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Immediate Treatment (immediate + treatment)
Selected AbstractsManagement of patients with acoustic neuromas: A Markov decision analysis,THE LARYNGOSCOPE, Issue 4 2010Daniel Morrison MD Abstract Objectives/Hypothesis: The management of patients with small (<1.5 cm) acoustic neuromas is controversial. Immediate treatment via microsurgical resection or radiosurgery is often advocated. A period of observation is sometimes advised followed by microsurgery or radiosurgery for tumors that demonstrate growth during the observation period. The purpose of this study is to calculate quality-adjusted life expectancy for the most commonly applied management strategies in hypothetical cohorts of patients of various ages. Study Design: Markov decision analysis; societal perspective. Methods: Assumptions used in creating this model and event probabilities were obtained from a thorough literature review. Key parameters were identified and defined by the best available evidence. The main outcome measure is the benefit derived from each management strategy in quality-adjusted life years (QALYs). Sensitivity analysis was used to define benchmark performance information for these parameters. Results: The benefit of a period of observation followed by radiosurgery, if needed, for significant tumor growth is greater then all other strategies for all age groups and both sexes. When compared to observation followed by microsurgery, the additional benefit is small. QALY totals for the two immediate treatment groups were significantly lower than that for the observation groups. Conclusions: For patients of all ages, a period of observation during which tumor growth and hearing thresholds are closely monitored is the superior strategy. For tumors that grow substantially or when hearing deteriorates, definitive management via radiosurgery is recommended. Laryngoscope, 2010 [source] Knowledge of oral health professionals of treatment of avulsed teethDENTAL TRAUMATOLOGY, Issue 6 2006Nestor Cohenca Abstract,,, The management and immediate treatment of an avulsed permanent tooth will determine the long-term survival of the tooth. The aim of this study was to evaluate the knowledge of oral health professionals on the new guidelines for emergency treatment of avulsed teeth. A 12-item questionnaire was distributed among general dentists, specialists, dental hygienists and dental assistants attending Continuing Education courses at the School of Dentistry, University of Southern California, between 2003 and 2004. This study reports only on the general practitioners who comprised 83% of the participants. The results revealed an uneven pattern of knowledge among them regarding the emergency management of an avulsed tooth. Statistically significant associations were related to the participants' previous dental trauma education and their age. In conclusion, there is a need to improve the knowledge of general dentists in the current guidelines for emergency treatment of avulsed teeth. [source] Clinical investigation of traumatic injuries in Yeditepe University, Turkey during the last 3 yearsDENTAL TRAUMATOLOGY, Issue 4 2005Nuket Sandalli Abstract,,, The aim of this study was to evaluate etiology, types of traumatic dental injuries, treatment and to determine the incidence of complications according to dental injuries in patients who referred to Yeditepe University, Faculty of Dentistry, Istanbul, Turkey. The study was based on the clinical data of the 161 traumatized teeth in 92 patients. WHO classification slightly modified by Andreasen & Andreasen for dental trauma was used. The causes and localization of trauma, traumatized teeth classification, treatment and complications were evaluated both primary and permanent teeth. The distribution of complications according to diagnosis and treatment of the injured teeth were evaluated. Of 35 (38%) girls and 56 (72%) boys with a mean age 7.6 ± 3.5 (ranging 1,14.2) participated to study and the mean followed up was 1.72 ± 1.28 years (ranging 0.10,3.8 years). From the 161 affected teeth, 69 (42.9%) were in primary teeth and 92 (57.1%) in permanent teeth. The highest frequency of trauma occurred in the 6,12 year age group. Overall boys significantly outnumbered girls by approximately 1:1.6. The most common type of injury in the primary and permanent teeth was seen as luxation (38%) and enamel fracture (20%) of the maxillary central incisors, respectively. Falls were the major sources of trauma both the primary (90%) and the permanent teeth (84%). In the primary dentition, the most common type of soft tissue injury is contusion (62.5%) and in the permanent dentition, it is laceration (49%). The most of the treatment choice was determined as examination only and extraction in primary teeth (58 and 24.6%, respectively) while it was applied as restoration and