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Use of Insulin Pumps in India: Suggested Guidelines Based on Experience and Cultural Differences.

Diabetes Technol Ther. 2010 Aug 31;

Authors: Kesavadev J, Das AK, Unnikrishnan R, Joshi SR, Ramachandran A, Shamsudeen J, Krishnan G, Jothydev S, Mohan V

Abstract All type 1 diabetes mellitus (T1DM) subjects and the majority of type 2 diabetes mellitus (T2DM) subjects at one time or another require insulin to sustain life. Syringes and pens are presently the most popular insulin delivery devices. Though in use for more than 3 decades, insulin pumps are now being more commonly used because of their unique ability to continuously infuse insulin, closely mimicking that of physiological secretion from a normal pancreas. Unlike insulin shots with syringes, pump infusion sites need to be changed less frequently. Scientific evidence from published studies have proven added benefit of insulin pumps in improving quality of life, normalizing sugars in recalcitrant diabetes, improving sexual function, and relieving the intractable pain of neuropathy. In the western world, pumps are commonly used with T1DM subjects, whereas in India 80% of pumpers are T2DM subjects. The success of insulin pump therapy depends on selection of the right candidate, extensive education, motivation, and implementing the sophisticated programs with skill. However, all affordable patients are not ideal candidates for pump therapy because for successful continuation of pump therapy other inclusion criteria should also be fulfilled. Among the other indications discussed are a high level of insulin resistance, brittle diabetes, chronic kidney disease on renal replacement therapy, and continuous glucose monitoring pattern strongly suggesting need for a variable basal insulin infusion rate. In International Diabetes Foundation data released in 2009, estimated diabetes prevalence for 2010 is 285 million, representing 6.4% of the world's adult population, with a prediction that by 2030 the number of people with diabetes will have increased to 438 million. Considering this massive growth in T2DM and its propensity after 10-15 years to lead to an insulin-deficient state, available evidence from studies is a compelling indication not to deny the benefits of continuous subcutaneous insulin infusion in selected T2DM subjects. This article aims at suggesting guidelines based on clinical experience and cultural diversity for India and developing countries.

PMID: 20807118 [PubMed - as supplied by publisher]

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< ![CDATA[

Use of Insulin Pumps in India: Suggested Guidelines Based on Experience and Cultural Differences.

Diabetes Technol Ther. 2010 Aug 31;

Authors: Kesavadev J, Das AK, Unnikrishnan R, Joshi SR, Ramachandran A, Shamsudeen J, Krishnan G, Jothydev S, Mohan V

Abstract All type 1 diabetes mellitus (T1DM) subjects and the majority of type 2 diabetes mellitus (T2DM) subjects at one time or another require insulin to sustain life. Syringes and pens are presently the most popular insulin delivery devices. Though in use for more than 3 decades, insulin pumps are now being more commonly used because of their unique ability to continuously infuse insulin, closely mimicking that of physiological secretion from a normal pancreas. Unlike insulin shots with syringes, pump infusion sites need to be changed less frequently. Scientific evidence from published studies have proven added benefit of insulin pumps in improving quality of life, normalizing sugars in recalcitrant diabetes, improving sexual function, and relieving the intractable pain of neuropathy. In the western world, pumps are commonly used with T1DM subjects, whereas in India 80% of pumpers are T2DM subjects. The success of insulin pump therapy depends on selection of the right candidate, extensive education, motivation, and implementing the sophisticated programs with skill. However, all affordable patients are not ideal candidates for pump therapy because for successful continuation of pump therapy other inclusion criteria should also be fulfilled. Among the other indications discussed are a high level of insulin resistance, brittle diabetes, chronic kidney disease on renal replacement therapy, and continuous glucose monitoring pattern strongly suggesting need for a variable basal insulin infusion rate. In International Diabetes Foundation data released in 2009, estimated diabetes prevalence for 2010 is 285 million, representing 6.4% of the world's adult population, with a prediction that by 2030 the number of people with diabetes will have increased to 438 million. Considering this massive growth in T2DM and its propensity after 10-15 years to lead to an insulin-deficient state, available evidence from studies is a compelling indication not to deny the benefits of continuous subcutaneous insulin infusion in selected T2DM subjects. This article aims at suggesting guidelines based on clinical experience and cultural diversity for India and developing countries.

PMID: 20807118 [PubMed - as supplied by publisher]

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Guidelines for the control of nausea and vomiting with chemotherapy of low or minimal emetic potential.

