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Intensive Management (intensive + management)
Selected AbstractsTherapeutic targets in the management of Type 1 diabetesDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue S1 2002P. D. Home Abstract For historical reasons, diabetes has long been linked with blood and urine glucose control, partly because these were clearly linked to acute symptoms, and partly because glucose became measurable around 200 years ago. Today it is recognized that there is far more to diabetes than simply monitoring symptoms and blood glucose. Intensive management has an impact on the quality of life. Late complications have their own risk factors and markers. Monitoring and early detection of these risk factors and markers can lead to changes in treatment before tissue damage is too severe. Accordingly, professionals now find themselves monitoring a range of adverse outcomes, markers for adverse outcomes, risk factors and risk markers for microvascular and arterial disease, acute complications of therapy, and the care structures needed to deliver this. Adverse outcomes lend themselves to targets for complication control in populations, and markers of adverse outcomes (such as retinopathy and raised albumin excretion rate) in treatment cohorts. Surveillance systems will have targets for yearly recall and review of early complications. Metabolic (surrogate) outcomes can be monitored in individual patients, but monitoring is only of value in so far as it guides interventions, and this requires comparison to some intervention level or absolute target. Even for blood glucose control this is not easy, for conventional measures such as glycated haemoglobin have their own problems, and more modern approaches such as post-prandial glucose levels are controversial and less convenient to measure. In many people with type 1 diabetes targets for blood pressure, LDL cholesterol, and serum triglycerides will also be appropriate, and need to be part of any protocol of management. Copyright © 2002 John Wiley & Sons, Ltd. [source] Improved glycaemic control with metformin,glibenclamide combined tablet therapy (Glucovance®) in Type 2 diabetic patients inadequately controlled on metforminDIABETIC MEDICINE, Issue 8 2002M. Marre Abstract Aims To evaluate the efficacy and safety of two dosage strengths of a single-tablet metformin,glibenclamide (glyburide) combination, compared with the respective monotherapies, in patients with Type 2 diabetes mellitus (DM) inadequately controlled by metformin monotherapy. Methods In this 16-week, double-blind, multicentre, parallel-group trial, 411 patients were randomized to receive metformin 500 mg, glibenclamide 5 mg, metformin,glibenclamide 500 mg/2.5 mg or metformin,glibenclamide 500 mg/5 mg, titrated with the intention to achieve fasting plasma glucose (FPG) , 7 mmol/l. Results Decreases in glycated haemoglobin (HbA1c) and FPG were greater (P < 0.05) for metformin,glibenclamide 500 mg/2.5 mg (,1.20% and ,2.62 mmol/l) and 500 mg/5 mg (,0.91% and ,2.34 mmol/l), compared with metformin (,0.19% and ,0.57 mmol/l) or glibenclamide (,0.33% and ,0.73 mmol/l). HbA1c < 7% was achieved by 75% and 64% of patients receiving metformin,glibenclamide 500 mg/2.5 mg and 500 mg/5 mg, respectively, compared with 42% for glibenclamide and 38% for metformin (P = 0.001). These benefits were achieved at lower mean doses of metformin or glibenclamide with metformin,glibenclamide 500 mg/2.5 mg and 500 mg/5 mg (1225 mg/6.1 mg and 1170 mg/11.7 mg) than with glibenclamide (13.4 mg) or metformin (1660 mg). Treatment-related serious adverse events occurred in two patients receiving glibenclamide. Plasma lipid profiles were unaffected and mean changes in body weight were , 1.0 kg. Conclusions Intensive management of Type 2 DM with a new metformin,glibenclamide combination tablet improved glycaemic control and facilitated the attainment of glycaemic targets at lower doses of metformin or glibenclamide compared with the respective monotherapies, without compromising tolerability. Diabet. Med. 19, 673,680 (2002) [source] Bacterial traits, organism mass, and numerical abundance in the detrital soil food web of Dutch agricultural grasslandsECOLOGY LETTERS, Issue 1 2005Christian Mulder Abstract This paper compares responses to environmental stress of the ecophysiological traits of organisms in the detrital soil food webs of grasslands in the Netherlands, using the relationship between average body mass M and numerical abundance N. The microbial biomass and biodiversity of belowground fauna were measured in 110 grasslands on sand, 85 of them farmed under organic, conventional and intensive management. Bacterial cell volume and abundance and electrophoretic DNA bands as well as bacterial activity in the form of either metabolic quotient (qCO2) or microbial quotient (Cmic/Corg) predicted the response of microorganisms to stress. For soil fauna, the logarithm of body mass log(M) was approximately linearly related to the logarithm of numerical abundance log(N) with slope near ,1, and the regression slope and the