Duration of treatment with 5-aminosalicylic acid compounds.

The development of 5-aminosalicylic acid (5-ASA) therapy as a life long treatment for ulcerative colitis is reviewed from its origins in the 1940s to the present day. The drug was designed to treat rheumatoid arthritis, but was found helpful in the management of nine patients with ulcerative colitis. This discovery preceded the emergence of the clinical trial as a tool for assessing a new drug's efficacy; as a result it lacked scientific rigour and was selective in its presentation of results. Nevertheless it identified the future cornerstone of therapy in ulcerative colitis. In 1962, the first double blind controlled trial of sulphasalazine was conducted on 40 patients. Outcome measures were subjective and included symptoms and an assessment of the rectal mucosa. In 1973, the first two papers on the role of sulphasalazine in maintenance of remission were published. Both used placebo controls and had a stratified design. Outcomes were measured using "an intention to treat" approach. The British study of 64 patients used both subjective and objective criteria to assess outcomes. Patients on placebo had a relapse rate four times patients on active treatment and this founded the basis for a life long approach to therapy with 5-ASA compounds in ulcerative colitis. However, in 1985, a small "on demand" study of 32 patients suggested this approach might be as effective as continuous treatment. Some support for this view came from an Italian study which showed no benefit to continued treatment for those in remission for two years or more. The central problem these studies identify is that of adherence to treatment in the long-term. Few studies have considered patients' attitudes to continuous therapy and it is an area that needs further investigation

Specialty care in the community: the birth of a new discipline

Will the majority of healthcare services be delivered by specialists in the community

Perception gaps between patients with ulcerative colitis and healthcare professionals: an online survey.

ABSTRACT: BACKGROUND: The purpose of this study was to examine the differing perspectives and perceptual gaps relating to ulcerative colitis (UC) symptoms and their management between patients and healthcare professionals (HCPs). METHODS: Structured, cross-sectional, Web-based questionnaires designed to assess a variety of disease indices were completed by adult patients with UC and HCPs involved in the care of patients with UC from Canada, France, Germany, Ireland, Spain, and the United Kingdom. RESULTS: Surveys were completed by 775 patients, 475 physicians, and 50 nurses. Patient self-reported classification of disease severity revealed generally greater severity (mild, 32 %; moderate, 53 %) compared with physician and nurse estimates of UC severity among their caseloads (mild, 52 % and 49 %; moderate, 34 % and 37 %, respectively). Patients reported that an average of 5.5 (standard deviation, 11.0) flares (self-defined) occurred over the past year, compared with 3.4 and 3.8 flares per year estimated by physicians and nurses. Perceived flare triggers differed between patients (stress ranked first) and HCPs (natural disease course ranked first). Fifty-five percent of patients stated that UC symptoms over the past year had affected their quality of life, while physicians and nurses estimated that 35 % to 37 % of patients would have a reduced quality of life over the same period. Patients ranked urgency and pain as the most bothersome symptoms, while physicians and nurses ranked urgency and stool frequency highest. About half of patients (47 %) defined remission as experiencing no symptoms; by comparison, 62 % to 63 % of HCPs defined remission as requiring the complete absence of symptoms. HCPs (doctors/nurses in general practice and/or hospital) were regarded by patients as their main source of UC information by 72 %; however, 59 % reported not arranging regular visits to see their HCPs. CONCLUSIONS: This large survey identified important differences between patients' and HCPs' perceptions of the impact of UC symptoms on patients' lives. Notably, HCPs may underestimate the effect of specific UC symptoms on patients and may fail to recognize issues that are important to patients

Assessment in Accounting: Concept and Tools

The monograph is devoted to the study of the valuation in accounting (financial, managerial, actuarial) accounting, in the interests of business management and information support for interested parties. Reliable standing display of all accounting objects is carried out through the mechanisms of evaluation. Modern change of their dominants in the system of international standards consists, in particular, in a gradual transition first to the widespread use of fair value measurement, and then to the mixed assessment model, as well as polyvariability in valuation for financial and management accounting, the use of actuarial mathematics in determining the value business. This requires the development of elements of a particular system, presented in the work. The study of complex objects is impossible without an evolutionary retrospective, periodization and systematization of their development trends. Therefore, it is important to establish a valuation for the genesis as a tool for accounting and managing and implementing forecasts for its near future. The transparency and validity of the formation of data on the cost of accounting objects and, on their basis, a reliable representation of the elements of financial statements, is a matter of internal contradiction – between the categorical requirements of institutional and legal norms and the evaluator of subjectivity of the valuer. Ways to mitigate this contradiction, through the variability of accounting policies for valuation for various purposes and various objects, are also explored in the work. Each economic entity is closely associated with stakeholders, groups of influence, which causes the need to study the relationship between the degree of satisfaction of groups of value influence and the value of the enterprise itself for such groups. To determine the degree of this dependence, an analysis of the sensitivity of the enterprise’s value to the satisfaction of the groups of value influence is conducted, making it possible to identify priority areas for their future activities. The monograph is intended for researchers, teachers, graduate students and doctoral students, university students, accountants and managers, other professionals interested in evaluation problems