Postępowanie w chorobie Leśniowskiego-Crohna – step-up czy top-down?

Top-down or step-up treatment in Crohn's disease?

In recent years, a change in the treatment goals for patients with Crohn's disease (CD) has come under intense discussion. Whereas 10 years ago treatment was initiated mainly in reaction to acute flares of the disease aimed to improve clinical symptoms, the focus now has changed to the prevention of damage to the intestinal wall. The prevention of structural damage by achievement of 'mucosal he...

Medical therapy for Crohn's disease: top-down or step-up?

The emergency of effective biological therapy in the treatment of Crohn's disease (CD) has led to a clinical debate about 'step-up versus top-down strategy'. Step-up refers to the classic therapeutic approach, namely progressive intensification of treatment as disease severity increases. Top-down refers to the early introduction, in all CD patients, of intensive therapies, including biological ...

Bottom-up, top-down

Bottom-Up Beats Top-Down

In PEPA, the calculation of the transitions enabled by a process accounts for a large part of the time for the state space exploration of the underlying Markov chain. Unlike other approaches based on recursion, we present a new technique that is iterative—it traverses the process’ binary tree from the sequential components at the leaves up to the root. Empirical results shows that this algorith...

Shared care: step down or step up?

ormal " shared care " in cancer remains controversial. It is promoted as offering patients care closer to home while, at the same time, reducing the burden on specialist services. Primary care practitioners are divided on the issue, some viewing shared care as enhancing their practice and others as another example of hospitals offloading work onto an already overloaded primary care sector. Ther...