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Prospective Evaluation (prospective + evaluation)
Selected AbstractsVenous thromboembolism in the medically ill patient: a call to actionINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 5 2005J.-F. Bergmann Summary The risk of venous thromboembolism (VTE) in medical patients is generally underestimated. However, recent studies including two large double-blind placebo-controlled trials, the Prospective Evaluation of Dalteparin Efficacy for Prevention of VTE in Immobilised Patients trial (PREVENT) and prophylaxis in MEDical patients with ENOXaparin, study show that low-molecular-weight heparins (LMWHs) provide effective thromboprophylaxis for medical patients at risk from VTE without increasing the risk of bleeding. In PREVENT the significant 45%, reduction in VTE among patients receiving dalteparin 5000 IU once daily for 14 days was attributed entirely to a reduction in clinically relevant VTE. The recently published guidelines for the prevention and treatment of VTE, issued by the American College of Chest Physicians, recommend prophylaxis with LMWHs (or low-dose unfractionated heparin) in acutely ill medical patients with risk factors for VTE (grade 1A). Current evidence should encourage the more widespread adoption of thromboprophylaxis in at-risk medical patients, and thus reduce the number of preventable deaths and complications due to VTE. [source] Prospective Evaluation of a Pediatric Inpatient Early Warning Scoring SystemJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 2 2009Karen M. Tucker PURPOSE. The present study evaluated the use of the Pediatric Early Warning Score (PEWS) for detecting clinical deterioration among hospitalized children. DESIGN/METHODS. A prospective, descriptive study design was used. The tool was used to score 2,979 patients admitted to a single medical unit of a pediatric hospital over a 12-month period. RESULTS. PEWS discriminated between children who required transfer to the pediatric intensive care unit and those who did not require transfer (area under the curve = 0.89, 95% CI = 0.84,0.94, p < .001). IMPLICATIONS. The PEWS tool was found to be a reliable and valid scoring system to identify children at risk for clinical deterioration. [source] Prospective Evaluation of Real-time Use of the Pulmonary Embolism Rule-out Criteria in an Academic Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 9 2010Jeffrey A. Kline MD Abstract Objectives:, The pulmonary embolism rule-out criteria (PERC rule) is a nine-component decision rule derived to exclude pulmonary embolism (PE) without the use of formal diagnostic testing (D-dimer, computed tomography pulmonary angiography, ventilation,perfusion lung scanning, or venous ultrasonography) when all nine components are negative ("PERC negative"). This study examined whether clinicians who document PERC negative also document results of all nine components of the PERC rule. Methods:, This was a pilot study at a single-center, urban teaching emergency department (ED) with a residency program in emergency medicine. Patients were over 17 years of age with at least one of nine predefined chief complaints. Clinicians were asked three questions regarding suspicion for PE, intent to use the PERC rule, and the result. Charts were independently reviewed by two authors for fidelity of the nine PERC components. Patients were followed for PE outcome at 14 days. Results:, The study examined 526 patients cared for by 82 clinicians, who indicated suspicion for PE in 183 of 526 (35%) and intent to use the PERC rule in 115 of 526 (22%) cases, of whom 65 of 115 were documented as PERC negative. No formal test for PE was ordered in 49 of 65 (75%), and 46 of 49 had incomplete documentation to support PERC negative. The most common deficiency was omission of two risk factors for PE in the rule (prior venous thromboembolism or recent surgery). Six patients had PE diagnosed within 14 days, but none of these had been deemed PERC negative. Conclusions:, Clinicians seldom document all nine data elements of the PERC rule in patients they deem PERC negative. These data suggest the need for paper or electronic aids to support use of the PERC rule. ACADEMIC EMERGENCY MEDICINE 2010; 17:1016,1019 © 2010 by the Society for Academic Emergency Medicine [source] A 5-Year Prospective Evaluation of DSM-IV Alcohol Dependence With and Without a Physiological ComponentALCOHOLISM, Issue 5 2003M. A. Schuckit Background: The DSM-III-R removed tolerance and withdrawal as required elements for a diagnosis of alcohol dependence. Although this practice was continued in DSM-IV, the more recent manual asked clinicians to note whether physiological aspects of withdrawal (tolerance and withdrawal) had ever been experienced. Few studies have determined the prognostic meaning of a history of a physiological component to DSM-IV alcohol dependence. Methods: Face-to-face structured interviews were used to evaluate the course of alcohol, drug, and psychiatric problems during the subsequent 5 years for 1094 alcohol-dependent men and women. These subjects had been classified into subgroups at the time of initial interview regarding evidence of tolerance or withdrawal, and all evaluations were based on DSM-IV criteria. At baseline, the application of DSM-IV diagnostic guidelines resulted in 649 (59.3%) individuals having a history of an alcohol withdrawal syndrome, with or without tolerance (group 1); 391 (35.7%) with histories of tolerance but not withdrawal (group 2); and 54 (4.9%) with no lifetime histories of tolerance or withdrawal (group 3). Results: During the 5-year follow-up, both the broad (group 1 plus 2 versus group 3) and narrow (group 1 versus group 2 plus group 3) definitions of physiological dependence were associated with more alcohol and drug problems. However, for most items, this differential primarily reflected differences between groups 1 and 3, with a less impressive effect by group 2. Although no group differences were noted for the rate of independent major depressive episodes, substance-induced depressions did differentiate among groups, a finding also most closely related to the distinction between groups 1 and 3. Conclusions: These data support the prognostic importance of noting the presence of a physiological component in alcohol dependence and indicate the potential relevance of limiting the definition of a physiological