pulpectomy in permanent teeth (31.5 and 18.5%, respectively). Complications were recorded on 37 teeth (23%) with a most common type of necrosis (10.5%) and dental abscess (7.4%). Necrosis was more frequent in luxation whereas dental abscess were in crown fracture with pulpal involvement in both dentitions. The study showed that boys were more prone to dental traumas than girls. Falls were more frequent trauma type with a high complication risk. It reveals that the time of the immediate treatment showed the important predisposing factors that increase the success of treatment and decrease the risk of complication. The correct diagnosis of dental injuries is more important for eliminating the occurrence of complications. [source] Mailed treatment to augment primary care for alcohol disorders: A randomised controlled trialDRUG AND ALCOHOL REVIEW, Issue 1 2009DAVID KAVANAGH Abstract Introduction and Aims. Remote delivery of interventions is needed to address large numbers of people with alcohol use disorders who are spread over large areas. Previous correspondence trials typically examined its effects as stand-alone treatment. This study aimed to test whether adding postal treatment to general practitioner (GP) support would lower alcohol use more than GP intervention alone. Design and Methods. A single-blind, randomised controlled trial with a crossover design was conducted over 12 months on 204 people with alcohol use disorders. Participants in an immediate correspondence condition received treatment over the first 3 months; those receiving delayed treatment received it in months 3,6. Results. Few participants were referred from GPs, and little intervention was offered by them. At 3 months, 78% of participants remained in the study. Those in immediate treatment showed greater reductions in alcohol per week, drinking days, anxiety, depression and distress than those in the delayed condition. However, post-treatment and follow-up outcomes still showed elevated alcohol use, depression, anxiety and distress. Greater baseline anxiety predicted better alcohol outcomes, although more mental distress at baseline predicted dropout. Discussion and Conclusions. The study gave consistent results with those from previous research on correspondence treatments, and showed that high levels of participant engagement over 3 months can be obtained. Substantial reductions in alcohol use are seen, with indications that they are well maintained. However, many participants continue to show high-risk alcohol use and psychological distress.[Kavanagh D, Connolly JM. Mailed treatment to augment primary care for alcohol disorders: A randomised controlled trial. Drug Alcohol Rev 2009;28:73,80] [source] Disease burden of chronic lymphocytic leukaemia within the European UnionEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 4 2008Louise Watson Abstract Objective:, Whilst Chronic lymphocytic leukaemia (CLL) is considered a rare disease, to our knowledge, the current prevalence of CLL within the European Union (EU) member states is not published. Understanding the number of individuals with CLL is vital to assess disease burden within the wider population. Methods:, Using 2002 data from the International Agency for Research on Cancer, we estimated the number of individuals with CLL (ICD-10 C91.1) from those reported for all leukaemias (C91,95) and extrapolated the figures by the population increase within the EU between 2002 and 2006, the last year with fully updated community population estimates. One- and 5-yr partial prevalence estimates are reported (i.e. the number of individuals still living 1,5 yr post-diagnosis). We then applied proportional estimates from the literature to assess those requiring immediate treatment, those under observation and their likely progression rates. Results:, We found that within the 27 EU states plus Iceland, Norway and Lichtenstein, 1- and 5-yr CLL partial prevalence estimates totalled approximately 13 952 and 46 633 individuals respectively in 2006. By applying Binet staging to the 1-yr estimate, 40% of patients will be stage B/C and require immediate treatment. Thus, 5581 individuals may be treated within the first year of diagnosis. Of the 60% (8371) under observation, by 5 yr up to 33% (2763) may have more advanced disease with increased risk of mortality. Conclusion:, Whilst CLL is a rare disease, the number of individuals burdened by the disease within the EU is considerable and thousands of patients require treatment and physician care, which has cost implications for member states. [source] Central venous access for haemodialysis: prospective evaluation of possible complicationsJOURNAL OF CLINICAL NURSING, Issue 2 2007Denise De Andrade PhD Aims and objectives., The combination of chronic renal insufficiency and haemodialysis represents a challenge for health professionals. Chronic renal insufficiency