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Sample records for twenty-nine patients received

  1. High Prevalence of Pseudotumors in Patients with a Birmingham Hip Resurfacing Prosthesis A Prospective Cohort Study of One Hundred and Twenty-nine Patients

    NARCIS (Netherlands)

    Bisschop, R.; Boomsma, M. F.; Van Raay, J. J. A. M.; Tiebosch, A. T. M. G.; Maas, M.; Gerritsma, C. L. E.

    2013-01-01

    Background: Recently, concern has emerged about pseudotumors (lesions that are neither malignant nor infective in the soft tissues surrounding total hip arthroplasty components) after hip arthroplasties with metal-on-metal bearings. Patients treated in our hospital for degenerative arthritis of the

  2. Risk profile of patients developing nonunion of the clavicle and outcome of treatment-analysis of fifty five nonunions in seven hundred and twenty nine consecutive fractures

    DEFF Research Database (Denmark)

    Ban, Ilija; Troelsen, Anders

    2016-01-01

    PURPOSE: The most common complication following treatment of a clavicle fracture is nonunion. Most nonunions are symptomatic and treatment is mostly operative. The aim of this study was to describe risk profiles of patients developing nonunion and what outcome is observed following operative...... treatment of clavicle nonunions. METHODS: In a consecutive series of 729 clavicle fractures we retrospectively identified 55 that developed nonunion (49 diaphysial and six lateral). All were treated operatively by reconstruction with (n = 28) or without (n = 27) autologous bone graft. Assessment...... was anatomic site, fracture complexity, female gender, smoking habits and initial treatment. A total of eight post-operative complications were found. Remission of symptoms was reported by 29 of the 33. Outright satisfaction with current shoulder condition was reported by 24. The overall median DASH was 8...

  3. 线粒体脑肌病29例临床特点分析%Analysis on the Clinical Characteristics of Twenty-nine Patients with Mitochondrial Myopathy

    Institute of Scientific and Technical Information of China (English)

    邢海辉; 余年; 徐辉; 姚燕; 林兴建

    2015-01-01

    目的:分析线粒体脑肌病(ME)患者各种非特异性临床表现和辅助检查结果,为该病早期诊断提供思路。方法:回顾性分析我院2008年05月至2013年12月收治的29例 ME 患者临床表现,寻找 ME 相对特异性的症状组合,并探索各项辅助检查结果(血和脑脊液的乳酸水平、脑电图、肌电图、神经影像、肌肉活检和基因检测)对各不同类型 ME 诊断的意义。结果:①本组患者最常见的临床表现依次为:癫痫(89.70%)、头痛(75.90%)、发作性无力(65.50%)等。②血空腹乳酸或乳酸运动试验阳性24例(82.8%);22例患者行脑脊液检查,其中蛋白升高12例(54.5%),乳酸升高8例(36.4%)。③29例患者的头颅 MRI 显示颞叶受累26例(89.7%),枕叶受累23例(79.3%),顶叶受累23例(79.3%),额叶受累 6例(20.7%),小脑受累2例(6.9%)。头颅磁共振波谱成像检查16例,病灶区均见明显乳酸峰,NAA 峰下降。④22例患者行肌肉活检,有阳性发现14例(63.6%)。9例患者行基因检查,5例(55.6%)发现线粒体 DNA 3243 A>G 点突变,1例(11.1%)发现线粒体 DNA8344 A>G 点突变。结论:ME 为一种具有特殊影像学及病理表现的疾病,临床表现为多组非特异性症状的组合,易误诊,肌肉活检及基因检测可为最终确诊提供重要的依据。%Objective:To analyze a variety of non-specific clinical features and laboratory examination results of mitochondrial myopathy (ME) patients , and to provide information for the early diagnosis of this disease. Methods:A retrospective study was performed to analyze the clinical manifestations of 29 patients with ME at our hospital from May 2008 to December 2013. A combination of relatively specific symptoms was explored and the signifi-cance of the results of the laboratory examinations [lactate levels in plasma and cerebrospinal fluid (CSF), EEG, EMG

  4. Japanese cancer patients' communication style preferences when receiving bad news.

    Science.gov (United States)

    Fujimori, Maiko; Parker, Patricia A; Akechi, Tatsuo; Sakano, Yuji; Baile, Walter F; Uchitomi, Yosuke

    2007-07-01

    This study describes the communication style preferences of Japanese patients when receiving bad news, examines the factor structure of the measure for patients' preferences (MPP) in a Japanese population, and explores variables that may be associated with patients' communication style preferences. Five hundred twenty-nine cancer outpatients completed several psychosocial measures including the Japanese version of the MPP (MPP-J), the Mental Adjustment to Cancer Scale (MAC), and the Hospital Anxiety and Depression Scale (HADS). The patients desired detailed information and a supportive environment when receiving bad news. The MPP-J demonstrated a 5-factor structure: support, facilitation, medical information, clear explanation, and encouraging question-asking. Regression analyses indicated that a female gender, the fighting spirit and anxious preoccupation dimensions of the MAC were positively associated with all 5 MPP-J factors. In conclusion, Japanese cancer patients' preferences for communication when receiving bad news differ somewhat from those of American patients. Japanese physicians should encourage patients to ask questions and should consider the demographic (e.g. gender), medical (disease status) and psychosocial characteristics (fighting spirit and anxious preoccupation) of patients when delivering bad news.

  5. Evaluation of Predicted and Observed Data on Biotransformation of Twenty-Nine Trace Organic Chemicals

    KAUST Repository

    Bertolini, Maria

    2011-07-01

    Trace organic chemicals present in household products, pesticides, pharmaceuticals and personal care products may have adverse ecotoxicological effects once they are released to the environment. These chemicals are usually transported with the sewage to wastewater treatment facilities, where they might be attenuated depending on the degree of treatment applied prior to discharge to receiving streams. This study evaluates the removal performance of 29 trace organic compounds during two different activated sludge treatment systems. Predominant attenuation processes such as biotransformation and sorption for the target compounds were identified. Biotransformation rate constants determined in this study were used to assess removal of compounds from other treatment plants with similar operational conditions, using data gathered from the literature. The commercial software Catalogic was applied to predict environmental fate of chemicals. The software program consisted of four models able to simulate molecular transformations and to generate degradation trees. In order to assess the accuracy of this program in predicting biotransformation, one biodegradation model is used to contrast predicted degradation pathway with metabolic pathways reported in the literature. The predicted outcome was correct for more than 40 percent of the 29 targeted substances, while 38 percent of the chemicals exhibited some degree of lower agreement between predicted and observed pathways. Percent removal data determined for the two treatment facilities was compared with transformation probability output from Catalogic. About 80 percent of the 29 compounds exhibited a good correlation between probability of transformation of the parent compound and percent removal data from the two treatment plants (R2 = 0.82 and 0.9). Based upon findings for 29 trace organic chemicals regarding removal during activated sludge treatment, attacked fragments present in their structures, predicted data from

  6. Twenty-nine day study of stability for six different parenteral nutrition mixtures.

    Science.gov (United States)

    Desport; Hoedt; Pelagatti; Lagarde; Lorieul; Chalmel; Sultan; Feiss

    1997-01-01

    : BACKGROUND: The aim of the study was to assess the particle size stability of six parenteral nutrition regimens, fitted to various pathologies, and used by the University Hospital of Limoges. The mixtures contained glucose (30 or 50%), amino acids (Hyperamine(R)25), and either long-chain triglycerides (20% Intralipide(R)) or a combination of medium and long-chain triglycerides (20% Médialipide(R)). The regimens were not supplemented. RESULTS: The visual examinations, particle size analysis and physico-chemical tests, carried out during a long storage period, did not reveal any significant evolution of the lipid emulsions. All the tested formulae were stable for 28 days at 4 degrees C plus 24 h at room temperature. CONCLUSIONS: It was concluded that the choice of lipid emulsions depends, for these formulae, on the metabolic and clinical needs of the treated patients.

  7. Twenty-nine-month follow-up of a paediatric zirconia dental crown.

    Science.gov (United States)

    Lopez Cazaux, Serena; Hyon, Isabelle; Prud'homme, Tony; Dajean Trutaud, Sylvie

    2017-06-14

    The aim of this paper is to present the long-term follow-up of one paediatric zirconia crown on a deciduous molar. Preformed crowns are part of the armamentarium in paediatric dentistry. In recent years, aesthetic alternatives to preformed metal crowns have been developed, first preveneered crowns and then zirconia crowns. This paper describes the restoration of a primary molar with a zirconia crown (EZ-Pedo, Loomis, California, USA) in an 8-year-old boy. In this clinical case, the protocol for the implementation and maintenance of zirconia crowns is detailed. The patient was followed up for 29 months until the natural exfoliation of his primary molar. The adaptation of the zirconia crown, the gingival health and the wear on the opposing tooth were considered. In this case, the paediatric zirconia crown allowed sustainable functional restoration while restoring a natural appearance of the tooth. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  8. Chapter Twenty Nine

    African Journals Online (AJOL)

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    From the liberal to the radical feminist, arguments abound as to which gender theory best would suit the African environment without it serving as “a red rag to the ..... change all this, it is still a man's world, which women will always help to.

  9. Normal Health-Related Quality of Life and Ability to Work Twenty-nine Years After in Situ Arthrodesis for High-Grade Isthmic Spondylolisthesis.

    Science.gov (United States)

    Joelson, Anders; Hedlund, Rune; Frennered, Karin

    2014-06-18

    The purpose of this mixed prospective and retrospective case series was to evaluate the long-term health-related quality of life and physical disability after in situ arthrodesis for high-grade isthmic spondylolisthesis. Thirty-five of forty consecutive patients who had in situ spinal arthrodesis for high-grade isthmic spondylolisthesis at a mean age of fifteen years (range, nine to twenty-five years) completed validated questionnaires (Short Form-36 [SF-36], EuroQol-5 Dimensions [EQ-5D], Zung depression scale, Oswestry disability index [ODI], Million score, and back and leg pain visual analog scale [VAS]) and underwent physical examination twenty-nine years (range, twenty-three to thirty-five years) after surgery. The mean age at the time of follow-up was forty-three years (range, thirty-seven to fifty-one years). In the absence of a formal control group, the scores on the SF-36 and EQ-5D were compared with Swedish normative data. The proportion of patients at work was compared with an age-matched control group derived from official statistics of Sweden. The Million score at the long-term follow-up was compared with the corresponding results at the mid-term follow-up of the same patients at a mean age of twenty-two years. The scores on the SF-36 and EQ-5D were similar to the scores of the general Swedish population. The mean Zung depression scale score was 30 (range, 20 to 52), the mean ODI score was 10 (range, 0 to 34), the mean back pain VAS score was 13 (range, 0 to 72), and the mean leg pain VAS score was 9 (range, 0 to 60). The Million score averaged 28 (range, 0 to 109) and was slightly worsened compared with the score of 19 (range, 0 to 94) at the mid-term follow-up (p = 0.034). The proportion of patients at work was the same as that for the age-matched general Swedish population. Our study shows good outcomes in health-related quality of life, disability, pain, and ability to work at up to twenty-nine years after in situ lumbar spine arthrodesis for high

  10. Difference of Phytic Acid Content and its Relation to Four Protein Composition Contents in Grains of Twenty-nine japonica Rice Varieties from Jiangsu and Zhejiang Provinces, China

    Institute of Scientific and Technical Information of China (English)

    WU Wei; CHENG Fang-min; LIU Zheng-hui; WEI Ke-su

    2007-01-01

    Twenty-nine japonica rice varieties collected from Jiangsu and Zhejiang Provinces, China were planted in Hangzhou,China, to investigate the phytic acid content in brown rice and its frequency distribution as well as the correlation among the contents of phytic acid, total protein and four protein compositions in brown rice. The phytic acid content in brown rice ranged from 0.699% to 1.034%, with a mean of 0.868% for the 29 tested rice varieties. Xiushui series rice varieties generally exhibited lower phytic acid level than Wuyujing and Huai series rice varieties. A rough normal distribution, with a mean of 8.722%, was observed for the total protein contents in the tested varieties. Of the four protein compositions, the glutelin, globulin and albumin contents had larger coefficient of variation than the prolamin content, although the difference in prolamin content was genotype-dependent. No significant correlation was found between the phytic acid and four protein composition contents, whereas the total protein content was significantly and positively related to the glutelin content in brown rice.

  11. Listeriosis in patients receiving biologic therapies.

    Science.gov (United States)

    Bodro, M; Paterson, D L

    2013-09-01

    The evolution of inflammatory diseases has radically changed since the introduction of biologic therapies, such as tumour necrosis factor alpha inhibitors (anti-TNFα). They, therefore, represent a widely used therapeutic modality. Nevertheless, post-marketing studies reveal an increased risk of infection in patients taking these drugs, especially granulomatous infections such as listeriosis. We aimed to evaluate the reported cases of listeriosis in patients treated with biologic treatments. We used the United States Food and Drug Administration (FDA) Adverse Event Reporting System (AERS) from 2004 to 2011. We also perform a literature review of previously reported cases of listeriosis in patients taking biologic therapies. We identified 266 cases of Listeria monocytogenes infection associated with biologic therapies. The majority of patients were receiving infliximab (77.1 %), followed by etanercept (11.7 %), adalimumab (9.8 %), rituximab (4.1 %), abatacept (0.4 %) and golimumab (0.4 %). Indications for the use of biologics were as follows: 47.7 % for rheumatologic diseases, 38 % for inflammatory bowel diseases, 3.4 % for haematological diseases and 10.5 % for other indications. Seventy-three percent of the patients were receiving concomitant immunosuppressant drugs, especially steroids (56 %) and methotrexate (31.6 %). The median time to the onset of infection was 184 days. Mortality rates range from 11.1 % in adalimumab-treated patients to 27.3 % in rituximab-treated patients (p = 0.7). Listeriosis is common in biologics-treated patients, especially related to infliximab use given concomitantly with other immunosuppressive therapies. Infections after treatment with biologics mostly occurred in the first year after initiating treatment.

  12. Hypocupremia in patients receiving total parenteral nutrition.

    Science.gov (United States)

    Bozzetti, F; Inglese, M G; Terno, G; Pupa, A; Sequeira, C; Migliavacca, S

    1983-01-01

    Although hypocupremia is a well-known consequence of long-term total parenteral nutrition (TPN), its incidence as well as the duration of TPN necessary to induce it are still unsettled. The purpose of this study is to review the changes in serum copper level in 25 patients receiving TPN for a period longer than 2 wk (mean duration 6 wk) at the Istituto Nazionale Tumori of Milan and to evaluate the possible relationship of cupremia with the basic disease. Main indications for TPN included enterocutaneous fistulas (11 patients), cancer cachexia (10 patients), radiation enteropathy (two patients), and severe postoperative stricture following esophagogastric resection (two patients). Mean value of serum copper at the beginning of the study was 143 micrograms/100 ml (normal value 65-165 micrograms/100 ml), and the regression analysis showed a mean fall of 5.64 micrograms/100 ml/wk. Hypocupremia occurred in four patients (three with intestinal fistulas and one with radiation obstructive enteritis) at 5th, 6th, 9th, and 6th wk of TPN, respectively. No patient with cancer cachexia developed hypocupremia. No patient with hypocupremia had clinical evidence of a copper deficiency syndrome. We conclude that 1) hypocupremia does not occur within the first month of TPN; 2) its incidence is about 16% in patients intravenously fed for period longer than 2 wk; 3) it is more frequent in patients with enterocutaneous fistulas, whereas it never occurs in patients with cancer cachexia, and 4) it is not necessarily associated to a clinicometabolic syndrome of copper deficiency. Finally, the "nutritional" meaning of serum copper should be questioned in cancer patients since it could represent a "tumor marker."

  13. Acute hepatitis C in patients receiving hemodialysis.

    Science.gov (United States)

    Griveas, I; Germanidis, G; Visvardis, G; Morice, Y; Perelson, A S; Pawlotsky, J M; Papadopoulou, D

    2007-01-01

    Hepatitis C virus (HCV) infection is frequent in patients with end-stage renal disease treated by chronic dialysis, with a prevalence varying from 10-65% according to the geographical data. The prevalence is significantly associated with the duration of dialysis and the number of transfused blood products[1,2] and has dramatically declined with efficient blood screening.[3] We studied patients with acute HCV infection in a dialysis unit. The diagnosis was based on both anti-HCV detection and HCV-RNA detection. Other virological tools including HCV genotype determination was also used to tailor treatment to the individual patient and determine its efficacy for a one-year follow-up period. Seventeen patients (7 male and 10 female, mean age: 63.7 +/- 11.6 SD) with acute hepatitis C were enrolled to our study. All of them were followed up for a period of one year after the diagnosis was established. Phylogenetic analysis distinguished two separate HCV subtypes 1b, which were both responsible for this acute infection (see Figure 1). These types did not differ in their behavior on the clinical situation of our patients, as confirmed by the fact that in both groups of patients, there was only one patient who presented with acute illness. Six patients of our study group, three months after the acute infection, received pegylated interferon (Peg-IFNa2a) 135 mug for a six-month period. Four of them responded very well to therapy and at the first determination HCV RNA was below the cutoff point. One of our patients with very high HCV levels (HCV RNA > 50,000,000 IU/mL), despite receiving the same therapy, did not respond well and developed cirrhosis. In conclusion, it is clear from our experience that better information is needed about the current incidence, prevalence, and risk factors for HCV infection in dialysis patients. Algorithms for the diagnosis and management of hepatitis C should be developed by academic societies. Routine screening for hepatitis C also would allow

  14. Twenty-nine cases of the pregnant women with Systemic Lupus Erythematosus in nursing%29例妊娠合并系统性红斑狼疮的护理

    Institute of Scientific and Technical Information of China (English)

    陆云波

    2011-01-01

    目的 探讨妊娠合并系统性红斑狼疮的护理方法.方法对本院29例妊娠合并系统性红斑狼疮孕产妇的临床资料进行回顾性分析.结果除了1例产妇因妊娠 29+1周新生儿重度窒息死亡外,其余28例孕产妇均能顺利度过孕产期,无并发症,新生儿均成活,母婴康复出院.结论 对妊娠合并系统性红斑狼疮孕产妇给予加强健康教育,重视产前检查,选择合适的妊娠时机,加强母儿监护,系统性红斑狼疮患者能够顺利生育.%Objective To investigate the nursing on pregnant women with systemic lupus erythematosus. Methods Twenty-nine cases of pregnant women with systemic lupus erythematosus clinical data are analyzed retrospectively. Results One ease of severe neonatal asphyxia was dead due to maternal pregnancy (29 + 1 ) weeks, the remaining 28 cases of pregnant women survived with no serious complications, and neonates also survived. Conclusions SLE patients should be educated with maternal health knowledge, and they should master the right time of pregnancy. If the care of the maternal and the fetal can be intensified, the better outcomes could occur.

  15. Diabetes mellitus in HIV-infected patients receiving antiretroviral ...

    African Journals Online (AJOL)

    the incidence of diabetes in HIV-infected adults receiving ART is between ... 6 Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of ... of HIV and DM in patients receiving antiretroviral therapy (ART) in Botswana.

  16. Depressive features among adult patients receiving antiretroviral ...

    African Journals Online (AJOL)

    general population;[11] therefore, the disease burden of HIV/AIDS is ... Globally, it is estimated that depressive features occur in 15 - 36% of people suffering from chronic .... ageing exposes HIV/AIDS patients to an increased risk of common.

  17. Foreign patients in ER: receiving, understanding, treating

    Directory of Open Access Journals (Sweden)

    Alberto Dal Molin

    2006-06-01

    Full Text Available In the last years the presence of foreign patients inside Emergency Departments is increased, this means many problems, like misunderstanding, communication difficulties and more problematic situations when, our work or our expectations meet the values sideboards and life style of our patients. This article purpose is to describe this phenomenon inside Biella Emergency Departments, because if you know a situation you can solve it better.

  18. Predictors for trismus in patients receiving radiotherapy.

    Science.gov (United States)

    van der Geer, S Joyce; Kamstra, Jolanda I; Roodenburg, Jan L N; van Leeuwen, Marianne; Reintsema, Harry; Langendijk, Johannes A; Dijkstra, Pieter U

    2016-11-01

    Trismus, a restricted mouth opening in head and neck cancer patients may be caused by tumor infiltration in masticatory muscles, radiation-induced fibrosis or scarring after surgery. It may impede oral functioning severely. The aims of our study were to determine: (1) the incidence of trismus at various time points; and (2) the patient, tumor, and treatment characteristics that predict the development of trismus after radiotherapy in head and neck cancer patients using a large database (n = 641). Maximal mouth opening was measured prior to and 6, 12, 18, 24, 36, and 48 months after radiotherapy. Patient, tumor, and treatment characteristics were analyzed as potential predictors for trismus using a multivariable logistic regression analysis. At six months after radiotherapy, 28.1% of the patients without trismus prior to radiotherapy developed trismus for the first time. At subsequent time points the incidence declined. Over a total period of 48 months after radiotherapy, the incidence of trismus was 3.6 per 10 person years at risk. Patients who had tumors located in the oral cavity, oropharynx or nasopharynx, and the salivary glands or ear, and who had a longer overall treatment time of radiotherapy, were more likely to develop trismus in the first six months after radiotherapy. Maximal mouth opening was a predictor for developing trismus at all time points. Incidence of trismus is 3.6 per 10 person years at risk. Tumor localization and overall treatment time of radiotherapy are predictors for developing trismus the first six months after radiotherapy. Maximal mouth opening is a significant predictor for developing trismus at all time points. Regular measurements of maximal mouth opening are needed to predict trismus.

  19. Predictors for trismus in patients receiving radiotherapy

    NARCIS (Netherlands)

    van der Geer, S. Joyce; Kamstra, Jolanda I.; Roodenburg, Jan L. N.; van Leeuwen, Marianne; Reintsema, Harry; Langendijk, Johannes A.; Dijkstra, Pieter U.

    2016-01-01

    Background: Trismus, a restricted mouth opening in head and neck cancer patients may be caused by tumor infiltration in masticatory muscles, radiation-induced fibrosis or scarring after surgery. It may impede oral functioning severely. The aims of our study were to determine: (1) the incidence of

  20. Music therapy for patients receiving spine surgery.

    Science.gov (United States)

    Lin, Pi-Chu; Lin, Man-Ling; Huang, Li-Ching; Hsu, Hsiu-Chu; Lin, Chiong-Chu

    2011-04-01

    The aim of this study was to evaluate the effects of music therapy on anxiety, postoperative pain and physiological reactions to emotional and physical distress in patients undergoing spinal surgery. Surgery-related anxiety and pain are the greatest concern of surgical patients, especially for those undergoing major procedures. A quasi-experimental study design was conducted in a medical centre in Taiwan from April-July 2006. Sixty patients were recruited. The study group listened to selected music from the evening before surgery to the second day after surgery. The control group did not listen to music. Patients' levels of anxiety and pain were measured with visual analogue scales (VAS). Physiological measures, including heart rate, blood pressure and 24-hour urinalysis, were performed. The average age of the 60 patients was 62·18 (SD 18·76) years. The mean VAS score for degree of anxiety in the study group was 0·8-2·0, compared with 2·1-5·1 in the control group. The mean VAS score for degree of pain in the study group was 1·7-3·0, compared with 4·4-6·0 in the control group. The differences between the two groups in VAS scores for both anxiety (p = 0·018-0·001) and pain (p = 0·001) were statistically significant. One hour after surgery, the mean blood pressure was significantly lower in the study group than in the control group (p = 0·014), but no significant differences were found between the two groups in urine cortisol (p = 0·145-0·495), norepinephrine (p = 0·228-0·626) or epinephrine values (p = 0·074-0·619). Music therapy has some positive effects on levels of anxiety and pain in patients undergoing spinal surgery. Complementary music therapy can alleviate pain and anxiety in patients before and after spinal surgery. © 2011 Blackwell Publishing Ltd.

  1. [Peritonitis in pediatric patients receiving peritoneal dialysis].

    Science.gov (United States)

    Jellouli, Manel; Ferjani, Meriem; Abidi, Kamel; Hammi, Yosra; Boutiba, Ilhem; Naija, Ouns; Zarrouk, Chokri; Ben Abdallah, Taieb; Gargah, Tahar

    2015-12-01

    Peritonitis on catheter of dialysis represents the most frequent complication of the peritoneal dialysis (PD) in the pediatric population. It remains a significant cause of morbidity and mortality. In this study, we investigated the risk factors for peritonitis in children. In this study, we retrospectively collected the records of 85 patients who were treated with PD within the past ten years in the service of pediatrics of the University Hospital Charles-Nicolle of Tunis. Peritonitis rate was 0.75 episode per patient-year. Notably, peritonitis caused by Gram-positive organisms were more common. Analysis of infection risk revealed three significant independent factors: the poor weight (P=0.0045), the non-automated PD (P=0.02) and the short delay from catheter insertion to starting PD (P=0.02). The early onset peritonitis was significantly associated with frequent peritonitis episodes (P=0.0008). The mean duration between the first and second episode of peritonitis was significantly shorter than between PD commencement and the first episode of peritonitis. We revealed a significant association between Gram-negative peritonitis and the presence of ureterostomy (0.018) and between Gram-positive peritonitis and the presence of exit-site and tunnel infections (0.02). Transition to permanent hemodialysis was needed in many children but no death occurred in patients with peritonitis. Considering the important incidence of peritonitis in our patients, it is imperative to establish a targeted primary prevention. Nutritional care must be provided to children to avoid poor weight. The automated dialysis has to be the modality of choice. Copyright © 2015 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

  2. Sexual function in hypertensive patients receiving treatment

    Directory of Open Access Journals (Sweden)

    Thorsten Reffelmann

    2006-12-01

    Full Text Available Thorsten Reffelmann, Robert A KlonerUniversity of Southern California, The Heart Institute, Good Samaritan Hospital, Division of Cardiovascular Medicine, Keck School of Medicine, Los Angeles, CA, USAAbstract: In many forms of erectile dysfunction (ED, cardiovascular risk factors, in particular arterial hypertension, seem to be extremely common. While causes for ED are related to a broad spectrum of diseases, a generalized vascular process seems to be the underlying mechanism in many patients, which in a large portion of clinical cases involves endothelial dysfunction, ie, inadequate vasodilation in response to endothelium-dependent stimuli, both in the systemic vasculature and the penile arteries. Due to this close association of cardiovascular disease and ED, patients with ED should be evaluated as to whether they may suffer from cardiovascular risk factors including hypertension, cardiovascular disease or silent myocardial ischemia. On the other hand, cardiovascular patients, seeking treatment of ED, must be evaluated in order to decide whether treatment of ED or sexual activity can be recommended without significantly increased cardiac risk. The guideline from the first and second Princeton Consensus Conference may be applied in this context. While consequent treatment of cardiovascular risk factors should be accomplished in these patients, many antihypertensive drugs may worsen sexual function as a drug specific side-effect. Importantly, effective treatment for arterial hypertension should not be discontinued as hypertension itself may contribute to altered sexual functioning; to the contrary, alternative antihypertensive regimes should be administered with individually tailored drug regimes with minimal side-effects on sexual function. When phosphodiesterase-5 inhibitors, such as sildenafil, tadalafil and vardenafil, are prescribed to hypertensive patients on antihypertensive drugs, these combinations of antihypertensive drugs and

  3. Current perspectives on dental patients receiving coumarin anticoagulant therapy.

    Science.gov (United States)

    Herman, W W; Konzelman, J L; Sutley, S H

    1997-03-01

    Despite approximately 40 years of experience with oral anticoagulant drugs, controversy still exists about the safety of dental treatment in a patient receiving this therapy. The authors review the topic in depth and offer detailed recommendations for the dental management of patients receiving coumarin anticoagulant therapy.

  4. Gastrointestinal symptoms and weight loss in cancer patients receiving chemotherapy.

    Science.gov (United States)

    Sánchez-Lara, Karla; Ugalde-Morales, Emilio; Motola-Kuba, Daniel; Green, Dan

    2013-03-14

    Cancer patients receiving chemotherapy have a high risk of malnutrition secondary to the disease and treatment, and 40-80 % of cancer patients suffer from different degrees of malnutrition, depending on tumour subtype, location, staging and treatment strategy. Malnutrition in cancer patients affects the patient's overall condition, and it increases the number of complications, the adverse effects of chemotherapy and reduces the quality of life. The aim of the present study was to evaluate weight-loss prevalence depending on the tumour site and the gastrointestinal (GI) symptoms of oncology patients receiving chemotherapy. We included 191 cancer patients receiving chemotherapy. Files of all patients were reviewed to identify symptoms that might potentially influence weight loss. The nutritional status of all patients was also determined. The cancer sites in the patients were as follows: breast (31·9 %); non-colorectal GI (18·3 %); colorectal (10·4 %); lung (5·8 %); haematological (13·1 %); others (20·5 %). Of these patients, 58 % experienced some degree of weight loss, and its prevalence was higher among the non-colorectal GI and lung cancer patients. Common symptoms included nausea (59·6 %), anorexia (46 %) and constipation (31·9 %). A higher proportion of patients with ≥ 5 % weight loss experienced anorexia, nausea and vomiting (OR 9·5, 2·15 and 6·1, respectively). In conclusion, these results indicate that GI symptoms can influence weight loss in cancer patients, and they should be included in early nutritional evaluations.

  5. Is phenytoin contraindicated in patients receiving cranial irradiation?

    Energy Technology Data Exchange (ETDEWEB)

    Borg, M.F. [Royal Adelaide Hospital, SA (Australia); Probert, J.C. [Auckland Hospital, Auckland (New Zealand). Dept. of Radiation Oncology; Zwi, L.J. [Auckland Univ. (New Zealand). Dept. of Medicine and Surgery

    1995-02-01

    Three recent publications have reported the development of erythema multiforme and Stevens-Johnson syndrome in patients receiving cranial irradiation and sodium phenytoin. Some authors have recommended that patients receiving whole brain radiation therapy and who have had seizures should not be prescribed phenytoin but an alternative anticonvulsant. This article reviews the current literature pertaining to the development of this potentially lethal complication in patients receiving whole brain radiation and phenytoin, with reference to the single recorded case of Stevens-Johnson syndrome in a patient receiving cranial irradiation and phenytoin in Auckland, New Zealand. While the clinical picture in the 16 patients reported in the literature and the current case report differed from the classical form of erythema multiforme, a similar pattern of presentation and outcome appeared in all patients reviewed, suggesting that the combination of phenytoin, cranial irradiation and the gradual reduction of concomitant steroids seem to lead to the development of erythema multiforme and/or Stevens-Johnson syndrome. The data presented, although sparse, suggest that phenytoin should not be prescribed in patients receiving cranial irradiation. 21 refs., 2 tabs., 3 figs.

  6. Enhanced mucosal reactions in AIDS patients receiving oropharyngeal irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Watkins, E.B.; Findlay, P.; Gelmann, E.; Lane, H.C.; Zabell, A.

    1987-09-01

    The oropharynx and hypopharynx are common sites of involvement in AIDS patients with mucocutaneous Kaposi's sarcoma. The radiotherapist is often asked to intervene with these patients due to problems with pain, difficulty in swallowing, or impending airway obstruction. We have noted an unexpected decrease in normal tissue tolerance of the oropharyngeal mucosa to irradiation in AIDS patients treated in our department. Data on 12 patients with AIDS and Kaposi's sarcoma receiving oropharyngeal irradiation are presented here. Doses ranged from 1000 cGy to 1800 cGy delivered in 150-300 cGy fractions. Seven of eight patients receiving doses of 1200 cGy or more developed some degree of mucositis, four of these developed mucositis severe enough to require termination of treatment. All patients in this study received some form of systemic therapy during the course of their disease, but no influence on mucosal response to irradiation was noted. Four patients received total body skin electron treatments, but no effect on degree of mucositis was seen. Presence or absence of oral candidiasis was not an obvious factor in the radiation response of the oral mucosa in these patients. T4 counts were done on 9 of the 12 patients. Although the timing of the T4 counts was quite variable, no correlation with immune status and degree of mucositis was found. The degree of mucositis seen in these patients occurred at doses much lower than expected based on normal tissue tolerances seen in other patient populations receiving head and neck irradiations. We believe that the ability of the oral mucosa to repair radiation damage is somehow altered in patients with AIDS.

  7. Abnormal vitamin levels in patients receiving home total parenteral nutrition.

    Science.gov (United States)

    Mikalunas, V; Fitzgerald, K; Rubin, H; McCarthy, R; Craig, R M

    2001-01-01

    The administration of multivitamins to patients receiving home parenteral nutrition (HPN) was decreased from once daily to three times weekly during the parenteral multivitamin shortage in 1997. Blood vitamin levels were measured to examine whether the decrement in the infused vitamins affected the levels. Six patients with normal renal and liver function, receiving HPN for 6 months to 10 years, were studied 6 months after the institution of 10 mL of multivitamins thrice weekly. Two patients with renal insufficiency who required hemodialysis and HPN were also studied. Multivitamin administration was eliminated in one patient and was reduced to once weekly when elevated pyridoxine levels were found in association with possible neurotoxicity. Five of the six patients with normal renal function had low serum ascorbic acid levels. Serum riboflavin levels were found to be low in one patient, serum pyridoxine was low in one, serum retinoids were low in three, and serum niacin was low in one. There were no clinically obvious untoward effects caused by the vitamin deficiencies. Each of the dialysis patients had elevated serum pyridoxine levels and had some neurologic disturbance (peripheral neuropathy, involuntary movements). The serum pyridoxine levels fell to normal in each after the cessation or decrease of the multivitamin preparation. Ascorbic acid levels were low in one patient and fell into abnormally low levels in the other when the parenteral multivitamins were reduced, but they corrected with the separate administration of intravenous vitamin C. In conclusion, the reduced administration of multivitamins in 1997 resulted in diminished ascorbic acid levels in seven of eight patients receiving total parenteral nutrition. Less often, low levels of retinoids, niacin, pyridoxine, and riboflavin were seen. Patients with chronic renal failure receiving HPN with multivitamins may develop elevated pyridoxine levels, which might result in neurologic sequelae.

  8. Patients With Brain Tumors: Who Receives Postacute Occupational Therapy Services?

    Science.gov (United States)

    Chan, Vincy; Xiong, Chen; Colantonio, Angela

    2015-01-01

    Data on the utilization of occupational therapy among patients with brain tumors have been limited to those with malignant tumors and small samples of patients outside North America in specialized palliative care settings. We built on this research by examining the characteristics of patients with brain tumors who received postacute occupational therapy services in Ontario, Canada, using health care administrative data. Between fiscal years 2004-2005 and 2008-2009, 3,199 patients with brain tumors received occupational therapy services in the home care setting after hospital discharge; 12.4% had benign brain tumors, 78.2% had malignant brain tumors, and 9.4% had unspecified brain tumors. However, patients with benign brain tumors were older (mean age=63.3 yr), and a higher percentage were female (65.2%). More than 90% of patients received in-home occupational therapy services. Additional research is needed to examine the significance of these differences and to identify factors that influence access to occupational therapy services in the home care setting.

  9. EuroQoL in assessment of the effect of pulmonary rehabilitation COPD patients

    DEFF Research Database (Denmark)

    Ringbaek, Thomas; Brøndum, Eva; Martinez, Gerd;

    2008-01-01

    BACKGROUND: The effect of pulmonary rehabilitation on EuroQol in COPD patients has not been investigated previously. METHODS/MATERIALS: Two hundred and twenty nine consecutive COPD patients who had completed a 7-week pulmonary rehabilitation programme were assessed with EuroQol five-dimension que......BACKGROUND: The effect of pulmonary rehabilitation on EuroQol in COPD patients has not been investigated previously. METHODS/MATERIALS: Two hundred and twenty nine consecutive COPD patients who had completed a 7-week pulmonary rehabilitation programme were assessed with EuroQol five...... scale. At completion of the programme, statistical significant improvements were seen for ESWT 157.3s; ptotal score -2.8units; p....1%). CONCLUSIONS: In COPD patients receiving rehabilitation, responsiveness of EQ-5D utility was poor. One explanation might be a "ceiling effect" of this instrument....

  10. Metabolic syndrome among patients receiving clozapine: A preliminary estimate

    Directory of Open Access Journals (Sweden)

    Sandeep Grover

    2011-01-01

    Full Text Available Objective : To study the prevalence of metabolic syndrome in patients receiving clozapine. Materials and Methods : For this study, 100 patients attending the psychiatry outpatient clinic of a tertiary care hospital who were receiving clozapine for more than three months were evaluated for the presence of metabolic syndrome using the International Diabetes Federation (IDF and modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III criteria. Results : Forty-six patients fulfilled IDF criteria and 47 met modified NCEP ATP-III criteria of metabolic syndrome. There was significant correlation between these two sets of criteria used to define the metabolic syndrome (Kappa value -0.821, P < 0.001. Among the individual parameters studied, increased waist circumference was the most common abnormality, followed by abnormal blood glucose levels and elevated triglyceride levels. All these abnormalities were seen in more than half (52-61% of the patients. When the sample was divided into two groups, i.e., those with and without metabolic syndrome, patients with metabolic syndrome had significantly higher body mass index and had spent more time in school. Logistic regression analysis revealed that these two variables together explained about 19% of the variance in metabolic syndrome (adjusted r 2 = 0193; F = 12.8; P < 0.001. Conclusion : The findings of the present study suggest that metabolic syndrome is highly prevalent in subjects receiving clozapine.

  11. [Cognitive plasticity in Alzheimer's disease patients receiving cognitive stimulation programs].

    Science.gov (United States)

    Zamarrón Cassinello, Ma Dolores; Tárraga Mestre, Luis; Fernández-Ballesteros, Rocío

    2008-08-01

    The main purpose of this article is to examine whether cognitive plasticity increases after cognitive training in Alzheimer's disease patients. Twenty six patients participated in this study, all of them diagnosed with mild Alzheimer's disease, 17 of them received a cognitive training program during 6 months, and the other 9 were assigned to the control group. Participants were assigned to experimental or control conditions for clinical reasons. In order to assess cognitive plasticity, all patients were assessed before and after treatment with three subtests from the "Bateria de Evaluación de Potencial de Aprendizaje en Demencias" [Assessment Battery of Learning Potential in Dementia] (BEPAD). After treatment, Alzheimer's disease patients improved their performance in all the tasks assessing cognitive plasticity: viso-spatial memory, audio-verbal memory and verbal fluency. However, the cognitive plasticity scores of the patients in the control group decreased. In conclusion, this study showed that cognitive stimulation programs can improve cognitive functioning in mildly demented patients, and patients who do not receive any cognitive interventions may reduce their cognitive functioning.

