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Improved knowledge of the complex pharmacology, metabolism, mechanism of action, and toxicity profile of thiopurines has guided the development of strategies to improve pharmacotherapy in patients with IBD. This Review discusses the clinical implications of these developments, such as reducing the risk of adverse events (e.g. myelodepression and hepatotoxicity) by genetic screening, metabolite level characterization, and dose reductions.
The local staging and management of rectal cancer has evolved in the past decade. Imaging modalities used for staging rectal cancer include computed tomography, endoscopic ultrasound, magnetic resonance imaging, and positron emission tomography. In this Review, the author discusses the strengths and limitation of these modalities, along with the management of rectal cancer.
Any worthwhile guideline must be evidence-based, or should it? Evidence for the construction of guidelines often comes from clinical trials that are performed in the West according to the priorities and goals of that population and those of the pharmaceutical industry whose resources are relied upon to perform such trials. This Viewpoint article discusses the development of guidelines using an evidence-based approach and whether this approach is applicable worldwide.
Clinical Guidelines are primarily developed in the affluent West. This Viewpoint article discusses whether these guidelines are really useful and relevant to resource-poor, developing countries, and whether attempts to adhere to such guidelines obscure more fundamental issues such as the provision of basic health care. The authors argue that if guidelines are adapted to local resources and needs, and employ a 'cascade' approach they can work.
Evidence-based guidelines from wealthy countries define optimum goals for resource-constrained countries. This Viewpoint article discusses how health-care policy in developing countries can only be influenced through local involvement in the construction and implementation of guidelines. The authors also discuss the potential yet controversial role of the biomedical industry in facilitating the development and dissemination of global guidelines.
Clinical understanding of IBS has been advanced considerably by studying a small subgroup of patients who develop IBS acutely after an episode of infectious gastroenteritis. This Viewpoint article discusses post-infective IBS and how psychosocial and gut-specific factors (including activation of the gut mucosal immune system) interact to produce IBS symptoms.