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[The German Health Survey. 1997/98].

The first German Health Survey, a representative study of the health status of the population in unified Germany, was started in October 1997. In this project which is being carried out by the Robert Koch Institute on behalf of the Federal Ministry of Health about 7,200 study participants aged between 18 and 79 are going through a medical check-up and are interviewed as to health-relevant issues. The German National Health Survey consists of a core survey and supplementary modules. These modules are, for the most part, carried out in subsamples of the study population. They partially have been designed and co-financed by cooperating institutions of the RKI. This time, the opportunity given to the individual Länder to increase the size of the sample was realized by Bavaria. This practised principle of a modular structure and co-financing may be regarded as a model and serve as an example for the cost effective implementation of such extensive health surveys. As a result, the German National Health Examination Survey will yield information enabling the RKI to deliver relevant health reports on a federal level and, therefore, to support decisions in health policy. The demand for representative population-based data will be met by supply of survey data as a file for public use.

Adolescent↗

Assessing your publication potential.

To be published in a professional nursing journal is an admirable goal and one that is obtainable if you have skills, knowledge, and tenacity and if you want to share information with others. Everything we do or accomplish in life is built on steps, and that translates into taking one step after another. Writing for publication is no different; this article enumerates and describes the 11 steps to becoming published. Self-answer questions direct the reader to consider whether to compose solo or with a co-author(s). The nursing journal review processes and options of where to submit queries or completed articles are covered. Books to help writers begin writing or refining their work are included. This article states that the first rule of becoming published is "where there's a will, there's a way." It concludes with the dictate, start now. Procrastination has stifled more projects than any other obstacle. Pick up your pen or turn on your computer and go to work.

Authorship↗

[Updating 1999 of Standards, Options and Recommendations (SOR) for the clinical use of erythropoietin in oncology. FEDERATION OF THE FRENCH CANCER CENTRES (FNCLCC)].

CONTEXT: The < > (SOR), started in 1993, are a collaborative project between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcomes for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary experts group, with feedback from specialists in cancer care delivery. The initial guidelines are being updated in case of new evidence. OBJECTIVES: To update the clinical practice guideline [39] with definitions of new Standards, Options and Recommendations for the use of recombinant human erythropoietin (rHuEPO) in oncology. METHODS: Data have been identified by literature search using Medline, Current Contents, Embase, Cancerlit (march 1996-march 1999). The main end points considered were hemoglobin level, haematocrit, quality of life, transfusion requirements, incidence and length of hospital stays, efficacy of cancer treatment, safety and costs. Once the guideline was updated and defined, the document was submitted to 42 reviewers for peer review, and to the medical committees of the 20 French Cancer Centres for review and agreement. RESULTS: The new key recommendations are: 1) The use of recombinant human erythropoietin in oncology is an alternative to treat chemotherapy-induced anemia when the chemotherapeutic regimen contains platinum; 2) Cancer-induced anemia reduces patients' quality of life. Treatment of anemia by transfusions of erythropoietin may improve quality of life; 3) We recommend assessment of haemoglobin levels during radiation therapy and the possible use of erythropoietin to optimise the efficacy of radiation therapy; 4) Erythropoietin is effective in others pathologies (multiple myeloma, non-Hodgkin lymphoma, non-platinum based chemotherapy.) and also in pediatric patients but the risk/benefit ratio for anemia therapy (i.e. transfusion or erythropoietin therapy) must be analysed for each individual; 5) We recommend an economic analysis of the need of erythropoietin within the context of the french health care system.

Anemia↗

Start-up of a multi-stage system for biogas production and solid waste treatment in low-tech countries.

Vegetable fruit garden wastes were treated anaerobically using a multistage Dranco system. The digesters were composed of three 50 L vessels kept in mesophilic conditions. They were operating at 14.5-17% TS. By controlling the pH in the system, the start-up for biogas production was shortened to 60 days. The pH correction was a buffering which enhanced methanogenic activity in the digesters. With a loading rate of 4.1 kg VS/m3 reactor/day, the production of biogas was 5 m3/m3 reactor/ day, and 60-70% methane content. This allowed making a multisystem by starting every 3 weeks with new vessels in order to maintain biogas production, to be used in industries or in local communities in low-tech countries. The designed model was started in Kinshasa (Congo) where a project is expected to treat one ton of solid waste on a daily basis, for a production of 100 m3 biogas. This cost effectiveness of the system is demonstrated and presents the opportunity for biowaste treatment coupled with environmental protection and substantial energy recovery.

