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Important Clinical (important + clinical)
Terms modified by Important Clinical Selected AbstractsParoxysmal Motor Disorders of Sleep: The Clinical Spectrum and Differentiation from EpilepsyEPILEPSIA, Issue 11 2006Christopher P. Derry Summary:, The diagnosis of paroxysmal events in sleep represents a significant challenge for the clinician, with the distinction of nocturnal epilepsy from nonepileptic sleep disorders often the primary concern. Diagnostic error or uncertainty is not uncommon in this situation, particularly with respect to nocturnal frontal lobe epilepsy (NFLE), which has a variable and often unusual presentation. Such errors can be minimized if the range of nonepileptic disorders with motor activity in sleep is fully appreciated. Here we review these disorders, before discussing the important clinical and electrographic features that allow their accurate differentiation from seizures. Particular emphasis is placed on the differentiation of nocturnal frontal lobe epilepsy from non,rapid eye movement (NREM) arousal disorders and other parasomnias. The value of recording episodes with video EEG polysomnography is discussed. [source] Patterns and frequency of anxiety in women undergoing gynaecological surgeryJOURNAL OF CLINICAL NURSING, Issue 3 2006Eloise Carr PhD, PGCEA Aims., Within a gynaecological surgical setting to identify the patterns and frequency of anxiety pre- and postoperatively; to identify any correlation between raised anxiety levels and postoperative pain; to identify events, from the patients' perspective, that may increase or decrease anxiety in the pre- and postoperative periods. Background., It is well documented that surgery is associated with increased anxiety, which has an adverse impact on patient outcomes. Few studies have been conducted to obtain the patient's perspective on the experience of anxiety and the events and situations that aggravate and ameliorate it. Method., The study used a mixed method approach. The sample consisted of women undergoing planned gynaecological surgery. Anxiety was assessed using the State Trait Anxiety Inventory. Trait anxiety was measured at the time of recruitment. State anxiety was then assessed at six time points during the pre- and postoperative periods. Postoperative pain was also measured using a 10 cm visual analogue scale. Taped semi-structured telephone interviews were conducted approximately a week after discharge. Results., State anxiety rose steadily from the night before surgery to the point of leaving the ward to go to theatre. Anxiety then increased sharply prior to the anaesthetic decreasing sharply afterwards. Patients with higher levels of trait anxiety were more likely to experience higher levels of anxiety throughout their admission. Elevated levels of pre- and postoperative anxiety were associated with increased levels of postoperative pain. Telephone interviews revealed a range of events/situations that patients recalled distressing them and many were related to inadequate information. Conclusion., This study found higher rates of anxiety than previously reported and anxiety levels appeared raised before admission to hospital. This has important clinical and research implications. Relevance to clinical practice., Patients with high levels of anxiety may be identified preoperatively and interventions designed to reduce anxiety could be targeted to this vulnerable group. Patient experiences can inform the delivery of services to meet their health needs better. [source] Sodium Bicarbonate versus Sodium Chloride and Oral N-Acetylcysteine for the Prevention of Contrast-Induced Nephropathy in Advanced Chronic Kidney DiseaseJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 6 2009LINDA SHAVIT M.D. Introduction: Contrast-induced acute kidney injury (CI-AKI) is one of the leading causes of hospital-acquired acute kidney injury. Multiple clinical studies have proposed several preventive strategies. Aims: To examine the efficacy of sodium bicarbonate compared with sodium chloride and oral N-acetylcysteine (NAC) for preventive hydration after cardiac catheterization. Methods: We conducted a prospective, single-center trial. Patients with chronic kidney disease (CKD) stage III,IV undergoing cardiac catheterization were allocated to receive either an infusion of 0.9% sodium chloride and oral NAC or 154 mEq/L sodium bicarbonate. Main: Outcome measure CI-AKI, defined as an increase of 25% or 0.3 mg/dL or more in plasma creatinine within 2 days of contrast administration. Results: Ninety-three patients were allocated to one of the two groups: 42 patients in the saline plus NAC group and 51 patients in the bicarbonate group. There were no statistically significant differences between the groups in the most important clinical and procedural characteristics. Baseline plasma creatinine