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PubMed1999

Pharmacological management of diabetes: recent progress and future perspective in daily drug treatment.

Glycaemic control in Type 1 diabetes has been proven efficient in preventing microvascular and neurological complications. The assumption that good control of hyperglycaemia may also have significant impact on alleviation of complications in Type 2 diabetes has gained growing support in recent years. Measures such as body weight reduction and exercise improve the metabolic defects, but pharmacological therapy is most frequently used. The sulphonylureas stimulate insulin secretion. Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycaemia. Acarbose helps to spread the dietary carbohydrate challenge to endogenous insulin over time. These pharmacological treatments can improve blood glucose regulation in Type 2 diabetes patients. However, the key to strict glycaemic control with use of exogenous insulin lies in the creation of delivery methods that emulate physiologic insulin secretion. Insulin lispro, a recombinant insulin analogue, is identical to human insulin except for the transposition of proline and lysine at positions 28 and 29 in the C-terminus of the B chain. Evidence suggests that patients perceive their quality of life to be improved with insulin lispro when compared with regular human insulin, and that satisfaction with treatment is greater with the insulin analogue. Numerous new pharmacological approaches are under active investigation, with the aim of promoting insulin secretion, improving the action of insulin, or slowing carbohydrate absorption. With respect to continuous subcutaneous insulin infusion therapy and implantable pumps, despite that this approach is not widely utilised, it appears to bring us as close to achieving glycaemic control as is feasible with current treatment approaches. However, general application of such technology requires significant improvements in several areas, such as improvement of patency of catheter, pump failures due to early battery depletion incidents, and pump miniaturisation. Future perspective resides on insulin analogues with longer half-lives that would provide better basal insulin coverage in association with fast-acting analogues.

Diabetes Mellitus↗

PubMed2006

[Positron emission tomography: current use in internal medicine and future perspectives].

PURPOSE: Fluorodeoxyglucose positron emission tomography (FDG-PET) is a promising imaging technique that has already proven effective in modifying patient care in oncology. Fluorodeoxyglucose still remains the main radiopharmaceutical agent routinely used for PET imaging. A growing interest has recently lead to broaden PET research on benign disorders. The field of inflammatory or immune diseases and globally the field of internal medicine could also be impacted by FDG-PET. MAIN POINTS: Great vessels vasculitides and fever of unknown origin have both been studied by several teams and could become indications for PET. In addition, current indications now extend to paraneoplastic syndromes. It is thus possible to foresee that the clinical applications for PET will continue to expand in these patients. PERSPECTIVES AND PROJECTS: In the future, inflammatory arthritis, chronic inflammatory bowel diseases, systemic erythematous lupus, histiocytosis, or pulmonary and retroperitoneal fibrosis might benefit from PET even if, available data remains scarce to this day. Although PET will probably alter the landscape of patient management in internal medicine in the near future, additional clinical research is still needed to ascertain the exact role of PET.

Fever of Unknown Origin↗

PubMed1992

[Indications, problems and future perspectives of bone marrow transplantation in pediatrics].

Bone marrow transplantation (BMT) is an established therapy in pediatric oncology and is increasingly used as curative approach in the treatment of congenital, non-oncologic diseases of the lymphohematopoietic system. There is increasing evidence, however, that BMT can be followed by severe long term effects including neuroendocrine, ophthalmologic, dental and central nervous system abnormalities, particularly in children. Therefore the indication to BMT depends on the results obtained by conventional therapy. Due to the high cure rates of leukemia with conventional therapy BMT is only warranted following relapse except for certain forms with poor prognosis factors. For patients with chronic myelogeneous leukemia, however, BMT is the only chance of cure. In solid tumors the role of BMT is more difficult, because there is no clear evidence that BMT is superior to conventional therapy with regard to long term survival. In severe aplastic anemia, however, the long term results of BMT are clearly better than those obtained by conventional therapy. Other undisputed indications for BMT are severe combined immuno deficiencies and other congenital diseases for which BMT is currently the only curative therapy. Progress with matched unrelated donor transplantations by better histocompatibility testing and more specific immunosuppressive therapy to reduce graft-versus-host disease, still a major problem of allogeneic BMT, as well as the perspectives of gen therapy in the future will offer a chance of cure to many patients without a matched sibling donor.

