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Monitoring Patients (monitoring + patient)
Selected AbstractsConnecting patient needs with treatment managementACTA PSYCHIATRICA SCANDINAVICA, Issue 2009R. Kerwin Objective:, To propose ideas for the development of a core strategy for monitoring patients with schizophrenia to ensure physical health and optimal treatment provision. Method:, A panel of European experts in the field of schizophrenia met in Bordeaux in June 2006 to discuss, ,Patient management optimisation through improved treatment monitoring.' Results:, Key consensus from the discussion deemed that weight gain, oral health and ECG parameters were core baseline parameters to be monitored in all patients with schizophrenia. Further, an identification of a patient's own barriers to treatment alongside local health service strategies might comprise elements of an individualised management strategy which would contribute to optimisation of treatment. Any monitoring strategy should be kept simple to encourage physician compliance. Conclusion:, A practical solution to the difficulties of providing holistic patient care would be to suggest a limited set of physical parameters to be monitored by physicians on a regular basis. [source] Correlation of YMDD mutation and breakthrough hepatitis with hepatitis B virus DNA and serum ALT during lamivudine treatmentHEPATOLOGY RESEARCH, Issue 2 2010Mariko Kobayashi Aim:, Continuous lamivudine treatment is associated with high frequency of drug resistance. We analyzed the incidence of tyrosine-methionine-aspartate-aspartate (YMDD) motif mutant and breakthrough hepatitis (BTH) in hepatitis B virus (HBV) DNA positive patients receiving lamivudine for > 1 year and correlated it with HBV DNA and alanine aminotransferase (ALT) levels to evaluate if these measurements can provide a practical option for monitoring patients in clinical practice and define early switch from lamivudine therapy. Methods:, Of the 929 patients receiving lamivudine for > 1 year, 359 patients who maintained an ALT level of , 40 IU/L during the course of lamivudine treatment were stratified into two groups based on the duration of lamivudine treatment , one receiving lamivudine for < 3 years and the other for , 3 years. Results:, The incidence of YMDD motif in patients receiving lamivudine for < 3 years was 27% in patients with ALT , 20 IU/L, 58% with ALT , 30 IU/L, and 63% with ALT , 40 IU/L, (P = 0.002). The corresponding incidence of BTH was 2%, 7%, and 48% (P < 0.001). The incidence of YMDD motif and BTH in these patients was 7% and 2% with HBV DNA < 2.6 (log copies/mL) and ALT , 20 IU/L, while with ALT at 21,30, the YMDD motif mutant was 16% and BTH was 0%. Conclusion:, Correlation of ALT and HBV DNA levels with YMDD motif mutant and BTH indicates that these measurements can be used in clinical practice for deciding early switch from lamivudine to other suitable antiviral therapies. [source] Predictors of cardiac events in high-risk patients undergoing emergency surgeryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2009A. OSCARSSON Background: The aim of this study was to determine the incidence of myocardial damage and left ventricular myocardial dysfunction and their influence on outcome in high-risk patients undergoing non-elective surgery. Methods: In this prospective observational study, 211 patients with American Society of Anesthesiologists classification III or IV undergoing emergent or urgent surgery were included. Troponin I (TnI) was measured pre-operatively, 12 and 48 h post-operatively. Pre-operative N-terminal fragment of B-type natriuretic peptide (NT-proBNP), as a marker for left ventricular systolic dysfunction, was analyzed. The diagnostic thresholds were set to TnI >0.06 ,g/l and NT-proBNP >1800 pg/ml, respectively. Post-operative major adverse cardiac events (MACE), 30-day and 3-months mortality were recorded. Results: Elevated TnI levels were detected in 33% of the patients post-operatively. A TnI elevation increased the risk of MACE (35% vs. 3% in patients with normal TnI levels, P<0.001) and 30-day mortality (23% vs. 7%, P=0.003). Increased concentrations of NT-proBNP were seen in 59% of the patients. Elevated NT-proBNP was an independent predictor of myocardial damage post-operatively, odds ratio, 6.2 [95% confidence interval (CI) 2.1,18.0] and resulted in an increased risk of MACE (21% vs. 2.5% in patients with NT-proBNP ,1800 pg/ml, P<0.001). Conclusion: Myocardial damage is common in a high-risk population undergoing unscheduled surgery. These results suggest a close correlation between myocardial damage in the post-operative period and increased