levels, estimated glomerular filtration rate, incidence of diabetes mellitus, hypertension, congestive heart failure, and contrast medium volume were similar. Mean plasma creatinine concentration was 1.76 ± 0.54 mg/dL in the saline and NAC group and 1.9 ± 1 mg/dL in the bicarbonate group (P = 0.23). The rate of CI-AKI was 9.8% in the bicarbonate group and 8.4% in the saline plus NAC group. No patient required renal replacement therapy. Conclusion: Hydration with sodium bicarbonate is not more effective than hydration with sodium chloride and oral NAC for prophylaxis of CI-AKI in patients with CKD stage III,IV undergoing cardiac catheterization. [source] The treatment of faecal incontinence following ileostomy takedown after rectal surgery for cancerJOURNAL OF NURSING AND HEALTHCARE OF CHRONIC ILLNE SS: AN INTERNATIONAL INTERDISCIPLINARY JOURNAL, Issue 3 2009Federico Attene MD Aim., The aim of this study was to assess the effectiveness of rehabilitative treatment of the pelvic floor on faecal incontinence after ileostomy take-down. Background., Several conditions can induce surgeons to fashion an excluding ileostomy. In our experience 40% of patients subjected to ileostomy takedown refer faecal incontinence which becomes a chronic condition if not treated. Design., Between 2006 and 2008 we observed fourteen patients with faecal incontinence after ileostomy takedown. Previous manometric assessment of the pelvic floor functionality they underwent rehabilitative treatment by electrostimulation of the anal sphincter. Methods., The rehabilitation program was organised in 10 sessions each of 15 minutes. In each session a double electrode probe was introduced through the anus which is able to conduct electric impulses at a frequency of 75 Hz with an intensity of 15,50 mA and duration of 150 ,s. Results., All patients showed important clinical and manometric improvement. Three patients needed a second rehabilitative treatment with subsequent clinical resolution of faecal incontinence. Conclusions., Improvement in all patients was found although the data are not statistically significant. Consideration of social and psychological implications of treatments is important. Patients need to acquire full control of their body and its functions. Considering that faecal incontinence is a pathology with high social costs it appears necessary to establish an effective and repeatable method of treatment. Electric stimulation seems to be the most adequate tool for this purpose. Relevance to clinical practice., The standardisation of parameters in the treatment protocol of incontinence could allow to extend this therapy to a lot of colo-proctological units. [source] Measurement of bone blood flow using the hydrogen washout technique,part II: Validation by comparison to microsphere entrapmentJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 6 2008Mikko Larsen Abstract Accurate and reproducible measurement of bone blood flow has important clinical and experimental applications. Hydrogen washout is simple, safe, and widely used, but its use in bone tissue has not been validated. To this end, we have compared cortical bone blood flow measurements obtained by radioactive-labeled microsphere entrapment with those from hydrogen washout. Blood flow was measured in tibial cortical bone of 12 New Zealand White rabbits by radioactive microsphere entrapment and by hydrogen washout. Besides a control group (n,=,6), four animals were treated with systemic epinephrine (0.8 µg/kg/min) (group 2) and two with nitroprusside (100 µg/kg/min) (group 3). Furthermore, nine femora from seven rats were isolated on their vascular pedicles and repeated bone blood flow measurements were made at each location with the hydrogen washout method to confirm reproducibility of blood flow determinations by hydrogen washout. An average flow of 2.3,±,2.0 mL/min/100 g was obtained with the microsphere method and 2.0,±,0.5 mL/min/100 g with the hydrogen washout method. There was a significant correlation and agreement: R2,=,0.97 (p,<,0.01). No consistent flow variations were found with systemic vasoactive drug administration. Hydrogen washout provided reproducible results and showed high sensitivity to flow changes. Hydrogen washout is both sensitive and reproducible in measuring bone blood flow. Results agree well with flow values obtained by labeled microsphere entrapment. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:746,752, 2008 [source] Non-therapeutic risk factors for onset of tardive dyskinesia in schizophrenia: A meta-analysis,,MOVEMENT DISORDERS, Issue 16 2009Diederik E. Tenback MD Abstract A meta-analysis of prospective studies with schizophrenia patients was conducted to examine whether the evidence exists for risk factors for the emergence of Tardive Dyskinesia (TD) in schizophrenia. A computer assisted Medline/PubMed and Embase search was conducted in January 2008 for the years 1985,2007. Selected were truly prospective studies of incident cases of TD in a population with at least 80% patients with schizophrenia. Measures of relative risk were collected from the individual studies, either directly or by calculating the relative risk from the cox- or logistic regression coefficient provided in the article. Hazard Ratio's and Odds Ratio's were pooled using fixed and random effect models in case of multiple studies using the same measure of risk and outcome. Only eight studies satisfied the inclusion criteria reporting on 25 different single estimate risk factors. Of 25 risk factors, six concerned replicated estimates suitable for meta-analysis. Of these, non-white ethnic group and early extrapyramidal symptoms qualified as risk factors for the emergence of TD in schizophrenia. The association with older age was suggestive but inconclusive. Despite many reported risk factors for TD in schizophrenia, little conclusive evidence exists to corroborate this. However, the fact that early EPS predicts onset of TD has important clinical and research implications. © 2009 Movement Disorder Society [source] Hyperhomocysteinemia in pediatric and young adult renal transplant recipientsPEDIATRIC TRANSPLANTATION, Issue 2 2004Amir Belson Abstract:, Hyperhomocysteinemia (HHcy) has been recently identified as an important and reversible cardiovascular risk factor in adult and pediatric renal transplant recipients. A retrospective cross-sectional analysis of 70 pediatric and young adult renal transplant recipients was performed to determine the prevalence, and important clinical and laboratory correlates of HHcy. Total homocysteine concentration, free and protein bound, was determined by fluorescence polarization immunoassay using an IMX analyzer. Hyperhomocysteinemia was defined as a serum homocysteine (Hcy) level above the 95th percentile for age. Fifty-four of 70 patients (77%) had HHcy. Comparison of patients with HHcy with patients without HHcy demonstrated no statistical difference in age (p = 0.35), gender (p = 0.76) or donor type (p = 0.20). Patients with HHcy had significantly lower calculated creatinine clearance values (Ccr) (p = 0.02), 67.3 ± 21.2 mL/min/1.73 m2 vs. 90.7 ± 32.3 mL/min/1.73 m2 for patients without HHcy. Immunosuppression did not correlate with the diagnosis of HHcy. Stepwise logistic regression identified patient age (0.18, p = 0.013) and Ccr (,0.04, p = 0.011) as significant variables. In conclusion, HHcy is more common than expected in pediatric renal transplant recipients. Patients with Ccr <80 mL/min/1.73 m2 were statistically more likely to have a diagnosis of HHcy. We recommend that Hcy levels should be evaluated in this high risk population. [source] Using medical records to supplement a claims-based comparative effectiveness analysis of antidepressants,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 8 2010Thomas W. Croghan Abstract Purpose Because health insurance claims lack clinical information, comparative effectiveness research studies that rely on these data may be challenging to interpret and may result in biased inference. We conducted an exploratory study to determine if medical information contained in patient charts could offer clinical details that would assist in interpreting the results of a claims-based comparative effectiveness study of selective serotonin reuptake inhibitors (SSRIs). Methods Retrospective review of 457 charts of patients initiating SSRI treatment. Descriptive data elements included patient diagnosis, symptoms of depressive and anxiety disorders, provider's assessment, and medication treatment and side effects. Results Most subjects were excluded from the study because their charts were not accessible (58.7%), they did not have a follow-up visit (55.6%), providers could not be contacted (58.0%), or providers refused participation in the study (36.5%). Among those included in the study, most patients were noted to have depression, but most charts lacked information on the majority of depression symptoms at baseline and follow-up. Few concomitant symptoms, side effects, and other important clinical and treatment characteristics were recorded. Conclusions Inability to obtain charts due to plan or provider refusal, lack of available information in charts at key times in the course of illness, and missing data elements posed considerable challenges and prevented firm conclusions beyond those drawn from the parent, claims-based study. Copyright © 2010 John Wiley & Sons, Ltd. [source] Discrimination, psychosocial stress, and health among Latin American immigrants in OregonAMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 3 2010Heather H. McClure Chronic psychosocial stress related to discrimination has been shown to be associated with biological measures such as elevated systolic blood pressure (SBP), increased body fat, and higher fasting glucose levels. Few studies have examined these relationships in immigrant populations. The present study recruited a sample of 132 Oregon Latino immigrant adults to investigate the relationships between perceived discrimination and several health measures (blood pressure, body mass index [BMI], and fasting glucose). Results indicate that perceived discrimination stress predicted elevated SBP among men but not among women. Perceived discrimination was significantly higher among obese women than among women of normal BMI. The same pattern was not observed for men. Further, a strong trend relationship was detected: the higher women's reported discrimination stress, the higher their fasting glucose levels. Again, this pattern was not observed for men. These results suggest that chronic psychosocial stress plays an important role in disease risk among Latin American immigrants, and that male and female immigrants may have distinctive physiological responses. If confirmed, these findings may have important clinical and public health implications for chronic disease prevention among Latinos. Am. J. Hum. Biol., 2010. © 2009 Wiley-Liss, Inc. [source] Potential Role of NKG2D and Its Ligands in Organ Transplantation: New Target for ImmunointerventionAMERICAN JOURNAL OF TRANSPLANTATION, Issue 2 2009B. Suárez-Álvarez NKG2D is one of the best characterized activating receptors on Natural Killer (NK) and CD8+ T cells. This receptor recognizes several different ligands (MICA/MICB and ULBPs) induced by cellular stress and infection. In addition to the role described in cancer surveillance, recent data highlight the importance of NKG2D and its ligands in organ transplantation. Allografts show evidence of MICA and MICB expression in both acute and chronic rejection. The presence of anti-MICA antibodies has been correlated with incidence of graft rejection. Furthermore, NKG2D-ligand engagement activates NK cells, which provides T-cell costimulation, and enhances antigen specific CTL-mediated cytotoxicity. Activated NK cells may function as a bridge between innate and adaptive immunity associated with transplantation. Activated NK cells in response to IL-15 can also trigger organ rejection through NKG2D and affect the maturation of both donor and recipient antigen presenting cells (APCs) and ultimately the T-cell allogeneic response. Regulatory T cells, which modulate T-cell responses in organ transplantation and infections, were reduced in numbers by NK cells exposed to intracellular pathogens, possibly via interaction with one NK2GD receptor. Blockage of NKG2D-NKG2D-L interactions provides a novel pathway for development of inhibitors. These studies have important clinical and therapeutic implications in solid organ transplantation. [source] Two-year clinical and radiographic results with combination etanercept,methotrexate therapy versus monotherapy in early rheumatoid arthritis: A two-year, double-blind, randomized study,ARTHRITIS & RHEUMATISM, Issue 3 2010Paul Emery Objective To evaluate how continuation of and alterations to initial year 1 combination etanercept,methotrexate (MTX) therapy and MTX monotherapy regimens affect long-term remission and radiographic progression in early, active rheumatoid arthritis. Methods Subjects were randomized at baseline for the entire 2-year period; those who completed 1 year of treatment with combination or MTX monotherapy entered year 2. The original combination group either continued combination therapy (the EM/EM group; n = 111) or received etanercept monotherapy (the EM/E group; n = 111) in year 2; the original MTX monotherapy group either received combination therapy (the M/EM group; n = 90) or continued monotherapy (the M/M group; n = 99) in year 2. Efficacy end points included remission (a Disease Activity Score in 28 joints [DAS28] <2.6) and radiographic nonprogression (change in the modified Sharp/van der Heijde score ,0.5) at year 2. A last observation carried forward analysis from the modified intention-to-treat population (n = 398) and a post hoc nonresponder imputation (NRI) analysis (n = 528) were performed for remission. Results At year 2, DAS28 remission was achieved by 62/108, 54/108, 51/88, and 33/94 subjects in the EM/EM, EM/E, M/EM, and M/M groups, respectively (P < 0.01 for the EM/EM and M/EM groups versus the M/M group). This effect was corroborated by a more conservative post hoc 2-year NRI analysis, with remission observed in 59/131, 50/134, 48/133, and 29/130 of the same respective groups (P < 0.05 for each of the EM/EM, EM/E, and M/EM groups versus the M/M group). The proportions of subjects achieving radiographic nonprogression (n = 360) were 89/99, 74/99, 59/79, and 56/83 in the EM/EM (P < 0.01 versus each of the other groups), EM/E, M/EM, and M/M groups, respectively. No new safety signals or between-group