Bacteria, Anaerobic↗

[Information system in primary health care].

The Croatian Ministry of Health started a health care system computerization project aimed at strengthening the collaboration among health care institutions, expert groups and individual health care providers. A tender for informatic system for Primary Health Care (PHC) general practice, pediatrics and gynecology, a vital prerequisite for project realization, has now been closed. Some important reasons for undertaking the project include rationalization of drug utilization, savings through a reduced use of specialists, consultants and hospitalization, then achievement of better cooperation, work distribution, result linking, data quality improvement (by standardization), and ensuring proper information-based decision making. Keeping non-standardized and thus difficult to process data takes too much time of the PHC team time. Since, however, a vast amount of data are collected on only a few indicators, some important information may remain uncovered. Although decisions made by health authorities should rely on evidence and processed information, the authorities spend most of the time working with raw data from which their decisions ultimately derive. The Informatic Technology (IT) in PHC is expected to enable a different approach. PHC teams should be relieved from the tedious task of data gathering and the authorities enabled to work with the information rather than data. The Informatics Communication Technology (ICT) system consists of three parts: hardware (5000 personal computers for work over the Internet), operative system with basic software (editor, etc.), and PHC software for PHC teams. At the national level (National Public Health Informatics System), a software platform will be built for data collection, analysis and distribution. This data collection will be based on the International Classification of Primary Care (ICPC-2) standard to ensure the utilization of medical records and quality assessment. The system permits bi-directional data exchange between a central database and sources at different levels, across the spectrum from basic PHC teams to local authorities. This will enable data collection control, comparisons with national averages and prompt distribution of information over the Internet. The investment into IT is a strategic imperative having no alternative. A cost/benefit analysis has shown its operation in the PHC system to return the investment in two years. As defined according to the Project priorities (with measurable objectives), the use of new technologies will be introduced by stages.

Croatia↗

[Continuity of care: community care in Italy and Sweden. A comparison].

One of the objectives of the Health 21 document, approved by the World Health Association, European Region, is to create by the year 2010 an integrate sanitary system, where the population of the region count on a better access to the health services aimed at the family and the community. In accordance with the tendencies of the European nation, which are more and more open to confrontation, the research has, as main objective, the parallel analysis of the welfare continuity and integration of the Italian Nursing Home Care Service compared to the Swedish Health Care Service. The research has been structured from a sanitary accreditation project that the Veneto Region has started with the collaboration of the Ottawa Council On Health Services Accreditation (Cchsa). The analysis puts in evidenced the completion of the offer of the territory home services present in Padua. The comparison with the Swedish situation however puts in evidence some gaps and some possible developments of the Italian service involving above all the complete transcription of the patient information and the continuity of its communication, in particular in the nursing field. Another possible development of the Italian service concerns the method continuity, between the working units themselves and with the territory, which could be achieved using common nursing guide lines and protocols to manage standard caring situations. From the analysis of the european services it results that it is the nurse who has the most relevant role for the care quality improvement.

Aged↗

[Informatics in the School of Medicine of the University of Chile. II. The school network and access to data bases].

Projects on informatics at the School of Medicine of the University of Chile are being brought about in accordance with both its institutional goals and present trends in technology. Prominent among the latter are the widespread distribution of autonomous processing power represented by low-cost computers and the ease of communication at local and worldwide levels. Our main project has been the design and start of a computer network that integrates the School's Departments and the geographically dispersed teaching hospitals. The principal services provided by the network are local and international electronic mail, access to data bases, and emulation of mainframe terminals (eg, to run remotely a mainframe's statistics software). Automated bibliographic search has been made available both through remote access to Medline data base and through local usage of compact disc (CD-ROM) versions. Since our network is open, it should become a forceful mean of assisting and integrating the biomedical community throughout the country.