patients undergoing haemodialysis treatment through a temporary double-lumen catheter were prospectively studied in order to identify the type and frequency of local and systemic complications. Methods., A six-month period was established with a view to the inclusion of new cases. Data were acquired through interviews, clinical assessment and patient records, and entered into a Microsoft Excel database through a double entry system and exported to the Statistical Package Social Sciences software. Sixty-four patients were evaluated prospectively, of which thirty-eight (59.4%) were men and 35 (54.7%) required catheter insertion for immediate treatment. During the study period, 145 catheters were inserted, ranging from 1 to 7 implants per patient, 29 (45.3%) were single insertions and 127 (87.6%) catheters were inserted into the jugular vein. The catheters were left in place for an average of 30 days. Results., Forty-one (64%) presented inadequate functioning, after about 26 days. A febrile state occurred in 24 (37.5%) patients after 34 days, secretion at the catheter entry site in 27 (42.2% after 26 days and bloodstream infection was encountered in 34(53%) after 34 days. Of the 61 blood culture samples, thirty (49%) were positive for Staphylococcus aureus that was the microorganism most frequently isolated. Conclusion., The findings indicate worrying aspects such as the catheters permanence time, exposing patients to different complications, including infection. Furthermore, inadequate catheter functioning leads to inefficient haemodialysis treatment. Relevance to clinical practice., Knowledge about complications allows for systematic care planning, prevention and control actions. [source] Culturally Competent Care of Patients with Acute Chest PainJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 9 2005Mary Sobralske PhD Purpose To inform nurse practitioners (NPs) about the influence of culture on patients' responses to pain using the example of acute chest pain. Data sources Selected clinical and research articles on pain and culture and the authors' clinical experiences providing care across a variety of cultures. Conclusions There is very little written and even fewer studies on the connection of culture and the response to acute chest pain. This topic needs more attention by nurse researchers. Implications for practice If NPs are not aware that some patients may not demonstrate behavior typically expected in acute myocardial infarction, they may miss the diagnosis and fail to treat or refer these patients for immediate treatment. [source] Are delayed-start design trials to show neuroprotection in Parkinson's disease fundamentally flawed?MOVEMENT DISORDERS, Issue 6 2008Carl E. Clarke BSc, FRCP Abstract Considerable effort has gone into preclinical neuroprotection research in Parkinson's disease (PD) and several large clinical trials have been mounted, but no agent has been conclusively shown to be protective. The latest innovation in PD neuroprotection trial design is the delayed-start design trial. If patients with early PD do better after 12 to 18 months of immediate drug therapy compared to those in whom it is delayed for 6 to 9 months, this is attributed to a neuroprotective effect. However, delayed-start design trials may be fundamentally flawed. It has been suggested that physiological mechanisms compensating for the loss of dopaminergic neurones in early PD may be deleterious and that immediate treatment may prevent such mechanisms and thereby be neuroprotective. If this hypothesis is correct, any drug with a symptomatic effect will be neuroprotective in early PD and delayed-start design trials will show this generic effect, not a neuroprotective effect specific to the drug. Delayed-start design trials require patients to potentially stay untreated for 6 to 9 months. This may lead to the selection of slowly progressive types of PD, such as that in younger patients and those with tremor-dominant disease, so the results may not be generalizable to the majority of patients. Delayed-start design trials are powered to find small differences in total UPDRS score which may not be clinically significant; larger and longer placebo-controlled trials are required to confirm the clinical significance of their findings. These arguments add to the growing tide of opinion for a fundamental rethink of our policy toward neuroprotection research in PD. © 2008 Movement Disorder Society [source] Early warning system scores and response times: an auditNURSING IN CRITICAL CARE, Issue 4 2003Barbara A Day Summary ,,In response to NHS reforms within critical care, the surgical directorate of the Southern Derbyshire Acute Hospitals NHS Trust developed and introduced a modified early warning system (DMEWS) ,,Anecdotal evidence from nursing staff indicated that response times by doctors, when triggered by use of the