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Clinical Routine (clinical + routine)
Selected AbstractsPredicting Recurrence of Vasovagal Syncope: A Simple Risk Score for the Clinical RoutineJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2009MUHAMMET A. AYDIN M.D. Background: Predictors for recurrence of syncope are lacking in patients with vasovagal syncope. The aim of this study was to identify risk factors for recurrence of syncope and develop a simple prognostic risk score of clinical value. Methods: Two hundred seventy-six patients with a history of vasovagal syncope were prospectively followed for 2 years. Diagnosis of vasovagal syncope was based on clinical history and negative standard work-up. Inclusion in the study was independent from the result of the head-up tilt test, which was performed in all cases. Risk factors for syncope recurrence were evaluated by the Cox proportional hazards regression model and implemented in a risk score, which was validated with the log-rank test and an internal cross-validation. Results: The Cox-regression analysis identified the number of previous syncopal events, history of bronchial asthma, and female gender as predictors for syncope recurrence (all P < 0.05). In contrast, head-up tilt test response had no predictive value (P = 0.881). Developing a risk score, study patients were identified as having high (recurrence rate during 2 years of follow-up: 37.2%), intermediate (24.8%), and low (6.5%) risk for syncope recurrence (receiver operating characteristic [ROC] of score 0.83, P < 0.01; Log-rank test for event-free survival, P < 0.005). Conclusions: In patients with vasovagal syncope, risk of recurrence can be stratified and is predictable based on a simple risk score. [source] Weight gain in bipolar disorder: pharmacological treatment as a contributing factorACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2008C. Torrent Objective:, The aim of this paper was to review the association of most commonly used psychopharmacological drugs with weight gain in bipolar disorder. Method:, Information was retrieved from a PubMed/Medline literature search reviewing weight gain in pharmacological studies in bipolar disorder. Results:, Obesity and overweight in bipolar disorder are partly related to prescribed drugs with a strong effect of clozapine and olanzapine. Lesser but still relevant weight gain is caused by quetiapine, risperidone, lithium, valproate, gabapentin and by some antidepressants. Ziprasidone, aripiprazole, carbamazepine and lamotrigine do not seem to cause significant overweight. Conclusion:, Careful monitoring of weight changes in patients before and after drug prescription should be implemented in the clinical routine and drugs which potentially cause weight gain should be avoided in overweight patients with bipolar disorder. Furthermore, eating habits and daily activities should be targeted as they may also have a significant impact on overall health and weight-related issues. [source] Improving detection of first-episode psychosis by mental health-care services using a self-report questionnaireEARLY INTERVENTION IN PSYCHIATRY, Issue 4 2009Nynke Boonstra Abstract Objective: To examine the utility of the Community Assessment of Psychic Experiences (CAPE)-42, a self-report questionnaire, to improve detection of first-episode psychosis in new referrals to mental health services. Method: At first contact with mental health-care services patients were asked to complete the CAPE-42 and were then routinely diagnosed by a clinician. Standard diagnoses were obtained by means of the mini-Schedule for Clinical Assessment in Neuropsychiatry. Results: Of the 246 included patients, 26 (10.6%) were diagnosed with psychosis according to the mini-Schedule for Clinical Assessment in Neuropsychiatry. Only 10 of them were recognized by clinical routine, and 16 psychotic patients were not properly identified. Using an optimal cut-off of 50 on the frequency or distress dimension of the positive subscale of the CAPE-42 detected 14 of these misdiagnosed patients. The sensitivity of the CAPE-42 at this cut-off point was 77.5 and the specificity 70.5. Conclusion: Systematic screening of patients using a self-report questionnaire for psychotic symptoms improves routine detection of psychotic patients when they first come into contact with mental health services. [source] Neurocognition and its influencing factors in the treatment of schizophrenia,effects of aripiprazole, olanzapine, quetiapine and risperidoneHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 2 2010M. Riedel Abstract Background To examine influencing variables of neurocognition in patients with schizophrenia and to predict cognition during antipsychotic treatment. Methods Data were obtained from patients with an acute episode of schizophrenia participating in two double-blind and one open label trial comparing the effects of different atypical antipsychotics on cognition. In total, 129 patients were enrolled in this analysis. Cognitive function was assessed at admission, week 4 and 8. Efficacy and tolerability were assessed weekly using the Positive and Negative Syndrome Scale (PANSS) and the Simpson Angus Sale (SAS). Patients were treated with aripirazole, olanzapine, quetiapine and risperidone. Regression analysis including mixed effect models was performed. Results A significant improvement in all cognitive domains was observed from baseline to week 8. Regarding the antipsychotic treatment applied quetiapine seemed to achieve the most favourable cognitive improvement. Negative and depressive symptoms, the patient's age and the concomitant and antipsychotic treatment applied were observed to significantly influence and predict neurocognition. Conclusion The results may indicate that schizophrenia is a static disorder with trait and state dependent cognitive components especially in the memory domains. The influence of negative and depressive symptoms should be considered in daily clinical routine. Copyright © 2010 John Wiley & Sons, Ltd. [source] Bedside screening for executive dysfunction in patients with subcortical ischemic vascular diseaseINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 9 2009Nils Margraf Objective We investigated several executive bedside tests for their effectiveness in the routine clinical diagnostics of dysexecutive syndrome in subcortical ischemic vascular disease (SIVD). Methods Five executive tests, CLOX, the Tower of London (ToL), a cognitive estimation test (CET), a verbal fluency test, and the Five-Point Test, were examined in 17 patients with marked cerebral microangiopathy in cranial MRI and clinical symptoms of SIVD. The test accuracy for discriminating the patients from 17 healthy comparison subjects closely matched for age, gender and level of education was determined. Results Aside from the CET we found a significant lower performance of the patients with SIVD in four of the five used executive tests. In receiver operating characteristic (ROC) analyses the accuracy of CLOX 1 showed excellent results for distinguishing between patients and comparison subjects (area under the curve (AUC) 0.901), while the ToL (AUC up to 0.845) and the productivity in the phonemic verbal fluency test (AUC 0.829) achieved a good accuracy. Differently the accuracy of the figural fluency was only poor to fair (AUC 0.706). However, the Youden Indices of the significant executive variables showed a wide range from 0.25 to 0.82. Conclusions Based on our data we consider CLOX, the ToL and the verbal fluency test promising executive bedside test concepts for diagnosing the dysexecutive syndrome in SIVD in clinical routine. Particularly for CLOX and the ToL a further psychometric evaluation is required. Copyright © 2009 John Wiley & Sons, Ltd. [source] Fractal Dimension of Trabecular Bone Projection Texture Is Related to Three-Dimensional MicroarchitectureJOURNAL OF BONE AND MINERAL RESEARCH, Issue 4 2000L. Pothuaud Abstract The purpose of this work was to understand how fractal dimension of two-dimensional (2D) trabecular bone projection images could be related to three-dimensional (3D) trabecular bone properties such as porosity or connectivity. Two alteration processes were applied to trabecular bone images obtained by magnetic resonance imaging: a trabeculae dilation process and a trabeculae removal process. The trabeculae dilation process was applied from the 3D skeleton graph to the 3D initial structure with constant connectivity. The trabeculae removal process was applied from the initial structure to an altered structure having 99% of porosity, in which both porosity and connectivity were modified during this second process. Gray-level projection images of each of the altered structures were simply obtained by summation of voxels, and fractal dimension (Df) was calculated. Porosity (,) and connectivity per unit volume (Cv) were calculated from the 3D structure. Significant relationships were found between Df, ,, and Cv. Df values increased when porosity increased (dilation and removal