concentration of NT-proBNP before surgery. The combinations of TnI and NT-proBNP are reliable markers for monitoring patients at risk in the peri-operative period as well as useful tools in our risk assessment pre-operatively in emergency surgery. [source] Comparison of immunoradiometric assays for determination of thyroglobulin: a validation studyJOURNAL OF CLINICAL LABORATORY ANALYSIS, Issue 3 2007L.A. Tortajada-Genaro Abstract In this study we compared and validated commercial immunoradiometric assays (IRMA) to determine thyroglobulin (Tg) levels in serum. From a set of 440 samples, 68 were selected to calculate the validation parameters and the clinical performance of the assays. The commercial kits evaluated were the Tg-CTK (DiaSorin), IRMAZenco Tg (ZenTech), and SELco-Tg (Medipan). We found that 21% of the collected samples were in the critical range of concentration. Detection limits were calculated as being below 3,µg/L. Intra- and inter-reproducibility were lower than 3.1% and 9.2%, respectively. Dilution and recovery studies provided quantitative determinations. Correlation regression coefficients from the results of the methods were obtained. The determined concentrations were compared with the clinical evidence of disease. Variation in the 125-iodine-labeled antibody concentration and control charts showed the robustness of the methods. Analysis time and the simplicity of the methods were also evaluated. Reliable Tg determination is important for monitoring patients with differentiated thyroid cancer (DTC), controlling other thyroid diseases, and assessing the quality of imaging techniques. A strategy for verification and comparison based on analytical parameters and clinical performance is proposed. J. Clin. Lab. Anal. 21:147,153, 2007. © 2007 Wiley-Liss, Inc. [source] Pathological study of idiopathic portal hypertension with an emphasis on cause of death based on records of Annuals of Pathological Autopsy Cases in JapanJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 2 2007Seiko Sawada Abstract Background and Aim:, Idiopathic portal hypertension (IPH) is thought to be benign if bleeding gastroesophageal varices can be controlled or prevented. A recent autopsy of a woman with IPH who died of hemorrhagic intestinal infarction related to mesenteric thrombosis prompted the authors to examine the terminal antemortem features and causes of death of IPH. Methods:, Autopsy cases registered as IPH from 1986 to 1997 were surveyed in the records of the Annuals of Pathological Autopsy Cases in Japan, with permission from the Japanese Society of Pathology. The records of 65 of these cases were collected and examined pathologically. Results:, It was found that the most frequent cause of death in these cases was (i) bacterial infection (20 cases). The next three causes of death were directly or indirectly related to hepatic disease or its altered portal hemodynamics as follows: (ii) progressive hepatic failure (16 cases); (iii) massive hemorrhage from ruptured gastroesophageal varices (11 cases); and (iv) hemorrhagic intestinal infarction due to mesenteric venous thrombosis (5 cases). Although portal venous thrombosis was closely associated with (iv), (ii) and (iii) seemed not to be associated with portal venous thrombosis. In addition, intracranial hemorrhage and other heterogeneous factors were identified as the cause of death in five cases and eight cases, respectively. Conclusion:, These results suggest that progressive hepatic failure and intestinal hemorrhagic infarction should be considered in addition to rupture of gastroesophageal varices when monitoring patients with IPH. Clinicians should be also aware of severe bacterial infection and intracranial hemorrhage as a fatal complication of IPH. [source] Development of real-time detection direct test for hepatitis B virus and comparison with two commercial tests using the WHO international standardJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 11 2003MOTOKAZU MUKAIDE Abstract Aims:, A highly reproducible and sensitive hepatitis B virus real-time detection direct (HBV RTD-direct) test using DNA extraction by magnetic beads coated with polyclonal anti-HBsAg, followed by the real-time detection polymerase chain reaction (PCR) method, was developed for the detection of HBV DNA. Methods:, The HBV DNA could be extracted from the HBsAg positive viral particles without resulting in viral DNA fragmentation. The HBV RTD-direct test was validated using a serial dilution panel of the WHO standard HBV DNA 97/746 I. Results:, The test had a dynamic range of 0.7,8.0 log10 international units (IU) per mL and the results were shown to be comparable