DMEWS, were outside the established timescale ,,An audit was undertaken to determine the response times to calls for assistance triggered by use of the DMEWS and to identify any disparity between response times ,,The audit confirmed that whilst DMEWS triggered the nurses to initiate action for immediate treatment, response by members of the surgical teams was below the agreed standards ,,Further studies are planned to indicate whether longer response times have an adverse effect on patient welfare or outcome [source] Natural history and outcome of optic pathway gliomas in children,PEDIATRIC BLOOD & CANCER, Issue 7 2009Gary Nicolin MD Abstract Background The optimal management of optic pathway gliomas (OPGs) is complicated by their variable natural history, the association with neurofibromatosis type 1 (NF1) and difficulties in defining progression and response to treatment. Methods This study is a retrospective review of all children presenting to a single institution with an OPG between 1990 and 2004. Results Of the 133 children included, 78 (59%) had NF1; 87 (71 NF1) were observed initially, of whom 23 (11 NF1) subsequently required treatment. Forty-six patients received immediate treatment. Initial treatment, without or with an observation period, comprised chemotherapy alone (32, 11 NF1); debulking,+,chemotherapy (15, 4 NF1); gross total resection (6); radiotherapy (2); debulking,+,radiotherapy (3); and debulking only (12, 3 NF1). Overall, 16 patients were irradiated during the study period. Four children died (overall survival at 5 and 10 years was 97.6% and 94.6% for those who required treatment). Progression-free survival (PFS) for the 69 patients who needed treatment was 48%. There was no difference in PFS between chemotherapy versus chemotherapy,+,debulking or debulking alone. PFS for the NF1 patients who required treatment was similar to that of non-NF1 patients. Mean follow-up time was 9.0 (range 0.6,18.0, median 8.6) years. Conclusions The study confirms the complexity of OPGs and that NF1 is a major determinant of the resultant behavior of the tumor. Pediatr Blood Cancer 2009; 53:1231,1237. © 2009 Wiley-Liss, Inc. [source] Periocular Hemangiomas: What Every Physician Should KnowPEDIATRIC DERMATOLOGY, Issue 1 2004Emily J. Ceisler M.D. Most hemangiomas remain asymptomatic and can be managed by close observation; however, immediate treatment is indicated for hemangiomas that may cause significant complications. Periocular hemangiomas warrant close evaluation and early, active treatment of those with the potential to threaten or permanently compromise vision. Herein we review the clinical features of periocular hemangiomas, differential diagnosis, possible ophthalmologic complications and sequelae, and therapeutic modalities. [source] Review of case reports of inadvertent intrathecal administration of vincristine: Recommendations to reduce occurrenceASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 2 2007Peter J GILBAR Abstract Vincristine has been in clinical use for over 40 years with initial publication of the results from successful trials in 1962. Catastrophic neurotoxicity has been associated with the administration of vincristine directly into the cerebrospinal fluid (CSF). Since the first case in 1968 there have been numerous other instances, of which 23 have been reported in the literature. Of these cases 18 resulted in death. The most prominent damage on autopsy was generally in the spinal cord, brain stem and cerebellum, with severity tending to be greater in the neurons adjacent to the CSF. Fatalities appeared due to a progressive ascending myeloencephalopathy. Early recognition and immediate treatment with CSF drainage and intrathecal exchange appears to be the only intervention that has improved patient survival. The volume of injection, dose and time from the incident until the ventriculo-lumbar washout appear critical, as these factors might contribute to the extent of drug distribution in the CNS. Although several antidotes for vincristine have been suggested, including folinic acid and glutamic acid, supportive evidence for their effectiveness is scant. Several recommendations regarding prevention of this catastrophic event have been proposed. [source] Actinic cheilitis in dental practiceAUSTRALIAN DENTAL JOURNAL, Issue 2010NW Savage Abstract Actinic cheilitis is a potentially premalignant condition involving predominantly the vermilion of the lower lip. The aim of the current paper was to review the clinical presentation of actinic cheilitis and demonstrate the development of management plans using a series of cases. These are designed to provide immediate treatment where required but also to address the medium and long-term requirements of the patient. The authors suggest that the clinical examination of lips and the assessment of actinic cheilitis and other lip pathology become