component to withdrawal. [source] Prospective Evaluation of Laparoscopic Pancreatic Biopsies in 11 Healthy CatsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2010K.L. Cosford Background: Definitive diagnosis of feline pancreatic disease is dependent on histologic examination of biopsies. Hypothesis: Laparoscopic punch biopsy of the pancreas does not significantly affect pancreatic health or clinical status of healthy cats, and provides an adequate biopsy sample for histopathology. Animals: Eleven healthy female domestic shorthair cats. Methods: Effects of laparoscopic pancreatic visualization alone in 5 cats compared with laparoscopic pancreatic visualization and punch biopsy in 6 cats were studied. Temperature, pulse, and respiratory rate, physical examination, and daily caloric intake were evaluated for 1 week before and 1 week after the procedure. Pain scores (simple descriptive score and dynamic interactive visual assessment score) were evaluated hourly during the 1st 6 hours postprocedure. Complete blood cell counts, serum biochemical profiles, serum feline pancreatic lipase immunoreactivity, and urine specific gravity were evaluated before the procedure and at 6, 24, and 72 hours postprocedure. One month postprocedure, during sterilization, the pancreas was reassessed visually in all cats, and microscopically in the biopsy group. Results: For all variables evaluated, there were no significant differences between biopsy and control cats. Re-evaluation of the pancreatic biopsy site 1 month later documented a normal tissue response to biopsy. The laparoscopic punch biopsy forceps provided high-quality pancreatic biopsy samples with an average size of 5 mm × 4 mm on 2-dimensional cut section. Conclusions and Clinical Importance: Laparoscopic pancreatic biopsy is a useful and safe technique in healthy cats. [source] Prospective Evaluation of Coagulation in Critically Ill Neonatal FoalsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2009A.I. Bentz Background: Coagulopathy is a potentially underrecognized complication of sepsis and septic shock in critically ill neonatal foals. Hypothesis: Critically ill neonatal foals have abnormalities in coagulation that are associated with disease severity and outcome. Animals: Foals <72 hours old admitted to a neonatal intensive care unit. Methods: Prospective, observational study. Blood was collected at admission, 24, and 48 hours for platelet count, prothrombin time, activated partial thromboplastin time, antithrombin activity and concentrations of fibrin degradation products, and fibrinogen in plasma from all foals. Results: Sixty-three foals were enrolled and classified as Septic Shock (12), Septic (28), and Other (23). At least 1 abnormal value was found in 18/28 (64%) samples from the Septic Shock group, 66/85 (78%) from the Septic group, and 30/59 (51%) from the Other group (P= .01). Coagulopathy (3 or more abnormal values) was present in 7/28 (25%) samples in the Septic Shock group, 14/85 (16%) samples in the Septic group, and 3/59 (5%) samples in the Other group (P= .0028). Clinically detectable bleeding occurred in 8/12 (67%) Septic Shock cases, 11/28 (39%) Septic cases, and 3/23 (13%) Other cases (P= .009). Foals in Septic Shock were 12.7 times more likely to have clinical evidence of bleeding than those in the Other group (95% CI 2.3,70, P= .004). Treatment with fluids or plasma did not have a detectable effect on coagulation values. Conclusions and Clinical Importance: Coagulopathy commonly occurs in critically ill neonatal foals, especially those with sepsis and septic shock. [source] Prospective Evaluation of the Balloon-to-Annulus Ratio for Valvuloplasty in the Treatment of Pulmonic Stenosis in the DogJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 4 2006Amara Estrada Background: In dogs, treatment of pulmonic valve stenosis (PS) with pulmonary balloon valvuloplasty (PBV) is a viable method to decrease the pressure gradient across the valve. However, to the authors' knowledge, the variables that influence the selection of the correct balloon size for the procedure have not been explored. Moreover, the lesions caused by the procedure have not been detailed. Hypothesis: Variables that influence the measurement of the annulus could affect selection of the balloon size. We sought to determine the effects of treatment when the balloon-to-annulus ratio (BAR) was or > 1.3, but within the recommended range of 1.2,1.5, regardless of whether dilation was performed with single or double balloon technique. Animals: Twenty-five Beagles with PS were studied. Methods: Inter-and intra-observer variability, echocardiography versus angiocardiography, and systolic versus diastolic timing were evaluated for the BAR. Assessment of right ventricular (RV) pressure, Doppler gradient, stenotic valve area, and RV wall thickness were compared before and 1, 90, and 180 days after treatment. Postmortem examination of the heart was done. Results: Significant correlations existed in measurement of the annulus; however, variation existed that would change balloon size. Improvement in the degree of PS was significant regardless of the BAR or single or double ballooning. In the most severely affected dogs, continued improvement was noted on day 90. Postmortem examination revealed tears in the commissures and the valve leaflets. Conclusions: Multiple factors influenced determination of the BAR and a range of 1.2,1.5 was effective without detrimental consequences. Dogs with severe PS had continued decrease in RV pressure 3 months after treatment. [source] Prospective Evaluation of Intraoperative Hemodynamics in Liver Transplantation with Whole, Partial and DCD GraftsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 8 2010M. Sainz-Barriga The interaction of systemic hemodynamics with hepatic flows at the time of liver transplantation (LT) has not been studied in a prospective uniform way for different types of grafts. We prospectively evaluated intraoperative hemodynamics of 103 whole and partial LT. Liver graft hemodynamics were measured using the ultrasound transit time method to obtain portal (PVF) and arterial (HAF) hepatic flow. Measurements were recorded on the native liver, the portocaval shunt, following reperfusion and after biliary anastomosis. After LT HAF and PVF do not immediately return to normal values. Increased PVF was observed after graft implantation. Living