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Target Goals (target + goal)
Selected AbstractsNonparametric population modeling of valproate pharmacokinetics in epileptic patients using routine serum monitoring data: implications for dosageJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 2 2004I. B. Bondareva Summary Therapeutic drug monitoring (TDM) of valproate (VAL) is important in the optimization of its therapy. The aim of the present work was to evaluate the ability of TDM using model-based, goal-oriented Bayesian adaptive control for help in planning, monitoring, and adjusting individualized VAL dosing regimens. USC*PACK software and routine TDM data were used to estimate population and individual pharmacokinetics of two commercially available VAL formulations in epileptic adult and pediatric patients on chronic VAL monotherapy. The population parameter values found were in agreement with values reported earlier. A statistically significant (P < 0.001) difference in median values of the absorption rate constant was found between enteric-coated and sustained-release VAL formulations. In our patients (aged 0·25,53 years), VAL clearance declined with age until adult values were reached at about age 10. Because of the large interindividual variability in PK behavior, the median population parameter values gave poor predictions of the observed VAL serum concentrations. In contrast, the Bayesian individualized models gave good predictions for all subjects in all populations. The Bayesian posterior individualized PK models were based on the population models described here and where most patients had two (a peak and a trough) measured serum concentrations. Repeated consultations and adjusted dosage regimens with some patients allowed us to evaluate any possible influence of dose-dependent VAL clearance on the precision of total VAL concentration predictions based on TDM data and the proposed population models. These nonparametric expectation maximization (NPEM) population models thus provide a useful tool for planning an initial dosage regimen of VAL to achieve desired target peak and trough serum concentration goals, coupled with TDM soon thereafter, as a peak,trough pair of serum concentrations, and Bayesian fitting to individualize the PK model for each patient. The nonparametric PK parameter distributions in these NPEM population models also permit their use by the new method of ,multiple model' dosage design, which allows the target goals to be achieved specifically with maximum precision. Software for both types of Bayesian adaptive control is now available to employ these population models in clinical practice. [source] Identification of a spatially efficient portfolio of priority conservation sites in marine and estuarine areas of FloridaAQUATIC CONSERVATION: MARINE AND FRESHWATER ECOSYSTEMS, Issue 4 2009Laura Geselbracht Abstract 1.A systematic conservation planning approach using benthic habitat and imperilled species data along with the site prioritization algorithm, MARXAN, was used to identify a spatially efficient portfolio of marine and estuarine sites around Florida with high biodiversity value. 2.Ensuring the persistence of an adequate geographic representation of conservation targets in a particular area is a key goal of conservation. In this context, development and testing of different approaches to spatially-explicit marine conservation planning remains an important priority. 3.This detailed case study serves as a test of existing approaches while also demonstrating some novel ways in which current methods can be tailored to fit the complexities of marine planning. 4.The paper reports on investigations of the influence of varying several algorithm inputs on resulting portfolio scenarios including the conservation targets (species observations, habitat distribution, etc.) included, conservation target goals, and socio-economic factors. 5.This study concluded that engaging stakeholders in the development of a site prioritization framework is a valuable strategy for identifying broadly accepted selection criteria; universal target representation approaches are more expedient to use as algorithm inputs, but may fall short in capturing the impact of historic exploitation patterns for some conservation targets; socio-economic factors are best considered subsequent to the identification of priority conservation sites when biodiversity value is the primary driver of site selection; and the influence of surrogate targets on portfolio selection should be thoroughly investigated to ensure unintended effects are avoided. 6.The priority sites identified in this analysis can be used to guide allocation of limited conservation and management resources. Copyright © 2008 John Wiley & Sons, Ltd. [source] Apolipoprotein Measurements: Is More Widespread Use Clinically Indicated?CLINICAL CARDIOLOGY, Issue 9 2009Michael H. Davidson MD Apolipoprotein (apo) B may be a more sensitive measure of atherogenicity than low-density lipoprotein cholesterol (LDL-C) and a better index for assessing cardiovascular risk. The refined risk assessment provided by apo B may be important in patients at high cardiometabolic risk such as those with diabetes mellitus or metabolic syndrome, as these conditions are often associated with normal LDL-C values but increased numbers of small, dense low-density lipoprotein (LDL) particles (indicating increased levels of apo B). Although apo B is not currently a treatment target in the United States cholesterol-lowering guidelines, a consensus conference endorsed by the American Diabetes Association and the American College of Cardiology recently recommended that apo B be added as a therapeutic target in patients at high cardiometabolic risk and in patients with clinical cardiovascular disease or diabetes. Suggested target goals are < 90 for high risk and < 80 mg/dL for highest risk patients. Current clinical data indicate that intensive statin therapy can lower apo B to meet this aggressive goal. While the proatherogenic/antiatherogenic ratio of apo B/apo A-I is a better risk discriminator than the single proatherogenic measurement (apo B), clinical trial data are lacking regarding the impact of increasing apo A-I and high-density lipoprotein on outcomes. Copyright © 2009 Wiley Periodicals, Inc. [source] Assessing coronary heart disease risk with traditional and novel risk factorsCLINICAL CARDIOLOGY, Issue S3 2004Peter W. F. Wilson M.D. Cardiovascular disease is the leading cause of death in the industrialized world, and a number of well-characterized factors, including advanced age, hypertension, dyslipidemia, diabetes, and smoking, contribute to cardiovascular risk. Integration of these factors using the Framingham calculation estimates the absolute 10-year risk for coronary heart disease (CHD), which can be used to guide therapy. Recent studies have demonstrated that additional markers, including elevated lipoprotein(a), homocysteine, sitosterol, and particularly C-reactive protein (CRP), are also associated with increased risk for CHD. In particular, high-sensitivity CRP has been shown to identify patients with high CHD risk who may not have elevated low-density lipoprotein cholesterol (LDL-C) and may add to the predictive value of the Framing-ham functions for CHD risk assessment. Assessment of global risk is particularly important in lipid management, as the LDL-C target goals are determined by risk category. [source] What Allows Cognitive Behavioral Therapy to Be Brief: Overview, Efficacy, and Crucial Factors Facilitating Brief TreatmentCLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, Issue 1 2001Lata K. McGinn Cognitive behavior therapy (CBT) has been traditionally used as a short-term treatment for a wide range of emotional disorders and problems. In the present paper, we review aspects of CBT that allow it to be time efficient. Specifically, CBT maximizes efficiency because it uses manual-based, empirically supported treatment strategies and defines specific, measurable, and achievable target goals. A focused assessment process and a relatively structured session format facilitate the implementation of treatment strategies without delay and allow the therapist to make efficient use of session time. Once treatment is implemented, a periodic review of treatment progress using objective criteria enables the therapist and client to make informed decisions about the direction of treatment. CBT uses strategies to enhance generalization and prevent relapse and empowers patients by providing them with skills they can use outside therapy sessions. Finally, the therapist's active, directive stance plays a critical role in making CBT time-efficient. [source] | ||||||||||