CD-ROM↗

Self-medication for elderly patients.

This paper describes the introduction of a self-medication programme for elderly in-patients using action research. The programme was initiated by a steering group which met regularly to implement and monitor self-medication. Ward staff were interviewed to assess their learning needs before the start, meetings were held as the project advanced, and a final staff evaluation questionnaire was administered. Patients' opinions were also monitored. Self-medication was successfully introduced and minor problems were rapidly solved by participating staff. Patients were highly satisfied with the new independence and self-esteem they had gained through taking their own medications. Nurses shared these feelings, but also felt that self-medication was more time consuming than previous drug rounds. Suggestions for further research and development are given.

Aged↗

[Work satisfaction and working conditions of the nursing staff as the basis of internal interventions].

Satisfaction and working conditions of nursing staff as a basis for internal interventions Can analyzing the working situation of nursing staff by means of a questionnaire contribute to improving working conditions and thus reduce fluctuation and increase work-satisfaction? This was the basic question of this investigation and aimed at creating an instrument that could help work out existing resources and strategies for possible interventions. Therefore, an anonymous questionnaire containing 114 questions concerning the current situation was presented to the nursing staff in two departments of internal medicine and one surgical department of a university hospital in southern Germany in April 1993. Analysis of the data of the different working fields (ordinary/intensive care, clinics) showed individual differences regarding resources and possible interventions. Furthermore, the assumption could be confirmed that by means of such a project the nursing management gains specific starting points for the preparation of change. The prospects of improving working conditions seem quite good, as these findings are based upon the statements of the staff concerned. It has to be emphasized that the nursing staff were able to identify themselves with the conclusions when the results were presented to them.

Hospitals, General↗

Job satisfaction and morale of nurses in NHS trusts.

In April 1991 the Daphne Heald Research Unit at the Royal College of Nursing (RCN) started a three-year research project to assess the job satisfaction of nurses working in the community. This took place against a backdrop of considerable change in the organisation and funding of community health care. Initially four NHS Trusts participated, one withdrew after the first year. A measure of job satisfaction was administered to the entire community nursing and practice nursing workforce in each area. The response rate varied from 74% (year 1) to 54% (year 2). Differences in satisfaction were detected between trusts, different groups of nurse and over time. Some nurses added comments to their questionnaire, voicing concerns over uncertainty, paperwork and a perceived change in ethos within their organisations. Trust managers interviewed as part of the study spoke of their strategies for local implementation of the national changes.

Health Care Reform↗

Developing community networks to deliver HIV prevention interventions.

Outreach has a long history in health and social service programs as an important method for reaching at-risk persons within their communities. One method of "outreach" is based on the recruitment of networks of community members (or "networkers") to deliver HIV prevention messages and materials in the context of their social networks and everyday lives. This paper documents the experiences of the AIDS Community Demonstration Projects in recruiting networkers to deliver HIV prevention interventions to high-risk populations, including injecting drug users not in treatment; female sex partners of injecting drug users; female sex traders; men who have sex with men but do not self-identify as gay; and youth in high-risk situations. The authors interviewed project staff and reviewed project records of the implementation of community networks in five cities. Across cities, the projects successfully recruited persons into one or more community networks to distribute small media materials, condoms, and bleach kits, and encourage risk-reduction behaviors among community members. Networkers' continuing participation was enlisted through a variety of monetary and nonmonetary incentives. While continuous recruitment of networkers was necessary due to attrition, most interventions reported maintaining a core group of networkers. In addition, the projects appeared to serve as a starting point for some networkers to become more active in other community events and issues.

Acquired Immunodeficiency Syndrome↗

[Unmarried women of the war generation: an explorative study of their goals in life and personal satisfaction].

Older never-married women are often confronted with negative stereotypes which find expression in terms like "spinster" or "old maid". Their life-situation, however, has rarely been a subject of empirical studies. In a research project at the University of Münster, started in 1985, some psychological and social aspects of the life-situation of never-married employed women born between 1919 and 1933 (in comparison to married women of the same age not employed) were studied by means of detailed interviews. Parts of the results concerning "life goals" and "life satisfaction" are described. The results relativize the negative stereotypes mentioned above. They indicate that in the retrospective view of their lives the never-married women had many life goals which they could not achieve, but that they do not regret this at present. They rate their life satisfaction as very high and actively pursue present goals and interests. There are only few differences between never-married and married women. The results are discussed with regard to cognitive theories of aging and to the specific historical background of the interviewees.

