Regular Monitoring (regular + monitoring)

Distribution by Scientific Domains


Selected Abstracts


The epidemiology of hepatitis C in Australia: Notifications, treatment uptake and liver transplantations, 1997,2006

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 10 2009
Heather F Gidding
Abstract Background and Aim:, Regular monitoring of hepatitis C (HCV)-related surveillance data is essential to inform and evaluate strategies to reduce the expanding HCV burden. The aim of this study was to examine trends in the epidemiology and treatment of HCV in Australia. Methods:, We reviewed data about HCV notifications, treatment of HCV infection through the Highly Specialised Drugs (s100) Program, and liver transplants (Australia and New Zealand Liver Transplant Registry) for the period 1997,2006. Results:, HCV case notification rates declined by almost 50% between 1999 and 2006, with the greatest reductions between 2001 and 2002 and amongst young adults. For newly acquired HCV cases, 89% were Australian-born and 90% reported injecting drug use as a risk factor for infection. Overall, 30% of liver transplant recipients had HCV-related cirrhosis, but the number and proportion of HCV diagnoses increased between 1997 and 2006. HCV treatment also increased over the review period. However, only 1.4% of the 202 400 people estimated to be living with chronic HCV at the end of 2006 received treatment that year. Conclusion:, The decline in HCV notifications is consistent with a decline in HCV incidence in Australia. However, the burden of advanced HCV disease continues to expand. To reduce this burden, treatment uptake needs to increase. Consistent and sensitive surveillance mechanisms are required to detect newly acquired cases together with an expansion of surveillance for chronic HCV infections. [source]


A history and review of school meal standards in the UK

JOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 2 2009
C. E. L. Evans
Abstract This review details the history of school meals in the UK, from their origin in the mid-19th Century, to the present day, and provides a summary of how each country has independently developed its own food and or nutrient-based standards for school meals. The standards in place in the UK are amongst some of the most detailed and comprehensive in the world. Regular monitoring to ensure that these standards are being met and that schools are improving healthy eating is essential to their success. Of no lesser importance are assessments to determine whether changes to school meals are having an impact on the diets of school children. It is early days in terms of evaluation because food-based standards have only recently been introduced and nutrient-based standards are in the process of being developed and implemented. Studies in England provide some evidence that the re-introduction of standards for school food is having a positive impact on both pupil's food choices and the nutritional profile of school lunches. At present, there does not appear to be a pattern between current obesity levels and the types of school meals provided, although it is anticipated that, in the long term, these comprehensive standards may contribute to a less obesogenic environment. [source]


Pituitary disease , perspectives of patients and partners

JOURNAL OF NURSING AND HEALTHCARE OF CHRONIC ILLNE SS: AN INTERNATIONAL INTERDISCIPLINARY JOURNAL, Issue 2 2009
FRCNA, Trisha Dunning AM
Aim. To explore experiences of pituitary disease of people with pituitary disease (PD) and their partners (PT). Background. Pituitary disease encompasses a range of hormonal abnormalities that produce a variety of signs and symptoms depending on the underlying cause. Design. A triangulated exploratory study. Methods. The study was conducted in three phases: (a) non-participant monitoring of an Internet pituitary chat room over four months; (b) in-depth structured interviews with PD attending a pituitary outpatient clinic (n = 8) and PT (n = 6), (c) focus groups (n = 12). Data were collected in 2005. Results. Four themes emerged from the discussion in each phase: ,need to be normal', ,emotional merry-go-round', ,damage to the self', and ,doctor ignorance'. Symptoms of pituitary disease were often mistaken for sinusitis, ,getting old before my time', hypochondria, stress, and ,something sinister changing the way I look'. Time to diagnosis varied from four weeks to 15 years. PD felt included in decision-making but partners relied on PD for information. Body image changes were significant making PD feel like a ,freak show for medical students' and the emotional distress persisted after treatment and ,cure'. The word ,tumour' caused significant stress and anxiety and depression was common. PD and PT felt general practitioners (GP) lacked information about pituitary disease. Conclusions. Pituitary disease has a major impact on psychological well-being. PD but not PT felt involved in decisions about their management. GPs may need more education about pituitary disease. The study adds important information about the emotional effects of pituitary disease and its treatment. Relevance to clinical practice. Pituitary disease is a generic term encompassing a range of underlying disease processes that often produce vague symptoms, often attributed to other causes, which delays diagnosis and treatment. Pituitary disease has a significant under recognised impact on people's mental and physical wellbeing and self-concept. Although the underlying hormonal imbalances associated with pituitary disease are largely reversible (cured), emotional distress persists. Regular monitoring of emotional wellbeing as well as medical and hormone status is warranted. [source]


Distribution of mountain hares Lepus timidus in Scotland: results from a questionnaire