Anemia, Aplastic↗

PubMed1993

The discipline of nursing: historical roots, current perspectives, future directions.

As advances in nursing science and research impact upon nursing education and clinical practice, new ways of looking at phenomena have led to a re-examination and refinement of the traditional concepts: person, environment, health and nursing. This evolving pattern of intellectual growth holds promise for the discipline of nursing through the advancement of knowledge based upon scientific inquiry into the practice of nursing. This paper discusses nursing as a discipline by examining the development of a unique body of knowledge from three viewpoints: historical past, current perspectives and future direction.

Community Participation↗

PubMed2000

Human exposure to PCDD/Fs in the UK: the development of a modelling approach to give historical and future perspectives.

In order to assess the long-term impact of persistent organic contaminants such as polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDD/Fs) it is important to be able to quantify historical exposure. An understanding of past exposure is not only important to place our current body burdens in perspective, but is useful in assessing our potential future exposure. Unfortunately, very few direct measurements of our main source of exposure (i.e., food) over the past decades are available. This study attempts to reconstruct the historical exposure of the UK population to PCDD/Fs using a combination of emission estimates, information on environmental temporal trends derived from sediment cores and archived materials, and environmental/human fate modelling. Predicted adipose and blood lipid concentrations for a typical cross section of the population are derived over time (1920-2000), which is compared with measured data. The approach has been tested with two PCDDs and two PCDFs and showed encouraging agreement with measured data. Certain parts of the modelling methodology have been highlighted where there is still poor understanding of the processes governing fate and behaviour. These areas are discussed and recommendations for future improvements are made. The paper thus represents an initial modelling approach which defines both the historical (1920-present) and future (present-2020) fate of PCDD/Fs in the UK population.

Adipose Tissue↗

PubMed1980

Future perspectives of automatization in clinical chemistry.

In planning the internal organization of central laboratories, the future needs for clinical chemistry in hospitals must be considered. For the next decade the medical laboratory will primarily be concerned with the interpretation of laboratory data and with organizational problems, such as sample identification, specimen splitting and especially the timing of its service. The consequences for instrumentation, newer technology for routine clinical chemistry, and recommendations for the future development of analytical systems are discussed.

Autoanalysis↗

PubMed2004

In vivo synergism between docetaxel and gemcitabine in patients with metastatic breast cancer: general concepts and future perspectives.

The docetaxel and gemcitabine combination is an active regimen as salvage therapy in taxane-resistant or taxane-refractory patients with metastatic breast cancer (MBC). We recently conducted a phase II study administering this combination to patients with MBC after docetaxel failure, with remarkably high response rates that could be attributed to an in vivo synergism between the two drugs. Women with MBC who were refractory or resistant to docetaxel monotherapy as first- or second-line treatment were recruited. Patients with progressive or stable disease after receiving a minimum of four cycles of docetaxel received gemcitabine 900 mg/m(2) on days 1 and 8 plus docetaxel 100 mg/m(2)on day 8, every 3 weeks. Forty-six percent of patients responded (three complete responses, 20 partial responses), while 28% had stable disease and 26% had progressive disease. Median duration of response was 6.07 +/- 2.43 months. Neutropenia was the only grade 4 toxicity, and reported in seven patients. Other grade 3 toxicities included neutropenia (12 patients), thrombocytopenia (seven patients), and anemia (one patient), while nonhematologic toxicities were easily manageable. These data outline the importance of a rational combination of existing, active chemotherapeutic agents for MBC, and broadens our perspectives for more effective combination regimens in various solid tumors in the future.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2002

Euromir 95 T4 experiment 'Human Posture in microgravity': global results and future perspectives.

After 7 years of studies on Euromir 95 T4 experiment 'Human Posture in microgravity' dataset, some important remarks can be proposed for best exploiting future experimental campaigns as well as for neurophysiological investigations on-ground. The main focus of such experiments was to monitor the process of learning and adapting to the new environment in performing complex voluntary movements. Euromir 95 was the first quantitative investigation with high technology instrumentation (ELITE-S) involving two subjects starting from 15 days after the launch until 5 months of mission. Results confirm the excellent capability of mutation of motor planning by the central nervous system (CNS) in order to best exploit environmental constraints and advantages. Under this view, the results offer a unique cue for improving the design of rehabilitation processes in motor pathologies.