proportion of predatory species were lower in intensive agroecosystems (more reduced substrates with higher energy content). Linear regression of log(N) on log(M) had slope not far from ,3/4. The approach to monitoring data illustrated in this paper could be useful in assessing land-use quality. [source] Prospects for conserving biodiversity in Amazonian extractive reservesECOLOGY LETTERS, Issue 3 2002Susan M. Moegenburg Abstract Non-timber forest product (NTFP) extraction is a popular alternative to timber extraction that figures prominently in efforts to utilize tropical forests sustainably. But the ability to conserve biodiversity through NTFP management, particularly in extractive reserves in Amazonia, has remained untested. We found that intensive management of Euterpe oleracea (Palmae) fruit, one of the most important extractive products in the Amazon, has substantial impacts on biodiversity, whereas moderate management does not. We mimicked traditional levels of fruit harvest in a replicated experiment over one fruiting season. High-intensity harvest (75% of fruits removed) reduced avian frugivore species diversity by 22%. Low-intensity harvest (40% of fruits removed), however, had no effect on diversity. On a larger scale, we found that forests with enriched densities of E. oleracea supported more fruit-eating birds but fewer non fruit-eating birds than non-enriched forests. Taken together, these results suggest that intensive NTFP management to meet market demands may trigger substantial ecological impacts, at least at the level of our study. E. oleracea harvest should be limited where conservation of biodiversity is a goal. [source] Effects of temperature and fertilization on nitrogen cycling and community composition of an urban lawnGLOBAL CHANGE BIOLOGY, Issue 9 2008NEETA S. BIJOOR Abstract We examined the influence of temperature and management practices on the nitrogen (N) cycling of turfgrass, the largest irrigated crop in the United States. We measured nitrous oxide (N2O) fluxes, and plant and soil N content and isotopic composition with a manipulative experiment of temperature and fertilizer application. Infrared lamps were used to increase surface temperature by 3.5±1.3 °C on average and control and heated plots were split into high and low fertilizer treatments. The N2O fluxes increased following fertilizer application and were also directly related to soil moisture. There was a positive effect of warming on N2O fluxes. Soils in the heated plots were enriched in nitrogen isotope ratio (,15N) relative to control plots, consistent with greater gaseous losses of N. For all treatments, C4 plant C/N ratio was negatively correlated with plant ,15N, suggesting that low leaf N was associated with the use of isotopically depleted N sources such as mineralized organic matter. A significant and unexpected result was a large, rapid increase in the proportion of C4 plants in the heated plots relative to control plots, as measured by the carbon isotope ratio (,13C) of total harvested aboveground biomass. The C4 plant biomass was dominated by crabgrass, a common weed in C3 fescue lawns. Our results suggest that an increase in temperature caused by climate change as well as the urban heat island effect may result in increases in N2O emissions from fertilized urban lawns. In addition, warming may exacerbate weed invasions, which may require more intensive management, e.g. herbicide application, to manage species composition. [source] Soil greenhouse gas fluxes and global warming potential in four high-yielding maize systemsGLOBAL CHANGE BIOLOGY, Issue 9 2007M. A. A. ADVIENTO-BORBE Abstract Crop intensification is often thought to increase greenhouse gas (GHG) emissions, but studies in which crop management is optimized to exploit crop yield potential are rare. We conducted a field study in eastern Nebraska, USA to quantify GHG emissions, changes in soil organic carbon (SOC) and the net global warming potential (GWP) in four irrigated systems: continuous maize with recommended best management practices (CC-rec) or intensive management (CC-int) and maize,soybean rotation with recommended (CS-rec) or intensive management (CS-int). Grain yields of maize and soybean were generally within 80,100% of the estimated site yield potential. Large soil surface carbon dioxide (CO2) fluxes were mostly associated with rapid crop growth, high temperature and high soil water content. Within each crop rotation, soil CO2 efflux under intensive management was not consistently higher than with recommended management. Owing to differences in residue inputs, SOC increased in the two continuous maize systems, but decreased in CS-rec or remained unchanged in CS-int. N2O emission peaks were mainly associated with high temperature and high soil water content resulting from rainfall or irrigation events, but less clearly related to soil NO3 -N levels. N2O fluxes in intensively managed systems were only occasionally greater than those measured in the CC-rec and CS-rec systems. Fertilizer-induced N2O emissions ranged from 1.9% to 3.5% in 2003, from 0.8% to 