donor LT showed the highest compliance to portal hyperperfusion. The amount of liver perfusion seemed to be related to the quality of the graft. A positive correlation for HAF, PVF and total hepatic blood flow with cardiac output was found (p = 0.001). Portal hypertension, macrosteatosis >30%, warm ischemia time and cardiac output, independently influence the hepatic flows. These results highlight the role of systemic hemodynamic management in LT to optimize hepatic perfusion, particularly in LDLT and split LT, where the highest flows were registered. [source] Prospective Evaluation of the Change of Predialysis Protein-Bound Uremic Solute Concentration With Postdilution Online HemodiafiltrationARTIFICIAL ORGANS, Issue 7 2010Natalie Meert Abstract Although protein-bound uremic compounds have been related to outcome in observational studies, few current dialysis strategies provide more removal of those compounds than standard hemodialysis. We evaluated the evolution of protein-bound uremic solutes after a switch from high-flux hemodialysis to postdilution hemodiafiltration (n = 13). We compared predialysis solute concentration at 4, 5, and 9 weeks versus baseline for several protein-bound compounds and water-soluble solutes, as well as for ,2 -microglobulin. After 9 weeks of postdilution hemodiafiltration, a significant decrease versus baseline could be detected for total concentration of protein-bound solutes: p-cresylsulfate (3.98 ± 1.51,3.17 ± 1.77 mg/dL, ,20%, P < 0.01) and 3-carboxyl-4-methyl-5-propyl-2-furanpropionic acid (0.72 ± 0.52,0.64 ± 0.46 mg/dL, ,11%, P < 0.01). For the other protein-bound solutes, hippuric acid, indoleacetic acid, and indoxylsulfate, no change in total concentration could be detected. The concentration of the middle molecule, ,2 -microglobulin, decreased as well after 9 weeks of postdilution hemodiafiltration (24.7 ± 9.3,18.1 ± 6.7 mg/L, ,27%, P < 0.01). For water-soluble compounds, no significant change of concentration was found. Postdilution hemodiafiltration in comparison to high-flux hemodialysis provided significant reduction of predialysis concentration of protein-bound compounds, especially those with the highest protein binding, and of ,2 -microglobulin, by ,11 to ,27% in 9 weeks. [source] Prospective Evaluation of Two Clinical Scores for Acute Asthma in Children 18 Months to 7 Years of AgeACADEMIC EMERGENCY MEDICINE, Issue 6 2010FRCPC, Serge Gouin MDCM Abstract Objectives:, The objective was to evaluate the discriminatory ability of two clinical asthma scores, the Preschool Respiratory Assessment Measure (PRAM) and the Pediatric Asthma Severity Score (PASS), during an asthma exacerbation. Methods:, This was a prospective cohort study in an academic pediatric emergency department (ED; 60,000 visits/year) conducted from March 2006 to October 2007. All patients 18 months to 7 years of age who presented for an asthma exacerbation were eligible. The primary outcome was a length of stay (LOS) of >6 hours in the ED or admission to the hospital. Clinical findings and components of the PRAM and the PASS were assessed by a respiratory therapist (RT) at the start of the ED visit and after 90 minutes of treatment. Results:, During the study period, 3,845 patients were seen in the ED for an asthma exacerbation. Of these, 291 were approached to participate, and eight refused. Moderate levels of discrimination were found between a LOS of >6 hours and/or admission and PRAM (area under the receiver-operating characteristic curve [AUC] = 0.69, 95% confidence interval [CI] = 0.59 to 0.79) and PASS (AUC = 0.70, 95% CI = 0.60 to 0.80) as calculated at the start of the ED visit. Significant similar correlations were seen between the physician's judgment of severity and PRAM (r = 0.54, 95% CI = 0.42 to 0.65) and PASS (r = 0.55, 95% CI = 0.43 to 0.65). Conclusions:, The PRAM and PASS clinical asthma scores appear to be measures of asthma severity in children with discriminative properties. ACADEMIC EMERGENCY MEDICINE 2010; 17:598,603 © 2010 by the Society for Academic Emergency Medicine [source] One-Year Prospective Evaluation of the Early Loading of Unsplinted Conical Brånemark Fixtures with Mandibular Overdentures Immediately following SurgeryCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 1 2001Alan G.T. Payne BDS, FCD(SA), MDent ABSTRACT Background: Prospective evaluation of the early loading of unsplinted Branemark implants with mandibular over-dentures opposing conventional dentures is not evident in the implant-related literature. Purpose: To clinically evaluate progressive and early loading of 20 unsplinted conical Brånemark implants in edentulous mandibles with overdentures. Materials and Methods: Ten edentulous patients all had two conical Brånemark implants placed in the anterior mandible with mandatory primary stability with bicortical anchorage. Ball abutment connection was performed simultaneously. Previously constructed conventional mandibular dentures were temporarily relined with tissue conditioner postoperatively and worn with moderation for the first 2 weeks to allow progressive loading. Early loading of the implants followed after 2 weeks, with inclusion of the respective matrices in the mandibular dentures, using a definitive reline procedure. Results: All patients successfully functioned with their mandibular implant overdentures from 2 to 52 weeks postoperatively. Mean marginal bone loss was within established criteria for success:0.22 mm (SD = 0.48 mm) mesially and 0.30 mm (SD = 0.39 mm) distally on the conical implants. Mobility tests using the Periotest instrument became more negative, although not at statistically significant levels. Difficulties in the management of the peri-implant mucosa between surgery and loading at 2 weeks were observed in 40% of the patients. Conclusions: These preliminary 1-year results show that successful early loading of unsplinted conical Brånemark implants with mandibular overdentures is possible. [source] Prospective evaluation of the retrograde percutaneous translaryngeal tracheostomy (Fantoni procedure) in a surgical intensive care unit: Technique and results of the Fantoni tracheostomyHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 4 2006Ralf Konopke MD Abstract Background. Controversy surrounds the safety and practicality of the retrograde percutaneous translaryngeal tracheostomy (Fantoni procedure) compared with other percutaneous