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PubMed1987

Strategies for community occupational therapy program development.

Occupational therapists who wish to see services expand in community settings must be prepared to take an active role in program development. The article examines 12 program development strategies which are illustrated using the experience of developing a rural program in a social service system. Community occupational therapy services in Prince Edward Island were initially developed, from 1977 to 1979, by a small group of occupational therapists. The group obtained Federal Welfare Demonstration Grant funding for a pilot project which was administered by the provincial Department of Social Services. In 1979, the Prince Edward Island Provincial Government approved on-going funding for an Island-wide community occupational therapy service.

Community Health Services↗
PubMedDate not supplied

Definition of medication therapy management: development of professionwide consensus.

OBJECTIVE: To describe events leading to development of a professionwide consensus definition of medication therapy management (MTM) and attendant programs and services and present the document (definition, services, and program requirements) resulting from the process. DATA SOURCES: Author's own knowledge and records of events. SUMMARY: Following the late 2003 passage of the Medicare Prescription Drug Improvement and Modernization Act, the pharmacy profession had a need to act quickly to define MTM so that a consensus definition would be available as regulations implementing the Medicare Part D benefit were being written. The American Pharmacists Association facilitated this process by convening a broad working group of members and other involved parties to draft a preliminary definition. The Pharmacy Practice Activity Classification was used to check elements of the definition for consistency with services being offered in a wide variety of settings. A professionwide stakeholders conference was then convened with representatives from each of 11 national pharmacy organizations. This group, following a daylong meeting in late May 2004 and several weeks of e-mail messages and conference calls, finalized the MTM definition, which was then approved by the chief executive officers of all 11 groups. CONCLUSION: Through the extraordinary efforts of the numerous organizations and participants, the MTM Services Definition is one that is applicable within diverse pharmacy practice segments, whose services are feasible for a majority of practitioners to implement, and whose elements are supported by a profession-wide consortium of 11 national professional pharmacy organizations. This historic achievement is the first step on a journey to find the best ways to effectively deliver MTM services to patients.

Chronic Disease↗
PubMed1995

Influence of the U.S. military and occupational therapy reconstruction aides in World War I on the development of occupational therapy.

The development of occupational therapy was heavily influenced by an early evolved relationship between orthopedists and reconstruction aides during the first World War. Orhopedists were largely responsible for both the presence of occupational therapy in the war and the eventual acceptance (by army personnel) of women fulfilling this military function. As a result of gender issues of that time--characterized by a dearth of employment opportunities for women and by a general resistance to women in military roles--this affiliation with orthopedists in World War I served to promote occupational therapy within the military environment. This affiliation also marked an early willingness by occupational therapists to accept the medical model as one guide for clinical practice.

Female↗
PubMed2004

The cost effectiveness of pharmacological smoking cessation therapies in developing countries: a case study in the Seychelles.

OBJECTIVE: To examine the incremental cost effectiveness of the five first line pharmacological smoking cessation therapies in the Seychelles and other developing countries. DESIGN: A Markov chain cohort simulation. SUBJECTS: Two simulated cohorts of smokers: (1) a reference cohort given physician counselling only; (2) a treatment cohort given counselling plus cessation therapy. INTERVENTION: Addition of each of the five pharmacological cessation therapies to physician provided smoking cessation counselling. MAIN OUTCOME MEASURES: Cost per life-year saved (LYS) associated with the five pharmacotherapies. Effectiveness expressed as odds ratios for quitting associated with pharmacotherapies. Costs based on the additional physician time required and retail prices of the medications. RESULTS: Based on prices for currently available generic medications on the global market, the incremental cost per LYS for a 45 year old in the Seychelles was 599 US dollars for gum and 227 dollars for bupropion. Assuming US treatment prices as a conservative estimate, the incremental cost per LYS was significantly higher, though still favourable in comparison to other common medical interventions: 3712 dollars for nicotine gum, 1982 dollars for nicotine patch, 4597 dollars for nicotine spray, 4291 dollars for nicotine inhaler, and 1324 dollars for bupropion. Cost per LYS increased significantly upon application of higher discount rates, which may be used to reflect relatively high opportunity costs for health expenditures in developing countries with highly constrained resources and high overall mortality. CONCLUSION: Pharmacological cessation therapy can be highly cost effective as compared to other common medical interventions in low mortality, middle income countries, particularly if medications can be procured at low prices.

