Home About us Contact
|
Home About us Contact | ||
|
|
||
Improved Management (improved + management)
Selected AbstractsEffectiveness of nurse-led cardiac clinics in adult patients with a diagnosis of coronary heart diseaseINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 1 2005Tamara Page RN BN HyperbaricNursCert GradDipNSc(HighDep) MNSc Executive summary Background, Coronary heart disease is the major cause of illness and death in Western countries and this is likely to increase as the average age of the population rises. Consumers with established coronary heart disease are at the highest risk of experiencing further coronary events. Lifestyle measures can contribute significantly to a reduction in cardiovascular mortality in established coronary heart disease. Improved management of cardiac risk factors by providing education and referrals as required has been suggested as one way of maintaining quality care in patients with established coronary heart disease. There is a need to ascertain whether or not nurse-led clinics would be an effective adjunct for patients with coronary heart disease to supplement general practitioner advice and care. Objectives, The objective of this review was to present the best available evidence related to nurse-led cardiac clinics. Inclusion criteria, This review considered any randomised controlled trials that evaluated cardiac nurse-led clinics. In the absence of randomised controlled trials, other research designs such as non-randomised controlled trials and before and after studies were considered for inclusion. Participants were adults (18 years and older) with new or existing coronary heart disease. The interventions of interest to the review included education, assessment, consultation, referral and administrative structures. Outcomes measured included adverse event rates, readmissions, admissions, clinical and cost effectiveness, consumer satisfaction and compliance with therapy. Results, Based on the search terms used, 80 papers were initially identified and reviewed for inclusion; full reports of 24 of these papers were retrieved. There were no papers included that addressed cost effectiveness or adverse events; and none addressed the outcome of referrals. A critical appraisal of the 24 remaining papers identified a total of six randomised controlled trials that met the inclusion criteria. Two studies addressed nurse-led clinics for patients diagnosed with angina, one looked at medication administration and the other looked at educational plans. A further four studies compared secondary preventative care with a nurse-led clinic and general practitioner clinic. One specifically compared usual care versus shared care introduced by nurses for patients awaiting coronary artery bypass grafting. Of the remaining three studies, two have been combined in the results section, as they are an interim report and a final report of the same study. Because of inconsistencies in reporting styles and outcome measurements, meta-analysis could not be performed on all outcomes. However, a narrative summary of each study and comparisons of specific outcomes assessed from within each study has been developed. Although not all outcomes obtained statistical significance, nurse-led clinics were at least as effective as general practitioner clinics for most outcomes. Recommendations, The following recommendations are made: ,The use of nurse-led clinics is recommended for patients with coronary heart disease (Level II). ,Utilise nurse-led clinics to increase clinic attendance and follow-up rates (Level II). ,Nurse-led clinics are recommended for patients who require lifestyle changes to decrease their risk of adverse outcomes associated with coronary heart disease (Level II). [source] Percutaneous Suture Closure for Management of Large French Size Arterial and Venous PunctureJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2000TED FELDMAN M.D. Aortic valvuloplasty procedures have been limited principally by the occurrence of restenosis in this patient population. Once a decision has been made to proceed with aortic valvuloplasty, one of the next major concerns is management of the femoral artery puncture. For these procedures, 12Fr and 14Fr sheath introducers and prolonged compression with clamps or hemostatic devices have been necessary. Prolonged immobilization is painful for the elderly population in whom aortic valvuloplasty is used. The ability to use percutaneous suture closure to eliminate the need for manual compression, especially for clamp or hemostatic devices, has greatly improved patient tolerance for these procedures. A technique for preloading the suture closure device prior to insertion of a large bore sheath is the technique of choice to make this possible. Mitral valvuloplasty has faced fewer limitations and of course yields results equivalent to surgical commissurotomy in randomized trials. Improved management of the 14Fr femoral venous site has made outpatient treatment simpler. The technical approach necessary for success in the venous system uses contrast injections through the Perclose device marker port to insure that the device is properly positioned prior to deployment of the sutures. More rapid immobilization and simplified postprocedural management can be achieved using