  12. Determinants of survival in patients receiving dialysis in Libya.

    Science.gov (United States)

    Alashek, Wiam A; McIntyre, Christopher W; Taal, Maarten W

    2013-04-01

    Maintenance dialysis is associated with reduced survival when compared with the general population. In Libya, information about outcomes on dialysis is scarce. This study, therefore, aimed to provide the first comprehensive analysis of survival in Libyan dialysis patients. This prospective multicenter study included all patients in Libya who had been receiving dialysis for >90 days in June 2009. Sociodemographic and clinical data were collected upon enrollment and survival status after 1 year was determined. Two thousand two hundred seventy-three patients in 38 dialysis centers were followed up for 1 year. The majority were receiving hemodialysis (98.8%). Sixty-seven patients were censored due to renal transplantation, and 46 patients were lost to follow-up. Thus, 2159 patients were followed up for 1 year. Four hundred fifty-eight deaths occurred, (crude annual mortality rate of 21.2%). Of these, 31% were due to ischemic heart disease, 16% cerebrovascular accidents, and 16% due to infection. Annual mortality rate was 0% to 70% in different dialysis centers. Best survival was in age group 25 to 34 years. Binary logistic regression analysis identified age at onset of dialysis, physical dependency, diabetes, and predialysis urea as independent determinants of increased mortality. Patients receiving dialysis in Libya have a crude 1-year mortality rate similar to most developed countries, but the mean age of the dialysis population is much lower, and this outcome is thus relatively poor. As in most countries, cardiovascular disease and infection were the most common causes of death. Variation in mortality rates between different centers suggests that survival could be improved by promoting standardization of best practice.

  13. Vascular access in patients receiving hemodialysis in Libya.

    Science.gov (United States)

    Alashek, Wiam A; McIntyre, Christopher W; Taal, Maarten W

    2012-01-01

    A native arteriovenous fistula (AVF) represents the optimal form of Vascular Access (VA) for patients receiving hemodialysis (HD). In Libya there are several barriers to AVF creation including lack of adequate preparation for dialysis and surgical services. We aimed to conduct the first comprehensive study of VA utilisation in HD patients in Libya. A prospective observational study included all adult patients receiving HD treatment in 25 HD facilities in Libya from May 2009 to Nov 2011. Researchers gathered data regarding VA through interviews with staff and patients as well as medical records. Patients with definitive VA were re-interviewed after 1 year. At baseline the majority of patients (91.9%; n=1573) were using permanent VA in the form of AVF or arteriovenous graft. Patients with permanent VA were more likely to be male and less likely to be diabetic than those with CVCs. Most patients had commenced HD using a temporary CVC (91.8%). VA-related complications were: thrombosis (46.7%), aneurysm (22.6%), infection (11.5%) and haemorrhage (10.2%). Incident VA thrombosis was reported by 14.7% in 1 year. Independent risk factors for incident thrombosis were female gender and diabetes. Hospitalisation for VA related complications was reported by 31.4%. Few patients in Libya initiate HD with definitive VA, but most achieve it thereafter. Improved dialysis preparation and increased provision of surgical services are required to increase the proportion of patients initiating HD with definitive VA and should be a priority in rebuilding health services in Libya after the recent conflict.

  14. [Prescribing drugs to patients receiving out-patient care].

    Science.gov (United States)

    Garjón Parra, F J

    2009-01-01

    Drug prescription has evolved to deal mainly with chronic diseases. Nowadays, repeating prescriptions using computers results in problems if this is not done with adequate control. Steps proposed for appropriate prescription are: defining the problem; specifying the objective; selecting the drug; initiating therapy with appropriate details; giving information; regular evaluation; considering cost; and using tools to reduce errors. Published recommendations for prescription, which have focused on elderly patients, include: avoiding polypharmacy; carrying out a regular medication review; stopping any current drugs that are not indicated and prescribing new drugs that have a clear indication; avoiding drugs that have deleterious effects; using dosages that are suitable for the age and renal function; using simple drug regimes and appropriate administration systems; considering non-pharmacological treatments; limiting the number of practitioners prescribing for each patient; and avoiding treating adverse drug reactions with further drugs. Examples of compliance with those recommendations in the Navarre Health Service, extracted from the prescription information system, are provided. The measures for improving prescription are: education, auditing, collaboration between health professionals and use of electronic tools.

  15. Polypharmacy in Older Patients ≥70 Years Receiving Palliative Radiotherapy.

    Science.gov (United States)

    Nieder, Carsten; Mannsăker, Bărd; Pawinski, Adam; Haukland, Ellinor

    2017-02-01

    Many older cancer patients receive five or more daily medications (polypharmacy). The purpose of this study was to assess the prevalence of polypharmacy in older patients undergoing palliative radiotherapy and its influence on the risk of being unable to complete the prescribed number of fractions, as well as the 30-day mortality and overall survival. Retrospective review of 289 patients aged 70 years or older. The median and mean Charlson comorbidity index (11) was 2, ranging between 0-7 (presently treated cancer not included). The median and mean number of daily medications was 7, ranging between 0-18. Only 27% of patients used less than 5 daily medications. Corticosteroids were used by 59% of the patients and opioid analgesics by 55%. Comorbidity, but also symptom severity, as indexed by pain medication, correlated significantly with the prevalence of polypharmacy. In multivariate analysis, neither polypharmacy nor use of corticosteroids or opioid analgesics influenced overall survival. No trends were seen for 30-day mortality or failure to complete radiotherapy. Polypharmacy is a common phenomenon in older patients receiving palliative radiotherapy and it does not predict adverse radiotherapy outcomes. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  16. The Significance of Sedation Control in Patients Receiving Mechanical Ventilation

    OpenAIRE

    2012-01-01

    Background Adequate assessment and control of sedation play crucial roles in the proper performance of mechanical ventilation. Methods A total of 30 patients with various pulmonary diseases were prospectively enrolled. The study population was randomized into two groups. The sedation assessment group (SAG) received active protocol-based control of sedation, and in the empiric control group (ECG), the sedation levels were empirically adjusted. Subsequently, daily interruption of sedation (DIS)...

  17. Bone Mineral Density in Patients Receiving Anticonvulsant Drugs

    Directory of Open Access Journals (Sweden)

    Kadir Yıldırım

    2002-12-01

    Full Text Available The study was carried out to determine possible effects of anticonvulsant drugs on bone mineral density. Twenty two patients with epilepsy who have been receiving anticonvulsant drugs and also 22 healthy controls were included in the study. The average age was 28.9 ± 8.9 years in the patients group and 30.5 ± 6.9 years in the control group. The average drug receiving time was 6.45 ± 4.2 years. At baseline ESR, hemogram, urine deoxypiridinoline (DPD, routine biochemical and hormonal values were determined in both groups. Lumbar spine and left femur bone mineral density (BMD values were determined with hologic 2000 DEXA. In the statistical analysis, urine DPD levels in the patient group were significantly higher than control group (p0.05. Lumbar spine and left femur BMD values were significantly decreased in patients group (respectively p<0.01, p<0.001. We determined that in the patients using anticonvulsant drugs there was an increase in bone resorption and this effect was more evident in cortical bone than trabecular bone.

  18. Management of HIV Infection in Patients With Cancer Receiving Chemotherapy

    Science.gov (United States)

    Mayer, Kenneth H.; Torres, Harrys A.; Mulanovich, Victor

    2014-01-01

    The optimal antiretroviral therapy (ART) regimen for human immunodeficiency virus (HIV)–infected patients with cancer remains unknown, as clinical trials are lacking and published data are insufficient to guide recommendations. When concomitant use of chemotherapy and ART is anticipated, overlap of toxic effects and drug–drug interactions between chemotherapy and ART may alter the optimal choice of ART. Prospective studies are urgently needed to further define the toxic effects of combined chemotherapy and ART in HIV-positive cancer patients. Such studies should aid the development of guidelines for treatment of this population. For now, clinicians should individualize decisions regarding treatment of HIV according to clinical and laboratory findings, cancer treatment plan (chemotherapy, radiotherapy, or surgery), liver or renal disease, potential adverse drug effects (eg, rash, gastrointestinal intolerance, bone marrow suppression), and patient preference. This review focuses on what infectious disease specialists need to know to select the most appropriate ART regimens for patients receiving chemotherapy. PMID:24642555

  19. Phage neutralization by sera of patients receiving phage therapy.

    Science.gov (United States)

    Łusiak-Szelachowska, Marzanna; Zaczek, Maciej; Weber-Dąbrowska, Beata; Międzybrodzki, Ryszard; Kłak, Marlena; Fortuna, Wojciech; Letkiewicz, Sławomir; Rogóż, Paweł; Szufnarowski, Krzysztof; Jończyk-Matysiak, Ewa; Owczarek, Barbara; Górski, Andrzej

    2014-08-01

    The aim of our investigation was to verify whether phage therapy (PT) can induce antiphage antibodies. The antiphage activity was determined in sera from 122 patients from the Phage Therapy Unit in Wrocław with bacterial infections before and during PT, and in sera from 30 healthy volunteers using a neutralization test. Furthermore, levels of antiphage antibodies were investigated in sera of 19 patients receiving staphylococcal phages and sera of 20 healthy volunteers using enzyme-linked immunosorbent assay. The phages were administered orally, locally, orally/locally, intrarectally, or orally/intrarectally. The rate of phage inactivation (K) estimated the level of phages' neutralization by human sera. Low K rates were found in sera of healthy volunteers (K ≤ 1.73). Low K rates were detected before PT (K ≤ 1.64). High antiphage activity of sera K > 18 was observed in 12.3% of examined patients (n = 15) treated with phages locally (n = 13) or locally/orally (n = 2) from 15 to 60 days of PT. High K rates were found in patients treated with some Staphylococcus aureus, Pseudomonas aeruginosa, and Enterococcus faecalis phages. Low K rates were observed during PT in sera of patients using phages orally (K ≤ 1.04). Increased inactivation of phages by sera of patients receiving PT decreased after therapy. These results suggest that the antiphage activity in patients' sera depends on the route of phage administration and phage type. The induction of antiphage activity of sera during or after PT does not exclude a favorable result of PT.

  20. [Pharmaceutical care program for pediatric patients receiving antiretroviral therapy].

    Science.gov (United States)

    Barrueco, N; Castillo, I; Ais, A; Martínez, C; Sanjurjo, M

    2005-01-01

    To present a pharmaceutical care program for pediatric patients receiving antiretroviral therapy. In order to establish the pharmaceutical care procedure, papers published up to 2004 on the pharmaceutical care provided to patients receiving antiretroviral therapy were reviewed through a search in Medline and the journal Farmacia Hospitalaria. In addition, bibliographic references that can be systematically used to analyze the pharmacotherapy of each patient have been selected. The pharmaceutical care procedure is divided in three stages (data collection, analysis of the pharmacotherapeutic profile and resolution of the drug-related problems identified) that take place through a semi-structured type of interview. In order to systematize the role of the pharmacist, a table with information on antiretroviral drugs used in Pediatrics was created, as well as an information three-page leaflet and a data collection form. The program includes the goals of the pharmaceutical care process as defined in the recommendations of GESIDA-SEFH-National AIDS Plan 2004 and systematizes the proposed intervention strategies, in an attempt to provide the patient and the caregiver with the information required for an optimum management, in the most comprehensive way and tailored to their individual characteristics.

  1. Plasma carnitine levels in patients receiving home parenteral nutrition.

    Science.gov (United States)

    Bowyer, B A; Fleming, C R; Ilstrup, D; Nelson, J; Reek, S; Burnes, J

    1986-01-01

    Patients on long-term home parenteral nutrition (HPN) are known to frequently develop hepatic steatosis or steatohepatitis. The etiology of this steatosis or steatohepatitis is unknown, but carnitine deficiency has been one of the postulated mechanisms. The importance of L-carnitine in hepatic fatty acid oxidation and the steatosis observed in primary and acquired carnitine deficiencies prompted us to determine plasma carnitine levels in 37 patients receiving long-term HPN. Thirteen patients (35%) had low total and free plasma carnitine levels. Fifteen of the 37 HPN patients were matched for age and sex with 15 patients with Crohn's disease who did not require HPN. Mean total and free plasma carnitine values were significantly lower (p less than 0.001) in these 15 HPN patients (32.2 +/- 11.9 and 28.4 +/- 10.8) when compared to Crohn's patients not requiring HPN (49.1 +/- 10.9 and 46.4 +/- 11.5). Associations were not detected between plasma carnitine and clinical or biochemical parameters that might have explained the low values.

  2. Renal function monitoring in patients receiving lithium carbonate.

    Science.gov (United States)

    Gelenberg, A J; Wojcik, J D; Coggins, C H; Rosenbaum, J F; LaBrie, R A

    1981-11-01

    As a screening test for renal function, urine concentration was measured following a 12-hour overnight fast in 54 outpatients taking lithium carbonate and 19 patients receiving antidepressant drugs. A significantly greater percentage of lithium patients failed to achieve a maximum urine concentration of 600 mOsm/kg (63% versus 33% in the antidepressant group, p less than .001). This level, a compromise between the sensitivity and specificity of the test, is viewed as a cutoff point for further testing. It is concluded that urine concentration testing is a feasible first-line screen for renal function among lithium-treated patients. Other preliminary studies include routine urinalysis, serum creatinine determination, and estimated creatinine clearance. Second-line testing includes a repeated dehydration test and administration of DDAVP.

  3. Associations Between Patient Characteristics and the Amount of Arthritis Medication Information Patients Receive.

    Science.gov (United States)

    Geryk, Lorie Love; Blalock, Susan; DeVellis, Robert F; Morella, Kristen; Carpenter, Delesha Miller

    2016-10-01

    Little is known about factors associated with the receipt of medication information among arthritis patients. This study explores information source receipt and associations between demographic and clinical/patient characteristics and the amount of arthritis medication information patients receive. Adult patients with osteoarthritis (OA) or rheumatoid arthritis (RA; n = 328) completed an online cross-sectional survey. Patients reported demographic and clinical/patient characteristics and the amount of arthritis medication information received from 15 information sources. Bivariate and multivariate linear regression analyses were used to investigate whether those characteristics were associated with the amount of medication information patients received. Arthritis patients received the most information from health professionals, followed by printed materials, media sources, and interpersonal sources. Greater receipt of information was associated with greater medication adherence, taking more medications, greater medication-taking concerns, more satisfaction with doctor medication-related support, and Black compared to White race. RA patients reported receiving more information compared to OA patients, and differences were found between RA patients and OA patients in characteristics associated with more information receipt. In conclusion, arthritis patients received the most medication information from professional sources, and both positive (e.g., greater satisfaction with doctor support) and negative (e.g., more medication-taking concerns) characteristics were associated with receiving more medication information.

  4. Skeletal mass in patients receiving chronic anticonvulsant therapy

    Energy Technology Data Exchange (ETDEWEB)

    Zanzi, I.; Roginsky, M.S.; Rosen, A.; Cohn, S.H.

    1981-01-01

    The technique of in vivo total body neutron activation analysis was used to measure total body calcium (TBCa), a sensitive and precise index of skeletal mass, expressed as the Ca ratio (TBCa observed/TBCa predicted). 23 unselected, ambulatory, noninstitutionalized, adult epileptic patients under long-term anticonvulsant therapy were studied. Ca ratio was normal in 20 of the patients, low in only 2 and borderline in 1 patient. Plasma alkaline phosphatase values were elevated in half the subjects. Plasma Ca (uncorrected) was in the normal range in all. Serum 25-hydroxvitamin D (25-OHD) was low in 67% of the subjects, but only 1 patient had a value below 5 ng/ml. There was no correlation between the Ca ratio and the alkaline phosphatase or 25-OHD values. No radiographic or other evidences of osteomalacia were observed. This study does not support the notion of a prevalence of osteopenia in ambulatory, noninstitutionalized, adult epileptic patients receiving chronic anticonvulsant therapy in this geographical area despite the frequent findings of biochemical abnormalities.

  5. Dental procedures in patients receiving oral anticoagulation therapy.

    Science.gov (United States)

    Saour, J N; Ali, H A; Mammo, L A; Sieck, J O

    1994-05-01

    Over a 10-year period a uniform management plan for patients receiving long term oral anticoagulation therapy for prosthetic heart valves and needing dental procedures was instituted. Those undergoing dental extraction or gum hygiene in the presence of gross gum pathology (Group A) had their oral anticoagulation discontinued two days prior to the procedure which was carried out only if the INR was 1.5 or less on the day of the procedure. Patients who needed dental fillings or gum hygiene in the absence of gross gum pathology (Group B) continued their anticoagulation therapy and had these procedures completed provided the INR was 3.0 or less. The main outcome measured were valve thrombosis, thromboembolism and excessive bleeding requiring hospitalization and/or blood transfusion. In Group A, 240 procedures were carried out; 212 dental extractions and 28 dental hygiene in the presence of gross gum pathology. They had a brief period of under-anticoagulation (3-7 days) to an INR of 1.5 or less. In Group B, 156 procedures were performed. No patient developed valve thrombosis or thromboembolism. Two patients, both in Group A needed hospitalization for observation but no blood transfusion. This management plan was easy to implement. Patients needed one extra visit to the anticoagulation clinic within one week of the procedure. It was both safe and effective.

  6. How health information is received by diabetic patients?

    Directory of Open Access Journals (Sweden)

    Firoozeh Zare-Farashbandi

    2015-01-01

    Full Text Available Background: Knowledge of correct information-seeking behavior by the patients can provide health specialists and health information specialists with valuable information in improving health care. This study aimed to investigate the passive receipt and active seeking of health information by diabetic patients. Materials and Methods: A survey method was used in this research on 6426 diabetic patients of whom 362 patients were selected by a no percentage stratified random sampling. The Longo information-seeking behavior questionnaire was used to collect data and they were analyzed by SPSS 20 software. Results: The most common information source by diabetic patients was practitioners (3.12. The minimum usage among the information sources were from charity organizations and emergency phone lines with a usage of close to zero. The amount of health information gained passively from each source has the lowest average of 4.18 and usage of this information in making health decision has the highest average score of 5.83. Analysis of the data related to active seeking of information showed that knowledge of available medical information from each source has the lowest average score of 3.95 and ability in using the acquired information for making medical decisions has the highest average score of 5.28. The paired t-test showed that differences between passive information receipt (41.68 and active information seeking (39.20 considered as statistically significant (P < 0.001. Conclusion: Because diabetic patients are more passive information receivers than active information seekers, the health information must be distributed by passive means to these patients. In addition, information-seeking behavior during different time periods should be investigated; to identify more effective distribution of health information.

  7. Surgical Outcomes for Mastectomy Patients Receiving Neoadjuvant Chemotherapy

    Science.gov (United States)

    Bowen, Megan E.; Mone, Mary C.; Buys, Saundra S.; Sheng, Xiaoming; Nelson, Edward W.

    2017-01-01

    Objective: To evaluate the risk of neoadjuvant chemotherapy for surgical morbidity after mastectomy with or without reconstruction using 1:1 matching. Background: Postoperative surgical complications remain a potentially preventable event for breast cancer patients undergoing mastectomy. Neoadjuvant chemotherapy is among variables identified as contributory to risk, but it has not been rigorously evaluated as a principal causal influence. Methods: Data from American College of Surgeons National Surgical Quality Improvement Program (2006–2012) were used to identify females with invasive breast cancer undergoing planned mastectomy. Surgical cases categorized as clean and undergoing no secondary procedures unrelated to mastectomy were included. A 1:1 matched propensity analysis was performed using neoadjuvant chemotherapy within 30 days of surgery as treatment. A total of 12 preoperative variables were used with additional procedure matching: bilateral mastectomy, nodal surgery, tissue, and/or implant. Outcomes examined were 4 wound occurrences, sepsis, and unplanned return to the operating room. Results: We identified 31,130 patient procedures with 2488 (7.5%) receiving chemotherapy. We matched 2411 cases, with probability of treatment being 0.005 to 0.470 in both cohorts. Superficial wound complication was the most common wound event, 2.24% in neoadjuvant-treated versus 2.45% in those that were not (P = 0.627). The rate of return to the operating room was 5.7% in the neoadjuvant group versus 5.2% in those that were not (P = 0.445). The rate of sepsis was 0.37% in the neoadjuvant group versus 0.46% in those that were not (P = 0.654). Conclusions: This large, matched cohort study, controlled for preoperative risk factors and most importantly for the surgical procedure performed, demonstrates that breast cancer patients receiving neoadjuvant chemotherapy have no increased risk for surgical morbidity. PMID:27280515

  8. Malnourished patients on hemodialysis improve after receiving a nutritional intervention

    Directory of Open Access Journals (Sweden)

    Adaiane Calegari

    2011-12-01

    Full Text Available INTRODUCTION: Malnutrition is multifactorial and may be modified by nutritional intervention. We aimed to assess the impact of an intervention on the nutritional status of malnourished hemodialysis patients and their acceptance of a non-industrialized nutritional supplement. METHODS: 18 patients were studied, they were selected from a previous nutritional assessment where nutritional risk was defined as: subjective global assessment > 15 plus one criterion for malnutrition. The following variables were assessed: anthropometric parameters, subjective global assessment, dietary intake, six-minute walking test, quality of life (SF-36, and biochemical tests. Patients were randomized to either Control or Intervention Groups. The Intervention Group received a dietetic supplement during dialysis containing 355 kcal, prepared from simple ingredients. After three months, subjects from the Control Group and other patients also considered at nutritional risk underwent the same intervention. The study groups were compared after three months, and all patients were analyzed before and after the intervention. RESULTS: Fifteen men and three women, aged 56.4 ± 15.6 years-old, nine in each group, were studied. The Intervention Group showed an improvement in the subjective global assessment (p = 0.04. There were differences in role physical and bodily pain domains of SF-36, with improvement in the Intervention Group and worsening in the Control Group (p = 0.034 and p = 0.021. Comparisons before and after intervention for all patients showed improvement in the subjective global assessment (16.18 ± 4.27 versus 14.37 ± 4.20, p = 0.04, and in the six-minute walking test (496.60 ± 132.59 versus 547.80 ± 132.48 m; p = 0.036. The nutritional supplement was well tolerated by all patients, and it did not cause side effects. CONCLUSIONS: The nutritional intervention improved the subjective global assessment and quality of life of hemodialysis patients at short-term. A

  9. Periodontal disease in a patient receiving Bevacizumab: a case report

    Directory of Open Access Journals (Sweden)

    Gujral Dorothy M

    2008-02-01

    Full Text Available Abstract Introduction Bevacizumab is a monoclonal antibody that inhibits the action of vascular endothelial growth factor (VEGF thereby acting as an angiogenesis inhibitor. As a result, supply of oxygen and nutrients to tissues is impaired and tumour cell growth is reduced. Reported side effects due to bevacizumab are hypertension and increased risk of bleeding. Bowel perforation has also been reported. Periodontal disease in patients on bevacizumab therapy has not been reported before. Case Presentation We report a case of a forty-three year old woman who developed periodontitis whilst receiving bevacizumab for lung cancer. The periodontal disease remained stable on discontinuation of the drug. Conclusion Further investigations are needed to determine the mechanism for bevacizumab-induced periodontal disease.

  10. Evaluation of bleeding in patients receiving direct oral anticoagulants.

    Science.gov (United States)

    Hellenbart, Erika L; Faulkenberg, Kathleen D; Finks, Shannon W

    2017-01-01

    Direct oral anticoagulants (DOACs) are recognized by evidence-based treatment guidelines as the first-line option for the treatment of venous thromboembolism and prevention of stroke and systemic embolism in nonvalvular atrial fibrillation. As use of these anticoagulants has become favored over the past several years, reported bleeding-related adverse drug events with these agents has increased. In randomized clinical trials, all DOACs have a reduced risk for intracranial hemorrhage, while major and other bleeding results have varied among the agents compared to vitamin K antagonists. We have reviewed the bleeding incidence and severity from randomized and real-world data in patients receiving DOACs in an effort to provide the clinician with a critical review of bleeding and offer practical considerations for avoiding adverse events with these anticoagulants.

  11. Creation of complexity assessment tool for patients receiving home care

    Directory of Open Access Journals (Sweden)

    Maria Leopoldina de Castro Villas Bôas

    2016-06-01

    Full Text Available Abstract OBJECTIVE To create and validate a complexity assessment tool for patients receiving home care from a public health service. METHOD A diagnostic accuracy study, with estimates for the tool's validity and reliability. Measurements of sensitivity and specificity were considered when producing validity estimates. The resulting tool was used for testing. Assessment by a specialized team of home care professionals was used as the gold standard. In the tool's reliability study, the authors used the Kappa statistic. The tool's sensitivity and specificity were analyzed using various cut-off points. RESULTS On the best cut-off point-21-with the gold standard, a sensitivity of 75.5% was obtained, with the limits of confidence interval (95% at 68.3% and 82.8% and specificity of 53.2%, with the limits of confidence interval (95% at 43.8% and 62.7%. CONCLUSION The tool presented evidence of validity and reliability, possibly helping in service organization at patient admission, care type change, or support during the creation of care plans.

  12. Carnitine ester excretion in pediatric patients receiving parenteral nutrition.

    Science.gov (United States)

    Schmidt-Sommerfeld, E; Penn, D; Bieber, L L; Kerner, J; Rossi, T M; Lebenthal, E

    1990-08-01

    Carnitine plasma concentrations and the excretion of carnitine and individual carnitine esters were determined in 25 children and adolescents with gastrointestinal diseases receiving carnitine-free parenteral nutrition for at least 1 mo using radiochemical and radioisotopic exchange HPLC methods. Children less than 12-y-old usually had carnitine plasma concentrations less than -2 SD from the normal mean for age, whereas patients greater than 12-y-old had carnitine plasma concentrations within the normal range. Age was the only variable to correlate significantly with plasma carnitine concentrations during parenteral nutrition. Free carnitine (FC) excretion was closely correlated with plasma FC concentrations and minimal at values less than 25 mumols/L. The excretion of FC and short-chain acylcarnitines was reduced by an order of magnitude in younger compared with older patients and controls, but the excretion of "other" acylcarnitines was less affected. Some of the latter were tentatively identified using gas-liquid chromatographic and mass spectroscopic techniques as unsaturated and/or branched medium-chain carnitine esters with a carbon chain of C8-C10. The results suggest that FC and short-chain acylcarnitine are conserved by the kidney in nutritional carnitine deficiency but that there may be an obligatory renal excretion of other carnitine esters that contributes to the development of hypocarnitinemia in the younger age group.

  13. A mathematical prognosis model for pancreatic cancer patients receiving immunotherapy.

    Science.gov (United States)

    Li, Xuefang; Xu, Jian-Xin

    2016-10-07

    Pancreatic cancer is one of the most deadly types of cancer since it typically spreads rapidly and can seldom be detected in its early stage. Pancreatic cancer therapy is thus a challenging task, and appropriate prognosis or assessment for pancreatic cancer therapy is of critical importance. In this work, based on available clinical data in Niu et al. (2013) we develop a mathematical prognosis model that can predict the overall survival of pancreatic cancer patients who receive immunotherapy. The mathematical model incorporates pancreatic cancer cells, pancreatic stellate cells, three major classes of immune effector cells CD8+ T cells, natural killer cells, helper T cells, and two major classes of cytokines interleukin-2 (IL-2) and interferon-γ (IFN-γ). The proposed model describes the dynamic interaction between tumor and immune cells. In order for the model to be able to generate appropriate prognostic results for disease progression, the distribution and stability properties of equilibria in the mathematical model are computed and analysed in absence of treatments. In addition, numerical simulations for disease progression with or without treatments are performed. It turns out that the median overall survival associated with CIK immunotherapy is prolonged from 7 to 13months compared with the survival without treatment, this is consistent with the clinical data observed in Niu et al. (2013). The validity of the proposed mathematical prognosis model is thus verified. Our study confirms that immunotherapy offers a better prognosis for pancreatic cancer patients. As a direct extension of this work, various new therapy methods that are under exploration and clinical trials could be assessed or evaluated using the newly developed mathematical prognosis model.

  14. Alcohol in Primary Care. Differential characteristics between alcohol-dependent patients who are receiving or not receiving treatment.

    Science.gov (United States)

    Barrio, Pablo; Miquel, Laia; Moreno-España, Jose; Martínez, Alicia; Ortega, Lluisa; Teixidor, Lidia; Manthey, Jakob; Rehm, Jürgen; Gual, Antoni

    2016-03-02

    primary health care services for other reasons. The aim of the present study is to describe the differential characteristics of AD patients in primary care, distinguishing between those who receive treatment and those who do not, and their reasons for not seeking it. In a cross-sectional study patients were evaluated by their general practitioner (GP) and interviewed by a member of the research team. Sociodemographic, diagnostic and clinical data were collected. From 1,372 patients interviewed in Catalonia, 118 (8.6%) were diagnosed as AD. These patients showed a lower socioeconomic status (48.3% vs 33.3%, odds ratio 2.02), higher unemployment rates (32.2% vs 19.2 %, odds ratio 2.11), and greater psychological distress and disability. Patients with AD receiving treatment (16.9%), were older (44 vs 36 years of age), reported higher unemployment rates (66% vs 25.5%, odds ratio 6.32) and higher daily alcohol consumption (61.5 vs 23.7 grams), suggesting a more advanced disease. Patients with AD in general showed a higher degree of comorbidity compared to other patients, with patients in treatment showing the most elevated level. The main reasons given for not seeking treatment were shame, fear of giving up drinking and barriers to treatment. Taken together, the data suggest the need to implement earlier strategies for the detection and treatment of AD.

  15. Treatment Outcome in Patients Receiving Assertive Community Treatment

    NARCIS (Netherlands)

    Kortrijk, H. E.; Mulder, C. L.; Roosenschoon, B. J.; Wiersma, D.

    2010-01-01

    In an observational study of severely mentally ill patients treated in assertive community treatment (ACT) teams, we investigated how treatment outcome was associated with demographic factors, clinical factors, and motivation for treatment. To determine psychosocial outcome, patients were routinely

  16. An Evaluation of Hepatotoxicity in Breast Cancer Patients Receiving ...

    African Journals Online (AJOL)

    hanumantp

    breast, stomach, lung, ovaries, thyroid, soft-tissue sarcoma, multiple myeloma, and ... 37% (49/132) of the total female cancer patient population, of which 46 patients with a mean age of 46.6 .... There were no obese patients in this study group.

  17. Improving outcomes for patients receiving transarterial chemoembolization for hepatocellular carcinoma.

    Science.gov (United States)

    McCurdy, Heather M

    2013-01-01

    Hepatocellular carcinoma is a cancer with increasing incidence in the veteran population. This type of cancer can be treated with transarterial chemoembolization, an invasive procedure performed by specially trained interventional radiologists. The most common serious complications are liver failure, sepsis secondary to ischemic cholecystitis or liver abscess, gastrointestinal bleeding, and death. However, nursing staff and physicians often have little or no experience in caring for patients in the hospital who have had this procedure. Patient safety can be threatened by this lack of knowledge. Sources of threat to patient safety are described by the Institute of Medicine as falling into 4 categories: management, workforce, work processes, and organizational culture. To promote patient safety, defenses need to be deployed to address each category. In this article, the author provides a case example, describes threats to the patient's safety, and describes a plan to improve the care of all patients undergoing this procedure.

  18. Patient satisfaction in urology: effects of hospital characteristics, demographic data and patients' perceptions of received care.

    Science.gov (United States)

    Schoenfelder, Tonio; Schaal, Tom; Klewer, Joerg; Kugler, Joachim

    2014-09-06

    To identify factors that are significantly associated with patient satisfaction in urology and to assess the extent to which satisfaction ratings might be related to hospital and patient characteristics. Data used in this study were obtained from 1040 randomly selected urology patients discharged from nine hospitals who responded to a mailed survey. Bivariate and multivariate techniques were used to reveal relations between patient assessments of received care, hospital and patient characteristics. Bivariate analysis showed a strong association between satisfaction scores and length of stay, provider status, work load of nurses and hospital size, with weaker findings pertaining to type of hospital (teaching versus non-teaching) and patient demographics. The multivariate analysis identified nine vari­ables which are associated with overall satisfaction. Strong factors were treatment outcome, the interper­sonal manner of medical practitioners and nurses, as well as hotel aspects like accommodation and quality of food. Variables reflecting information receiving about the undergoing treatment were not found to have a significant influence on patient satisfaction. This study identified variables that are related to satisfaction in a urological setting and de­livers information about aspects of the hospital stay that are not perceived as relevant by patients. These findings support healthcare professionals with valuable information to meet needs and preferences of pa­tients in urology.

  19. Promoting effective communication for patients receiving mechanical ventilation.

    Science.gov (United States)

    Grossbach, Irene; Stranberg, Sarah; Chlan, Linda

    2011-06-01

    Communicating effectively with ventilator-dependent patients is essential so that various basic physiological and psychological needs can be conveyed and decisions, wishes, and desires about the plan of care and end-of-life decision making can be expressed. Numerous methods can be used to communicate, including gestures, head nods, mouthing of words, writing, use of letter/picture boards and common words or phrases tailored to meet individualized patients' needs. High-tech alternative communication devices are available for more complex cases. Various options for patients with a tracheostomy tube include partial or total cuff deflation and use of a speaking valve. It is important for nurses to assess communication needs; identify appropriate alternative communication strategies; create a customized care plan with the patient, the patient's family, and other team members; ensure that the care plan is visible and accessible to all staff interacting with the patient; and continue to collaborate with colleagues from all disciplines to promote effective communication with nonvocal patients.

  20. Underutilization of preventive strategies in patients receiving NSAIDs.

    NARCIS (Netherlands)

    M.C.J.M. Sturkenboom (Miriam); T.A. Burke; J.P. Dieleman (Jeanne); M.J. Tangelder; F. Lee; J.L. Goldstein

    2003-01-01

    textabstractBACKGROUND: Multiple treatment guidelines for non-steroidal anti-inflammatory drugs (NSAIDs) suggest that patients with one or more risk factors for NSAID-associated upper gastrointestinal (UGI) ulcer complications should be prescribed preventive strategies such as

  1. Underutilization of preventive strategies in patients receiving NSAIDs.

    NARCIS (Netherlands)

    M.C.J.M. Sturkenboom (Miriam); T.A. Burke; J.P. Dieleman (Jeanne); M.J. Tangelder; F. Lee; J.L. Goldstein

    2003-01-01

    textabstractBACKGROUND: Multiple treatment guidelines for non-steroidal anti-inflammatory drugs (NSAIDs) suggest that patients with one or more risk factors for NSAID-associated upper gastrointestinal (UGI) ulcer complications should be prescribed preventive strategies such as

  2. Trajectories of personal control in cancer patients receiving psychological care

    NARCIS (Netherlands)

    Zhu, Lei; Schroevers, Maya J.; van der Lee, Marije; Garssen, Bert; Stewart, Roy E.; Sanderman, Robbert; Ranchor, A.V.

    2015-01-01

    Objective This study aimed to (1) identify subgroups of cancer patients with distinct personal control trajectories during psychological care, (2) examine whether socio-demographic, clinical, and psychological care characteristics could distinguish trajectories, and (3) examine differential patterns

  3. Trajectories of personal control in cancer patients receiving psychological care

    NARCIS (Netherlands)

    Zhu, Lei; Schroevers, Maya J.; van der Lee, Marije; Garssen, Bert; Stewart, Roy E.; Sanderman, Robbert; Ranchor, Adelita V.

    2015-01-01

    Objective: This study aimed to (1) identify subgroups of cancer patients with distinct personal control trajectories during psychological care, (2) examine whether socio-demographic, clinical, and psychological care characteristics could distinguish trajectories, and (3) examine differential pattern

  4. Trajectories of personal control in cancer patients receiving psychological care

    NARCIS (Netherlands)

    Zhu, Lei; Schroevers, Maya J.; Lee, van der Marije; Garssen, Bert; Stewart, Roy E.; Sanderman, R.; Ranchor, A.V.

    2015-01-01

    Objective This study aimed to (1) identify subgroups of cancer patients with distinct personal control trajectories during psychological care, (2) examine whether socio-demographic, clinical, and psychological care characteristics could distinguish trajectories, and (3) examine differential patterns

  5. Reduced Need for Rescue Antiemetics and Improved Capacity to Eat in Patients Receiving Acupuncture Compared to Patients Receiving Sham Acupuncture or Standard Care during Radiotherapy

    Science.gov (United States)

    Steineck, Gunnar; Börjeson, Sussanne

    2017-01-01

    Objective. To evaluate if consumption of emesis-related care and eating capacity differed between patients receiving verum acupuncture, sham acupuncture, or standard care only during radiotherapy. Methods. Patients were randomized to verum (n = 100) or sham (n = 100) acupuncture (telescopic blunt sham needle) (median 12 sessions) and registered daily their consumption of antiemetics and eating capacity. A standard care group (n = 62) received standard care only and delivered these data once. Results. More patients in the verum (n = 73 of 89 patients still undergoing radiotherapy; 82%, Relative Risk (RR) 1.23, 95% Confidence Interval (CI) 1.01–1.50) and the sham acupuncture group (n = 79 of 95; 83%, RR 1.24, CI 1.03–1.52) did not need any antiemetic medications, as compared to the standard care group (n = 42 out of 63; 67%) after receiving 27 Gray dose of radiotherapy. More patients in the verum (n = 50 of 89; 56%, RR 1.78, CI 1.31–2.42) and the sham acupuncture group (n = 58 of 94 answering patients; 62%, RR 1.83, CI 1.20–2.80) were capable of eating as usual, compared to the standard care group (n = 20 of 63; 39%). Conclusion. Patients receiving acupuncture had lower consumption of antiemetics and better eating capacity than patients receiving standard antiemetic care, plausible by nonspecific effects of the extra care during acupuncture. PMID:28270851

  6. Surgical Approach, Findings, and Eight-Year Follow-Up in a Twenty-Nine Year Old Female With Freeman-Sheldon Syndrome Presenting With Blepharophimosis Causing Near-Complete Visual Obstruction.

    Science.gov (United States)

    Portillo, Augusto L; Poling, Mikaela I; McCormick, Rodger J

    2016-07-01

    The authors describe the surgical approach, findings, and 8-year follow-up in a 29-year-old woman, with severe Freeman-Sheldon syndrome, presenting with congenital blepharophimosis of both upper eyelids resulting in near-complete functional visual obstruction. To avoid possible Freeman-Sheldon syndrome-associated complications of malignant hyperthermia, difficult vascular access, and challenging endotracheal intubation, the surgery was completed under local anesthesia without sedation, and anatomical and functional correction was immediate and remained stable at 8-year follow-up. Unlike many congenital craniofacial syndromes, which frequently involve life-long impairments, important implications exist for plastic surgeons to facilitate opportunities for patients to overcome functional limitations.

  7. Visceral leishmaniasis in a rheumatoid arthritis patient receiving methotrexate.

    Science.gov (United States)

    Reina, Delia; Cerdà, Dacia; Güell, Elena; Martínez Montauti, Joaquín; Pineda, Antonio; Corominas, Hèctor

    2016-08-11

    Patients with rheumatoid arthritis (RA) treated with disease-modifying antirheumatic drugs are susceptible to severe infections such as leishmaniasis. As L. infantum is endemic in the Mediterranean region, it is necessary to rule this infectious process out in any RA patient presenting with fever and pancytopenia. An early diagnosis based on a high suspicion can prevent a fatal outcome. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  8. Oral care of the cancer patient receiving radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Holtzhausen, T. (Medical Univ. of Southern Africa, Pretoria (South Africa). Dept. of Community Dentistry)

    1982-07-01

    Radiation therapy is frequently being used for the patient with oral cancer. The survival rate is increasing, due to more effective treatment technique. The question of whether any teeth should be extracted, the mode of therapy and the side effects of radiation like Xerostomia, caries, stomatitis, trismus and osteo-radionecrosis and also post radiation care are discussed.