Aged↗

[Attitudes and behavior of pregnant women towards HIV screening in Abidjan (Ivory Coast) in 1995 and 1996].

A research program into ways of reducing the maternal transmission of HIV (Project DITRAME, trial ANRS 049) was started in December 1994 in the maternity and child health clinics of the University Hospital and a community health center (Formation Sanitaire de Yopougon, FSU) in Abidjan. The first stage of this program was the introduction of voluntary HIV testing for pregnant women. During their first visit to the maternity clinic, all women were asked their age, how long they had been pregnant and where they were planning to give birth. Women over the age of 18, less than 32 weeks into gestation, who were planning to give birth in Abidjan were routinely offered an HIV test. Women who gave written consent to the test then gave a blood sample for HIV testing. Those testing positive for HIV were given posttest counseling and were invited to participate in a clinical trial of AZT. There were high rates of refusal to be tested and failure to return for posttest counseling during the first year of voluntary HIV testing. We therefore carried out a qualitative study of the reasons for refusal and failing to return. The study involved in-depth interviews with 50 pregnant women who refused to be tested and 50 others who missed the posttest appointment. Most of the women who refused to be tested thought they were probably HIV-positive. The main reason for refusing the test was the fear that the disease process would accelerate once they were informed of their HIV infection. Many women were also afraid of the reactions of their relatives, and particularly of their husband or partner, to a positive test result. There was also concern about possible breaches of confidentiality. Some women felt that pregnancy was not the best time to find out that they were HIV-positive. The reasons for not returning after testing were essentially the same, although some women were confused about the date of the appointment or did not understand the difference between standard prenatal blood test and HIV testing. Our study shows that even when most pregnant women accept the test, there are persistent problems. Some relate to the perception of HIV infection in Africa as "the disease" that cannot be cured, resulting in the view that there is no point in knowing that you are infected. Refusal to be tested is also associated with the socioeconomic vulnerability of women and their fear of exclusion. Means of reducing the maternal transmission of HIV will shortly become available in developing countries. Therefore, we need to address this problem and make voluntary HIV testing for pregnant women as widely available as possible.

Adult↗

[Standards, Options, and Recommendations for the management of patients with malignant mesothelioma of the pleura. Fédération Nationale des Centres de Lutte Contre le Cancer].

The "Standards, Options and Recommandations" (SOR), started in 1993, are a collaborative project between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcomes for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary experts group, with feedback from specialists in cancer care delivery. The objectives are to develop a clinical practice guideline with definitions of Standards. Options and Recommendations for the clinical care of malignant pleural mesothelioma. Data have been identified by literature search using Medline (1966-June 1997) and personal references lists. The main criteria considered were incidence, risk factors, pronostic factors and efficacy of cancer treatment. Once the guideline was defined, the document was submitted to 40 independent reviewers for peer review, and to the medical committees of the 20 French Cancer Centres for review and agreement. The results are: 1) systematic assessment of (professional) exposure to asbestos is based on a standardized interrogatory, completed by specific consultation for professional disease; 2) diagnostic and clinical staging is based on multiple biopsies under thoracoscopy and thoracic scanner; 3) there is no indication for extemporaneous examination, immunocytochemistry should use cytokeratine, EMA, vimentine, ACE, Leu-M1; 4) clinical care: the recommended staging classification is the IMIG (International Mesothelioma Interest Group) classification; 5) validated, independent pronostic factors are stage of disease patient's functional status and histologic type (i.e. epithelial lesions are of better prognosis); 6) treatment is based on symptomatic and palliative treatment options. Anticancer treatments (surgery, chemotherapy, immunotherapy, radiotherapy) did not show significant improvement of survival. The inclusion of patients in clinical trials is recommended.

Humans↗

[Standards, Options, and Recommendations for using erythropoietin in cancerology].