percutaneous suture closure for large caliber sheaths after mitral and aortic valvuloplasty. [source] Reducing delirium in elderly patients with hip fracture: a multi-factorial intervention studyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2010K. B. BJÖRKELUND Background: There is an evident need for improved management of elderly patients with trauma in order to avoid common and troublesome complications such as delirium. The aim of this study was to investigate whether an implementation of a multi-factorial program including intensified pre-hospital and perioperative treatment and care could reduce the incidence of delirium in elderly patients with hip fracture, cognitively intact at admission to the hospital. In addition, we explored the factors that characterize patients who developed delirium. Methods: A prospective, quasi-experimental design was used. A total of 263 patients with hip fracture (,65 years), cognitively intact at admission, were consecutively included between April 2003 and April 2004. On 1 October 2003, a new program was introduced. All patients were screened for cognitive impairment within 30 min after admission to the emergency department using The Short Portable Mental Status Questionnaire (SPMSQ). To screen for delirium, patients were tested within 4 h of admission and thereafter daily, using the Organic Brain Syndrome scale. Results: The number of patients who developed delirium during hospitalization was 74 (28.1%), with a decrease from 34% (45 of 132) in the control group to 22% (29 of 131) in the intervention group (P=0.031). Patients who developed delirium were statistically older, more often had >4 prescribed drugs at admission and scored less well in the SPMSQ test. Conclusion: The use of a multi-factorial intervention program in elderly hip fracture patients, lucid at admission, reduced the incidence of delirium during hospitalization by 35%. [source] Understanding the motivations of ecotourists: the case of trekkers in Annapurna, NepalINTERNATIONAL JOURNAL OF TOURISM RESEARCH, Issue 6 2002Andrew Holden Abstract Despite the growth in eco- and nature-based tourism, relatively little is understood about the intrinsic motivations of ecotourists. In addition to furthering our knowledge of the market, such an understanding may also provide a basis for the improved management of tourists for environmental goals. This paper is based upon empirical research of the intrinsic motivations of ecotourists visiting Annapurna in Nepal. Conclusions are reached that the medium of nature is central to the fulfilment of trekkers needs and that environmental education is essential for improved management. It also is suggested that the success of tourism in Annapurna should not be judged primarily on increasing the number of visitor arrivals. Copyright © 2002 John Wiley & Sons, Ltd. [source] Disruption of an exotic mutualism can improve management of an invasive plant: varroa mite, honeybees and biological control of Scotch broom Cytisus scoparius in New ZealandJOURNAL OF APPLIED ECOLOGY, Issue 2 2010Quentin Paynter Summary 1.,A seed-feeding biocontrol agent Bruchidius villosus was released in New Zealand (NZ) to control the invasive European shrub, broom Cytisus scoparius, in 1988 but it was subsequently considered unable to destroy sufficient seed to suppress broom populations. We hypothesized that an invasive mite Varroa destructor, which has caused honeybee decline in NZ, may cause pollinator limitation, so that the additional impact of B. villosus might now reach thresholds for population suppression. 2.,We performed manipulative pollination treatments and broad-scale surveys of pollination, seed rain and seed destruction by B. villosus to investigate how pollinator limitation and biocontrol interact throughout the NZ range of broom. 3.,The effect of reduced pollination in combination with seed-destruction was explored using a population model parameterized for NZ populations. 4.,Broom seed rain ranged from 59 to 21 416 seeds m,2 from 2004 to 2008, and was closely correlated with visitation frequency of honeybees and bumblebees. Infestation of broom seeds by B. villosus is expected to eventually reach 73% (the average rate observed at the localities adjacent to early release sites). 5.,The model demonstrated that 73% seed destruction, combined with an absence of honeybee pollination, could cause broom extinction at many sites and, where broom persists, reduce the intensity of treatment required to control broom by conventional means. 6.,Nevertheless, seed rain was predicted to be sufficient to maintain broom invasions over many sites in NZ, even in the presence of the varroa mite and B. villosus, largely due to the continued presence of commercial beehives that are treated for varroa mite infestation. 7.,Synthesis and applications. Reduced pollination through absence of honeybees can reduce broom seed set to levels at which biocontrol can be more effective. To capitalize on the impact of the varroa mite on feral honeybees, improved management of commercial beehives (for example, withdrawal of licences for beekeepers to locate hives on Department of Conservation land) could be used as part of a successful integrated broom management programme at many sites in NZ. [source] Factors affecting predation by buzzards Buteo buteo on released pheasants Phasianus colchicusJOURNAL OF APPLIED ECOLOGY, Issue 4 2001R.E. Kenward Summary 1Information on the effects of wildlife predation on game and livestock is required to allow improved management of all organisms involved. Monitoring of prey, predators and predation mechanisms each suggests important methods, illustrated here by data from common buzzards Buteo buteo and ring-necked pheasants Phasianus colchicus. 