada. By using a standard protocol, consecutive ED patients with COPD exacerbation were interviewed, and their charts were reviewed. Predictors of admission were determined by multivariate logistic regression. Results Of 384 patients, 233 (61%; 95% confidence interval = 56% to 66%) were admitted. Multivariate analysis showed that a higher likelihood of admission was associated with older age, female gender, more pack-years of smoking, recent use of inhaled corticosteroid, self-reported activity limitation in the past 24 hours, higher respiratory rate at ED presentation, and a concomitant diagnosis of pneumonia. Patients who reported the ED as their usual site for problem COPD care, or who had mixed COPD and asthma, were less likely to be admitted. The authors confirmed five of the seven testable indications for hospital admission in the GOLD guidelines. Conclusions Several patient factors were independently associated with hospital admission among ED patients with COPD exacerbations. Overall, concordance with admission recommendations in the GOLD guidelines was high. The authors also identified a few novel predictors of admission (female gender, ED as the usual site for problem COPD care, mixed diagnosis of COPD and asthma, recent use of inhaled corticosteroid) that require replication in future studies. [source] Multicentre trial evaluating alveolar NO fraction as a marker of asthma control and severityALLERGY, Issue 5 2010B. Mahut To cite this article: Mahut B, Trinquart L, Le Bourgeois M, Becquemin M-H, Beydon N, Aubourg F, Jala M, Bidaud-Chevalier B, Dinh-Xuan A-T, Randrianarivelo O, Denjean A, de Blic J, Delclaux C. Multicentre trial evaluating alveolar NO fraction as a marker of asthma control and severity. Allergy 2010; 65: 636,644. Abstract Background:, Exhaled NO can be partitioned in its bronchial and alveolar sources, and the latter may increase in the presence of recent asthmatic symptoms and in refractory asthma. The aim of this multicentre prospective study was to assess whether alveolar NO fraction and FENO could be associated with the level of asthma control and severity both at the time of measurement and in the subsequent 3 months. Methods:, Asthma patients older than 10 years, nonsmokers, without recent exacerbation and under regular treatment, underwent exhaled NO measurement at multiple constant flows allowing its partition in alveolar (with correction for back-diffusion) and bronchial origins based on a two-compartment model of NO exchange; exhaled NO fraction at 50 ml/s (FENO,0.05) was also recorded. On inclusion, severity was assessed using the four Global initiative for asthma (GINA) classes and control using Asthma Control Questionnaire (ACQ). Participants were followed-up for 12 weeks, control being assessed by short-ACQ on 1st, 4th, 8th and 12th week. Results:, Two-hundred patients [107 children and 93 adults, median age (25th; 75th percentile) 16 years (12; 38)], 165 receiving inhaled corticosteroid, were included in five centres. The two-compartment model was valid in 175/200 patients (87.5%). Alveolar NO and FENO,0.05 did not correlate to control on inclusion or follow-up (either with ACQ /short-ACQ values or their changes), nor was influenced by severity classes. Alveolar NO negatively correlated to MEF25,75% (rho = ,0.22, P < 0.01). Conclusion:, Alveolar and exhaled NO fractions are not indexes of control or severity in asthmatic children and adults under treatment. [source] Good practice in plasma collection and fractionationISBT SCIENCE SERIES: THE INTERNATIONAL JOURNAL OF INTRACELLULAR TRANSPORT, Issue n1 2010C. Schärer The control strategy to ensure safety of blood products includes a combination of measures focusing on ensuring the quality and safety of starting material by careful donor selection and testing strategies at different levels, together with validated manufacturing processes, including steps to inactivate or remove potential contaminating agents. Using an approach based on good manufacturing practice (GMP) provides a manufacturing model that allows for a documented system of incorporating quality throughout the entire manufacturing process and describes the activities and controls needed to consistently produce products that comply with specifications and are safe for use. There are no doubts that the aim of providing safe and high-quality product to the patients should be the same for all products derived from human blood, independent of its use either as a blood component for direct transfusion or as industrially manufactured product. It would be difficult to justify whether for blood components the good practice standards and for plasma derivatives the GMP standards for manufacturing would not ensure equivalent levels of quality and safety. To ensure a high level of quality and safety of blood components and plasma derivatives, the implementation of double standards in blood establishments and fractionation industry would not be effective and should be avoided. Harmonized standards and good practices for collection and fractionation, based on the principles of GMP, should be envisaged in the whole chain of manufacturing blood components and plasma derivatives. Global initiatives to further promote the implementation of harmonized GMP for the collection in blood establishments and a stringent regulatory control are ongoing. This would further contribute to the global availability of plasma-derived medicinal products. [source] Evaluation of the Asthma Life Quality test for the screening and severity assessment of asthmaALLERGY, Issue 11 2004J. A. Fonseca Background:, Asthma Life Quality (ALQ) test, a 20-question questionnaire developed by the American College of Allergy, Asthma and Immunology, has