MAMMAL REVIEW, Issue 4 2010
Vikki PATTON
ABSTRACT A questionnaire survey of land owners, managers and gamekeepers was conducted in order to assess the distribution of mountain hares in Scotland, assess their current management, collate numbers harvested in 2006,07 and estimate distribution change by comparing with similar data collected in 1995,96. The land area covered by returned questionnaires was 71098km2 (90% of Scotland). Mountain hares were reported as present on 34359km2 (48%) and absent from 36739km2 (52%). Mountain hare presence was strongly associated with heather moorland managed for red grouse shooting. Moorland managed for driven grouse shooting had the highest percentage area of mountain hare presence (median 64%) followed by moorland managed for walked-up grouse shooting (median 9%) and moorland with no grouse shooting (median 0%). Approximately 25000 mountain hares were harvested in 2006,07. Based on the estimated UK population in 1995 of 350000 (range ±50%), this represents around 7% of the population (range 5,14%). Reasons given by respondents for harvesting hares were tick control (50%), sport (40%) and forestry or crop protection (10%). Comparison of the estates surveyed in both 2006,07 and 1995,96 (a total area of 20462km2) indicated no net gain or loss in hare distribution. Furthermore, there was no evidence that levels of harvest had reduced the range of mountain hares in this area. It is not possible to comment on any distribution change outside this area (58737km2). Similarly, as no data were collected on abundance, it is not possible to draw conclusions on changes in density. Regular monitoring of mountain hare distribution within Scotland is required to identify any distribution changes. Measures of abundance throughout the range are necessary to estimate the population size, investigate the relationship between harvest intensity and changes in abundance and further assess the conservation status of this UK Biodiversity Action Plan species. [source]


The white dwarf in AE Aqr brakes harder

MONTHLY NOTICES OF THE ROYAL ASTRONOMICAL SOCIETY, Issue 4 2006
Christopher W. Mauche
ABSTRACT Taking advantage of the very precise de Jager et al. optical white dwarf orbit and spin ephemerides; ASCA, XMM,Newton and Chandra X-ray observations spread over 10 yr; and a cumulative 27-yr baseline, we have found that in recent years the white dwarf in AE Aqr is spinning down at a rate that is slightly faster than predicted by the de Jager et al. spin ephemeris. At the present time, the observed period evolution is consistent with either a cubic term in the spin ephemeris with , which is inconsistent in sign and magnitude with magnetic dipole radiation losses, or an additional quadratic term with , which is consistent with a modest increase in the accretion torques spinning down the white dwarf. Regular monitoring, in the optical, ultraviolet and/or X-rays, is required to track the evolution of the spin period of the white dwarf in AE Aqr. [source]


Physical activity trends in Queensland (2002 to 2008): are women becoming more active than men?

AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 3 2010
Corneel Vandelanotte
Abstract Objective: Regular monitoring of population levels of physical activity is an effective way to assess change over time towards meeting public health recommendations. The objective of this study was to determine physical activity trends in Central Queensland over the period 2002 to 2008. Methods: Data was obtained from the Central Queensland Social Survey (CQSS) conducted annually from 2002 to 2008. A total sample of 8,936 adults aged 18 and over participated in seven cross-sectional surveys. Physical activity was measured using the Active Australia Questionnaire. Binary logistic regression was used to examine trends in sufficient physical activity. Results: Averaged over all survey years 46.5% of study participants met national physical activity guidelines. A small significant upward trend was found for meeting physical activity recommendations across all years (OR=1.03; 95%CI=1.01,1.05), indicating that the odds of meeting the guidelines increased by an average of 3% per year from 2002 to 2008. Slightly more men than women met the activity guidelines (ns); however a significant positive trend in achieving sufficient activity levels was present in women only (4%). Conclusions and Implications: Although an increasing trend for sufficient physical activity was observed, overall physical activity levels in Central Queensland remain suboptimal and more efforts to increase physical activity are needed. The gender differences in physical activity trends indicate that men and women might need to be targeted differently in health promotion messages. The continuous monitoring of population levels of physical activity in Australia, which allow both state specific and international comparisons, is needed. [source]


One-stop neck lump clinic: phase 2 of audit.

CLINICAL OTOLARYNGOLOGY, Issue 6 2001
How are we doing?
One-stop neck lump clinic: phase 2 of audit. How are we doing? Regular monitoring and audit of a service are integral to ensuring maintenance of efficiency and standards. This is particularly important where the quality of the service is operator dependent, as is the case in the clinical diagnosis of neck lumps and fine needle aspiration cytology. The one-stop neck lump clinic has now been running in the department for more than 20 months. A previous article described the results of the first phase audit carried out at 6 months and had identified a waiting time to be seen that was longer than that recommended by the British Association of Otorhinolaryngologists, Head and Neck Surgeons. Measures were implemented to reduce this waiting time and a second audit was carried out after another 10 months with the aims of assessing if modification of the means of referral reduces waiting time and if the outcomes of clinical performance in phase 1 could be maintained or improved. We discuss the results of phase 2 in the audit spiral. [source]


