Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Disease management has been around a long time, certainly since Pasteur. Its initial focus was to eliminate or contain epidemics. In the 20th century, American public health scientists and officials have used disease management to address a high-risk, often poor population. Currently, the population-based principles of disease management, including disease prevention activities, are being applied to noninfectious diseases. Two examples of public health disease prevention strategies are vaccinations and chlorination of water. Hospitals are now providing post-hospital disease management programs for selected chronic conditions that account for a high volume of repeat admissions or emergency department visits, such as chronic heart failure, asthma, and cancer. In other words, hospitals are spending money on a program that, if done right, will reduce their inpatient revenues. They are doing so for various reasons (e.g., because they have established at-risk financial partnerships with their physicians, or possibly because other area hospitals are doing it, or possibly because they want to keep the ancillaries [x-rays, laboratory, pharmacy, ambulatory surgery, etc]). Regardless of the reasons, hospital case managers will be charged with referring qualified patients to both hospital-based and provider-based disease management programs.
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PMID:The disease management approach to cost containment. 1006 45

Therapy for asthma is being prescribed more frequently. However, asthma mortality remains high in many countries. Fatal outcome is not always related to inadequate follow-up. In this article we report that children with mild to moderate symptoms may present a fatal attack. Many factors are responsible for such an outcome: asphyxia +3 due to ventilation/perfusion mismatch and/or bronchospasm, cardiac failure, cardiac arrhythmia, intrinsic positive expiratory pressure, or metabolic disturbances (hypokalemia, for example). Such problems can occur in predisposed patients: it has been shown that the chemosensitivity to hypoxia and the perception of dyspnoea are altered in certain patients with near-fatal asthma. It is very important to identify children at risk of severe asthma and to organize care so as to optimize the management of such children.
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PMID:[Acute severe asthma in children. Epidemiological, physiopathological and clinical aspects]. 1019 29

An analysis was made of 414 admissions during a one-year period to three general practitioner beds. Within the first day, 20% of the patients were discharged, while 22% were transferred to the main hospital after examination and primary treatment. 58% stayed more than one day. The mean stay was 5.0 days. The three major groups of medical conditions according to the International Classification of Primary Care were cardiovascular diseases, diseases of the musculoskeletal system and diseases of the lungs and the respiratory tract. Patients > or = 60 years of age constituted 55.8% of the total, taking up 80.6% of total bed days. In the age group > or = 80 years of age, there were three admissions for every five inhabitants, while two in five had one or more hospital stay. 65% of all patients (15.7%) had two stays or more, taking up a total of 60.5% of total bed days. Using the general practitioner beds as a low threshold service proved especially useful with patients suffering from heart failure, asthma or chronic obstructive lung disease. The beds had a key function in the rehabilitation of the elderly, in the care of cancer patients, and in terminal care. They were of basic importance to the organisation of daily emergencies.
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PMID:[The use of cottage hospitals' beds in Nordkapp]. 1080 83

We investigated the effect of amrinone, a phosphodiesterase III inhibitor, on rat airway smooth muscle, and thereafter, compared its activity with aminophylline and diltiazem. Amrinone produced relaxation of the acetylcholine-induced airway contraction in a dose-related manner. This bronchodilatory activity of amrinone was similar to that of aminophylline, but smaller than that of diltiazem. The 50% relaxant effect (ED50) of amrinone, aminophylline and diltiazem were 3.6 x 10(-4) M, 1.4 x 10(-4) M and 1.4 x 10(-5) M, respectively. Diltiazem was the most potent airway relaxant, and amrinone was less potent in these experiments. Taken together in its positive inotropic and chronotropic effects and anti-inflammatory activity, however, amrinone could be beneficial for treatment of patients suffering from asthma or heart failure with cardiac asthma.
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PMID:Comparative effect of amrinone, aminophylline and diltiazem on rat airway smooth muscle. 1090 23

Increases in expenditure on medicines above the level of increases in health care are generally, a feature of all Western health systems. From the early 1990's, the average annual growth rate (AAGR) in pharmaceutical expenditure exceeded the AAGR in health among all the European member states 1. In Ireland, the expenditure on drugs, as a percentage of health care spending, was 7.1% in 1987 compared with 9.2% in 1997. The state expenditure on medicines increased from 165.8 million Pounds in 1993 to 278 million Pounds in 1998 representing an average increase of 11% each year. All the available evidence indicates that the expenditure on medicines will continue to show real growth, and take an increasing share of the total health care budget. Analysis shows that the main reasons driving such growth include those of "product mix"--the prescribing of newer, more expensive medicines, in addition to the 'volume effect' comprising growth in the number of tablets per prescription. These two factors account for 80% of the observed increase in drug cost 2. Six therapeutic classes accounted for 16 of the top 20 most expensive drugs prescribed under the GMS in 1998 3. These areas can be classified as follows: peptic ulcer disease, asthma, hypertension/cardiac failure, antidepressants, anti inflammatory and lipid lowering drugs. In this article we discuss the clinical evidence base, and the pharmacoeconomic implications of lipid lowering therapy in this country.
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PMID:Pharmacoeconomics of lipid lowering therapy in Ireland. 1096 65

