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Other Patient Populations (other + patient_population)
Selected AbstractsIntroduction to therapy of hepatitis CHEPATOLOGY, Issue 5B 2002Karen L. Lindsay 1640 Marengo St. Since the 1997 National Institutes of Health Consensus Development Conference on management of hepatitis C there have been several important advances that significantly impact its therapy; notably the availability of sensitive, specific, and standardized assays for identifying hepatitis C virus (HCV) RNA in the serum, the addition of ribavirin to alpha interferon, the pegylation of alpha interferon, and the demonstration that sustained virological response (SVR) is the optimal surrogate endpoint of treatment. Using pegylated interferon and ribavirin, virological response with relapse and nonresponse are less common, but remain poorly understood. Current studies are evaluating nonvirological endpoints of treatment, namely biochemical response and histological response. To date, definitive treatment trials have primarily been conducted in adult patients with elevated aminotransferase levels, clinically compensated chronic liver disease, and no other significant medical disorder. Limited data are available from studies of other patient populations, and the safety of interferon-based treatment has not yet been established in several patient groups. Future research is needed to elucidate the mechanisms of viral response and clearance, to develop effective therapies for interferon nonresponse or intolerance, to define the role of complementary and alternative medicine and other nonspecific therapies, and to develop strategies for the optimal management and treatment of special patient populations who probably represent the majority of persons with chronic hepatitis C in the United States. [source] Introduction to therapy of hepatitis CHEPATOLOGY, Issue S1 2002Karen L. Lindsay M.D. Since the 1997 National Institutes of Health Consensus Development Conference on management of hepatitis C there have been several important advances that significantly impact its therapy; notably the availability of sensitive, specific, and standardized assays for identifying hepatitis C virus (HCV) RNA in the serum, the addition of ribavirin to alpha interferon, the pegylation of alpha interferon, and the demonstration that sustained virological response (SVR) is the optimal surrogate endpoint of treatment. Using pegylated interferon and ribavirin, virological response with relapse and nonresponse are less common, but remain poorly understood. Current studies are evaluating nonvirological endpoints of treatment, namely biochemical response and histological response. To date, definitive treatment trials have primarily been conducted in adult patients with elevated aminotransferase levels, clinically compensated chronic liver disease, and no other significant medical disorder. Limited data are available from studies of other patient populations, and the safety of interferon-based treatment has not yet been established in several patient groups. Future research is needed to elucidate the mechanisms of viral response and clearance, to develop effective therapies for interferon nonresponse or intolerance, to define the role of complementary and alternative medicine and other nonspecific therapies, and to develop strategies for the optimal management and treatment of special patient populations who probably represent the majority of persons with chronic hepatitis C in the United States. (HEPATOLOGY 2002;36:S114,S120). [source] Developing and maintaining the therapeutic alliance with self-injuring patientsJOURNAL OF CLINICAL PSYCHOLOGY, Issue 11 2007Nira Nafisi In this article, the authors outline methods of strengthening the therapist,patient bond with individuals who self-injure. Self-injuring patients present with a host of challenges that differ from other patient populations and therefore certain approaches may be more effective than others. Among the strategies described are validation, checking in, working collaboratively toward goals, providing support, and repairing a ruptured alliance. Potential pitfalls (e.g., reinforcing maladaptive behavior, negative judging, and the fundamental attribution error) to which psychotherapists often fall prey are discussed as well. Self-injury is explained as functional rather than manipulative behavior and detailed clinical guidelines and examples are provided to better illustrate approaches that will improve the therapeutic alliance. © 2007 Wiley Periodicals, Inc. J Clin Psychol: In Session 63: 1069,1079, 2007. [source] Overweight in medical paediatric inpatients: Detection and parent expectationsJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 4 2007Karen McLean Aims: (i) To determine prevalence and rates of detection of overweight/obesity among general paediatric inpatients. (ii) To explore parental expectations regarding detection and management of overweight/obesity during admission. Methods: This is a cross-sectional survey conducted in the Royal Children's Hospital, Melbourne, Australia. A total of 102 children aged 2,12 years admitted to a general paediatric unit at the Royal Children's Hospital and their parents participated in the survey. The main outcome measures