UNLABELLED: The "Standards, Options and Recommendations" (SOR), started in 1993, are a collaborative project between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcomes for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary experts group, with feedback from specialists in cancer care delivery. OBJECTIVES: To develop a clinical practice guideline with definitions of Standards, Options and Recommendations for the use of recombinant human erythropoietin (rHuEPO) in oncology. METHODS: Data have been identified by literature search using Medline (up to march 1996) and Current Contents (up to october 1996) and personal references lists. The main end points considered were hemoglobin level, haematocrit, quality of life, transfusion requirements, incidence and length of hospital stays, efficacy of cancer treatment, safety and costs. Once the guideline was defined, the document was submitted to 39 reviewers for peer review, and to the medical committees of the 20 French Cancer Centres for review and agreement. RESULTS: The key recommendations are: 1) the use of recombinant human erythropoietin in oncology is validated for chemotherapy-induced anemia when the chemotherapeutic regimen contains platinum. In other cases, we recommend to suggest patients participating in prospective clinical trials; 2) for chemotherapy (platinum based)-induced anemia, the benefits/risks ratio for anemia therapy (i.e. transfusion or erythropoietin therapy) must be analysed for each individual patient; 3) we recommend participation in studies to identify predictive factors for non-response to erythropoietin therapy to select non-responding patients; 4) to investigate the clinical benefit of erythropoietin therapy for anemia due to intensive cytotoxic chemotherapy and radiation therapy, we recommend to suggest patients participating in large multicentre phase III trials; 5) at the present time, there is insufficient evidence to recommend the use of erythropoietin therapy in children.

Anemia↗

Extension and retraction of axonal projections by some developing neurons in the leech depends upon the existence of neighboring homologues. I. The HA cells.

The role of homologues in the establishment of the pattern of axonal projections of identified segmentally homologous neurons was investigated by means of selective cell ablation and dye injection. The cells studied were the bilateral pairs of heart accessory (HA) neurons found in the fifth and sixth segmental ganglia of the leech ventral nerve cord. Homologues start their morphological differentiation with identical axonal projections, and segmental differences are manifested later, when specific branches stop growing and disappear. The deletion of single HA cells at early stages, however, permits these branches to survive in their ipsilateral homologues and to grow and take over the projections of the deleted neurons. In addition, if both HA homologues on the same side of the nerve cord, or three of the four HA cells, are deleted in an animal, the remaining HA cells often extend novel projections. These observations suggest that either competition for targets, inputs or growth factors, or direct interactions among homologous cells may play a role in the differentiation of segment specific patterns of axonal projections.

Animals↗

Oxipurinol: alloxanthine, Oxyprim, oxypurinol.