Self-monitoring in Type 2 diabetes mellitus: a meta-analysis

DIABETIC MEDICINE, Issue 11 2000
S. Coster
SUMMARY Aims Self-monitoring of blood or urine glucose is widely used by subjects with Type 2 diabetes mellitus. This study evaluated the effectiveness of the technique at improving blood glucose control through a systematic review and meta-analysis. Methods Randomized controlled trials were identified that compared the effects of blood or urine glucose monitoring with no self-monitoring, or blood glucose self-monitoring with urine glucose self-monitoring, on glycated haemoglobin as primary outcome in Type 2 diabetes. Results , Eight reports were identified. These were rated for quality and data were abstracted. The mean (sd) quality score was 15.0 (1.69) on a scale ranging from 0 to 28. No study had sufficient power to detect differences in glycated haemoglobin (GHb) of less than 0.5%. One study was excluded because it was a cluster randomized trial of a complex intervention and one because fructosamine was used as the outcome measure. A meta-analysis was performed using data from four studies that compared blood or urine monitoring with no regular monitoring. The estimated reduction in GHb from monitoring was ,0.25% (95% confidence interval ,0.61 to 0.10%). Three studies that compared blood glucose monitoring with urine glucose monitoring were also combined. The estimated reduction in GHb from monitoring blood glucose rather than urine glucose was ,0.03% (,0.52 to 0.47%). Conclusions The results do not provide evidence for clinical effectiveness of an item of care with appreciable costs. Further work is needed to evaluate self-monitoring so that resources for diabetes care can be used more efficiently. [source]


Summer changes in cyanobacterial bloom composition and microcystin concentration in eutrophic Czech reservoirs

ENVIRONMENTAL TOXICOLOGY, Issue 3 2006
Petr Znachor
Abstract In mid-July and August 2003 and 2004, 18 reservoirs in the Czech Republic were sampled for phytoplankton species composition and concentration of intracellular microcystins (MCs). As a consequence of high nutrient loading, most of the reservoirs experienced cyanobacterial blooms of various intensities, with the prevalence of cyanobacteria increasing markedly in August, along with a conspicuous shift in species composition toward dominance of Microcystis spp. Microcystins were detected in 90% of the samples, and their amount also increased considerably in August, reflecting the cyanobacterial biomass. In Microcystis -dominated samples, a significantly higher amount of MCs (p < 0.001) occurred than in samples in which other taxa prevailed. Microcystins were positively correlated with chlorophyll a and cyanobacterial biovolume (p < 0.05, R2 = 0.61 and 0.66, respectively), with the strongest correlation found for Microcystis spp. biovolume (p < 0.001, R2 = 0.87). This taxon was the most important producer of MCs in Czech reservoirs. The main structural variants of MCs were MC-LR, MC-RR, and MC-YR. This study's data also indicate that the relative share of MC variants (MC-LR and MC-RR) varies considerably with time, most likely as a consequence of different species and strain compositions during the summer. This study clearly demonstrates a high prevalence of MC-producing cyanobacteria in Czech reservoirs. Therefore, regular monitoring of these reservoirs is highly desirable in an effort to minimize potential health risks to the human population. © 2006 Wiley Periodicals, Inc. Environ Toxicol 21: 236,243, 2006. [source]


HIV and the body: a review of multidisciplinary management

HIV MEDICINE, Issue 2010
J Rockstroh
Abstract The increase in the life expectancy achieved following the introduction of more effective antiretroviral therapy (ART) in recent years now means that the HIV-infected population are for the first time being exposed to the age-related diseases that affect the general population. Nevertheless, the prevalence of these diseases (which include cardiovascular disease, dyslipidaemia, glucose intolerance and diabetes) is higher, and their onset earlier in the HIV population, probably due to the complex interplay between HIV infection, coinfection with hepatitis B and C, and ART. As a result, HIV physicians are now required to adopt a new approach to the management of HIV, which involves screening and regular monitoring of all HIV-infected individuals for the presence of comorbidities and prompt referral to other clinical specialties when required. If this challenge to patient management is to be overcome, it is clear that educating physicians in the diagnosis and treatment of age-associated comorbidities is essential, either through ongoing programmes such as the HIV and the Body initiative, an overarching independent medical education programme established in 2007 and overseen by an independent Steering Committee, organized and funded by Gilead, and/or through internal training. To assist in this process, this article provides an overview of common comorbidities affecting HIV-infected persons and provides practical guidance on their management. [source]


Requesting patterns for serum calcium concentration in patients on long-term lithium therapy