1.5% in 2004 and from 0.4% to 0.5% in 2005, with no consistent differences among the four systems. All four cropping systems where net sources of GHG. However, due to increased soil C sequestration continuous maize systems had lower GWP than maize,soybean systems and intensive management did not cause a significant increase in GWP. Converting maize grain to ethanol in the two continuous maize systems resulted in a net reduction in life cycle GHG emissions of maize ethanol relative to petrol-based gasoline by 33,38%. Our study provided evidence that net GHG emissions from agricultural systems can be kept low when management is optimized toward better exploitation of the yield potential. Major components for this included (i) choosing the right combination of adopted varieties, planting date and plant population to maximize crop biomass productivity, (ii) tactical water and nitrogen (N) management decisions that contributed to high N use efficiency and avoided extreme N2O emissions, and (iii) a deep tillage and residue management approach that favored the build-up of soil organic matter from large amounts of crop residues returned. [source] Latest news and product developmentsPRESCRIBER, Issue 4 2008Article first published online: 20 MAR 200 Suicide warning for all antidepressants All antidepressants are to include a warning of the risk of suicide in their product information, the MHRA says. The requirement formerly applied only to SSRIs but, following a US review of safety data, the Agency says the risk is similar for all classes of antidepressants. Patients at increased risk include young people with psychiatric morbidity and those with a history of suicidal ideation. Patients are at increased risk of suicide until remission occurs, and clinical experience shows that the risk is increased during the early stages of recovery. Confusion over type 2 diabetes management Contradictory findings have been reported from two studies of intensive management of type 2 diabetes. The STENO-2 study (N Engl J Med 2008;358:580-91) found that tight control of blood glucose, blood pressure and lipids plus low-dose aspirin in 160 patients with type 2 diabetes and microalbuminuria significantly reduced all-cause mortality, cardiovascular events, cardiovascular death and microvascular complications by 40-60 per cent. The US National Heart, Blood and Lung Institute has announced the end of the intensive treatment arm of the ACCORD study (unpublished). This study was comparing intensive lowering of blood glucose below currently recommended levels (target HbA1C <6 per cent) with conventional management in adults with type 2 diabetes at especially high risk for heart attack and stroke. Although mortality was reduced in both arms compared with other populations, intensive treatment was associated with increased mortality equivalent to three deaths per 1000 patients per year over four years. Another antibiotics campaign The Government has launched another campaign to promote public awareness that antibiotics are not appropriate for viral infections causing coughs, colds and sore throats. Get Well Soon , Without Antibiotics is supported by a national advertising campaign and leaflets and posters encouraging the public to ask advice rather than demand a prescription. Details are available at www.dh.gov.uk. Episenta: once-daily sodium valproate Following a launch to specialists last year, a new once-daily modified-release formulation of sodium valproate is being promoted more widely to GPs. Episenta is licensed for the treatment of all forms of epilepsy and is formulated as modified-release capsules of 150mg and 300mg and sachets of modified-release granules of 500mg and 1000mg. The dose may be administered once or twice daily. Patients may be switched from enteric-coated tablets of valproate to the same dose given as Episenta. Episenta costs £5.70 or £10.90 for 100 × 150mg or 300mg capsules, and £18 or £35.50 for 100 × 500mg or 1000mg sachets. Latest NICE agenda The Department of Health has referred a new batch of topics for appraisal by NICE. Six of seven technology appraisals are for cancer drugs; the last is for dabigatran etexilate for venous thromboembolism. There will be four new clinical guidelines: autism spectrum disorders, hypertension in pregnancy, bed-wetting in children and severe mental illness with substance abuse. Two combined public health and clinical guidelines will address alcohol misuse. Varenicline vs NRT Varenicline (Champix) offers slightly greater smoking cessation rates than nicotine replacement therapy (NRT) in the long term and better symptom improvement, an international study has shown (Thorax 2008; published online:10.1136/ thx.2007.090647). A total of 746 smokers were randomised to treatment with varenicline 1mg twice daily for 12 weeks or transdermal NRT (21mg reducing to 7mg per day) for 10 weeks. Continuous abstinence rates for the last four weeks of treatment were 56 vs 43 per cent. The corresponding rates for one year were 26 and 20 per cent. Varenicline was associated with greater reductions in cravings, withdrawal