Adult↗
PubMed1992

HRT: developments in therapy.

Various forms of oestrogen have been available for use as Hormone Replacement Therapy (HRT) for approximately 50 years. However, there has been little change in the mode of administration until the last 10-15 years. Although the oral route has remained the mainstay of therapy, non-oral routes of administration have been developed. During the 1970s it became clear that use of unopposed oestrogens in women with an intact uterus resulted in an increase in risk of endometrial carcinoma and thus the current practice of adding a sequential progestogen each month, to prevent endometrial hyperplasia, was introduced. However, certain progestogens can cause side-effects and some of the metabolic changes which they induce are potentially undesirable. Thus the search continues for new oral progestogens which are more 'metabolically friendly' than those in current use. Additionally, non-oral delivery systems for progestogens have been studied, such as the transdermal route (patches) and local administration within the uterine cavity (progestogen-containing intra-uterine devices). Both these strategies may minimise their symptomatic, psychological and metabolic effects. Continuous (every day) administration of progestogens in combination with the oestrogen, or the use of new compounds (e.g. tibolone) may overcome the problem of regular withdrawal bleeding which some women find unacceptable. However, it remains to be determined whether such therapies are as efficacious as conventional oestrogen/sequential progesterone regimens.

Administration, Cutaneous↗
PubMed2003

Mammalian epigenomics: reprogramming the genome for development and therapy.

Epigenetic modifications of DNA and chromatin are important for genome function during development and in adults. DNA and chromatin modifications have central importance for genomic imprinting and other aspects of epigenetic control of gene expression. In somatic lineages, modifications are generally stably maintained and are characteristic of different specialized tissues. The mammalian genome undergoes major reprogramming of modification patterns in germ cells and in the early embryo. Some of the factors that are involved both in maintenance and in reprogramming, such as methyltransferases, are being identified. Epigenetic reprogramming is deficient in animal cloning, which is a major explanation for the inefficiency of the cloning procedure. Deficiencies in reprogramming are likely to underlie the occurrence of epimutations and of epigenetic inheritance. Environmental factors can alter epigenetic modifications and may thus have long-lasting effects on phenotype. Epigenomics methods are being developed to catalogue genome modifications under normal and pathological conditions. Epigenetic engineering is likely to play an important role in medicine in the future.

Animals↗
PubMed2003

Drug-induced myelosuppression : diagnosis and management.

Myelosuppression is a common and anticipated adverse effect of cytotoxic chemotherapy. It is a potential but rare idiosyncratic effect with any other drug, but there is a recognised association with a number of higher-risk agents which justify additional vigilance. Genetic risk factors are being identified which may predispose individuals to this reaction with particular drugs. As marker tests become available, dose adjustment or alternative treatment choices may help to avoid more severe reactions. Myelosuppression is potentially life threatening because of the infection and bleeding complications of neutropenia and thrombocytopenia. Strategies for monitoring, early detection, diagnostic confirmation and appropriate supportive care are well developed for cytotoxic therapy. Developments in antimicrobial chemotherapy, blood product transfusion support and growth factor therapy have improved outcomes. These advances are largely applicable to idiosyncratic drug-induced myelosuppression, reinforcing the importance of early recognition and referral to appropriate expertise. Many reactions will resolve on drug withdrawal with appropriate supportive care during the period of cytopenia. Prolonged marrow failure may require more specific treatment with intensive immunosuppression or consideration of bone marrow transplantation.

Antineoplastic Agents↗
PubMed2003

Optimizing targeted therapy and developing novel outcome measures for patients with advanced prostate cancer at Memorial Sloan-Kettering Cancer Center.

Hormonal therapy and chemotherapy, though active treatments for prostate cancer, are not curative for patients with metastatic disease. Targeted therapy has the potential to control, if not eradicate, cells resistant to castration and chemotherapy. Despite several years of development, however, a biologic approach with clear clinical benefits has yet to emerge from a crowded field. This review outlines the approaches being studied at Memorial Sloan-Kettering Cancer Center to optimize biologic therapy. Trials of targeted therapy are designed on the basis of a clinical states model that describes both patient clinical risks and tumor biology. Drugs that act on multiple pathways are being developed, and targets that are expressed across all phases of the disease are selected. New molecular imaging techniques permit assessments of the target before, during, and after treatment. High-throughput preclinical assays of gene expression are being developed to enhance selection of drug sequences and combinations for clinical testing.