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 1 2009
B. J. Jones
Summary Aim:, Long-term lithium therapy is associated with hypercalcaemia in 10,60% of patients, but unlike creatinine and thyroid stimulating hormone (TSH), monitoring by general practitioners of serum calcium for patients on lithium is not a requirement of the Qualities and Outcomes Framework (QOF) of 2004. We aimed to assess requesting patterns for serum calcium in patients on long-term lithium therapy and subsequent diagnosis of hypercalcaemia. Methods:, We identified 100 patients on long-term lithium therapy, as indicated by regular monitoring of lithium levels in our laboratory for at least 1 year. We determined how many of these patients had had serum calcium analysed, noting the assay date, concentration, source of request and clinical details stated. Results:, Forty-three out of hundred patients had serum calcium analysed during the course of their treatment including 28 in the previous 15 months. Twenty-one patients had serum calcium analysed by their GP, including 12 in the previous 15 months. Hypercalcaemia was diagnosed in five patients (11.6%). Conclusion:, A significant proportion of patients in whom calcium was checked developed hypercalcaemia on lithium therapy. However, only 12% of the patients had serum calcium requested by their GP in the previous 15 months, which compares unfavourably with TSH and creatinine, for which monitoring approaches 100%. We recommend that serum calcium be checked every 15 months along with creatinine and TSH. This might be achieved by incorporating appropriate targets into the QOF, or by reflective or reflex adding-on of calcium to lithium specimens from patients who have not had calcium analysed in the previous 15 months. [source]


Distribution of endosulfan in water, sediment and fish from Warri river, Niger delta, Nigeria

AFRICAN JOURNAL OF ECOLOGY, Issue 1 2010
Lawrence Ikechukwu Ezemonye
Abstract This article presents the first attempt to quantify the levels and distribution pattern of endosulfan, an organochlorine pesticide in surface water, sediment and fish (Chrysichthys furcatus and Tilapia zilli). The samples were collected from three stations (Ovwian, Ekakpamre and Ovu) of Warri River in the western Niger Delta of Nigeria in 2006 during the dry and wet seasons (January,August). A total of 96 samples made up of 24 samples each for water, sediment and fish were analysed in this study. The pesticide levels were analysed using high performance liquid chromatography (HPLC model CECIL 1010) to elucidate its distribution in various environmental compartments. The ranges of concentrations of the pesticide in the matrices were: 0.01,9.23 ,g/l (water), 0.06,11.98 ,g/gdw (sediment), 0.01,15.06 ,g/gdw (Chrysichthys furcatus) and 0.01,1.80 ,g/gdw (Tilapia zilli). From this result, decreasing order of occurrence of the pesticide is as follows: fish > sediment > water. The concentrations observed in fish (Chrysichthys furcatus) were higher than the levels observed in sediment and water suggesting bioaccumulation of the pesticide by the fish. Spatial variations occurred with downstream stations having statistically higher concentrations in all matrices at P < 0.05. Seasonal variations occurred with higher concentrations in dry season for water and sediment only, while the fish species had higher concentrations in the wet season. The observed values of endosulfan were above the ecological bench marks (0.02 ,g/l) recommended by Nigeria Environmental Protection Agency and European Union. They were also relatively higher than those in previous studies on the Nigerian environment, an observation that calls for regular monitoring of the Niger Delta water bodies. Résumé Cet article présente le premier essai de quantifier les teneurs et le schéma de distribution de l'endosulfan, un pesticide organochloré, dans l'eau de surface, les sédiments et les poissons (Chrysichthys furcatus et Tilapia zilli). Les échantillons ont été récoltés en 2006 dans trois stations (Ovwian, Ekakpamre et Ovu) de la rivière Warri, dans le delta occidental du Niger, au Nigeria, pendant les saisons des pluies et sèche (janvier et août). Un total de 96 échantillons furent prélevés et analysés, à savoir 24 échantillons pour l'eau, pour les sédiments et pour les deux espèces de poissons. La teneur en pesticide a été analysée par la chromatographie en phase liquide à haute performance (HPLC modèle Cecil 1010) pour connaître sa distribution dans les différents compartiments environnementaux. La concentration du pesticide dans les matrices était de 0,01,9,23 ,g/l (eau), 0.06,11.98 ,g/gMS (sédiment), 0,01,15,06 ,g/gMS (Chrysichthys furcatus) et 0,01,1,80 ,g/gMS (Tilapia zilli). De ces résultats, nous pouvons dire que l'ordre d'occurrence du pesticide est le suivant: poissons > sédiment >eau. Les concentrations observées chez le poisson Chrysichthys furcatusétaient plus élevées que celles des sédiments et de l'eau, ce qui suggère une bio-accumulation du pesticide dans le poisson. Il y avait aussi des variations spatiales: les stations situées en aval avaient des concentrations statistiquement plus grandes dans toutes les matrices àP < 0,05. Il y avait des variations saisonnières, et les concentrations étaient plus élevées en saison sèche pour l'eau et les sédiments seulement, alors que les deux espèces de poissons présentaient une teneur plus élevée en saison des pluies. Les teneurs en endosulfan constatées étaient plus élevées que les normes écologiques (0,02 ,g/l) recommandées par l'Agence de protection environnementale du Nigeria et par l'Union européenne. Elles étaient aussi relativement plus élevées que celles décelées lors d'études antérieures de l'environnement au Nigeria, observation qui appelle à un suivi régulier des étendues d'eau du delta du Niger. [source]


An assessment of the puku (Kobus vardonii Livingstone 1857) population at Lake Rukwa, Tanzania

