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Patient Months (patient + month)
Selected Abstracts(634) Reliability and Clinical Utility of an Implanted Intraspinal Catheter Used in the Treatment of Spasticity and PainPAIN MEDICINE, Issue 2 2000Article first published online: 25 DEC 200 Authors: Elliot Krames, Pacific Pain Treatment Center; Iva Chapple, Carolina Pain Center Objectives: To examine the performance and reliability of a redesigned implantable intrathecal catheter. Materials: A total of 212 catheters were implanted in 202 patients in this 22-center, prospective study of an implantable catheter/pump system used to deliver intrathecal drugs for the treatment of pain and spasticity. Along with physician assessments of each use, the rates of common catheter complications (dislodgements, disconnections, fractures, and kinks) experienced during the study were analyzed in relation to implant conditions (catheter entry site, tip position, and anchoring method). Results: A cumulative study of 3112.8 months of patient experience (average: 15.4 months; range: 0 to 30.2 months per catheter) revealed an overall catheter-caused complication rate of 0.3% per patient month. Physician assessments were favorable, with 89% rating this catheter as better than previously used intraspinal catheters. A measure of catheter survival estimates (Kaplan-Meier) at 9 months was 89% including all complications. Comparison of data relating to implant techniques demonstrated a variety of catheter implant techniques (entry, positioning, anchoring) with no correlation between any one technique and the common complications. Conclusions: Performance data and physician assessments indicate that this catheter is an improvement over the previously available catheter. [source] Effective interventions with chlorhexidine gluconate (CHG) to decrease hemodialysis (HD) tunneled catheter-related infectionsHEMODIALYSIS INTERNATIONAL, Issue 1 2005N. Redman Purpose:,Identify practices to reduce HD catheter access related bacteremias (ARB). Methods:,Data was collected per the CDC Dialysis Surveillance Network protocol. ARB was defined as a patient with a positive blood culture with no apparent source other than the vascular access catheter. ARB's were calculated in events per 100 patient months with 3 cohorts. Cohort 1 was observed for 12 months, Cohort 2 for the subsequent 10 months, and Cohort 3 for the final 10 months. Cohort 1 had weekly transparent dressing changes, cleansing of the skin and 5 minute soaking of the connection lines with 10% povidone-iodine (PI) solution, and HCW use of clean gloves and face shield without a mask. Cohort 2 changes consisted of thrice weekly gauze dressing changes, skin cleansing with ChloraPrep, a 2% CHG/70% isopropyl alcohol applicator, masks on the patients, adding a face mask to the shield, and application of 10% PI ointment to the exit site. Cohort 3 changes included weekly application of BioPatch (BioP), an antimicrobial dressing with CHG, sterile glove use, and replacing the PI line soaks with 4% CHG. Results:,The catheter-associated ARB rate per 100 patient months was 7.9 (17ARB/216 patient months) in Cohort 1, 8.6 (13/151) in Cohort 2, and 4.7 (5/107) in Cohort 3(p = 0.31 compared with Cohorts 1 and 2 combined). During the last 2 months, in Cohort 3, 9 catheter lumen cracks occurred, with one of the patients having a bacteremia. Conclusions:,Addition of CHG line soaks and BioP reduced tunneled catheter infections, although this is not statistically significant. The increased number of catheter lumen cracks raises concern with the use of CHG line soaks. Further investigation with use of CHG line soaks and the BioP for decreasing ARB is needed. [source] A Comparison of CV-Catheters (CV) Grafts (GR) and Fistulae (FI) in Quotidian HemodialysisHEMODIALYSIS INTERNATIONAL, Issue 1 2003C Kjellstrand We studied longevity and complications from CV, GR, and FI in 23 patients on quotidian hemodialysis. There were a total of 409 patient months, mean 18,10 months observation and a total of 9209 dialyses. There were 14 FI, 5 GR and 4 CV. 1, 1 and 2 replacements were necessary during a total observation time of 254, 105 and 50 patient months, respectively. For fistulae there were 0.02 replacements/year vs. 0.30 for GR and 0.41 for CV. P = 0.042 FI vs. other. The cumulative survival at 15 months was 100% for FI, 80% for GR and 20% for CV. P = 0.041. The cumulative survival at 3 years were 80% for fistulae and grafts, no CV lasted beyond 15 months. P = 0.013. There were 27 events requiring hospitalization or outpatient intervention. FI: 0.42/patient year, GR 1.22/patient year and CV 1.36/patient year. P = 0.080, FI vs. Other. Patients reported more problems between dialysis for FI, 3.2% of the days and least on GR (0.2%), CV (0.4%). P < 0.0001. Of the problems 85% were pain and redness. To the contrary there were more problems during dialysis with CV, 9.1% vs. FI 2.7%, and GR 0.9%. P < 0.0001. The complications and survival data are similar to those reported by others for quotidian hemodialysis and no different from reports on conventional 3 times per week dialyses. Conclusion: Daily hemodialysis does not adversely affect the different types of blood access. The survival and intervention need of accesses is best for fistulae, worst for CV, but GR, when functioning, have fewer problems between and during dialyses. [source] Single-center experience with mycophenolate mofetil in pediatric renal transplant recipientsPEDIATRIC TRANSPLANTATION, Issue 4 2001Mumtaz Virji Abstract: Mycophenolate mofetil (MMF), a potent and specific inhibitor of guanosine nucleotide synthesis, is a new immunosuppressive drug used to prevent rejection in transplant patients. Extensive data on its utility and efficacy exists in adult patients but there is limited experience in pediatrics. Twenty-four children (14 male, 10 female; 2,19 yr of age), eight of whom had received living-related donor (LRD) transplants and 16 of whom had received cadaveric donor (CD) transplants, have been treated with MMF in our institution since September 1996. MMF was administered for a duration ranging from 13 weeks to 38 months, at an average dose of 600 mg/m2 (range: 200,1,000 mg/dose) every 12 h, for a total experience of 304 patient months. MMF capsules were used in 16 patients and/or pediatric suspension in eight. Five patients were switched to MMF from azathioprine as a result of rejection episodes or inability to taper prednisone, between 5 weeks and 3.5 yr post-transplant. All patients received prednisone, cyclosporin A (CsA), and induction therapy with anti-lymphocyte globulin (19 patients), anti-thymocyte globulin (one patient) or daclizumab (four patients). In 12 patients started on MMF at the time of CD transplant, five (42%) had an acute rejection episode. In seven who received a LRD transplant, one (14%) had an acute rejection episode. No patients who were converted to MMF were treated for acute rejection following conversion to MMF. One LRD graft was lost at 19 days following injury to the donor artery at the time of retrieval. At the last follow-up, the average creatinine level was 93 µmol/L and average urea level was 8.6 mmol/L. One patient developed epigastric distress. Three patients developed diarrhea/abdominal pain requiring dose adjustment. Five episodes of leukopenia and one episode of thrombocytopenia required dose adjustment. Two patients developed symptomatic cytomegalovirus (CMV) infection, one while on acyclovir prophylaxis. No malignancy has been encountered to date. Hence, MMF can be administered safely to children with good effect and with an acceptable side-effect profile. [source] | ||||||||||