processes) and when connectivity decreased (only removal process). These variations were in accordance with all previous clinical studies, suggesting that fractal evaluation of trabecular bone projection has real meaning in terms of porosity and connectivity of the 3D architecture. Furthermore, there was a statistically significant linear dependence between Df and Cv when , remained constant. Porosity is directly related to bone mineral density and fractal dimension can be easily evaluated in clinical routine. These two parameters could be associated to evaluate the connectivity of the structure. [source] Robotic Surgery Using ZeusÔ MicroWristÔ TechnologyJOURNAL OF CARDIAC SURGERY, Issue 1 2003The Next Generation Methods: We used the ZeusÔ (Computer Motion Inc., Goleta, Calif, USA) telemanipulation system to perform the internal mammary artery (IMA) takedown in 56 patients, in 12 of whom we used the newest model with MicroWristÔ (Computer Motion Inc., Goleta, Calif, USA) technology. Port orientation was based on thoracic anatomy, the decisive landmarks being the mammillary line and the axillary line. The distance between ports was at least 9 cm, and the patient's arm was positioned with the left shoulder raised and angulated by not more than 90 degrees. Results: Mean setup time was 44 ± 18 minutes for the first five patients and 16 ± 7 minutes for the last five patients, with an overall average of 24 ± 12 minutes. IMA harvest time at the beginning reached a mean of 95 ± 23 minutes and decreased to 44 ± 18 minutes in the last five cases. Average IMA takedown time was 58 ± 17 minutes. The IMA was patent with a good flow in all 56 patients. Conclusions: The introduction of robotic technology into clinical routine has resulted in safe procedures with a short learning curve. However, basic training in the modality is a must in order to achieve technical excellence. (J Card Surg 2003; 18:1-5) [source] Combination of Cobe AutoPBSC and Gambro Elutra as a platform for monocyte enrichment in dendritic cell (DC) therapy: Clinical studyJOURNAL OF CLINICAL APHERESIS, Issue 5 2008Ying Chen Abstract Monocytes are a common source for generating dendritic cells (DCs). The aim of the present study was to evaluate the efficiency of a platform for monocyte collection and enrichment in a clinical setting. The platform was based on the combination of two semiautomated devices; the Cobe Spectra Auto PBSC for mononuclear cells (MNC) collection followed by counterflow elutriation for monocyte enrichment (Gambro BCT Elutra). Twenty-four patients with various types of epithelial cancer participated in the study. MNC collections were first performed as large volume leukapheresis (LVL). Subsequently, MNC products were processed with an elutriation system for monocyte isolation. LVL resulted in the collection of MNC at a median of 8.1 × 109 cells, containing of 31.4% monocytes. A similar efficacy was also shown in patients with lower peripheral blood counts. Elutriation of the MNC product with the Cobe Elutra device resulted in the enrichment of monocytes at a median of 2.7 × 109 cells, with a recovery of 80.2% and a purity of 90.7%. These monocytes were then successfully developed into DCs for clinical therapy after in vitro manipulation. These data suggest that the combination of the Cobe Spectra Auto PBSC and the Gambro BCT Elutra is an effective platform for monocyte enrichment in clinical practice according to GCP standards and GMP guidelines, and can be easily implemented in the clinical routine under current DC protocols. J. Clin. Apheresis, 2008. © 2008 Wiley-Liss, Inc. [source] Role of enzyme-treated cells in RBC antibody screening using the gel test: a study of anti-RH1, -RH2, and -RH3 antibodiesJOURNAL OF CLINICAL LABORATORY ANALYSIS, Issue 2 2007Jocelyne Conne Abstract The role of enzyme-treated cells (ETCs) in red blood cell (RBC) antibody screening has been the subject of controversy, and its place in the clinical routine remains to be determined. In this work, plasma samples containing anti-RH1 (anti-D; N = 10), anti-RH2 (anti-C; N = 10), or anti-RH3 (anti-E; N = 10) antibodies were studied. The samples were diluted in nonbuffered or buffered normal saline, as well as in a pool of AB plasma samples. Titers and scores were determined by means of the gel test, using the indirect antiglobulin test (IAT) as well as ETCs, with R0r, r,r, or r,r test cells. Our results showed that compared to the IAT, ETCs allowed a clearer detection of anti-RH2 and anti-RH3, but not of anti-RH1 antibodies. Based on our study, it is not clear whether the ETC phase of the gel test should be maintained for RBC antibody screening. J. Clin. Lab. Anal. 21:61,66, 2007. © 2007 Wiley-Liss, Inc. [source] Small-volume resuscitation: from experimental evidence to clinical routine.ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2002Advantages, disadvantages of hypertonic solutions Background: The concept of small-volume resuscitatioin (SVR) using hypertonic solutions encompasses the rapid infusion of a small dose (4 ml per kg body weight, i.e. approximately 250 ml in an adult patient) of 7.2,7.5% NaCl/colloid solution. Originally, SVR was aimed for initial therapy of severe hypovolemia and shock associated with trauma. Methods: The present review focusses on the findings concerning the working mechanisms responsible for the rapid onset of the circulatory effect, the impact of the colloid component on microcirculatory resuscitation, and describes the indications for its application in the preclinical scenario as well as perioperatively and in intensive care medicine. Results: With respect to the actual data base of clinical trials SVR seems to be superior to conventional volume therapy with regard to faster normalization of microvascular perfusion during shock phases and early resumption of organ function. Particularly patients with head trauma in association with systemic hypotension appear to benefit. Besides, potential indications for this concept include cardiac and cardiovascular surgery (attenuation of reperfusion injury during declamping phase) and burn injury. The review also describes disadvantaages and potential adverse effects of SVR: Conclusion: Small-volume resuscitation by means of hypertonic NaCl/colloid solutions stands for one of the most innovative concepts for primary resuscitation from trauma and shock established in the past decade. Today the spectrum of potential indications envolves not only prehospital trauma care, but also perioperative and intensive care therapy. [source] Reaction time during semi-automated kinetic perimetry (SKP) in patients with advanced visual field lossACTA OPHTHALMOLOGICA, Issue 1 2010Katarzyna Nowomiejska Abstract. Purpose:, This study aimed to evaluate reaction time (RT) in patients with advanced visual field (VF) loss using semi-automated kinetic perimetry (SKP). Methods:, Seventy-eight patients with advanced VF loss caused by glaucoma (31) or retinitis pigmentosa (19), homonymous VF loss caused by post-chiasmal lesions (18) and unilateral anterior ischaemic optic neuropathy (AION) (10) were examined with SKP (Octopus 101 perimeter). One eye in each patient was enrolled. Additionally, VFs in the 10 healthy fellow eyes of the patients with AION were compared with those in the 10 affected eyes. Reaction time was assessed during the SKP session by presenting kinetic stimuli (III4e) with constant angular velocities of 3 °/second moving linearly along so-called ,RT vectors' at four different locations inside the III4e isoptre. Each stimulus presentation was repeated four times in randomized order. Results:, The geometric mean RT was 794 ms (95% reference interval [RI] 391,1615 ms) in patients with glaucoma, 702 ms (95% RI 306,1608 ms) in patients with retinitis pigmentosa and 675 ms (95% RI 312,1460 ms) in patients with hemianopia. Increases in RT for every 1 ° of eccentricity were 1%, 0.9% and 0.4%, respectively. The geometric mean RT in the 10 patients with unilateral optic neuropathy was 644 ms in affected eyes and 435 ms in unaffected eyes, reflecting an increase of 51% (95% confidence interval 42,62%). Conclusions:, We found substantial inter-subject variability in RT in patients with advanced VF loss. It is possible to correct the position of the isoptres by assessing individual RT. There were no relevant differences in RT between the disease groups. Reaction time increases with eccentricity. In monocular disease (AION), RT is prolonged, compared with in healthy fellow eyes. However, in clinical routine the RT-related displacement of isoptres is negligible in the vast majority of cases. [source] Most readily usable methods to measure ocular blood flowACTA OPHTHALMOLOGICA, Issue 2009K GUGLETA Purpose SIS Lecture. Methods Literature search. Results Ocular Blood Flow Research Association (OBFRA, recently merged with another organization - ISOCO, into one single Association for Ocular CDirculation - AOC) made a significant contribution to standardization of the blood flow measuring techniques in the field of ophthalmology. A consens