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Routine Clinical Use (routine + clinical_use)
Selected AbstractsHelicobacter pylori Culture from a Positive, Liquid-Based Urease Test for Routine Clinical Use: A Cost-Effective ApproachHELICOBACTER, Issue 1 2000Bernhard H. Jaup Background. The aim of our study was to test the feasibility of culturing Helicobacter pylori directly from biopsies aimed for rapid urease test in routine clinical practice. Materials and Methods. In 260 consecutive patients referred for gastroscopy because of dyspepsia one antral biopsy was routinely used for our "in house" rapid urease test (RUT). Positive biopsies were placed in a transport medium and sent to the laboratory. The biopsies were cultured and incubated at 37°C for 5,7 days. H. pylori was identified and routinely tested for antimicrobial resistance by using the E -test. Results. In 118 out of 260 patients (45%) the urease test turned positive and the growth of H. pylori was sufficient to allow testing of antimicrobial resistance. Conclusion.H. pylori could be cultured from almost all positive RUT specimens. A liquid RUT is thus more suitable for culture, saving additional biopsies. [source] Routine clinical use of alemtuzumab in patients with heavily pretreated B-cell chronic lymphocytic leukemia,,CANCER, Issue 10 2006A nation-wide retrospective study in Austria Abstract BACKGROUND. In previous studies, alemtuzumab demonstrated considerable activity in patients with previously treated B-cell chronic lymphocytic leukemia (CLL), including fludarabine-refractory disease. In this retrospective study, the authors evaluated the benefit of alemtuzumab monotherapy in unselected patients with advanced, previously treated CLL who received treatment in the routine clinical setting. METHODS. Data were collected from 115 consecutive patients who received alemtuzumab therapy at 25 participating centers in Austria. Patients received a median of 3 prior lines of therapy (range, 1,11 prior lines of therapy), and 59% had fludarabine-refractory disease. Alemtuzumab was administered intravenously or subcutaneously with a planned schedule of 30 mg 3 times per week for up to 12 weeks. Patients received valacyclovir and trimethoprim/sulfamethoxazole for antiinfective prophylaxis. RESULTS. The overall response rate was 23%, with complete responses achieved in 5% of patients. Stable disease (SD) was achieved in 36% of patients. After a median follow-up of 17.5 months, the median overall survival (OS) was 20.2 months for all patients. A multivariate Cox regression analysis that included pretreatment baseline characteristics, response to therapy, and cumulative dose of alemtuzumab indicated that bulky lymphadenopathy, the administration of ,3 previous therapies, and lack of response to alemtuzumab remained significant independent risk factors for inferior OS. The median OS had not been reached for responding patients. The median OS was 29.5 months for patients with SD and 10.8 months for patients with progressive disease. CONCLUSIONS. The broad use of alemtuzumab in the routine clinical practice setting is feasible and active in unselected patients with pretreated CLL, and the current results confirmed the activity and safety of this agent, as reported in previously published clinical studies. Cancer 2006. © 2006 American Cancer Society. [source] Lithium treatment in Aarhus: contributions and controversies through half a centuryACTA PSYCHIATRICA SCANDINAVICA, Issue 2004Per Vestergaard In 1954 the first of several hundred publications on the use of lithium for treatment of affective disorders, lithium's unwanted effects, and its pharmacology was authored at the Aarhus University Psychiatric Hospital, the majority with Professor, now emeritus, Mogens Schou playing the principal part. The early part of this long series of papers highlights the pharmacology of lithium with its renal excretion, low therapeutic index, and ensuing risk of intoxication, the prophylactic effect not only against manic episodes but also the depressive ones and finally the long-term renal structural and functional impairment. Later papers present the problems related to lithium's lower effectiveness in routine clinical use, the problems of non-adherence, the dose effect relationships, and the problems inherent to establishing effective treatment service delivery. The present priority of the Aarhus lithium group is the simple large scale pragmatic effectiveness studies in which, together with domestic and foreign collaborators, we compare the long-term effectiveness of lithium with new promising drugs with mood stabilizing properties. The story of treatment with lithium in aarhus highlights important steps in the development of effective and comprehensive treatments for bipolar patients. [source] An optimized