been shown to be useful for asthma diagnosis. We aimed to determine the relation between ALQ scores and (a) diagnosis of asthma; (b) physician's classification of asthma severity according to National Institutes of Health/Global Initiative for Asthma (GINA). Methods:, Standard translation and cultural adaptation to Portuguese was performed. Patients self-administered the ALQ in the waiting room; the attending allergist classified them, blindly for the test. The scores of nonasthmatics were compared with those of asthma patients. Asthma patients were analyzed in two severity groups: intermittent and mild persistent asthma (IMPA), and moderate and severe persistent asthma (MSPA); sensitivity, specificity, positive and negative predictive values were calculated and receiver operating characteristic curve plotted. Logistic regression analysis models were computed. Results:, From 283 patients, 237 tests were analyzed. Non-asthmatic patients ALQ scores (mean ± SD) were 6 ± 4 and, for asthmatics, 10 ± 5 [mean difference 4.6 (95%CI 3.3,5.9)]. The odds of positive diagnosis increased 1.27 times (95%CI 1.17,1.38) for each one-unit increase in the test. For asthma severity ALQ scores were 9 ± 4 for IMPA, 15 ± 3 for MSPA [difference 6.0 (95%CI 4.8,7.1)]; with a sensitivity of 88% and specificity of 74% for a score of 12. The odds of MSPA increased 1.49 times (95%CI 1.28,1.74) per unit increase in ALQ. Conclusions:, ALQ can help both to identify patients with asthma and to differentiate those more likely to have moderate/severe asthma. These are relevant characteristics for the possible use of this simple, self-administered questionnaire in the assessment of asthma patients needing additional medical management. [source] CHRONIC KIDNEY DISEASE,MINERAL AND BONE DISORDER (CKD-MBD): A NEW TERM FOR A COMPLEX APPROACHJOURNAL OF RENAL CARE, Issue 2009Franti, vára MD SUMMARY The global widespread of the chronic kidney disease (CKD) is a worldwide health problem. Its increasing incidence and prevalence and adverse outcomes (including decreased quality of life, increased morbidity and mortality) represents a huge challenge for all recent health are systems. Reflecting this situation, the new, global initiative (KDIGO) was established to enhance communication and clinical decision-making, promote the use of evidence based medicine and facilitate clinical research. The new definition, evaluation and classification of "renal osteodystrophy"; has been one of the first outcome of this initiative, suggesting the topic of chronic kidney disease,mineral and bone disorder (CKD-MBD) to be a hot problem of recent nephrology. The new terminology is consistent with a recent view on this topic and describes CKD-MBD as a complex syndrome, including abnormal mineral and PTH metabolism, altered bone structure as far as extra-skeletal calcifications. [source] DNA barcodes for globally threatened marine turtles: a registry approach to documenting biodiversityMOLECULAR ECOLOGY RESOURCES, Issue 2 2010EUGENIA NARO-MACIEL Abstract DNA barcoding is a global initiative that provides a standardized and efficient tool to catalogue and inventory biodiversity, with significant conservation applications. Despite progress across taxonomic realms, globally threatened marine turtles remain underrepresented in this effort. To obtain DNA barcodes of marine turtles, we sequenced a segment of the cytochrome c oxidase subunit I (COI) gene from all seven species in the Atlantic and Pacific Ocean basins (815 bp; n = 80). To further investigate intraspecific variation, we sequenced green turtles (Chelonia mydas) from nine additional Atlantic/Mediterranean nesting areas (n = 164) and from the Eastern Pacific (n = 5). We established character-based DNA barcodes for each species using unique combinations of character states at 76 nucleotide positions. We found that no haplotypes were shared among species and the mean of interspecific variation ranged from 1.68% to 13.0%, and the mean of intraspecific variability was relatively low (0,0.90%). The Eastern Pacific green turtle sequence was identical to an Australian haplotype, suggesting that this marker is not appropriate for identifying these phenotypically distinguishable populations. Analysis of COI revealed a north,south gradient in green turtles of Western Atlantic/Mediterranean nesting areas, supporting a hypothesis of recent dispersal from near equatorial glacial refugia. DNA barcoding of marine turtles is a powerful tool for species identification and wildlife forensics, which also provides complementary data for conservation genetic research. [source] Americanist Archaeologies: 2008 in ReviewAMERICAN ANTHROPOLOGIST, Issue 2 2009B. Sunday Eiselt ABSTRACT A review of published literature, conference proceedings, and Internet sources pertaining to "Americanist archaeology" in 2008 reveals three major themes: conflict, catastrophe, and collaboration. Scholars debated the role of archaeology in planning for and executing military operations in the Middle East while maintaining a vigorous interest in structural and physical violence worldwide. Environmental archaeologists considered the effects of catastrophic events, including new theories over the demise of Clovis cultures. In addition, several major reports and regulations highlighted the complexities of indigenous relations and gender equity in the profession. Enhanced technologies, funding for global initiatives in human rights, economic and environmental sustainablility, and creative forms of engagement are reshaping "Americanist archaeology" as a democratic, anthropological, and relevant pursuit. [Keywords: archaeology, annual review, conflict, catastrophe, collaboration] [source] | ||||||||||