was reached on the number of OBF measurements techniques that occured in the past decades. Particular emphasis was placed on the basic technology, specific parameters and interpretation, accuracy and reproducibility, field of clinical applications. Open questions were extensively discussed, limits of each technique clearly postulated. and a consensus statement put together for each of the technique involved. It encompassed techniques like color Doppler imaging, laser Doppler flowmetry (continuous as well as scanning LDF), laser Doppler velocimetry, Retinal Vessel Analyzer, combination of the vessel diameter measurement and the LDV, laser interferometry of the fundus pulsations amplitude, retinal oxymetry, measurements of the pulsatile component of the blood flow, blue field entoptic method and the newest - Doppler OCT. Conclusion There is no overwhelming measuring technique able to cover all the aspects of the research and the daily clinical routine. Various parameters and various vascular beds are involved, which makes the interpretation of the obtained results strenuous. Of particular importance is the capability of OBF measuring techniques to capture one dynamic feature of ocular circulation - its ability to regulate and to response to various challenges. It is widely believed that not the constantly reduced blood flow, but rather the lack of regulation thereof, leads to prevalent ocular diseases. [source] Sutureless encircling band , biomechanical calculations and clinical experienceACTA OPHTHALMOLOGICA, Issue 2009M MAIER Purpose In cases with multiple retinal breaks and in combination with vitrectomy in eyes with Proliferative vitreoretinopathy (PVR) for retinal detachment surgery often an encircling band is used. Usually the encircling band is fixed with non absorbable sutures. Methods A fixation method for an encircling band in retinal detachment surgery with one scleral tunnel in every of the 4 quadrants is reported. We describe our experience and biomechanical calculations of this fixation technique. Results In comparison to conventional fixation technique we found the following advantages: No suture is necessary, this means no additional foreign body can produce irritations. The scleral tunnel is safe and the preparation under the microscope can be performed fast and well controlled. Sclera tunnel fixation is very comfortable in combination with a vitrectomy. Conclusion With a short learning curve the operating time is as short as with conventional suture fixation of the encircling band. There is less perforating risc, less irritation and less patient discomfort postoperatively. A sutureless encircling band with sclera tunnel fixation is a very usefull operation technique in clinical routine. [source] Diagnostic evaluation of planar and tomographic ventilation/perfusion lung images in patients with suspected pulmonary emboliCLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 5 2004Marika Bajc Summary Planar lung ventilation/perfusion scintigraphy (V/PPLANAR) is a standard method for diagnosis of pulmonary embolism (PE). The goals of this study were to test whether the diagnostic information of ventilation/perfusion tomography (V/PSPET) applied in clinical routine might enhance information compared with V/PPLANAR and to streamline data processing for the demands of clinical routine. This prospective study includes 53 patients suspected for PE referred for lung scintigraphy. After inhalation of 99mTc-DTPA planar ventilation imaging was followed by tomography, using a dual-head gamma camera. 99mTc-MAA was injected i.v. for perfusion tomography followed by planar imaging. Patients were examined in supine position, unchanged during V/P tomography. Two reviewers evaluated V/PPLANAR and V/PSPET images separately and randomly. Mismatch points were calculated on the basis of extension of perfusion defects with preserved ventilation. Patients were followed up clinically for at least 6 months. With V/PSPET the number of patients with PE was higher and 53% more mismatch points were found. In V/PSPET interobserver variation was less compared with V/PPLANAR. Ancillary findings were observed by both techniques in half of the patients but more precisely interpreted with V/PSPET. V/PSPET shows more and better delineated mismatch defects, improved quantification and less interobserver variation compared with V/PPLANAR. V/PSPET is amenable to implementation for clinical routine and suitable even when there is demand for a high patient throughput. [source] | ||||||||||