2Location data from 136 radio-tagged common buzzards, together with prey remains from 40 nest areas, records from 10 gamekeepers and vegetation surveys, were used to investigate raptor predation at 28 pens from which pheasants were released in southern England. 3Among 20 725 juvenile pheasants released in 1994,95, gamekeepers attributed 4·3% of deaths to buzzards, 0·7% to owls, 0·6% to sparrowhawks, 3·2% to foxes and 0·5% to other mammals. 4Fresh pheasant remains were found on 7% of 91 visits to buzzard nests, and 8% of radio-tagged buzzards had significantly more association than other buzzards with pheasant pens. 5Predation by buzzards was most likely to be recorded at release pens with little shrub cover, deciduous canopies and a large number of released pheasants. The number of pheasants killed was greatest in large pens with extensive ground cover, and the highest proportion of released pheasants was killed in large pens where few were released. However, only 21% of 55 releases had > 2 pheasant kills per week. 6Radio-tagged buzzards were located most often at pheasant-release pens with open, deciduous canopies. Pens were most likely to be visited by buzzards that had fledged nearby, but the proximity of buzzard nests had little influence on how much predation occurred. 7Only a minority of buzzards associated frequently with pheasant pens, and predation was heavy at only a minority of sites, where pen characteristics and release factors probably made it easy for individual buzzards to kill pheasants. We suggest that the occasional heavy losses could be avoided by encouraging shrubs rather than ground cover in pens, by siting pens where there are few perches for buzzards, and perhaps also by high-density releases. [source] Waiting for scheduled services in Canada: development of priority-setting scoring systemsJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2003T. W. Noseworthy MD MSc MPH FRCPC FACP FCCP FCCM CHE Abstract Rationale, aims and objectives An Achilles' heel of Canadian Medicare is long waits for elective services. The Western Canada Waiting List (WCWL) project is a collaboration of 19 partner organizations committed to addressing this issue and influencing the way waiting lists are structured and managed. The focus of the WCWL project has been to develop and refine practical tools for prioritizing patients on scheduled waiting lists. Methods Scoring tools for priority setting were developed through extensive clinical input and highly iterative exchange by clinical panels constituted in five clinical areas: cataract surgery; general surgery procedures; hip and knee replacement; magnetic resonance imaging (MRI) scanning, and children's mental health. Several stages of empirical work were conducted to formulate and refine criteria and to assess and improve their reliability and validity. To assess the acceptability and usability of the priority-setting tools and to identify issues pertaining to implementation, key personnel in the seven regional health authorities (RHAs) participated in structured interviews. Public opinion focus groups were conducted in the seven western cities. Results Point-count scoring systems were constructed in each of the clinical areas. Participating clinicians confirmed that the tools offered face validity and that the scoring systems appeared practical for implementation and use in clinical settings. Reliability was strongest for the general surgery and hip and knee criteria, and weakest for the diagnostic MRI criteria. Public opinion focus groups endorsed wholeheartedly the application of point-count priority measures. Regional health authorities were generally supportive, though cautiously optimistic towards implementation. Conclusions While the WCWL project has not ,solved' the problem of waiting lists and times, having a standardized, reliable means of assigning priority for services is an important step towards improved management in Canada and elsewhere. [source] The impact of integrated aquaculture,agriculture on small-scale farms in Southern MalawiAGRICULTURAL ECONOMICS, Issue 1 2010Madan M. Dey Aquaculture; Malawi; Participatory research; Technical efficiency Abstract Sustainable agricultural intensification is an urgent challenge for Sub-Saharan Africa. One potential solution is to rely on local farmers' knowledge for improved management of diverse on-farm resources and integration among various farm enterprises. In this article, we analyze the farm-level impact of one recent example, namely the integrated aquaculture,agriculture (IAA) technologies that have been developed and disseminated in a participatory manner in Malawi. Based on a 2004 survey of 315 respondents (166 adopters and 149 nonadopters), we test the hypothesis that adoption of IAA is associated with improved farm productivity and more efficient use of resources. Estimating