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Observational Period (observational + period)
Selected AbstractsPreliminary results of a fine-grain analysis of mood swings and treatment modalities of bipolar I and II patients using the daily prospective life-chart-methodologyACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2009C. Born Objective:, The study aimed to increase the knowledge about the detailed course differences between different forms of bipolar disorder. Method:, Using the prospective life-chart-clinician version, we compared the fine-grain analysis of mood swings and treatment modalities of 18 bipolar II with 31 bipolar I patients. Results:, During an observational period of a mean of 26 months we observed an increase of euthymic days, and a decrease of (sub)depressive and (hypo)manic days. Days in a (sub)depressed state were more frequent than days of (hypo)mania as well as days of subdepression or hypomania in comparison to days of full-blown depression or mania. Bipolar II patients showed an increase in hypomanic days receiving more frequently antidepressants. Bipolar I patients, with a decrease of manic days, were significantly taking more often mood stabilizers. Conclusion:, Treatment in a specialized bipolar clinic improves the overall outcome, but bipolar II disorder seems to be still treated sub-optimally with a possible iatrogenic increase of hypomanic days. [source] Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementiaINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 7 2007Sytse U. Zuidema Abstract Objective To estimate the prevalence of neuropsychiatric symptoms of dementia patients in Dutch nursing homes. Methods Cross-sectional study in a large sample of 1322 demented patients living in 59 dementia special care units (SCUs) in The Netherlands. Symptoms were observed by licensed vocational nurses during regular care-giving in a 2-week observational period prior to assessment. Neuropsychiatric symptoms were assessed using the Neuropsychiatric Inventory- Nursing home version (NPI-NH; frequency X severity score , 4) and the Cohen-Mansfield Agitation Inventory (CMAI; symptoms occurring at least once a week). Results More than 80% of these patients suffered from at least one clinically significant symptom, as defined with the NPI-NH frequency X severity score , 4. Measured with the NPH-NH agitation/aggression, apathy and irritability were the most frequently observed behaviors, with prevalences of 30,35%. Using the CMAI, 85% of the patients showed at least one symptom of agitation, of which general restlessness was observed most frequently (44%). Other frequently observed symptoms with prevalence rates of 30% were cursing or verbal aggression, constant request for attention, negativism, repetitious sentences, mannerisms, pacing, and complaining. Physically aggressive symptoms such as hitting, kicking, biting occurred less often (less than 13%). Conclusions Prevalence rates of neuropsychiatric symptoms in Dutch nursing home patients with dementia residing in SCUs are high, especially agitation and apathy. Insight into the prevalence rates of individual symptoms in patients with dementia has important practical consequences for the accurate planning of staff allotment and stresses the need for patient oriented care. Copyright © 2006 John Wiley & Sons, Ltd. [source] Cost of Alzheimer's disease in a developing country settingINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 7 2005M. Zencir Abstract Purpose To evaluate the economic impact of AD in Denizli, Turkey. Design and Methods This observational study was conducted with 42 AD patients and their primary caregivers. During the initial interview, demographic data and medical histories were collected with questionnaires. For an observational period of 15 days, data on time spent for patient care were collected using standard forms. Calculations on direct cost (e.g. per day medication, outpatient physician visits during the last 3 months), indirect cost (e.g. time spent for care by caregiver for daily living (ADL) and instrumental activity of daily living (IADL)) were made by summing up and taking averages of the appropriate items. ANOVA, and linear regressions were the methods for comparisons. Results The primary caregivers of the patients mainly were their children and/or spouses. The maximum mean time spent (h/week) was 21.0 (17.5) for severely damaged cognition. The average annual cost per case was between $1,766 [95% Confidence Intervals (CI); 1.300,2.231] and $4,930 (95% CI; 3.3714,6.147). The amount of caregiver cost was the most significant