International journal of clinical practice. Supplement
-
The predominant number of papers published from the middle of 2009 to the middle of 2010 about alternative routes of insulin administration (ARIA) were still about inhaled insulin. Long-term experience with Exubera was the topic of a number of publications that are also of relevance for inhaled insulin in general. The clinical trials performed with AIR insulin by Eli Lilly were published in a supplement issue of one diabetes technology journal and most of these will be presented. ⋯ Selection of the manuscripts from all publications was predominately based on the fact whether they presented data from clinical studies or not. The selected studies were critically reviewed for novelty and appropriate study design etc. In some cases also reviews about a given topic were selected if they provide relevant novel insights.
-
Int J Clin Pract Suppl · Feb 2011
ReviewDiabetes technology and treatments in the paediatric age group.
Type 1 diabetes (T1D) is one of the most common chronic childhood diseases and its incidence has doubled during the last decade. The goals of intensive management of diabetes were established in 1993 by the Diabetes Control and Complications Trial (DCCT) (1). Children with T1D and their caregivers continue to face the challenge to maintain blood glucose levels in the near-normal range. ⋯ Similarly, β-cell function was shown to be preserved in children receiving the lower of two doses of ingested human recombinant interferon-α (hrINF-α) in comparison with subjects who received placebo (18). A future larger trial of both of these agents will be of interest. In this review of the literature we have tried to select recent publications that offer some insight into these issues in paediatric patients with T1D.
-
Int J Clin Pract Suppl · Jan 2011
ReviewDrugs and toxins-associated pulmonary arterial hypertension: lessons learned and challenges ahead.
Since the identification of the link between pulmonary arterial hypertension (PAH) and exposure to certain drugs and toxins nearly fifty years ago, the expanding landscape of available pharmaceuticals and illicit drugs is further fueling this association. While some causative agents in drugs and toxins associated PAH (D&T-APAH) have been identified, little is known about the exact biology and clinical implications of the disease. In this review, we discuss the historical evidence that links PAH with exposure to anorexinogens, cocaine, and methamphetamines and concentrate on what is known about potential pathogenesis, clinical manifestations, and current management. We conclude that future research should focus on studies looking at clinical outcome and susceptibility factors.
-
Int J Clin Pract Suppl · Nov 2010
ReviewHow has epoprostenol changed the outcome for patients with pulmonary arterial hypertension?
Pulmonary arterial hypertension (PAH), characterized by increased pulmonary vascular resistance and pulmonary artery pressure, is a significant cause of morbidity and mortality in children and adults. Prior to 1995, there were no approved therapies for PAH. ⋯ Due to the mode of delivery of epoprostenol, i.e. continuous intravenous infusion 24/7 via an indwelling central venous line, there are significant side effects than can occur with its use, e.g. bacteremia, sepsis, thromboembolic events, that can be fatal. Furthermore, there is significant variability in the optimal dose in both children and adult patients. It remains unclear why there is such dose variability between patients to achieve optimal efficacy. Furthermore, its mechanism(s) of action remain unclear.
-
Int J Clin Pract Suppl · Feb 2010
ReviewInternet and information technology use in treatment of diabetes.
This chapter contains clinical studies and reviews of the state-of-the-art regarding how information technology can help improve outcomes for patients with diabetes through enhanced education and support. With the increasing sophistication of diabetes treatment protocols and diabetes-related devices this new modality offers a remarkable opportunity for clinicians and patients. For the first time, with online tools clinicians are in a position to have a major impact on diabetes outcomes by providing robust and affordable just-in-time support to large numbers of patients who want to improve their diabetes outcomes through enhanced self-management of the complex behaviours so essential for good outcomes. ⋯ As with online intervention, a 'virtual coach' can provide individualised guidance and support based on readily available analyses of each patient's characteristics and performance. In addition, the clinician can communicate frequently and efficiently, offering personalised email support to each patient without requiring in-person meetings, as well as monitor 'virtual support groups' where patients interact with others online via informational chat rooms and blogs. By incorporating web-based patient self-management and support into traditional treatment methods, one clinician can effectively support many patients - one patient at a time.