AFRICAN JOURNAL OF ECOLOGY, Issue 4 2009
Matthias Waltert
Abstract The population of puku, Kobus vardonii, at Lake Rukwa, one of only two in Tanzania, is poorly known. A multi-species dry season game count carried out in Rukwa Game Reserve (RGR) in 2004 estimated a population size of 1729, but was associated with a high margin of error [coefficient of variation (CV) 0.88]. To increase the precision for the local puku population estimate, we conducted a zig-zag line transect survey restricted only to areas occupied by puku in the dry season of 2006. This survey technique produced an estimate of 776 individuals and the CV was considerably reduced to 0.29. Puku herd size was comparable with the studies carried out in the Kilombero valley, Tanzania and in Kasanka National Park, Zambia, thus broadly confirming the herding ecology of this species. We found that pukus were restricted to the central parts of the floodplains, suggesting an avoidance of habitats used by pastoralists at the edge of RGR. Compared with the estimates of the puku population made in the 1980s, the puku population has declined. We recommend regular monitoring and enforcement of the current management plan to conserve the local puku population. Résumé Le statut de la population du puku Kobus vardonii au lac Rukwa, une des deux seules populations de Tanzanie, est mal connu. Un dénombrement de nombreuses espèces animales réalisé en saison sèche dans la Réserve de Faune de Rukwa (RGR) en 2004 a estimé la taille de la population à 1 729, mais ce chiffre était associéà une grande marge d'erreur (CV 0,88). Pour améliorer la précision de l'estimation de la population de pukus, nous avons mené une étude par transect en zigzag limitée aux zones occupées par les pukus, pendant la saison sèche de 2006. Cette technique d'étude a donné une estimation de 776 individus, et la CV était considérablement réduite, à 0,29. La taille des hardes de pukus était comparable à celle relevée dans la vallée de Kilombero, en Tanzanie, et dans le Parc National de Kasanka, en Zambie, confirmant ainsi l'écologie en harde de cette espèce. Nous avons découvert que les pukus se limitaient aux parties centrales des plaines inondables, ce qui suggère qu'ils évitent les habitats fréquentés par les pasteurs à la limite de la Réserve de Faune de Rukwa. Comparée aux estimations de cette population de pukus réalisées dans les années 1980, cette population a décliné. Nous avons recommandé d'assurer un suivi régulier et d'appliquer le plan de gestion actuel pour conserver la population locale de pukus. [source]


Liver fibrosis attributed to lipid lowering medications: two cases

JOURNAL OF INTERNAL MEDICINE, Issue 3 2001
Z. 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]


Biowaiver monographs for immediate release solid oral dosage forms: ethambutol dihydrochloride,,

JOURNAL OF PHARMACEUTICAL SCIENCES, Issue 4 2008
C. Becker
Abstract Literature data relevant to the decision to allow a waiver of in vivo bioequivalence (BE) testing for the approval of immediate release (IR) solid oral dosage forms containing ethambutol dihydrochloride as the only active pharmaceutical ingredient (API) are reviewed. Ethambutol dihydrochloride is a Biopharmaceutics Classification System (BCS) Class III drug with permeability properties approaching the border between BCS Class I and III. BE problems of ethambutol formulations containing different excipients and different dosages forms have not been reported and hence the risk of bioinequivalence caused by excipients is low. Ethambutol has a narrow therapeutic index related to ocular toxicity. However, as long as the prescribers' information of the test product stipulates the need for regular monitoring of ocular toxicity, the additional patient risk is deemed acceptable. It is concluded that a biowaiver can be recommended for IR solid oral dosage forms provided that the test product (a) contains only excipients present in ethambutol IR solid oral drug products approved in ICH or associated countries, for instance as presented in this paper, (b) complies with the criteria for "very rapidly dissolving" and (c) has a prescribers' information indicating the need for testing the patient's vision prior to initiating ethambutol therapy and regularly during therapy. © 2007 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 97:1350,1360, 2008 [source]


Adherence rate to inhaled corticosteroids and their impact on asthma control

ALLERGY, Issue 5 2009
L. Lasmar
Background:, Poor asthma control is associated to high morbidity. The objective of this study was to assess the association between adherence rates to beclomethasone dipropionate (BDP) and the degree of asthma control. Methods:, A cohort concurrent study was carried out for 12 months with 122 asthmatic patients, aged 3,12 years, randomly selected in a pediatric pulmonology outpatient clinic, who received BDP free of charge. Adherence rates were verified by pharmacy records. Clinical control was assessed through a scoring system comprised four variables (nocturnal and morning symptoms, limitation of physical activities and exacerbations). Total score was 16 points. Patients whose score was below or equal to two were considered controlled (group 1), and patients whose score was above or equal to three were considered uncontrolled (group 2). For patients able to perform spirometry, we considered as controlled the patients with forced expiratory volume in 1 s (FEV1) equal to or above 80% of the predicted value, and as uncontrolled the patients with FEV1 below 80%. Results:, Fewer than half (40.3% maximum) of the 122 patients maintained asthma control. Median adherence rate of groups 1 and 2 were 85.5% and 33.8%, (P < 0.001) in the 4th month, 90.0% and 48.0% (P < 0.001) in the 8th month and 84.4% and 47.0% in the 12th month (P < 0.001), respectively. Conclusion:, In all periods, there were statistically significant differences in adherence rates for maintaining or not maintaining the asthma control. Optimal asthma control entailed adherence rate higher than 80%. Strategies for reducing asthma morbidity should include a regular monitoring of adherence to inhaled steroids. [source]