Journal Article↗

PubMed2000

Future perspectives on veterinary hemoparasite research in the tropics at the start of this century.

This paper has two main objectives: (1) to promote discussion about the future of veterinary hemoparasite research at the start of the twenty-first century and the third millennium, and (2) to stimulate young students to start research on parasitology, in particular in the field of veterinary tropical diseases. It is well known that in the twenty-first century human society will be challenged by several major problems resulting from the demographic explosion, since the Earth's population for the year 2020 will reach 8.5 billion, or 10 billion for the year 2050, as long as the birth rate decreases from 2.8 births per woman today to 2.0 by the year 2030 (data released by the U.N. Population Fund, 1998). Since the food production rate, either from plant or animal origin, is lower than the human birth rate, the challenge ahead will be to produce enough food for ten billion people. Consequently, to deal with this problem, especially in developing nations, it is proposed: (1) to give priority status to scientific research in the agriculture and animal fields; (2) to concentrate financial support and efforts for research especially on hemoparasitic diseases (i.e., babesiosis, anaplasmosis, cowdriosis, ehrlichiosis, and trypanosomosis), in particular to apply biotechnology techniques to those animal diseases; and (3) to grant a better role to studies on veterinary and medical parasitology in universities of the Americas and Europe, since in these universities parasitology is currently considered a secondary subject.

Agriculture↗

PubMed1992

[Development and future perspectives of PET technology].

The physical principle of PET is discussed, and its advantages compared with SPECT are presented. Starting from the status of PET today, future developments are discussed with special reference to three-dimensional acquisition and reconstruction.

Humans↗

PubMed2004

Trends in laryngeal cancer incidence in Lithuania: a future perspective.

OBJECTIVES: The aim of the present study was to assess the incidence of larynx cancer in Lithuania in the years 1978-2001 and to outline possible future trends. MATERIALS AND METHODS: The number of new laryngeal cancer cases in 1978-2001 was obtained from the Lithuanian Cancer Registry. The Lithuanian Department of Statistics provided data on the population being at the same age in the same years. The data were adjusted for age, using the direct method in accordance with the European standard; a linear regression analysis of trends in the larynx cancer incidence was performed. RESULTS: After standardization of data for the period of 1978-2001, an upward trend was registered for both men and women: in 1978 the incidence was 10.73 for men and 0.26 for women per 100000 population, in 2001 the corresponding data were 11.6 and 0.7. Throughout the study period the incidence was higher in men than in women and the mean age of male and female larynx cancer patients was increasing: mean age for men was annually increasing by 0.1566 years and for women by 0.0602 years. The forecast for men in 2006 is 13.88 and for women 0.54 cases per 100000 population. CONCLUSIONS: The increase in larynx cancer incidence is growing more rapidly among women than among men, and the mean age of the patients is also increasing. The forecast is that in 2006 the incidence rate will be increasing, and both men and women will get ill at an older age.

Adolescent↗

PubMed1994

[Possible indications for human recombinant growth hormone in adults: current data and future perspectives].

Growth hormone (GH) secretion persists during adulthood with mostly metabolic effects, stimulating lipolysis and protein synthesis. Besides GH-deficient patients, other adult patients might in the future benefit from recombinant GH (rhGH) therapy. These conditions would mainly include: 1. Highly catabolic states in intensive-care patients (conflicting results); 2. Osteoporosis, because of significant, although moderate improvement in bone density; 3. Aging: compensating for age-related GH-deficiency has yielded positive results concerning nutritional status; in the elderly however, the risk of side-effects, above all hypervolemia, should not be overlooked; 4. Uremia, frequently associated with poor nutritional status: preliminary results in hemodialysis patients are certainly encouraging; rhGH coupled with intradialytic parenteral nutrition might be particularly efficient. Treatment of uremic patients before end-stage renal failure seems also to be contemplated since, in spite of hyperfiltration and glomerulosclerosis observed in rats receiving high doses of rhGH, no case of worsened renal failure has ever been reported in pre-dialysis children treated for stunted growth.