item in the overall cost and it showed an increase with the declining cognitive function of patients. Daily medication cost reflected the same pattern. In contrast, cost of outpatient physician was the lowest among the patients with the worst cognition. Conclusions These results suggest that recently AD has become a significant cost for developing countries. This pilot study gives an idea of the cost of AD in developing countries where determining the actual cost can be difficult. Copyright © 2005 John Wiley & Sons, Ltd. [source] Antithrombin plasma levels decrease is associated with preeclampsia worseningINTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 2 2009M. MARIETTA Summary Antithrombin plasma levels (AT) have been found decreased in women with preeclampsia (PE), but little is known about the trend of AT during the course of this disease. We prospectively investigated AT in consecutive women admitted to our hospital with a diagnosis of PE, to assess if AT fluctuations could be associated with the evolution of the disease. AT, platelet count and d -dimer levels were determined every other day. In the 73 patients studied, AT, platelet count and fibrinogen progressively reduced during the observational period, reaching a nadir on the day of delivery, whereas d -dimer progressively increased over time. Statistical analysis was restricted to the 39 women that had an AT measurement performed on each of days ,1, 0 and +1, with respect to the day of delivery. These subjects showed a significant decrease in AT on the day of delivery compared to the day just before (77.8 ± 15.1%vs. 85.4 ± 14.2%, P = 0.027), followed by a recovery on the first day after delivery (87.6 ± 21.3% from 77.8 ± 15.1%, P = 0.005). Our study demonstrates that a significant drop in AT levels is associated with the clinical worsening of PE, regardless of its severity. [source] Outpatients undergoing therapeutic endoscopic retrograde cholangiopancreatography: Six-hour versus overnight observationJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 10 2004CHEE-KIN HUI Abstract Background and Aim:, The purpose of the present retrospective study was to compare the proportion of post-endoscopic retrograde cholangiopancreatography (ERCP) complications detected with 6-h observation followed by same-day discharge (SDD) versus overnight observation (OO) after therapeutic ERCP. Methods:, There were 134 outpatients in the SDD group and 178 outpatients in the OO group. The SDD group was discharged after a 6-h observation while the OO group was discharged after overnight observation. Patients in the SDD group were admitted from the recovery room for evaluation if they had systolic blood pressure (BP) < 100 mmHg, pulse > 100/min, temperature > 37.5°C, or post-procedure abdominal pain. The primary outcome of the present study was the proportion of post-ERCP complications detected within the observational period between the SDD group and the OO group. Results:, The post-ERCP complication rate of therapeutic ERCP in the SDD and OO groups were 9.7% and 9.6%, respectively (P = 0.964). Eleven patients (8.2%) in the SDD group and 13 patients (7.3%) in the OO group were found to have post-ERCP complications within the observation period. There was no significant difference in the proportion of post-ERCP complications detected within the observational period between the two groups (P = 0.672). Conclusion:, Outpatient therapeutic ERCP with observation of 6 h can detect the same proportion of patients with post-ERCP complications as overnight observation. © 2004 Blackwell Publishing Asia Pty Ltd [source] A Methodology for Evaluation of Dietary Feeding Stimulants for the Pacific White Shrimp, Litopenaeus vannameiJOURNAL OF THE WORLD AQUACULTURE SOCIETY, Issue 1 2005Dagoberto R. Sanchez A simple and practical method for quantification of feeding stimulation of shrimp Litopenaeus vannamei was developed using feed preference as an index of comparison. Feed preference was defined as the percentage of shrimp observed in each feeding tray. Preliminary trials were undertaken with two commercial feeds (45% protein with 5% squid meal and 40% protein without squid meal). Results indicated the following criteria were suitable for use as methodology for evaluating feeding stimulation in 5-m diameter static flow tanks: shrimp density (2.5 shrimp/m2); observational period (1 or 2 h post-addition of feed to trays), feed rate (2%), and between-trial feed rate (2%). A further investigation was undertaken to evaluate the influence of protein level and source on feed preference using a basal diet consisting of wheat