Energy Regulation and Aging: Recent Findings and Their Implications

NUTRITION REVIEWS, Issue 4 2000
Susan B. Roberts Ph.D.
Old age is a time of vulnerability to unintentional weight loss, a factor that is associated with increased morbidity and premature death. Many possible causes of weight loss in old age have been suggested. The so-called anorexia of aging may play a particular role, by either reducing food intake directly or reducing food intake in response to such adverse factors as age-associated reductions in taste and smell, poor dentition, use of multiple prescription medicines, and depression. Recent studies also raise the question of whether a reduction in dietary variety may be important. These findings emphasize the need for regular monitoring of body weight to detect unintentional weight loss in older individuals and suggest testable ways to minimize the impact of the anorexia of aging on body weight through improved dietary management. [source]


Severe iron overload in Blackfan-Diamond anemia: A case-control study,

AMERICAN JOURNAL OF HEMATOLOGY, Issue 11 2009
Simona Roggero
Chronic iron overload is a serious complication in transfusion-dependent patients. Few studies have addressed this issue in Diamond-Blackfan anemia (DBA). We describe a retrospective analysis of iron overload, and its related complications in 31 transfusion-dependent Italian DBA patients whose records included one or more evaluation of liver iron concentration (LIC) by means of noninvasive magnetic liver susceptometry with a superconductive quantum interference device (SQUID). This cohort is also matched with a group of transfusion-dependent ,-thalassemia major patients to look for differences. A severe iron overload was observed in 54% patients, especially among those inadequately chelated. The DBA patients displayed a significantly higher LIC than the regularly chelated ,-thalassemics. This difference may have been attributable to nonoptimal chelation (late onset, type, dose, prescription, and compliance), or an unknown biological mechanism that lead to an early severe iron overload. We therefore suggest that all transfusion patients should have an accurate record of their iron intake, a regular monitoring of iron overload, in order to start chelation when a critical transfusion load is reached, and to test the efficacy/compliance of chelation treatment. Physicians taking care of transfusion-dependent DBA patients must be concerned about the frequent and early complications such as cardiac toxicity. Am. J. Hematol., 2009. © 2009 Wiley-Liss, Inc. [source]


Transjugular intrahepatic portosystemic shunt: an analysis of outcomes

ANZ JOURNAL OF SURGERY, Issue 10 2009
Timothy P. Kurmis
Abstract Background:, Transjugular intrahepatic portosystemic shunts (TIPS) are utilized for the management of complications of portal hypertension, particularly diuretic-resistant ascites and recurrent variceal bleeding. It has also been applied in Budd,Chiari syndrome and hepatorenal syndrome. We report the results in a small series, over 9 years, from a single centre, and compare these to those published in the literature. Methods:, A retrospective case note review of 20 consecutive TIPS procedures performed at Flinders Medical Centre from January 1997 to December 2005 was completed. All indications were included in the analysis. Underlying liver disease, peri-procedure complications, relief of symptoms and patient survival were recorded. Data on type of TIPS, shunt patency and method of follow-up were recorded. Results:, Thirty-six TIPS were performed in 20 subjects. All initial TIPS attempts were successful. Indications were: refractory ascites (18), acute variceal bleeding (12) and hepatorenal syndrome (2). There were no peri-procedure deaths, however. Ninety-day mortality was 20%. Outcomes in model of end-stage liver disease score and biochemical characteristics post-TIPS were comparable to those reported. Overall, TIPS dysfunction rate was 35% at 1 year. TIPS follow-up and patency surveillance was an ad hoc combination of Doppler ultrasound and venography. Conclusion:, TIPS procedure outcomes in our centre are similar to those reported in the literature from large centres. TIPS patency rates may be improved with regular monitoring and early intervention when stenosis occurs. [source]


Assessment of impact of aquaculture on Kolleru Lake (India) using remote sensing and Geographical Information System