differences in serious adverse events were seen. Conclusion Early sustained combination etanercept,MTX therapy was consistently superior to MTX monotherapy. Combination therapy resulted in important clinical and radiographic benefits over 2 study years, without significant additional safety risk. [source] The relationship between the onset of electrographic seizure activity after birth and the time of cerebral injury in uteroBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2005P. Filan In the fetal lamb model of hypoxic,ischaemic injury, the insult is followed by EEG depression, after which seizures emerge at 7,13 hours. We explored the relationship between the emergence of electrographic seizures and our estimate of the time of the cerebral injury in nine babies who underwent continuous video-EEG monitoring from soon after birth. Babies with prelabour insults had their first seizures before 12 hours of age, whereas those whose insult was peripartum had seizure onset at 18,20 hours of age. EEG seizure onset time could have important clinical and medico-legal applications, and be related to the time or severity of the insult, or both. [source] Comparison between differentcell kinetic variables in human breast cancerCELL PROLIFERATION, Issue 2 2000F. Barzanti Cell kinetics holds a prominent role among biological factors in predicting clinical outcome and response to treatment in neoplastic patients. Different cell kinetic variables are often considered as valid alternatives to each other, but the limited size of case series analysed in several studies and the lack of simultaneous determinations of all the variables on the same tumours do not justify this conclusion. In the present study, the correlation between [3H]thymidine labelling index ([3H]dT LI), flow cytometric S phase cell fraction (FCM-S) and Ki-67 immunoreactivity (Ki-67/MIB-1) was verified and the type of correlation with the most important clinical, pathological and biological patient and tumour characteristics was investigated in a very large series of breast cancer patients. Ki-67/MIB-1, FCM-S and [3H]dT LI were determined in 609, 526 and 485 patients, respectively, and all three cell proliferation indices were evaluated in parallel on the same tumour in a series of 330 breast cancer patients. All the cell kinetic determinations were performed within the context of National Quality Control Programmes. Very poor correlation coefficients (ranging from 0.37 to 0.18) were observed between the different cell kinetic variables determined in parallel on the same series of breast cancers. Moreover, Ki-67/MIB-1 and FCM-S showed a significant relationship with histological type, grade and tumour size, whereas statistically significant correlations were not observed for [3H]dT LI. In conclusion, the results show that the different cell kinetic variables provide different biological information and cannot be considered as alternatives to each other. [source] 4267: Diagnosis and management of iris melanomas: a clinical follow-up study of 12 yearsACTA OPHTHALMOLOGICA, Issue 2010L RAZZAQ Purpose Diagnosis of iris melanoma is challenging as no clear cut differentiating points exists for differentiation between iris naevi and melanoma. On the basis of our and others experience of iris tumors, an "iris melanoma module" was developed at LUMC in 1997 which included important clinical and UBM features of iris melanoma to diagnose and differentiate between iris naevi and -melanoma. This study is to identify important clinical and UBM variables predictive of diagnosing iris melanoma. Methods Between January 1997 and December 2007, total 117 patients were seen with suspected iris melanocytic tumors and the iris melanoma module is filled in all these patients. On the basis of the module score for each patient, decision was made whether to treat or observe the patient. We analyzed all these patients on the basis of follow-up and current status that whether the management strategy of these patients' iris tumors on the basis of module was right. Results 37 Patients were treated with plaque radiation (32%), 15 patients had excision or enucleation (13%), whereas in 65 patients lesions were observed with periodic follow-up (55%). The follow-up period is 2-12 years. Of the 65 lesions observed for growth only 6(9%) showed growth. Most of the lesions which were excised proved to be the iris melanoma. All the variables of iris melanoma module were also analysed using the univariate and multivariate analysis. Conclusion Clinical and UBM features of the iris tumors included in iris melanoma module appear to enable clinicians to differentiate reasonably well between probable malignant melanoma, for which prompt treatment is appropriate, and benign naevi, for which observation with periodic follow-up is the good management option. 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