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The authors reflect ton the use of randomised trials to decide when to monitor response to a new treatment. They suggest that a new framework should be developed for deciding whether surrogate outcomes should be used to monitor initial response to treatment in chronic disease. They argue that when monitoring achieves the goal of ensuring treatment is tailored to the individual patients will benefit but current monitoring schedules are rarely based on research and may be harmful to patients.

Objective: To investigate the effects of compliance and periodic telephone counselling by a pharmacist on mortality in patients receiving polypharmacy. Design: Two year randomised controlled trial. Setting: Hospital medical clinic. Participants: 502 of 1011 patients receiving five or more drugs for chronic disease found to be non-compliant at the screening visit were invited for randomisation to either the telephone counselling group (n = 219) or control group (n = 223) at enrollment 12-16 weeks later. Main outcome measures: Primary outcome was all cause mortality in randomised patients. Association between compliance and mortality in the entire cohort of 1011 patients was also examined. Patients were defined as compliant with a drug if they took 80-120% of the prescribed daily dose. To calculate a compliance score for the whole treatment regimen, the number of drugs that the patient was fully compliant with was divided by the total number of prescribed drugs and expressed as a percentage. Only patients who complied with all recommended drugs were considered compliant (100%). Results: 60 of the 502 patients defaulted and only 442 patients were randomised. After two years, 31 (52%) of the defaulters had died, 38 (17%) of the control group had died, and 25 (11%) of the intervention group had died. After adjustment for confounders, telephone counselling was associated with a 41% reduction in the risk of death (relative risk 0.59, 95% confidence interval 0.35 to 0.97; P = 0.039). The number needed to treat to prevent one death at two years was 16. Other factors included old age, living alone, rate of admission to hospital, compliance score, number of drugs for chronic disease, and non-treatment with lipid lowering drugs at screening visit. In the cohort of 1011 patients, the adjusted relative risk for death was 1.61 (1.05 to 2.28; P = 0.029) and 2.87 (1.80 to 2.57; P < 0.001) in patients with compliance scores of 34-66% and 0-33% compared with those who had a compliance score of 67% or more. Conclusion: In patients receiving polypharmacy, poor compliancy was associated with increased mortality. Periodic telephone counselling by the pharmacist improved compliance and reduced mortality.Trial registration: International Standard Randomised Controlled Trial Number Register: SRCTN48076318. [ABSTRACT FROM AUTHOR]

The authors present a summary of the diagnosis and treatment of ulcerative colitis for physicians who manage the condition. The article mentions the causes of ulcerative colitis and its symptoms. It discusses methods of diagnosis and the drugs used to treat the condition. Ulcerative colitis is a chronic disease and remissions and relapses are discussed.

Examines the psychological impact of chronic diseases on patients and physicians. Impact of chronic diseases on world health systems; Suggestion that a lack of possible cure for chronic diseases causes frustration on the part of physicians; Discussion of treating the chronic diseases of patients in high security psychiatric facilities; Significance of collaborative care management on chronic care; Emphasis on the need for health care providers to address psychological aspects of chronic disease; Recommendations for shaping physician and patient interactions in chronic care; Need for increased training of medical care providers working with chronically ill patients.

Presents the results of a study on health care policy for the treatment of chronic diseases. Impact of chronic diseases on world health systems; Challenges to the effective administration of health care services; Details of the SA HealthPlus trial, which examined the care of patients with multiple service needs in Australia; Critique of disease management health care models; Focus of the study on the creation of a generic model of coordinated health assessment and planning; Report that a population-based model of health care brought improved health outcomes for rural and urban Australians; Implications of the study for health services administration.

Discusses models of payment in the care of patients with chronic diseases. Impact of chronic diseases on world health care systems; Critique of the current fee-for-service payment model; Description of a fee-for-condition payment model, which would allow patients to pay a set fee determined by their established condition; Methods for determining payments in a fee-for-condition model; Significance of outcome data provided by health care personnel to ensuring the effectiveness of care; Impact of a fee-for-condition payment model on health care quality and physician and patient relations.