microchip electrophoresis system for mutation detection by tandem SSCP and heteroduplex analysis for p53,gene exons,5,9ELECTROPHORESIS, Issue 19 2006Christa N. Hestekin Abstract With the complete sequencing of the human genome, there is a growing need for rapid, highly sensitive genetic mutation detection methods suitable for clinical implementation. DNA-based diagnostics such as single-strand conformational polymorphism (SSCP) and heteroduplex analysis (HA) are commonly used in research laboratories to screen for mutations, but the slab gel electrophoresis (SGE) format is ill-suited for routine clinical use. The translation of these assays from SGE to microfluidic chips offers significant speed, cost, and sensitivity advantages; however, numerous parameters must be optimized to provide highly sensitive mutation detection. Here we present a methodical study of system parameters including polymer matrix, wall coating, analysis temperature, and electric field strengths on the effectiveness of mutation detection by tandem SSCP/HA for DNA samples from exons,5,9 of the p53 gene. The effects of polymer matrix concentration and average molar mass were studied for linear polyacrylamide (LPA) solutions. We determined that a matrix of 8%,w/v 600,kDa LPA provides the most reliable SSCP/HA mutation detection on chips. The inclusion of a small amount of the dynamic wall-coating polymer poly- N -hydroxyethylacrylamide in the matrix substantially improves the resolution of SSCP conformers and extends the coating lifetime. We investigated electrophoresis temperatures between 17 and 35°C and found that the lowest temperature accessible on our chip electrophoresis system gives the best condition for high sensitivity of the tandem SSCP/HA method, especially for the SSCP conformers. Finally, the use of electrical fields between 350 and 450,V/cm provided rapid separations (<10,min) with well-resolved DNA peaks for both SSCP and HA. [source] Do the ABCS 135 short cognitive screen and its subtests discriminate between normal cognition, mild cognitive impairment and dementia?INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 3 2007Timothy I. M. Standish Abstract Background Cognitive screening instruments are either too long for routine clinical use or not sensitive to distinguish mild cognitive impairment (MCI) from normal cognition (NC) or dementia. Objective To evaluate the sensitivity and specificity of the AB Cognitive Screen (ABCS) and its subtests with a view to improving its ability to differentiate between dementia, MCI and NC. The influence of age and education on sensitivity and specificity is also examined. Design Cross-sectional study. Methods Participants with dementia and MCI were recruited from those presenting to four specialty geriatric clinics in southern Ontario. Participants with NC were recruited from the family and friends of patients. A comprehensive geriatric assessment was done including ABCS, SMMSE and 15 point Geriatric Depression Scale. Analysis of variance and receiver operating characteristic (ROC) curves compared test scores. SMMSE scores were also analysed for comparison purposes. Results Three hundred and two participants had dementia, 166 had MCI and 174 had NC. ABCS total scores were significantly different between NC and MCI (mean difference 7.1, 1.8,12.5 CI, p,=,0.000) while SMMSE scores were not (mean difference 0.5, ,0.7,1.7, p,<,0.628). Of individual ABCS subtests, verbal fluency and delayed recall were most sensitive to differences between NC and MCI. ROC curve analysis, which presents sensitivity and specificity, showed verbal fluency was better than delayed recall in distinguishing between NC and MCI, among participants 75 years of age or older. Conclusion The AB Cognitive Screen (ABCS) can be administered in 3,5,min. The SMMSE and ABCS total and subtests significantly distinguished between dementia and MCI or NC. Verbal fluency and delayed recall were best at distinguishing between MCI and NC. The analysis illustrates how each subtest contributes to the sensitivity of the ABCS and suggests ways that sensitivity might be improved. Copyright © 2006 John Wiley & Sons, Ltd. [source] Clinical predictors of response to acetyl cholinesterase inhibitors: experience from routine clinical use in NewcastleINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 10 2003S. Pakrasi Abstract Background Acetyl Cholinesterase Inhibitors (AChEIs) have been in clinical use for the past five years in the UK for the symptomatic treatment of Alzheimer's disease (AD). There are few data on the patterns and predictors of response to AChEI therapy in routine clinical practice. We therefore investigated clinical variables that may distinguish between AChEI responders and non-responders. Methods A retrospective sample of 160 consecutive patients with dementia who were treated on clinical grounds with an AChEI was studied. Treatment response was defined in two ways: (a) A clinical response was achieved when there was no deterioration or there was an improvement on a global clinical assessment (CGI) and (b) a Mini-Mental-State-Examination (MMSE) response when there was an improvement of 2 or more MMSE points. Results A total of 62 (45%) patients achieved an MMSE response. A diagnosis of dementia with Lewy Bodies (DLB) and Parkinson's disease+Dementia (PDD) was associated with a MMSE response, as were hallucinations, and lower MMSE scores at baseline. 