Adult↗

PubMed2005

Future perspectives for intraoperative MRI.

MRI-guided neurosurgery not only represents a technical challenge but a transformation from conventional hand-eye coordination to interactive navigational operations. In the future, multimodality-based images will be merged into a single model, in which anatomy and pathologic changes are at once distinguished and integrated into the same intuitive framework. The long-term goals of improving surgical procedures and attendant outcomes, reducing costs, and achieving broad use can be achieved with a three-pronged approach: 1. Improving the presentation of preoperative and real-time intraoperative image information 2. Integrating imaging and treatment-related technology into therapy delivery systems 3. Testing the clinical utility of image guidance in surgery The recent focus in technology development is on improving our ability to understand and apply medical images and imaging systems. Areas of active research include image processing, model-based image analysis, model deformation, real-time registration, real-time 3D (so-called "four-dimensional") imaging, and the integration and presentation of image and sensing information in the operating room. Key elements of the technical matrix also include visualization and display platforms and related software for information and display, model-based image understanding, the use of computing clusters to speed computation (ie, algorithms with partitioned computation to optimize performance), and advanced devices and systems for 3D device tracking (navigation). Current clinical applications are successfully incorporating real-time and/or continuously up-dated image-based information for direct intra-operative visualization. In addition to using traditional imaging systems during surgery, we foresee optimized use of molecular marker technology, direct measures of tissue characterization (ie, optical measurements and/or imaging), and integration of the next generation of surgical and therapy devices (including image-guided robotic systems). Although we expect the primary clinical thrusts of MRI-guided therapy to remain in neurosurgery, with the possible addition of other areas like orthopedic, head, neck, and spine surgery, we also anticipate increased use of image-guided focal thermal ablative methods (eg, laser, RF, cryoablation, high-intensity focused ultrasound). By validating the effectiveness of MRI-guided therapy in specific clinical procedures while refining the technology that serves as its underpinning at the same time, we expect many neurosurgeons will eventually embrace MRI as their intraoperative imaging choice. Clearly, intraoperative MRI offers several palpable advantages. Most important among these are improved medical outcomes, shorter hospitalization, and better and faster procedures with fewer complications. Certain economic and practical barriers also impede the large-scale use of intraoperative MRI. Although there has been a concerted technical effort to increase the benefit/cost ratio by gathering more accurate information, designing more localized and less invasive treatment devices, and developing better methods to orient and position therapy end-effectors, further research is needed. Indeed, the drive to improve and upgrade technology is ongoing. Specifically, in the context of the real-time representation of the patient's anatomy, we have improved the quality and utility of the information presented to the surgeon, which, in turn, contributes to more successful surgical outcomes. We can also expect improvements in intraoperative imaging systems as well as increased use of nonimaging sensors and robotics to facilitate more widespread use of intraoperative MRI.

Humans↗

PubMed1998

Palliative care: past, present, and future perspectives.

OBJECTIVES: To provide a review of the development and impact of palliative care; to discuss quality of lie as a framework for guiding clinical practice and research in palliative care; and to identify future trends that are likely to affect palliative care services. DATA SOURCES: Research studies, review articles, and book chapters. CONCLUSIONS: Palliative care is in the process of dynamic change. Advocates of palliative care are suggesting that cost-effective holistic care strategies should be available to patients and families throughout the illness trajectory, not just reserved for end of life care. IMPLICATIONS FOR NURSING PRACTICE: Incorporation of palliative care principles across the cancer illness trajectory requires an attitude shift by all members of the multidisciplinary team.

Hospice Care↗

PubMed2002

Gemcitabine and pemetrexed (Alimta) in thoracic cancers: present and future perspectives. Introduction and current controversies.