methods. Methods. We used the Fantoni tracheostomy for 245 patients in our intensive care unit (ICU) over a period of 3 years 6 months and conducted a prospective analysis. Results. We are able to report a low incidence of complications (1.2%) with the Fantoni procedure. Advantages of the method are reduced tissue trauma and optimal adaptation of the stoma to the cannula, leading to less stomal bleeding and fewer infectious complications. We observed no procedure-related mortality. Under mandatory bronchoscopic control, proper puncture location and cannula placement are ensured, which prevents tracheal wall injury and paratracheal placement of the cannula. Conclusions. Our experience shows that the major advantage of the use of the Fantoni tracheostomy is the retrograde dilatation of the stoma, which prevents serious complications compared with other techniques. © 2005 Wiley Periodicals, Inc. Head Neck28: 355,359, 2006 [source] Prospective evaluation of intestinal homing memory T cells in ulcerative colitisINFLAMMATORY BOWEL DISEASES, Issue 5 2004A. L. Hart Abstract Background: Intestinal homing (,7+) memory T cells reflect the mucosal environment in which they were primed. We hypothesized that prospective assessment of cytokine production by intestinal homing (,7+) memory T cells in ulcerative colitis patients followed from remission to early relapse may elucidate shifts in cytokine production relevant to the mucosal environment associated with the early phase of inflammation. Methods: Twelve patients with frequently relapsing ulcerative colitis (,2 relapses in the previous 12 months) were recruited in remission and followed prospectively until relapse. Antibody labeling of whole blood and flow cytometry were used to identify ,7+ cells and ,7, populations within CD3+CD45RA, leukocytes. Production of cytokines (IFN-,, TNF-,, IL-2, IL-10, TGF-,, and IL-4) was determined by intracellular labeling. Results: Early relapse of ulcerative colitis was associated with a shift of T cells from the naive to the memory T cell pool, and further the ratio of ,7+:,7, memory T cells was significantly reduced at relapse (p < 0.01). A greater proportion of intestinal homing ,7+ memory T cells produced IL-4 (p < 0.02) and TNF-, (p < 0.05) at disease relapse compared with remission. Non-intestinal homing ,7,memory T cells also showed a tendency toward an increased production of TH1 and TH2 cytokines. Conclusions: The earliest phase of intestinal inflammation in ulcerative colitis patients is associated with an increase in both TH1 (TNF-, and TH2 (IL-4) cytokines by intestinal homing ,7+ memory T cells. These data support the principles of targeting lymphocyte trafficking as therapies in ulcerative colitis. [source] Ablation of Focally Induced Atrial Fibrillation:JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 2 2004Selective or Extensive? Introduction: Focally induced atrial fibrillation (AF) often is due to ectopic activity in the pulmonary veins (PV). Although initial approaches were aimed at ablating only the ectopic foci, more extensive ablation approaches have evolved that isolate all PVs empirically and/or create circumferential ablation lines in the left atrium (LA). These techniques last longer and may be associated with more risks. We retrospectively evaluated the outcome and risks of ablation for focally induced AF in a single-center patient population. Methods and Results: We report on 47 patients (32 men and 15 women; age 47 ± 10 years) in whom 52 ablations were performed. In 19 patients (22 sessions), ablation was directed at the site(s) of overt ectopic activity ("selective" group), whereas in 28 patients (30 sessions) without sufficient ectopy to determine the culprit PV a mean of 3.5 PVs were empirically targeted for bidirectional disconnection from the LA ("extensive" group). On a preprocedural Holter recording, the "selective" group had significantly more isolated atrial ectopy (3,276 ± 2,933 vs 620 ± 937 beats/24 hours) and runs of atrial tachycardia (330 ± 202 vs 53 ± 87 runs/24 hours) than the "extensive" group (P < 0.01 for both). Only 11% had persistent AF before ablation. Acute procedural success was 81% (elimination of all ectopy) and 83%, respectively (bidirectional and fully circumferential isolation of all targeted PVs). Procedure and fluoroscopy times were significantly shorter in the "selective" group. There were no major complications, but 7 minor complications and 2 acute PV stenoses > 50% in the 30 "extensive" procedures were observed. Mean follow-up was 8.4 ± 8.5 months (median 6.9). Kaplan-Meier analysis, excluding recurrences during only the first month ("delayed cure"), showed AF recurrence in 45% after 6 months and in 55% after 1 year. Outcome was not dependent on ablation approach ("selective" or "extensive") nor was time to first AF (22 ± 64 days and 30 ± 69 days). AF recurrence tended to be higher in patients with larger LA (P = 0.08), underlying heart disease or hypertension (P = 0.08), and those "extensive" patients in whom not all 4 PVs were targeted (P = 0.07). Conclusion: Trigger-directed ablation for focally induced AF is associated with a relatively high recurrence rate during follow-up. Apart from recurrence of the ectopic trigger, this may point to underlying structural changes in the atrial substrate not addressed by the ablation. Prospective evaluation of the risk-to-benefit profile of any technique (selective, extensive, including linear lines) is required. (J Cardiovasc Electrophysiol, Vol. 15, pp. 200-205, February 2004) [source] Prospective evaluation of the time to peak effect of propofol to target the effect site in childrenACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2009H. R. MUÑOZ Background: The plasma-effect site equilibration rate constant (ke0) of propofol has been determined in children with the use of the time to maximum effect (tpeak), however, it has not been validated. The objective was to measure the tpeak; of propofol with two depths of anesthesia monitors in children and to evaluate these measurements with a target-controlled infusion (TCI) system. Methods: Unpremedicated, ASA I children from 3 to 11 years were studied. In Part 1, children were monitored simultaneously with the bispectral index (BIS) and the A-Line ARX-index (AAI) from the Alaris A-Line auditory-evoked potential monitor/2. The tpeak after a bolus dose of propofol was measured. In Part 2, the