flour, casein, carboxymethyl cellulose binder, and limestone, with or without krill meal as a feeding stimulant. A significant difference was shown in feeding preference for the 16% protein/4% krill meal vs. one without krill meal; however, this relationship was not shown in 45% protein feed comparisons. A second trial comparing 0, 16,30, and 45 % protein/casein-based feeds showed similar results. From these findings, it was postulated that casein, itself, also serves as a feeding stimulant at high dietary inclusion levels. A third trial comparing 16% protein/casein or wheat gluten-based feeds Indicated a delay of at least 2 h in maximum feeding preference response in feeds in which 4% krill meal was added as a feeding stimulant. It was postulated that chemical stimulants from krill meal were more slowly released in wheat gluten-based feeds. Our methodology appears suitable for evaluation of potential feeding stimulants when incorporated into low-protein casein-based or wheat-gluten-based feeds. [source] Lack of de novo hepatitis C virus infections and absence of nosocomial transmissions of GB virus C in a large cohort of German haemodialysis patientsJOURNAL OF VIRAL HEPATITIS, Issue 4 2009R. S. Ross Summary., To determine the prevalence and incidence of hepatitis C virus (HCV) infections among haemodialysis patients, a large prospective multicentre trial was conducted in the German Federal State of North Rhine-Westphalia. Sera obtained from the recruited patients in two separate sampling rounds run 1 year apart were analysed for both anti-HCV antibodies and HCV RNA. HCV RNA positive samples were also genotyped by direct sequencing of an HCV core fragment. In the first and second rounds, 150 (5.2%) of 2909 and 114 (5.4%) of 2100 patients were anti-HCV positive, respectively, and 4% of individuals were viraemic. Evaluation of potential risk factors in a case,control study indicated that the factors ,foreign country of birth', ,blood transfusions given before 1991' and ,duration of treatment on haemodialysis' were associated with the risk of HCV infection. Among the 2100 patients of whom ,paired' serum samples from both rounds were available for testing, not a single ,de novo' HCV infection could be recorded. The fact that in a subset of about 20% of these patients no nosocomial GB virus C (GBV-C) transmission occurred during the observational period suggests that the lack of HCV seroconversions was not only attributable to the isolation of HCV-infected patients but also to the strict adherence to so-called universal hygienic precautions for infection control maintained in the participating dialysis centres. [source] Orbit characteristics of the tristatic EISCAT UHF meteorsMONTHLY NOTICES OF THE ROYAL ASTRONOMICAL SOCIETY, Issue 1 2008C. Szasz ABSTRACT The tristatic EISCAT 930-MHz UHF system is used to determine the absolute geocentric velocities of meteors detected with all three receivers simultaneously at 96 km, the height of the common radar volume. The data used in this study were taken between 2002 and 2005, during four 24-h runs at summer/winter solstice and vernal/autumnal equinox to observe the largest seasonal difference. The observed velocities of 410 tristatic meteors are integrated back through the Earth atmosphere to find their atmospheric entry velocities using an ablation model. Orbit calculations are performed by taking zenith attraction, Earth rotation as well as obliquity of the ecliptic into account. The results are presented in the form of different orbital characteristics. None of the observed meteors appears to be of extrasolar or asteroidal origin; comets, particularly short-period (<200 yr) ones, may be the dominant source for the particles observed. About 40 per cent of the radiants can be associated with the north apex sporadic meteor source and 58 per cent of the orbits are retrograde. There is evidence of resonance gaps at semimajor axis values corresponding to commensurabilities with Jupiter, which may be the first convincing evidence of Jupiter's gravitational influence on the population of small sporadic meteoroids surveyed by radar. The geocentric velocity distribution is bimodal with a prograde population centred around 38 km s,1 and a retrograde population peaking at 59 km s,1. The EISCAT radar system is located close to the Arctic Circle, which means that the North Ecliptic Pole (NEP) is near zenith once every 24 h, i.e. during each observational period. In this particular geometry, the local horizon coincides with the ecliptic plane. The meteoroid influx should therefore be directly comparable throughout the