  9. Perioperative Considerations and Management of Patients Receiving Anticoagulants

    Science.gov (United States)

    Shaikh, Safiya Imtiaz; Kumari, R. Vasantha; Hegade, Ganapati; Marutheesh, M.

    2017-01-01

    Anticoagulants remain the primary strategy for the prevention and treatment of thrombosis. Unfractionated heparin, low molecular weight heparin (LMWH), fondaparinux, and warfarin have been studied and employed extensively with direct thrombin inhibitors typically reserved for patients with complications or those requiring interventions. Novel oral anticoagulants have emerged from clinical development and are expected to replace older agents with their ease to use and more favorable pharmacodynamic profiles. Increasingly, anesthesiologists are being requested to anesthetize patients who are on some form of anticoagulants and hence it is important to have sound understanding of pharmacology, dosing, monitoring, and toxicity of anticoagulants. We searched the online databases including PubMed Central, Cochrane, and Google Scholar using anticoagulants, perioperative management, anesthetic considerations, and LMWH as keywords for the articles published between 1994 and 2015 while writing this review. In this article, we will review the different classes of anticoagulants and how to manage them in the perioperative settings.

  10. Cardiotoxicity in Asymptomatic Patients Receiving Adjuvant 5-fluorouracil

    DEFF Research Database (Denmark)

    Nielsen, Karin; Polk, Anne; Nielsen, Dorte Lisbet

    2014-01-01

    Evolving evidence of cardiotoxicity in cancer patients treated with 5-fluorouracil (5-FU) has been reported. We report two different clinical manifestations of asymptomatic 5-FU-associated cardiotoxicity in patients operated for colorectal cancer and treated with adjuvant chemotherapy of 5-FU...... (bolus-injection and continuous infusion for 46 hours), folinic acid and oxaliplatin (FOLFOX). For a research study evaluating cardiac events during 5-FU treatment, Holter monitoring, electrocardiogram (ECG) and echocardiography were done and cardiac markers monitored before and during the first...... and hyperlipidemia as well as an incidental finding of negative T-waves in electrocardiogram years before 5-FU treatment. No subjective cardiac symptoms were described during infusion, but approximately 12 hours after infusion she suffered from cardiac arrest but was revived. Subsequent analysis of the Holter...

  11. [The development of severe methemoglobinemia in patients receiving "Almagel A"].

    Science.gov (United States)

    Starkov, Iu G; Kazennov, V V; Vybornyĭ, M I; Amerov, D B; Shumkina, L V

    2014-01-01

    This clinical case and the literature review show possible development of methemoglobinemia due to the use of local anesthetics, included in drugs for the gastrointestinal diseases treatment, in particular benzocaine, which is the methaemoglobin forming agent. These drugs are common and often taken by the patients themselves without any control. The aim of our paper is to draw the attention of physicians to the risk of the widely known drug administration which can be purchased without a prescription.

  12. Practical management of patients with myelofibrosis receiving ruxolitinib.

    Science.gov (United States)

    Harrison, Claire; Mesa, Ruben; Ross, David; Mead, Adam; Keohane, Clodagh; Gotlib, Jason; Verstovsek, Srdan

    2013-10-01

    Myelofibrosis (MF) is characterized by bone marrow fibrosis, progressive anemia and extramedullary hematopoiesis, primarily manifested as splenomegaly. Patients also experience debilitating constitutional symptoms, including sequelae of splenomegaly, night sweats and fatigue. Ruxolitinib (INC424, INCB18424, Jakafi, Jakavi), a JAK1 and JAK2 inhibitor, was approved in November 2011 by the US FDA for the treatment of intermediate- or high-risk MF, and more recently in Europe and Canada for the treatment of MF-related splenomegaly or symptoms. These approvals were based on data from two randomized Phase III studies: COMFORT-I randomized against placebo, and COMFORT-II randomized against best available therapy. In these studies, ruxolitinib rapidly improved multiple disease manifestations of MF, reducing splenomegaly and improving quality of life of patients and potentially prolonging survival. However, as with other chemotherapies, ruxolitinib therapy is associated with some adverse events, such as anemia and thrombocytopenia. The aims of this article are to provide a brief overview of ruxolitinib therapy, to discuss some common adverse events associated with ruxolitinib therapy and to provide clinical management recommendations to maximize patients' benefit from ruxolitinib.

  13. Fertility preservation in patients receiving cyclophosphamide therapy for renal disease.

    Science.gov (United States)

    Gajjar, Radha; Miller, Steven D; Meyers, Kevin E; Ginsberg, Jill P

    2015-07-01

    Cyclophosphamide continues to have an important role in the treatment of renal disease, including nephrotic syndrome and lupus nephritis, despite known complications of gonadotoxicity and potential infertility in both male and female patients. It is important that the physician recommending this therapy mitigates the effect of the drug on fertility by adhering to recommendations on dosing limits and offering fertility-preserving strategies. In addition to well-established methods, such as sperm banking and embryo cryopreservation, advances in reproductive technology have yielded strategies such as oocyte cryopreservation, resulting in more fertility-preserving options for the pediatric patient. Despite these advances, there continues to be a significant barrier to referral and access to sperm banks and fertility specialists. These issues are further complicated by ethical issues associated with the treatment of pediatric patients. In this review we explore the development of recommended dosing limits and include a discussion of the available fertility-preserving methods, strategies for increasing access to fertility specialists, and the ethical considerations facing the pediatric healthcare provider.

  14. Dental management of patients receiving anticoagulation or antiplatelet treatment.

    Science.gov (United States)

    Pototski, Mariele; Amenábar, José M

    2007-12-01

    Antiplatelet and anticoagulant agents have been extensively researched and developed as potential therapies in the prevention and management of arterial and venous thrombosis. On the other hand, antiplatelet and anticoagulant drugs have also been associated with an increase in the bleeding time and risk of postoperative hemorrhage. Because of this, some dentists still recommend the patient to stop the therapy for at least 3 days before any oral surgical procedure. However, stopping the use of these drugs exposes the patient to vascular problems, with the potential for significant morbidity. This article reviews the main antiplatelet and anticoagulant drugs in use today and explains the dental management of patients on these drugs, when subjected to minor oral surgery procedures. It can be concluded that the optimal INR value for dental surgical procedures is 2.5 because it minimizes the risk of either hemorrhage or thromboembolism. Nevertheless, minor oral surgical procedures, such as biopsies, tooth extraction and periodontal surgery, can safely be done with an INR lower than 4.0.

  15. Doses Received by Patients during Thorax X-Ray Examinations

    Directory of Open Access Journals (Sweden)

    Nsikan U. Esen

    2013-03-01

    Full Text Available Introduction Radiation exposures from diagnostic medical examinations are generally low and are almost always justified by the benefits of accurate diagnosis of possible disease conditions. Therefore, entrance skin dose (ESD, body organ dose (BOD, and effective dose (ED from adult patients undergoing routine thorax posterior-anterior (PA and thorax right lateral (RLAT were estimated in University Hospital, Port Harcourt, Southern Nigeria. Materials and Methods Totally, 102 patients were considered in this work. Using software packages to carry out ESD, BOD, and ED is a recent resource in dosimetry and is being widely used in hospitals. The software used in this work was  CALDose_X 5.0. The software makes use of the technical exposure parameters and the tube output of the X-ray machine. Results The estimated ESD median values were 0.96 and 1.85 mGy for thorax posterior anterior (PA and right lateral (RLAT, respectively. The highest BOD was in the adrenals (270 µGy for thorax PA and Liver (263 µGy for thorax RLAT. Similarly, ED for thorax PA and RLAT examination were 0.068 and 0.107 mGy, respectively. Conclusion It could be observed that examinations that imparted the highest ESD were thorax PA when compared with the established dose level. Therefore, these results call for quality assurance program (QAP in diagnostic X-ray units in Nigeria hospitals.

  16. Pedicle versus free flap reconstruction in patients receiving intraoperative brachytherapy.

    Science.gov (United States)

    Geiger, Erik J; Basques, Bryce A; Chang, Christopher C; Son, Yung; Sasaki, Clarence T; McGregor, Andrew; Ariyan, Stephan; Narayan, Deepak

    2016-08-01

    Introduction This study compared complication rates between pedicle flaps and free flaps used for resurfacing of intraoperative brachytherapy (IOBT) implants placed following head and neck tumour extirpation to help clarify the ideal reconstructive procedure for this scenario. Patients and methods A retrospective review of reconstructions with IOBT at our institution was conducted. Patient and treatment details were recorded, as were the number and type of flap complications, including re-operations. Logistic regressions compared complications between flap groups. Results Fifty free flaps and 55 pedicle flaps were included. On multivariate analysis, free flap reconstruction with IOBT was significantly associated with both an increased risk of having any flap complication (OR = 2.9, p = 0.037) and with need for operative revision (OR = 3.5, p = 0.048) compared to pedicle flap reconstruction. Conclusions In the setting of IOBT, free flaps are associated with an increased risk of having complications and requiring operative revisions.

  17. Plaque, caries level and oral hygiene habits in young patients receiving orthodontic treatment

    DEFF Research Database (Denmark)

    Martignon, S; Ekstrand, K R; Lemos, M I

    2010-01-01

    To assess plaque, caries, and oral hygiene habits amongst patients receiving fixed-orthodontic treatment at the Dental-Clinic, Universidad-El-Bosque, Bogotá, Colombia.......To assess plaque, caries, and oral hygiene habits amongst patients receiving fixed-orthodontic treatment at the Dental-Clinic, Universidad-El-Bosque, Bogotá, Colombia....

  18. Recombinant Human Thrombopoietin Treatment Promotes Hematopoiesis Recovery in Patients with Severe Aplastic Anemia Receiving Immunosuppressive Therapy

    OpenAIRE

    2015-01-01

    Objective. To assess the effectiveness of recombinant human thrombopoietin (rhTPO) in severe aplastic anemia (SAA) patients receiving immunosuppressive therapy (IST). Methods. Eighty-eight SAA patients receiving IST from January 2007 to December 2012 were included in this retrospective analysis. Of these, 40 subjects received rhTPO treatment (15000 U, subcutaneously, three times a week). rhTPO treatment was discontinued when the platelet count returned to normal range. Hematologic response, b...

  19. Peptic ulcer disease and other complications in patients receiving dexamethasone palliation for brain metastasis

    Energy Technology Data Exchange (ETDEWEB)

    Penzner, R.D.; Lipsett, J.A.

    1982-11-01

    A retrospective analysis was done of 106 patients who received radiation therapy for brain metastasis. Dexamethasone therapy was instituted in 97 patients. Peptic ulcer disease developed in 5 of 89 patients (5.6 percent) who received a dosage of at least 12 mg a day, but did not occur in patients who received a lower dose or in those who did not receive steroids. The interval between institution of dexamethasone therapy and the development of peptic ulcer disease ranged from three to nine weeks. Two patients had perforated ulcers, one of whom required surgical resection. Peptic ulcer disease contributed to the general deterioration and death of three of the five patients. Overall, in 14 of the 89 patients (15.7 percent) a complication of steroid therapy developed in the form of peptic ulcer disease, steroid myopathy or diabetes mellitus (or a combination of these).

  20. Recombinant Human Thrombopoietin Treatment Promotes Hematopoiesis Recovery in Patients with Severe Aplastic Anemia Receiving Immunosuppressive Therapy

    Directory of Open Access Journals (Sweden)

    Huaquan Wang

    2015-01-01

    Full Text Available Objective. To assess the effectiveness of recombinant human thrombopoietin (rhTPO in severe aplastic anemia (SAA patients receiving immunosuppressive therapy (IST. Methods. Eighty-eight SAA patients receiving IST from January 2007 to December 2012 were included in this retrospective analysis. Of these, 40 subjects received rhTPO treatment (15000 U, subcutaneously, three times a week. rhTPO treatment was discontinued when the platelet count returned to normal range. Hematologic response, bone marrow megakaryocyte recovery, and time to transfusion independence were compared. Results. Hematologic response was achieved in 42.5%, 62.5%, and 67.5% of patients receiving rhTPO and 22.9%, 41.6%, and 47.9% of patients not receiving rhTPO at 3, 6, and 9 months after treatment, respectively (P = 0.0665, P = 0.0579, and P = 0.0847, resp.. Subjects receiving rhTPO presented an elevated number of megakaryocytes at 3, 6, and 9 months when compared with those without treatment (P = 0.025, P = 0.021, and P = 0.011, resp.. The time to platelet and red blood cell transfusion independence was shorter in patients who received rhTPO than in those without rhTPO treatment. Overall survival rate presented no differences between the two groups. Conclusion. rhTPO could improve hematologic response and promote bone marrow recovery in SAA patients receiving IST.

  1. Predicting postoperative vomiting among orthopedic patients receiving patient-controlled epidural analgesia using SVM and LR.

    Science.gov (United States)

    Wu, Hsin-Yun; Gong, Cihun-Siyong Alex; Lin, Shih-Pin; Chang, Kuang-Yi; Tsou, Mei-Yung; Ting, Chien-Kun

    2016-06-01

    Patient-controlled epidural analgesia (PCEA) has been applied to reduce postoperative pain in orthopedic surgical patients. Unfortunately, PCEA is occasionally accompanied by nausea and vomiting. The logistic regression (LR) model is widely used to predict vomiting, and recently support vector machines (SVM), a supervised machine learning method, has been used for classification and prediction. Unlike our previous work which compared Artificial Neural Networks (ANNs) with LR, this study uses a SVM-based predictive model to identify patients with high risk of vomiting during PCEA and comparing results with those derived from the LR-based model. From January to March 2007, data from 195 patients undergoing PCEA following orthopedic surgery were applied to develop two predictive models. 75% of the data were randomly selected for training, while the remainder was used for testing to validate predictive performance. The area under curve (AUC) was measured using the Receiver Operating Characteristic curve (ROC). The area under ROC curves of LR and SVM models were 0.734 and 0.929, respectively. A computer-based predictive model can be used to identify those who are at high risk for vomiting after PCEA, allowing for patient-specific therapeutic intervention or the use of alternative analgesic methods.

  2. Factors affecting willingness to receive a kidney transplant among hemodialysis patients in West China

    OpenAIRE

    Tan, Qiling; Song, Turun; Jiang, Yamei; Qiu, Yang; Liu, Jingpeng; Huang, Zhongli; Wang, Xianding; Lin, Tao

    2017-01-01

    Abstract Many factors are associated with the willingness of ESRD patients to receive a kidney transplant. No data are available for patients in China. The study aim was to describe the attitudes toward transplantation in a cohort of patients at a single dialysis center in China. A study questionnaire derived from previously published literature was completed by 239 hemodialysis outpatients. Factors associated with willingness to receive a transplant were identified by univariate and multivar...

  3. Serum soluble Klotho level is associated with abdominal aortic calcification in patients on maintenance hemodialysis

    Institute of Scientific and Technical Information of China (English)

    蔡宏

    2013-01-01

    Objective To determine the relationship between serum soluble Klotho(sKL) level and abdominal aortic calcification in maintenance hemodialysis(MHD) patients.Methods One hundred and twenty nine cases of MHD patients were

  4. Five-Year Survival Among Stage IIIA Lung Cancer Patients Receiving Two Different Treatment Modalities.

    Science.gov (United States)

    Bilfinger, Thomas; Keresztes, Roger; Albano, Denise; Nemesure, Barbara

    2016-07-21

    BACKGROUND Five-year survival rates among stage IIIA lung cancer patients range between 2% and 15%, and there is currently no consensus regarding optimal treatment approaches for these patients. The current investigation evaluated survival outcomes among stage IIIA lung cancer patients receiving 2 different treatment modalities, neoadjuvant chemotherapy followed by resection versus chemoradiation alone. MATERIAL AND METHODS This retrospective study is based on 127 patients attending the Lung Cancer Evaluation Center at Stony Brook Cancer Center between 2002 and 2014. Patients were treated either with neoadjuvant chemotherapy followed by resection or a regimen of chemoradiation alone. Kaplan-Meier curves were used to compare survival outcomes between groups and Cox proportional hazard models were used to evaluate treatment effects on survival, while adjusting for possible confounders. RESULTS Approximately one-fourth (n=33) of patients received neoadjuvant chemotherapy followed by surgery, whereas 94 patients received definitive chemoradiation. Patients in the surgical group were found to be significantly younger than those receiving chemoradiation alone (60.1 vs. 67.9 years, respectively; p=0.001). Five-year survival among patients receiving preoperative chemotherapy followed by resection was significantly higher than that among patients receiving chemoradiation alone (63% vs. 19%, respectively; p<0.001), whereas the hazard ratio (HR) was 3-4 times greater in the latter group (HR=3.77, 95% confidence interval=1.87, 7.61). CONCLUSIONS Findings from this study indicate that preoperative chemotherapy followed by resection can improve survival outcomes for stage IIIA lung cancer patients compared with chemoradiation alone. The results reflect a select surgical group of patients; thus, the data highlight the need to develop new therapies that may result in more patients being viable surgical candidates.

  5. Infection Rates among Acute Leukemia Patients Receiving Alternative Donor Hematopoietic Cell Transplantation

    NARCIS (Netherlands)

    Ballen, Karen; Woo Ahn, Kwang; Chen, Min; Abdel-Azim, Hisham; Ahmed, Ibrahim; Aljurf, Mahmoud; Antin, Joseph; Bhatt, Ami S; Boeckh, Michael; Chen, George; Dandoy, Christopher; George, Biju; Laughlin, Mary J; Lazarus, Hillard M; MacMillan, Margaret L; Margolis, David A; Marks, David I; Norkin, Maxim; Rosenthal, Joseph; Saad, Ayman; Savani, Bipin; Schouten, Harry C; Storek, Jan; Szabolcs, Paul; Ustun, Celalettin; Verneris, Michael R; Waller, Edmund K; Weisdorf, Daniel J; Williams, Kirsten M; Wingard, John R; Wirk, Baldeep; Wolfs, Tom; Young, Jo-Anne H; Auletta, Jeffrey; Komanduri, Krishna V; Lindemans, Caroline; Riches, Marcie L

    Alternative graft sources (umbilical cord blood [UCB], matched unrelated donors [MUD], or mismatched unrelated donors [MMUD]) enable patients without a matched sibling donor to receive potentially curative hematopoietic cell transplantation (HCT). Retrospective studies demonstrate comparable

  6. Bone density threshold and other predictors of vertebral fracture in patients receiving oral glucocorticoid therapy.

    NARCIS (Netherlands)

    Staa, T.P. van; Laan, R.F.J.M.; Barton, I.P.; Cohen, S.; Reid, D.M.; Cooper, C.

    2003-01-01

    OBJECTIVE: To evaluate predictors of vertebral fractures, including a threshold for bone mineral density (BMD), in patients receiving oral glucocorticoids (GCs). METHODS: Data were obtained from 2 randomized clinical trials (prevention and treatment trials of risedronate) using similar methods, but

  7. Infection Rates among Acute Leukemia Patients Receiving Alternative Donor Hematopoietic Cell Transplantation

    NARCIS (Netherlands)

    Ballen, Karen; Woo Ahn, Kwang; Chen, Min; Abdel-Azim, Hisham; Ahmed, Ibrahim; Aljurf, Mahmoud; Antin, Joseph; Bhatt, Ami S; Boeckh, Michael; Chen, George; Dandoy, Christopher; George, Biju; Laughlin, Mary J; Lazarus, Hillard M; MacMillan, Margaret L; Margolis, David A; Marks, David I; Norkin, Maxim; Rosenthal, Joseph; Saad, Ayman; Savani, Bipin; Schouten, Harry C; Storek, Jan; Szabolcs, Paul; Ustun, Celalettin; Verneris, Michael R; Waller, Edmund K; Weisdorf, Daniel J; Williams, Kirsten M; Wingard, John R; Wirk, Baldeep; Wolfs, Tom; Young, Jo-Anne H; Auletta, Jeffrey; Komanduri, Krishna V; Lindemans, Caroline; Riches, Marcie L

    2016-01-01

    Alternative graft sources (umbilical cord blood [UCB], matched unrelated donors [MUD], or mismatched unrelated donors [MMUD]) enable patients without a matched sibling donor to receive potentially curative hematopoietic cell transplantation (HCT). Retrospective studies demonstrate comparable outcome

  8. Breakthrough trichosporonosis in patients receiving echinocandins: case report and literature review

    Institute of Scientific and Technical Information of China (English)

    LIAO Yong; Thomas Hartmann; ZHENG Tao; YANG Rong-ya; AO Jun-hong; WANG Wen-ling

    2012-01-01

    Trichosporon species now ranks as the second most common cause of disseminated yeast infections with a high mortality rate.Breakthrough trichosporonosis in patients receiving echinocandins therapy is being recognized recently.We present a case of breakthrough trichosporonosis with acute viral myocarditis while receiving caspofungin therapy.Trichosporon infection should be considered in patients,who have risk factors for invasive fungal infection and develop unexplained clinical manifestations of infection despite treatment with echinocandins.

  9. Comparing the clinical outcomes in patients with atrial fibrillation receiving dual antiplatelet therapy and patients receiving an addition of an anticoagulant after coronary stent implantation

    Science.gov (United States)

    Chaudhary, Nabin; Bundhun, Pravesh Kumar; Yan, He

    2016-01-01

    Abstract Background: Data regarding the clinical outcomes in patients with atrial fibrillation (AF) receiving dual antiplatelet therapy (DAPT) and an anticoagulant in addition to DAPT (DAPT + vitamin K antagonist [VKA]) after coronary stent implantation are still controversial. Therefore, in order to solve this issue, we aim to compare the adverse clinical outcomes in AF patients receiving DAPT and DAPT + VKA after percutaneous coronary intervention and stenting (PCI-S). Methods: Observational studies comparing the adverse clinical outcomes such as major bleeding, major adverse cardiovascular events, stroke, myocardial infarction, all-cause mortality, and stent thrombosis (ST) in AF patients receiving DAPT + VKA therapy, and DAPT after PCI-S have been searched from Medline, EMBASE, and PubMed databases. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to express the pooled effect on discontinuous variables, and the pooled analyses were performed with RevMan 5.3. Results: Eighteen studies consisting of a total of 20,456 patients with AF (7203 patients received DAPT + VKA and 13,253 patients received DAPT after PCI-S) were included in this meta-analysis. At a mean follow-up period of 15 months, the risk of major bleeding was significantly higher in DAPT + VKA group, with OR 0.62 (95% CI 0.50–0.77, P < 0.0001). There was no significant differences in myocardial infarction and major adverse cardiovascular event between DAPT + VKA and DAPT, with OR 1.27 (95% CI 0.92–1.77, P = 0.15) and OR 1.17 (95% CI 0.99–1.39, P = 0.07), respectively. However, the ST, stroke, and all-cause mortality were significantly lower in the DAPT + VKA group, with OR 1.98 (95% CI 1.03–3.81, P = 0.04), 1.59 (95% CI 1.08–2.34, P = 0.02), and 1.41 (95% CI 1.03–1.94, P = 0.03), respectively. Conclusion: At a mean follow-up period of 15 months, DAPT + VKA was associated with significantly lower risk of stroke, ST, and

  10. Phase II Study of Bevacizumab in Patients With HIV-Associated Kaposi's Sarcoma Receiving Antiretroviral Therapy

    Science.gov (United States)

    Uldrick, Thomas S.; Wyvill, Kathleen M.; Kumar, Pallavi; O'Mahony, Deirdre; Bernstein, Wendy; Aleman, Karen; Polizzotto, Mark N.; Steinberg, Seth M.; Pittaluga, Stefania; Marshall, Vickie; Whitby, Denise; Little, Richard F.; Yarchoan, Robert

    2012-01-01

    Purpose Alternatives to cytotoxic agents are desirable for patients with HIV-associated Kaposi's sarcoma (KS). Vascular endothelial growth factor-A (VEGF-A) contributes to KS pathogenesis. We evaluated the humanized anti–VEGF-A monoclonal antibody, bevacizumab, in patients with HIV-KS. Patients and Methods Patients with HIV-KS who either experienced progression while receiving highly active antiretroviral therapy (HAART) for at least 1 month or did not regress despite HAART for at least 4 months were administered bevacizumab 15 mg/kg intravenously on days 1 and 8 and then every 3 weeks. The primary objective was assessment of antitumor activity using modified AIDS Clinical Trial Group (ACTG) criteria for HIV-KS. HIV-uninfected patients were also eligible and observed separately. Results Seventeen HIV-infected patients were enrolled. Fourteen patients had been receiving effective HAART for at least 6 months (median, 1 year). Thirteen patients had advanced disease (ACTG T1), 13 patients had received prior chemotherapy for KS, and seven patients had CD4 count less than 200 cells/μL. Median number of cycles was 10 (range, 1 to 37 cycles); median follow-up was 8.3 months (range, 3 to 36 months). Of 16 assessable patients, best tumor responses observed were complete response (CR) in three patients (19%), partial response (PR) in two patients (12%), stable disease in nine patients (56%), and progressive disease in two patients (12%). Overall response rate (CR + PR) was 31% (95% CI, 11% to 58.7%). Four of five responders had received prior chemotherapy for KS. Over 202 cycles, grade 3 to 4 adverse events at least possibly attributed to therapy included hypertension (n = 7), neutropenia (n = 5), cellulitis (n = 3), and headache (n = 2). Conclusion Bevacizumab is tolerated in patients with HIV-KS and has activity in a subset of patients. PMID:22430271

  11. Supportive Nursing Care and Satisfaction of Patients Receiving Electroconvulsive Therapy: A Randomized Controlled Clinical Trial

    OpenAIRE

    Navidian, Ali; EBRAHIMI, Hossein; Keykha, Roghaieh

    2015-01-01

    Background: Patient satisfaction is the most important criterion in evaluating the quality of care. Besides, its assessment in patients with severe mental disorder treated by electroconvulsive therapy (ECT) is highly appropriate. The ECT is accompanied by lower satisfaction and may exacerbate the patients’ condition. Objectives: The current study aimed to determine the effect of supportive nursing care on the satisfaction of patients receiving ECT. Patients and Methods: This randomized contro...

  12. Clinical outcome in patients with venous thromboembolism receiving concomitant anticoagulant and antiplatelet therapy.

    Science.gov (United States)

    Tzoran, Inna; Brenner, Benjamin; Sakharov, Gleb; Trujillo-Santos, Javier; Lorenzo, Alicia; Madridano, Olga; López-Sáez, Juan Bosco; Monreal, Manuel

    2014-11-01

    Patients with arterial disease receiving antiplatelet agents may develop venous thromboembolism (VTE) and need anticoagulant therapy, although concomitant use of these drugs may increase bleeding risk. We analyzed RIETE data and compared clinical outcomes depending on decision to discontinue or maintain antiplatelet therapy at VTE diagnosis. Consecutive patients with acute VTE were enrolled in RIETE. Only patients receiving antiplatelet therapy at baseline were included in this analysis. Primary outcomes were: rate of subsequent ischemic events, major bleeding or death during anticoagulation course. 1178 patients who received antiplatelet drugs at VTE diagnosis were included. Antiplatelet therapy was discontinued in 62% of patients. During anticoagulation course, patients also receiving antiplatelet therapy had higher rates of lower limb amputations (2.28 vs. 0.21 events per 100 patients-years; pantiplatelet therapy were found to have a significantly higher rate of limb amputations (odds ratio: 15.3; 95% CI: 1.02-229) and an increased number of composite outcomes including all-cause deaths, arterial and VTE events (odds ratio: 1.46; CI: 1.03-2.06), with no differences in major bleeding rate. Concomitant anticoagulant and antiplatelet therapy in patients with VTE and arterial disease is not associated with increased risk for bleeding, recurrent VTE or death. The worse outcome observed in patients who continued antiplatelet therapy requires further investigations. Copyright © 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  13. Metabolic syndrome in patients with severe mental illness undergoing psychiatric rehabilitation receiving high dose antipsychotic medication

    Directory of Open Access Journals (Sweden)

    Bapu V Ravindranath

    2012-01-01

    Full Text Available Background: To review evidence of chronic antipsychotic medication and the association with metabolic syndrome in mentally ill patients. This evidence was used to analyse a cohort of patients with severe mental illness and to deduce a correlation between the prevalence of metabolic syndrome and their dose regimens. Materials and Methods: Twenty-four male patients undergoing Psychiatric rehabilitation underwent a review of current medication and assessment of risk factors for metabolic syndrome. Assessment criteria was based upon National Cholesterol Education Programme expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III (NCEP ATP III criteria, incorporating waist circumference, raised triglycerides, reduced high density lipoprotein, raised blood pressure and fasting blood glucose. PubMed, Nature and Science Direct databases have been used to compile the medical and scientific background on metabolic syndrome and antipsychotic medication and the effect on patients particularly on high dose. Results: Out of 24 patients, 10 patients (41.7% were receiving high dose antipsychotics (HDA and four were on maximum dosage limits of 100%. 8.3% (2/24 patients were receiving only one first generation antipsychotics (FGA, 37.5% (9/24 patients were receiving only one second generation antipsychotic (SGA, 45.8% patients (11/24 were receiving two or more SGA only, and only one patient was receiving two or more FGA. One patient was receiving a combination of FGA and SGA. PRN ("as needed" therapy was not included in this study as their usage was limited. Clozapine was mostly prescribed in these patients (10/24, 41.6%. Four out of the 24 patients refused blood tests therefore were excluded from the following results. In the patients evaluated, 55% (11/20 had confirmed metabolic syndrome. In these patients with metabolic syndrome, 45.4% (5/11 were on HDA and 27.3% (3/11 were on maximum British National

  14. Incidence of anemia in patients diagnosed with solid tumors receiving chemotherapy, 2010–2013

    Science.gov (United States)

    Xu, Hairong; Xu, Lanfang; Page, John H; Cannavale, Kim; Sattayapiwat, Olivia; Rodriguez, Roberto; Chao, Chun

    2016-01-01

    Purpose The purpose of this study was to evaluate and characterize the risk of anemia during the course of chemotherapy among patients with five common types of solid tumors. Patients and methods Patients diagnosed with incident cancers of breast, lung, colon/rectum, stomach, and ovary who received chemotherapy were identified from Kaiser Permanente Southern California Health Plan (2010–2012). All clinical data were collected from the health plan’s electronic medical records. Incidence proportions of patients developing anemia and 95% confidence intervals were calculated overall and by anemia severity and type, as well as by stage at cancer diagnosis, and by chemotherapy regimen and cycle. Results A total of 4,426 patients who received chemotherapy were included. Across cancers, 3,962 (89.5%) patients developed anemia during the course of chemotherapy (normocytic 85%, macrocytic 10%, microcytic 5%; normochromic 47%, hyperchromic 44%, hypochromic 9%). The anemia grades were distributed as follows: 58% were grade 1, 34% grade 2, 8% grade 3, and anemia ranged from 26.3% in colorectal cancer patients to 59.2% in ovarian cancer patients. Incidence of grade 2+ anemia increased from 29% in stage I to 49% in stage IV. Incidence of grade 2+ anemia varied from 18.2% in breast cancer patients treated with cyclophosphamide + docetaxel regimen to 59.7% in patients with ovarian cancer receiving carboplatin + paclitaxel regimen. Conclusion The incidence of moderate-to-severe anemia (hemoglobin anemia was greater in patients with distant metastasis. PMID:27186078

  15. MRI assessment of suppression of structural damage in patients with rheumatoid arthritis receiving rituximab

    DEFF Research Database (Denmark)

    Peterfy, Charles; Emery, Paul; Tak, Paul P;

    2014-01-01

    OBJECTIVE: To evaluate changes in structural damage and joint inflammation assessed by MRI following rituximab treatment in a Phase 3 study of patients with active rheumatoid arthritis (RA) despite methotrexate (MTX) who were naive to biological therapy. METHODS: Patients were randomised to receive...

  16. Tuberculosis chemoprophylaxis in rheumatoid arthritic patients receiving tumor necrosis factor inhibitors or conventional therapy

    Directory of Open Access Journals (Sweden)

    Saad Rabie Samra

    2015-01-01

    Conclusion: There was no significant increased risk for tuberculosis among RA patients receiving anti-TNF therapy when screening and chemoprophylaxis was applied, so screening of RA patients before anti-TNF therapy for latent tuberculosis and TB chemoprophylaxis should be done.

  17. Sex differences in chronic pain management practices for patients receiving opioids from the Veterans Health Administration.

    Science.gov (United States)

    Oliva, Elizabeth M; Midboe, Amanda M; Lewis, Eleanor T; Henderson, Patricia T; Dalton, Aaron L; Im, Jinwoo J; Seal, Karen; Paik, Meenah C; Trafton, Jodie A

    2015-01-01

    Women experience chronic pain and use pain-related health care at higher rates than men. It is not known whether the pain-related health care female veterans receive is consistent with clinical practice guideline recommendations or whether receipt of this care differs between men and women. The aim of this study was to identify whether sex differences in chronic pain management care exist for patients served by the Veterans Health Administration (VHA). Data on patient demographics, diagnostic criteria, and health care utilization were extracted from VHA administrative databases for fiscal year 2010 (FY10). Patients in this study included all VHA patients (excluding metastatic cancer patients) who received more than 90 days of a short-acting opioid medication or a long-acting opioid medication prescription in FY10 study. Multilevel logistic regressions were conducted to identify sex differences in receipt of guideline-recommended chronic pain management. A total of 480,809 patients met inclusion criteria. Female patients were more likely to receive most measures of guideline-recommended care for chronic pain including mental health assessments, psychotherapy, rehabilitation therapy, and pharmacy reconciliation. However, women were more likely to receive concurrent sedative prescriptions, which is inconsistent with guideline recommendations. Most of the observed sex differences persisted after controlling for key demographic and diagnostic differences. Findings suggest that female VHA patients are more likely to receive an array of pain management practices than male patients, including both contraindicated and recommended polypharmacy. Quality improvement efforts to address underutilization of mental health and rehabilitative services for pain by male patients and polypharmacy in female patients should be considered. Wiley Periodicals, Inc.

  18. Colon Cancer Screening among Patients Receiving Dialysis in the United States: Are We Choosing Wisely?

    Science.gov (United States)

    Carlos, Christopher A; McCulloch, Charles E; Hsu, Chi-Yuan; Grimes, Barbara; Pavkov, Meda E; Burrows, Nilka R; Shahinian, Vahakn B; Saran, Rajiv; Powe, Neil R; Johansen, Kirsten L

    2017-08-01

    The American Society of Nephrology recommends against routine cancer screening among asymptomatic patients receiving maintenance dialysis on the basis of limited survival benefit. To determine the frequency of colorectal cancer screening among patients on dialysis and the extent to which screening tests were targeted toward patients at lower risk of death and higher likelihood of receiving a kidney transplant, we performed a cohort study of 469,574 Medicare beneficiaries ages ≥50 years old who received dialysis between January 1, 2007 and September 30, 2012. We examined colorectal cancer screening tests according to quartiles of risk of mortality and kidney transplant on the basis of multivariable Cox modeling. Over a median follow-up of 1.5 years, 11.6% of patients received a colon cancer screening test (57.9 tests per 1000 person-years). Incidence rates of colonoscopy, flexible sigmoidoscopy, and fecal occult blood test were 27.9, 0.6, and 29.5 per 1000 person-years, respectively. Patients in the lowest quartile of mortality risk were more likely to be screened than those in the highest quartile (hazard ratio, 1.53; 95% confidence interval, 1.49 to 1.57; 65.1 versus 46.4 tests per 1000 person-years, respectively), amounting to a 33% higher rate of testing. Additionally, compared with patients least likely to receive a transplant, patients most likely to receive a transplant were more likely to be screened (hazard ratio, 1.68; 95% confidence interval, 1.64 to 1.73). Colon cancer screening is being targeted toward patients on dialysis at lowest risk of mortality and highest likelihood of transplantation, but absolute rates are high, suggesting overscreening. Copyright © 2017 by the American Society of Nephrology.

  19. Occupational Therapy and Physiotherapy in Acute Stroke: Do Rural Patients Receive Less Therapy?

    Directory of Open Access Journals (Sweden)

    Josie Merchant

    2016-01-01

    Full Text Available Objective. To assess whether acute stroke patients in rural hospitals receive less occupational therapy and physiotherapy than those in metropolitan hospitals. Design. Retrospective case-control study of health data in patients ≤10 days after stroke. Setting. Occupational therapy and physiotherapy services in four rural hospitals and one metropolitan hospital. Participants. Acute stroke patients admitted in one health district. Main Outcome Measures. Frequency and duration of face-to-face and indirect therapy sessions. Results. Rural hospitals admitted 363 patients and metropolitan hospital admitted 378 patients. Mean age was 73 years. Those in rural hospitals received more face-to-face (p>0.0014 and indirect (p=0.001 occupational therapy when compared to those in the metropolitan hospital. Face-to-face sessions lasted longer (p=0.001. Patients admitted to the metropolitan hospital received more face-to-face (p>0.000 and indirect (p>0.000 physiotherapy when compared to those admitted to rural hospitals. Face-to-face sessions were shorter (p>0.000. Almost all were seen within 24 hours of referral. Conclusions. Acute stroke patients in Australian rural hospital may receive more occupational therapy and less physiotherapy than those in metropolitan hospitals. The dose of therapy was lower than recommended, and the referral process may unnecessarily delay the time from admission to a patient’s first therapy session.

  20. Dentin hypersensitivity-like tooth pain seen in patients receiving steroid therapy: An exploratory study

    OpenAIRE

    Noriaki Shoji; Yu Endo; Masahiro Iikubo; Tomonori Ishii; Hideo Harigae; Jun Aida; Maya Sakamoto; Takashi Sasano

    2016-01-01

    To ascertain whether steroid therapy evokes dentin hypersensitivity (DH)-like tooth pain, we performed a study based on compelling evidence from patients receiving steroid therapy. An exploratory study was conducted using a questionnaire for 220 patients prescribed steroids who attended the Department of Hematology and Rheumatology of Tohoku University Hospital. Group comparisons between patients with and without steroid pulse therapy were analysed by statistical means. In this study, any DH-...

  1. Reductions in Anaemia and Fatigue are Associated with Improvements in Productivity in Cancer Patients Receiving Chemotherapy

    OpenAIRE

    2005-01-01

    Objective: Cancer-related anaemia is associated with fatigue that adversely affects patients' everyday functioning and wellbeing. We explore the impact of fatigue on patient productivity and caregiver burden. Methods: The analyses are based on data from a randomised, open-label, active-controlled, dose-finding trial of darbepoetin alfa among solid-tumour cancer patients with anaemia, who are receiving chemotherapy. Fatigue is assessed with the Functional Assessment of Cancer Therapy (FACT)-Fa...