AQUACULTURE RESEARCH, Issue 16 2006
Marappan Jayanthi
Abstract Aquaculture is one of the fastest growing food industries and the rapid growth of aquaculture worldwide has resulted in growing concerns about its impact on important ecosystems. Kolleru Lake, India's largest fresh water body, and Ramsar site have undergone tremendous changes due to the development of aquaculture. To assess the impact of aquaculture on Kolleru, satellite data were found appropriate because of the synoptic-detailed overview and accuracy. Satellite data of IRS 1D, LISS III from 2004 and Survey of India topographic maps from 1967 were processed using image processing techniques in erdas imagine and analysed in Geographical Information System (GIS) such as arc gis 9.1. Land use map prepared from the satellite data was verified in the field using Global Positioning System to check the land and water use classes and its areal extent. It was estimated from the topographic maps of 1967 that the total lake boundary area was 180.38 km2, in which 70.70 km2 had water throughout the year and 100.97 km2 had water during the rainy season. The digital image processing of 2004 satellite data revealed that Kolleru was no longer a lake and the lake area of 62.65 km2 (34.73%) only remained in a degraded state, extensively colonized by macrophytes. The total loss of lake area was 109.02 km2 between 1967 and 2004, in which aquaculture was developed in 99.74 km2, which represented 55.3% of the 1967 lake area. The maximum conversion to aquaculture occurred from the lake liable to be inundated during the 1967 rainy season. The area under agriculture was 16.62 km2 in 2004, the increase in lake area for agriculture between 1967 and 2004 being 8.22 km2 (4.55% of lake). If human induced degradation is allowed to continue, the lake will very soon disappear. Now, the Government of Andhra Pradesh, India, has initiated schemes and laws to restore the lake to its pre-development state. Lessons learnt from the Kolleru Lake cautioned that there is a need for regular monitoring of important water resources throughout the world to protect the biodiversity of the earth. [source]


Thalidomide experience of a major Australian teaching hospital

AUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 4 2002
Rohan B Crouch
SUMMARY St Vincent's Hospital Melbourne cautiously prescribes thalidomide as a treatment for recalcitrant dermatoses. The guidelines used for prescribing and monitoring thalidomide for dermatological conditions at this institution are presented. Fourteen patients were treated with thalidomide (11 women, three men) over a 5-year period. The diagnoses of patients treated were actinic prurigo, prurigo nodularis, lupus erythematosus and Behçet's syndrome. A clinical improvement was noted in 10 patients (71.4%) prescribed thalidomide. Cessation of thalidomide treatment occurred in seven patients (50%) because of adverse effects. Of the patients with adverse effects, four developed abnormal nerve conduction studies and three developed intolerable adverse events (such as dizziness and vomiting). Adverse effects from thalidomide treatment are common but, through vigilant treatment planning, patient education and regular monitoring, the risk of permanent peripheral neuropathy and teratogenicity from thalidomide toxicity can be minimized. [source]


Veterinarians' preferences for anticonvulsant drugs for treating seizure disorders in dogs and cats

AUSTRALIAN VETERINARY JOURNAL, Issue 11 2009
EK Kluger
Objective To identify veterinarians' approaches and concerns when managing canine and feline patients with acute and chronic seizure disorders. Design Cross-sectional survey. Method A questionnaire was distributed to veterinarians to determine how many dogs and cats they were actively treating for seizures, their anticonvulsant drug (ACD) preferences for treating acute and chronic seizure disorders and whether serum anticonvulsant concentrations and/or biochemical analytes were routinely measured. Additional questions involved the respondent's year and place of graduation and identified concerns they faced when managing patients with seizure disorders. Results Phenobarbitone was the most commonly used ACD for managing chronic seizure disorders in both dogs and cats, with 82% of respondents using a combination of phenobarbitone and potassium bromide to manage refractory seizure disorders in dogs. Most respondents (96%) felt comfortable managing seizures in dogs, but only 63% were comfortable managing affected cats. Routine monitoring of serum ACD concentrations and of liver biochemical analytes was performed routinely by 71% and 45% of respondents, respectively. Of the respondents, 86% graduated from Australian universities and of these 53% had graduated after 1985. Conclusion Veterinarians identified when to commence medication, whether regular monitoring of serum ACD concentrations and liver enzyme activity was necessary, and if the cost was justified. Veterinarians also identified the need to balance dose rates and side-effects by using combination therapy, and the importance of providing accurate information to clients about what to expect in terms of seizure control for their pet. [source]


Declining medical decision-making capacity in mild AD: a two-year longitudinal study,

BEHAVIORAL SCIENCES & THE LAW, Issue 4 2006
Justin S. Huthwaite Psy.D.
This is a report of a two-year longitudinal study comparing healthy older adult subjects (n,=,15) and mild Alzheimer's disease (AD) patients (n,=,20) using an objective performance measure of medical decision-making capacity (MDC). Capacity to consent to medical treatment was measured using the Capacity to Consent to Treatment Instrument (CCTI). The CCTI is a psychometric measure that tests MDC using a series of four core capacity standards: S1 (evidencing/communicating choice), S3 (appreciating consequences), S4 (providing rational reasons), and S5 (understanding treatment situation), and one experimental standard [S2] (making the reasonable treatment choice). For each standard, mild AD patients were assigned one of three capacity outcomes (capable, marginally capable, or incapable) based on cut-off scores derived from control group performance. At baseline, mild AD patients performed equivalently with controls on simple standards of evidencing a choice (S1) and making the reasonable choice ([S2]), but significantly below controls on complex standards of appreciation, reasoning, and understanding (S3, S4, and S5) (p,<,0.02). Control performance was stable over time on all capacity standards. At one-year follow-up, the mild AD group did not show significant decline from baseline on any capacity standard. However, at two-year follow-up the mild AD group showed significant declines from baseline on the three complex standards (S3, S4, and S5) (p,<,0.02), and a trend on one of the simple standards (S1). Over the two-year period, the proportion of marginally capable and incapable outcomes in the AD group increased substantially for four of the five standards (S1, S3, S4, and S5). Performance on [S2] remained stable over time in the AD group. We conclude that mild AD patients have impaired MDC at baseline, and demonstrate significant additional decline on complex consent abilities of appreciation, reasoning, and understanding over a two-year period. AD patients also show emerging impairment on the simple consent ability of evidencing choice at two-year follow-up. Capacity outcome data reflect similar declines over time for these four consent standards. The findings suggest the value of early assessment and regular monitoring at two-year intervals of MDC in patients with mild AD. Copyright © 2006 John Wiley & Sons, Ltd. [source]


