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Selected AbstractsShared Care in Geriatric Oncology: Primary Care Providers' and Medical/Oncologist's PerspectivesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2009Cynthia Owusu MD Existing literature lends support to the benefit of shared care in the management of chronic diseases, but there are limited data on the feasibility, cost-effectiveness, or benefits of shared care in oncology. A recent conference organized by the Aging and Cancer Program of the Case Comprehensive Cancer Center sought to explore the perceptions of physicians and other allied health professionals who attended the conference about shared care in the acute management of older patients with cancer using a case history presentation and an anonymous audience response system. Analyses of the audience response indicated that shared responsibility and enhanced information exchange in addition to the current level of communication between providers involved in the acute management of older patients with cancer is desirable. Studies exploring the feasibility and benefits of a shared care model in the management of older patients with cancer are needed. [source] The biology of insularity: an introductionJOURNAL OF BIOGEOGRAPHY, Issue 5-6 2002Donald R. Drake Insular environments, ranging from oceanic islands to fragments of once-contiguous natural systems, have long been used by biologists to test basic principles of ecology, evolution and biogeography. More recently, insular environments have figured prominently in conservation ecology, where the aim has usually been to conserve species or assemblages unique to isolated habitats. Improving the level of communication among the evolutionary biologists, theoretical ecologists and conservation biologists who study insular biotas will work to the benefit of all. This volume was inspired by a recent conference on the ecology of insular biotas, in which participants from a wide range of disciplines came together to compare ecological processes across a variety of taxonomic groups inhabiting a wide range of isolated environments. In this introduction, we point out the themes underlying these very diverse contributions. First we elaborate on the value of islands for elucidating processes underlying ecosystem functioning, population dynamics of reintroduced species, and restoration of disturbed habitats, and emphasize those areas where the use of islands could be expanded. The second section focuses on the link between ecology and evolutionary processes in insular systems and includes examples from oceanic islands, naturally patchy habitats and recently fragmented habitats. The third section illustrates some of the ways that invasive alien species on oceanic islands affect plant,animal mutualisms, particularly seed dispersal and pollination. The final section, on consequences of habitat fragmentation, focuses mainly on studies that describe the consequences that fragmentation has for plants and animals as they are forced into artificially insular environments. We close with a study that points out the differences among types of insular systems and identifies gaps in our knowledge of insular biotas, particularly the importance of explicitly incorporating patch type, age and patch,matrix contrasts in research. Finally, we recommend a greater emphasis on linking ecological theory and applied research, and improving communication between those who ask basic ecological questions and those who use insular systems for conservation. [source] Review article: the optimal medical management of acute severe ulcerative colitisALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 5 2010A. L. Hart Aliment Pharmacol Ther 2010; 32: 615,627 Summary Background, Management of acute severe ulcerative colitis (UC) is a clinical challenge, with a mortality rate of approximately 1,2%. The traditional management with intravenous corticosteroids has been modified by introduction of ciclosporin and more recently, infliximab. Aim, To provide a detailed and comprehensive review of the medical management of acute severe UC. Methods, PubMed and recent conference abstracts were searched for articles relating to treatment of acute severe UC. Results, Two-thirds of patients respond to intravenous steroids in the short term. In those who fail steroids, low-dose intravenous ciclosporin at 2 mg/kg/day is effective. Approximately 75% and 50% of patients treated with ciclosporin avoid colectomy in the short and long-terms, respectively. Long-term outcome of ciclosporin therapy is improved by introduction of azathioprine on discharge from hospital, together with oral ciclosporin as a bridging therapy. Controlled data show that infliximab is effective as rescue therapy for acute severe UC and the effect appears to be durable, although longer-term follow-up data are needed. Conclusions, Both ciclosporin and infliximab have demonstrated efficacy as rescue medical therapies in patients with acute severe UC, but surgery needs to be considered if there is failure to improve or clinical deterioration. [source] Review article: the current management of acute liver failureALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2010D. G. N. CRAIG Aliment Pharmacol Ther,31, 345,358 Summary Background, Acute liver failure is a devastating clinical syndrome with a persistently high mortality rate despite critical care advances. Orthotopic liver transplantation (OLT) is a life-saving treatment in selected cases, but effective use of this limited resource requires accurate prognostication because of surgical risks and the requirement for subsequent life-long immunosuppression. Aim, To review the aetiology of acute liver failure, discuss the evidence behind critical care management strategies and examine potential treatment alternatives to OLT. Methods, Literature review using Ovid, PubMed and recent conference abstracts. Results, Paracetamol remains the most common aetiology of acute liver failure in developed countries, whereas acute viral aetiologies