Support Care Cancer. 2010 Aug 29;

Authors: Olver I, Clark-Snow RA, Ballatori E, Espersen BT, Bria E, Jordan K

PURPOSE: The purpose of this study is to update the guidelines for antiemetic therapy to be used with anticancer agents of low to minimal emetic potential. METHODS: Experts from the Multinational Association of Supportive Care in Cancer (MASCC) met in Perugia in 2009 to revise the MASCC antiemetic consensus guidelines. There is an increasing number of anticancer agents which are classified as being associated with a low or minimal risk of nausea and vomiting. However, the emetic potential of such agents and particularly those given as prolonged oral therapy is not well documented, and neither is the optimal antiemetic therapy. RESULTS: The consensus is that patients receiving anticancer therapy of low emetic potential should receive single-agent antiemetic prophylaxis such as dexamethasone, 5 hydroxytryptamine3 (5HT3) receptor antagonists, or dopamine receptor antagonists. Those receiving anticancer therapy of minimal emetic potential and who have no prior history of nausea and vomiting should not receive antiemetic prophylaxis. Those who experience nausea and vomiting subsequently can receive single-agent dexamethasone, 5HT3 receptor antagonists, or dopamine receptor antagonists. CONCLUSIONS: More data are needed on the emetic potential and the outcome of antiemetic treatment with agents likely to fall into the low or minimal emetic potential category.

PMID: 20803222 [PubMed - as supplied by publisher]

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< ![CDATA[

Guidelines for the control of nausea and vomiting with chemotherapy of low or minimal emetic potential.

Support Care Cancer. 2010 Aug 29;

Authors: Olver I, Clark-Snow RA, Ballatori E, Espersen BT, Bria E, Jordan K

PURPOSE: The purpose of this study is to update the guidelines for antiemetic therapy to be used with anticancer agents of low to minimal emetic potential. METHODS: Experts from the Multinational Association of Supportive Care in Cancer (MASCC) met in Perugia in 2009 to revise the MASCC antiemetic consensus guidelines. There is an increasing number of anticancer agents which are classified as being associated with a low or minimal risk of nausea and vomiting. However, the emetic potential of such agents and particularly those given as prolonged oral therapy is not well documented, and neither is the optimal antiemetic therapy. RESULTS: The consensus is that patients receiving anticancer therapy of low emetic potential should receive single-agent antiemetic prophylaxis such as dexamethasone, 5 hydroxytryptamine3 (5HT3) receptor antagonists, or dopamine receptor antagonists. Those receiving anticancer therapy of minimal emetic potential and who have no prior history of nausea and vomiting should not receive antiemetic prophylaxis. Those who experience nausea and vomiting subsequently can receive single-agent dexamethasone, 5HT3 receptor antagonists, or dopamine receptor antagonists. CONCLUSIONS: More data are needed on the emetic potential and the outcome of antiemetic treatment with agents likely to fall into the low or minimal emetic potential category.

PMID: 20803222 [PubMed - as supplied by publisher]

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[When guidelines are confronted with health care reality : Purpose of guidelines from the perspective of a psychiatrist.]

Nervenarzt. 2010 Aug 28;

Authors: Mönter N

The National Health Care guidelines on unipolar depression play a leading role regarding the multitude of players providing general care services, regarding scientific research and, last but not least, regarding common etiologic and therapeutic concepts as perceived by affected people and their relatives. In terms of health care, depression as a universal disorder comprises qualitative and quantitative aspects. For practicing neurologists/psychiatrists the guidelines provides many suggestions for different forms of treatment of the many kinds of depressive patients. When using a comprehensive approach, the criteria of evidence-based medicine are particularly important for practicing psychiatrists regarding the knowledge based on medical experience and patients preferences. It is important to point out that the hitherto fervently debated treatment dichotomy of psychotherapy versus pharmacotherapy is beginning to diminish. This is also reflected by the holistic perception of diseases and treatment approaches prevailing among established psychiatrists and the apparent development of health care quality towards individualized medicine.

PMID: 20798914 [PubMed - as supplied by publisher]

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[The concept of the development of S3 guidelines : Additional benefit compared to traditional standards, problems and solutions.]

Nervenarzt. 2010 Aug 28;

Authors: Pfennig A, Kopp I, Strech D, Bauer M

Guidelines for the diagnosis and treatment of psychiatric disorders developed on the highest qualitative methodical standard cover reliable decision guidance and are an important instrument of quality improvement in health care. They have to be accessible with little effort and should be concise and clearly presented to be used in daily routine. Early integration of members of the different professions, patients and their care givers into the development process is essential for acceptance. The development process of a S3 guideline is complex and poses a difficult challenge to personal manpower and funding, which is met by the associations of the Association of Medical Societies in Germany. Further scientific discussion is necessary to find adequate solutions for problematic topics or potential distortion, such as the consequences of inadequate reporting of studies, insufficient recording and reporting of the risk of damage, unpublished data and lacking interest of sponsors in specific topics.