a technical inefficiency function shows that IAA farms were significantly more efficient compared to nonadopters. IAA farms also had higher total factor productivity, higher farm income per hectare, and higher returns to family labor. [source] Small U.S. dairy farms: can they compete?AGRICULTURAL ECONOMICS, Issue 2009Richard Nehring Pasture-based system; Technical efficiency; Returns to scale; Dairy Abstract The U.S. dairy industry is undergoing rapid structural change, evolving from a structure including many small farmers in the Upper Midwest and Northeast to one that includes very large farms in new production regions. Small farms are struggling to retain competitiveness via improved management and low-input systems. Using data from USDA's Agricultural Resource Management Survey, we determine the extent of U.S. conventional and pasture-based milk production during 2003,2007, and estimate net returns, scale efficiency, and technical efficiency associated with the systems across different operation sizes. We compare the financial performance of small conventional and pasture-based producers with one another and with large-scale producers. A stochastic production frontier is used to analyze performance over the period for conventional and pasture technologies identified using a binomial logit model. Large conventional farms generally outperformed smaller farms using most economic measures,technical efficiency, various profitability measures, and returns to scale. [source] What is the real gain after liver transplantation?LIVER TRANSPLANTATION, Issue S2 2009James Neuberger Key Points 1. For most liver allograft recipients, both the quality and length of life are greatly improved after transplantation. However, neither the quality of life nor the length of life in the survivors returns to that seen in age-matched and sex-matched normal subjects. 2. The gain in survival after transplantation can be estimated by a comparison of the actual outcome after transplantation and the predicted survival in the absence of transplantation. 3. The reduction in graft and patient survival, in comparison with a normal age-matched and sex-matched population, is determined by several factors: short-term survival is affected by the patient's condition pre-transplant and the quality of the graft, and for longer term survival, recurrent disease accounts for most of the differences seen between different indications. Some of the causes of premature death (such as infection, de novo malignancy, and cardiovascular and cerebrovascular disease) that are increased in the liver allograft recipient may be reduced by improved management with more aggressive surveillance and treatment. 4. The aims of selection and allocation vary in different health care systems: transparency, objectivity, equity of access, justice, mortality awaiting transplantation, utility, and transplant benefit are all important but often competing demands. Understanding the associated increase in survival will allow for a rational approach to this complex area. Liver Transpl 15:S1,S5, 2009. © 2009 AASLD. [source] ESTIMATING EFFECTS OF SYSTEMATIC TREATMENT ON RENAL FAILURE AND DEATH WITHOUT A PARALLEL PLACEBO CONTROL GROUPNEPHROLOGY, Issue 3 2000Hoy We Background: Chronic disease programs are poorly developed in most Aboriginal communities. Much disease is unrecognised or inadequately treated, although appropriate interventions profoundly reduce morbidity and mortality in nonAboriginal populations. Programs of improved management must aspire to best practice for all, so that maintaining parallel untreated control groups is unethical. This poses challenges for evaluating effect. Methods: We identified a large burden of chronic disease in a 1990-1995 screening program in one community, and started a renal & cardiovascular-protection program in Nov 1995. This centred around use of ACE inhibitors, rigorous BP control, better control of glycemia and lipids, & health education. By late 1999 about 275 people, or 30% of all adults had enrolled. The courses of BP, albuminuria and GFR was compared with those in the pre-program era (ANZSN, 1999). Treatment effects on renal failure & natural death were estimated in 3 ways. 1) Comparison of these endpoints in the "intention to treat" group with those in persons potentially eligible for treatment on their 1990-1995 screening results, ,controls'. There was 50% overlap between the groups, & controls were younger and had less severe disease than the treatment group. 2.Community-based trends in endpoints. 3. Comparison of these trends with those in other NT Top End communities. Results: 1. Risk ratios of rates, Kaplan Meier survivals, and Cox hazard ratios all showed better survival of the treated group over controls, with estimates of 41%-64% reductions in endpoints, after accounting for disease severity. 2. Dialysis starts in the entire community have fallen by at least 38% and natural deaths by 32%. 