Inventory and description of disease management programs in Switzerland

Background: Disease management, a system of coordinated health care interventions for populations with chronic diseases in which patient self-care is a key aspect, has been shown to be effective for several conditions. Little is known on the supply of disease management programs in Switzerland. Objectives: To systematically search, record and evaluate data on existing disease management programs in Switzerland. Methods: Programs met our operational definition of disease management if their interventions targeted a chronic disease, included a multidisciplinary team and lasted at least 6 months. To find existing programs, we searched Swiss official websites, Swiss web-pages using Google, medical electronic database (Medline), and checked references from selected documents. We also contacted personally known individuals, those identified as possibly working in the field, individuals working in major Swiss health insurance companies and people recommended by previously contacted persons (snow ball strategy). We developed an extraction grid and collected information pertaining to the following 8 domains: patient population, intervention recipient, intervention content, delivery personnel, method of communication, intensity and complexity, environment and clinical outcomes (measures?). Results: We identified 8 programs fulfilling our operational definition of disease management. Programs targeted patients with diabetes, hypertension, heart failure, obesity, alcohol dependence, psychiatric disorders or breast cancer, and were mainly directed towards patients. The interventions were multifaceted and included education in almost all cases. Half of the programs included regularly scheduled follow-up, by phone in 3 instances. Healthcare professionals involved were physicians, nurses, case managers, social workers, psychologists and dietitians. None fulfilled the 6 criteria established by the Disease Management Association of America. Conclusions: Our study shows that disease management programs, in a country with universal health insurance coverage and little incentive to develop new healthcare strategies, are scarce, although we may have missed existing programs. Nonetheless, those already implemented are very interesting and rather comprehensive. Appropriate evaluation of these programs should be performed in order to build upon them and try to design a generic disease management framework suited to the Swiss healthcare system.

Eating disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders

Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders - NICE Guidance

Standard Evaluation Framework for Weight Management Interventions - Core Criteria

The National Obesity Observatory was established to provide a single point of contact for wide-ranging authoritative information on data and evidence related to obesity, overweight, underweight and their determinants. The Standard Evaluation Framework is a list of data collection criteria and supporting guidance for collecting high quality information to support the evaluation of weight management interventions. This is a quick reference guide to the core criteria of the Standard Evaluation Framework. Essential criteria are presented as the minimum recommended data for evaluating a weight management intervention. Desirable criteria are additional data that would enhance the evaluation.refer to the resource

Standard Evaluation Framework (SEF) for weight management interventions Presentation

This presentation summaries the Standard Evaluation Framework which is designed to support high quality, consistent evaluation of weight management interventions in order to increase the evidence base.

Nonenzymatic oxidation of trienoic fatty acids contributes to reactive oxygen species management in Arabidopsis.

In higher plants such as Arabidopsis thaliana, omega-3 trienoic fatty acids (TFAs), represented mainly by alpha-linolenic acid, serve as precursors of jasmonic acid (JA), a potent lipid signal molecule essential for defense. The JA-independent roles of TFAs were investigated by comparing the TFA- and JA-deficient fatty acid desaturase triple mutant (fad3-2 fad7-2 fad8 (fad3 fad7 fad8)) with the aos (allene oxide synthase) mutant that contains TFAs but is JA-deficient. When challenged with the fungus Botrytis, resistance of the fad3 fad7 fad8 mutant was reduced when compared with the aos mutant, suggesting that TFAs play a role in cell survival independently of being the precursors of JA. An independent genetic approach using the lesion mimic mutant accelerated cell death2 (acd2-2) confirmed the importance of TFAs in containing lesion spread, which was increased in the lines in which the fad3 fad7 fad8 and acd2-2 mutations were combined when compared with the aos acd2-2 lines. Malondialdehyde, found to result from oxidative TFA fragmentation during lesion formation, was measured by gas chromatography-mass spectrometry. Its levels correlated with the survival of the tissue. Furthermore, plants lacking TFAs overproduced salicylic acid (SA), hydrogen peroxide, and transcripts encoding several SA-regulated and SA biosynthetic proteins. The data suggest a physiological role for TFAs as sinks for reactive oxygen species.

Management Framework Agreement between the Department of Education and Skills and City of Dublin ETB

Management Framework Agreement between the Department of Education and Skills and City of Dublin ETB. Provided by the Department of Education and Skills, Ireland.

Environmental management for the control of Triatoma dimidiata (Latreille, 1811), (Hemiptera: Reduviidae) in Costa Rica: a pilot project

An ecological control method, using environmental management operations, based on biological and behavioral characteristics of Triatoma dimidiata (Latreille, 1811), was implemented as a pilot project in an area of Costa Rica where the bug is prevalent. The sample was represented by 20 houses with peridomestic colonies (two also had indoor infestation), divided in two equivalent groups of 10 each. In one group we intervened the houses, i.e. all objects or materials that were serving as artificial ecotopes for the bugs were removed, and the second group was used as control houses. After a year of periodic follow up, it became evident that in those houses with a modified environment the number of insects had decreased notoriously even after the first visits and this was more evident after a period of 12.5 to 13.5 months in which no insects were detected in eight of the houses. It also became clear that in this group of houses, recolonization by wild bugs from the surrounding areas, became more difficult, probably due to the absence of protection from bug predators. In the control houses, with the exception of three in which the inhabitants decided to intervene on their own, and another house with a peculiar situation, the insect populations remained the same or even showed a tendency to increase, as confirmed at the end of the experiment. We believe that the method is feasible, low costing and non contaminating. It could be used successfully in other places where T. dimidiata is common and also in countries where other species colonize peridomestic areas of homes. Environmental management of this kind should seek the participation of the members of the communities, in order to make it a more permanent control measure.