symptoms and smoking satisfaction, but more nausea (37 vs 10 per cent). Adverse reactions class effect of statins The MHRA has identified several adverse effects that it says are class effects of the statins (Drug Safety Update 2008;1:Issue 7). Following a review of clinical trials and spontaneous reports, it is now apparent that any statin may be associated with sleep disturbance, depression, memory loss and sexual dysfunction; interstitial lung disease has been reported rarely. Product information is being updated to include the new information. Depression, including suicidal ideation, has also been associated with varenicline (Champix), the MHRA says; affected patients should stop treatment immediately. The combination of transdermal nicotine replacement therapy (NRT) and varenicline appears to be associated with a higher incidence of nausea, headache, vomiting, dizziness, dyspepsia and fatigue than NRT alone. The MHRA has also announced that, following the suspension of marketing authorisation for carisoprodol (Carisoma), it is considering a phased withdrawal of the closely-related meprobamate , the main active metabolite of carisoprodol. Following a successful pilot study, the public are being encouraged to report adverse reactions on yellow cards; the MHRA notes that health professionals provide more complete reports but patients include more information about quality of life. The scheme will be promoted via community pharmacies throughout the UK from February 2008. Cochrane: evidence on back pain interventions The latest release of Cochrane reviews includes three meta-analyses assessing interventions for back pain. Overall, NSAIDs were found to be effective as short-term treatment for acute or chronic back pain but the effect size was small. They were comparable with paracetamol but associated with more adverse effects; COX-2 selective NSAIDs were similarly effective, with slightly fewer adverse effects. There was no evidence that antidepressants reduced back pain but intensive individual patient education (lasting 2.5 hours) was effective for acute and subacute back pain and comparable with manipulation and physiotherapy; its effects on chronic pain were unclear. Copyright © 2008 Wiley Interface Ltd [source] Increased Expression of Regulatory Tr1 Cells in Recurrent Hepatitis C after Liver TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2009A. Carpentier Immune response failure during HCV infection has been associated with the activity of regulatory T cells. Hepatitis C-related cirrhosis is the main reason for liver transplantation. However, 80% of transplanted patients present an accelerated recurrence of the disease. This study assessed the involvement of regulatory T-cell subsets (CD4+CD25+ cells: ,Treg' and CD49b+CD18+ cells: ,T regulatory-1' cells), in the recurrence of HCV after liver transplantation, using transcriptomic analysis, ELISA assays on serum samples and immunohistochemistry on liver biopsies from liver recipients 1 and 5 years after transplantation. Three groups of patients were included: stable HCV-negative recipients and those with mild and severe hepatitis C recurrence. At 5 years, Treg markers were overexpressed in all HCV+ recipients. By contrast, Tr1 markers were only overexpressed in patients with severe recurrence. At 1 year, a trend toward the overexpression of Tr1 was noted in patients evolving toward severe recurrence. IL-10 production, a characteristic of the Tr1 subset, was enhanced in severe recurrence at both 1 and 5 years. These results suggest that Tr1 are enhanced during severe HCV recurrence after liver transplantation and could be predictive of HCV recurrence. High levels of IL-10 at 1 year could be predictive of severe recurrence, and high IL-10 producers might warrant more intensive management. [source] Tight orbit syndrome: a previously unrecognized cause of open-angle glaucomaACTA OPHTHALMOLOGICA, Issue 1 2010Graham A. Lee ABSTRACT. Purpose:, To describe a new syndrome of tight orbit and intractable glaucoma with a poor visual prognosis. Methods:, A retrospective observational case series of six patients seen at two centres between 2001 and 2007 assessing intraocular pressure (IOP), best-corrected visual acuity and visual field. Results:, Three men and three women, ranging in age at diagnosis from 14 to 53 years, demonstrated similar orbital features and progressive visual field loss despite intensive management with medication and laser and operative surgery. Highest IOPs ranged from 30 to 50 mmHg. Trabeculectomy and/or glaucoma drainage devices were attempted in five patients but all failed. One patient underwent orbital decompression with achievement of IOP control. Final IOP at last follow-up was variable; only two patients achieved IOP in the normal range, with the rest ranging from 25 to 40 mmHg. All patients had advanced visual field loss. Conclusion:, Tight orbit syndrome presents a serious clinical challenge. Despite maximum medical therapy and surgical intervention IOP is difficult to control, resulting in progressive visual field loss. [source] | |||||||||||||