第１章 ＧＥＭ調査の概要（分析の枠組み；調査方法；起業活動の定義；起業活動率；起業活動と経済成長；起業の計画と失敗） 第２章 起業家と事業特性（起業家の背景；起業家の能力；事業特性；起業家教育） 第３章 起業の環境（社会的資源；起業家に対する評価；経済危機の影響；起業活動の投資環境） 第４章 専門家調査（資金調達；政府の方針；支援プログラム；教育システム；技術移転；コマーシャル・サービス；起業文化；事業機会；経営能力；起業家に対する評価；女性への支援；急成長への注目；イノベーションへの関心；調査結果） 第５章 政策への提

起業と経済成長 : global entrepreneurship monitor調査報告

Background
Approximately 25% of adults regularly experience heartburn, a symptom of gastro-oesophageal reflux disease (GORD). Most patients are treated empirically (without specific diagnostic evaluation e.g. endoscopy. Among patients who have an upper endoscopy, findings range from a normal appearance, mild erythema to severe oesophagitis with stricture formation. Patients without visible damage to the oesophagus have endoscopy negative reflux disease (ENRD). The pathogenesis of ENRD, and its response to treatment may differ from GORD with oesophagitis.

Objectives
Summarise, quantify and compare the efficacy of short-term use of proton pump inhibitors (PPI), H2-receptor antagonists (H2RA) and prokinetics in adults with GORD, treated empirically and in those with endoscopy negative reflux disease (ENRD).

Search methods
We searched MEDLINE (January 1966 to November 2011), EMBASE (January 1988 to November 2011), and EBMR in November 2011.

Selection criteria
Randomised controlled trials reporting symptomatic outcome after short-term treatment for GORD using proton pump inhibitors, H2-receptor antagonists or prokinetic agents. Participants had to be either from an empirical treatment group (no endoscopy used in treatment allocation) or from an endoscopy negative reflux disease group (no signs of erosive oesophagitis).

Data collection and analysis
Two authors independently assessed trial quality and extracted data.

Main results
Thirty-four trials (1314 participants) were included: fifteen in the empirical treatment group, fifteen in the ENRD group and four in both. In empirical treatment of GORD the risk ratio (RR) for heartburn remission (the primary efficacy variable) in placebo-controlled trials for PPI was 0.37 (two trials, 95% confidence interval (CI) 0.32 to 0.44), for H2RAs 0.77 (two trials, 95% CI 0.60 to 0.99) and for prokinetics 0.86 (one trial, 95% CI 0.73 to 1.01). In a direct comparison PPIs were more effective than H2RAs (seven trials, RR 0.66, 95% CI 0.60 to 0.73) and prokinetics (two trials, RR 0.53, 95% CI 0.32 to 0.87).

In treatment of ENRD, the RR for heartburn remission for PPI versus placebo was 0.71 (ten trials, 95% CI 0.65 to 0.78) and for H2RA versus placebo was 0.84 (two trials, 95% CI 0.74 to 0.95). The RR for PPI versus H2RA was 0.78 (three trials, 95% CI 0.62 to 0.97) and for PPI versus prokinetic 0.72 (one trial, 95% CI 0.56 to 0.92).

Authors' conclusions
PPIs are more effective than H2RAs in relieving heartburn in patients with GORD who are treated empirically and in those with ENRD, although the magnitude of benefit is greater for those treated empirically.

Short‐term treatment with proton pump inhibitors, H2‐receptor antagonists and prokinetics for gastro‐oesophageal reflux disease‐like symptoms and endoscopy negative reflux disease

Gastro-oesophageal reflux disease

Digestion assays with simulated gastric fluid have been introduced for characterization of food proteins to imitate the effect of stomach proteolysis on dietary compounds in vitro. By using these tests, dietary proteins can be categorized as digestion-resistant class 1 (true allergens triggering direct oral sensitization) or as labile class 2 allergens (nonsensitizing elicitors). Thus the results of these digestion assays mirror situations of intact gastric proteolysis. Alterations in the gastric milieu are frequently experienced during a lifetime either physiologically in the very young and the elderly or as a result of gastrointestinal pathologies. Additionally, acid-suppression medications are frequently used for treatment of dyspeptic disorders. By increasing the gastric pH, they interfere substantially with the digestive function of the stomach, leading to persistence of labile food protein during gastric transit. Indeed, both murine and human studies reveal that antiulcer medication increases the risk of food allergy induction. Gastric digestion substantially decreases the potential of food proteins to bind IgE, which increases the threshold dose of allergens required to elicit symptoms in patients with food allergy. Thus antiulcer agents impeding gastric protein digestion have a major effect on the sensitization and effector phase of food allergy.