Focuses on the medical policies of Great Britain's National Health Service (NHS) treatment of chronic diseases. Impact of the NHS Improvement Plan on the administration of chronic care; Incidence of chronic disease in Great Britain; Details of health care intervention sought by patients with chronic illness; Emphasis of NHS policy on the role of primary care trusts in managing chronic diseases; Financial incentives used to encourage the role of primary care trusts; Efforts of the NHS to coordinated the services of primary, secondary, and social care organizations.

Recommends methods for the treatment of chronic disease. Importance of regular examinations and medical screening for the effective treatment of chronic conditions; Benefits of regular and appropriate monitoring of signs and symptoms; Discussion of the stages of monitoring, including pretreatment, treatment, adjustment, and cessation phases; Recommended strategies for monitoring patient conditions; Comments on patient self-monitoring; View that medical personnel working in chronic care must be trained in proper monitoring techniques.

Reports on the limitations of the systematic review of randomized controlled trials for patients with chronic or lifelong diseases. Suggestion that long-term observational studies have a place in the evaluation of the benefits and risks of treatment; Antibiotic therapy in cystic fibrosis; Evidence of an increase in antibiotic resistance in patients treated with one antibiotic compared with two; Inability of systematic reviews to provide adequate information about long-term outcomes.

The article presents the authors' opinions on Great Britain's expert patient programs for chronic diseases. Arguments are presented which suggest that the programs need further evaluation before they can be recommended over other established programs and they may not be as effective as the government thought since four randomised clinical trials in the country found that while the programs did increase patiets' confidence to manage their diseases they didn't reduce hospital admissions or the use of health care resources in the country's National Health Service.

The article focuses on a multi-disciplinary approach to the management of chronic obstructive pulmonary disorder, including exercise training, education, nutritional management and psychological support. The possibility of surgery is discussed, and anxiety and depression measurements are discussed.

Provides advice and guidance for preventing chronic diseases in the developing world. Emphasis on highlighting personal responsibility for healthy behaviors and choices; Importance of fully implementing health intervention methods, including smoking cessation and obesity prevention; Recommendation that health intervention programs maintain a wide focus on several conditions and methods of prevention; Role of political leaders and mass media in effective public health programs; View that preventive measures should be emphasized along with programs focused on treating chronic diseases.

Examines the role of specialists in the treatment of patients with chronic diseases. Policies of health care administration systems on the partnership between primary care and specialist medical personnel; Increasing role of nurses in caring for the chronically ill; Key changes in the understanding of specialized care, including a focus on population-based care and the introduction of stepped care; Role of specialist consultants in clinical care; Emphasis on the coordination of care between primary and specialist personnel.

Examines the preparation of health care delivery systems for the treatment of chronic conditions. Prevalence of chronic diseases in international public health; Impact of a shortage of health care workers in developing countries; Need for cooperation between health care providers to effectively treat chronic conditions; Description of core competencies for treating chronic conditions outlined by the World Health Organization; Key elements of core competencies, including patient-centered care, quality improvement, information technology, and public health perspective; Importance of core competencies to health care programs in developing countries; Significance of training health care workers in developing countries to treat chronic conditions, including HIV and AIDS.

Questions whether depression should be managed as a chronic disease. How the burden of depression is not being reduced; Suggestion that the episodic nature of depression and the acute response to treatment means that episodes seem easy to treat; Main problem of depression is in the next recurrence; Belief that depression should be managed proactively to ensure long term compliance with treatment.

The author reflects on patients with chronic pain. He suggests that the burden of chronic pain for those that have it and their families is substantial and that chronic pain patients deserve better care than they now receive. He argues that chronic diseases come low on the political priority list and that the issue of chronic pain just gets forgotten.

The author reflects on improving adherence to drugs for hypertension. He suggests that general practitioners who provide effective explanations of treatment to their patients achieve better results. He argues that management of chronic diseases can be successful only if health professionals prescribe appropriately and if drugs are taken appropriately to maximize their pharmacological effects.

Presents a letter to the editor about the management of chronic diseases.