tpeak measured was used to target the effect site with a TCI system. The median (MD) and the absolute median (MDA) difference between the predicted time of peak concentration at the effect site (Ce) and the measured time of peak effect in the index of depth of anesthesia (terror) was used to evaluate the performance of the system. Results: The BIS recordings were of a better quality than the AAI. The mean ± standard deviation tpeak was 65 ± 14 s with the BIS (n=25) and 201 ± 74 s with the AAI (n=10)(P<0.001). Validation was only performed with the BIS monitor in 40 children, yielding an MD terror of ,9.5 s and an MDA terror of 10.0 s. Conclusions: The small delay between the evolution of Ce of propofol and the observed effect suggests that this can be a useful model to target the effect site in children. [source] GASTROENTEROLOGY: Prospective evaluation of a clinical guideline recommending early patients discharge in bleeding peptic ulcerJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 9 2010María Chaparro Abstract Background and Aim:, To validate an early discharge policy in patients admitted with upper gastrointestinal bleeding (UGIB) due to ulcers. Methods:, Patients with gastroduodenal ulcer or erosive gastritis/duodenitis were included in a previous study aiming to develop a practice guideline for early discharge of patients with UGIB. Variables associated with unfavorable evolution were analyzed in order to identify patients with low-risk of re-bleeding. After that, a one-year prospective analysis of all UGIB episodes was carried out. Results:, A total of 341 patients were identified in the retrospective study. Variables associated with unfavorable evolution were: systolic blood pressure , 100 mmHg, heart rate , 100 bpm, and a Forrest endoscopic classification of severe. 10% of patients were immediately discharged; however, if predictive variables obtained in the multivariate analysis had been used, hospitalization could have been prevented in 34% of patients. A total of 77 patients were included in the prospective analysis. Although only 19.5% of patients were immediately discharged without complications, 29 patients (37.7%) were theoretically suitable for early discharge. Conclusions:, Patients with UGIB who have clean-based ulcers and are stable on admission can be safely discharged immediately after endoscopy. Implementation of the clinical practice guideline safely reduced hospital admission for those patients. [source] Prospective evaluation of the management of moderate to severe cellulitis with parenteral antibiotics at a paediatric day treatment centreJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 4 2008Serge Gouin Aim: To assess the clinical outcome of patients with moderate to severe cellulitis managed at a paediatric day treatment centre (DTC). Methods: Prospective observational study of all patients (3 months to 18 years) with a presumed diagnosis of moderate to severe cellulitis made in a university-affiliated paediatric emergency department (ED) (September 2003 to September 2005). Patients treated at the DTC were given ceftriaxone or clindamycin. Results: During the study period, a presumed diagnosis of moderate to severe cellulitis was made in 224 patients in the ED. Ninety-two patients were treated at the DTC (41%). The cellulitis had a median width of 7.0 cm (range: 1.0,50.0 cm) and a median length of 6.5 cm (range: 1.0,40.0 cm). Blood cultures were performed in 95.7%; one was positive for Staphylococcus aureus. After a mean of 2.5 days of intravenous therapy (first injection in the ED and a mean of 1.5 days at the DTC), 73 patients (79.3%) were successfully discharged from the DTC and switched to an oral agent. For these patients no relapse occurred. Nineteen patients (20.7%) required inpatient admission for further therapy. No patient was diagnosed with necrotizing fasciitis in the course of therapy. Seventy-eight satisfaction questionnaires were handed in and revealed very good to excellent parental satisfaction with treatment at the DTC in 94.8%. Conclusion: Treatment with parenteral antibiotic at a DTC is a viable alternative to hospitalisation for moderate to severe cellulitis in children. [source] Prospective assessment of the effect on quality of life of anti-tumour necrosis factor therapy for perineal Crohn's fistulasALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2009S. C. NG Summary Background, Anti-tumour necrosis factor (TNF) therapy effectively treats Crohn's perineal fistulas (CPF); the effect on health-related quality of life (HRQoL) remains unknown. Aims, To evaluate the effect of anti-TNF therapy on the HRQoL of patients with CPF in daily clinical practice. Methods, Prospective evaluation of clinical and magnetic resonance imaging (MRI) responses, disease activity (Perianal Disease Activity Index , PDAI), and HRQoL assessment [Inflammatory Bowel Disease Questionnaire (IBDQ)] in patients receiving anti-TNF therapy for CPF treated up to 12 months. Results, In all, 26 patients with CPF were treated (mean age 39 years; 19 infliximab, 7 adalimumab). At baseline, 85% patients had impaired IBDQ scores (mean 137; ,normal' >170). At 12 months, mean increases in IBDQ score for infliximab and adalimumab treated patients were 40 and 41 points respectively (P < 0.05). There were significant improvements in all IBDQ subscores (bowel, emotional, systemic, social) at 12 months (all P , 0.003). Fourteen patients (74%) on infliximab and six on adalimumab (86%) achieved IBDQ score ,170. Mean increase in IBDQ score was 50, 34 and 16 points in patients with clinical fistula closure (P < 0.001), clinical response (P = 0.002) and no response (n = 1) respectively. IBDQ score increased for patients with MRI healing (P < 0.001) and MRI improvement (P = 0.016), but not for those with no MRI change (n = 2). IBDQ correlated significantly with PDAI at baseline and at 12 months. Conclusion, Anti-TNF therapy improves HRQoL in patients with CPF at 12 months and this improvement is most pronounced in patients with clinical and MRI healing. [source] Evaluation of Abdominal Fluid: Peripheral Blood Creatinine and Potassium Ratios for Diagnosis of Uroperitoneum in DogsJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 4 2001Chad Schmiedt DVM, DACVS Objective:To determine the clinical efficacy of abdominal fluid to peripheral blood ratios of creatinine and potassium concentrations to diagnose