3. In contrast dialysis continue to increase at 11% per yr in other communities and deaths have not fallen. These results all suggest a marked benefit from the treatment program. Similar methods might be used where truly controlled observations are not feasible. [source] ESTIMATING EFFECTS OF SYSTEMATIC TREATMENT ON RENAL FAILURE AND DEATH WITHOUT A PARALLEL PLACEBO CONTROL GROUPNEPHROLOGY, Issue 3 2000Hoy We Background: Chronic disease programs are poorly developed in most Aboriginal communities. Much disease is unrecognised or inadequately treated, although appropriate interventions profoundly reduce morbidity and mortality in nonAboriginal populations. Programs of improved management must aspire to best practice for all, so that maintaining parallel untreated control groups is unethical. This poses challenges for evaluating effect. Methods: We identified a large burden of chronic disease in a 1990-1995 screening program in one community, and started a renal & cardiovascular-protection program in Nov 1995. This centred around use of ACE inhibitors, rigorous BP control, better control of glycemia and lipids, & health education. By late 1999 about 275 people, or 30% of all adults had enrolled. The courses of BP, albuminuria and GFR was compared with those in the pre-program era (ANZSN, 1999). Treatment effects on renal failure & natural death were estimated in 3 ways. 1) Comparison of these endpoints in the "intention to treat" group with those in persons potentially eligible for treatment on their 1990-1995 screening results, ,controls'. There was 50% overlap between the groups, & controls were younger and had less severe disease than the treatment group. 2.Community-based trends in endpoints. 3. Comparison of these trends with those in other NT Top End communities. Results: 1. Risk ratios of rates, Kaplan Meier survivals, and Cox hazard ratios all showed better survival of the treated group over controls, with estimates of 41%-64% reductions in endpoints, after accounting for disease severity. 2. Dialysis starts in the entire community have fallen by at least 38% and natural deaths by 32%. 3. In contrast dialysis continue to increase at 11% per yr in other communities and deaths have not fallen. These results all suggest a marked benefit from the treatment program. Similar methods might be used where truly controlled observations are not feasible. [source] PERSPECTIVE: Trends and Drivers of Success in NPD Practices: Results of the 2003 PDMA Best Practices Study,THE JOURNAL OF PRODUCT INNOVATION MANAGEMENT, Issue 1 2009Gloria Barczak Since 1990, the Product Development & Management Association (PDMA) has sponsored best practice research projects to identify trends in new product development (NPD) management practices and to discern which practices are associated with higher degrees of success. The objective of this ongoing research is to assist managers in determining how to improve their own product development methods and practices. This paper presents results, recommendations, and implications for NPD practice stemming from PDMA's third best practices study, which was conducted in 2003. In the eight years since the previous best practices study was conducted, firms have become slightly more conservative in the portfolio of projects, with lower percentages of the total number of projects in the new-to-the-world and new-to-the-firm categories. Although success rates and development efficiencies have remained stable, this more conservative approach to NPD seems to have negatively impacted the sales and profits impact of the new products that have been commercialized. As formal processes for NPD are now the norm, attention is moving to managing the multiple projects across the portfolio in a more orchestrated manner. Finally, firms are implementing a wide variety of software support tools for various aspects of NPD. NPD areas still seriously in need of improved management include idea management, project leadership and training, cross-functional training and team communication support, and innovation support and leadership by management. In terms of aspects of NPD management that differentiate the "best from the rest," the findings indicate that the best firms emphasize and integrate their innovation strategy across all the levels of the firm, better support their people and team communications, conduct extensive experimentation, and use numerous kinds of new methods and techniques to support NPD. All companies appear to continue to struggle with the recording of ideas and making them readily available to others in the organization, even the best. What remains unclear is whether there is a preferable approach for organizing the NPD endeavor, as no one organizational approach distinguished top NPD performers. [source] Magnification devices for endodontic therapyAUSTRALIAN DENTAL JOURNAL, Issue 4 2009M Del Fabbro Background:, After the introduction of microsurgical principles in endodontics, involving new techniques for root canal treatment, there has been a continuous search for enhancing the visualization of the surgical field. It would be interesting to know if the technical advantages for the operator brought in by magnification devices like surgical microscope, endoscope and magnifying loupes, are also associated with advantages for the patient, in terms of improvement of clinical and radiographic outcomes. Objectives:, The purpose of this systematic review was to evaluate and compare the effects of endodontic treatment performed with the aid of magnification devices versus endodontic treatment without magnification devices. We also aimed at comparing among them the different