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In both adults and children with diabetes, technologies such as continuous subcutaneous insulin infusion using insulin pumps and continuous glucose monitoring can help improve diabetes control, reduce hypoglycaemia and improve quality of life. Access to these technologies in the UK is very variable. Some technologies are recommended by the National Institute for Health and Care Excellence, while others have not been appraised, and new technologies are emerging all the time. Additionally, different guidelines for adults and children further complicate access to diabetes technology in the transition from paediatric to adult care. Against this background, Diabetes UK and NHS England have brought together a multidisciplinary group of experts, including clinicians and people with diabetes, to develop this consensus guideline, combining the different technologies into a common pathway to aid clinical and policy decision‐making. We created a pathway that supports the incremental addition of technology as monotherapy and then dual therapy in the same way that we incrementally add in therapeutic agents to support people with Type 2 diabetes to achieve their personalized glycaemic targets. The pathway emphasizes the importance of structured education, specialist support and appropriate access to psychological therapies, as essential pillars for optimized use of diabetes‐related technology, and recommends the re‐evaluation of its use when the individual is unable either to use the technology appropriately or to achieve the intended outcomes. This pathway is endorsed by UK‐wide clinical and patient associations and we recommend that providers and commissioners use it to ensure the right individual with diabetes has access to the right technology in a timely way to help achieve better outcomes. 相似文献
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Martín-Nares Eduardo Zuñiga-Tamayo Diego Hinojosa-Azaola Andrea 《Clinical rheumatology》2019,38(1):97-106
Clinical Rheumatology - We aimed to estimate the frequency of overlap of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with systemic autoimmune diseases. Retrospective... 相似文献
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M. Lauda-Maillen E. Liuu M. Catroux A. Caupenne M. Priner F. Cazenave-Roblot C. Burucoa P. Ingrand M. Paccalin 《Médecine et maladies infectieuses》2019,49(3):173-179
Objective
Age > 65 years is associated with the recurrence and poor prognosis of Clostridium difficile infection (CDI). Data on elderly patients (≥ 75 years) is scarce, and little is known about compliance with European guidelines in terms of specific treatment. We aimed to analyze the treatment and prognosis of CDI in two groups of patients aged < and ≥ 75 years.Patients and methods
We performed a prospective survey from May 2014 to April 2015 in a university hospital including all patients presenting with microbiologically confirmed CDI. Sociodemographic and clinical data, treatment of CDI, recurrences (< 8 weeks after CDI treatment completion), new episodes, and mortality were recorded. Follow-up was performed until February 2016.Results
Overall, 101 patients were included; 45 were aged ≥ 75 years (44.6%). More than two-thirds of CDIs (71/101) were severe. Seven per cent of patients presenting with severe CDI and 10% of patients at increased risk of recurrence received the adequate treatment as per European guidelines. Mean follow-up was 15 ± 4 months (range: 10–22). Among patients aged ≥ 75 years, we observed the same number of recurrences and new episodes of CDI during the follow-up. The 3-month case fatality was significantly higher in the elderly group (P < 0.001). The one-year survival rate was 73.2% in younger patients and 45.7% in elderly patients (P = 0.0004).Conclusion
This study confirms the poor prognosis of CDI in elderly patients and highlights the lack of compliance with treatment guidelines. 相似文献109.
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