The role of protein digestibility and antacids on food allergy outcomes.

BACKGROUND: Gastroesophageal reflux disease (GERD) is the most prevalent acid-related disorder in Canada and is associated with significant impairment of health-related quality of life. Since the last Canadian Consensus Conference in 1996, GERD management has evolved substantially.

https://downloads.hindawi.com/journals/cjgh/2005/836030.pdf

Canadian Consensus Conference on the Management of Gastroesophageal Reflux Disease in Adults – Update 2004

Enhancing business performance is of increasing interest to all business leaders in today’s business environment. Studies relating to both large firms and small and medium enterprises (SMEs) constantly emphasise a positive relationship between business practices, management activities and performance, as it is often articulated that best business practices produce superlative business performance. This study examines empirically which business practices are implemented by SMEs in some selected areas in South Africa and how these business practices impact on their optimal performance. The population for the study comprised business owner-managers in the SME sector in Bloemfontein, Botshabelo and Thaba’Nchu (Free State province of South Africa). A statistical methodology was used to test the relationships hypothesised in the research model. The results reveal that all six selected business practices that were examined (marketing practices, strategic planning practices, human resource management practices, risk management practices, performance management practices and teamwork practices) have a positive and significant relationship with SME performance. Moreover, 97.1% of the SMEs that implemented all six business practices had optimal business performance. This study could serve as a guide for business consultants and SME support mechanisms to develop SME training programmes to help SME owners/managers to acquire the necessary skills to properly implement these six business practices, which will enable SMEs to achieve optimal performance.Achieving optimal business performance through business practices Key words: SMEs, business practices, SME performance, optimal performance, South Africa

/pdf/achieving-optimal-business-performance-through-business-3x9xncz2md.pdf

Achieving optimal business performance through business practices: evidence from SMEs in selected areas in South Africa

BACKGROUND AND AIM The aim of this study was to compare the efficacy and tolerability of low dose pantoprazole (20 mg) (a gastric proton pump inhibitor) with standard dose ranitidine (300 mg) (a histamine-receptor antagonist), in their ability to relieve symptoms and heal oesophageal lesions associated with gastrooesophageal reflux disease (GORD). METHODS Patients with endoscopically established mild GORD (stage I, modified Savary-Miller classification) were enrolled into a multicentre, randomized, double-blind, parallel-group comparison study (intention-to-treat population, n = 201; age range, 18-82 years). Patients took either oral pantoprazole 20 mg in the morning (n = 101) or ranitidine 300 mg in the evening (n = 100) once daily for 4 weeks or, if the healing was not complete, 8 weeks. Relief from key symptoms (heartburn, acid regurgitation, pain on swallowing) was assessed after 2, 4, and if applicable, 8 weeks. Healing of lesions was confirmed endoscopically after 4 and, if applicable, 8 weeks. RESULTS Complete relief from key symptoms was noted after 2 weeks in 70/88 (80%) patients treated with pantoprazole vs 45/89 (51%) patients treated with ranitidine ('per-protocol and key-point available' populations, P < 0.001); the corresponding results after 4 weeks were 77/88 (88%) vs 51/88 (58%) (P < 0.001). Complete healing of lesions after 4 weeks of treatment was seen in 74/88 (84%) vs 49/89 (55%) in the pantoprazole and ranitidine group, respectively (P < 0.001, per-protocol); by week 8 the cumulative healing rates were 84/88 (95%) vs 69/89 (78%) in the pantoprazole and ranitidine group, respectively (P < 0.001). For the intention-to-treat populations, the corresponding values for healing after 4 and 8 weeks were 73% vs 49% (P < 0.001) and 83% vs 69% (P < 0.05), respectively. Both study medications were well tolerated. CONCLUSION Compared to ranitidine 300 mg, the regimen with pantoprazole 20 mg provides faster relief from symptoms and is significantly more effective in healing of oesophageal lesions in patients with mild reflux-oesophagitis. Thus, the low dose of pantoprazole offers a treatment approach which minimizes drug exposure and costs while retaining high efficacy.

