Introduction: Nowadays the trend to travel abroad has extremely grown. This is while, paying attention to travelers’ health is an incredibly important issue. Many organizations try their best to ...provide health services during travelers’ trips. Meanwhile, the biggest and most effecting health care providers all around the world are hospitals. Regarding this fact, a theory has been presented to help these organizations coordinate and direct much more effectively in compared to the past. It is noticeable to mention that this theory can help health care providers to gain a more sustainable position in order to develop medical tourism in their centers.
Methods: A theory has been presented in this research with different dimensions. The major aspects of this model have been designed according to the relationships which exist in families. These relationships include: parents, children and others. Each of these aspects have been divided into two segments which are female and male. These aspects play their roles in three different dimensions.
Results: According to the results this study, it can be mentioned that there are 6 relationships in regards to the HEXAL Model in health service providers. These relationships include mother, father, sister, brother, step sister and other relationships. It can be also said that each of these dimensions have different responsibilities in both health care providers and travel medicine.
Conclusion: By using this model, health service providers can collaborate much more effectively. As a result, medical tourists and even other tourists can experience much more satisfying trips throughout their lives.
This systematic review was performed to evaluate the efficacy and safety of tramadol in patients with premature ejaculation (PE).
A systematic search of PubMed®, Embase® and the Cochrane Library was ...performed to identify all randomized controlled trials (RCTs) that compared the effects of tramadol with placebo or no drug for patients with PE. The outcomes included post-therapeutic intravaginal ejaculation latency time (IELT), increases in IELT, satisfaction with sexual intercourse, control over ejaculation and side effects (SEs). The Cochrane Collaboration Review Manager software (RevMan 5.1.4) was used for statistical analysis.
A total of 5 trials, involving 715 patients, met the inclusion criteria. The synthesized data from these RCTs indicated that compared with the control, tramadol significantly increased IELT values post-therapeutically (SMD 3.51, 95% CI 2.14-4.88, p < 0.00001) and changes in IELT values were more pronounced in the tramadol group (SMD 2.87, 95% CI 2.63-3.10, p < 0.00001). Satisfaction with sexual intercourse and the ability to control ejaculation were both improved in patients in the tramadol group (p < 0.05). The incidence of SEs in the tramadol group were significantly higher than in the control group (RR 3.55, 95% CI 1.34-9.40, p = 0.01), however most SEs were mild or moderate and transient.
Tramadol may be effective in PE treatment, especially when patients have failed therapies, like selective serotonin reuptake inhibitors. However, the possibility of drug addiction and SEs should still be considered before initial use or after chronic use of this agent. More high-quality (clear randomization sequences, allocation concealment and blinding introduction), long-term, RCTs with a large number of PE patients are expected.
A meeting of 14 transplant and pharmacokinetic specialists from Europe and North America was convened in November 2001 to evaluate scientific and clinical data regarding the use of different ...formulations of cyclosporin A (CsA). The following consensus was achieved. (1) CsA is a critical-dose drug with a narrow therapeutic window. Clinical outcomes after transplantation are affected by the pharmacokinetic properties of CsA, particularly by its bioavailability, and by intrapatient variability in CsA exposure. (2) Standard bioequivalence criteria do not address differences in CsA pharmacokinetics between transplant recipients and healthy volunteers, or between subpopulations of transplant recipients. (3) In some circumstances, currently available formulations of CsA that meet standard bioequivalence criteria are likely to be nonequivalent with respect to pharmacokinetic characteristics. (4) The choice of CsA formulation can affect the short- and long-term clinical outcome. Currently, there is a lack of clinical comparisons between generic CsA formulations and the Neoral® formulation (Novartis Pharmaceuticals Corporation, East Hanover, New Jersey). Initial retrospective data from the Collaborative Transplant Study suggest that use of generic CsA formulations may result in reduced graft survival at 1 year. (5) Management of transplant recipients by monitoring Neoral concentrations 2 hours after dosing (C
2) reduces the incidence and severity of acute rejection compared with monitoring of trough concentrations with no increase in toxicity. C
2 monitoring has been developed based on the pharmacokinetics of Neoral only and has not been evaluated or validated for generic formulations of CsA. (6) The major costs of care after transplantation relate to the management of poor clinical outcomes and toxicity. CsA formulations with different pharmacokinetic properties may be associated with varying clinical outcomes, which would be expected to affect total health care costs. (7) The transplant physician is responsible for selecting immunosuppressive agents and formulations for his or her patients. Any switch between CsA formulations in a particular patient should take place only in a controlled setting with adequate pharmacokinetic monitoring.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
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