  2. Indacaterol therapy in patients with COPD not receiving other maintenance treatment.

    Science.gov (United States)

    Decramer, Marc; Rossi, Andrea; Lawrence, David; McBryan, Danny

    2012-12-01

    Recent findings of rapid lung function decline in younger patients with moderate COPD severity suggest the need for effective early treatment. To evaluate the effectiveness of indacaterol as maintenance therapy in COPD patients not receiving other maintenance treatments. Pooled data from three randomised, placebo-controlled studies provided a population of patients with moderate-to-severe COPD not receiving maintenance treatment at baseline and who received once-daily, double-blind treatment with indacaterol 150 μg, indacaterol 300 μg or placebo. Data from an open-label tiotropium treatment arm in one study were available for comparison. Efficacy evaluations included trough FEV₁, dyspnoea (transition dyspnoea index, TDI) and health status (St George's Respiratory Questionnaire, SGRQ) at 6 months and risk of COPD exacerbations. The maintenance-naïve population comprised 232 (indacaterol 150 μg), 220 (indacaterol 300 μg) and 325 (placebo) patients, plus 156 (tiotropium) (30% of overall study population). Patients treated with indacaterol 150 and 300 μg had statistically significant improvements relative to placebo (p Indacaterol, given to patients with moderate-to-severe COPD not receiving other maintenance treatments, provided effective bronchodilation with significant, clinically relevant improvements in dyspnoea and health status compared with placebo. Copyright © 2012 Elsevier Ltd. All rights reserved.

  3. Flucytosine Pharmacokinetics in a Critically Ill Patient Receiving Continuous Renal Replacement Therapy.

    Science.gov (United States)

    Kunka, Megan E; Cady, Elizabeth A; Woo, Heejung C; Thompson Bastin, Melissa L

    2015-01-01

    Purpose. A case report evaluating flucytosine dosing in a critically ill patient receiving continuous renal replacement therapy. Summary. This case report outlines an 81-year-old male who was receiving continuous venovenous hemofiltration (CVVH) for acute renal failure and was being treated with flucytosine for the treatment of disseminated Cryptococcus neoformans infection. Due to patient specific factors, flucytosine was empirically dose adjusted approximately 50% lower than intermittent hemodialysis (iHD) recommendations and approximately 33% lower than CRRT recommendations. Peak and trough levels were obtained, which were supratherapeutic, and pharmacokinetic parameters were calculated. The patient experienced thrombocytopenia, likely due to elevated flucytosine levels, and flucytosine was ultimately discontinued. Conclusion. Despite conservative flucytosine dosing for a patient receiving CVVH, peak and trough serum flucytosine levels were supratherapeutic (120 μg/mL at 2 hours and 81 μg/mL at 11.5 hours), which increased drug-related adverse effects. The results indicate that this conservative dosing regimen utilizing the patient's actual body weight was too aggressive. This case report provides insight into flucytosine dosing in CVVH, a topic that has not been investigated previously. Further pharmacokinetic studies of flucytosine dosing in critically ill patients receiving CVVH are needed in order to optimize pharmacokinetic and pharmacodynamic parameters while avoiding toxic flucytosine exposure.

  4. Essential fatty acid deficiency in patients receiving home parenteral nutrition 1,2

    DEFF Research Database (Denmark)

    Jeppesen, P. B.; Høy, Carl-Erik; Mortensen, Per B

    1998-01-01

    Home parenteral nutrition (HPN), initiated in patients with severe malabsorption or decreased oral intake, may exhaust stores of essential fatty acids and cause clinical manifestations, mainly dermatitis. Plasma fatty acid profiles were measured by gas-liquid chromatography in 37 healthy control...... of essential fatty acid deficiency (EFAD). The effect of parenteral lipid on plasma phospholipids was evaluated in subgroups of patients. In patients with > 200 cm of remaining small intestine, those receiving parenteral lipids had only minor changes in the fatty acids of plasma phospholipids compared...... with patients not receiving parenteral lipids. In patients with parenteral lipids had increased concentrations of total n-6 fatty acids; however, these did not reach the concentrations in control subjects. No differences were seen in n-3 fatty acids. Twenty...

  5. Identifying drivers of overall satisfaction in patients receiving HIV primary care: a cross-sectional study.

    Directory of Open Access Journals (Sweden)

    Bich N Dang

    Full Text Available OBJECTIVE: This study seeks to understand the drivers of overall patient satisfaction in a predominantly low-income, ethnic-minority population of HIV primary care patients. The study's primary aims were to determine 1 the component experiences which contribute to patients' evaluations of their overall satisfaction with care received, and 2 the relative contribution of each component experience in explaining patients' evaluation of overall satisfaction. METHODS: We conducted a cross-sectional study of 489 adult patients receiving HIV primary care at two clinics in Houston, Texas, from January 13-April 21, 2011. The participation rate among eligible patients was 94%. The survey included 15 questions about various components of the care experience, 4 questions about the provider experience and 3 questions about overall care. To ensure that the survey was appropriately tailored to our clinic population and the list of component experiences reflected all aspects of the care experience salient to patients, we conducted in-depth interviews with key providers and clinic staff and pre-tested the survey instrument with patients. RESULTS: Patients' evaluation of their provider correlated the strongest with their overall satisfaction (standardized β = 0.445, p<0.001 and accounted for almost half of the explained variance. Access and availability, like clinic hours and ease of calling the clinic, also correlated with overall satisfaction, but less strongly. Wait time and parking, despite receiving low patient ratings, did not correlate with overall satisfaction. CONCLUSIONS: The patient-provider relationship far exceeds other component experiences of care in its association with overall satisfaction. Our study suggests that interventions to improve overall patient satisfaction should focus on improving patients' evaluation of their provider.

  6. Patients receiving lithium therapy have a reduced prevalence of neurological and cardiovascular disorders.

    Science.gov (United States)

    Prosser, James M; Fieve, Ronald R

    2016-11-03

    A variety of evidence from laboratory and animal studies suggests that lithium has neurotrophic and cytoprotective properties, and may ameliorate or prevent some disease states. We investigated whether such a protective effect can be observed in human psychiatric patients receiving lithium therapy. We carried out a retrospective chart review of 1028 adult psychiatric male and female outpatients attending four lithium clinics in metropolitan New York City. Patients were divided into two groups based on lithium usage, and the prevalence of neurological and cardiovascular disorders was compared. The main outcome measures were the occurrence in the two patient groups of a variety of neurological disorders and myocardial infarction. Odds ratios were calculated to assess the risk of having a disorder for patients receiving lithium compared to patients not receiving lithium: for seizures, the odds ratio was 0.097; for amyotrophic lateral sclerosis, the odds ratio was 0.112; for dementia not otherwise specified, the odds ratio was 0.112; and for myocardial infarction, the odds ratio was 0.30. Logistical regression analysis showed that lithium treatment is a significant negative predictive factor in the prevalence of each of these disease states, when age, duration of clinic attendance, and use of anti-psychotic medications are taken into account. Our results show that patients receiving regular lithium treatment have a reduced prevalence of some neurological disorders and myocardial infarctions. One possible explanation of these results is that a protective effect of lithium observed in laboratory and animal studies may also be present in human patients receiving regular lithium therapy. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Flucytosine Pharmacokinetics in a Critically Ill Patient Receiving Continuous Renal Replacement Therapy

    Directory of Open Access Journals (Sweden)

    Megan E. Kunka

    2015-01-01

    Full Text Available Purpose. A case report evaluating flucytosine dosing in a critically ill patient receiving continuous renal replacement therapy. Summary. This case report outlines an 81-year-old male who was receiving continuous venovenous hemofiltration (CVVH for acute renal failure and was being treated with flucytosine for the treatment of disseminated Cryptococcus neoformans infection. Due to patient specific factors, flucytosine was empirically dose adjusted approximately 50% lower than intermittent hemodialysis (iHD recommendations and approximately 33% lower than CRRT recommendations. Peak and trough levels were obtained, which were supratherapeutic, and pharmacokinetic parameters were calculated. The patient experienced thrombocytopenia, likely due to elevated flucytosine levels, and flucytosine was ultimately discontinued. Conclusion. Despite conservative flucytosine dosing for a patient receiving CVVH, peak and trough serum flucytosine levels were supratherapeutic (120 μg/mL at 2 hours and 81 μg/mL at 11.5 hours, which increased drug-related adverse effects. The results indicate that this conservative dosing regimen utilizing the patient’s actual body weight was too aggressive. This case report provides insight into flucytosine dosing in CVVH, a topic that has not been investigated previously. Further pharmacokinetic studies of flucytosine dosing in critically ill patients receiving CVVH are needed in order to optimize pharmacokinetic and pharmacodynamic parameters while avoiding toxic flucytosine exposure.

  8. Factors associated with knowledge and safety skills of arthritis patients receiving biologics: A survey of 677 patients.

    Science.gov (United States)

    Rat, Anne-Christine; Fautrel, Bruno; Flipon, Elisabeth; Gossec, Laure; Marguerie, Laurent; Nataf, Henri; Pallot-Prades, Béatrice; Poilvert, Rose-Marie; Royant, Valérie; Sadji, Fatiha; Sordet, Christelle; Thevenot, Corinne; Beauvais, Catherine

    2017-03-01

    We aimed to determine patient and rheumatologist factors associated with the safety skills of patients receiving bDMARDs for inflammatory arthritis. Data were obtained from a descriptive observational cross-sectional nationwide survey performed in 2011 in France. Community- and hospital-based rheumatologists were selected at random. The BioSecure questionnaire was used to collect information on patient safety skills. Of the 677 patients included (mean age 53±13years old; 452 (67%) women, 411 (61%) had RA; 421 (64%) received subcutaneous bDMARDs). Patients had received information about their treatments from their physician 610 (90%), a nurse 207 (31%), by a written booklet 398 (59%), and/or during therapeutic patient education (TPE) sessions 99 (15%). The median BioSecure total score was 72/100 (IQR 60-82). In total, 99 (16.4%) patients had a low skill level; 321 (53.2%) a moderate skill level and 183 (30.3%) a high skill level. On multivariate regression analysis, as compared with high safety skills, low skills were associated with living alone (OR 2.8 [95% CI 1.3⿿6.0]), low educational level (OR 4.3 [2.1⿿8.9]), living in a large city (OR 3.1 [1.2⿿8.2]), being unemployed (OR 3.3 [1.6⿿6.7]) and not receiving written information, participating in TPE sessions or consulting a nurse (OR 3.8 [1.6⿿8.8]). One rheumatologist-related factor was a high number of patients receiving bDMARDs in the practice. We reveal factors associated with low safety skills of patients receiving bDMARDs for inflammatory arthritis, which should be addressed to improve safety skills in this population. Copyright © 2016 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  9. Pharmacokinetics of Peramivir in an Adolescent Patient Receiving Continuous Venovenous Hemodiafiltration

    OpenAIRE

    Dillon, Ryan C.; Witcher, Robert; Cies, Jeffrey J.; Moore, Wayne S.; Chopra, Arun

    2017-01-01

    Critically ill patients requiring renal replacement therapy commonly experience pharmacokinetic alterations. This case report describes the pharmacokinetics of peramivir (Rapivab, BioCryst Pharmaceuticals, Inc, Durham, NC), the first US Food and Drug Administration?approved intravenous neuraminidase inhibitor for the treatment of influenza, in an adolescent patient receiving continuous renal replacement therapy (CRRT). A 49.5-kg, 17-year-old Caucasian female presented with fever, cough, and p...

  10. Predictors of mortality in patients with extensively drug-resistant Acinetobacter baumannii pneumonia receiving colistin therapy.

    Science.gov (United States)

    Choi, Ik Sung; Lee, Yu Ji; Wi, Yu Mi; Kwan, Byung Soo; Jung, Kae Hwa; Hong, Woong Pyo; Kim, June Myong

    2016-08-01

    The ratio of the area under the free (unbound) concentration-time curve to minimum inhibitory concentration (fAUC/MIC) was proposed to be the pharmacokinetic/pharmacodynamic index most strongly linked to the antibacterial effect of colistin against Acinetobacter baumannii. A retrospective study of patients who received colistin to treat pneumonia caused by extensively drug-resistant (XDR) A. baumannii over a 4-year period was performed to assess the impact of the colistin MIC on mortality. A total of 227 patients were included in the analysis. The 7-day and 14-day mortality rates of patients with XDR A. baumannii pneumonia receiving colistin therapy were 15.0% and 23.8%, respectively. In the multivariate analysis, Acute Physiology and Chronic Health Evaluation (APACHE) II score, days from index culture to first dose of colistin, underlying tumour and septic shock at presentation were independent predictors of mortality in patients with XDR A. baumannii pneumonia receiving colistin therapy. In the univariate analysis, the colistin dose based on ideal body weight (IBW) correlated with patient outcome. Therefore, the use of IBW appeared to be more appropriate to calculate the colistin dosage. In addition, these results highlight the clinical significance of colistin MIC in patients with XDR A. baumannii pneumonia receiving colistin therapy. Although MICs were in the 'susceptible' range, patients infected with isolates with high colistin MICs showed a poorer clinical response rate than patients infected with isolates with low colistin MICs. Further clinical studies are needed to evaluate the roles of colistin MIC for predicting mortality in XDR A. baumannii pneumonia with a high colistin MIC.

  11. Iatrogenic Cushing syndrome after intra-articular triamcinolone in a patient receiving ritonavir-boosted darunavir.

    Science.gov (United States)

    Hall, Jill J; Hughes, Christine A; Foisy, Michelle M; Houston, Stan; Shafran, Stephen

    2013-09-01

    Drug interactions involving human immunodeficiency virus protease inhibitors are common due to their inhibition of the cytochrome P450 3A4 isoenzyme. We describe the case of an HIV-infected patient treated with ritonavir-boosted darunavir who developed cushingoid features following an intra-articular injection of triamcinolone acetate. We review the probable mechanism for this interaction and describe similar cases of Cushing syndrome in patients receiving concomitant ritonavir and triamcinolone.

  12. Caregiver Burden in Patients Receiving Ranibizumab Therapy for Neovascular Age Related Macular Degeneration

    OpenAIRE

    Rishma Gohil; Roxanne Crosby-Nwaobi; Angus Forbes; Ben Burton; Phil Hykin; Sobha Sivaprasad

    2015-01-01

    Purpose To assess the caregiver burden and factors determining the burden in patients receiving ranibizumab therapy for neovascular AMD (nAMD). Methods This is a cross-sectional questionnaire survey of 250 matched patient caregiver dyads across three large ophthalmic treatment centres in United Kingdom. The primary outcome was the subjective caregiver burden measured using caregiver reaction assessment scale (CRA). Objective caregiver burden was determined by the caregiver tasks and level of ...

  13. Outcome of Inhaler Withdrawal in Patients Receiving Triple Therapy for COPD

    OpenAIRE

    Kim, Sae Ahm; Lee, Ji-Hyun; Kim, Eun-Kyung; Kim, Tae-Hyung; Kim, Woo Jin; Lee, Jin Hwa; Yoon, Ho Il; Baek, Seunghee; Lee, Jae Seung; Oh, Yeon-Mok; Lee, Sang-Do

    2015-01-01

    Background The purpose of this study was to document outcomes following withdrawal of a single inhaler (step-down) in chronic obstructive pulmonary disease (COPD) patients on triple therapy (long-acting muscarinic antagonist and a combination of long-acting β2-agonists and inhaled corticosteroid), which a common treatment strategy in clinical practice. Methods Through a retrospective observational study, COPD patients receiving triple therapy over 2 years (triple group; n=109) were compared w...

  14. Recall of UVB-induced erythema in breast cancer patient receiving multiple drug chemotherapy

    DEFF Research Database (Denmark)

    Andersen, Klaus Ejner; Lindskov, R

    1984-01-01

    One day after sunbathing, a breast cancer patient received intravenous methotrexate, cyclophosphamide and 5-fluorouracil and had a recall of her UV erythema over the following week. Phototesting with UVA and UVB prior to and after a subsequent chemotherapy treatment showed a UVB-induced recall of...

  15. Acupressure in Controlling Nausea in Young Patients Receiving Highly Emetogenic Chemotherapy | Division of Cancer Prevention

    Science.gov (United States)

    RATIONALE: Acupressure wristbands may prevent or reduce nausea and caused by chemotherapy. It is not yet known whether standard care is more effective with or without acupressure wristbands in controlling acute and delayed nausea. PURPOSE: This randomized phase III trial is studying how well acupressure wristbands work with or without standard care in controlling nausea in young patients receiving highly emetogenic chemotherapy. |

  16. Incidence of cardiac conduction disorders in patients with rheumatic disease receiving hydroxychloroquine

    Directory of Open Access Journals (Sweden)

    Vijaya Prasanna Parimi

    2015-06-01

    Conclusion: This study highlights need for periodic cardiac evaluation of patients receiving long-term antimalarials. Reversibility of antimalarial toxicity is also highlighted in this study. Conduction disorders observed were similar to that expected in general population thus adding further evidence on safety of HCQ. [Int J Basic Clin Pharmacol 2015; 4(3.000: 565-567

  17. Portraits of Caregivers of End-Stage Dementia Patients Receiving Hospice Care

    Science.gov (United States)

    Sanders, Sara; Butcher, Howard K.; Swails, Peggy; Power, James

    2009-01-01

    The purpose of this study was to investigate how caregivers respond to the end stages of dementia with the assistance from hospice. Data were collected from 27 family caregivers over the course of 10 months, with each caregiver being interviewed up to 4 times during the time that the patient received hospice care. Chart review data were also…

  18. Septic arthritis due to Roseomonas mucosa in a rheumatoid arthritis patient receiving infliximab therapy.

    Science.gov (United States)

    Sipsas, Nikolaos V; Papaparaskevas, Joseph; Stefanou, Ioanna; Kalatzis, Konstantinos; Vlachoyiannopoulos, Panayiotis; Avlamis, Athina

    2006-08-01

    We report a case of septic arthritis due to Roseomonas mucosa in a rheumatoid arthritis patient receiving infliximab therapy. This is the first report of septic arthritis due to R. mucosa, and infliximab therapy might be a predisposing factor because this infection was never reported in the pre-anti-tumor necrosis factor alpha therapy period.

  19. A systematic review of oral fungal infections in patients receiving cancer therapy

    NARCIS (Netherlands)

    Lalla, Rajesh V.; Latortue, Marie C.; Hong, Catherine H.; Ariyawardana, Anura; D'Amato-Palumbo, Sandra; Fischer, Dena J.; Martof, Andrew; Nicolatou-Galitis, Ourania; Patton, Lauren L.; Elting, Linda S.; Spijkervet, Fred K. L.; Brennan, Michael T.

    The aims of this systematic review were to determine, in patients receiving cancer therapy, the prevalence of clinical oral fungal infection and fungal colonization, to determine the impact on quality of life and cost of care, and to review current management strategies for oral fungal infections.

  20. Cognitive/Attentional Distraction in the Control of Conditioned Nausea in Pediatric Cancer Patients Receiving Chemotherapy.

    Science.gov (United States)

    Redd, William H.; And Others

    1987-01-01

    Investigated use of cognitive/attentional distraction (via commercially available video games) to control conditioned nausea in pediatric cancer patients receiving chemotherapy. Video game-playing resulted in significantly less nausea. The introduction and withdrawal of the opportunity to play video games produced significant changes (reduction…

  1. Reduced corticosteroid use in adult patients with primary immune thrombocytopenia receiving romiplostim

    NARCIS (Netherlands)

    M. Michel (Marc); P.A.W. te Boekhorst (Peter); A. Janssens (Andre); I. Pabinger-Fasching (Ingrid); M.A. Sanz (Miguel Angel); K. Nie (Kun); G. Kreuzbauer (Georg)

    2011-01-01

    textabstractAdult patients with primary immune thrombocytopenia requiring first-line treatment typically receive corticosteroids, which are associated with low response rates and many potential side effects. In a retrospective analysis of two 6-month, placebo-controlled, phase III trials, corticoste

  2. A systematic review of oral fungal infections in patients receiving cancer therapy

    NARCIS (Netherlands)

    Lalla, Rajesh V.; Latortue, Marie C.; Hong, Catherine H.; Ariyawardana, Anura; D'Amato-Palumbo, Sandra; Fischer, Dena J.; Martof, Andrew; Nicolatou-Galitis, Ourania; Patton, Lauren L.; Elting, Linda S.; Spijkervet, Fred K. L.; Brennan, Michael T.

    2010-01-01

    The aims of this systematic review were to determine, in patients receiving cancer therapy, the prevalence of clinical oral fungal infection and fungal colonization, to determine the impact on quality of life and cost of care, and to review current management strategies for oral fungal infections. T

  3. 75 FR 20511 - Respecting the Rights of Hospital Patients to Receive Visitors and to Designate Surrogate...

    Science.gov (United States)

    2010-04-20

    ... origin, religion, sex, sexual orientation, gender identity, or disability. The rulemaking should take... Documents#0;#0; #0; #0;Title 3-- #0;The President ] Memorandum of April 15, 2010 Respecting the Rights of...' Bill of Rights to give each patient ``the right to designate visitors who shall receive the...

  4. Postpancreatectomy Hemorrhage After Pancreatic Surgery in Patients Receiving Anticoagulation or Antiplatelet Agents.

    Science.gov (United States)

    Mita, Kazuhito; Ito, Hideto; Takahashi, Koudai; Hashimoto, Masatoshi; Nagayasu, Kiichi; Murabayashi, Ryo; Asakawa, Hideki; Koizumi, Kazuya; Hayashi, Takashi; Fujino, Keiichi

    2016-06-01

    Background Postpancreatectomy hemorrhage (PPH) is a serious complication after pancreatic surgery. In this study, we evaluated PPH and thromboembolic complications after pancreatic surgery in patients with perioperative antithrombotic treatment. Methods Medical records of patients undergoing pancreatic surgery were reviewed retrospectively. Patients receiving thromboprophylaxis were given either bridging therapy with unfractionated heparin or continued on aspirin as perioperative antithrombotic treatment according to clinical indications and published recommendations. The International Study Group of Pancreatic Surgery definition of PPH was used. Risk factors associated with PPH were assessed by multivariate analysis. Results Thirty-four of 158 patients received perioperative antithrombotic treatment; this group had a significantly higher PPH rate (29.4% vs 6.5%, P = .001) and mortality (11.8% vs 2.4%, P = .039) than patients not receiving thromboprophylaxis. Multivariate analysis revealed that perioperative antithrombotic treatment was the only independent risk factor for PPH after pancreatic surgery (odds ratio 4.77; 95% CI 1.61-14.15; P = .005). Conclusions Perioperative antithrombotic treatment is an independent risk factor for PPH in patients undergoing pancreatic surgery, although this treatment effectively prevents postoperative thromboembolic events.

  5. Reversible skeletal disease and high fluoride serum levels in hematologic patients receiving voriconazole.

    Science.gov (United States)

    Gerber, Bernhard; Guggenberger, Roman; Fasler, David; Nair, Gayathri; Manz, Markus G; Stussi, Georg; Schanz, Urs

    2012-09-20

    We here investigate the occurrence of fluoride intake-associated alterations in patients with hematologic disease on triazol antifungal medication. Clinical, laboratory, and radiology data of overall 43 patients with hematologic malignancies taking voriconazole (n = 20), posaconazole (n = 8), and itraconazole (n = 4), and a hematologic patient control group (n = 11) are described. Bone pain and radiologic evidence of periostitis were exclusively observed in patients receiving long-term voriconazole. Cessation of treatment led to clinical improvement in all cases. In line with clinical evidence, fluoride serum concentration was elevated in patients receiving voriconazole (median, 156.5 μg/L; interquartile range, 96.8 μg/L; normal < 30 μg/L) but not in the other treatment groups (P < .001 for all comparisons vs voriconazole). We conclude that serum fluoride levels were elevated on average 5-fold above normal levels in hematologic patients receiving voriconazole. Clinically relevant skeletal disease was associated with renal insufficiency and above 10-fold elevated fluoride levels, and was reversible on termination of voriconazole treatment.

  6. Improving adherence with oral antiemetic agents in patients with breast cancer receiving chemotherapy.

    Science.gov (United States)

    Hendricks, Carolyn B

    2015-05-01

    In this small breast cancer-dedicated solo practice, a retrospective medical record review disclosed the following: significant rate of chemotherapy-related nausea and vomiting and discordance between patient-reported compliance with prescribed antiemetics and medical record documentation of compliance. As part of the curriculum for the American Society of Clinical Oncology (ASCO) Quality Training Program, a quality improvement project was developed to improve adherence to oral antiemetics in our patients with breast cancer receiving highly emetogenic chemotherapy. The following steps were undertaken in plan-do-study-act cycles to improve adherence: enhanced patient education at time of chemotherapy consent, implementation of standardized in-person or e-mail contact with our patients receiving chemotherapy, and improvement of our electronic health record documentation of adherence to oral antiemetics. A run chart was generated to analyze our data. After our interventions, the percentage of patients who took their antiemetics as prescribed rose from a baseline of 49% to 79%. Significant improvement in adherence to oral antiemetics among patients with breast cancer receiving chemotherapy was achieved and sustained in this small-practice setting using the framework provided by participation in the ASCO Quality Training Program. Copyright © 2015 by American Society of Clinical Oncology.

  7. 胸腔镜下胸交感干并旁路纤维切断术治疗原发性手汗症29例%Twenty-nine cases primary palmar hyperhidrosis treatment by thoracoscopic thoracic sympathetic trunk and kuntz beam cut off

    Institute of Scientific and Technical Information of China (English)

    张东东; 洪丰; 江春苗

    2012-01-01

    目的:探讨胸腔镜下胸交感干并旁路纤维切断术治疗原发性手汗症的疗效和预防术后并发症的措施.方法:回顾性分析29例原发性手汗症手术,对相关临床资料进行比较分析.结果:全组无手术死亡和严重并发症,术后手掌多汗症状消失,无复发病例,术后有2例出现轻度代偿性出汗,1例出现中度代偿性出汗,无重度代偿性出汗病例.结论:胸腔镜下胸交感干并旁路纤维切断术是治疗原发性手汗症安全有效的微创方法.%Aim: Explore the treatment of primary palmar hyperhidrosis efficacy and prevention of postoperative complications by thoracoscopic thoracic sympathetic trunk and kuntz beam amputation. Methods; Twenty-nine cases of primary palmar hyperhidrosis symptoms underwent surgery and clinical data were analysed. Results; No operative death and serious complications, palm hyperhidrosis symptoms disappeared postoperatively, no recurrence, 2 cases of mild compensatory sweating, 1 case of moderate compensatory sweating, no severe compensatory sweating cases. Conclusion:Thoracoscopic thoracic sympathetic trunk and kuntz beam amputation is safe and effective minimal invasive method for the treatment of primary palmar hyperhidrosis.

  8. Side effects in melanoma patients receiving adjuvant interferon alfa-2b therapy: a nurse's perspective.

    Science.gov (United States)

    Rubin, Krista M; Vona, Karen; Madden, Kathleen; McGettigan, Suzanne; Braun, Ilana M

    2012-08-01

    The aim of this review was to examine the toxicity profile of adjuvant interferon (IFN) alfa-2b in melanoma patients from a nursing perspective and to summarize practical information to guide the effective management of common IFN toxicities to improve patient comfort. This is a narrative summary of both research and review articles identified by searching PubMed, National Cancer Institute, and American Cancer Society websites. It also assesses recognized guidelines on the management of adjuvant IFN toxicity relevant to nurses who are caring for patients receiving adjuvant IFN therapy. Adjuvant high-dose IFN alfa-2b (HDI) as compared with observation significantly prolongs relapse-free survival in patients with melanoma at high risk for recurrence after surgical resection; however, treatment compliance and patient quality of life can be compromised by its toxicity profile. HDI toxicities affect a number of organ systems and the majority of patients will experience some side effects. Common toxicities such as flu-like symptoms, fatigue, anorexia, neuropsychiatric symptoms, and laboratory abnormalities are discussed, along with both pharmacological and nonpharmacological management strategies. The considerable side effects of HDI can be managed using established strategies. Oncology nurses play a significant role in the management of patients with melanoma receiving adjuvant HDI, and their prompt recognition of side effects, together with an understanding of effective pharmacological and nonpharmacological interventions, will improve patient comfort; this has the potential to positively influence treatment adherence and completion of the recommended treatment course.

  9. Posaconazole plasma concentration in pediatric patients receiving antifungal prophylaxis after allogeneic hematopoietic stem cell transplantation.

    Science.gov (United States)

    Heinz, Werner J; Cabanillas Stanchi, Karin M; Klinker, Hartwig; Blume, Olivia; Feucht, Judith; Hartmann, Ulrike; Feuchtinger, Tobias; Lang, Peter; Handgretinger, Rupert; Döring, Michaela

    2016-02-01

    Posaconazole has been proven to be effective for antifungal prophylaxis in adults after hematopoietic stem cell transplantation (HSCT). Due to low gastrointestinal resorption of posaconazole suspension, bioavailability is impaired. Fatty food improves the uptake of posaconazole, but insufficient data on the pharmacokinetics of posaconazole in pediatric patients are available so far. The single-center analysis investigated 161 posaconazole serum concentrations in 27 pediatric patients after HSCT receiving 12 mg·kg BW(-1)·d(-1) posaconazole suspension depending on age, gender, and intestinal graft-versus-host (iGvHD) disease, and the influence of posaconazole on cyclosporine A plasma concentrations. To improve the uptake of posaconazole, one patient cohort received higher fat nutrition with the drug administration. A comparison of the regular nutrition and higher-fat nutrition groups revealed the following values: 31 (27.4%) versus 8 (16.7%) 2000 ng/ml. The mean posaconazole concentrations in patients with regular nutrition was 1123 ± 811 ng/ml and with higher-fat nutrition was 1191 ± 673 ng/ml. Posaconazole levels in patients with iGvHD were significantly lower (P = 0.0003) than in patients without GvHD. The majority of samples showed a sufficient posaconazole concentration above 700 ng/ml. Posaconazole levels were slightly higher in patients with higher-fat nutrition and significantly lower in patients with iGvHD. Cyclosporine A levels were not significantly higher during posaconazole administration.

  10. Improving physical health monitoring for patients with chronic mental health problems who receive antipsychotic medications

    Science.gov (United States)

    Abdallah, Nihad; Conn, Rory; Latif Marini, Abdel

    2016-01-01

    Physical health monitoring is an integral part of caring for patients with mental health problems. It is proven that serious physical health problems are more common among patients with severe mental health illness (SMI), this monitoring can be challenging and there is a need for improvement. The project aimed at improving the physical health monitoring among patients with SMI who are receiving antipsychotic medications. The improvement process focused on ensuring there is a good communication with general practitioners (GPs) as well as patient's education and education of care home staff. GP letters requesting physical health monitoring were updated; care home staff and patients were given more information about the value of regular physical health monitoring. There was an improvement in patients' engagement with the monitoring and the monitoring done by GPs was more adherent to local and national guidelines and was communicated with the mental health service. PMID:27559474

  11. Improving physical health monitoring for patients with chronic mental health problems who receive antipsychotic medications.

    Science.gov (United States)

    Abdallah, Nihad; Conn, Rory; Latif Marini, Abdel

    2016-01-01

    Physical health monitoring is an integral part of caring for patients with mental health problems. It is proven that serious physical health problems are more common among patients with severe mental health illness (SMI), this monitoring can be challenging and there is a need for improvement. The project aimed at improving the physical health monitoring among patients with SMI who are receiving antipsychotic medications. The improvement process focused on ensuring there is a good communication with general practitioners (GPs) as well as patient's education and education of care home staff. GP letters requesting physical health monitoring were updated; care home staff and patients were given more information about the value of regular physical health monitoring. There was an improvement in patients' engagement with the monitoring and the monitoring done by GPs was more adherent to local and national guidelines and was communicated with the mental health service.

  12. The effect of geriatric intervention in frail elderly patients receiving chemotherapy for colorectal cancer

    DEFF Research Database (Denmark)

    Lund, C M; Vistisen, K K; Dehlendorff, C

    2017-01-01

    or first-line treatment due to side effects. The Comprehensive Geriatric Assessment (CGA) is a multidisciplinary evaluation of an elderly individual's health status. This assessment in older patients with cancer can predict survival, chemotherapy toxicity and morbidity. METHODS: This randomized phase II...... trial (GERICO) is designed to investigate whether comprehensive geriatric assessment and intervention before and during treatment with chemotherapy in frail elderly patients with stages II-IV CRC will increase the number of patients completing chemotherapy. All patients ≥70 years in whom chemotherapy...... patients are offered inclusion and are then randomized to two groups (the intervention group and the control group). Patients in the intervention group receive a full geriatric assessment of comorbidity, medication, psycho-cognitive function, physical, functional and nutrition status, and interventions...

  13. Performance on a probabilistic inference task in healthy subjects receiving ketamine compared with patients with schizophrenia

    Science.gov (United States)

    Almahdi, Basil; Sultan, Pervez; Sohanpal, Imrat; Brandner, Brigitta; Collier, Tracey; Shergill, Sukhi S; Cregg, Roman; Averbeck, Bruno B

    2012-01-01

    Evidence suggests that some aspects of schizophrenia can be induced in healthy volunteers through acute administration of the non-competitive NMDA-receptor antagonist, ketamine. In probabilistic inference tasks, patients with schizophrenia have been shown to ‘jump to conclusions’ (JTC) when asked to make a decision. We aimed to test whether healthy participants receiving ketamine would adopt a JTC response pattern resembling that of patients. The paradigmatic task used to investigate JTC has been the ‘urn’ task, where participants are shown a sequence of beads drawn from one of two ‘urns’, each containing coloured beads in different proportions. Participants make a decision when they think they know the urn from which beads are being drawn. We compared performance on the urn task between controls receiving acute ketamine or placebo with that of patients with schizophrenia and another group of controls matched to the patient group. Patients were shown to exhibit a JTC response pattern relative to their matched controls, whereas JTC was not evident in controls receiving ketamine relative to placebo. Ketamine does not appear to promote JTC in healthy controls, suggesting that ketamine does not affect probabilistic inferences. PMID:22389244

  14. Long-Term Survival of Patients Receiving Artificial Nutrition in Japanese Psychiatric Hospitals

    Directory of Open Access Journals (Sweden)

    Keiichi Abe

    2016-10-01

    Full Text Available Background/Aims: Most patients with dementia suffer from dysphagia in the terminal stage of the disease. In Japan, most elderly patients with dysphagia receive either tube feeding or total parenteral nutrition. Methods: In this study, we investigated the factors determining longer survival with artificial nutrition. Various clinical characteristics of 168 inpatients receiving artificial nutrition without oral intake in psychiatric hospitals in Okayama Prefecture, Japan, were evaluated. Results: Multiple logistic regression analysis showed that the duration of artificial nutrition was associated with a percutaneous endoscopic gastrostomy (PEG tube, diagnosis of mental disorder, low MMSE score, and absence of decubitus. Conclusion: Patients with mental disorders survived longer than those with dementia diseases on artificial nutrition. A PEG tube and good nutrition seem to be important for long-term survival.

  15. Effects of carnitine administration to multiple injury patients receiving total parenteral nutrition.

    Science.gov (United States)

    Testasecca, D

    1987-01-01

    Blood, urine and tissue concentrations of carnitine have been found to be below the normal values in patients receiving total parenteral nutrition (TPN). It might be postulated that the carnitine deficiency is responsible for the metabolic disturbances observed during TPN. To 20 patients (10 male and 10 female) in a state of coma following multiple injuries or brain injury and submitted to a TPN regimen (hypertonic polycarbohydrate, 7% aminoacid solutions on 10% lipid suspensions), we have administered 3-8 g/day of carnitine i.v. as a single bolus each morning. We have found no increase in cholesterol and triglycerides serum levels and a normalization of pyruvate and lactate serum levels. Our results seem to confirm the importance of carnitine in improving metabolism of the energy-giving substrate in patients receiving TPN.

  16. Incidence of anemia in patients diagnosed with solid tumors receiving chemotherapy, 2010–2013

    Directory of Open Access Journals (Sweden)

    Xu H

    2016-04-01

    Full Text Available Hairong Xu,1 Lanfang Xu,2 John H Page,1 Kim Cannavale,2 Olivia Sattayapiwat,2 Roberto Rodriguez,3 Chun Chao2 1Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA; 2Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA; 3Department of Hematology Oncology, Los Angeles Medical Center, Kaiser Permanente Southern California, Psadena, CA, USA Purpose: The purpose of this study was to evaluate and characterize the risk of anemia during the course of chemotherapy among patients with five common types of solid tumors. Patients and methods: Patients diagnosed with incident cancers of breast, lung, colon/rectum, stomach, and ovary who received chemotherapy were identified from Kaiser Permanente Southern California Health Plan (2010–2012. All clinical data were collected from the health plan’s electronic medical records. Incidence proportions of patients developing anemia and 95% confidence intervals were calculated overall and by anemia severity and type, as well as by stage at cancer diagnosis, and by chemotherapy regimen and cycle. Results: A total of 4,426 patients who received chemotherapy were included. Across cancers, 3,962 (89.5% patients developed anemia during the course of chemotherapy (normocytic 85%, macrocytic 10%, microcytic 5%; normochromic 47%, hyperchromic 44%, hypochromic 9%. The anemia grades were distributed as follows: 58% were grade 1, 34% grade 2, 8% grade 3, and <1% grade 4. The incidence of grade 2+ anemia ranged from 26.3% in colorectal cancer patients to 59.2% in ovarian cancer patients. Incidence of grade 2+ anemia increased from 29% in stage I to 49% in stage IV. Incidence of grade 2+ anemia varied from 18.2% in breast cancer patients treated with cyclophosphamide + docetaxel regimen to 59.7% in patients with ovarian cancer receiving carboplatin + paclitaxel regimen. Conclusion: The incidence of moderate-to-severe anemia (hemoglobin <10 g/dL remained considerably

  17. Prevalence of cirrhosis in patients with thrombocytopenia who receive bone marrow biopsy

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    Muhammad Y Sheikh

    2012-01-01

    Full Text Available Background/Aim: Thrombocytopenia is a common finding in patients with cirrhosis and may lead to unnecessary referral for bone marrow (BM biopsy. To date, the prevalence of cirrhosis in patients with thrombocytopenia who receive BM biopsy is largely unknown. Materials and Methods: Between fiscal years 2006-2010, 744 patients (≥18 years who underwent BM biopsies for thrombocytopenia at our hospital were identified retrospectively. 541 patients were excluded who had hematologic malignancies and received chemotherapy. Remaining 203 patients with predominant isolated thrombocytopenia were included in the study. Results: Of 203 patients, 136 (67% had a normal and 67 (33% had an abnormal BM examination. Prevalence of cirrhosis in the study population was 35% (95% CI: 28.4-41.9. 51% patients with normal BM were found to have cirrhosis compared to 3% of patients with abnormal BM exam (P < 0.0001. Common causes of cirrhosis were nonalcoholic steatohepatitis (NASH (47%, followed by alcohol and Hepatitis C virus infection. Idiopathic thrombocytopenia and myelodysplastic syndrome were most frequent causes of thrombocytopenia in patients without cirrhosis. Patients with NASH had higher body mass index (BMI (33.4 vs. 25.8, P < 0.001 and lower MELD scores (11.1 vs. 16, P = 0.028 when compared to non-NASH patients with cirrhosis. Conclusion: Approximately, one third (35% of patients with cirrhosis induced thrombocytopenia may undergo unwarranted BM biopsies. Clinical diagnosis of cirrhosis is still a challenge for many physicians, particularly with underlying NASH. We propose cirrhosis to be the prime cause of isolated thrombocytopenia.

