Standard-of-care

Experience indicates that careful selection of base oils and anti-oxidation additives considerably reduce such deposits. Nevertheless, the use of top-class oil is no guarantee against trouble if maintenance is neglected. For complete safety, both the oil and the compressor system must enjoy high standards of care. 

Interim results from the SPRINT-1 phase 2 trial of boceprevir (SCH 503034) have been released. In subjects who received boceprevir plus interferon-a and ribavirin, viral RNA loads were suppressed at week 12 in between 70 and 79% of subjects infected with genotype 1 HCV, compared with only 34% in the interferon-o/ ribavirin standard of care arm (www.sch-plough.com/schering plough/news/release. jsp releaseID = 1064540). However, it is not yet known if this enhanced early response will translate into sustained response. 

Hacke W, Warach S. Diffusion-weighted MRI as an evolving standard of care in acute stroke. Neurology 2000 54 1548-1549. 

Because the costs for chronic preventative pharmacotherapy are the same for primary and secondary prevention, while the risk of events is higher with secondary prevention, secondary prevention is more cost effective than primary prevention of CHD. Pharmacotherapy demonstrating cost effectiveness to prevent death in the ACS and post-MI patient includes fibrinolytics ( 2,000 to 33,000 cost per year of life saved), aspirin, glycoprotein Ilb/IIIa receptor blockers ( 13,700 to 16,500 per year of life added), (3-blockers (less than 5,000 to 15,000 cost per year of life saved), ACE inhibitors ( 3,000 to 5,000 cost per year of life saved), eplerenone ( 15,300 to 32,400 per year of life gained), statins ( 4,500 to 9,500 per year of life saved) and gemfibrozil ( 17,000 per year of life saved).49-58 Because cost-effectiveness ratios of less than 50,000 per added life-year are considered economically attractive from a societal perspective,49 pharmacotherapy described above for ACS and secondary prevention are standards of care because of their efficacy and cost attractiveness to payors. 

Ruoff G, Urban G. Treatment of primary headache episodic tension-type headache. In Standards of care for headache diagnosis and treatment. Chicago National Headache Foundation, 2004 53-58. 

Administration of 100 meg to 1 mg phytonadione intramuscularly at birth is the standard of care in the United States. A... 

Adjuvant chemotherapy is not needed in patients with stage I colon cancer, is controversial in patients with stage II colon cancer, and is standard of care in patients with stage III colon cancer. 

Fluorouracil-based chemotherapy is the standard of care for the adjuvant treatment of colorectal cancer either as a single agent or, more commonly, in combination with other agents. 5-Fluorouracil (5-FU) alone results in a small improvement in survival that can vary based on the method of 5-FU administration. Studies suggest that protracted or continuous intravenous (IV) 5-FU infusion treatment schedules are more effective than bolus therapy.20... 

In an attempt to reduce relapse rate and late toxicity, combined-modality therapy using lower doses of radiation and an abbreviated course of chemotherapy has been evaluated.16 The goal of decreased relapse rate has been achieved, but no overall survival benefit has been documented. A limitation of this approach is exposing patients to the additive toxicities of chemotherapy. Trials that have investigated this approach typically have incorporated between two and four cycles of a standard regimen for HL, such as ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) with involved-field radiation. At present, combined-modality therapy is considered to be a standard of care for stage I/II HL. 

After initial surgery, the gold standard of care is six cycles of a taxane/platinum-containing regimen for patients with advanced ovarian cancer. 

Combination chemotherapy or biochemotherapy increases toxicity significantly without offering overall survival benefit thus they are not standard of care for stage IV melanoma. 

Due to the high relapse rate following acute therapy for C. neoformans, AIDS patients require lifelong maintenance or suppressive therapy. The standard of care for AIDS-associated cryptococcal meningitis is primary therapy, generally using amphotericin B with or without flucytosine followed by maintenance therapy with fluconazole for the fife of the patient. 

Adjuvant chemotherapy significantly decreases risk of cancer recurrence and death in stage III colon cancer and is standard of care. 

Recall that liability for malpractice requires proof that the defendant-physician violated not the jury s standards, but the standards of fellow practitioners when prescribing DES. The allocation of the liability risks in the DES cases between manufacturer and physician is only illustrative rather than prescriptive of the form of allocation that will occur for the products of pharmacogenomics. The main thrust of the DES cases is to illustrate that the standard of care for physicians undergoes a major shift when physicians are operating on the frontiers of medical practice or engaged in clinical research. This allows for the manufacturer s responsibility to be derivative of the physician s duty to deal "fairly" with patients with regard to the risks. 

The latter view prevailed but generated yet another set of issues as to whether disclosure rules should be evaluated from the perspective of professionals or patients. Some courts took the narrower view of duty by ruling that professional standards should be used to determine what should be disclosed to patients. Although this theory of "lack of informed consent" was distinct from whether the health care provider had violated the standard of care, most courts, and many legislatures, confined the doctrine s operation to a very narrow set of circumstances consistent with the negligence standard underlying the standard of care in medical cases. Other courts took what is called the broader view and leaned toward the patient s perspective while requiring juries to impose the reasonable patient s view of risk rather than the particular patient s view of risks. 

Fleischer, L., "From Pill-Counting to Patient Care Pharmacists Standard of Care in Negligence," Fordham L. Rev., 68, 165-207 (1999). 

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