are body mass index (BMI); documentation of weight, height and BMI in patient notes; parent description of child's weight, parent concern about child's weight, and parent opinion about detection and management of overweight. Results: Twelve of 102 children (11.7%, 95% confidence intervals 6.2%, 19.7%) were overweight or obese. All children had a documented weight, two children (2.0%) had a documented height and none had BMI documented. Seven of 12 parents of overweight children described their child's weight as healthy; five of 12 parents of overweight children were not concerned about their child's weight. Eight of 12 parents of overweight children believed all admitted children should have their BMI calculated. All parents thought the hospital should take action if a child was found to be overweight. Conclusions: Although prevalence of overweight was lower than expected, documentation of overweight did not occur for any patient in the study. Parents of overweight children with acute illnesses believed that the hospital should screen for overweight and discuss it with parents. Further studies are required to determine expectations among other patient populations. [source] A pharmacodynamic assessment of the impact of antihypertensive non-adherence on blood pressure controlPHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 7 2000DrPh, Peter W. Choo MD Abstract Objectives To evaluate if antihypertensive regimens that conform to present FDA guidelines by maintaining ,,50% of their peak effect at the end of the dosing interval protect patients during sporadic lapses in adherence. Methods 169 patients on monotherapy for high blood pressure underwent electronic adherence monitoring for 3 months. Blood pressures were measured during non-study office visits and were retrieved from automated medical records. Questionnaires were used to obtain other covariate information. The ratio of the dosing interval to the half-life of drug activity (I,) was used to capture conformity with FDA guidelines. Data analysis focused on the interaction between I, and the impact on blood pressure of delayed dosing. Results The average (,±,standard deviation) blood pressure during the study was 139.0 (,±,12.0)/85.0 (,±,6.9) mm Hg. Lisinopril followed by sustained-release verapamil, atenolol, and hydrochlorothiazide were the most frequently prescribed agents. The majority of regimens (99%) conformed to FDA dosing guidelines. Of the patients 23% missed a dose before their blood pressure check. Non-adherence, however, did not have a direct impact on blood pressure, and no interaction with I, of was detected. Conclusions Among patients with relatively mild hypertension on single-drug therapy, regimens that conform to current FDA dosing guidelines may prevent losses of blood pressure control during episodic lapses of adherence. These findings should be replicated in other patient populations with standardized blood pressure measurement to confirm their validity. Copyright © 2000 John Wiley & Sons, Ltd. [source] Cesarean Delivery in Native American Women: Are Low Rates Explained by Practices Common to the Indian Health Service?BIRTH, Issue 3 2005Sheila F. Mahoney CNM ABSTRACT:,Background: Studying populations with low cesarean delivery rates can identify strategies for reducing unnecessary cesareans in other patient populations. Native American women have among the lowest cesarean delivery rates of all United States populations, yet few studies have focused on Native Americans. The study purpose was to determine the rate and risk factors for cesarean delivery in a Native American population. Methods: We used a case-control design nested within a cohort of Native American live births, , 35 weeks of gestation (n = 789), occurring at an Indian Health Service hospital during 1996,1999. Data were abstracted from the labor and delivery logbook, the hospital's primary source of birth certificate data. Univariate and multivariate analyses examined demographic, prenatal, obstetric, intrapartum, and fetal factors associated with cesarean versus vaginal delivery. Results: The total cesarean rate was 9.6 percent (95% CI 7.2,12.0). Nulliparity, a medical diagnosis, malpresentation, induction, labor length > 12.1 hours, arrested labor, fetal distress, meconium, and gestations < 37 weeks were each significantly associated with cesarean delivery in unadjusted analyses. The final multivariate model included a significant interaction between induction and arrested labor (p < 0.001); the effect of arrested labor was far greater among induced (OR 161.9) than noninduced (OR 6.0) labors. Other factors significantly associated with cesarean delivery in the final logistic model were an obstetrician labor attendant (OR 2.4; p = 0.02) and presence of meconium (OR 2.3; p = 0.03). Conclusions: Despite a higher prevalence of medical risk factors for cesarean delivery, the rate at this hospital was well below New Mexico (16.4%, all races) and national (21.2%, all races) cesarean rates for 1998. Medical and practice-related factors were the only observed independent correlates of cesarean delivery. Implementation of institutional and practitioner policies common to the Indian Health Service may reduce cesarean deliveries in other populations. [source] | ||||||||||