  18. Efficacy of olanzapine in symptom relief and quality of life in gastric cancer patients receiving chemotherapy

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    Novin Nikbakhsh

    2016-01-01

    Full Text Available Background: Considering the incidence and prevalence rates of gastric cancer in Mazandaran Province of Iran, this research was performed to evaluate the efficacy and safety of olanzapine in symptom relief and quality of life (QOL improvement of gastric patients receiving chemotherapy. Materials and Methods: This clinical trial was conducted on thirty new cases of gastric cancer patients whose treatment protocol was planned on chemotherapy and were allocated into two groups by simple random sampling. Intervention group (15 patients received olanzapine tablets (2.5–10 mg/day a day before the beginning of chemotherapy; in the 1st day of chemotherapy to 8 weeks after chemotherapy, besides the routine treatment regimens. The control group received only the routine treatment regimens. The patients were followed for 8 weeks after intervention. All of the patients were assessed with Hospital Anxiety and Depression Scale (HADS and WHO-QOL-BREF questionnaires; further, Rhodes index was used to evaluate nausea and vomiting (N/V status. Results: All the recruited patients continued the allocated interventions (no lost to follow-up. N/V decreased in the case group, but the difference was not statistically significant (P = 0.438. The patients' appetite and body mass index increased (P = 0.006. Anxiety and depression subscales of HADS had significant differences between the two groups (P 0.05. No significant increase was observed in fasting and 2-h postprandial blood glucose and lipid profile (P > 0.05. Conclusion: Olanzapine can be considered as an effective drug to increase appetite and decrease anxiety and depression in patients with gastric cancer.

  19. Effect of Desmopressin in Reducing Bleeding after Cardiac Surgery in Patients Receiving Anti-Platelet Agents

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    Kamran Shadvar

    2016-07-01

    Full Text Available Background: Severe bleeding is an important cause of morbidity and mortality in cardiac surgery using the cardiopulmonary bypass (CPB pump. Desmopressin, a synthetic analogue of vasopressin, is used to prevent postoperative bleeding in patients with renal insufficiency. The aim of the present study was to evaluate the effect of desmopressin in reducing blood loss after cardiac surgery in patients receiving antiplatelet drugs. Methods: In this prospective clinical trial, 40 patients undergoing coronary artery bypass grafting (CABG surgery with CPB, aged over 18 years, and on antiplatelet therapy for a week before surgery were divided in two groups. Case and control groups received nasal desmopressin spray and nasal normal saline spray, respectively. Patient vital signs, blood loss, administration of blood products, prescription drugs to improve the coagulation status, serum and whole intake and output of patients, need for a second surgery to control the bleeding, remaining sternum open, mortality due to bleeding, duration of intensive care unit (ICU stay and mechanical ventilation were recorded. Results: In the case and control groups there were no differences in duration of operation, mechanical ventilation and length of ICU stay. There was no significant difference in terms of postoperative bleeding and intake of blood products between two groups (P>0.05. Reoperation due to bleeding in the case and control groups was observed in 3 (15%, and 1 (5% patient(s, respectively (P=0.3. Conclusion: Desmopressin has no significant effect on reducing the amount of bleeding after cardiac surgery in patients receiving anti-platelet agents.   Keywords: CABG; cardio pulmonary bypass pump; hemorrhage; desmopressin

  20. Immunological evaluation of β-thalassemia major patients receiving oral iron chelator deferasirox.

    Science.gov (United States)

    Aleem, Aamer; Shakoor, Zahid; Alsaleh, Khalid; Algahtani, Farjah; Iqbal, Zafar; Al-Momen, Abdulkareem

    2014-07-01

    To determine the immune abnormalities and occurrence of infections in transfusion-dependent β-thalassemia major patients receiving oral iron chelator deferasirox (DFX). An observational study. Hematology Clinics, King Khalid University Hospital, Riyadh, Saudi Arabia, from July to December 2010. Seventeen patients with β-thalassemia major (12 females, median age 26 years) receiving deferasirox (DFX) for a median duration of 27 months were observed for any infections and had their immune status determined. Immune parameters studied included serum immunoglobulins and IgG subclasses, serum complement (C3 and C4) and anti-nuclear antibody (ANA) level, total B and T-lymphocytes, CD4+ and CD8+ counts, CD4+/CD8+ ratio, and natural killer (NK) cells. Immunological parameters of the patients were compared with age, gender, serum ferritin level and splenectomy status. Lymphocyte subsets were also compared with age and gender matched normal controls. A considerable reduction in serum ferritin was achieved by DFX from a median level of 2528 to 1875 μmol/l. Serum IgG levels were increased in 7 patients. Low C4 levels were found in 9 patients. Total B and T-lymphocytes were increased in 14 patients each, while CD4+, CD8+ and NK cells were increased in 13, 12 and 11 patients respectively. Absolute counts for all lymphocyte subsets were significantly higher compared to the normal controls (p ² 0.05 for all parameters). Raised levels of IgG were associated with older age, female gender, splenectomized status and higher serum ferritin levels but this did not reach statistical significance except for the higher ferritin levels (p=0.044). Increased tendency to infections was not observed. Patients with β-thalassemia major receiving DFX exhibited significant immune abnormalities. Changes observed have been described previously, but could be related to DFX. The immune abnormalities were not associated with increased tendency to infections.

  1. Effective Dose from Stray Radiation for a Patient Receiving Proton Therapy for Liver Cancer

    Science.gov (United States)

    Taddei, Phillip J; Krishnan, Sunil; Mirkovic, Dragan; Yepes, Pablo; Newhauser, Wayne D

    2010-01-01

    Because of its advantageous depth-dose relationship, proton radiotherapy is an emerging treatment modality for patients with liver cancer. Although the proton dose distribution conforms to the target, healthy tissues throughout the body receive low doses of stray radiation, particularly neutrons that originate in the treatment unit or in the patient. The aim of this study was to calculate the effective dose from stray radiation and estimate the corresponding risk of second cancer fatality for a patient receiving proton beam therapy for liver cancer. Effective dose from stray radiation was calculated using detailed Monte Carlo simulations of a double-scattering proton therapy treatment unit and a voxelized human phantom. The treatment plan and phantom were based on CT images of an actual adult patient diagnosed with primary hepatocellular carcinoma. For a prescribed dose of 60 Gy to the clinical target volume, the effective dose from stray radiation was 370 mSv; 61% of this dose was from neutrons originating outside of the patient while the remaining 39% was from neutrons originating within the patient. The excess lifetime risk of fatal second cancer corresponding to the total effective dose from stray radiation was 1.2%. The results of this study establish a baseline estimate of the stray radiation dose and corresponding risk for an adult patient undergoing proton radiotherapy for liver cancer and provide new evidence to corroborate the suitability of proton beam therapy for the treatment of liver tumors. PMID:20865142

  2. Relationship Between Triglyceride Tolerance, Body Mass Index, and Fat Depots in Hospitalized Patients Receiving Parenteral Nutrition.

    Science.gov (United States)

    Frazee, Erin N; Nystrom, Erin M; McMahon, M Molly; Williamson, Eric E; Miles, John M

    2015-11-01

    Hypertriglyceridemia has been associated with adverse outcomes in patients receiving intravenous fat emulsions (IVFEs), but little is known about its prevalence and causes. The study investigated whether a relationship exists between body mass index (BMI) and triglyceride tolerance in parenterally fed patients. We conducted a retrospective analysis of 287 adults receiving parenteral nutrition to determine whether patients with very low BMI (VLBMI, triglyceride concentration during IVFE was significantly lower in VLBMI patients at 107 mg/dL compared with 124 mg/dL in non-VLBMI patients (P = .016), despite higher lipid infusion rates in the VLBMI group. There was a significant association between triglycerides and BMI in the aggregate cohort (R = 0.2375, P triglyceride concentrations correlated with visceral fat but not subcutaneous abdominal fat. In summary, patients with VLBMI have lower triglyceride concentrations during IVFEs than do other individuals, but there is considerable variability in triglycerides and body fat in this group. Caution should be employed with the use of IVFEs, especially in HBMI patients. © 2014 American Society for Parenteral and Enteral Nutrition.

  3. Antibiotic dosing in critically ill patients receiving CRRT: underdosing is overprevalent.

    Science.gov (United States)

    Lewis, Susan J; Mueller, Bruce A

    2014-01-01

    Published CRRT drug dosing algorithms and other dosing guidelines appear to result in underdosed antibiotics, leading to failure to attain pharmacodynamic targets. High mortality rates persist with inadequate antibiotic therapy as the most important risk factor for death. Reasons for unintended antibiotic underdosing in patients receiving CRRT are many. Underdosing may result from lack of the recognition that better hepatic function in AKI patients yields higher nonrenal antibiotic clearance compared to ESRD patients. Other factors include the variability in body size and fluid composition of patients, the serious consequence of delayed achievement of antibiotic pharmacodynamic targets in septic patients, potential subtherapeutic antibiotic concentrations at the infection site, and the influence of RRT intensity on antibiotic concentrations. Too often, clinicians weigh the benefits of overcautious antibiotic dosing to avoid antibiotic toxicity too heavily against the benefits of rapid attainment of therapeutic antibiotic concentrations in critically ill patients receiving CRRT. We urge clinicians to prescribe antibiotics aggressively for these vulnerable patients. © 2014 Wiley Periodicals, Inc.

  4. The Effect of Consolidation Chemotherapy for LA-NSCLC Patients Receiving Concurrent Chemoradiotherapy

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    Yelda Varol

    2016-09-01

    Full Text Available Aim: The efficacy and safety of consolidation chemotherapy (CCT following concurrent chemoradiotherapy are not adequately established for patients with locally advanced non-small-cell lung cancer (LA-NSCLC. In this context, the present study aims to evaluate the efficacy and toxicity of CCT.Material and Method: We retrospectively analyzed the overall survival (OS and progression-free survival (PFS of 83 LA-NSCLC patients treated with concurrent CRT as an initial treatment with (n:20 or without CCT (n:63. All patients were cytohistologically proven to have NSCLC and diagnosed with clinical Stage III (n:48 for IIIA and n:35 for IIIB according to the staging system published by the American Joint Committee on Cancer (AJCC in 2009. All patients received curative thoracic radiotherapy with concurrent platinum doublet chemotherapy. Results: The mean age of the lung cancer patients was 59 (±7.3; 89.2% were male (n:74,and there were only 9 female patients (10.8%.When we compared the outcome of LA-NSCLC patients treated with CCT (median 10.4 months to the patients treated without CCT (median 13.8 months, the log-rank analysis demonstrated a statistically significant difference for an inferior progression-free survival (p=0.046 in patients receiving CCT. However, no significant association was observed for overall survival (17.4, 21 months, respectively (p>0.05. Patients with CCT presented higher levels of hematological side effects compared with the patients without CCT (p

  5. Long-term survival for COPD patients receiving noninvasive ventilation for acute respiratory failure

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    Titlestad IL

    2013-04-01

    Full Text Available Ingrid L Titlestad,1 Annmarie T Lassen,2 Jørgen Vestbo1,3 1Department of Respiratory Medicine, 2Department of Emergency Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark; 3Respiratory Research Group, Manchester Academic Health Sciences Centre, University Hospital South Manchester NHS Foundation Trust, University of Manchester, Manchester, UK Abstract: Implementation of noninvasive ventilation (NIV as an add-on treatment has been routinely used in a non-intensive care setting since 2004 for patients with chronic obstructive pulmonary disease (COPD and acute hypercapnic respiratory failure at a university hospital in Denmark. Although randomized controlled trials show lowered mortality rates in highly selected patients with acute exacerbation and respiratory failure, there are only few reports on long-term survival after receiving NIV. We present long-term all-cause mortality data from patients receiving NIV for the first time. Method: Data from medical records were retrospectively retrieved from all patients receiving NIV for the first time after being admitted acutely to an acute medical ward and further transfer to a respiratory ward with respiratory failure and a diagnosis of COPD in the period January 1, 2005 to December 31, 2007; patients were followed until January 2012. Demographic data collected included age, sex, diagnoses at discharge, and, when present, FEV1; a “not-to-intubate” order was also registered when listed. Results: In total, 253 patients (143 female, 110 male received NIV for the first time. The median age was 72 years (range 46–91 years. The 30-day mortality rate was 29.3%. The 5-year survival rate was 23.7%. Women showed a trend towards better survival than men (25.7% vs 19.2%, P = 0.25, and the trend was even more pronounced for patients with COPD. Conclusion: The mortality rate of patients receiving NIV is high, as expected in a real-life setting, but with a 5-year survival rate

  6. Central venous catheter-related blood stream infections in patients receiving intravenous iloprost for pulmonary hypertension.

    Science.gov (United States)

    Sammut, D; Elliot, C A; Kiely, D G; Armstrong, I J; Martin, L; Wilkinson, J; Sephton, P; Jones, J; Hamilton, N; Hurdman, J; McLellan, E; Sabroe, I; Condliffe, R

    2013-07-01

    Catheter-related blood stream infection (CR-BSI) in patients with pulmonary hypertension (PH) receiving intravenous iloprost via an indwelling central line has previously not been fully described. Recent studies have suggested a link between the pH of prostanoid infusions and the rate and nature of CR-BSI. We have investigated CR-BSI in patients receiving intravenous iloprost at our unit. Databases and hospital records were interrogated for all patients receiving intravenous iloprost between September 2007 and June 2012. Fifty-nine patients received intravenous iloprost via an indwelling central catheter with a total of 23,072 treatment days. There were 15 episodes of CR-BSI, identified using a systematic screening protocol, involving 11 patients giving an overall CR-BSI rate of 0.65/1,000 treatment days. CR-BSI rate for Gram-positive organisms was 0.26/1,000 treatment-days and for Gram-negative organisms was 0.39/1,000 treatment-days. The pH of iloprost in typical dosing regimens was comparable to the pH used in standard-diluent treprostinil and dissimilar to alkaline epoprostenol infusions. The proportion of Gram-negative CR-BSI was similar to that reported for standard-diluent treprostinil. CRP was normal on admission in 33 % of cases of confirmed CR-BSI and remained normal in 13 % of cases. CR-BSI rates with intravenous iloprost are comparable to those observed for other prostanoids. The high proportion of Gram-negative organisms observed and the neutral pH of iloprost infusions support the previously hypothesised link between pH and antimicrobial activity. Although usually elevated during a CR-BSI, CRP may be normal in early infection and a normal result cannot completely exclude infection.

  7. QT dispersion in HIV-infected patients receiving combined antiretroviral therapy.

    Science.gov (United States)

    Wongcharoen, Wanwarang; Suaklin, Somkhuan; Tantisirivit, Nualnit; Phrommintikul, Arintaya; Chattipakorn, Nipon

    2014-11-01

    A higher prevalence of QT prolongation has been reported among human immunodeficiency virus (HIV)-infected patients. Previous studies have demonstrated that QT dispersion is a better predictor of serious ventricular tachyarrhythmia and cardiac mortality than corrected QT (QTc) interval. However, data of QT dispersion in HIV-infected patients receiving a combined antiretroviral therapy (cART) is limited. We sought to assess QTc interval and QT dispersion in HIV-infected patients receiving cART. The association between QT parameters and heart rate variability (HRV) was also examined. Ninety-one HIV-infected patients receiving cART (male = 33, mean age = 44 ± 10 years) and 70 HIV-seronegative subjects (male = 25, mean age = 44 ± 8 years) were enrolled in the study. In a resting 12-lead electrocardiogram, QT interval was measured by the tangent method in all leads with well-defined T waves. The QT dispersion was defined as the difference between maximum and minimum QTc intervals in any of 12 leads. The baseline characteristics were not different between the two groups. We demonstrated the significantly longer mean QTc interval (420 ± 21 vs. 409 ± 21 ms, P dispersion in HIV-infected group compared to the control group (85 ± 29 vs. 55 ± 23 ms, P dispersion (92 ± 28 vs. 81 ± 29 ms, P = 0.098). There were no associations between QT parameters and either HRV or cART regimens. HIV-infected patients receiving cART were associated with prolonged QTc interval and increased QT dispersion, independent of autonomic dysfunction and antiretroviral drugs, which may have led to the potentially higher risk of ventricular arrhythmia and cardiac mortality. © 2014 Wiley Periodicals, Inc.

  8. Characteristics of Symptomatic Intracranial Hemorrhage in Patients Receiving Non-Vitamin K Antagonist Oral Anticoagulant Therapy.

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    Hisanao Akiyama

    Full Text Available The first non-vitamin K antagonist oral anticoagulant (NOAC introduced to the market in Japan was dabigatran in March 2011, and three more NOACs, rivaroxaban, apixaban, and edoxaban, have since become available. Randomized controlled trials of NOACs have revealed that intracranial hemorrhage (ICH occurs less frequently with NOACs compared with warfarin. However, the absolute incidence of ICH associated with NOACs has increased with greater use of these anticoagulants, and we wanted to explore the incidence, clinical characteristics, and treatment course of patients with NOACs-associated ICH.We retrospectively analyzed the characteristics of symptomatic ICH patients receiving NOACs between March 2011 and September 2014.ICH occurred in 6 patients (5 men, 1 woman; mean ± SD age, 72.8 ± 3.2 years. Mean time to onset was 146.2 ± 111.5 days after starting NOACs. Five patients received rivaroxaban and 1 patient received apixaban. None received dabigatran or edoxaban. Notably, no hematoma expansion was observed within 24 h of onset in the absence of infusion of fresh frozen plasma, activated prothrombin complex concentrate, recombinant activated factor VIIa or hemodialysis. When NOAC therapy was initiated, mean HAS-BLED and PANWARDS scores were 1.5 ± 0.5 and 39.5 ± 7.7, respectively. Mean systolic blood pressure was 137.8 ± 15.9 mmHg within 1 month before spontaneous ICH onset.Six symptomatic ICHs occurred early in NOAC therapy but hematoma volume was small and did not expand in the absence of infusion of reversal agents or hemodialysis. The occurrence of ICH during NOAC therapy is possible even when there is acceptable mean systolic blood pressure control (137.8 ± 15.9 mmHg and HAS-BLED score ≤ 2. Even stricter blood pressure lowering and control within the acceptable range may be advisable to prevent ICH during NOAC therapy.

  9. Patient perspectives on care received at community acupuncture clinics: a qualitative thematic analysis.

    Science.gov (United States)

    Tippens, Kimberly M; Chao, Maria T; Connelly, Erin; Locke, Adrianna

    2013-10-29

    Community acupuncture is a recent innovation in acupuncture service delivery in the U.S. that aims to improve access to care through low-cost treatments in group-based settings. Patients at community acupuncture clinics represent a broader socioeconomic spectrum and receive more frequent treatments compared to acupuncture users nationwide. As a relatively new model of acupuncture in the U.S., little is known about the experiences of patients at community acupuncture clinics and whether quality of care is compromised through this high-volume model. The aim of this study was to assess patients' perspectives on the care received through community acupuncture clinics. The investigators conducted qualitative, thematic analysis of written comments from an observational, cross-sectional survey of clients of the Working Class Acupuncture clinics in Portland, Oregon. The survey included an open-ended question for respondents to share comments about their experiences with community acupuncture. Comments were received from 265 community acupuncture patients. Qualitative analysis of written comments identified two primary themes that elucidate patients' perspectives on quality of care: 1) aspects of health care delivery unique to community acupuncture, and 2) patient engagement in health care. Patients identified unique aspects of community acupuncture, including structures that facilitate access, processes that make treatments more comfortable and effective and holistic outcomes including physical improvements, enhanced quality of life, and empowerment. The group setting, community-based locations, and low cost were highlighted as aspects of this model that allow patients to access acupuncture. Patients' perspectives on the values and experiences unique to community acupuncture offer insights on the quality of care received in these settings. The group setting, community-based locations, and low cost of this model potentially reduce access barriers for those who might not

  10. The importance of knowing the home conditions of patients receiving long-term oxygen therapy

    Directory of Open Access Journals (Sweden)

    Godoy I

    2012-07-01

    Full Text Available Ilda Godoy,1 Suzana Erico Tanni,2 Carme Hernández,3 Irma Godoy21Department of Nursing, Botucatu School of Medicine, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil; 2Department of Pulmonology, Botucatu School of Medicine, Universidade Estadual Paulista, São Paulo, Brazil; 3Integrated Care Unit, Hospital Clinic, Barcelona, SpainPurpose: Long-term oxygen therapy (LTOT is one of the main treatments for patients with chronic obstructive pulmonary disease. Patients receiving LTOT may have less than optimal home conditions and this may interfere with treatment. The objective of this study was, through home visits, to identify the characteristics of patients receiving LTOT and to develop knowledge regarding the home environments of these patients.Methods: Ninety-seven patients with a mean age of 69 plus or minus 10.5 years were evaluated. This study was a cross-sectional descriptive analysis. Data were collected during an initial home visit, using a questionnaire standardized for the study. The results were analyzed retrospectively.Results: Seventy-five percent of the patients had chronic obstructive pulmonary disease, and 11% were active smokers. The patients’ mean pulse oximetry values were 85.9% plus or minus 4.7% on room air and 92% plus or minus 3.9% on the prescribed flow of oxygen. Most of the patients did not use the treatment as prescribed and most used a humidifier. The extension hose had a mean length of 5 plus or minus 3.9 m (range, 1.5–16 m. In the year prior to the visit, 26% of the patients received emergency medical care because of respiratory problems. Few patients reported engaging in leisure activities.Conclusion: The home visit allowed us to identify problems and interventions that could improve the way LTOT is used. The most common interventions related to smoking cessation, concentrator maintenance and cleaning, use of a humidifier, and adjustments of the length of the connector hose. Therefore, the home visit

  11. Prevalence of saphenous nerve injury after adductor-canal-blockade in patients receiving total knee arthroplasty

    DEFF Research Database (Denmark)

    Henningsen, Maja; Jæger, Pia; Hilsted, K L;

    2013-01-01

    BACKGROUND: Adductor-canal-blockade is a new technique for pain relief after knee surgery. This block could cause nerve injury and the aim of this follow-up study was to determine the prevalence of saphenous nerve injury in patients receiving adductor-canal-blockade for pain treatment after total...... knee arthroplasty. METHODS: All patients included in two former studies of adductor-canal-blockade following total knee arthroplasty were invited to participate in this follow-up study 3-6 months after surgery. We examined the cutaneous area on the medial aspect of the lower leg (medial crural branch......, 76 patients could not discriminate between blunt and sharp stimulation with a needle, 81 patients could not discriminate between cold and warmth, and 82 patients displayed an altered sensation to light brush. CONCLUSION: We found no indications of saphenous nerve injury caused by the adductor-canal...

  12. Association of Donor Age and Sex With Survival of Patients Receiving Transfusions

    DEFF Research Database (Denmark)

    Edgren, Gustaf; Ullum, Henrik; Rostgaard, Klaus

    2017-01-01

    Importance: Following animal model data indicating the possible rejuvenating effects of blood from young donors, there have been at least 2 observational studies conducted with humans that have investigated whether donor age affects patient outcomes. Results, however, have been conflicting....... Objective: To study the association of donor age and sex with survival of patients receiving transfusions. Design, Setting, and Participants: A retrospective cohort study based on the Scandinavian Donations and Transfusions database, with nationwide data, was conducted for all patients from Sweden...... number of transfusions and mortality revealed a nonlinear pattern. After adjustments to accommodate nonlinearity, donor age and sex were no longer associated with patient mortality. Conclusions and Relevance: Donor age and sex were not associated with patient survival and need not be considered in blood...

  13. Effects of Cinacalcet on Fracture Events in Patients Receiving Hemodialysis: The EVOLVE Trial.

    Science.gov (United States)

    Moe, Sharon M; Abdalla, Safa; Chertow, Glenn M; Parfrey, Patrick S; Block, Geoffrey A; Correa-Rotter, Ricardo; Floege, Jürgen; Herzog, Charles A; London, Gerard M; Mahaffey, Kenneth W; Wheeler, David C; Dehmel, Bastian; Goodman, William G; Drüeke, Tilman B

    2015-06-01

    Fractures are frequent in patients receiving hemodialysis. We tested the hypothesis that cinacalcet would reduce the rate of clinical fractures in patients receiving hemodialysis using data from the Evaluation of Cinacalcet HCl Therapy to Lower Cardiovascular Events trial, a placebo-controlled trial that randomized 3883 hemodialysis patients with secondary hyperparathyroidism to receive cinacalcet or placebo for ≤64 months. This study was a prespecified secondary analysis of the trial whose primary end point was all-cause mortality and non-fatal cardiovascular events, and one of the secondary end points was first clinical fracture event. Clinical fractures were observed in 255 of 1935 (13.2%) patients randomized to placebo and 238 of 1948 (12.2%) patients randomized to cinacalcet. In an unadjusted intention-to-treat analysis, the relative hazard for fracture (cinacalcet versus placebo) was 0.89 (95% confidence interval [95% CI], 0.75 to 1.07). After adjustment for baseline characteristics and multiple fractures, the relative hazard was 0.83 (95% CI, 0.72 to 0.98). Using a prespecified lag-censoring analysis (a measure of actual drug exposure), the relative hazard for fracture was 0.72 (95% CI, 0.58 to 0.90). When participants were censored at the time of cointerventions (parathyroidectomy, transplant, or provision of commercial cinacalcet), the relative hazard was 0.71 (95% CI, 0.58 to 0.87). Fracture rates were higher in older compared with younger patients and the effect of cinacalcet appeared more pronounced in older patients. In conclusion, using an unadjusted intention-to-treat analysis, cinacalcet did not reduce the rate of clinical fracture. However, when accounting for differences in baseline characteristics, multiple fractures, and/or events prompting discontinuation of study drug, cinacalcet reduced the rate of clinical fracture by 16%-29%.

  14. Glucose status in patients with acromegaly receiving primary treatment with the somatostatin analog lanreotide.

    Science.gov (United States)

    Couture, Elisabeth; Bongard, Vanina; Maiza, Jean-Christophe; Bennet, Antoine; Caron, Philippe

    2012-12-01

    To describe glucose status changes in patients with acromegaly receiving somatostatin analog lanreotide as primary treatment. This retrospective, single-center study conducted during 1996-2008, included acromegalic patients receiving primary lanreotide treatment. Baseline and last follow-up visit assessments included glucose status (according to American Diabetes Association criteria), growth hormone (GH), and insulin-like growth factor-1 (IGF-1) levels. Glucose control was considered improved when fasting plasma glucose or antidiabetic treatments were reduced, and deteriorated if fasting glucose was the same/higher but with increased antidiabetic treatments. 42 patients (median age 50 years; range 29-75 years) were included. At baseline, 26 (62%) were normoglycemic, eight (19%) had impaired glucose tolerance/fasting glycemia, and eight (19%) had diabetes mellitus; family history of diabetes mellitus was significantly associated with abnormal glucose status. At final visit, the mean (SE) lanreotide dose was 108 (21) mg/month. Median treatment duration was 23 months, range 3-138 months, and 74% of patients received the 120-mg dose. Median GH levels decreased significantly (baseline, 12 [5-20] μg/l; final visit, 2.1 [1.0-4.7] μg/l; P < 0.0001); IGF-1 levels were age- and sex-normalized in 33% of patients. Glucose control deteriorated in seven patients (17%) and improved from abnormal levels in 10 (24%). Deterioration was associated with smaller GH decreases (median change, -3.4 μg/l vs. -10.7 μg/l, P = 0.014) and improvement with trend to lower BMI and younger age. During primary lanreotide treated acromegalic patients 60% had no change, 24% had an improvement and 17% had a worsening of glucose status. Deterioration was significantly associated with smaller GH decreases during primary lanreotide treatment.

  15. Clinical outcomes for Saudi and Egyptian patients receiving deceased donor liver transplantation in China.

    Science.gov (United States)

    Allam, N; Al Saghier, M; El Sheikh, Y; Al Sofayan, M; Khalaf, H; Al Sebayel, M; Helmy, A; Kamel, Y; Aljedai, A; Abdel-Dayem, H; Kenetman, N M; Al Saghier, A; Al Hamoudi, W; Abdo, A A

    2010-08-01

    Long waiting list times in liver transplant programs in Saudi Arabia and unavailability of deceased donor transplantation in Egypt have led several patients to seek transplantation in China. All patients who received transplants in China and followed in three centers from January 2003-January 2007 were included. All patients' charts were reviewed. Mortality and morbidity were compared to those transplanted in King Faisal Specialist Hospital & Research Centre (KFSH&RC) during the same period. Seventy-four adult patients were included (46 Saudi nationals; 28 Egyptians). One-year and 3-year cumulative patient survival rates were 83% and 62%, respectively compared to 92% and 84% in KFSH&RC. One-year and 3-year cumulative graft survival rates were 81% and 59%, respectively compared to 90% and 84% in KFSH&RC. Compared to KFSH&RC, the incidence of complications was significantly higher especially biliary complications, sepsis, metastasis and acquired HBV infection posttransplant. Requirements of postoperative interventions and hospital admissions were also significantly greater. Our data show high mortality and morbidity rates in Saudi and Egyptian patients receiving transplants in China. This could be related to more liberal selection criteria, use of donation after cardiac death (DCD) donors or possibly more limited posttransplant care.

  16. Aneuploidy in sperm of Hodgkin`s disease patients receiving NOVP chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Robbins, W.A.; Cassel, M.J.; Wyrobek, A.J. [Lawrence Livermore National Lab., CA (United States)] [and others

    1994-09-01

    Induction of genetic damage in germ cells of young patients receiving chemo- or radiotherapy for cancers with probable cure, such as Hodgkin`s disease, is cause for concern. These young patients may someday desire children, and germ cell alterations presenting as numerical chromosomal abnormalities in sperm may place their future offspring at risk. To address this concern, we measured aneuploidy in sperm from eight young Hodgkin`s disease patients: four pre-treatment, four during treatment, and three over a 45 month period following treatment with NOVP (Novantrone, Oncovin, Vinblastine and Prednisone). Patients ranged in stage of disease from IA-IIEB and none had received prior radiation or chemotherapy. Using multi-chromosome sperm FISH with repetitive sequence probes specific for chromosomes X, Y and 8, we found a significant 2-4 fold increase in particular numerical chromosomal abnormalities during treatment which were limited in persistence post-treatment. Additionally, pre-treatment Hodgkin`s disease patients showed elevations in some numerical chromosomal abnormalities when compared to a healthy reference group. In several men, the fraction of aneuploid sperm did not return to healthy reference group levels even after completion of therapy. These results show that elevated sperm aneuploidy occurs in germ cells of young cancer patients during chemotherapy and suggest caution to prevent conceptions during this period. The elevated sperm aneuploidy appears transient, but in some cases never returns to healthy reference group levels.

  17. The lack of predictors for rapid progression in prostate cancer patients receiving sipuleucel-T.

    Science.gov (United States)

    Ng, Laura; Heck, Wendy; Lavsa, Stacey; Crowther, David; Atkinson, Brad; Xiao, Lianchun; Araujo, John

    2013-05-06

    Sipuleucel-T is an immunotherapy indicated for the treatment of metastatic prostate cancer. It offers a new mechanism to treat prostate cancer without the side effects of hormone therapies and chemotherapies. In previous studies sipuleucel-T did not delay disease progression, but demonstrated an overall survival benefit compared to placebo. While clinical trials have evaluated the effects of sipuleucel-T on overall survival and progression, more studies are needed to evaluate its effectiveness and role in the management of prostate cancer. The objective of this study is to identify the incidence and possible predictors for disease progression in patients receiving sipuleucel-T. A retrospective review of patients who received sipuleucel-T between 1 September 2010 and 11 October 2011 was conducted (n = 36). Patients who changed therapy or died within 120 days were classified as experiencing rapid progression. Potential predictors of rapid progression were examined using logistic regression. Seven patients met criteria for rapid progression. Progression occurred in 72.2% of all patients. The median days to progression was 158. No significant predictors of rapid progression were identified. Currently no predictors have been found to be associated with rapid progression in prostate cancer patients on sipuleucel-T.

  18. The Lack of Predictors for Rapid Progression in Prostate Cancer Patients Receiving Sipuleucel-T

    Directory of Open Access Journals (Sweden)

    John Araujo

    2013-05-01

    Full Text Available Sipuleucel-T is an immunotherapy indicated for the treatment of metastatic prostate cancer. It offers a new mechanism to treat prostate cancer without the side effects of hormone therapies and chemotherapies. In previous studies sipuleucel-T did not delay disease progression, but demonstrated an overall survival benefit compared to placebo. While clinical trials have evaluated the effects of sipuleucel-T on overall survival and progression, more studies are needed to evaluate its effectiveness and role in the management of prostate cancer. The objective of this study is to identify the incidence and possible predictors for disease progression in patients receiving sipuleucel-T. A retrospective review of patients who received sipuleucel-T between 1 September 2010 and 11 October 2011 was conducted (n = 36. Patients who changed therapy or died within 120 days were classified as experiencing rapid progression. Potential predictors of rapid progression were examined using logistic regression. Seven patients met criteria for rapid progression. Progression occurred in 72.2% of all patients. The median days to progression was 158. No significant predictors of rapid progression were identified. Currently no predictors have been found to be associated with rapid progression in prostate cancer patients on sipuleucel-T.

  19. Antiepileptic dosing for critically ill adult patients receiving renal replacement therapy.

    Science.gov (United States)

    Smetana, Keaton S; Cook, Aaron M; Bastin, Melissa L Thompson; Oyler, Douglas R

    2016-12-01

    The aim of this review was to evaluate current literature for dosing recommendations for the use of antiepileptic medications in patients receiving renal replacement therapy (RRT). With the assistance of an experienced medical librarian specialized in pharmacy and toxicology, we searched MEDLINE, EMBASE, CINAHL, Web of Science, WorldCat, and Scopus through May 2016. Four hundred three articles were screened for inclusion, of which 130 were identified as potentially relevant. Micromedex® DRUGDEX as well as package inserts were used to obtain known pharmacokinetic properties and dosage adjustment recommendations in RRT if known. Data regarding antiepileptic drug use in RRT are limited and mostly consist of case reports limiting our proposed dosing recommendations. Known pharmacokinetic parameters should guide dosing, and recommendations are provided where possible. Additional studies are necessary before specific dosing recommendations can be made for most antiepileptic drugs in critically ill patients receiving RRT, specifically with newer agents. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. A Case of Gingival Candidiasis with Bone Destruction on Gastric Cancer Patient Receiving Cytotoxic Chemotherapy

    Directory of Open Access Journals (Sweden)

    Seungtaek Lim

    2014-01-01

    Full Text Available We herein report a case of gingival candidiasis in an advanced gastric cancer patient while receiving palliative cytotoxic chemotherapy. A 46-year-old male patient admitted to our hospital for known advanced gastric cancer with newly developed multiple liver metastases. While receiving 2nd line cytotoxic chemotherapy with 5FU, leucovorin, and paclitxel, he complained of gingival swelling accompanied by pain and whitish plaque. Due to lack of response to the conservative oral care, incisional biopsy of gingiva was done and the pathology confirmed gingival candidiasis. Although the lesion healed apparently after two-week antifungal therapy, pain as well as bony destruction remains. By presenting this case report, we intend to emphasize the immunocompromising effect of cancer while being on systemic chemotherapy.

  1. Fatal miliary Coccidioidomycosis in a patient receiving infliximab therapy: a case report

    Directory of Open Access Journals (Sweden)

    Rogan Mark P

    2007-09-01

    Full Text Available Abstract A 78-year-old white male from Iowa in the United States of America receiving the anti- tumor necrois factor (TNF agent infliximab therapy for rheumatoid arthritis developed a cheek ulcer which failed to respond to empiric antibiotic therapy. He subsequently presented with progressive respiratory failure from miliary coccidioidomycosis which proved fatal. The patient vacationed in Arizona 6 months previously and likely contracted the organism there as Iowa is not an endemic area for coccidioidomycosis. Respiratory failure from miliary infiltration is an uncommon presentation of coccidioidomycosis. Physicians should be aware of the importance of travel history and potential for life-threatening coccidioidomycosis in patients receiving tumor necrosis factor inhibitors.

  2. Risk factors for upper gastrointestinal bleeding in coronary artery disease patients receiving both aspirin and clopidogrel

    Directory of Open Access Journals (Sweden)

    Kuang-Wei Huang

    2013-01-01

    Conclusion: ACS and mechanical ventilation are important risk factors of UGIB at the early stage (≤ 2 weeks. Additionally, old age (>75 years, past peptic ulcer disease history, and the use of mechanical ventilation play important roles in the occurrence of UGIB at late stage (>2 weeks. However, it was also noted that use of PPI plays a protective role in patients with CAD receiving aspirin and clopidogrel therapy.

  3. Associations of ATM Polymorphisms With Survival in Advanced Esophageal Squamous Cell Carcinoma Patients Receiving Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Du, Zhongli [State Key Laboratory of Molecular Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Department of Etiology and Carcinogenesis (Beijing Key Laboratory for Carcinogenesis and Cancer Prevention), Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Zhang, Wencheng [Department of Radiation Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Zhou, Yuling; Yu, Dianke; Chen, Xiabin; Chang, Jiang; Qiao, Yan; Zhang, Meng; Huang, Ying; Wu, Chen [State Key Laboratory of Molecular Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Department of Etiology and Carcinogenesis (Beijing Key Laboratory for Carcinogenesis and Cancer Prevention), Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Xiao, Zefen, E-mail: xiaozefen@sina.com [Department of Radiation Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Tan, Wen, E-mail: tanwen@cicams.ac.cn [State Key Laboratory of Molecular Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Department of Etiology and Carcinogenesis (Beijing Key Laboratory for Carcinogenesis and Cancer Prevention), Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); and others

    2015-09-01

    Purpose: To investigate whether single nucleotide polymorphisms (SNPs) in the ataxia telangiectasia mutated (ATM) gene are associated with survival in patients with esophageal squamous cell carcinoma (ESCC) receiving radiation therapy or chemoradiation therapy or surgery only. Methods and Materials: Four tagSNPs of ATM were genotyped in 412 individuals with clinical stage III or IV ESCC receiving radiation therapy or chemoradiation therapy, and in 388 individuals with stage I, II, or III ESCC treated with surgery only. Overall survival time of ESCC among different genotypes was estimated by Kaplan-Meier plot, and the significance was examined by log-rank test. The hazard ratios (HRs) and 95% confidence intervals (CIs) for death from ESCC among different genotypes were computed by a Cox proportional regression model. Results: We found 2 SNPs, rs664143 and rs664677, associated with survival time of ESCC patients receiving radiation therapy. Individuals with the rs664143A allele had poorer median survival time compared with the rs664143G allele (14.0 vs 20.0 months), with the HR for death being 1.45 (95% CI 1.12-1.89). Individuals with the rs664677C allele also had worse median survival time than those with the rs664677T allele (14.0 vs 23.5 months), with the HR of 1.57 (95% CI 1.18-2.08). Stratified analysis showed that these associations were present in both stage III and IV cancer and different radiation therapy techniques. Significant associations were also found between the SNPs and locosregional progression or progression-free survival. No association between these SNPs and survival time was detected in ESCC patients treated with surgery only. Conclusion: These results suggest that the ATM polymorphisms might serve as independent biomarkers for predicting prognosis in ESCC patients receiving radiation therapy.