Functional Regression Analysis of Fluorescence Curves

BIOMETRICS, Issue 2 2009
Christian Ritz
Summary Fluorescence curves are useful for monitoring changes in photosynthesis activity. Various summary measures have been used to quantify differences among fluorescence curves corresponding to different treatments, but these approaches may forfeit valuable information. As each individual fluorescence curve is a functional observation, it is natural to consider a functional regression model. The proposed model consists of a nonparametric component capturing the general form of the curves and a semiparametric component describing the differences among treatments and allowing comparisons of treatments. Several graphical model-checking approaches are introduced. Both approximate, asymptotic confidence intervals as well as simulation-based confidence intervals are available. Analysis of data from a crop experiment using the proposed model shows that the salient features in the fluorescence curves are captured adequately. The proposed functional regression model is useful for analysis of high throughput fluorescence curve data from regular monitoring or screening of plant growth. [source]


The effect of intestinal urinary reservoirs on renal function: a 10-year follow-up

BJU INTERNATIONAL, Issue 3 2000
E. Fontaine
Objective To study the effect of the storage of urine in intestinal reservoirs on long-term renal function and the possible causes of deterioration. Patients and methods Eighty-seven patients (aged 4,35 years) with bladder exstrophy who underwent reconstruction of the lower urinary tract using a bowel segment were enrolled in a prospective protocol. The glomerular filtration rate (GFR) was measured before and after surgery at 1, 2, 5 and 10 years using 51Cr-ethylenediamine tetra-acetic acid. Patients with a decline in GFR of > 5% were investigated to identify the cause. Results Of 58 patients with a follow-up of , 10 years, 53 were evaluable, four having been lost to follow-up and one refusing to accept the protocol. In these 53 patients, the mean ( sd) GFR decreased from 97.9 (20.4) to 92.9 (23.6) mL/min/1.73 m2 (P = 0.24). However, this decrease was accounted for by 10 patients (19%) whose GFR fell by ,,20% over the 10 years. The causes of renal deterioration in these 10 patients were; chronic retention and/or infection caused by inadequate catheterization in poorly compliant patients (five), uretero-ileal stenosis (one), a high-pressure reservoir (one) and uncertain causes (three). Conclusions For 80% of the patients, the storage of urine in intestinal reservoirs did not change renal function for at least 10 years. However, ,,20% of patients had some deterioration in renal function during the 10-year follow-up, usually from identifiable and remediable causes. The storage of urine in bowel does not appear to be inherently damaging to kidney function. Patients with an enterocystoplasty need regular monitoring of renal function; when deterioration is detected the urinary tract must be functionally assessed. [source]


Reliability and validity of the Childhood Cancer Survivor Study Neurocognitive Questionnaire

CANCER, Issue 8 2008
Kevin R. Krull PhD
Abstract BACKGROUND. Up to 40% of childhood cancer survivors may experience neurocognitive impairment in 1 or more specific domains. As such, regular monitoring has been recommended for patients exposed to cranial irradiation and/or antimetabolite chemotherapy. This study reports the results of a questionnaire developed to identify those survivors who may be experiencing neurocognitive problems. METHODS. Participants for this study were 7121 members of the Childhood Cancer Survivor Study cohort (6739 survivors and 382 siblings). These participants completed a new neurocognitive questionnaire designed to assess functions commonly affected by cancer therapy, as well as a standard measure of emotional functioning. A measure of cognitive and emotional functioning was also completed on a subset of the patients roughly 7 years before the current questionnaire. Responses to the questionnaires among subgroups of survivors were then analyzed to examine the reliability and validity of the new neurocognitive questionnaire. RESULTS. Four reliable factors were identified that assessed task efficiency, emotional regulation, organization, and memory skills. These neurocognitive factors accurately discriminated survivors who were at "high risk" for neurocognitive dysfunction, because of neurologic abnormalities or a history of intensive focal cranial irradiation, from healthy "low-risk" survivors and siblings. CONCLUSIONS. The questionnaire demonstrated excellent reliability, as well as construct and discriminative validity. It appears to be a practical and efficient tool for monitoring neurocognitive outcomes in adult survivors of pediatric cancer. Cancer 2008. © 2008 American Cancer Society. [source]