Oxipurinol [alloxanthine, Oxyprim, oxypurinol] is the active metabolite of the only commercially available xanthine oxidase inhibitor, allopurinol. Oxipurinol is also a xanthine oxidase inhibitor. Oxipurinol is currently being developed by Cardiome Pharma. It is waiting for approval in the US for the treatment of allopurinol-intolerant hyperuricaemia (gout) and is in phase III trials for the treatment of congestive heart failure. Allopurinol is indicated for the treatment of symptomatic hyperuricaemia, or gout. Approximately 3-5% of patients receiving allopurinol develop intolerance to the drug. Oxipurinol was originally developed by Burroughs Wellcome (later GlaxoSmithKline), and has been available on a compassionate-use basis since 1967 for use in allopurinol-intolerant patients. The licensee company ILEX Oncology has stated that oxipurinol does not have patent protection. Oxipurinol's potential for treatment of congestive heart failure is based on the possibility that xanthine oxidase inhibitors may improve myocardial work efficiency by sensitising cardiac muscle cells to calcium ions, which are a key determinant of cardiac muscle function. This results in more efficient contraction of cardiac muscle cells, without the same increase in oxygen demand. At the second annual BioPartnering North America conference (BPN-2004) [February 2004, Vancouver, Canada], Cardiome Pharma stated that it was seeking a commercialisation partner to market and distribute oxipurinol in the US for the treatment of allopurinol-intolerant hyperuricaemia. In 1995, ILEX Oncology obtained an exclusive licence to oxipurinol from Burroughs Wellcome. Burroughs Wellcome later became part of Glaxo Wellcome, which merged with SmithKline Beecham in December 2000 to form GlaxoSmithKline. ILEX's licence agreement is now with GlaxoSmithKline and The Wellcome Foundation. In December 2001, ILEX granted Paralex, a privately held New York-based company, an exclusive sublicence to all of ILEX's rights to oxipurinol for the treatment of hyperuricaemia in allopurinol-intolerant patients. Paralex additionally gained the right to develop and commercialise oxipurinol in all fields, under data and technology owned by ILEX. Furthermore, Paralex had licensed certain intellectual property rights from The John Hopkins University relating to cardiovascular applications of xanthine oxidase inhibitors. Paralex was acquired by Cardiome Pharma in March 2002. Cardiome Pharma announced early in May 2002 that it had exercised its option to acquire from ILEX Oncology Inc. rights to clinical trial data for oxypurinol for the treatment of gout in allopurinol-intolerant patients. ILEX completed its open-label phase II clinical study of Oxyprim in allopurinol-intolerant gout patients, and the trial data were transferred to Cardiome. Cardiome stated in May 2002 that it intended to commence a further phase II trial of oxypurinol in gout. Phase III trials were in progress in 2003 in this indication. In 1995, ILEX Oncology continued the compassionate use distribution of oxipurinol while establishing a US FDA-approved registration plan for the agent. In November 1998, ILEX received Orphan Drug status for the use of oxipurinol in patients with symptomatic hyperuricaemia. ILEX Oncology's Development Pipeline for 1998 stated that oxipurinol had entered phase II clinical trials for the treatment of hyperuricaemia. In 2001, the clinical trials listing service CenterWatch stated that oxipurinol was in a phase II clinical trial with ILEX Oncology for the treatment of symptomatic hyperuricaemia in patients who are intolerant to allopurinol. The trial appeared to be taking place in the US, and was a multicentre, open-label, 14-week study in 90 patients. In February 2003, Cardiome confirmed beginning patient enrollment in three smaller phase II studies, with the first trial (EXOTIC) now completed. These three smaller proof-of-concept studies will observe surrogate endpoints such as cardiac output and exercise tolerance. The second proof-of-concept study in patients with CHF of ischemic aetiology (IV), known as EXOTIC-EF (Evaluation of XanThine Oxidase Inhibition on Cardiac Ejection Fraction), will assess the effects of oxypurinol on left ventricular performance. The EXOTIC-EF trial will start in the first quarter of 2004 and be completed by the second quarter of 2004. The third, LA PLATA, proof-of-concept study will explore the effects of 1 month of oral oxypurinol therapy on exercise capacity and left ventricular performance. It is projected that the LA PLATA study will start in the first quarter of 2004 and be completed by the third quarter of 2004. During the Heart Failure Society of America's meeting on 21 September 2003, Cardiome presented clinical data from its first proof-of-concept EXOTIC (European Xanthine Oxidase Inhibitors Trial In Cardiac Disease) study. Cardiome intends to conduct a second trial, at the Eppendorf Clinic at the University of Hamburg, to determine the effect of oxypurinol on left ventricular performance in patients with CHF of ischaemic aetiology. This study will be an extension of the original proof-of-concept study. According to the 1st Annual BioPartnering conference held in Vancouver, Canada, in February 2003, Cardiome is seeking co-development partners for oxipurinol in the treatment of congestive heart failure. In July 2003, the US Patent and Trademark Office issued a new patent providing additional protection to Cardiome's programme focused on treatment of congestive heart failure with oxypurinol. The patent, No. 6,569,862, was the second issued to the Johns Hopkins University (JHU) in this field. The key claims in the new patent cover use of the entire family of drugs known as xanthine oxidase inhibitors applied to contractile disorders of the heart, including congestive heart failure. An earlier patent issued to JHU contained provisions relating to a specific mechanism of action and to specific forms of heart disease. Both patents and related intellectual property are licensed exclusively to Cardiome.

Drugs, Investigational↗