  4. Serum iron metabolism and erythropoiesis in patients with myelodysplastic syndrome not receiving RBC transfusions

    OpenAIRE

    Cui, Rui; Gale, Robert Peter; Zhu, Guoqing; Xu, Zefeng; Qin, Tiejun; Zhang, Yue; Huang, Gang; Li, Bing; Fang, Liwei; Zhang, Hongli; Pan, Lijuan; Hu, Naibo; Qu, Shiqiang; Xiao, Zhijian

    2014-01-01

    Dysregulation of hepcidin, a key iron regulating hormone, is important in the pathogenesis of iron overload in patients with myelodysplatic syndrome (MDS). However, most studies of hepcidin levels are complicated by concomitant RBC transfusions. To evaluate the relationship between iron metabolism and erythropoiesis, we measured serum levels of hepcidin, growth-differentiation factor-15 (GDF15) and other markers of erythropoiesis in 107 subjects with MDS not receiving RBC transfusions. Patien...

  5. Clinically significant drug interactions among HIV-infected patients receiving antiretroviral therapy.

    Science.gov (United States)

    So-Ngern, Apichot; Montakantikul, Preecha; Manosuthi, Weerawat

    2014-09-01

    We conducted a cross sectional study of the outpatient medical records of 1000 HIV-infected patients receiving antiretroviral therapy (ART) in 2011 to determine the incidence of clinically significant drug interactions (CSDI). The severities of the CSDI were graded following the Micromedex" 2.0 database and the Department of Health and Human Services (DHHS) 2012 HIV treatment guidelines. Three hundred thirty-five patients (34%) had 554 episodes of CSDI. Of which 337 episodes (61%), 163 episodes (29%) and 54 episodes (10%) had grades 2, 3 and 4 severity CSDI, respectively. The CSDI were caused by protease inhibitor (PI)-based drug regimens in 79%, by efavirenz-based regimens in 34% and by nevirapine-based regimens in 10% (p5 items prescribed at a time (OR 1.80; 95% CI: 1.23-2.63), seeing a doctor >4 times a year (OR 1.72; 95% CI: 1.20-2.46), having hypertension (OR 0.60; 95% CI: 0.37-0.98), having a duration of receiving ART of >5 years (OR 0.46; 95% CI: 0.28-0.77) and having a CD4 count of >200 cells/mm3 (OR 0.46; 95%CI: 0.26-0.84). CSDI were common among HIV-infected patients receiving ARV in our outpatient clinic. Patients having a low CD, count, having dyslipidemia, receiving PI-based ART, having a frequent number of visits per year and having a large number of items prescribed at each visit had a greater chance of a CSDI.

  6. Patient perspectives on care received at community acupuncture clinics: a qualitative thematic analysis

    OpenAIRE

    2013-01-01

    Abstract Background Community acupuncture is a recent innovation in acupuncture service delivery in the U.S. that aims to improve access to care through low-cost treatments in group-based settings. Patients at community acupuncture clinics represent a broader socioeconomic spectrum and receive more frequent treatments compared to acupuncture users nationwide. As a relatively new model of acupuncture in the U.S., little is known about the experiences o...

  7. Increase in overall mortality risk in patients with type 2 diabetes receiving different oral diabetes drugs

    Directory of Open Access Journals (Sweden)

    E A Pigarova

    2012-12-01

    Full Text Available Реферат по статье: Pantalone KM, Kattan MW, Yu C, Wells BJ, Arrigain S, Jain A, Atreja A, Zimmerman RS. Increase in overall mortality risk in patients with type 2 diabetes receiving glipizide, glyburide or glimepiride monotherapy versus metformin: a retrospective analysis. Diabetes Obes Metab. 2012 Sep;14(9:803-809.

  8. Stevens-Johnson syndrome limited to multiple sites of radiation therapy in a patient receiving phenobarbital.

    Science.gov (United States)

    Duncan, K O; Tigelaar, R E; Bolognia, J L

    1999-03-01

    Stevens-Johnson syndrome (SJS) is a severe cutaneous eruption that most often appears as an adverse reaction to a medication. There have been 21 reported cases of atypical erythema multiforme, toxic epidermal necrolysis, and SJS arising in patients receiving radiation therapy in addition to phenytoin, phenobarbital, or carbamazepine. We report the second case of SJS resulting from concomitant phenobarbital and radiation therapy, in which the eruption was limited to the sites of radiation, which were multiple.

  9. Characteristics of Patients Who Receive Home Health Services and Expectations of Caregivers

    Directory of Open Access Journals (Sweden)

    Yasemin Çayır1

    2013-09-01

    Full Text Available Objective: It is expected that Home Health Services (HHS reduce unnecessary health spending as well as decrease burden on hospitals, and provide high capacity to use available resources more efficiently. Thus we sought to assess these services including patients’ characteristics and caregiver’s expectation and satisfaction from HHS. Methods: Fifty-seven patient and their caregivers were included in the study. Patients’ daily life activities were evaluated with Katz scale and socio-demographic and clinical characteristics of patients were also recorded. Further caregiver’s expectations and satisfaction from HHS was evaluated with the help of a standard form. Analysis was done with the SPSS software. Results: The mean age was 68.7±19.2 years. Out of total, 61.4% of patients (n=35 were female. Diagnoses according to the frequency were as follows: hemophilia (n=15; 26.3%, Alzheimer (n=12; 21.1%, terminal cancer (n=10; 17.5%, chronic obstructive pulmonary disease (n=6; 10.5%, Parkinson (n=4; 7%, the patients received postoperative care (n=4; 7%. Out of those who receive HHS, 42.1% patients had pressure ulcer during the evaluation. As the duration of being bedridden increases so chances of presence of pressure ulcer was significantly increased (p<0.05. Total 59.6% caregivers were waiting to examine patients in their home. The opinion survey shows that 89.5% of caregivers thought there would be a reduction in the frequency of hospitalization if patients utilize HHS appropriately, and 82.5% of caregivers believed that already benefited enough from the HHS. Conclusion: HHS was given with professional team will meet expectations of patients and their relatives as well as decrease frequency of hospitalization and will prevent unnecessary applications to the outpatient clinics. In order to enable more people in need to benefit from this service, family physicians should identify their patients requiring HHS and give them appropriate guidance.

  10. Malfunctions of Implantable Cardiac Devices in Patients Receiving Proton Beam Therapy: Incidence and Predictors

    Energy Technology Data Exchange (ETDEWEB)

    Gomez, Daniel R., E-mail: dgomez@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Poenisch, Falk [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Pinnix, Chelsea C. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Sheu, Tommy [Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Chang, Joe Y. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Memon, Nada [Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Mohan, Radhe [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Rozner, Marc A. [Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Dougherty, Anne H. [Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2013-11-01

    Purpose: Photon therapy has been reported to induce resets of implanted cardiac devices, but the clinical sequelae of treating patients with such devices with proton beam therapy (PBT) are not well known. We reviewed the incidence of device malfunctions among patients undergoing PBT. Methods and Materials: From March 2009 through July 2012, 42 patients with implanted cardiac implantable electronic devices (CIED; 28 pacemakers and 14 cardioverter-defibrillators) underwent 42 courses of PBT for thoracic (23, 55%), prostate (15, 36%), liver (3, 7%), or base of skull (1, 2%) tumors at a single institution. The median prescribed dose was 74 Gy (relative biological effectiveness; range 46.8-87.5 Gy), and the median distance from the treatment field to the CIED was 10 cm (range 0.8-40 cm). Maximum proton and neutron doses were estimated for each treatment course. All CIEDs were checked before radiation delivery and monitored throughout treatment. Results: Median estimated peak proton and neutron doses to the CIED in all patients were 0.8 Gy (range 0.13-21 Gy) and 346 Sv (range 11-1100 mSv). Six CIED malfunctions occurred in 5 patients (2 pacemakers and 3 defibrillators). Five of these malfunctions were CIED resets, and 1 patient with a defibrillator (in a patient with a liver tumor) had an elective replacement indicator after therapy that was not influenced by radiation. The mean distance from the proton beam to the CIED among devices that reset was 7.0 cm (range 0.9-8 cm), and the mean maximum neutron dose was 655 mSv (range 330-1100 mSv). All resets occurred in patients receiving thoracic PBT and were corrected without clinical incident. The generator for the defibrillator with the elective replacement indicator message was replaced uneventfully after treatment. Conclusions: The incidence of CIED resets was about 20% among patients receiving PBT to the thorax. We recommend that PBT be avoided in pacing-dependent patients and that patients with any type of CIED receiving

  11. MRI assessment of suppression of structural damage in patients with rheumatoid arthritis receiving rituximab

    DEFF Research Database (Denmark)

    Peterfy, Charles; Emery, Paul; Tak, Paul P

    2016-01-01

    Objective. To evaluate changes in structural damage and joint inflammation assessed by MRI following rituximab treatment in a Phase 3 study of patients with active rheumatoid arthritis (RA) despite methotrexate (MTX) who were naive to biological therapy. Methods. Patients were randomised to receive...... two infusions of placebo (n=63), rituximab 500 mg (n=62), or rituximab 1000 mg (n=60) intravenously on days 1 and 15. MRI scans and radiographs of the most inflamed hand and wrist were acquired at baseline, weeks 12 (MRI only), 24 and 52. The primary end point was the change in MRI erosion score from...

  12. Contributors to fatigue in patients receiving mechanical ventilatory support: A descriptive correlational study.

    Science.gov (United States)

    Chlan, Linda L; Savik, Kay

    2015-10-01

    To describe levels of fatigue and explore clinical factors that might contribute to fatigue in critically ill patients receiving mechanical ventilation. Descriptive, correlational design. Sample was a sub-set of patients enrolled in a randomised clinical trial testing patient-directed music for anxiety self-management. Clinical factors included age, gender, length of ICU stay, length of ventilatory support, illness severity (APACHE III), and sedative exposure (sedation intensity and frequency). Descriptive statistics and mixed models were used to address the study objectives. Medical and surgical intensive care units in the Midwestern United States. Fatigue was measured daily via a 100-mm Visual Analogue Scale, up to 25 days. A sample of 80 patients (50% female) receiving ventilatory support for a median 7.9 days (range 1-46) with a mean age of 61.2 years (SD 14.8) provided daily fatigue ratings. ICU admission APACHE III was 61.5 (SD 19.8). Baseline mean fatigue ratings were 60.7 (SD 27.9), with fluctuations over time indicating a general trend upward. Mixed models analysis implicated illness severity (β(se(β))=.27(.12)) and sedation frequency (β(se(β))=1.2(.52)) as significant contributors to fatigue ratings. Illness severity and more frequent sedative administration were related to higher fatigue ratings in these mechanically ventilated patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Changes of Hemoglobin and Hematocrit in Elderly Patients Receiving Lower Joint Arthroplasty without Allogeneic Blood Transfusion

    Institute of Scientific and Technical Information of China (English)

    Qi Zhou; Yiqin Zhou; Haishan Wu; Yuli Wu; Qirong Qian; Hui Zhao; Yunli Zhu

    2015-01-01

    Background:It has rarely been reported about the changes of hemoglobin (Hb) and hematocrit (Hct) in elderly patients receiving total knee arthroplasty (TKA) or total hip arthroplasty (THA).This study aimed to evaluate the changes of Hb and Hct after TKA or THA in elderly patients,and analyze its relationship with sex and type of arthroplasty.Methods:This is a prospective cohort study,including 107 patients receiving TKA or THA without allogeneic blood transfusion.There were 54 males and 53 females,with a mean age of 69.42 years.Levels of Hb and Hct were examined preoperatively and during the 6 months follow-up after operation.Results:Levels of Hb and Hct decreased postoperatively and reached their minimum points on postoperative day 4.Thereafter,Hb and Hct recovered to their preoperative levels within 6-12 weeks.No significant differences in the levels of Hb and Hct were noticed between different sexes.THA patients showed significantly greater drop in Hb and Hct than TKA patients in the first 4 days postoperatively (P < 0.05).Conclusions:Levels of Hb and Hct decreased during the first 4 days after arthroplasty and gradually returned to their normal levels within 6-12 weeks postoperatively.THA may be associated with higher postoperative blood loss than TKA.

  14. Comparison of survival in patients with end-stage renal disease receiving hemodialysis versus peritoneal dialysis.

    Science.gov (United States)

    Beladi Mousavi, Seyed Seifollah; Hayati, Fatemeh; Valavi, Ehsan; Rekabi, Fazlollah; Mousavi, Marzieh Beladi

    2015-03-01

    Although the life expectancy of patients with end-stage renal disease (ESRD) has improved in recent years, it is still far below that of the general population. In this retrospective study, we compared the survival of patients with ESRD receiving hemodialysis (HD) versus those on peritoneal dialysis (PD). The study was conducted on patients referred to the HD and PD centers of the Emam Khomini Hospital and the Aboozar Children's Hospital from January 2007 to May 2012 in Ahvaz, Iran. All ESRD patients on maintenance HD or PD for more than two months were included in the study. The survival was estimated by the Kaplan-Meier method and the differences between HD and PD patients were tested by the log-rank test. Overall, 239 patients, 148 patients on HD (61.92%) and 91 patients on continuous ambulatory PD (CAPD) (38.55%) with mean age of 54.1 ± 17 years were enrolled in the study. Regardless of the causes of ESRD and type of renal replacement therapy (RRT), one-, two- and three-year survival of patients was 65%, 51% and 35%, respectively. There was no significant difference between type of RRT in one- (P-value = 0.737), two- (P-value = 0.534) and three- (P-value = 0.867) year survival. There was also no significant difference between diabetic and non-diabetic patients under HD and CAPD in the one-, two- and three-year survival. Although the three-year survival of diabetic patients under CAPD was lower than that of non-diabetic patients (13% vs. 34%), it was not statistically significant (P-value = 0.50). According to the results of the current study, there is no survival advantage of PD during the first years of initiation of dialysis, and the one-, two- and three-year survival of HD and PD patients is also similar.

  15. Phylogeny and drug resistance of HIV PR gene among HIV patients receiving RT inhibitors in Iran

    Institute of Scientific and Technical Information of China (English)

    Kazem Baesi; Majedeh Moradbeigi; Mehrdad Ravanshad; Ashrafolnesa Baghban

    2016-01-01

    Objective: To survey the level and patterns of reverse transcriptase-based drug resistance and subtype distribution among antiretroviral-treated HIV-infected patients receiving only reverse transcriptase inhibitors in Iran. Methods: A total of 25 samples of antiretroviral therapy experienced patients with no history of using protease inhibitors were collected. After RNA extraction, reverse transcriptase-nested PCR was performed. The final products were sequenced and then analysed for drug-resistant mutations and subtypes. Results: No drug resistant mutations were observed among the 25 subjects. The results showed the following subtypes among patients:CRF 35_AD (88%), CRF 28_BF (8%), and CRF 29_BF (4%). Conclusions: A significant increase in drug resistance has been noted in recently-infected patients worldwide. Subtype distributions are needed to perform properly-designed surveillance studies to continuously monitor rates and patterns of transmitted drug resistance and subtypes to help guide therapeutic approaches and limit transmission of these variants.

  16. Financial hardship and the intensity of medical care received near death.

    Science.gov (United States)

    Tucker-Seeley, Reginald D; Abel, Gregory A; Uno, Hajime; Prigerson, Holly

    2015-05-01

    Although end-of-life (EOL) care can present a substantial financial burden for the household, the influence of this burden on the intensity of care received at the EOL remains unknown. The goal of this study was to determine the association between financial hardship and intensive care in the last week of life. The Coping with Cancer (CwC) Study is a longitudinal, multisite cohort study of terminally ill cancer patients and their informal caregivers, September 2002-February 2008. Patients (N = 281) were followed from baseline to death, a median of 4.4 months after baseline assessment. Intensive care was defined as the use of resuscitation and/or ventilation in the patient's last week of life. Financial hardship was measured at study baseline as a positive response to whether the household had to use all or most of their savings because of the family member's illness. Twenty-nine percent reported financial hardship, and 9% received intensive EOL care. Patients reporting financial hardship had a 3.22 (95% CI: 1.38, 7.53) higher likelihood of receiving intensive EOL care compared with patients not reporting financial hardship. After adjusting for sociodemographic characteristics and patient preferences, patients reporting financial hardship had a 3.05 (95% CI: 1.22, 7.62) higher likelihood of receiving intensive EOL care. The depletion of a family's financial resources is a significant predictor of intensive EOL care, over and above the influence of sociodemographic characteristics and patient preferences. Copyright © 2014 John Wiley & Sons, Ltd.

  17. Prognostic implication of gene mutations on overall survival in the adult acute myeloid leukemia patients receiving or not receiving allogeneic hematopoietic stem cell transplantations.

    Science.gov (United States)

    Chou, Sheng-Chieh; Tang, Jih-Luh; Hou, Hsin-An; Chou, Wen-Chien; Hu, Fu-Chang; Chen, Chien-Yuan; Yao, Ming; Ko, Bor-Sheng; Huang, Shang-Yi; Tsay, Woei; Chen, Yao-Chang; Tien, Hwei-Fang

    2014-11-01

    Several gene mutations have been shown to provide clinical implications in patients with acute myeloid leukemia (AML). However, the prognostic impact of gene mutations in the context of allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains unclear. We retrospectively evaluated the clinical implications of 8 gene mutations in 325 adult AML patients; 100 of them received allo-HSCT and 225 did not. The genetic alterations analyzed included NPM1, FLT3-ITD, FLT3-TKD, CEBPA, RUNX1, RAS, MLL-PTD, and WT1. In patients who did not receive allo-HSCT, older age, higher WBC count, higher lactate dehydrogenase level, unfavorable karyotype, and RUNX1 mutation were significantly associated with poor overall survival (OS), while CEBPA double mutation (CEBPA(double-mut)) and NPM1(mut)/FLT3-ITD(neg) were associated with good outcome. However, in patients who received allo-HSCT, only refractory disease status at the time of HSCT and unfavorable karyotype were independent poor prognostic factors. Surprisingly, RUNX1 mutation was an independent good prognostic factor for OS in multivariate analysis. The prognostic impact of FLT3-ITD or NPM1(mut)/FLT3-ITD(neg) was lost in this group of patients receiving allo-HSCT, while CEBPA(double-mut) showed a trend to be a good prognostic factor. In conclusion, allo-HSCT can ameliorate the unfavorable influence of some poor-risk gene mutations in AML patients. Unexpectedly, the RUNX1 mutation showed a favorable prognostic impact in the context of allo-HSCT. These results need to be confirmed by further studies with more AML patients.

  18. Patient Decisions to Receive Secondary Pharmacogenomic Findings and Development of a Multidisciplinary Practice Model to Integrate Results Into Patient Care.

    Science.gov (United States)

    Hicks, J Kevin; Shealy, Amy; Schreiber, Allison; Coleridge, Marissa; Noss, Ryan; Natowicz, Marvin; Moran, Rocio; Moss, Timothy; Erwin, Angelika; Eng, Charis

    2017-07-27

    Whole exome sequencing (WES) has the potential of identifying secondary findings that are predictive of poor pharmacotherapy outcomes. The purpose of this study was to investigate patients' wishes regarding the reporting of secondary pharmacogenomic findings. WES results (n = 106 patients) were retrospectively reviewed to determine the number of patients electing to receive secondary pharmacogenomic results. Phenotypes were assigned based on Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines. The percent of patients with a predicted phenotype associated with a gene-based CPIC dosing recommendation was determined. Ninety-nine patients (93.4%) elected to receive secondary pharmacogenomic findings. For each gene-drug pair analyzed, the number of patients with an actionable phenotype ranged from two (2%) to 43 patients (43.4%). Combining all gene-drug pairs, 84 unique patients (84.8%) had an actionable phenotype. A prospective multidisciplinary practice model was developed for integrating secondary pharmacogenomic findings into clinical practice. Our model highlights a unique collaboration between physician-geneticists, pharmacists, and genetic counselors. © 2017 The Authors. Clinical and Translational Science published by Wiley Periodicals, Inc. on behalf of American Society for Clinical Pharmacology and Therapeutics.

  19. Factors associated with patient satisfaction in surgery: the role of patients' perceptions of received care, visit characteristics, and demographic variables.

    Science.gov (United States)

    Schoenfelder, Tonio; Klewer, Joerg; Kugler, Joachim

    2010-11-01

    Measures of satisfaction of surgical patients can be used to evaluate and redesign the process of care or to complement established procedures to improve quality of services. However, study findings regarding aspects of patient satisfaction are often inconsistent and depend on the setting. The primary goals of this research were to identify factors associated with satisfaction among patients in a surgical setting. Data used in this study were obtained from randomly selected 2699 surgical patients discharged during January-December 2008 from 26 hospitals who responded to a mailed survey. The instrument assessed satisfaction regarding 23 items of perceived care, patient demographic, and visit characteristics. Bivariate and multivariate techniques were used to reveal relations between indicators and overall satisfaction. Bivariate statistics showed strong relations between overall satisfaction and perceived care with weaker findings pertaining to demographic and visit characteristics. The Multivariate logistic regression predicting overall satisfaction demonstrated that patients receiving surgical services predominantly have similar demands and priorities regardless of age and gender. The strongest factors were (P < 0.05) the interpersonal manner of medical practitioners and nurses, organization of operations, admittance, and discharge, as well as perceived length of stay. This study identified factors that are related to satisfaction of surgical patients and indicated the intensity of this relationship. These findings support health care providers and medical practitioners with valuable information to meet needs and preferences of patients receiving surgical services. Copyright © 2010 Elsevier Inc. All rights reserved.

  20. Risk factors for upper gastrointestinal bleeding in coronary artery disease patients receiving both aspirin and clopidogrel.

    Science.gov (United States)

    Huang, Kuang-Wei; Luo, Jiing-Chyuan; Leu, Hsin-Bang; Huang, Chin-Chou; Hou, Ming-Chih; Chen, Tseng-Shing; Lu, Ching-Liang; Lin, Han-Chieh; Lee, Fa-Yauh; Chang, Full-Young

    2013-01-01

    Dual therapy (aspirin and clopidogrel) increases the risk of upper gastrointestinal bleeding (UGIB). Acute coronary syndrome (ACS), a critical ill condition, may increase the risk of UGIB due to stress-related mucosal disease and the impact of receiving dual antiplatelet agents. We identified risk factors of UGIB in patients with coronary artery disease (CAD) receiving dual therapy. Patients who received dual therapy due to ACS or postpercutaneous coronary intervention (elective, primary, or urgent) were enrolled retrospectively. We assessed the occurrence of UGIB and identified the risk factors for UGIB at early stage (dual therapy ≤ 2 weeks) and late stage (> 2 weeks) by Cox regression analysis. During a mean follow-up period of 125 days, 67 (12.5 %) out of 534 patients developed UGIB (32 patients at early stage, 35 patients at late stage). Cox regression analysis showed that use of proton pump inhibitor therapy has a protective role in these patients [hazard ratio (HR): 0.10, 95% confidence interval (CI): 0.01-0.71]. ACS (HR: 2.67, 95% CI: 1.33-5.34) has a high risk of developing UGIB at an early stage. Old age (>75 years of age) (HR: 2.13, 95% CI: 1.02-4.47) and prior history of peptic ulcer disease (HR: 3.27, 95% CI: 1.28-8.34) each have an associated high risk for developing UGIB at a late stage. The use of mechanical ventilation (HR: 5.85, 95% CI: 2.19-15.58) also increased UGIB risk at both the early and late stages. ACS and mechanical ventilation are important risk factors of UGIB at the early stage (≤ 2 weeks). Additionally, old age (>75 years), past peptic ulcer disease history, and the use of mechanical ventilation play important roles in the occurrence of UGIB at late stage (>2 weeks). However, it was also noted that use of PPI plays a protective role in patients with CAD receiving aspirin and clopidogrel therapy. Copyright © 2012. Published by Elsevier B.V.

  1. Sexual dysfunction in clinically stable patients with bipolar disorder receiving lithium.

    Science.gov (United States)

    Grover, Sandeep; Ghosh, Abhishek; Sarkar, Siddharth; Chakrabarti, Subho; Avasthi, Ajit

    2014-08-01

    There is limited data on the prevalence of sexual dysfunction in patients with bipolar disorder receiving lithium. This study aimed to evaluate the prevalence of sexual dysfunction in patients with bipolar disorder receiving lithium and to study the correlates of sexual dysfunction. One hundred clinically stable patients with bipolar disorder (Global Assessment for Functioning score of >70, Hamilton Depression Rating Scale score of ≤7 and Young Mania Rating Scale score of ≤7, and no change in medications at least in the last 3 months) receiving lithium were evaluated on Arizona Sexual Experience Scale and Brief Adherence Rating Scale. The mean age of study sample was 44.3 years. The mean Hamilton Depression Rating Scale score was 1.06 (SD, 1.7) and the mean Young Mania Rating Scale score was 0.1 (SD, 0.5) and the mean Global Assessment for Functioning scale score was 84 (SD, 6.0). The mean duration of lithium use was approximately 119.62 (SD, 99.6) months, and the mean dose of lithium was 799.5 (SD, 251.4) mg/d. Of the 100 patients, approximately one third of the patients (n = 37) were found to have sexual dysfunction as per Arizona Sexual Experience Scale. Compared with those without sexual dysfunction, those with sexual dysfunction were older (t value = 3; P = 0.003). Those with sexual dysfunction had lower level of functioning (Global level of functioning score of 81.7 vs 85.5; t value = 3.2; P = 0.002), higher number of other adverse effects with lithium (total number of other adverse effects, 2.9 vs 1.4; t value = 4.2; P lithium experience sexual dysfunction, and it is associated with poor medication adherence.

  2. Patterns of Care Among Patients Receiving Radiation Therapy for Bone Metastases at a Large Academic Institution

    Energy Technology Data Exchange (ETDEWEB)

    Ellsworth, Susannah G. [Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Alcorn, Sara R., E-mail: salcorn2@jhmi.edu [Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Hales, Russell K.; McNutt, Todd R.; DeWeese, Theodore L. [Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Smith, Thomas J. [Department of Medical Oncology and Harry J. Duffey Family Program in Palliative Care, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States)

    2014-08-01

    Purpose: This study evaluates outcomes and patterns of care among patients receiving radiation therapy (RT) for bone metastases at a high-volume academic institution. Methods and Materials: Records of all patients whose final RT course was for bone metastases from April 2007 to July 2012 were identified from electronic medical records. Chart review yielded demographic and clinical data. Rates of complicated versus uncomplicated bone metastases were not analyzed. Results: We identified 339 patients whose final RT course was for bone metastases. Of these, 52.2% were male; median age was 65 years old. The most common primary was non-small-cell lung cancer (29%). Most patients (83%) were prescribed ≤10 fractions; 8% received single-fraction RT. Most patients (52%) had a documented goals of care (GOC) discussion with their radiation oncologist; hospice referral rates were higher when patients had such discussions (66% with vs 50% without GOC discussion, P=.004). Median life expectancy after RT was 96 days. Median survival after RT was shorter based on inpatient as opposed to outpatient status at the time of consultation (35 vs 136 days, respectively, P<.001). Hospice referrals occurred for 56% of patients, with a median interval between completion of RT and hospice referral of 29 days and a median hospice stay of 22 days. Conclusions: These data document excellent adherence to American Society for Radiation Oncolology Choosing Wisely recommendation to avoid routinely using >10 fractions of palliative RT for bone metastasis. Nonetheless, single-fraction RT remains relatively uncommon. Participating in GOC discussions with a radiation oncologist is associated with higher rates of hospice referral. Inpatient status at consultation is associated with short survival.

  3. [Therapy education for patients receiving oral anti-coagulants vitamin K antagonists].

    Science.gov (United States)

    Satger, Bernadette; Blaise, Sophie; Fontaine, Michèle; Yver, Jacqueline; Allenet, Benoît; Baudrant, Magali; Pernod, Gilles; Bosson, Jean-Luc

    2009-12-01

    The vitamin K antagonists (VKA) remain to this day the only oral form of therapeutic anticoagulation. Approximately 1% of the French population, mainly elderly, is treated with these anticoagulants. Oral anticoagulants have significant risks of iatrogenic complications; indeed they are the leading cause of such drug-induced complications, predominantly hemorrhages. AFSSAPS (French Drug and Medical Products Agency) clinical practice recommendations, repeatedly disseminated, emphasize the education of patients receiving VKAs. Managing oral anticoagulant treatment is challenging, with a significant risk of under- or overdosing and consequently, thrombosis or hemorrhage. The therapeutic window is narrow, multiple drug-interactions are possible, and the specific dose required for a particular individual to achieve appropriate International Normalized Ratio (INR) levels is unpredictable. The literature contains few randomized controlled trials about the efficacy of education for patients treated with oral anticoagulants. These education programs are not standardized and are therefore varied and difficult to compare. Nevertheless, studies demonstrate the importance of patient education programs in reducing the risk of hemorrhage and achieving better treatment stability. The Grenoble region hospital-community network for vascular diseases (GRANTED) has developed an education program for these patients, consisting of individual sessions for the patient and/or a friend or family member (either at a health care facility or at the patient's home), telephone support and group sessions, and using educational tools and supports. There is also a link with the general practitioner who receives a report. This approach makes it possible to adapt the educational message to individual patients and their daily lives, as well as directly involving them in the management of their treatment.

  4. Patients receiving androgen deprivation therapy for prostate cancer have an increased risk of depressive disorder

    Science.gov (United States)

    Chung, Shiu-Dong; Xirasagar, Sudha

    2017-01-01

    Androgen deprivation therapy (ADT) results in testosterone suppression, a hypothesized mechanism linking ADT to depressive symptoms. This study investigated the relationship between ADT and the risk of subsequently being diagnosed with depressive disorder (DD) during a 3-year follow-up period. The patient sample for this population-based, retrospective cohort study was retrieved from the Taiwan Longitudinal Health Insurance Database 2005. We included all 1714 patients aged over 40 years with a first-time diagnosis of prostate cancer (PC) during 2001 to 2010 who did not have an orchiectomy. Among them, we defined 868 patients who received ADT during the 3-year follow-up period as the study group, and 846 patients who did not receive ADT as the comparison group. The incidence rates of DD per 1000 person-years were 13.9 (95% confidence interval (CI): 9.5~19.6) and 6.7 (95% CI: 3.7~11.0), respectively. Cox proportional hazard regressions showed that the adjusted hazard ratio for DD for ADT recipients was 1.93 (95% CI: 1.03~3.62) relative to the comparison group. This study presents epidemiological evidence of an association between ADT and a subsequent DD diagnosis. PMID:28253340

  5. Delirium in adult patients receiving palliative care: a systematic review of the literature.

    Science.gov (United States)

    Sánchez-Román, Sofía; Beltrán Zavala, Cristina; Lara Solares, Argelia; Chiquete, Erwin

    2014-01-01

    Delirium in palliative care patients is common and its diagnosis and treatment is a major challenge. Our objective was to perform a literature analysis in two phases on the recent scientific evidence (2007-2012) on the diagnosis and treatment of delirium in adults receiving palliative care. In phase 1 (descriptive studies and narrative reviews) 133 relevant articles were identified: 73 addressed the issue of delirium secondarily, and 60 articles as the main topic. However, only 4 prospective observational studies in which delirium was central were identified. Of 135 articles analysed in phase 2 (clinical trials or descriptive studies on treatment of delirium in palliative care patients), only 3 were about prevention or treatment: 2 retrospective studies and one clinical trial on multicomponent prevention in cancer patients. Much of the recent literature is related to reviews on studies conducted more than a decade ago and on patients different to those receiving palliative care. In conclusion, recent scientific evidence on delirium in palliative care is limited and suboptimal. Prospective studies are urgently needed that focus specifically on this highly vulnerable population. Copyright © 2013 SEP y SEPB. Published by Elsevier España. All rights reserved.

  6. Symptom management in patients with cancer of the female reproductive system receiving chemotherapy.

    Science.gov (United States)

    Phianmongkhol, Yupin; Suwan, Natthawan

    2008-01-01

    This study was conducted to examine the feelings, symptom management, and needs of patients with gynecological cancer receiving chemotherapy at Chiang Mai University Hospital, Chiang Mai, Thailand. During the period July 2006 and June 2007, 286 patients were recruited. The most common chemotherapeutic regimen was paclitaxel and carboplatin followed by single carboplatin and weekly cisplatin. Five severe and frequent complications were as follows: alopecia, anorexia, fatigue, nausea, and vomiting. Some 41.9% could well tolerate with such complications but 50.3% had various feelings including irritability, boredom, dejection, fear, stress, and anxiety. Anorexia was the symptom that the majority of them could best manage, 17.4% by eating as much as they can and 32.6% by selecting different foods from normal, such as fruit, sweetmeats, noodles, milk. For nausea and vomiting, 31.3% managed by eating fruit, drinking sour juice, and holding sour fruit in mouth, and 16.0% used the breathing method, eating something cold, such as ice-cream, or hot food like noodles. For health needs, 41.0% needed encouragement, care, health education, and information from doctors and nurses, and 5.0% needed care and encouragement from their family, and sympathy from neighbors and colleagues. In conclusion, gynecological cancer patients receiving chemotherapy experience a variety of feelings, symptom management. and health needs. Nurses need to explain the pathology of the occurring symptoms so that the patients can understand and accept the symptoms to lessen their negative impact.

  7. Risk factors of thyroid abnormalities in bipolar patients receiving lithium: a case control study

    Directory of Open Access Journals (Sweden)

    Dehpour Ahmad Reza

    2003-05-01

    Full Text Available Abstract Background Lithium-induced thyroid abnormalities have been documented in many studies. They may occur despite normal plasma lithium levels. The objectives of this study were: 1 to determine possible relationship between lithium ratio, defined as erythrocyte lithium concentrations divided by plasma lithium concentrations, and thyroid abnormalities in bipolar patients receiving lithium and 2 to find other possible risk factors for developing thyroid abnormalities in the subjects. Methods Sixty-eight bipolar patients receiving lithium therapy were enrolled in a cross-sectional evaluation of thyroid function test and thyroid size. Patients were divided into two groups based on their thyroid function tests and thyroid sizes. Erythrocyte and plasma lithium concentrations were determined by atomic absorption spectrometry for each patient. Lithium ratio was then calculated. Results No significant differences were found between age, positive family history of affective disorder, plasma lithium concentration, erythrocyte lithium concentration, and lithium ratio comparing the two groups. Thyroid abnormalities was significantly higher in women than in men (p Conclusions Lithium ratio does not appear to have a predictive role for thyroidal side effects of lithium therapy. Female gender was the main risk factor. We suggest more frequent thyroid evaluation of bipolar women who are treated with lithium.

  8. Management of critically ill patients receiving noninvasive and invasive mechanical ventilation in the emergency department

    Directory of Open Access Journals (Sweden)

    Rose L

    2012-03-01

    Full Text Available Louise RoseLawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, CanadaAbstract: Patients requiring noninvasive and invasive ventilation frequently present to emergency departments, and may remain for prolonged periods due to constrained critical care services. Emergency clinicians often do not receive the same education on management of mechanical ventilation or have similar exposure to these patients as do their critical care colleagues. The aim of this review was to synthesize the evidence on management of patients requiring noninvasive and invasive ventilation in the emergency department including indications, clinical applications, monitoring priorities, and potential complications. Noninvasive ventilation is recommended for patients with acute exacerbation of chronic obstructive pulmonary disease or cardiogenic pulmonary edema. Less evidence supports its use in asthma and other causes of acute respiratory failure. Use of noninvasive ventilation in the prehospital setting is relatively new, and some evidence suggests benefit. Monitoring priorities for noninvasive ventilation include response to treatment, respiratory and hemodynamic stability, noninvasive ventilation tolerance, detection of noninvasive ventilation failure, and identification of air leaks around the interface. Application of injurious ventilation increases patient morbidity and mortality. Lung-protective ventilation with low tidal volumes based on determination of predicted body weight and control of plateau pressure has been shown to reduce mortality in patients with acute respiratory distress syndrome, and some evidence exists to suggest this strategy should be used in patients without lung injury. Monitoring of the invasively ventilated patient should focus on assessing response to mechanical ventilation and other interventions, and avoiding complications, such as ventilator-associated pneumonia. Several key aspects of management of noninvasive

  9. Symptom burden & quality of life among patients receiving second-line treatment of metastatic colorectal cancer

    Directory of Open Access Journals (Sweden)

    Walker Mark S

    2012-06-01

    Full Text Available Abstract Background Bevacizumab (B and cetuximab (C are both approved for use in the treatment of metastatic colorectal cancer (mCRC in the second-line. We examined patient reported symptom burden during second-line treatment of mCRC. Methods Adult mCRC patients treated in the second-line setting with a regimen that included B, C, or chemotherapy only (O and who had completed ≥ 1 Patient Care Monitor (PCM surveys as part of routine clinical care were drawn from the ACORN Data Warehouse. Primary endpoints were rash, dry skin, itching, nail changes, nausea, vomiting, fatigue, burning in hands/feet, and diarrhea. Linear mixed models examined change in PCM scores across B, C and O (B = reference. Results 182 patients were enrolled (B: n = 106, C: n = 38, O: n = 38. Patients were 51% female, 67% Caucasian, with mean age of 62.0 (SD = 12.6. Groups did not differ on demographic or clinical characteristics. The most common second-line regimens were FOLFIRI ± B or C (23.1% and FOLFOX ± B or C (22.5%. Results showed baseline scores to be strongly predictive of second-line symptoms across all PCM items (all p’s  Conclusions Patients receiving second-line treatment for mCRC with B report less symptom burden, especially dermatologic, compared to patients treated with C.