uroperitoneum in dogs. Design:Records of 13 dogs with confirmed uroabdomen were retrospectively analyzed. Prospective evaluation of 8 dogs with nonrenal ascites provided data for a control population. Setting:Veterinary Medical Teaching Hospital. Animals:Client owned dogs. Interventions:None Measurements and Main Results:Abdominal fluid potassium (mEq/L) and creatinine concentrations (mg/dl) were recorded. Peripheral blood potassium and creatinine concentrations were also recorded. Ratios were calculated based on these values. An abdominal fluid creatinine concentration to peripheral blood creatinine concentration ratio of > 2:1 was predictive of uroabdomen in dogs (specificity 100%, sensitivity 86%). An abdominal fluid potassium concentration to peripheral blood potassium concentration of > 1.4:1 is also predictive of uroabdomen in dogs (specificity 100%, sensitivity 100%). All dogs with uroabdomen had an abdominal fluid creatinine concentration that was at least 4 times normal peripheral blood levels. Conclusion:Abdominal fluid to peripheral blood potassium and creatinine ratios provide a means to diagnose uroperitoneum in dogs without elevated peripheral blood creatinine. [source] Prospective evaluation in children of a new medical device intended to insure the correct administration of intrathecal antineoplastic agentsPEDIATRIC BLOOD & CANCER, Issue 1 2003A. Lecomte PharmD No abstract is available for this article. [source] Prospective evaluation of acute and chronic renal function in children following matched related donor hematopoietic stem cell transplantationPEDIATRIC TRANSPLANTATION, Issue 1 2010Talia Ileri Ileri T, Ertem M, Ozcakar ZB, Ince Unal E, Biyikli Z, Uysal Z, Ekim M, Yalcinkaya F. Prospective evaluation of acute and chronic renal function in children following matched related donor hematopoietic stem cell transplantation. Pediatr Transplantation 2010: 14: 138,144. © 2009 John Wiley & Sons A/S. Abstract:, Acute and chronic renal impairment are important complications after HSCT. A prospective study was conducted to investigate the glomerular renal function in children who received allogeneic HSCT from matched related donors. Non-radiation conditioning regimens were used in all but one patient. CrCl and serial measurements of serum creatinine were evaluated prior to HSCT, within the first 100 days and one yr after. AKI was defined as at least a 1.5-fold rise in pre-HSCT serum creatinine within the first 100 days and classified as grade 1 to 3 according to the new definition criteria proposed by "AKI Network." Fifty-seven patients were enrolled in the study and 24 patients (42%) had AKI. CsA, amphotericin B, and SOS were found as risk factors for AKI. One yr after HSCT five patients (10%) had CKD and none of them required dialysis. None of the parameters were found as a predictor for CKD. We conclude that AKI is an important complication of HSCT. Careful monitoring of renal function, minimizing the use of nephrotoxic medication, prophylaxis, and effective treatment of SOS might be effective preventive measures to decrease the incidence of AKI. [source] Prospective evaluation of flex-rigid pleuroscopy for indeterminate pleural effusion: Accuracy, safety and outcomeRESPIROLOGY, Issue 6 2007Pyng LEE Objective: This study aimed to assess prospectively the accuracy, safety and outcome of flex-rigid pleuroscopy in the diagnosis of patients with indeterminate pleural effusions. Methods: Included in the study were all patients with unilateral exudative pleural effusions of unknown aetiology who underwent diagnostic flex-rigid pleuroscopy from July 2003 to June 2005, and were followed until December 2005. The procedure was conducted in the endoscopy suite under local anaesthesia and, where indicated, talc poudrage was carried out at the same time. Clinical data, length of hospitalization, chest tube drainage, outcome, diagnostic accuracy of pleuroscopy and procedure-related adverse events were recorded prospectively. Results: Fifty-one patients were recruited (20 male and 31 female). Median age was 53 years (range 45,67). Flex-rigid pleuroscopy was 96% accurate and yielded a diagnosis in 49 out of 51 patients. It was safely carried out without need for surgical intervention, blood transfusion or endotracheal intubation. Culture-negative fever was observed in eight patients (16%), and five patients (10%) required additional analgesia for postoperative pain. Duration of chest tube drainage and length of stay for patients who underwent diagnostic pleuroscopy were 1 and 2 days, respectively, while they were both 3 days when talc poudrage was carried out. Success rates with pleuroscopic talc pleurodesis for malignant pleural effusions were 94%, 92% and 89.5% at 3, 6 and 12 months, respectively, and the 30-day mortality was 0%. Conclusion: Flex-rigid pleuroscopy is a safe procedure with a high diagnostic accuracy and should be considered for the evaluation of indeterminate pleural effusion. [source] The Utility of Second-Look Operation After Laser Microresection of Glottic Carcinoma Involving the Anterior Commissure,THE LARYNGOSCOPE, Issue 8 2008Jong-Lyel Roh MD Abstract Objectives/Hypothesis: Transoral laser microsurgery for the treatment of glottic carcinoma with anterior commissure (A-com) involvement is associated with a high rate of recurrence. We prospectively evaluated the outcomes of laser microsurgery and the efficacy of second-look operation in these patients. Study Design: Prospective evaluation. Methods: Twenty-seven patients with glottic carcinomas involving the A-com underwent transoral laser microresection. Twenty-five patients underwent second-look operations 3 months after laser surgery. Results: After transoral laser microresection, all patients achieved microscopic clear resection margins. Local recurrence was found in 7 of 27 patients (25.9%). Regional recurrence was found in two patients. Patients with recurrences underwent laser re-resection or neck dissection; four received radiotherapy, two lost their larynxes, and three died of disease. At second-look operation, early local recurrence was found in two patients, and anterior glottic webs and granulomas causing dysphonia were treated in 8 and 11 patients, respectively. Conclusions: Laser microsurgery is an effective treatment modality in early glottic cancer with A-com involvement but is still associated with a high rate of recurrence. Second-look