125 (78%) patients achieved a CGI response for which there were no clinical predictors. Conclusions Severity of illness, a diagnosis of DLB and PDD, and presence of hallucinations at baseline were predictive of a MMSE response. Non-AD dementia and severe dementia responded equally well to AChEI treatment and results of further randomised, placebo-controlled studies are needed to clarify the role of AChEI in the treatment of these disorders. Copyright © 2003 John Wiley & Sons, Ltd. [source] Calibration of T-Scan® sensors for recording bite forces in denture patientsJOURNAL OF ORAL REHABILITATION, Issue 9 2009G. S. THROCKMORTON Summary, Although measurement of maximum voluntary biting force is an important indicator of health of the masticatory system, few commercially available transducers have been validated for routine clinical use. The T-Scan III® system records distribution of relative forces around the tooth row during clenching, but not absolute forces. This study assesses the reliability of T-Scan® sensors with and without protection materials and develops calibration curves that allow measurement of absolute forces with the T-Scan III®. [source] A qualitative systematic review of peri-operative dextromethorphan in post-operative painACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2006T. H. Duedahl Background:, The N -methyl- d -aspartate (NMDA) receptor antagonist, dextromethorphan (DM), has received interest as an adjunctive agent in post-operative pain management. Clinical trials have been contradictory. This systematic review aims to evaluate the available literature examining the analgesic efficacy of DM in post-operative patients. Methods:, Twenty-eight randomized, double-blind, clinical studies, with 40 comparisons, including a variety of dosing regimens comparing DM treatment with placebo, were included. Meta-analysis was intended but deemed to be inappropriate because of the substantial difference in methodology and reporting between trials. The outcome measures (pain scores at rest, time to first analgesic request and supplemental analgesic consumption) were evaluated qualitatively by significant difference (P < 0.05) as reported in the original investigations. Results:, DM did not reduce the post-operative pain score with a clinically significant magnitude. The time to first analgesic request was significantly prolonged in most comparisons with DM. Significant decreases in supplemental opioid consumption were observed in the majority of parenteral DM studies and in about one-half of the oral studies. The decreases were of questionable clinical importance in most comparisons, although a relationship between a decrease in opioid consumption and opioid-related side-effects was established in some studies. Conclusion:, Based on the studies available, DM has the potential to be a safe adjunctive agent to opioid analgesia in post-operative pain management, but the consistency of the potential opioid-sparing and pain-reducing effect must be questioned. Consequently, it is not possible to recommend dose regimens or routine clinical use of DM in post-operative pain. The route of administration may be important for the beneficial effect. [source] Hepatic tissue engineering for adjunct and temporary liver support: Critical technologiesLIVER TRANSPLANTATION, Issue 11 2004Christina Chan The severe donor liver shortage, high cost, and complexity of orthotopic liver transplantation have prompted the search for alternative treatment strategies for end-stage liver disease, which would require less donor material, be cheaper, and less invasive. Hepatic tissue engineering encompasses several approaches to develop adjunct internal liver support methods, such as hepatocyte transplantation and implantable hepatocyte-based devices, as well as temporary extracorporeal liver support techniques, such as bioartificial liver assist devices. Many tissue engineered liver support systems have passed the "proof of principle" test in preclinical and clinical studies; however, they have not yet been found sufficiently reliably effective for routine clinical use. In this review we describe, from an engineering perspective, the progress and remaining challenges