PMID: 20798915 [PubMed - as supplied by publisher]

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[Guideline intentions of the German Society of Psychiatry, Psychotherapy and Nervous Diseases (DGPPN).]

Nervenarzt. 2010 Aug 28;

Authors: Wobrock T, Schneider F, Falkai P

The practice guidelines of the German Society of Psychiatry, Psychotherapy and Nervous Diseases (DGPPN) include systematically developed and evidence-based treatment recommendations which assist clinicians and patients in making decisions about appropriate treatment for specific conditions. The intentions of practice guidelines are to improve the quality of care and the outcome of mental diseases. This paper describes the methodology behind the development of the guidelines and lists the already existing practice guidelines as well as the guidelines actually being developed. In addition, it is outlined how quality indicators may be derived from guidelines. A major aim of the German Society of Psychiatry, Psychotherapy and Nervous Diseases (DGPPN) is to assure the quality of inpatient and outpatient care of the mentally ill by developing evidence-based consensus guidelines.

PMID: 20798916 [PubMed - as supplied by publisher]

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[Evidence-based therapy of depression : S3 guidelines on unipolar depression.]

Nervenarzt. 2010 Aug 28;

Authors: Härter M, Klesse C, Bermejo I, Bschor T, Gensichen J, Harfst T, Hautzinger M, Kolada C, Kopp I, Kühner C, Lelgemann M, Matzat J, Meyerrose B, Mundt C, Niebling W, Ollenschläger G, Richter R, Schauenburg H, Schulz H, Weinbrenner S, Schneider F, Berger M

Unipolar depressive disorders are among the most frequent reasons for utilizing the health care system. Although efficacious treatments are available and further advances have recently been made there is still a need for improving diagnostic and therapeutic procedures. Alignment of treatment on evidence-based treatment guidelines establishes an essential mainstay. The new S3 and National Health Care guidelines on unipolar depression, the compilation of which was coordinated by the German Society of Psychiatry, Psychotherapy and Neurology (DGPPN) and which were approved by 29 scientific and professional associations, is the ambitious effort to present state of the art evidence and clinical consensus for the treatment of depression. For pharmacotherapy of depression differentiated recommendations can be given, also separate from and in addition to psychotherapy.

PMID: 20802992 [PubMed - as supplied by publisher]

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< ![CDATA[

[When guidelines are confronted with health care reality : Purpose of guidelines from the perspective of a psychiatrist.]

Nervenarzt. 2010 Aug 28;

Authors: Mönter N

The National Health Care guidelines on unipolar depression play a leading role regarding the multitude of players providing general care services, regarding scientific research and, last but not least, regarding common etiologic and therapeutic concepts as perceived by affected people and their relatives. In terms of health care, depression as a universal disorder comprises qualitative and quantitative aspects. For practicing neurologists/psychiatrists the guidelines provides many suggestions for different forms of treatment of the many kinds of depressive patients. When using a comprehensive approach, the criteria of evidence-based medicine are particularly important for practicing psychiatrists regarding the knowledge based on medical experience and patients preferences. It is important to point out that the hitherto fervently debated treatment dichotomy of psychotherapy versus pharmacotherapy is beginning to diminish. This is also reflected by the holistic perception of diseases and treatment approaches prevailing among established psychiatrists and the apparent development of health care quality towards individualized medicine.

PMID: 20798914 [PubMed - as supplied by publisher]

]]>

Related Articles

< ![CDATA[

[The concept of the development of S3 guidelines : Additional benefit compared to traditional standards, problems and solutions.]

Nervenarzt. 2010 Aug 28;

Authors: Pfennig A, Kopp I, Strech D, Bauer M

Guidelines for the diagnosis and treatment of psychiatric disorders developed on the highest qualitative methodical standard cover reliable decision guidance and are an important instrument of quality improvement in health care. They have to be accessible with little effort and should be concise and clearly presented to be used in daily routine. Early integration of members of the different professions, patients and their care givers into the development process is essential for acceptance. The development process of a S3 guideline is complex and poses a difficult challenge to personal manpower and funding, which is met by the associations of the Association of Medical Societies in Germany. Further scientific discussion is necessary to find adequate solutions for problematic topics or potential distortion, such as the consequences of inadequate reporting of studies, insufficient recording and reporting of the risk of damage, unpublished data and lacking interest of sponsors in specific topics.

PMID: 20798915 [PubMed - as supplied by publisher]

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