Clinical Trials as Topic↗
PubMed2002

Molecular epidemiology of HIV-1 genetic forms and its significance for vaccine development and therapy.

Since their initial expansion in human beings roughly seven decades ago in central Africa, the HIV-1 pandemic strains have diversified extensively through mutation and recombination. 24 circulating genetic forms of the main HIV-1 group are presently recognised, including 11 subtypes or sub-subtypes and 13 circulating recombinant forms. New genetic forms are being introduced in different areas of the world, changing the molecular epidemiology of the infection. It is generally agreed that the control of the HIV-1 pandemic requires the development of vaccines that efficiently protect against the range of HIV-1 genetic forms. The introduction of effective antiretroviral therapies in areas of high HIV-1 prevalence may also contribute to the control of the pandemic, as has been documented in developed countries. Efficient targeting of the extensive genetic diversity of HIV-1 constitutes one of the major challenges in present efforts against the pandemic, although the significance of HIV-1 genetic forms for vaccine development and therapy remains to be defined.

AIDS Vaccines↗
PubMed1997

Clinical characteristics and long-term outcome of patients in whom congestive heart failure develops after thrombolytic therapy for acute myocardial infarction: development of a predictive model.

Ischemic heart disease is the most common cause of congestive heart failure, which often begins after acute myocardial infarction. To better delineate the clinical characteristics and outcomes of patients in whom congestive heart failure develops after acute myocardial infarction in the thrombolytic era, we prospectively evaluated patients enrolled in six of the TAMI trials. The study cohort comprised 1619 consecutive patients who had at least 1 mm of ST-segment elevation in two contiguous electrocardiographic leads within 6 hours of the onset of acute myocardial infarction and who received intravenous thrombolytic therapy. We prospectively collected clinical characteristics, baseline demographics, acute and 1-week angiographic variables, and in-hospital and 1-year outcome data. We performed stepwise multivariable regression analysis to determine the noninvasive and invasive predictors of the development of in-hospital congestive heart failure. Congestive heart failure developed in 301 patients in the hospital (19% of 1521 patients admitted were not in heart failure). These patients were likely to be older and female, have diabetes mellitus and previous myocardial infarction, and have an anterior wall myocardial infarction. On acute angiography, they had lower ejection fractions and a higher incidence of multivessel disease. Patency at 90 minutes was lower in the patients with congestive heart failure, and acute mitral regurgitation occurred in 1.6% versus 0.21% of patients without congestive heart failure. Patients with congestive heart failure had higher mortality, more in-hospital complications, and longer hospitalizations. At 1-year follow up, 21% of the patients in whom congestive heart failure developed had died versus 5% in the group without congestive heart failure. Predictors of new congestive heart failure included increased age, anterior wall myocardial infarction, lower pulse pressure and systolic blood pressure, diabetes mellitus, and the presence of rales on admission. The acute angiographic variables of reduced ejection fraction, increased number of diseased vessels, and attempted percutaneous intervention improved the concordance of the predictive model by 6%. Congestive heart failure remains a common clinical problem after acute myocardial infarction and is associated with a twofold increase in in-hospital morbidity and a fourfold increase in in-hospital and 1-year mortality. The development of congestive heart failure in the hospital can be predicted from noninvasive and invasive baseline characteristics. We present a simple table to predict congestive heart failure from baseline characteristics and invasive information.

Age Factors↗
PubMed2003

Low-cost anti-HIV compounds: potential application for AIDS therapy in developing countries.

A considerable progress has been made in recent years in the field of drug development against HIV. However, the current cost of AIDS drugs is the main obstacle that prevents their use in developing countries, where 95% of HIV-infected patients reside. The average yearly price of AIDS therapy and related health care of affected patients in the USA runs as high as $22,000 - an amount that corresponds to the combined income of as many as one hundred individuals in developing countries. Even in the USA, patients without medical insurance cannot afford the costly therapy. From the beginning it was clear that the most feasible and economic means of finding a solution is to identify anti-HIV drugs among already available and preferably over-the-counter pharmaceuticals, which have historically been used for unrelated clinical purposes. This review summarizes the development and discovery of affordable and potentially promising AIDS drugs. The anti-HIV activity of drugs and immunomodulating substances such as warfarin, cimetidine, levamisole, acetaminophen, gramicidin, and V-1 immunitor are described and discussed in relation to their clinical application. These compounds may be used in a cocktail drug combination.