operation may help detect early local recurrence and treat postoperative airway or voice problems. [source] Impact of the Endoscopic Sinus Surgical Simulator on Operating Room PerformanceTHE LARYNGOSCOPE, Issue 7 2002Charles V. Edmond Jr. MD Abstract Objectives/Hypothesis The aim of this study is to evaluate an endoscopic sinus surgical simulator (ESS) as a training device and to introduce a methodology to assess its impact on actual operating room performance. Study Design Prospective evaluation of the endoscopic sinus surgical simulator as a trainer. Methods Ten junior and senior ear, nose and throat residents served as subjects, some of whom had prior training with the simulator. The evaluation team collected several measures, which were analyzed for a statistical correlation, including simulator scores, operating room performance rating, ratings of videotaped operating room procedures, and surgical competency rating. Results These findings suggest the ESS simulator positively affects initial operating room performance across all measures as judged by senior surgeons rating anonymous videotapes of those procedures. The two simulation-trained residents were rated consistently better than the other two residents across all measures. These differences approached statistical significance for two items: anterior ethmoidectomy (P = .06;P <.05) and surgical confidence (P = .09;P <.05). In addition, the 3 subjects with the highest overall scores on the competency evaluation also had 3 of the 4 highest cumulative simulation times. Conclusions The endoscopic sinus surgical simulator is a valid training device and appears to positively impact operating room performance among junior otolaryngology residents. [source] Variance of Vestibular-Evoked Myogenic Potentials,THE LARYNGOSCOPE, Issue 3 2001Kentaro Ochi MD Abstract Objectives/Hypothesis Vestibular-evoked myogenic potential (VEMP) has been thought to originate from sacculus. The variance of this potential and the effectiveness of the adjustments of pInII amplitudes using average muscle tonus of ipsilateral sternocleidomastoid muscle were evaluated. In addition, clinical application of VEMP was examined in patients with acoustic tumors (ATs) and vestibular neurolabyrinthitis (VNL). Study Design Prospective evaluation of the VEMP in 18 normal volunteers and 6 patients. Methods Variance and left,right difference of each parameter, including pI latency, nII latency, pInII amplitude, and threshold, was analyzed. Input, output function of pInII amplitude was evaluated. Average muscle tonus was calculated in 20 ears and applied for adjustment of pInII amplitude. Sensitivity of each parameter of VEMP was examined in 3 patients with ATs and 3 patients with VNL. Results VEMP was present in all 36 ears of 18 control subjects. Thresholds of VEMP for normal subjects were 80 to 95 dB normal hearing level (nHL). The muscle tonus affected pInII amplitude significantly; however, no statistically significant improvement was observed in test,retest investigation after adjustment using muscle tonus. The threshold of the affected side was elevated compared with the non-affected side in all patients with ATs, whereas 2 of 3 patients showed normal pInII-ratio. One patient with VNL presented normal VEMP, whereas 2 patients presented no VEMP to the highest stimulus intensity. Conclusions Interaural difference of thresholds might be the most useful parameters. Adjustment using average muscle tonus is not necessary when the subject is able to get sufficient muscle tonus. [source] INTEGRATION OF PROSPECTIVE QUALITY OF LIFE AND NUTRITIONAL ASSESSMENT AS ROUTINE COMPONENTS OF MULTIDISCIPLINARY CARE OF PATIENTS WITH HEAD AND NECK CANCERANZ JOURNAL OF SURGERY, Issue 1-2 2008Justine Oates Background: Quality of life (QOL) and nutritional assessment of patients with head and neck cancer can provide additional information about the effects of treatment beyond the standard measures of disease control and survival. Integrating a prospective evaluation program into a multidisciplinary service may ensure that a more holistic model of care is developed. Methods: Prospective evaluation of QOL and nutrition before and after treatment for head and neck cancer was implemented in 2001. All patients enrolled in the program were treated with curative intent. Patients completed the European Organisation for Research and Treatment of Cancer Core QOL Questionnaire and Head and Neck Specific Module before treatment and at 3, 6 and 12 months after completion of therapy. In conjunction, patients underwent nutritional assessment by body mass index, biochemical parameters and the patient-generated subjective global assessment tool. Results: Among 288 patients who consented to participate in this study, 134 patients completed the QOL assessment criteria and were eligible for evaluation. Examples of QOL and nutritional data for patients with cancers of the oral cavity, oropharynx, nasopharynx, larynx, hypopharynx, parotid gland and paranasal sinus, and also unknown primary cancers are given. Implementation of this prospective assessment program required appropriate resources and was hampered by time constraints, logistics with blood tests and patient compliance. Conclusions: Despite difficulties with implementation, the information concerning QOL and nutritional status obtained in this study provided an appreciation of the long-term functional effects of treatment for head and neck cancer. Prospective QOL assessment and nutritional evaluation should become integral components of the care of patients with cancers of the head and neck. [source] Prospective evaluation of angiogenic, hypoxic and EGFR-related biomarkers in recurrent glioblastoma multiforme treated with cetuximab, bevacizumab and irinotecanAPMIS, Issue 8 2010Benedikte Hasselbalch Hasselbalch B, Eriksen JG, Broholm H, Christensen IJ, Grunnet K, Horsman MR, Poulsen HS, Stockhausen M-T, Lassen U. Prospective evaluation of angiogenic, hypoxic and EGFR-related biomarkers in recurrent glioblastoma multiforme treated with cetuximab, bevacizumab and irinotecan. APMIS 2010; 118: 585,94. Several recent studies have demonstrated a beneficial effect of anti-angiogenic treatment with the vascular endothelial growth factor-neutralizing antibody bevacizumab in recurrent high-grade glioma. In the current study, immunohistochemical evaluation of biomarkers involved in angiogenesis, hypoxia