magnification devices used in endodontics (microscope, endoscope, magnifying loupes). Search strategy:, The Cochrane Oral Health Group Trials Register, CENTRAL, MEDLINE and EMBASE were searched with appropriate search strategies. Handsearching included nine dental journals. The bibliographies of relevant clinical trials and relevant articles were checked for identifying studies outside the handsearched journals. Seven manufacturers of instruments in the field of endodontics and/or endodontic surgery, as well as the authors of the identified randomized controlled trials (RCTs) were contacted in order to identify unpublished or ongoing RCTs. There were no language restrictions. The last electronic search was conducted on 2nd April 2009, and the last handsearching was undertaken on 31st January 2009. Selection criteria:, All randomized and quasi-randomized trials comparing endodontic therapy performed with or without using one or more types of magnification device, as well as randomized and quasi-randomized trials comparing two or more magnification devices used as an adjunct to endodontic therapy were considered. Data collection and analysis:, Screening of studies and data extraction were conducted independently and in duplicate. The Cochrane Collaboration statistical guidelines were to be followed for data synthesis. Main results:, No trial could be included in the present review. All of the prospective trials that were identified, all dealing with endodontic surgery, had to be excluded for various reasons. Only one RCT was identified comparing three magnificators (magnifying loupes, surgical microscope, endoscope) in endodontic surgery. No RCT was found that compared the outcome of endodontic therapy using or without using a given magnification device. Authors' conclusions:, No objective conclusion can be drawn from the results of this review as no article was identified in the current literature that satisfied the criteria for inclusion. It is unknown if and how the type of magnification device affects the treatment outcome, considering the high number of factors that may have a significant impact on the success of endodontic surgical procedure. This should be investigated by further long-term RCTs with large sample size. Technical advantages of magnificators have been widely reported in low evidence level studies, but they should be systematically addressed to know if there can be the clinical indication for using a given magnification device for specific clinical situations, such as for molar teeth, or if they can all be used interchangeably. Well-designed RCTs should also be performed to determine the true difference in terms of treatment success rates between using or not using a magnification device in both conventional and surgical endodontic treatment, if any exist. Plain language summary:, Magnification devices for endodontic therapy. There are no data to draw a sound conclusion on the effect of adopting either a microscope, an endoscope, or magnifying loupes for better visualization in endodontic therapy, in terms of clinical outcomes. Though the use of magnification devices has often been associated with technical advantages for the operator and with an improved management of the root canal due to a better visualization of the operative field, it still has to be demonstrated that their use may lead to an improved treatment success rate. More long-term well-designed randomized trials with a large sample size are urgently needed to address the issues of the present review. [source] Comedication related to comorbidities: a study in 1203 hospitalized patients with severe psoriasisBRITISH JOURNAL OF DERMATOLOGY, Issue 5 2008S. Gerdes Summary Background, Psoriasis is a common dermatological disorder characterized by an immune-mediated chronic inflammation which is associated with a variety of other diseases commonly referred to as comorbidities. The treatments for these diseases may interfere with the course and the treatment of psoriasis. Little is known on the general drug intake of patients with psoriasis. Objectives, To gain more insight into the general drug intake of patients with severe psoriasis. A correlation of comedication to respective diseases could lead to a better knowledge of comorbidities. Methods, Data on demographics, comedication and comorbidities from 1203 patients with severe psoriasis in Germany were analysed. As a control group data from 7099 subjects from the German National Health Survey 1998 were used. Results, Patients with severe psoriasis are receiving significantly more different systemic drugs on average than the general population, with the most prominent difference in multidrug treatment. Drugs used in the treatment of arterial hypertension, diabetes mellitus and other diseases of the metabolic syndrome as well as oral anticoagulants and anticonvulsant agents showed the greatest differences. Special characteristics of antihypertensive drug treatments could be determined. Conclusions, The data obtained in this study provide the basis for an improved management of patients with psoriasis. Knowledge of existing comedication and comorbidities may lead to the ability to treat psoriasis and comorbidities at the same time more safely and to use possible synergistic effects. [source] | |||||||||||||