  10. Saxagliptin efficacy and safety in patients with type 2 diabetes receiving concomitant statin therapy.

    Science.gov (United States)

    Bryzinski, Brian; Allen, Elsie; Cook, William; Hirshberg, Boaz

    2014-01-01

    To examine whether concomitant statin therapy affects glycemic control with saxagliptin 2.5 and 5mg/d in patients with type 2 diabetes mellitus (T2DM). Efficacy and safety were analyzed post hoc for pooled data from 9 saxagliptin randomized, placebo-controlled trials with a primary 24-week treatment period (4 monotherapy, 2 add-on to metformin, 1 each add-on to a sulfonylurea, thiazolidinedione, or insulin±metformin). Safety was also assessed in an 11-study, 24-week pool and an extended 20-study pool, which included 9 additional 4- to 52-week randomized studies. Comparisons were performed for patient groups defined by baseline statin use. Saxagliptin produced greater mean reductions in glycated hemoglobin than placebo, with no interaction between treatment and baseline statin use (P=0.47). In patients receiving saxagliptin 2.5 and 5mg and placebo, the proportion of patients with ≥1 adverse event (AE) was 78.1%, 64.0%, and 63.2%, respectively, in patients with any statin use and 70.6%, 57.9%, and 55.0% in patients with no statin use. Serious AEs, deaths, and symptomatic confirmed hypoglycemia (fingerstick glucose ≤50mg/dL) were few and similar, irrespective of baseline statin use. Saxagliptin improves glycemic control and is generally well tolerated in patients with T2DM, irrespective of concomitant statin therapy. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Managing patients receiving sorafenib for advanced hepatocellular carcinoma: a case study.

    Science.gov (United States)

    Hull, Diana; Armstrong, Ceri

    2010-05-01

    Despite improvements in cytotoxic chemotherapy agents over the last 50 years, the outlook for patients with many of the most common solid tumours has remained poor. However, in recent years a number of targeted therapies have been licensed in the European Union for use in these cancer types. One such therapy, a tyrosine kinase inhibitor (sorafenib) is now used to treat patients with advanced hepatocellular carcinoma (HCC) and metastatic renal cell carcinoma. This article will explore the role of the oncology nurse in managing patients receiving sorafenib for advanced HCC. A brief overview of sorafenib as a current treatment approved for advanced HCC in the palliative setting is presented. This is followed by a case study-based discussion with particular reference to some of the key care coordination challenges facing the oncology nurse. The management of treatment-related adverse events and the importance of using a multidisciplinary team approach is also reviewed.

  12. QTc interval in patients with schizophrenia receiving antipsychotic treatment as monotherapy or polypharmacy

    DEFF Research Database (Denmark)

    Elliott, Anja Friis; Johan Mørk, Thibault; Højlund, Mikkel

    2017-01-01

    Objective: Antipsychotics are associated with a polymorphic ventricular tachycardia, torsades de pointes, which, in the worst case, can lead to sudden cardiac death. The QT interval corrected for heart rate (QTc) is used as a clinical proxy for torsades de pointes. The QTc interval can be prolong...... on monitoring the QTc interval in women with schizophrenia receiving antipsychotics as polypharmacy....... by antipsychotic monotherapy, but it is unknown if the QTc interval is prolonged further with antipsychotic polypharmaceutical treatment. Therefore, this study investigated the associations between QTc interval and antipsychotic monotherapy and antipsychotic polypharmaceutical treatment in schizophrenia......, and measured the frequency of QTc prolongation among patients. Methods: We carried out an observational cohort study of unselected patients with schizophrenia visiting outpatient facilities in the region of Central Jutland, Denmark. Patients were enrolled from January of 2013 to June of 2015, with follow...

  13. ACTION DURATION OF ATRACURIUM IN HYPERTENSIVE PREGNANT PATIENTS WHO RECEIVED MAGNESIUM SULFATE

    Directory of Open Access Journals (Sweden)

    P SAJEDI

    2000-03-01

    Full Text Available Introduction. Usually, infusion of intermittent doses of succinylcholin is used for relaxation of muscles in the preeclamptic pregnant women treated with magnesium sulfate during cesarian. section This drug has complications such as hyperkalemia, phase 11block, etc. On the other hand non depolarizing muscle relaxant in these patients should be used only in the presence of nerve stimulator and with careful titration. Methods. Duration of clinical action of a medium acting non depolarizing muscle relaxant "atracurium" with succinylcolin's infusion was studied in 86 preeclamptic pregnant women who received therapeutic doses of magnesium sulfate. Findings. Magnesium sulfate did not prolong clinical action of atracurium. Conclusion. Based on this study it can be concluded that administration of atracurium in the pregnant women who received therapeutic dose of magnesium sulfate in the absence of peripheral nerve stimulator is not contraindicated.

  14. Validation of PAGE-B model in Asian chronic hepatitis B patients receiving entecavir or tenofovir.

    Science.gov (United States)

    Kim, Mi Na; Hwang, Seong Gyu; Rim, Kyu Sung; Kim, Beom Kyung; Park, Jun Yong; Kim, Do Young; Ahn, Sang Hoon; Han, Kwang-Hyub; Kim, Seung Up

    2017-04-18

    A new hepatocellular carcinoma risk prediction model, PAGE-B, which includes age, gender and platelet count as constituent variables, has recently been proposed in Caucasian chronic hepatitis B patients. We validated PAGE-B model and compared its accuracy with that of conventional risk prediction models in Asian chronic hepatitis B patients. Chronic hepatitis B patients treated with entecavir or tenofovir were consecutively recruited. The performance of PAGE-B and three conventional risk prediction models (CU-HCC, GAG-HCC and REACH-B) were analysed. A total of 1092 chronic hepatitis B patients (668 men, 61.2%) were selected between August 2006 and January 2015. The mean age was 48 years. During the follow-up period (median, 43.6 months), 36 (3.3%) patients developed hepatocellular carcinoma. Older age (hazard ratio [HR]=1.077), male gender (HR=3.676) and lower platelet count (HR=0.984) were independent predictors of hepatocellular carcinoma development. The PAGE-B showed similar area under receiver operating characteristic curves (AUROCs) to GAG-HCC and CU-HCC at 3 years (0.777 vs 0.793 and 0.743, respectively; all P>.05) and 5 years (0.799 vs 0.803 and 0.744, respectively; all P>.05), whereas the AUROCs of PAGE-B were significantly higher than those of the REACH-B (0.602 at 3 years and 0.572 at 5 years, P<.05). Our study demonstrated that PAGE-B is applicable to Asian chronic hepatitis B patients receiving ETV or TDF therapy. The PAGE-B showed similar predictive performance to GAG-HCC and CU-HCC. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. Continuous infusion of vancomycin in septic patients receiving continuous renal replacement therapy.

    Science.gov (United States)

    Covajes, Cecilia; Scolletta, Sabino; Penaccini, Laura; Ocampos-Martinez, Eva; Abdelhadii, Ali; Beumier, Marjorie; Jacobs, Frédérique; de Backer, Daniel; Vincent, Jean-Louis; Taccone, Fabio Silvio

    2013-03-01

    Vancomycin is frequently administered as a continuous infusion to treat severe infections caused by Gram-positive bacteria. Previous studies have suggested a loading dose of 15 mg/kg followed by continuous infusion of 30 mg/kg in patients with normal renal function; however, there are no dosing recommendations in patients with renal failure undergoing continuous renal replacement therapy (CRRT). Data from all adult septic patients admitted to a Department of Intensive Care over a 3-year period in whom vancomycin was given as a continuous infusion were reviewed. Patients were included if they received vancomycin for ≥48h during CRRT. Vancomycin levels were obtained daily. During the study period, 85 patients (56 male; mean age 65±15 years; weight 85±24kg) met the inclusion criteria. Median (interquartile range) APACHE II and SOFA scores were 24 (20-29) and 11 (7-14), respectively, and the overall mortality rate was 59%. Mean vancomycin doses were 16.4±6.4 (loading dose), 23.5±8.1 (Day 1), 23.2±7.4 (Day 2) and 23.3±11.0 (Day 3) mg/kg, resulting in blood concentrations of 24.7±9.0 (Day 1), 26.0±8.1 (Day 2) and 27.7±9.3 (Day 3) μg/mL. On Day 1, 43 patients (51%) had adequate drug concentrations (20-30 μg/mL), 17 (20%) had levels >30 μg/mL and 25 (29%) had levels drug concentrations received a daily dose of 16-35 mg/kg. The intensity of CRRT directly influenced vancomycin concentrations on Day 1 of therapy. Copyright © 2012 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

  16. Study of HIV-1 Drug Resistance in Patients Receiving Free Antiretroviral Therapy in China

    Institute of Scientific and Technical Information of China (English)

    Xin-ping LI; Hai-wei ZHOU; Jiang-hong HUANG; Hong PENG; Peng-fei MA; Yi-ming SHAO; Hui XING; Zhe WANG; Xue-feng SI; Lian-en WANG; Hua CHENG; Wei-guo CUI; Shu-lin JIANG; Ling-jie LIAO

    2007-01-01

    To investigate the prevalence of drug-resistance mutations, resistance to antiretroviral drugs, and the subsequent virological response to therapy in treatment-naive and antiretroviral-treated patients infected with HIV/AIDS in Henan, China, a total of 431 plasma samples were collected in Queshan county between 2003 and 2004, from patients undergoing the antiretroviral regimen Zidovudine + Didanosine + Nevirapine (Azt+Ddi+Nvp). Personal information was collected by face to face interview. Viral load and genotypic drug resistance were tested. Drug resistance mutation data were obtained by analyzing patient-derived sequences through the HIVdb Program (http://hivdb.stanford.edu). Overall, 38.5% of treatment-naive patients had undetectable plasma viral load (VL), the rate significantly increased to 61.9% in 0 to 6 months treatment patients (mean 3 months) (P<0.005) but again significantly decrease to 38.6% in 6 to 12 months treatment patients (mean 9 months) (P<0.001) and 40.0% in patients receiving more than 12 months treatment (mean 16 months) (P<0.005). The prevalence of drug resistance in patients who had a detectable VL and available sequences were 7.0%, 48.6%, 70.8%, 72.3% in treatment-na(1)ve, 0 to 6 months treatment, 6 to 12 months treatment, and treatment for greater than 12 months patients, respectively. No mutation associated with resistance to Protease inhibitor (PI) was detected in this study. Nucleoside RT inhibitor (NRTI) mutations always emerged after non-nucleoside RT inhibitor (NNRTI) mutations, and were only found in patients treated for more than 6 months, with a frequency less than 5%, with the exception of mutation T215Y (12.8%, 6/47) which occurred in patients treated for more than 12 months. NNRTI mutations emerged quickly after therapy begun, and increased significantly in patients treated for more than 6 months (P<0.005), and the most frequent mutations were K103N, V106A, Y181C, G190A. There had been optimal viral suppression in

  17. Trimethoprim-sulfamethoxazole induced hyperkalaemia in elderly patients receiving spironolactone: nested case-control study

    Science.gov (United States)

    Gomes, Tara; Mamdani, Muhammad M; Yao, Zhan; Hellings, Chelsea; Garg, Amit X; Weir, Matthew A; Juurlink, David N

    2011-01-01

    Objectives To characterise the risk of admission to hospital for hyperkalaemia in elderly patients treated with trimethoprim-sulfamethoxazole in combination with spironolactone. Design Population based nested case-control study. Setting Ontario, Canada, from 1 April 1992 to 1 March 2010. Participants Cases were residents of Ontario aged 66 years or above receiving chronic treatment with spironolactone and admitted to hospital with hyperkalaemia within 14 days of receiving a prescription for either trimethoprim-sulfamethoxazole, amoxicillin, norfloxacin, or nitrofurantoin. Up to four controls for each case were identified from the same cohort, matched on age, sex, and presence or absence of chronic kidney disease and diabetes, and required to have received one of the study antibiotics within 14 days before the case’s index date. Main outcome measures Odds ratio for association between admission to hospital with hyperkalaemia and receipt of a study antibiotic in the preceding 14 days, adjusted for conditions and drugs that may influence risk of hyperkalaemia. Results During the 18 year study period, 6903 admissions for hyperkalaemia were identified, 306 of which occurred within 14 days of antibiotic use. Of these, 248 (81%) cases were matched to 783 controls. 10.8% (17 859/165 754) of spironolactone users received at least one prescription for trimethoprim-sulfamethoxazole. Compared with amoxicillin, prescription of trimethoprim-sulfamethoxazole was associated with a marked increase in the risk of admission to hospital for hyperkalaemia (adjusted odds ratio 12.4, 95% confidence interval 7.1 to 21.6). The population attributable fraction was 59.7%, suggesting that approximately 60% of all cases of hyperkalaemia in older patients taking spironolactone and treated with an antibiotic for a urinary tract infection could be avoided if trimethoprim-sulfamethoxazole was not prescribed. Treatment with nitrofurantoin was also associated with an increase in the risk of

  18. Posaconazole plasma concentrations in pediatric patients receiving antifungal prophylaxis during neutropenia.

    Science.gov (United States)

    Döring, Michaela; Cabanillas Stanchi, Karin Melanie; Klinker, Hartwig; Eikemeier, Melinda; Feucht, Judith; Blaeschke, Franziska; Schwarze, Carl-Philipp; Ebinger, Martin; Feuchtinger, Tobias; Handgretinger, Rupert; Heinz, Werner J

    2016-10-04

    Invasive fungal infections are one of the major complications in pediatric patients during prolonged neutropenia after chemotherapy. Evaluation of the efficacy and safety of the triazole posaconazole in these patients is missing. This multicenter survey analyzed trough concentrations of 33 pediatric patients with a median age of 8 years during 108 neutropenic episodes who received prophylactic posaconazole oral suspension. A total of 172 posaconazole trough levels were determined to median 438 ng/ml (range 111-2011 ng/ml; mean 468 ± 244 ng/ml). Age and gender had no influence on posaconazole plasma levels. Posaconazole was not discontinued due to adverse events in any of the patients. Only hepatic parameters significantly increased beyond the upper normal limit to median values of ALT of 87 U/l (P posaconazole trough concentration of 306 ng/ml experienced an invasive fungal infection. In conclusion, posaconazole was effective, safe and feasible in 33 pediatric patients with neutropenia ≥5 days after chemotherapy. Median posaconazole plasma concentrations were approximately 1.6-fold lower than the recommended plasma level of 700 ng/ml. Larger patient cohorts are needed to evaluate these findings.

  19. Dentin hypersensitivity-like tooth pain seen in patients receiving steroid therapy: An exploratory study.

    Science.gov (United States)

    Shoji, Noriaki; Endo, Yu; Iikubo, Masahiro; Ishii, Tomonori; Harigae, Hideo; Aida, Jun; Sakamoto, Maya; Sasano, Takashi

    2016-11-01

    To ascertain whether steroid therapy evokes dentin hypersensitivity (DH)-like tooth pain, we performed a study based on compelling evidence from patients receiving steroid therapy. An exploratory study was conducted using a questionnaire for 220 patients prescribed steroids who attended the Department of Hematology and Rheumatology of Tohoku University Hospital. Group comparisons between patients with and without steroid pulse therapy were analysed by statistical means. In this study, any DH-like tooth pain that commenced subsequent to steroid treatment was defined as steroid-derived (SD) tooth pain. The prevalence of SD tooth pain was 17.7% (39/220 patients). SD tooth pain was triggered in many vital teeth by cold and/or hot water (84.2% and 23.7%, respectively) with the pain characterised as continuous, in contrast to typical DH tooth pain. SD tooth pain was significantly more frequent in pulse therapy patients than in non-pulse therapy patients (p pain score (ρ = 0.642). Dose reduction or discontinuation of steroid therapy relieved SD tooth pain in all cases. Thus, steroid therapy can evoke DH-like tooth pain during treatment. Copyright © 2016 The Authors. Production and hosting by Elsevier B.V. All rights reserved.

  20. Current Status of Implant-based Breast Reconstruction in Patients Receiving Postmastectomy Radiation Therapy

    Science.gov (United States)

    Kronowitz, Steven J.

    2014-01-01

    Background Increasing numbers of patients with breast cancer are being treated with postmastectomy radiation therapy (PMRT). The author reviewed the literature to determine the clinical impact of this increasing use of PMRT in patients with breast cancer who desire implant-based breast reconstruction. Methods The author searched the MEDLINE database for articles on breast reconstruction and radiation therapy published between January 2008 and June 2011, and reviewed the abstracts of those articles to identify articles with information about the impact of radiation on implant-based breast reconstruction. This subgroup of articles was reviewed in detail. Results Two-hundred eighty-five articles were identified. 19 papers were reviewed in detail. 8 papers provided level III evidence; one provided level I or II (n = 8) evidence from high-quality multicenter or single-center randomized controlled trials or prospective cohort studies. Two papers provided level IV evidence from case series and were included in the review because they offered a novel approach or perspective. The most recent studies find a significant need for unplanned or major corrective surgery in irradiated breasts reconstructed with implants. Although breast implant reconstruction in irradiated breasts is associated with high rates of complications; only a minority of patients require conversion to an autologous tissue flap. Conclusions Although the majority of patients who undergo implant-based reconstruction and receive radiation ultimately keep the implant reconstruction, patient surveys show that radiation has a significantly negative effect on patient satisfaction. PMID:23018711

  1. Perceived needs of caregivers of stroke patients’ receiving out-patient physiotherapy treatment in Lusaka, Zambia

    Directory of Open Access Journals (Sweden)

    O. Khondowe

    2007-02-01

    Full Text Available Caregivers of stroke patients have needs that should be addressed. The aim of this study was to gain information regarding the expressed needs of informal caregivers of stroke patients who are receiving out-patient physiotherapy treatment at the University Teaching Hospital in Lusaka, Zambia. A qualitative study, using indepth interviews, was carried out to collect data regarding the needs of these caregivers. Ten caregivers formed the study sample. The interviews were audiotaped, transcribed and analysed into themes that emerged from the data. Five themes relating to the needs of the care-givers emerged following the analysis of the data. These included: the lack of information regarding stroke; the need for skills training to enable the caregiver to assist the patient at home; the need for financial support; a need for home-based therapy and the need for physical assistance when caring for patients at home. The caregivers of patients need more information regarding strokes as well as a community-based rather than an institution-based approach to rehabilitation.  Rehabilitation professionals in Zambia could use the information gained from this study to implement rehabilitation programmes, which wouldaddress the needs of caregivers in that country

  2. Risk factors for nosocomial infections in patients receiving extracorporeal membrane oxygenation supportive therapy.

    Science.gov (United States)

    Sun, Geqin; Li, Binfei; Lan, Haili; Wang, Juan; Lu, Lanfei; Feng, Xueqin; Luo, Xihua; Yan, Haizhong; Mu, Yuejing

    2017-06-22

    The aim of this study was to analyze risk factors for nosocomial infection (NI) in patients receiving extracorporeal membrane oxygenation (ECMO) support. Clinical NI data were collected from patients who received ECMO support therapy, and analyzed retrospectively. Among 75 ECMO patients, 20 were found to have developed NI (infection rate 26.7%); a total of 58 pathogens were isolated, including 43 strains of gram-negative bacteria (74.1%) and 15 strains of gram-positive bacteria (25.9%). Multi-drug resistant strains were highly concentrated and were mainly shown to be Acinetobacter baumannii, Pseudomonas aeruginosa, and coagulase-negative staphylococci. Incidence of NI was related to the duration of ECMO support therapy and the total length of hospital stay, and the differences were statistically significant (P<.05). A prolonged period of ECMO support extended the hospital stay, but it did not increase the mortality rate. However, an elevated level of lactic acid increased the mortality rate in this study population. ECMO-associated secondary NIs correlated significantly with the length of hospital stay and with the duration of ECMO support. Therefore, to reduce the incidence of ECMO-associated NIs, preventive strategies that aim to shorten the duration of ECMO support therapy and avoid lengthy hospitalization should be applied, wherever possible. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  3. Increased Long-Term Mortality among Black CABG Patients Receiving Preoperative Inotropic Agents

    Directory of Open Access Journals (Sweden)

    Jimmy T. Efird

    2015-07-01

    Full Text Available The aim of this study was to examine racial differences in long-term mortality after coronary artery bypass grafting (CABG, stratified by preoperative use of inotropic agents. Black and white patients who required preoperative inotropic support prior to undergoing CABG procedures between 1992 and 2011 were compared. Mortality probabilities were computed using the Kaplan-Meier product-limit method. Hazard ratios (HR and 95% confidence intervals (CI were computed using a Cox regression model. A total of 15,765 patients underwent CABG, of whom 211 received preoperative inotropic agents within 48 hours of surgery. Long-term mortality differed by race (black versus white among preoperative inotropic category (inotropes: adjusted HR = 1.6, 95% CI = 1.009–2.4; no inotropes: adjusted HR = 1.15, 95% CI = 1.08–1.2; Pinteraction < 0.0001. Our study identified an independent preoperative risk-factor for long-term mortality among blacks receiving CABG. This outcome provides information that may be useful for surgeons, primary care providers, and their patients.

  4. Statement on the safety of glucosamine for patients receiving coumarin anticoagulants

    DEFF Research Database (Denmark)

    Tetens, Inge

    2011-01-01

    The European Food Safety Authority (EFSA) asked the Panel on Dietetic Products, Nutrition and Allergies to provide a scientific statement on the safety of glucosamine for patients receiving coumarin anticoagulants. More than 40 case reports have been collected by drug-monitoring agencies that sho......The European Food Safety Authority (EFSA) asked the Panel on Dietetic Products, Nutrition and Allergies to provide a scientific statement on the safety of glucosamine for patients receiving coumarin anticoagulants. More than 40 case reports have been collected by drug-monitoring agencies...... that showed in some patients being prescribed coumarin anticoagulants, especially warfarin, that the International Normalised Ratio (INR) increased after they began taking glucosamine, which indicated an increase in the coagulation time. In most cases the increased INR values were symptomless but in some...... cases haemorrhage occurred in a variety of organs, and in one case this resulted in a persistent vegetative state. The evidence for an interaction between glucosamine and coumarin anticoagulants is strengthened by the observation that in the majority of cases the INR began to fall to normal values when...

  5. Assessment and monitoring of patients receiving chemotherapy for multiple myeloma: strategies to improve outcomes

    Directory of Open Access Journals (Sweden)

    Faiman B

    2016-05-01

    Full Text Available Beth Faiman, Jason Valent Department of Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA Abstract: Improved understanding as to the biology of multiple myeloma (MM and the bone marrow microenvironment has led to the development of new drugs to treat MM. This explosion of new and highly effective drugs has led to dramatic advances in the management of MM and underscores the need for supportive care. Impressive and deep response rates to chemotherapy, monoclonal antibodies, and small molecule drugs provide hope of a cure or prolonged remission for the majority of individuals. For most patients, long-term, continuous therapy is often required to suppress the malignant plasma cell clone, thus requiring clinicians to become more astute in assessment, monitoring, and intervention of side effects as well as monitoring response to therapy. Appropriate diagnosis and monitoring strategies are essential to ensure that patients receive the appropriate chemotherapy and supportive therapy at relapse, and that side effects are appropriately managed to allow for continued therapy and adherence to the regimen. Multiple drugs with complex regimens are currently available with varying side effect profiles. Knowledge of the drugs used to treat MM and the common adverse events will allow for preventative strategies to mitigate adverse events and prompt intervention. The purpose of this paper is to review updates in the diagnosis and management of MM, and to provide strategies for assessment and monitoring of patients receiving chemotherapy for MM. Keywords: multiple myeloma, treatment, symptoms, assessment, monitoring, symptom management, targeted therapies

  6. Do patients receive recommended treatment of osteoporosis following hip fracture in primary care?

    Directory of Open Access Journals (Sweden)

    Petrella Robert J

    2006-05-01

    Full Text Available Abstract Background Osteoporosis results in fractures and treatment of osteoporosis has been shown to reduce risk of fracture particularly in those who have had a history of fracture. Methods A prospective study was conducted using patients admitted to a hip fracture rehabilitation program at a large referral center to evaluate the use of treatments recommended for secondary prevention of osteoporotic fracture between September 1, 2001 and September 30, 2003. The frequency of medication use for the treatment of osteoporosis including estrogen replacement therapy, bisphosponates, calcitonin, calcium and vitamin D therapy was determined on admission, at 6 weeks post discharge and one year following discharge. All patients were discharged to the care of their family physician. All family physicians in the referral region received a copy of the Canadian Consensus recommendations for osteoporosis management 1–3 months prior to the study. Results During the study period, 174 patients were enrolled and 121 completed all assessments. Fifty-seven family physicians were identified as caring for 1 or more of the study patients. Only 7 patients had previous BMD, only 5 patients had previously been prescribed a bisphosponate and 14 patients were taking calcium and/or vitamin D. All patients were prescribed 2500 mg calcium, 400 IU vitamin D and 5 mg residronate daily during rehabilitation and at discharge. Following discharge, a significant improvement was seen in all clinical indices of functional mobility, including the functional independence measure (FIM, walking distance, fear of falling score (FFS, and the Berg balance score (BBS. At six weeks a significant (p Conclusion Few patients admitted for hip fracture had previously taken recommended osteoporosis therapy including bisphosphonates. While compliance with Canadian Consensus recommendations was observed at six weeks, this was not the case at twelve months post hip fracture rehabilitation

  7. Muscle mass loss and intermuscular lipid accumulation were associated with insulin resistance in patients receiving hemodialysis

    Institute of Scientific and Technical Information of China (English)

    WANG Hui-ling; DING Ting-ting; LU Shi; XU Ye; TIAN Jun; HU Wei-feng; ZHANG Jin-yuan

    2013-01-01

    Background An accelerated muscle wasting was the pivotal factor for protein-energy wasting in end stage renal disease.However,very few researches have examined the skeletal muscle quantity and quality in clinical patients.This study investigated the muscle morphologic changes by magnetic resonance imaging (MRI) and analyzed the related factors in hemodialysis patients.Methods Fifty-eight patients receiving maintenance hemodialysis (HD) were investigated and 28 healthy adults with gender and age matched were used as controls (Control).Anthropometry,cytokine factors,and laboratory data were measured.The muscle and intermuscular adipose tissues (IMAT) were analyzed via a Thigh MRI.The bicep samples were observed after HE staining.Homeostatic model assessment of insulin resistance (HOMA-IR) was measured and their association with muscle wasting was analyzed.Results HD patients tended to have a lower protein diet,anthropometry data,and serum albumin,but the C reactive protein and interleukin-6 increased significantly.The MRI showed that HD patients had less muscle mass and a lower muscle/total ratio,but the fat/muscle and IMAT was higher when compared to the Control group.The muscle fiber showed atrophy and fat accumulation in the biceps samples come from the HD patients.Moreover,we found that the HD patients presented with a high level of plasma fasting insulin and increased HOMA-IR which negatively correlated with the muscle/total ratio,but positively with the fat/muscle ratio.Conclusions Muscle wasting presented early before an obvious malnutrition condition emerged in HD patients.The main morphological change was muscle atrophy along with intermuscular lipid accumulation.Insulin resistance was associated with muscle wasting in dialysis patients.

  8. Bispectral index for monitoring anesthetic depth in patients with severe burns receiving target-controlled infusion of remifentanil and propofol.

    Science.gov (United States)

    Guo, Z G; Jia, X P; Wang, X Y; Li, P; Su, X J; Hao, J H

    2015-07-13

    This study evaluated the feasibility and effectiveness of using the bispectral index (BIS) to monitor anesthetic depth in patients with severe burns receiving intravenous target-controlled infusion (TCI) of remifentanil and propofol. We randomly assigned 80 patients undergoing elective escharectomy (depth in patients with severe burns receiving TCI of remifentanil and propofol during the perioperative period reduces propofol consumption and shortens the consciousness recovery time in patients.

  9. Platelet function monitoring guided antiplatelet therapy in patients receiving high-risk coronary interventions

    Institute of Scientific and Technical Information of China (English)

    Xu Li; Wang Lefeng; Yang Xinchun; Li Kuibao; Sun Hao; Zhang Dapeng; Wang Hongshi

    2014-01-01

    Background Large-scale clinical trials have shown that routine monitoring of the platelet function in patients after percutanous coronary intervention (PCI) is not necessary.However,it is still unclear whether patients received high-risk PCI would benefit from a therapy which is guided by a selective platelet function monitoring.This explanatory study sought to assess the benefit of a therapy guided by platelet function monitoring for these patients.Methods Acute coronary syndrome (ACS) patients (n=384) who received high-risk,complex PCI were randomized into two groups.PCI in the two types of lesions described below was defined as high-risk,complex PCI:lesions that could result in severe clinical outcomes if stent thrombosis occurred or lesions at high risk for stent thrombosis.The patients in the conventionally treated group received standard dual antiplatelet therapy.The patients in the platelet function monitoring guided group received an antiplated therapy guided by a modified thromboelastography (TEG) platelet mapping:If inhibition of platelet aggregation (IPA) induced by arachidonic acid (AA) was less than 50% the aspirin dosage was raised to 200 mg/d; if IPA induced by adenosine diphosphate (ADP) was less than 30% the clopidogrel dosage was raised to 150 mg/d,for three months.The primary efficacy endpoint was a composite of myocardial infarction,emergency target vessel revascularization (eTVR),stent thrombosis,and death in six months.Results This study included 384 patients; 191 and 193 in the conventionally treated group and platelet function monitoring guided group,respectively.No significant differences were observed in the baseline clinical characteristics and interventional data between the two groups.In the platelet function monitoring guided group,the mean IPA induced by AA and ADP were (69.2±24.5)% (range,4.8% to 100.0%) and (51.4±29.8)% (range,0.2% to 100.0%),respectively.The AAinduced IPA of forty-three (22.2%) patients was less

  10. Fluconazole pharmacokinetics in a morbidly obese, critically ill patient receiving continuous venovenous hemofiltration.

    Science.gov (United States)

    Lopez, Natasha D; Phillips, Kristy M

    2014-09-01

    Current fluconazole dosing strategies can be described using either standardized doses (800 or 400 mg) or as weight-based dosing recommendations (12 mg/kg loading dose followed by 6 mg/kg maintenance dose). The ideal method of fluconazole dosing is still unclear for certain patient populations, such as those receiving renal replacement therapy or the morbidly obese. We describe a 48-year-old man with a body mass index of 84 kg/m(2) who was receiving continuous venovenous hemofiltration (CVVH) and was treated with fluconazole by using a weight-based dose determined by lean body weight, infused at a rate of 200 mg/hour. Blood samples were collected at hour 0 (i.e., ~24 hrs after the loading dose was administered) and at 3.5, 6.8, and 11.3 hours after the start of the 600-mg maintenance dose, infused over 3 hours. Pharmacokinetic parameters calculated were maximum serum concentration 9.64 mg/L, minimum serum concentration 5.98 mg/L, area under the serum concentration-time curve from 0-24 hours (AUC0-24 ) 184.75 mg/L•hour, elimination rate constant 0.0199 hour(-1) , elimination half-life 34.8 hours, and total body clearance 3.25 L/hour. Our data, when combined with previously published literature, do not support using a linear dose-to-AUC approximation to estimate drug dosing needs in the critically ill patient population receiving CVVH. In addition, our results suggest that morbidly obese patients are able to achieve pharmacodynamic goals defined as an AUC:MIC ratio higher than 25 by using a lean body weight for fluconazole dosing calculations.

  11. Safety of ultrasound-guided transrectal extended prostate biopsy in patients receiving low-dose aspirin

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    Ioannis Kariotis

    2010-06-01

    Full Text Available PURPOSE: To determine whether the peri-procedural administration of low-dose aspirin increases the risk of bleeding complications for patients undergoing extended prostate biopsies. MATERIALS AND METHODS: From February 2007 to September 2008, 530 men undergoing extended needle biopsies were divided in two groups; those receiving aspirin and those not receiving aspirin. The morbidity of the procedure, with emphasis on hemorrhagic complications, was assessed prospectively using two standardized questionnaires. RESULTS: There were no significant differences between the two groups regarding the mean number of biopsy cores (12.9 ± 1.6 vs. 13.1 ± 1.2 cores, p = 0.09. No major biopsy-related complications were noted. Statistical analysis did not demonstrate significant differences in the rate of hematuria (64.5% vs. 60.6%, p = 0.46, rectal bleeding (33.6% vs. 25.9%, p = 0.09 or hemospermia (90.1% vs. 86.9%, p = 0.45. The mean duration of hematuria and rectal bleeding was significantly greater in the aspirin group compared to the control group (4.45 ± 2.7 vs. 2.4 ± 2.6, p = < 0.001 and 3.3 ± 1.3 vs. 1.9 ± 0.7, p < 0.001. Multivariate logistic regression analysis revealed that only younger patients (mean age 60.1 ± 5.8 years with a lower body mass index (< 25 kg/m2 receiving aspirin were at a higher risk (odds ratio = 3.46, p = 0.047 for developing hematuria and rectal bleeding after the procedure. CONCLUSIONS: The continuing use of low-dose aspirin in patients undergoing extended prostatic biopsy is a relatively safe option since it does not increase the morbidity of the procedure.

  12. Late Diabetic Complications in Patients with Type 1 Diabetes who Received Simultaneous Pancreas-Kidney Transplantation

    Directory of Open Access Journals (Sweden)

    Aleksandra Mikhaylovna Glazunova

    2015-03-01

    Full Text Available Aim. The aim of this study was to investigate late diabetic complications in patients with Type 1 diabetes mellitus (T1DM who received simultaneous pancreas-kidney transplantation (SPK.Materials and Methods. The study included 16 patients with T1DM who received SPK. All patients underwent clinical examination and diagnostic investigation.Results. After SPK, 93.75% of the patients had a functioning pancreas transplant, and 100% had a functioning kidney transplant within 4–48 months [mean 21 months (10 is revealed; 36. All patients had euglycaemia according to daily monitoring. The mean level of glycated haemoglobin (HbA1c before surgery was 9.1% (range 8.7%–11% and was 5.7% after surgery (5.55%–5.9%; p < 0.0001. The baseline level of insulin was 12.5 μIU/ml (11.4–15.3 μIU/ml and the baseline level of C-peptide was 2.02 ng/ml (1.07–2.77 ng/ml. Normal renal function was observed (glomerular filtration rate 76 ml/min/1.73 m2 (68–90 ml/min/1.73 m2. Other laboratory findings included haemoglobin 127 g/l (120–130 g/l, serum parathyroid hormone 77.5 pg/ml (61–85 pg/ml, serum phosphate 1.2 mmol/l (1.07–1.3 mmol/l and blood pressure 110(100–120/70(64–80 mmHg. In 37.5% of the patients, vitrectomy and additional laser panretinal photocoagulation were performed for proliferative diabetic retinopathy. Other ophthalmological disorders included newly diagnosed cataract (81.25%, secondary cataract (25% that required YAG discission in three patients, glaucoma (25% and macular oedema (12.5%. Ulcers of the lower extremities were observed in 31.25% of the patients, and chronic osteoarthropathy was observed in four. One patient underwent amputation of index and ring fingers and resection of the first and third metatarsal heads to treat osteomyelitis. One patient underwent balloon angioplasty and stenting for advanced atherosclerotic stenosis of blood vessels of the lower extremities.Conclusions. Euglycaemia and recovery of renal function

  13. Hypomagnesemia as a possible explanation behind episodes of severe pain in cancer patients receiving palliative care.

    Science.gov (United States)

    López-Saca, José Mario; López-Picazo, José Maria; Larumbe, Ana; Urdíroz, Juli; Centeno, Carlos

    2013-02-01

    Within an oncology setting, certain chemotherapy drugs, such as cisplatin, may lead to magnesium loss causing nephropathy. Neurological and cardiovascular symptoms caused by hypomagnesaemia are well known. The relationship between serious hypomagnesemia and severe pain is not well documented but nevertheless, when faced with unexplained episodes of pain which do not respond to powerful analgesics, it is important to review blood magnesium levels. We present two cases of opioid-refractory pain attacks. Patients received drugs which have been linked to hypomagnesemia. In both cases, endovenous magnesium replacement led to a drastic improvement in pain management.

  14. Necrotizing fasciitis in a patient receiving tocilizumab for rheumatoid arthritis - Case report.

    Science.gov (United States)

    Rosa-Gonçalves, Diana; Bernardes, Miguel; Costa, Lúcia

    2016-12-29

    We present a case of necrotizing fasciitis in a 66-year-old Caucasian woman with rheumatoid arthritis receiving tocilizumab, and provide a review of published cases. The patient exhibited no systemic symptoms and discreet cutaneous inflammatory signals at presentation. She was successfully treated with broad-spectrum empiric antibiotic therapy and surgical debridement. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  15. Recall of UVB-induced erythema in breast cancer patient receiving multiple drug chemotherapy

    DEFF Research Database (Denmark)

    Andersen, Klaus Ejner; Lindskov, R

    1984-01-01

    One day after sunbathing, a breast cancer patient received intravenous methotrexate, cyclophosphamide and 5-fluorouracil and had a recall of her UV erythema over the following week. Phototesting with UVA and UVB prior to and after a subsequent chemotherapy treatment showed a UVB-induced recall...... of erythema, as well as a phototoxicity-like response. Skin biopsies from test sites were compatible with phototoxic dermatitis. The occurrence of both erythema recall and the phototoxicity-like reaction suggests that more than one mechanism is involved in this side effect....

  16. Potentially avoidable inpatient nights among warfarin receiving patients; an audit of a single university teaching hospital.

