Standards of treatment

Randomized, controlled clinical trials reduce bias and variability by a process of selection, randomization and standardization of treatment, and often take place under artificial conditions isolated from those of routine clinical practice (Freemande et al, 1993 Simon et al, 1995b). Yet it is the uncontrolled interactions of a dmg technology with patients, health-care workers and the system of health care that ultimately lead to much of the variability in outcomes and expenditures in clinical practice. Thus the value of RCTs in evaluating cost-effectiveness in clinical practice maybe limited (Reeder, 1995 Simon et al, 1995b Hotopf et al, 1996). 

The current gold standard of treatment for cognitive symptoms includes pharmacologic management with a cholinesterase inhibitor and/or an N-methyl-D-aspartate (NMDA) antagonist. 

The present standard of treatment for TTP is urgent plasma exchange (PEX). If PEX is unavailable, treatment with plasma infusion and glucocorticoids is indicated until PEX is available.34... 

The current standard of treatment for chronic HCV infection is a combination of once-weekly PEG-IFN and a daily oral dose of ribavirin. Sustained virologic response rates are 54% to 56%. Therapy is optimized based on genotype, patient weight, and response to therapy. Recommended treatment regimens for HCV infection are given in Table 25-8 and Fig. 25-3. 

The federal clean water statute makes a distinction between conventional and toxic pollutants. As a result, two standards of treatment are required prior to then-discharge into the navigable waters of the nation. For conventional pollutants... 

Clozapine is considered to be the gold standard of treatment of schizophrenia with patients usually moving onto it after treatment failure with two other antipsychotics. Yet the history of it is quite chequered. When it was first introduced onto the European market in 1975 it was used freely with no restrictions on use. Following the death of eight patients in Finland from agranulocytosis, a very rare (< 1 %) but often fatal condition occur-ing normally within the first few months of use, it was voluntarily taken off the market. 

Treatment of patients with chronic HCV infection is recommended for those with an increased risk for progression to cirrhosis. The parameters for selection are complex. In those who are to be treated, however, the current standard of treatment is once-weekly pegylated interferon alfa in combination with daily oral ribavirin. Pegylated interferon alfa-2a and -2b have replaced their unmodified interferon alfo counterparts because of superior efficacy in combination with ribavirin, regardless of genotype. It is also clear that combination therapy with oral ribavirin is more effective than monotherapy with either interferon or ribavirin alone. Therefore, monotherapy with pegylated interferon alfa is recommended only in patients who cannot tolerate ribavirin. Factors associated with a favorable response to therapy include HCV genotype 2 or 3, absence of cirrhosis on liver biopsy, and low pretreatment HCV RNA levels. 

The AZT trials triggered the revision and elaboration of documents such as the Declaration of Helsinki, the CIOMS-WHO Guidelines, a new report of the NBAC of the U.S. The battlefields of the standard of treatment debate were research ethical codes. The revision of the Declaration of Helsinki (WMA 2000) at the end of the 1990s is an... 

What have we learned so far The first issue has to do with the scope that the modification of standards would imply. The double standard as a criterion is broader than the scope that appeared to guide the initial reflections. It began by targeting AIDS but quickly pervaded all research. It has affected not only standards of treatment, but also the placebo debate. If it had been introduced into ethical codes like the Declaration of Helsinki, it would have implied a "universal policy" regulating all research. 

Byrne, Andrew. Lessons from 20 Years of Addiction Treatment Look After Individuals and Public Health Improvements Follow. Journal of Addiction and Mental Health, vol. 7, Autumn 2003, p. 20. Drawing on his considerable experience, the author suggests that standardization of treatment is important in order to make programs widely available, but that treatment strategies must also be tailored to the individual. Harm reduction and public health-oriented measures have reduced overdose deaths in Switzerland and HIV transmission rates in Australia, but the United States has been slow to adopt needle exchange programs. 

Perhaps psychopharmacological treatments for psychotic disorders in the future will need to borrow a chapter out of the book of cancer chemotherapy and HIV/ AIDS therapy, in which the standard of treatment is to use multiple drugs simultaneously to attain therapeutic synergy. Combination chemotherapy for malignancy uses the approach of adding together several independent therapeutic mechanisms. When successful, this results in a total therapeutic response that is greater than the sum of its parts. 

Moisturizers and emollients have been used for years in patients with dry skin with some relief in pruritus. Moisturizers are one of the gold standards of treatment in atopic dermatitis, the hallmark... 

Ruggenenti P, Remuzzi G. Is therapy with combined ACE inhibitor and angiotensin receptor antagonist the new gold standard of treatment for nondiabetic, chronic proteinuric nephropathies NephSAP 2003 2 235-237. 

Surgery is the gold standard of treatment, as it is the only intervention that relieves symptoms in the greatest number of men with BPH. However, the two most widely used techniques are associated with the highest rates of complications, including retrograde ejaculation and erectile dysfunction. 

Technology-based controls consist of uniform EPA established standards of treatment that apply to direct industrial dischargers and publicly owned waste water treatment works. These uniform standards, known as effluent limitations, generally are in the heart of NPDES permits and place numeric limits on the amount of effluent pollutant concentrations permitted at the point of discharge (end-of-pipe). 

In the fourth chapter, biomedical applications of shape-memory polymers are presented. Vascular, orthopaedic, and neuronal applications are elaborated to illustrate how SMP can improve the standard of treatment. Additionally, the practical challenges of the development of SMP for biomedical devices are described. The fifth chapter deals with multifunctional SMP. The combination of the shape-memory effect with hydrolytic degradability and the capability to release a drug in a controlled way are described as an example of multifunctionality. Drug loading and release, as well as the effects of the drugs on the shape-memory properties are discussed and potential applications in minimally-invasive surgery are outlined. 

While many cancer treatments exist, they are limited by ensuing complications. Surgery is currently the gold standard of treatment, but it is effective only if the cancer is localized. 

Morphine has hypotensive effects, increasing peripheral vascular capacity and decreasing blood pressure, which may be mediated through adenosine. For this reason, as well as its analgesic properties, intravenous morphine has been given for myocardial infarction, although it is not a part of the current standard of treatment. 

Furthermore, it was felt that gastric ulcers in the prepyloric area not only should be managed by gastrectomy, but also should include a vagotomy. More recently, with a recognition of the potency of acid-suppressive medication and the critical role of H. pylori in perforated gastric ulcer, placation of the perforation and omental patch have become the standard of treatment in most centers. 

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