With more than 1 million new cases annually worldwide, lung cancer remains a major public health problem, and ongoing efforts against tobacco consumption will not modify this situation in the near future. Most patients with lung tumors have advanced disease at the time of presentation and are thus treated with palliative intent. Several new active cytotoxic agents (ie, gemcitabine, irinotecan, the taxanes, and vinorelbine) have emerged during the last decade, and in combination with cisplatin, offer response rates of 35% to 50% and median survival durations of 9 to 11 months. Nevertheless, the results remain disappointing in the majority of cases, and data on long-term survivors are still anecdotal. Several strategies might improve treatment efficacy: administering multidrug combinations to increase antitumor activity, ameliorating the tolerance of chemotherapy, treating patients at an earlier stage of their disease, and developing new agents. This article discusses these promising strategies and places them in proper perspective.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2003

Medical education, palliative care and moral attitude: some objectives and future perspectives.

CONTEXT: Adequate medical education has 3 interrelated aspects: theoretical knowledge, practical skills and the personal attitude of the doctor. The current emphasis on medical science diverts attention from the importance of the attitude aspect of medical education. We argue that the integration of palliative care into medical curricula can correct this imbalance between knowledge, skills and attitude. In our view, incorporating palliative care into medical training not only improves the quality of palliative care, but also contributes to the moral quality of the doctors being trained. To support our argument we emphasise the moral aspects of attitude. Moral attitude focuses on the capacity to respond to others in a humane manner and can be compared with the way a virtuous doctor acts. We show the crucial role this moral attitude plays in palliative care and the surplus value palliative care education can have in general medical training. PERSPECTIVES: We suggest that clinical experience in palliative care, supplemented by reflection on narratives about chronically ill or dying patients and mourning or ageing processes, offers prospects for developing palliative care education. These perspectives can contribute to the transformation of the present 'hidden curriculum' of contemporary medical education, which implicitly shapes the student's moral attitude, into a future more explicit enculturation into the medical realm. Ultimately, this will improve health care as a whole.

Attitude of Health Personnel↗

PubMed1999

[Endovascular graft treatment of aortic aneurysms: future perspectives].

Endovascular graft treatment of aortic aneurysms, first clinically applied by Parodi et al., has gained popularity. Although it was initially limited to high-risk patients, its indications have been gradually expanded. From literature and our own experience, the future of this method is discussed. The concept of this method is to place the intravascular stent graft in the aneurysm, excluding the aneurysmal sac and maintaining the arterial blood flow, thus preventing further dilatation and possible rupture in the future. However, these were some cases in which aneurysms, excluded completely during surgery became patent due to endoleak years after the procedure. A prospective study of abdominal aortic aneurysms, which compared endovascular graft and conventional open repair, demonstrated less major morbidity with the former but no difference in mortality, Considering those and the fact that long-term results of conventional surgical treatment have been satisfactory, the current indications for stent grafting should be limited to high-risk patients. For thoracic aortic aneurysms, endovascular treatment may become a useful alternative for those with localized as well as dissecting aneurysms because of the high perioperative morbidity accompanying conventional open repair. In summary, most patients with aortic aneurysms are senile and may have concomitant multiple organ failure. Less invasive, intravascular stent grafting has a definite role in the management of some patients with aortic aneurysms.

Aged↗

PubMed1986

Energy balance and blood-pressure regulation. Update and future perspectives.

The relationship of blood pressure to body weight within populations is well documented: it is also generally accepted that the body mass index, as well as the change in body mass index over time, are predictive of risk for future hypertension. Short-term clinical trials suggest that satisfactory blood-pressure control can be more easily achieved in obese hypertensive subjects by a successful program of weight reduction. On the other hand, the pathophysiological aspects of the association between excessive weight and high blood pressure are still obscure; particularly the putative role of hyperinsulinemia, as well as exaggerated sympathetic activity, need to be confirmed. Recent evidence indicates that upper body fat predominance and low habitual physical exercise may be factors contributing to the increase in blood pressure, but the importance of still other factors, such as associated abnormalities of cell cation transport, has to be further elucidated. From the therapeutic point of view, there is a strong need for controlled trials to confirm feasibility and effectiveness of long-term programs of weight reduction as a means to control hypertension in the obese. Based on these considerations and the enormous potential for primary prevention, the problem of energy balance and blood-pressure regulation stands as a most important issue for future cardiovascular research.

Adult↗