to those obtained with two commercially available tests: the HBV DNA transcription-mediated amplification-hybridization protection assay and the Amplicor HBV Monitor test. In addition, the HBV RTD-direct test, based on magnetic extraction, successfully eliminated PCR inhibitors in clinical specimens. Conclusion:, We conclude that the HBV RTD-direct test is an excellent alternative for monitoring patients undergoing antiviral treatment or for screening various clinical specimens. [source] Liver fibrosis attributed to lipid lowering medications: two casesJOURNAL OF INTERNAL MEDICINE, Issue 3 2001Z. Punthakee Abstract. Punthakee Z, Scully LJ, Guindi MM, Ooi TC (Department of Medicine, Division of Gastroenterology, Department of Pathology and the Laboratory of Medicine and the Division of Endocrinology and Metabolism, The Ottawa Hospital , Civic Campus, University of Ottawa, Ottawa, Canada). Liver fibrosis attributed to lipid lowering medications: two cases (Case Report). J Intern Med 2001; 250: 249,254. We identified two cases of chronic active hepatitis with liver fibrosis induced by lipid lowering drugs of the statin and fibrate classes despite regular monitoring of transaminases. There are few reports of clinically significant hepatitis induced by these drugs and even fewer cases of fibrosis. Given the growing use of these drugs, there are implications for monitoring patients on long-term therapy for liver damage. [source] Portal-systemic shunting in patients with fibrosis or cirrhosis due to chronic hepatitis C: the minimal model for measuring cholate clearances and shuntALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2007G. T. EVERSON Summary Background, Measurement of portal inflow and portal-systemic shunt using cholate clearances could be useful in monitoring patients with liver disease. Aim, To examine relationships of cholate clearances and shunt to cirrhosis and varices and to define minimal sampling requirements. Methods, Five hundred forty-eight studies were performed in 282 patients enrolled in the Hepatitis C Antiviral Long-term Treatment to prevent Cirrhosis (HALT-C) trial. Stable, non-radioactive isotopes of cholate were administered intravenously and orally, clearances (Cliv and Cloral) were calculated from [dose/area under curve (AUC)] and cholate shunt from [(AUCoral:AUCiv) x (Doseiv:Doseoral) x 100%]. Results, Cholate Cloral and cholate shunt correlated with prevalences of both cirrhosis and varices (P < 0.0001 for all). Peripheral venous sampling at 5, 20, 45, 60 and 90 min defined the minimal model. Linear regression of cholate shunt determined from five points within 90 min vs. the standard method of 14 points over 3 h yielded slope of 1.0 and intercept 0.5% (r2 = 0.98, P < 0.0001). Results were identical in the 189 validation studies (slope 1.0, intercept 0.5%, r2 = 0.99, P < 0.0001). Conclusions, Cholate Cloral and cholate shunt may be useful in monitoring patients with liver disease. The 5-point model enhances application of cholate Cloral and cholate shunt in the non-invasive assessment of the portal circulation. [source] Urinary leukotriene E4 levels in children with allergic rhinitis treated with specific immunotherapy and anti-IgE (Omalizumab)PEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 5 2003Matthias Volkmar Kopp Recently, we were able to demonstrate that Omalizumab, a humanized monoclonal anti-IgE antibody, reduces in vitro leukotriene (LT) release of peripheral leukocytes stimulated with allergen in children with allergic rhinitis undergoing allergen immunotherapy. The aim of this study was to investigate the effect of anti-IgE in combination with specific immunotherapy (SIT) on urinary leukotriene E4 (LTE4) levels. Children and adolescents with sensitization to birch and grass pollens and suffering from seasonal allergic rhinitis were included in a phase III, placebo-controlled, multicenter clinical study. Within the four-arm study, patients were randomized to receive SIT for either birch or grass pollen and to receive either subcutaneous anti-IgE or placebo for 24 weeks during the pollen season. From a total population of 225 children, we collected three urine samples in a subgroup of 19 children [n = 12 boys (63%); mean age 11.8 years; range 7.2,17.5 years; Group A (n = 10): SIT (grass or birch) + anti-IgE; Group B (n = 9): SIT (grass or birch) + placebo]. Urine samples were collected before, during and at the end of treatment. Endogenous urinary LTE4 was separated by high-performance liquid chromatography (HPLC) and determined by enzyme immunoassay with a specific antibody. No differences in urinary LTE4 concentrations were observed between the