year. [source] Early administration of surfactant in spontaneous breathing with nCPAP: feasibility and outcome in extremely premature infants (postmenstrual age ,27 weeks)PEDIATRIC ANESTHESIA, Issue 4 2007ANGELA KRIBS MD Summary Background:, Spontaneous breathing supported by nasal continuous positive airway pressure (nCPAP) is thought to have some advantages compared with mechanical ventilation in extremely premature infants. In addition, early or prophylactic surfactant administration has been shown to be superior to delayed use. A strategy to combine these two principles was tested in our neonatal intensive care unit (NICU). The aim of this feasibility study was to describe the procedure and compare short-term results with a historical control. Methods:, The study took place in a level III NICU. In the observational period all extremely premature infants with clinical signs of moderate to severe respiratory distress syndrome despite nCPAP received 100 mg·kg,1 of a natural surfactant preparation via an intratracheal catheter during spontaneous breathing. In the historical control period those infants were intubated and ventilated to receive surfactant. Results:, Twenty-nine of 42 infants fulfilled the criteria and were treated with the new approach. In five cases ventilation with manual bag was necessary after administration of surfactant but all infants could be retransferred to nCPAP within a few minutes. Ten infants were intubated later during the first 3 days. Mortality was 7% in the group of infants treated in this way and 12% in all infants treated during the observational period. Mortality was 35% in the historical control period. Morbidity was within ranges reported by other authors. Conclusions:, Surfactant administration during nCPAP is feasible. First results indicate that early complications are rare. This warrants a prospective randomized trial. [source] 19 A Novel Approach to Residency Education in EMS: The MD-PM AmbulanceACADEMIC EMERGENCY MEDICINE, Issue 2008Angela Fiege Challenge:, Indiana University EM residents have actively provided prehospital care as crew members on a hospital-based air ambulance service. This service functions as a secondary responder for high acuity patients who have already had first tier evaluation and care. First response, ground EMS experiences have been observational only as residents have ridden along with a two-paramedic team on an urban ambulance service for 24 hours during their residency careers. Resident understanding of first response care and challenges faced by initial EMS providers has been limited to that gleaned during their observational period. Solution:, Most EM residencies do not provide opportunities for residents to function as first response providers. Therefore, we developed a Physician-Paramedic team to provide first response care within a busy metropolitan area. This two-member team operates within a "geozone" that includes a diverse patient population with both medical and trauma complaints. Unlike other residency ground EMS programs, the MD-PM truck responds primarily to all ambulance requests within their designated geozone and assists outside their designated geozone for multi-patient casualties in which a physician response would benefit patient care (fires, motor vehicle accidents, multiple gunshot victims). Residents on the MD-PM truck not only provide care equivalent to that expected of a nationally certified paramedic (IVs, drug administration, splinting, packaging), but also perform advanced skills such as RSI which is outside the scope of a traditional two-paramedic team. Immersion into the first response ground EMS system will provide valuable insight into the challenges of providing care outside of the hospital. [source] Long-term benefit to pallidal deep brain stimulation in a case of dystonia secondary to pantothenate kinase-associated neurodegenerationMOVEMENT DISORDERS, Issue 12 2006Martin Krause MD Abstract Pantothenate kinase-associated neurodegeneration (PKAN) is a rare autosomal recessive disorder with onset in childhood and rapid progression. There is no causative and insufficient symptomatic drug therapy. Deep brain stimulation (DBS) of the internal pallidum (GPi) has been reported to improve motor function. Most case reports, however, are limited to short observational periods. The impact of DBS on the progression and life expectancy in PKAN is unknown. We present a 5-year outcome and video documentation of bilateral GPi-DBS of an adolescent patient suffering from genetically defined PKAN. © 2006 Movement Disorder Society [source] | ||||||||||||||||||||||