that must be resolved in order to develop the next generation of implantable and extracorporeal devices for adjunct or temporary liver assist. (Liver Transpl 2004;10:1331,1342.) [source] Allosteric ligands for G protein-coupled receptors: A novel strategy with attractive therapeutic opportunitiesMEDICINAL RESEARCH REVIEWS, Issue 3 2010Marco De Amici Abstract Allosteric receptor ligands bind to a recognition site that is distinct from the binding site of the endogenous messenger molecule. As a consequence, allosteric agents may attach to receptors that are already transmitter-bound. Ternary complex formation opens an avenue to qualitatively new drug actions at G protein-coupled receptors (GPCRs), in particular receptor subtype selective potentiation of endogenous transmitter action. Consequently, suitable exploitation of allosteric recognition sites as alternative molecular targets could pave the way to a drug discovery paradigm different from those aimed at mimicking or blocking the effects of endogenous (orthosteric) receptor activators. The number of allosteric ligands reported to modulate GPCR function is steadily increasing and some have already reached routine clinical use. This review aims at introducing into this fascinating field of drug discovery and at providing an overview about the achievements that have already been made. Various case examples will be discussed in the framework of GPCR classification (family A, B, and C receptors). In addition, the behavior at muscarinic receptors of hybrid derivatives incorporating both an allosteric and an orthosteric fragment in a common molecular skeleton will be illustrated. © 2009 Wiley Periodicals, Inc. Med Res Rev, 30, No. 3, 463,549, 2010 [source] Are therapeutic ultrasound units a potential vector for nosocomial infection?PHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 2 2006Siobhan Schabrun Abstract Background and Purpose.,Nosocomial infections present a widespread problem in today's healthcare environment, with a significant number of patients acquiring an infection annually. With the contemporary transition of immunocompromised and high-risk patients to community-based care, therapeutic ultrasound has the potential to be a vector of infection in the physiotherapy setting. The purpose of the present study was to determine the degree of contamination on therapeutic ultrasound transducer heads and ultrasound gel after routine clinical use, and to evaluate the efficacy of recommended infection control procedures.,Method.,The study consisted of two phases. Using a prospective cross-sectional design, microbiological cultures were obtained from 44 transducer heads and 43 gels. Subjects were drawn from a variety of physiotherapy practice settings. All samples containing more than five colony forming units per cm2 were considered contaminated. Following these measurements, a repeated-measures design was used to re-evaluate the 44 transducer heads for the amount and type of bacteria present after cleaning with a 70% alcohol wipe.,Results.,Twenty-seven per cent of transducer heads and 28% of gels were contaminated. Transducer heads showed fairly low levels of contamination across the sample, with the majority of organisms isolated found in normal skin and environmental flora. Gels were heavily contaminated with opportunistic and potentially pathogenic organisms, including Stenotrophomonas maltophilia, Staphylococcus aureus, Acinetobacter baumannii and Rhodotorula mucilaginosa. No multi-resistant organisms were identified. Cleaning with 70% alcohol significantly reduced the level of contamination on transducer heads (p < 0.01).,Conclusions.,Therapeutic ultrasound equipment is a potential vector for nosocomial infection in physiotherapy patients. The risk of infection from transducer heads can be effectively removed by cleaning with 70% alcohol between patients. Further research into possible strategies to reduce the risk of infection from ultrasound gels is needed. Copyright © 2006 John Wiley & Sons, Ltd. [source] Hemoglobin-based Red Blood Cell SubstitutesARTIFICIAL ORGANS, Issue 9 2004Thomas Ming Swi Chang Abstract:, Polyhemoglobin is already well into the final stages of clinical trials in humans with one approved for routine clinical use in South Africa. Conjugated hemoglobin is also in ongoing clinical trials. Meanwhile, recombinant Hb has been modified to modulate the effects of nitric oxide. Other systems contain antioxidant enzymes for those clinical applications that may have potential problems related to ischemia-reperfusion injuries. Other developments are based on hemoglobin-lipid vesicles and also the use of nanotechnology and biodegradable copolymers to prepare nanodimension artificial red blood cells containing hemoglobin and complex enzyme systems. [source] | ||||||||||