anti-IgE and the placebo groups before (A: 35.2; B: 36.5 nmol/mol creatinine), during (A: 27.0; B: 29.3) and after treatment (A: 28.9; B: 26.5 nmol/mol creatinine). We conclude that urinary LTE4 levels are not helpful in monitoring patients treated with anti-IgE and SIT. [source] Electroconvulsive Therapy: Issues in the ElderlyPSYCHOGERIATRICS, Issue 4 2002Arunava Das Abstract: The elderly psychiatrically ill constitute a high proportion of the patients who receive electroconvulsive therapy (ECT). There is evidence to say that the efficacy of ECT may be enhanced in the elderly. Clinical and biological markers are increasingly being recognised as predictors of outcome to ECT. The doses of anticholinergic, anaesthetic and relaxant agents may need to be modified in accordance with physiological changes associated with aging. ECT stimulus and ECT technique should be selected against the background of increased seizure threshold and possibility of greater ECT-induced cognitive dysfunction in the elderly, particularly those with pre-existing cognitive or neurologic impairment. New brain-imaging techniques and biochemical measures of brain damage have proved that ECT does not cause brain damage. The physical risk with ECT is considered to be low. There is some evidence to say that cardiovascular complications reported with ECT are related to the nature of pre-existing cardiac disease. Although the short-term response to ECT in the elderly is quite good, post-ECT relapse rates are quite high. Continuation-maintenance ECT has a definite role in minimising relapses and recurrences in the elderly, taking care not to enhance physical and cognitive risks. With increasing administration of outpatient ECT, it is important to refine methods for monitoring patients for adverse effects of treatment. The roles of repetitive trans-cranial magnetic stimulation (rTMS) and vagus nerve stimulation (VNS) in geriatric psychiatry are yet to be established. [source] Replacement of routine liver biopsy by procollagen III aminopeptide for monitoring patients with psoriasis receiving long-term methotrexate: a multicentre audit and health economic analysisBRITISH JOURNAL OF DERMATOLOGY, Issue 3 2005R.J.G. Chalmers Summary Background, Patients receiving long-term methotrexate for psoriasis are at risk of developing hepatic fibrosis. Repeated liver biopsy has long been regarded as the only reliable method of detecting this and it is still recommended by the American Academy of Dermatology (AAD). More recently, monitoring by serum procollagen III aminopeptide (PIIINP) measurement (Orion Diagnostica, Espoo, Finland) has been advocated as a means of significantly reducing the need for liver biopsy. Objectives, To assess the validity of guidelines developed in Manchester for the use of PIIINP to monitor patients with psoriasis receiving long-term methotrexate; to assess the anticipated benefits to patients of introducing this change in practice, including reduction in requirement for liver biopsy; and to determine the impact of its introduction on healthcare costs. Methods, A multicentre audit was conducted over a 24-month period to compare the healthcare costs and outcomes of two intervention groups from centres where serial PIIINP measurement was employed with those of two control groups from centres in which AAD guidelines were followed. Results, A sevenfold reduction in the need for liver biopsy was observed in the two intervention groups (n = 166; 0·04 and 0·02 biopsies/patient/year, respectively) compared with the two control groups (n = 87; 0·26 and 0·30 biopsies/patient/year, respectively). Abnormalities of sufficient severity to influence management were identified in one in five patients biopsied in the main intervention group compared with one in 16 in the control groups. The overwhelming majority of patients surveyed expressed a preference for being monitored by methods that would minimize the need for liver biopsy. The adoption of PIIINP for monitoring would result in significant cost savings. Conclusions, This audit has shown that patients managed by the Manchester protocol using serial PIIINP measurement and selective liver biopsy were not disadvantaged in comparison with those managed according to AAD guidelines; they were subjected to sevenfold fewer liver biopsies without evidence that important liver toxicity was missed in the process. If PIIINP monitoring were widely adopted, methotrexate would become a more acceptable option for many patients who are dissuaded from considering it because of the threat of repeated liver biopsy; it would also result in significant savings to the healthcare budget. [source] | ||||||||||