AIDS Vaccines↗
PubMed1997

How new periodontal therapies are developed and evaluated.

General dental practitioners comprise the target market for manufacturers wishing to sell new therapies for the treatment of periodontal disease. However, because of the often limited information supplied by manufactures, GDPs may be unable to make informed decisions about whether a new product can benefit their patients and practice. This article explains the stages of clinical research undertaken before products can be marketed and discusses a potential role for GDPs in clinical research.

Clinical Trials as Topic↗
PubMed1993

[Future developments in thrombolytic therapy].

A primary failure rate to achieve reperfusion by thrombolytic therapy in acute myocardial infarction of 20-40%, an early reocclusion rate of 5-20%, as well as an increased risk of bleeding that excludes many patients from this form of therapy are today considered main problems. Better application of conventional thrombolytic agents, new conjunctive therapies and development of improved plasminogen activators are investigated with the aim of minimizing these problems.

Anticoagulants↗
PubMed2000

Group therapy program development: clinician-administrator collaboration in new practice settings.

Despite being practiced widely and applied to many conditions, group therapy is underutilized in some segments of the market. One important reason for its underuse is the lack of a model for group program development. Program development requires an integrated effort involving many disciplines. Effective collaboration between clinicians and administrators is an essential but underappreciated component in the development of group programs in independent practice associations.

Health Facility Administrators↗
PubMed2005

[Superficial needle therapy and development of acup-moxibustion sciences].

Superficial needle is a new type of needling tools. Superficial needling therapy is adopted mainly monouse superficial needle as treatment tools, with local disease as basic marker and needling the surroundings of the disease, with the needle tip towards the focus, and the needle body inserted along the superficial fascial layer, making a sweeping motion and then it was retained. The superficial needling therapy has wide indications, particularly, rapid and lasting analgesic effect for injury and pain of soft tissue.

Acupuncture Points↗
PubMed1991

[Development of therapy of acute myeloid leukemia at the First Internal Medicine Clinic in Plzen].

The authors summarize the development of diagnosis and treatment of acute myeloid leukaemias (AML) at the First Medical Clinic in Plzen in a (group) of 102 patients treated during 1966-1990. On their own results they demonstrate the importance of intensive post-remission treatment with large doses of cytosine arabinoside (ara-c) which makes possible long survival or complete recovery of some patients, and at the same time the necessity and pretentious character of comprehensive supportive treatment is emphasized.

Acute Disease↗
PubMed1992

Effects of diuretic therapy on the development of tolerance during continuous therapy with nitroglycerin.

OBJECTIVES: This study examined the effects of concurrent diuretic therapy on the hemodynamic responses to short-term and sustained therapy with transdermal nitroglycerin. BACKGROUND: Sodium retention and plasma volume expansion occur during therapy with nitroglycerin and may play a role in the loss of nitroglycerin effects during sustained therapy. METHODS: Twenty-two normal male volunteers were treated for 1 week with either hydrochlorothiazide and amiloride (50 + 5 mg) (n = 11) or placebo (n = 11) in a randomized, double-blind fashion. All 22 subjects then received continuous transdermal nitroglycerin (19 +/- 1 mg/24 h) for 5 to 7 days. RESULTS: On the first and last day of transdermal nitroglycerin therapy, standing heart rate, systolic blood pressure and hematocrit values were assessed at 8, 9 and 10 AM and 12 noon. Heart rate and blood pressure responses to sublingual nitroglycerin (0.6 mg) were also evaluated before and after sustained transdermal nitroglycerin therapy. A significant loss of the hemodynamic effects of transdermal and sublingual nitroglycerin occurred during sustained therapy in both the diuretic and placebo therapy groups. In both groups, transdermal nitroglycerin therapy was associated with a significant decrease in hematocrit that persisted for the entire treatment period. CONCLUSIONS: These results suggest that diuretic therapy does not prevent plasma volume expansion or the loss of hemodynamic effects during sustained transdermal nitroglycerin therapy. The persistent decrease in hematocrit suggests that plasma volume expansion plays a role in the attenuation of nitrate effects. It also provides evidence of continued vascular activity of nitroglycerin despite loss of systemic hemodynamic effects.

Administration, Cutaneous↗