Comments on health planning for patients with multiple service needs. Critique of the SA HealthPlus trial, which focused on creating a coordinated health care model for Australia; Report that the SA HealthPlus model did not reduce costs, but succeeded in improving health outcomes; Impact of the trial on health care policy implementation; Methods for regulating coordinated care; Discussion of applying the outcomes of the trial to different cultural settings and countries.

Focuses on the role of nurses in the chronic care model for treating patients. Observation that nurses are key to implementing the chronic care model due to the nature of their education and role in medical care, and not doctors; Interaction between an informed, active patient and a prepared, proactive practice team; Study showing that half of patients finish an office visit not understanding what the doctor told them, which makes them less likely to adopt healthy behaviors; Success of nurses in securing positive outcomes to care visits due to better communication between nurse and patient.

Focuses on the option of providing palliative care to patients with chronic illnesses who are at the end of their lives. Tendency of doctors and patients to avoid focusing on the eventuality of death when dealing with a progressive chronic illness, which is described as "prognosis paralysis"; Need for doctors to be pro-active in suggesting the adoption of a holistic palliative care approach.

Editorial. Examines the effectiveness of coordinated and patient-centered health care. Increase of demands on health systems around the globe; Rise in the number of chronic disease sufferers; Complications in the drug treatment for chronic illnesses.

Discusses the importance of educational programs for patients with rheumatoid arthritis. Treatment of chronic diseases; Effects of education programs based on a systematic review; Lack of major drawbacks; Comparison with drug intervention; Clinical significance.

The author suggests that dedicated centers be set up for the care of sickle cell disease patients. He maintains that sickle cell disease is a lifelong disorder and clinical complications are followed by periods of relative well-being known as the steady state. Most physicians feel that monitoring the steady state affords the best care for patients.

The article focuses on medical policy in England and Health Secretary Patricia Hewett's statement on managing chronic disease. The NHS could save about £400m per year with better health-management strategies in a community setting that reduce hospital admissions. Ms. Hewitt based her recommendations on a study by the NHS Institute for Innovation and Improvement. Andrew Lansley, the opposition health spokesperson, comments on hospital closings. The NHS Confederation supports the recommendation.

Presents an excerpt of an article found in a 1905 issue of the "British Medical Journal." Discussion of the intellectual cooperation between England and the United States due to the cheapness of the press cable rates between the two countries; Exchange of scientific knowledge on the subject of human disease and its treatment; Description of a cure that involves standing naked in the rain; Claim that this cures many chronic diseases, including nervous disorders and rheumatism; Suggestion that England should keep its ports open for people who cannot obtain treatment in their own country due to a shortage of rainfall.

Presents news briefs related to medical care and health as of June 4, 2005. Results of research on the attitudes of women at high risk for breast cancer to the use of preventive tamoxifen; Potential for abnormal metabolism to cause vascular disease in nonsmokers; Efficacy of nicotine replacement therapy and smoking bans; Report that homeless men and women in the U.S. have similar rates of chronic illness to the wider population, but worse medical care.

Presents a letter to the editor in response to the article "Role of specialists in common chronic diseases," by L. Gask, in the March 19, 2005 issue.

Discusses the opinion of the author about the pursuit of longevity. Belief that such a pursuit is a form of hedonism; Human strategies to postpone death; Drawbacks of chronic disease management; Statement that the law of diminishing returns applies to societal longevity; Relationship between longevity and investment; Ethical consequences.

Reports on the resignation of members of a group working on a government report on the treatment of chronic fatigue syndrome in Great Britain. How ten people from the original working group have resigned; Suggestion that the report does not give enough attention to the psychological and social aspects of the condition; Debate over the best treatment for the condition.

Discusses the author's technique for observing the life of a chronically ill patient. Opinion that doctor's often do not understand the burden of disease since they only see the patient a few times a year; Request that a patient undergoing anticoagulant treatment take pictures of his day; Discovery that any type of treatment can have a profound effect on a patient's life.

Comments on a British study that shows a weak association between markers for chronic or past infection with Chlamydia pneumoniae and incident ischaemic heart disease. Findings; Analysis; Impact of the results; Suggestions.