predominate elsewhere. Cerebral oedema is a major cause of death, and its prevention and prompt recognition are vital components of critical care support, which strives to provide multiorgan support and ,buy time' to permit either organ regeneration or psychological and physical assessment prior to acquisition of a donor organ. Artificial liver support systems do not improve mortality in acute liver failure, whilst most other interventions have limited evidence bases to support their use. Conclusion, Acute liver failure remains a truly challenging condition to manage, and requires early recognition and transfer of patients to specialist centres providing intensive, multidisciplinary input and, in some cases, OLT. [source] Review article: the current and evolving treatment of colonic diverticular diseaseALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2009A. TURSI Summary Background, Formation of colonic diverticula, via herniation of the colonic wall, is responsible for the development of diverticulosis and consequently diverticular disease. Diverticular disease can be associated with numerous debilitating abdominal and gastrointestinal symptoms (including pain, bloating, nausea, constipation and diarrhoea). Aims, To review the state of treatment for diverticular disease and its complications, and briefly discuss potential future therapies. Methods, PubMed and recent conference abstracts were searched for articles describing the treatment of diverticular disease. Results, Many physicians will recommend alterations to lifestyle and increasing fibre consumption. Empirical antibiotics remain the mainstay of therapy for patients with diverticular disease and rifaximin seems to be the best choice. In severe or relapsing disease, surgical intervention is often the only remaining treatment option. Although novel treatment options are yet to become available, the addition of therapies based on mesalazine (mesalamine) and probiotics may enhance treatment efficacy. Conclusions, Data suggest that diverticular disease may share many of the hallmarks of other, better-characterized inflammatory bowel diseases; however, treatment options for patients with diverticular disease are scarce, revolving around antibiotic treatment and surgery. There is a need for a better understanding of the fundamental mechanisms of diverticular disease to design treatment regimens accordingly. [source] Review article: pain and chronic pancreatitisALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2009J. G. LIEB II Summary Background, Pain in chronic pancreatitis chronic pancreatitis is a frustrating and challenging symptom for both the patient and clinician. It is the most frequent and most significant symptom. Many patients fail the currently available conservative options and require opiates or endoscopic/surgical therapy. Aim, To highlight the pathophysiology and management of chronic pancreatitis pain, with an emphasis on recent developments and future directions. Methods, Expert review, utilizing in addition a comprehensive search of PubMed utilizing the search terms chronic pancreatitis and pain, treatment or management and a manual search of recent conference abstracts for articles describing pain and chronic pancreatitis. Results, Pancreatic pain is heterogenous in its manifestations and pathophysiology. First-line medical options include abstinence from alcohol and tobacco, pancreatic enzymes, adjunctive agents, antioxidants, and non-opiate or low potency opiate analgesics. Failure of these options is not unusual. More potent opiates, neurolysis and endoscopic and surgical options can be considered in selected patients, but this requires appropriate expertise. New and better options are needed. Future options could include new types of pancreatic enzymes, novel antinociceptive agents nerve growth factors, mast cell-directed therapy, treatments to limit fibrinogenesis and therapies directed at the central component of pain. Conclusions, Chronic pancreatitis pain remains difficult to treat. An approach utilizing conservative medical therapies is appropriate, with more invasive therapies reserved for failure of this conservative approach. Treatment options will continue to improve with new and novel therapies on the horizon. [source] Review article: 5-aminosalicylate formulations for the treatment of ulcerative colitis , methods of comparing release rates and delivery of 5-aminosalicylate to the colonic mucosaALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2008G. R. LICHTENSTEIN Summary Background, Many oral 5-aminosalicylic acid (5-ASA) formulations are designed to maximize 5-ASA release in the colon where it acts topically on the colonic mucosa. Delayed-release formulations and azo-prodrugs minimize 5-ASA absorption in the upper gastrointestinal (GI) tract. Aims, To review methods for assessing 5-ASA release and colonic distribution from oral formulations, and the potential use of this information for guiding clinical decisions. Methods, PubMed and recent conference abstracts were searched for articles describing techniques used to assess 5-ASA release from ulcerative colitis (UC) therapies. Results, In-vitro GI models, although unable to simulate more complex aspects of GI physiology, can provide useful data on 5-ASA release kinetics and bioaccessibility. Gamma-scintigraphy is useful for investigating GI disintegration of different formulations, but may not accurately reflect 5-ASA distribution. Plasma pharmacokinetic studies provide data on systemic exposure, but not on colonic distribution or mucosal uptake. Mucosal biopsies provide direct evidence of colonic distribution and may predict clinical efficacy, but must be interpreted cautiously because of considerable inter-subject variability and other confounding factors. Conclusion, While assessment of 5-ASA release is important, limitations of individual measurement techniques mean that randomized clinical studies in UC patients remain the best guide for dosing and treatment regimen decisions. [source] | ||||||||||