beta(1)- and beta(2)-adrenergic receptors are G protein-coupled receptors expressed throughout the body and serve as receptors for the catecholamines epinephrine and norepinephrine. They are targets for therapeutive agonists and/or antagonists in treatment of heart failure and asthma. Nonsynonymous coding and promoter polymorphisms of both receptors have been identified in the general population. These have been mimicked in transfected cell systems and transgenic mice, and show altered expression, ligand binding, coupling, or regulation phenotypes. Clinical studies to date have revealed that some of these polymorphisms have a significant disease modifying effect or alter the response to treatment. These are some of the first G protein coupled receptor polymorphisms to undergo extensive in vitro study and clinical validation; there are likely to be polymorphisms of other receptors of the superfamily that will have clinical relevance as well.
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PMID:Pharmacogenetics of beta-1- and beta-2-adrenergic receptors. 1097 Dec 2

Recent studies have shown that particulate air pollution is a risk factor for hospitalization for heart and lung disease; however, little is known about what subpopulations are most sensitive to this pollutant. We analyzed Medicare hospital admissions for heart disease, chronic obstructive pulmonary disorders (COPD) and pneumonia in Chicago, Cook County, Illinois, between 1985 and 1994. We examined whether previous admissions or secondary diagnoses for selected conditions predisposed persons to having a greater risk from air pollution. We also considered effect modification by age, sex, and race. We found that the air-pollution-associated increase in hospital admissions for cardiovascular diseases was almost doubled in subjects with concurrent respiratory infections. The risk was also increased by a previous admission for conduction disorders. For COPD and pneumonia admissions, diagnosis of conduction disorders or dysrhythmias increased the risk of particulate matter < 10 microm in aerodynamic diameter (PM(10))-associated admissions. Persons with asthma had twice the risk of a PM(10)-associated pneumonia admission and persons with heart failure had twice the risk of PM(10)-induced COPD admissions. The PM(10) effect did not vary by sex, age, and race. These results suggest that patients with acute respiratory infections or defects in the electrical control of the heart are a risk group for particulate matter effects.
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PMID:Are there sensitive subgroups for the effects of airborne particles? 1101 88

Acute infections of the lower respiratory tract first require a weighing up of risks, which is of importance in particular for the decision for or against antibiotic therapy. Severe or longlasting exacerbations of a chronic obstructive bronchitis, severe and rapidly progressive bronchial asthma or infection associated with bronchiectasis in an underlying antibody deficiency syndrome, primary ciliary dyskinesia and mucoviscidosis. In the case of systemic immunodeficiencies such as the antibody deficiency syndrome, HIV infection or immunosuppressive therapy, the indication for antibiotic treatment is more liberally established. In combination with respiratory tract infections, serious underlying disease such as left heart insufficiency or diseases of the lungs, may become life-threatening. Of decisive importance for the outcome in such cases are, besides the use of antibiotics, such as treatment of the cardiac insufficiency or long-term oxygen therapy. Timely vaccination can prevent severe illness.
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PMID:[Acute infection of the lower respiratory tract: how long to observe?]. 1113 86

This review briefly overviews the pathophysiology of dyspnoea and then focuses on discussion of the most frequent causes of chronic and acute dyspnoea in the elderly. The most common causes of dyspnoea in the elderly include heart failure, chronic obstructive pulmonary disease and asthma. Other causes include parenchymal lung disease, pulmonary vascular diseases, upper airway obstruction and pneumonia. Dyspnoea should not be attributed to aging alone. Careful clinical evaluation and spirometry is indicated, and additional testing may be appropriate. In this article, emphasis is placed on the clinical manifestations of dyspnoea in the elderly and an approach to their differential diagnosis is provided. Discussion of available therapy is beyond the scope of this article.
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PMID:Dyspnoea in the elderly: a clinical approach to diagnosis. 1130 85

On any given day a patient seen by the dental hygienist has the potential of experiencing a life-threatening medical emergency. All dental hygiene practitioners should be aware of potential risks that a patient may present, take steps to prevent life-threatening events from occurring, and plan for problems in advance of their happening. The primary goal of this course is to help dental hygienists carry out the ethical, moral, legal, and professional obligation owed any patient. The course will review the basics of medical emergencies, with particular emphasis on those that are most likely to occur in the dental office. Discussion will center on general aspects of prevention and preparation, and will focus on the recognition and emergency treatment of specific conditions. Vasodepressor syncope, orthostatic hypotension, acute adrenal insufficiency, hyperventilation, asthma, heart failure and acute pulmonary edema, cerebrovascular accident seizures, hyperglycemia, hypoglycemia, myocardial infarction, angina pectoris, and anaphylaxis will be emphasized.
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PMID:Medical emergencies in the oral health care setting. 1131 57


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