and mediators of the epidermal growth factor receptor (EGFR) pathway were investigated. Tumor tissue was obtained from a previous phase II study, treating recurrent primary glioblastoma multiforme (GBM) patients with the EGFR inhibitor cetuximab in combination with bevacizumab and irinotecan. Of the 37 patients with available tumor tissue, 29 were evaluable for response. We concurrently performed immunohistochemical stainings on tumor tissue from 21 GBM patients treated with bevacizumab and irinotecan. We found a tendency of correlation between the hypoxia-related markers, indicating that they share the same regulatory mechanisms. None of the EGFR-related biomarkers showed any significant correlations with each other. None of the biomarkers tested alone or in combination could identify a patient population likely to benefit from bevacizumab and irinotecan, with or without the addition of cetuximab. There is still an urgent need for one or more reliable and reproducible biomarkers able to predict the efficacy of anti-angiogenic therapy. [source] Prospective evaluation of cognitive function in patients with early breast cancer receiving adjuvant chemotherapyASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 3 2007Michelle RUZICH Abstract Aim: To assess cognitive function prospectively in women with early breast cancer before, during and after the administration of adjuvant chemotherapy. Methods: Between May 2000 and November 2001, 35 assessable patients were entered into the study. Thirty-one received oral cyclophosphamide, methotrexate and 5-fluorouracil (CMF) and four received epirubicin and cyclophosphamide followed by CMF ((cyclophosphamide, methotrexate and 5-fluorouracil)). Testing consisted of the completion of a battery of neuropsychological and psychological inventories and was performed prior to chemotherapy and repeated after 3 (n = 31) and 6 months (n = 30) of chemotherapy and also 6 months after the completion of chemotherapy (n = 27). Results: Prior to chemotherapy a proportion of the patients already exhibited some evidence of impairment of cognitive function. However, on completion of chemotherapy, the neuropsychological scores for short-term verbal memory and verbal learning were significantly lower than prior to, or 6 months after chemotherapy. In all other domains, cognitive function either remained constant or even appeared to improve. Symptom scales showed that fatigue, nausea and vomiting, constipation and diarrhea were worst half way through the chemotherapy. Quality of life scales indicated that functioning was best after completion of chemotherapy. Conclusion: Patients with early breast cancer may have impaired cognitive function before chemotherapy. Although transient deteriorations in verbal memory and verbal learning were observed on completion of chemotherapy, overall, cognitive function did not decline. It is likely that practice effects influenced our findings. [source] Prospective evaluation of hybrid 18F-fluorodeoxyglucose positron emission tomography/computed tomography in staging clinically node-negative patients with penile carcinomaBJU INTERNATIONAL, Issue 5 2009Joost A.P. Leijte OBJECTIVE To prospectively evaluate the performance of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to detect occult metastasis in patients with clinically node-negative (cN0) penile carcinoma, as there is little information on the use of 18F-FDG-PET/CT in penile carcinoma. PATIENTS AND METHODS In 24 patients, scheduled to undergo dynamic sentinel-node biopsy, hybrid PET/CT was used before surgery to assess the nodal status of the cN0-groins. Six of the 24 patients were unilaterally cN0. Thus, 42 cN0-groins were evaluated for occult metastasis using PET/CT. All scans were assessed by two experienced nuclear physicians. The histopathological tumour status of the removed sentinel node was used as the standard of care to evaluate the PET/CT-results. RESULTS Histopathology was tumour-positive in five of the 42 (12%) evaluated cN0-groins, two of which contained only micrometastases (<2 mm). One of the five tumour-positive cN0-groins was correctly predicted on the PET/CT-images. All false-negative PET/CT scans contained metastasis of ,10 mm. Of the remaining 37 tumour-negative groins, 34 were correctly predicted with PET/CT (specificity 92%). CONCLUSION The role of PET/CT in evaluating the groins of patients with cN0 penile cancer appears to be limited, due to its low sensitivity. In this series, only one of the five tumour-positive groins was identified. Surgical staging methods remain necessary at present. [source] Prospective evaluation of cell kinetics, yields and donor experiences during a single large-volume apheresis versus two smaller volume consecutive day collections of allogeneic peripheral blood stem cellsBRITISH JOURNAL OF HAEMATOLOGY, Issue 5 2003Charles D. Bolan Summary. We report cell kinetics, yields and donation experiences of 20 demographically matched allogeneic peripheral blood stem cell (PBSC) donors who were prospectively assigned to undergo either a single 25 l or two consecutive daily 15 l (15 l × 2) apheresis procedures. Procedures were performed using prophylactic intravenous calcium administration after standard granulocyte colony-stimulating factor (GCSF) mobilization (10 ,g/kg/d). Central line placements (two each), initial CD34 cell counts (0·077 vs 0·078 × 109/l) and yields (7·9 vs 8·1 × 108 CD34 cells) were similar in the two groups; however, 25 l donors spent significantly less time both in the clinic (7·5 vs 10·8 h) and with central venous catheters in place (8·5 vs 29·5 h) than 15 l × 2 donors. End-procedure platelet counts were below 100 × 109/l in one out of 10 25 l donors versus five out of 10 in 15 l × 2 donors (41%vs 53% mean decrease in platelet counts, P = 0·02). PBSC collection efficiency increased by 37% after 15 l of the 25-l volume had been processed, compared with no significant change during 15 l × 2 procedures. Results similar to these prospective findings were also observed in CD34 yields, symptoms and platelet counts in additional 25 l and 15 l procedures performed during the same period and evaluated retrospectively. This study indicates that a single 25-l apheresis procedure results in similar yields and symptoms, but less donor thrombocytopenia and inconvenience than two consecutive daily 15-l procedures. [source] | ||||||||||||||||||||||||||||||||||