Efficacy and tolerability of 20 mg pantoprazole versus 300 mg ranitidine in patients with mild reflux-oesophagitis: a randomized, double-blind, parallel, and multicentre study.

Background

: Pantoprazole is a benzimidazole derivative which selectively inhibits the proton pump H+, K+-ATPase, necessary for the final step in gastric acid secretion.



Aim

: To assess safety and efficacy of oral pantoprazole (40 mg o.d.) used as a prophylaxis against relapse in patients with healed reflux oesophagitis during an open-label, 2-year study.



Methods

: Outpatients (n=157) with healed stage II or III reflux oesophagitis (Savary–Miller classification) were enrolled into a long-term, multicentre maintenance study. Endoscopy was performed at entry into the study, after 12 and 24 months, or when disease-specific symptoms occurred on more than three consecutive days. Symptoms were assessed at 3-monthly intervals. Endoscopically confirmed relapses (at least stage I) were evaluated as treatment failures.



Results

: Of the 178 adverse events, experienced by 88 (56%) patients (intention-to-treat population), 12 (7%) were assessed by the investigators as possibly related to the study medication. Median serum gastrin levels increased from a baseline of 46 ng/L to 90 ng/L, reaching a plateau after 9 months. For the intention-to-treat population the endoscopic remission rates after 12 and 24 months were 87% and 76%, respectively (Life-Table survival analysis, Kaplan–Meier).



Conclusion

: Pantoprazole 40 mg proved to be safe and efficacious during a 2-year prophylaxis treatment in patients with healed reflux oesophagitis.

https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1365-2036.1999.00573.x

Safety and efficacy of pantoprazole 40 mg daily as relapse prophylaxis in patients with healed reflux oesophagitis-a 2-year follow-up.

Background/Aim: Gastroesophageal reflux disease (GERD) is a prevalent disease associated with a high symptom burden and a reduced quality of life. This multicenter, randomized, doub

Efficacy and Safety of Pantoprazole versus Ranitidine in the Treatment of Patients with Symptomatic Gastroesophageal Reflux Disease

UNLABELLED Sucralfate binds with denuded protein to form a stable complex to protect the damaged mucosa. By utilising this property, technetium-99m-labelled sucralfate can be used to demonstrate ulceration in the upper gastro-intestinal tract. AIM The aim of this study was to evaluate 99mTc-labelled sucralfate in the diagnosis of grade II-III reflux oesophagitis. METHODS Ten patients with endoscopic proof of grade II-III reflux oesophagitis and 10 patients with normal findings on oesophagoscopy were evaluated after they had swallowed 5 ml 99mTc sucralfate. Radionuclide imaging was done until activity in the oesophagus had ceased. RESULTS Retention of activity from 10 minutes up to 1 1/2 hours could be demonstrated in 9 patients with endoscopically proven oesophagitis. In the control group complete clearance of activity was seen in 7 patients. Gastro-oesophageal reflux could be demonstrated in 4 patients. CONCLUSION In conclusion we found 99mTc sucralfate to be a sensitive and specific method for the non-invasive diagnosis of grade II or grade III oesophagitis when compared with endoscopy [corrected].

/pdf/evaluation-of-reflux-oesophagitis-with-technetium-99m-2ae8g1nmi2.pdf

J. H. Van Zyl

Papers

Achieving optimal business performance through business practices: evidence from SMEs in selected areas in South Africa

Efficacy and tolerability of 20 mg pantoprazole versus 300 mg ranitidine in patients with mild reflux-oesophagitis: a randomized, double-blind, parallel, and multicentre study.

Safety and efficacy of pantoprazole 40 mg daily as relapse prophylaxis in patients with healed reflux oesophagitis-a 2-year follow-up.

Efficacy and Safety of Pantoprazole versus Ranitidine in the Treatment of Patients with Symptomatic Gastroesophageal Reflux Disease

Evaluation of reflux oesophagitis with technetium-99m-labelled sucralfate.