Atherosclerotic renal artery stenosis: update on management strategies.

Purpose of reviewAtherosclerotic renal artery stenosis (ARAS) usually occurs in patients at high risk of vascular disease, and is associated with increased mortality. The primary goals of ARAS treatment include the control of blood pressure (BP), the improved renal function, and the benefit on cardiovascular events. Although medical therapy remains the standard approach to the management of ARAS, percutaneous transluminal renal angioplasty (PTRA) revascularization can be a therapeutic option under certain conditions.Recent findingsRecent evidence confirms that ARAS increases cardiovascular risk, independent of BP and renal function. This suggests that revascularization might potentially improve overall prognosis, but no data are available currently. In cases of significant ARAS, the accepted indications for PTRA are uncontrollable hypertension, gradual or acute renal function decline with the use of agents blocking the renin-angiotensin-aldosterone system, and recurrent flash pulmonary edema. The key point of treatment success remains in all cases a careful patient selection.SummaryAlthough the atherosclerotic lesions of the renal arteries tend to progress over time, the anatomical lesion progression is not always associated with changes in BP. Furthermore, a poor correlation was noted between the degree of anatomic stenosis and glomerular filtration rate. The high cardiovascular risk warrants aggressive pharmacological treatment to prevent progression of the generalized vascular disorder. Ongoing trials will show whether PTRA revascularization has added, long-term effects on BP, renal function, and cardiovascular prognosis. With or without PTRA revascularization, medical therapy using antihypertensive agents, statins, and aspirin is necessary in almost all cases.

Asthma self-management action plan

This�self-management action plan allows each patient to record and manage the symptoms of�asthma.

Guidelines for the Management of HIV Positive Pregnant Women in Northern Ireland

This guidance aims to support health care staff to provide the optimum care for HIV positive women during pregnancy and delivery within Northern Ireland.

An analysis of the components of pain, function, and health-related quality of life in patients with failed back surgery syndrome treated with spinal cord stimulation or conventional medical management

Objectives: Failed back surgery syndrome (FBSS) patients experience pain, functional disability, and reduced health-related quality of life (HRQoL) despite anatomically successful surgery. Examining sub-dimensions of health outcomes measures provides insight into patient well-being. Materials and Methods: The international multicenter PROCESS trial collected detailed HRQoL (EuroQol-5D; Short-Form 36) and function (Oswestry Disability Index) information on 100 FBSS patients. Results: At baseline, patients reported moderate-to-severe leg and back pain adversely affecting all dimensions of function and HRQoL. Compared with conventional medical management alone, patients also receiving spinal cord stimulation (SCS) reported superior pain relief, function, and HRQoL at six months on overall and most sub-component scores. The majority of these improvements with SCS were sustained at 24 months. Nonetheless, 36-40% of patients experienced ongoing marked disability (standing, lifting) and HRQoL problems (pain/discomfort). Conclusions: Longer-term patient management and research must focus on these refractory FBSS patients with persisting poor function and HRQoL outcomes.

Management of a post-operative multi-resistant infectious spondylitis associated with a kyphotic deformity.

Anterior spinal infection (prevertebral abscess and/or discitis) after posterior instrumentation for vertebral fractures is a challenging complication, since a new implant may become necessary anteriorly, in a septic environment. Generally accepted management guidelines are yet to be established. The authors present a case of posterior instrumentation for fractures of T12 and L1, complicated after 9 months with an anterior infection (prevertebral abscess and discitis) with extended-spectrum beta-lactamase (ESBL) producing Escherichia coli (E. coli). This case is unique in that the multi-resistant organism was isolated only after the second stage of infection treatment, which consisted of anterior débridement and anterior implantation of titanium cages and rods. In this particular case, infection was controlled despite implantation of multiple cages, screws and rods, and fusion was achieved, by means of intravenous antibiotic treatment for 12 months. At the latest follow-up, 24 months post surgery, there was no evidence of infection. This problem case may be helpful for surgeons confronted with spinal deformities secondary to infections with multi-resistant organisms.

Douleurs neuropathiques : quelques pistes pour une évaluation structurée et une prise en charge spécifique et globale [Neuropathic pain: tips and tools for specific and comprehensive pain management]

Les syndromes neuropathiques sont caractérisés par une douleur d'intensité élevée, de longue durée et résistante aux analgésiques classiques. De fait, il existe un risque important de répercussions sur la vie et le bien-être des patients. A travers une vignette clinique, cet article abordera le diagnostic, le traitement spécifique et l'impact de la douleur neuropathique sur la qualité de vie et les conséquences psychologiques associées, comme la dépression et l'anxiété. Nous présenterons des outils validés qui permettent d'objectiver la composante neuropathique aux douleurs et les comorbidités psychiatriques associées. Cette évaluation globale favorise un meilleur dialogue avec les patients ainsi que l'élaboration de stratégies thérapeutiques, notamment par le biais d'antidépresseurs, dont l'efficacité sera discutée en fin d'article. Neuropathic pain syndromes are characterized by intense and long lasting pain that is resistant to usual analgesics. Patients are therefore at high risk of decreased quality of life and impaired well-being. Using a case report, we will consider in this article the diagnosis and treatment of neuropathic pain as well as its impact on the quality of life including psychological consequences such as depression and anxiety. We will present simple and reliable scales that can help the general practitioner evaluate the neuropathic component of the pain syndrome and its related psychiatric co-morbidities. This comprehensive approach to pain management should facilitate communication with the patient and help the practitioner select the most appropriate therapeutic strategy, notably the prescription of antidepressants, the efficacy of which we will discuss at the end of the article.