a regular part of the routine soft tissue examination undertaken as a part of the periodic examination of dental patients. Early recognition of actinic cheilitis can allow the development of strategies for individual patients that prevent progression. These are based on past sun exposure, future lifestyle changes and the daily use of emollient sunscreens, broad-brimmed hats and avoidance of sun exposure during the middle of the day. This is a service that is not undertaken as a matter of routine in general medical practice as patients are not seen with the regularity of dental patients and generally not under the ideal examination conditions available in the dental surgery. [source] Chromosomal anomalies in oligodendroglial tumors are correlated with clinical featuresCANCER, Issue 5 2003M.D., Martin J. van den Bent Ph.D. Abstract BACKGROUND Patients who have oligodendrogliomas (OD) that demonstrate loss of both 1p and 19q appear to have a better prognosis after they receive chemotherapy and radiotherapy compared with patients who have OD without these characteristics. It is unclear whether this improvement in outcome is due only to a better response to treatment. The authors investigated the correlation between genetic and clinical characteristics of OD in 33 patients who received chemotherapy with procarbazine, lomustine, and vincristine for recurrent disease after receiving radiotherapy. METHODS The initial presentation, prior treatments, overall survival, and response to chemotherapy were assessed. The 1p and 19q status in OD lesions was determined with fluorescence in situ hybridization on paraffin embedded, archival material using locus specific probes. P53 mutations were assessed by polymerase chain reaction,single-strand conformation polymorphism analysis and immunohistochemistry for P53; the proliferation index was assessed with the MIB-1 antibody. RESULTS Patients who had OD lesions with a combined loss of 1p and 19q typically presented with low-grade tumors that manifested with seizures of long-standing duration. In contrast, patients who had OD lesions without a combined loss of 1p and 19q usually presented with focal deficits that required immediate treatment. Both the response rate to chemotherapy and the time to disease progression after chemotherapy were significantly better in patients who had a combined loss of 1p and 19. Tumors with classic OD morphology more often had a combined loss of 1p and 19q, although the genotype was better at identifying patients with chemoresponsive tumors. P53 mutations were observed in three tumors, none of which had a combined loss of 1p and 19q. CONCLUSIONS OD lesions with combined a loss of 1p and 19q have a more indolent nature compared with OD lesions that do not have these losses. Virtually all patients with these tumors present with low-grade tumors accompanied by seizures and remain stable for prolonged periods. Future trials must keep these tumor types apart. Cancer 2003;97:1276,84. © 2003 American Cancer Society. DOI 10.1002/cncr.11187 [source] Zone-I retinopathy of prematurity, progression and scheduling of treatmentACTA OPHTHALMOLOGICA, Issue 2009I AKKOYUN Purpose To evaluate the progression celerity and scheduling of suitable treatment time for Zone-I Retinopathy of Prematurity (ROP). Methods Records of 36 eyes (18 infants) with Zone-I ROP, which were screened for ROP at the Neonatal Intensive Care Unit of Baskent University, Ankara, Turkey, between January 2004-March 2009, were evaluated retrospectively. Birth weight ranged between 480-1000g, gestational age ranged from 24-28 weeks. First fundus examination was performed at 29-31 weeks gestational age, and was repeated once or more per week. The first treatment was performed using laser photocoagulation and the progression criteria for laser photocoagulation treatment were: (1) Zone-I ROP less than stage-3 with plus disease (ETROP-type 1); (2) Zone-I stage 3 ROP with or without plus disease (ETROP-type 1). Results Twenty eyes of 10 infants showed criterion (1) and 16 eyes of 8 infants criterion (2). Corneal opacity, pupillary rigidity, tunica vasculosa lentis and vitreous haze were observed until 31-33 weeks gestational age. The time period for the progression of stage-1 to stage-3 retinopathy ranged between 0.7-3.7 weeks. The mean age at the first treatment was 33 weeks (range 30-35 weeks). The mean time between the development of stage-1 retinopathy and the laser treatment was 9.8 days in mean (5-23 days), and 69.3 % of the infants were treated within 12 days after the diagnosis of stage-1 ROP. Additional treatments were performed in 7 eyes, scleral buckling+cryotherapy in 5 eyes, vitrectomy in 2 eyes. Thirty-two eyes had favorable and 4 eyes had unfavorable outcomes. Conclusion The diagnosis of Zone-I ROP requires close-meshed follow-up and immediate treatment. [source] | ||||||||||||||||||||||