    LENUS (Irish Health Repository)

    Forde, Dónall

    2009-01-01

    BACKGROUND: Warfarin is an oral anticoagulant (OAT) that needs active management to ensure therapeutic range. Initial management is often carried out as an inpatient, though not requiring inpatient facilities. This mismatch results in financial costs which could be directed more efficaciously. The extent of this has previously been unknown. Here we aim to calculate the potential number of bed nights which may be saved among those being dose optimized as inpatients and examine associated factors. METHODS: A 6 week prospective audit of inpatients receiving OAT, at Cork University Hospital, was carried out. The study period was from 11th June 2007 to 20th July 2007. Data was collected from patient\\'s medications prescription charts, medical record files, and computerised haematology laboratory records. The indications for OAT, the patient laboratory coagulation results and therapeutic intervals along with patient demographics were analysed. The level of potentially avoidable inpatient nights in those receiving OAT in hospital was calculated and the potential cost savings quantified. Potential avoidable bed nights were defined as patients remaining in hospital for the purpose of optimizing OAT dosage, while receiving subtherapeutic or therapeutic OAT (being titred up to therapeutic levels) and co-administered covering low molecular weight heparin, and requiring no other active care. The average cost of euro638 was taken as the per night hospital stay cost for a non-Intensive Care bed. Ethical approval was granted from the Ethical Committee of the Cork Teaching Hospitals, Cork, Ireland. RESULTS: A total of 158 patients were included in the audit. There was 94 men (59.4%) and 64 women (40.6%). The mean age was 67.8 years, with a median age of 70 years.Atrial Fibrillation (43%, n = 70), followed by aortic valve replacement (15%, n = 23) and pulmonary emboli (11%, n = 18) were the commonest reasons for prescribing OAT. 54% had previously been prescribed OAT prior to

  17. Patients' experiences of living with and receiving treatment for fibromyalgia syndrome: a qualitative study

    Directory of Open Access Journals (Sweden)

    Carville Serene F

    2009-10-01

    Full Text Available Abstract Background Fibromyalgia syndrome (FMS presents a challenge for patients and health care staff across many medical specialities. The aetiology is multi-dimensional, involving somatic, psychological and social factors. Patients' views were obtained to understand their experience of living with this long-term condition, using qualitative interviews. Methods 12 patients were recruited and stratified by age, gender and ethnicity from one rheumatology outpatient clinic, and a departmental held database of patients diagnosed with FMS. Results Patients' accounts of their experience of FMS resonated well with two central concepts: social identity and illness intrusiveness. These suggested three themes for the analytical framework: life before and after diagnosis (e.g. lack of information about FMS, invisibility of FMS; change in health identity (e.g. mental distress, impact on social life and perceived quality of care (e.g. lack of contact with nurses, attitudes of specialists. The information provided from one male participant did not differ from the female patients, but black and ethnic community patients expressed a degree of suspicion towards the medication prescribed, and the attitudes displayed by some doctors, a finding that has not been previously reported amongst this patient group. Patients expected more consultation time and effective treatment than they received. Subjective experiences and objective physical and emotional changes were non-overlapping. Patients' accounts revealed that their physical, mental and social health was compromised, at times overwhelming and affected their identity. Conclusion FMS is a condition that intrudes upon many aspects of patients' lives and is little understood. At the same time, it is a syndrome that evokes uneasiness in health care staff (as current diagnostic criteria are not well supported by objective markers of physiological or biochemical nature, and indeed because of doubt about the existence

  18. Fewer acute respiratory infection episodes among patients receiving treatment for gastroesophageal reflux disease

    Science.gov (United States)

    Xirasagar, Sudha; Chung, Shiu-Dong; Tsai, Ming-Chieh; Chen, Chao-Hung

    2017-01-01

    Patients with gastroesophageal reflux disease (GERD) present with comorbid complications with implications for healthcare utilization. To date, little is known about the effects of GERD treatment with a proton-pump inhibitor (PPI) on patients’ subsequent healthcare utilization for acute respiratory infections (ARIs). This population-based study compared ARI episodes captured through outpatient visits, one year before and one year after GERD patients received PPI treatment. We used retrospective data from the Longitudinal Health Insurance Database 2005 in Taiwan, comparing 21,486 patients diagnosed with GERD from 2010 to 2012 with 21,486 age-sex matched comparison patients without GERD. Annual ARI episodes represented by ambulatory care visits for ARI (visits during a 7-day period bundled into one episode), were compared between the patient groups during the 1-year period before and after the index date (date of GERD diagnosis for study patients, first ambulatory visit in the same year for their matched comparison counterpart). Multiple regression analysis using a difference-in-difference approach was performed to estimate the adjusted association between GERD treatment and the subsequent annual ARI rate. We found that the mean annual ARI episode rate among GERD patients reduced by 11.4%, from 4.39 before PPI treatment, to 3.89 following treatment (mean change = -0.5 visit, 95% confidence interval (CI) = (-0.64, -0.36)). In Poisson regression analysis, GERD treatment showed an independent association with the annual ARI rate, showing a negative estimate (with p<0.001). The study suggests that GERD treatment with PPIs may help reduce healthcare visits for ARIs, highlighting the importance of treatment-seeking by GERD patients and compliance with treatment. PMID:28222168

  19. Quantitative ultrasound evaluation of tumor cell death response in locally advanced breast cancer patients receiving chemotherapy.

    Science.gov (United States)

    Sadeghi-Naini, Ali; Papanicolau, Naum; Falou, Omar; Zubovits, Judit; Dent, Rebecca; Verma, Sunil; Trudeau, Maureen; Boileau, Jean Francois; Spayne, Jacqueline; Iradji, Sara; Sofroni, Ervis; Lee, Justin; Lemon-Wong, Sharon; Yaffe, Martin; Kolios, Michael C; Czarnota, Gregory J

    2013-04-15

    Quantitative ultrasound techniques have been recently shown to be capable of detecting cell death through studies conducted on in vitro and in vivo models. This study investigates for the first time the potential of early detection of tumor cell death in response to clinical cancer therapy administration in patients using quantitative ultrasound spectroscopic methods. Patients (n = 24) with locally advanced breast cancer received neoadjuvant chemotherapy treatments. Ultrasound data were collected before treatment onset and at 4 times during treatment (weeks 1, 4, and 8, and preoperatively). Quantitative ultrasound parameters were evaluated for clinically responsive and nonresponding patients. Results indicated that quantitative ultrasound parameters showed significant changes for patients who responded to treatment, and no similar alteration was observed in treatment-refractory patients. Such differences between clinically and pathologically determined responding and nonresponding patients were statistically significant (P < 0.05) after 4 weeks of chemotherapy. Responding patients showed changes in parameters related to cell death with, on average, an increase in mid-band fit and 0-MHz intercept of 9.1 ± 1.2 dBr and 8.9 ± 1.9 dBr, respectively, whereas spectral slope was invariant. Linear discriminant analysis revealed a sensitivity of 100% and a specificity of 83.3% for distinguishing nonresponding patients by the fourth week into a course of chemotherapy lasting several months. This study reports for the first time that quantitative ultrasound spectroscopic methods can be applied clinically to evaluate cancer treatment responses noninvasively. The results form a basis for monitoring chemotherapy effects and facilitating the personalization of cancer treatment.

  20. Transfusion-dependent low-risk myelodysplastic patients receiving deferasirox: Long-term follow-up

    Science.gov (United States)

    IMPROTA, SALVATORE; VILLA, MARIA ROSARIA; VOLPE, ANTONIO; LOMBARDI, ANGELA; STIUSO, PAOLA; CANTORE, NICOLA; MASTRULLO, LUCIA

    2013-01-01

    Myelodysplastic syndromes (MDSs) are characterized by ineffective hematopoiesis that results in peripheral cytopenias. Anemia is the most common symptom of MDS and the majority of patients become transfusion-dependent with the risk of iron overload, which may lead to cardiac, hepatic and endocrine complications. Deferasirox is an orally available iron chelator administered once-daily in transfusion-dependent patients with various chronic anemias. Its efficacy has been established in controlled clinical trials. In the present study, we describe our experience with 55 consecutive MDS patients [International Prognostic Scoring System risk score of low (n=32) or intermediate-1 (n=23)] treated with deferasirox in a routine clinical setting following Consensus Guidelines on Iron Chelation Therapy. According to WHO classifications, patients had refractory anemia (n=30), refractory anemia with ringed sideroblasts (n=16), refractory cytopenia with multilineage dysplasia (n=8) or refractory cytopenia with multilineage dysplasia and ringed sideroblasts (n=1). The median monthly transfusion requirement at baseline was 3 units. Patients received a starting dosage of 10 mg/kg/day, subsequently titrated according to serum ferritin (SF) levels which were measured monthly. Safety assessment included monitoring of liver and renal parameters and recording adverse events (AE) during treatment. At the baseline, the mean ± SD SF level was 2,362±172 ng/ml and after 24 months, the mean ± SD decrease in SF was 1,679±209 ng/ml. Sixteen patients had sustained hematological improvement meeting International Working Group 2006 criteria. One patient became transfusion-independent. No severe AE were reported. In conclusion, deferasirox therapy was effective and safe in reducing transfusional iron overload and it reduces transfusion requirement in a subset of patients. PMID:24260074

  1. Relationships between perceived social support and retention patients receiving methadone maintenance treatment in China mainland

    Institute of Scientific and Technical Information of China (English)

    Kai-Na Zhou; Heng-Xin Li; Xiao-Li Wei; Xiao-Mei Li; Gui-Hua Zhuang

    2016-01-01

    Objective: The purpose of this study was to explore the relationships between perceived social support and retention in Chinese mainland patients receiving methadone maintenance treatment (MMT). Methods: This was a cross-sectional two-year follow-up study. The data collected included patients' baseline characteristics, perceived social support and retention in MMT. Results: A total of 1212 patients completed the cross-sectional survey;809 (66.7%) had good perceived social support and 458 (37.8%) had experienced readmissions. With and without controlling for baseline characteristics, past retention had no significant influence on perceived social support. By the end of the follow-up, 527 (43.5%) patients had terminated MMT. The patients without good perceived social support were more likely to terminate treatment than those with good perceived social support [hazard ratio: 1.31, 95%confidence interval:1.10, 1.57;1.25 (1.04, 1.51)] regardless of their baseline characteristics and past retention. Conclusions: Retention, thus, had no significant influence on perceived social support in MMT, whereas good perceived social support was a strong protective predictor of retention.

  2. Renography and biopsy-verified acute rejection in renal allotransplanted patients receiving cyclosporin A

    Energy Technology Data Exchange (ETDEWEB)

    Thomsen, H.S.; Nielsen, S.L.; Larsen, S.; Lokkegaard, H.

    1987-01-01

    Acute impairment of renal function caused by cyclosporin A can be hard to differentiate from acute rejection. Therefore, kidney function after cadaveric allograft transplantation was repeatedly determined by renography in 42 patients receiving either high dose cyclosporin A (32 patients) or azathioprine and prednisone (10 patients) until a graft biopsy showed either acute rejection or no rejection within the first 5 postoperative weeks. The graft function as judged from the renograms was significantly poorer when cyclosporin A was used than when azathioprine and prednisone were the immunosuppressants. In the azathioprine and prednisone group a biopsy showing acute rejection was always preceded by a deterioration in the renogram. In cyclosporin A treated patients a graft biopsy following an early deterioration in the renogram showed acute rejection in only 56% of the biopsies. It was not possible to identify a time course or a function level of the renogram that could predict rejection in these patients. It is concluded that graft biopsies should be used liberally to diagnose rejection during cyclosporin A treatment if surgical complications after transplantations have been ruled out. Radionuclide studies may offer an invaluable aid in determining a nonnephrotoxic initial dose of the drug.

  3. Ki67, chemotherapy response, and prognosis in breast cancer patients receiving neoadjuvant treatment

    Directory of Open Access Journals (Sweden)

    Fasching Peter A

    2011-11-01

    Full Text Available Abstract Background The pathological complete response (pCR after neoadjuvant chemotherapy is a surrogate marker for a favorable prognosis in breast cancer patients. Factors capable of predicting a pCR, such as the proliferation marker Ki67, may therefore help improve our understanding of the drug response and its effect on the prognosis. This study investigated the predictive and prognostic value of Ki67 in patients with invasive breast cancer receiving neoadjuvant treatment for breast cancer. Methods Ki67 was stained routinely from core biopsies in 552 patients directly after the fixation and embedding process. HER2/neu, estrogen and progesterone receptors, and grading were also assessed before treatment. These data were used to construct univariate and multivariate models for predicting pCR and prognosis. The tumors were also classified by molecular phenotype to identify subgroups in which predicting pCR and prognosis with Ki67 might be feasible. Results Using a cut-off value of > 13% positively stained cancer cells, Ki67 was found to be an independent predictor for pCR (OR 3.5; 95% CI, 1.4, 10.1 and for overall survival (HR 8.1; 95% CI, 3.3 to 20.4 and distant disease-free survival (HR 3.2; 95% CI, 1.8 to 5.9. The mean Ki67 value was 50.6 ± 23.4% in patients with pCR. Patients without a pCR had an average of 26.7 ± 22.9% positively stained cancer cells. Conclusions Ki67 has predictive and prognostic value and is a feasible marker for clinical practice. It independently improved the prediction of treatment response and prognosis in a group of breast cancer patients receiving neoadjuvant treatment. As mean Ki67 values in patients with a pCR were very high, cut-off values in a high range above which the prognosis may be better than in patients with lower Ki67 values may be hypothesized. Larger studies will be needed in order to investigate these findings further.

  4. Fixed Drug Eruption in an Epileptic Patient Previously Receiving Treatment With Phenytoin for Seven Years

    Directory of Open Access Journals (Sweden)

    Keaton S. Smetana

    2013-11-01

    Full Text Available A 52-year-old African American female presented with severe left thigh pain of unknown etiology. She had a past medical history of generalized seizure disorder treated with phenytoin for 7 years without incident. During admission a nurse witnessed a seizure, and consequently loading and maintenance doses of phenytoin were administered to obtain a therapeutic serum concentration. The patient had a history of noncompliance with multiple subtherapeutic phenytoin levels. Subsequently, unifocal blue discolored spots appeared, progressing to a bullous component that was positive for skin sloughing. Drug-induced fixed drug eruption was diagnosed and attributed to phenytoin. Clinicians should be cognizant of drug-induced fixed drug eruption in patients just initiated and those receiving long-term treatment with phenytoin. The administration rate of phenytoin may be associated with the development of fixed drug eruption.

  5. RADIONUCLIDE DIAGNOSIS OF THE FUNCTIONAL STATUS OF THE URETERS IN CERVICAL CANCER PATIENTS RECEIVING COMBINATION TREATMENT

    Directory of Open Access Journals (Sweden)

    L. A. Ashrafyan

    2009-01-01

    Full Text Available Researches of the capabilities of radionuclide diagnosis are one of the most important trends in modern medical science and practice, especially in the area of dynamic renal scintigraphy. This technique proved to be safe and highly informative when used in oncogyne- cology to evaluate defects of renal drainage. However, failure to make an objective evaluation of ureteral patency reduces significant- ly the capabilities of the technique in patients after small pelvis surgery and radiotherapy. The study issues presented in this article are devoted to this particular problem. The authors have developed an original procedure for evaluating renal drainage disorders during dynamic renal scintigraphy. The specific visual and digital parameters which characterize both normal and obstructed urine outflow in the supravesical segment are given. Criteria for serious disorders in urine derivation from the kidneys through the ureters are defined. Risk factors for urine outflow disorders are identified in cervical cancer patients who receive various treatments.

  6. Preferred treatment frequency in patients receiving androgen deprivation therapy for advanced prostate cancer

    DEFF Research Database (Denmark)

    Fode, Mikkel; Nielsen, Torben K; Al-Hamadani, Muhammad;

    2014-01-01

    for analysis. A total of 38.1% of participants preferred frequent treatment ("Every month", "Every third month"), 32.4% preferred infrequent treatment ("Every sixth month", "Every twelfth month") and 29.6% stated that length of the treatment intervals made no difference (p = 0.37). Patients with disease......OBJECTIVE: The aim of this study was to assess patient preference regarding the length of treatment intervals of androgen deprivation therapy (ADT) with gonadotropin-releasing hormone agonists for prostate cancer. MATERIAL AND METHODS: The study was conducted as a questionnaire-based, cross...... satisfaction and side-effects. Overall, 238 men receiving ADT for prostate cancer were presented with the questionnaire between September 2011 and May 2012. Descriptive statistics, the chi-squared test and multiple regression were used for analyses. RESULTS: In total, 176 questionnaires (74%) were available...

  7. Cytomegalovirus colitis in a patient with Behcet's disease receiving tumor necrosis factor alpha inhibitory treatment

    Institute of Scientific and Technical Information of China (English)

    Ismail Sari; Merih Birlik; Can Gonen; Server Akar; Duygu Gurel; Fatos Onen; Nurullah Akkoc

    2008-01-01

    Anti-tumor necrosis factor alpha (TNF-α) inhibitors are effective in the treatment of various inflammatory rheumatic conditions. Increased risks of serious infections are the major issues concerning the long-term safety of these agents. We present a case of a young male Behcet's patient whose disease was complicated by cytomegalovirus (CMV) colitis. Colitis started 10 d after the third Infliximab dose and responded to the cessation of TNF blocking treatment and administration of ganciclovir. Tumor necrosis factor alpha and interferon gamma act at several levels in combating viral infections.CMV infections should be kept in mind and included in the differential diagnosis of severe gastrointestinal symptoms in patients receiving anti-TNF agents.

  8. Cerebral tuberculoma in a patient receiving anti-TNF alpha (adalimumab) treatment.

    LENUS (Irish Health Repository)

    Lynch, Karen

    2010-10-01

    We report a case of a cerebral tuberculoma in a 60-year-old woman with rheumatoid arthritis while receiving the anti-tumor necrosis factor alpha monoclonal antibody, adalimumab (Humira), for active disease. MR brain imaging for dyspraxia revealed a left parietal ring-enhancing lesion, which on resection was shown to be a necrotizing granuloma. There were no associated pulmonary lesions, and the patient was systemically well. Sputum and urine cultures were negative for tuberculosis. The patient was treated with anti-tuberculous medications and made an excellent recovery. We consider this to be the first documented case of tuberculosis involving the central nervous system occurring in the setting of adalimumab treatment.

  9. Pharmacokinetics of continuous-infusion meropenem in a pediatric patient receiving extracorporeal life support.

    Science.gov (United States)

    Cies, Jeffrey J; Moore, Wayne S; Dickerman, Mindy J; Small, Christine; Carella, Dominick; Chopra, Arun; Parker, Jason

    2014-10-01

    Meropenem, a broad-spectrum carbapenem, is commonly used for empirical and definitive therapy in the pediatric intensive care unit (ICU). Pharmacokinetic data to guide dosing in children, however, are limited to healthy volunteers or patients who are not in the ICU. Adult data demonstrate that pharmacokinetic parameters such as the volume of distribution and clearance can be significantly altered in individuals receiving extracorporeal membrane oxygenation (ECMO). Alterations in the volume of distribution and clearance of antimicrobials in patients with sepsis and septic shock have also been documented, and these patients have demonstrated lower than expected antimicrobial serum concentrations based on standard dosing regimens. Therefore, an understanding of the pharmacokinetic changes in critically ill children receiving ECMO is crucial to determining the most appropriate dose and dosing interval selection for any antimicrobial therapy. In this case report, we describe the pharmacokinetics of a continuous infusion of meropenem in a pediatric cardiac ICU patient who was receiving concurrent extracorporeal life support. The patient was an 8-month-old male infant who underwent a Glenn procedure and pulmonary artery reconstruction. Postoperatively, he required ECMO with a total run of 21 days. On day 11 of ECMO, a bronchoalveolar lavage was performed, and blood cultures from days 11 and 12 of ECMO grew Pseudomonas aeruginosa, with a meropenem minimum inhibitory concentration (MIC) of 0.5 μg/ml. On ECMO day 13, meropenem was initiated with a loading dose of 40 mg/kg and infused over 30 minutes, followed by a continuous infusion of 200 mg/kg/day. A meropenem serum concentration measured 8 hours after the start of the infusion was 46 μg/ml. Repeat levels were measured on days 3 and 9 of meropenem therapy and were 39 and 42 μg/ml, respectively. Repeat blood and respiratory cultures remained negative. This meropenem regimen (40-mg/kg bolus followed by a

  10. Laboratory measures of methylphenidate effects in cocaine-dependent patients receiving treatment.

    Science.gov (United States)

    Roache, J D; Grabowski, J; Schmitz, J M; Creson, D L; Rhoades, H M

    2000-02-01

    Two experiments examined the effects of methylphenidate in male and female patients enrolled in an outpatient treatment program for primary cocaine dependence. The first study was a component of a double-blind efficacy trial wherein 57 patients were first tested in a human laboratory for their initial responsiveness to medication. Patients were randomly assigned to receive either placebo or methylphenidate treatment and received their first dose in the human laboratory environment before continuing in outpatient treatment. Methylphenidate was given as a 20-mg sustained-release dose (twice daily) plus an additional 5-mg immediate-release dose combined with the morning dose. Methylphenidate increased heart rate and subjective ratings; however, the subjective effects were primarily of a "dysphoric" nature, and significant effects were limited to increases in anxiety, depression, and anger on the Profile of Mood States; shaky/jittery ratings on a visual analog scale; and dysphoria on the lysergic acid diethylamide (LSD) scale of the Addiction Research Center Inventory. Methylphenidate did not increase cocaine craving nor ratings suggesting abuse potential (i.e., Morphine-Benzedrine Group or drug-liking scores, etc.). None of the drug effects observed in the human laboratory was of clinical concern, and no subject was precluded from continuing in the outpatient study. After outpatient treatment completion, 12 patients were brought back into a second double-blind human laboratory study in which three doses (15, 30, and 60 mg) of immediate-release methylphenidate were administered in an ascending series preceded and followed by placebo. Methylphenidate produced dose-related increases in heart rate, subjective ratings of shaky/jittery, and LSD/dysphoria without significantly altering cocaine craving or stimulant euphoria ratings. These results suggest that stimulant substitution-type approaches to the treatment of cocaine dependence are not necessarily contraindicated

  11. Pilot study of "miracle fruit" to improve food palatability for patients receiving chemotherapy.

    Science.gov (United States)

    Wilken, Marlene K; Satiroff, Bernadette A

    2012-10-01

    Taste changes in patients undergoing chemotherapy are common and can be of long duration, are associated with poor nutrition, and can reduce quality of life. A pilot study of the fruit Synsepalum dulcificum-known as "miracle fruit"-as a novel supportive intervention was conducted with eight patients with cancer who were being treated with chemotherapy and reporting taste changes. Miraculin, a naturally occurring protein in miracle fruit, has the unusual ability to transduce a sweet signal in an acidic environment, profoundly changing food taste profiles for a short duration, masking unpleasant tastes, and increasing the palatability of certain foods. This pilot study was designed to determine whether consumption of the Miracle Fruit™ supplement would improve chemotherapy-associated taste changes, thereby improving the taste of food and ultimately leading to better nutrition. Four of the participants were given a two-week supply of the supplement and the other four were given a two-week supply of a placebo. After two weeks, the supplement group received a two-week supply of the placebo and the placebo group received a two-week supply of the supplement. Participants recorded food and drink intake in daily food dairies and rated taste changes with each food as better, worse, or no change. All study participants reported positive taste changes with the supplement.

  12. Association of hypothyroidism with adverse events in patients with heart failure receiving cardiac resynchronization therapy.

    Science.gov (United States)

    Sharma, Ajay K; Vegh, Eszter; Orencole, Mary; Miller, Alexandra; Blendea, Dan; Moore, Stephanie; Lewis, Gregory D; Singh, Jagmeet P; Parks, Kimberly A; Heist, E Kevin

    2015-05-01

    Hypothyroidism is associated with an adverse prognosis in cardiac patients in general and in particular in patients with heart failure (HF). The aim of this study was to evaluate the impact of hypothyroidism on patients with HF receiving cardiac resynchronization therapy (CRT). Additionally, the impact of level of control of hypothyroidism on risk of adverse events after CRT implantation was also evaluated. We included consecutive patients in whom a CRT device was implanted from April 2004 to April 2010 at our institution with sufficient follow-up data available for analysis; 511 patients were included (age 68.5±12.4 years, women 20.4%); 84 patients with a clinical history of hypothyroidism, on treatment with thyroid hormone repletion or serum thyroid-stimulating hormone level≥5.00 μU/ml, were included in the hypothyroid group. The patients were followed for up to 3 years after implant for a composite end point of hospitalization for HF, left ventricular assist device placement, or heart transplant and cardiac death; 215 composite end point events were noted in this period. In a multivariate model, hypothyroidism (hazard ratio [HR] 1.46, 95% confidence interval [CI] 1.027 to 2.085, p=0.035), female gender (HR 0.64, 95% CI 0.428 to 0.963, p=0.032), and creatinine (HR 1.26, 95% CI 1.145 to 1.382, phypothyroidism at baseline developed the composite end point compared with 39.8% of those with euthyroidism (p=0.02). In conclusion, hypothyroidism is associated with a worse prognosis after CRT implantation.

  13. Low-level viremia and the increased risk of hepatocellular carcinoma in patients receiving entecavir treatment.

    Science.gov (United States)

    Kim, Jung Hee; Sinn, Dong Hyun; Kang, Wonseok; Gwak, Geum-Youn; Paik, Yong-Han; Choi, Moon Seok; Lee, Joon Hyeok; Koh, Kwang Cheol; Paik, Seung Woon

    2017-08-01

    The long-term clinical impact of low-level viremia (LLV; <2,000 IU/mL) is not well understood. As a result, it is unclear whether the development of LLV during entecavir monotherapy requires a change in therapy. A retrospective cohort of 875 treatment-naive chronic hepatitis B virus (HBV) monoinfected patients (mean age 47.7 years, male = 564 [65.5%], cirrhosis = 443 [50.6%]) who received entecavir monotherapy were analyzed for the development of hepatocellular carcinoma (HCC). The HCC risk was compared between patients who maintained virological response (MVR), defined by persistently undetectable HBV DNA (<12 IU/mL), and patients who experienced LLV, defined by either persistent or intermittent episodes of <2,000 IU/mL detectable HBV DNA. During a median 4.5 years of follow-up (range 1.0-8.7 years), HCC was diagnosed in 85 patients (9.7%). HCC developed more frequently in patients who experienced LLV than MVR (14.3% versus 7.5% at 5 years, P = 0.015). The hazard ratio comparing those with LLV to MVR was 1.98 (95% confidence interval = 1.28-3.06, P = 0.002, adjusted for age, sex, hepatitis B e antigen, baseline HBV DNA levels, and cirrhosis). Among patients with cirrhosis, those with LLV exhibited a significantly higher HCC risk than those with MVR (HCC incidence rate at 5 years 23.4% versus 10.3%, adjusted hazard ratio = 2.20, 95% confidence interval 1.34-3.60; P = 0.002). However, for patients without cirrhosis, there was no significant difference in the HCC risk between LLV and MVR. LLV observed during entecavir monotherapy was associated with a higher risk of HCC, especially for those with cirrhosis, indicating that LLV during potent antiviral therapy is consequential. (Hepatology 2017;66:335-343). © 2016 by the American Association for the Study of Liver Diseases.

  14. Reactivation of BK polyomavirus in patients with multiple sclerosis receiving natalizumab therapy.

    LENUS (Irish Health Repository)

    Lonergan, Roisin M

    2012-02-01

    Natalizumab therapy in multiple sclerosis has been associated with JC polyomavirus-induced progressive multifocal leucoencephalopathy. We hypothesized that natalizumab may also lead to reactivation of BK, a related human polyomavirus capable of causing morbidity in immunosuppressed groups. Patients with relapsing remitting multiple sclerosis treated with natalizumab were prospectively monitored for reactivation of BK virus in blood and urine samples, and for evidence of associated renal dysfunction. In this cohort, JC and BK DNA in blood and urine; cytomegalovirus (CMV) DNA in blood and urine; CD4 and CD8 T-lymphocyte counts and ratios in peripheral blood; and renal function were monitored at regular intervals. BK subtyping and noncoding control region sequencing was performed on samples demonstrating reactivation. Prior to commencement of natalizumab therapy, 3 of 36 patients with multiple sclerosis (8.3%) had BK viruria and BK reactivation occurred in 12 of 54 patients (22.2%). BK viruria was transient in 7, continuous in 2 patients, and persistent viruria was associated with transient viremia. Concomitant JC and CMV viral loads were undetectable. CD4:CD8 ratios fluctuated, but absolute CD4 counts did not fall below normal limits. In four of seven patients with BK virus reactivation, transient reductions in CD4 counts were observed at onset of BK viruria: these resolved in three of four patients on resuppression of BK replication. No renal dysfunction was observed in the cohort. BK virus reactivation can occur during natalizumab therapy; however, the significance in the absence of renal dysfunction is unclear. We propose regular monitoring for BK reactivation or at least for evidence of renal dysfunction in patients receiving natalizumab.

  15. Increasing risk of cataract in HCV patients receiving anti-HCV therapy: A nationwide cohort study

    Science.gov (United States)

    Lin, Shih-Yi; Lin, Cheng-Li; Ju, Shu-Woei; Wang, I-Kuan; Lin, Cheng-Chieh; Lin, Chih-Hsueh; Hsu, Wu-Huei

    2017-01-01

    Purpose Hepatitis C virus (HCV) infection is associated with increased systemic oxidative stress, which leads to cardiovascular events, diabetes, and chronic kidney disease. Similarly, cataract is also associated with increased oxidative stress. The association between HCV infection and increased risk of cataract remains unclear. Methods A total of 11,652 HCV-infected patients and 46,608 age- and sex-matched non-HCV infected patients were identified during 2003–2011. All patient data were tracked until a diagnosis of cataract, death, or the end of 2011. Cumulative incidences and hazard ratios (HRs) were calculated. Results The mean follow-up durations were 5.29 and 5.86 years for the HCV and non-HCV cohorts, respectively. The overall incidence density rate for cataract was 1.36 times higher in the HCV cohort than in the non-HCV cohort (1.86 and 1.37 per 100 person-y, respectively). After adjusting for age, sex, comorbidities of diabetes, hypertension, hyperlipidemia, asthma, chronic obstructive pulmonary disease, coronary artery disease, and anxiety, patients with HCV infection had an increased risk of cataract compared with those without HCV infection [adjusted HR = 1.23, 95% confidence interval (CI) = 1.14–1.32]. HCV-infected patients receiving interferon–ribavirin therapy had a 1.83 times higher (95% CI = 1.40–2.38) risk of cataract than non-HCV infected patients did. Conclusion HCV infection, even without the complication of cirrhosis, is associated with an increased risk of cataract, and this risk is higher in HCV-infected patients undergoing interferon–ribavirin therapy. PMID:28264004

  16. Quality of life in low-grade glioma patients receiving temozolomide

    Science.gov (United States)

    Liu, Raymond; Solheim, Karla; Polley, Mei-Yin; Lamborn, Kathleen R.; Page, Margaretta; Fedoroff, Anne; Rabbitt, Jane; Butowski, Nicholas; Prados, Michael; Chang, Susan M.

    2009-01-01

    The purpose of this study was to describe the quality of life (QOL) of low-grade glioma (LGG) patients at baseline prior to chemotherapy and through 12 cycles of temozolomide (TMZ) chemotherapy. Patients with histologically confirmed LGG with only prior surgery were given TMZ for 12 cycles. QOL assessments by the Functional Assessment of Cancer Therapy–Brain (FACT-Br) were obtained at baseline prior to chemotherapy and at 2-month intervals while receiving TMZ. Patients with LGG at baseline prior to chemotherapy had higher reported social well-being scores (mean difference = 5.0; p < 0.01) but had lower reported emotional well-being scores (mean difference = 2.2; p < 0.01) compared to a normal population. Compared to patients with left hemisphere tumors, patients with right hemisphere tumors reported higher physical well-being scores (p = 0.01): 44% could not drive, 26% did not feel independent, and 26% were afraid of having a seizure. Difficulty with work was noted in 24%. Mean change scores at each chemotherapy cycle compared to baseline for all QOL subscales showed either no significant change or were significantly positive (p < 0.01). Patients with LGG on TMZ at baseline prior to chemotherapy reported QOL comparable to a normal population with the exception of social and emotional well-being, and those with right hemisphere tumors reported higher physical well-being scores compared to those with left hemisphere tumors. While remaining on therapy, LGG patients were able to maintain their QOL in all realms. LGG patients’ QOL may be further improved by addressing their emotional well-being and their loss of independence in terms of driving or working. PMID:18713953

  17. Psychometric Evaluation of a Treatment Acceptance Measure for Use in Patients Receiving Treatment via Subcutaneous Injection.

    Science.gov (United States)

    Tatlock, Sophi; Arbuckle, Rob; Sanchez, Robert; Grant, Laura; Khan, Irfan; Manvelian, Garen; Spertus, John A

    2017-03-01

    Alirocumab, a proprotein convertase subtilisin/kexin type 9 inhibitor, significantly reduces low-density lipoprotein cholesterol, but requires subcutaneous injections rather than oral pills. To measure patients' acceptance of this treatment modality, a new patient-reported outcome, the Injection-Treatment Acceptance Questionnaire (I-TAQ), was developed. To psychometrically evaluate the I-TAQ with patients at high risk of cardiovascular events receiving alirocumab. The 22-item, 5-domain I-TAQ was administered cross-sectionally to 151 patients enrolled in alirocumab clinical trials. Item response distributions, factor and multitrait analyses, interitem correlations, correlations with an existing measure of acceptance (convergent validity), and comparison of known-groups were performed to assess the I-TAQ's psychometric properties. Completion rates were high, with no patients missing more than two items and 91.4% missing no data. All items displayed high ceiling effects (>30%) because of high treatment acceptance. Factor analysis supported the a priori hypothesized item-domain structure with good fit indices (root mean square error approximation = 0.070; comparative fit index = 0.988) and high factor loadings. All items demonstrated item convergent validity (item-scale correlation ≥0.40), except for the side effects domain, which was limited by small numbers (n = 46). Almost all items correlated most highly with the domain to which they were assigned (item discriminant validity). Internal reliability was acceptable for all domains (Cronbach α range 0.72-0.88) and convergent validity was supported by a logical pattern of correlations with the Chronic Treatment Acceptance Questionnaire. These findings provide initial evidence of validity and reliability for the I-TAQ in patients treated with subcutaneous alirocumab. The I-TAQ could prove to be a valuable patient-reported outcome for therapies requiring subcutaneous injection. Copyright © 2017 International Society

  18. Dose delivered from Varian's CBCT to patients receiving IMRT for prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Wen Ning; Guan Huaiqun; Hammoud, Rabih; Pradhan, Deepak; Nurushev, T; Li Shidong; Movsas, Benjamin [Henry Ford Health System, Detroit, MI (United States)

    2007-04-21

    With the increased use of cone beam CT (CBCT) for daily patient setup, the accumulated dose from CBCT may be significantly higher than that from simulation CT or portal imaging. The objective of this work is to measure the dose from daily pelvic scans with fixed technical settings and collimations. CBCT scans were acquired in half-fan mode using a half bowtie and x-rays were delivered in pulsed-fluoro mode. The skin doses for seven prostate patients were measured on an IRB-approved protocol. TLD capsules were placed on the patient's skin at the central axis of three beams: AP, left lateral (Lt Lat) and right lateral (Rt Lat). To avoid the ring artefacts centred in the prostate, the treatment couch was dropped 3 cm from the patient's tattoo (central axis). The measured AP skin doses ranged 3-6 cGy for 20-33 cm separation. The larger the patient size the less the AP skin dose. Lateral doses did not change much with patient size. The Lt Lat dose was {approx}4.0 cGy, which was {approx}40% higher than the Rt Lat dose of {approx}2.6 cGy. To verify this dose asymmetry, surface doses on an IMRT QA phantom (oval shaped, 30 cm x 20 cm) were measured at the same three sites using TLD capsules with 3 cm table-drop. The dose asymmetry was due to: (1) kV source rotation which always starts from the patient's Lt Lat and ends at Lt Lat. Gantry rotation gets much slower near the end of rotation but dose rate stays constant and (2) 370{sup 0} scan rotation (10{sup 0} scan overlap on the Lt Lat side). In vivo doses were measured inside a Rando pelvic heterogeneous phantom using TLDs. The left hip (femoral head and neck) received the highest doses of {approx}10-11 cGy while the right hip received {approx}6-7 cGy. The surface and in vivo doses were also measured for phantoms at the central-axis setup. The difference was less than {approx}12% to the table-drop setup.

  19. Pharmacokinetics of Peramivir in an Adolescent Patient Receiving Continuous Venovenous Hemodiafiltration.

    Science.gov (United States)

    Dillon, Ryan C; Witcher, Robert; Cies, Jeffrey J; Moore, Wayne S; Chopra, Arun

    2017-01-01

    Critically ill patients requiring renal replacement therapy commonly experience pharmacokinetic alterations. This case report describes the pharmacokinetics of peramivir (Rapivab, BioCryst Pharmaceuticals, Inc, Durham, NC), the first US Food and Drug Administration-approved intravenous neuraminidase inhibitor for the treatment of influenza, in an adolescent patient receiving continuous renal replacement therapy (CRRT). A 49.5-kg, 17-year-old Caucasian female presented with fever, cough, and persistent hypoxia. She quickly progressed to acute respiratory and renal failure in the setting of viral septic shock as a result of a severe influenza H1N1 infection. On hospital day 3, therapy was switched from oseltamivir (Tamiflu, Roche Laboratories Inc, Nutley, NJ) to peramivir owing to the concern for inadequate enteral absorption. On the third day of peramivir treatment, at a dose of 200 mg daily, peramivir serum concentrations revealed a smaller peak concentration, larger volumes of distribution, similar 24-hour area under the curve, and a shorter half-life as compared to adult patients with normal renal function. This illustrated the significant differences in pharmacokinetics when administered in the setting of CRRT. The patient had resolution of viral infection as evidenced by negative respiratory viral panel polymerase chain reaction at hospital day 14 and was eventually discharged at her baseline.

  20. Effects of Tramadol Coadministration on Prothrombin Time-International Normalized Ratio in Patients Receiving Warfarin.

    Science.gov (United States)

    Hosono, Tomomi; Kondo, Aiko; Kambayashi, Yasuyuki; Homma, Masato

    2017-01-01

     Several case studies have reported a possible drug interaction between warfarin and tramadol where tramadol coadministration enhanced the antithrombotic effects of warfarin. To assess this drug interaction, changes in prothrombin time-international normalized ratio (PT-INR) before and after tramadol coadministration were investigated in patients receiving warfarin. For this study, we examined 54 patients (male/female: 22/32, 68.4±12.7 years) who were being treated with warfarin for deep vein thrombosis, atrial fibrillation, arteriosclerosis obliterans, congestive heart failure, and other vascular diseases. Significant increases in PT-INR were observed 9.5 (1-118) d after coadministration of tramadol (1.81±0.56 vs. 2.47±1.10, ptramadol were compared with other groups of patients to find drug interaction risk factors. Logistic regression analysis revealed that lower levels of albumin (3.5 g/dL or less) [odds ratio (OR) 22.1; 95%CI 2.9-169.9]; lower eGFR (50 mL/min or less) (OR 7.7; 95%CI 1.4-42.0); and PT-INR before tramadol coadministration (OR 38.2; 95%CI 3.7-397.6) were characteristic of the PT-INR increased group. These results suggest that tramadol coadministration enhanced the antithrombotic effects of warfarin in patients with higher PT-INR, lower albumin levels and decreased renal function as the risk factors for this drug interaction.

  1. Morphological changes in muscle tissue of patients with infantile Pompe's disease receiving enzyme replacement therapy.

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    Winkel, Léon P F; Kamphoven, Joep H J; van den Hout, Hannerieke J M P; Severijnen, Lies A; van Doorn, Pieter A; Reuser, Arnold J J; van der Ploeg, Ans T

    2003-06-01

    Pompe's disease (glycogen storage disease type II) is an autosomal recessive myopathy caused by lysosomal alpha-glucosidase deficiency. Enzyme replacement therapy (ERT) is currently under development for this disease. We evaluated the morphological changes in muscle tissue of four children with infantile Pompe's disease who received recombinant human alpha-glucosidase from rabbit milk for 72 weeks. The patients were 2.5-8 months of age at entry. Prior to treatment, all patients showed lysosomal glycogen storage in skeletal and smooth muscle cells, vascular endothelium, Schwann cells, and perineurium. The first response to treatment was noticed in vascular endothelium and in peripheral nerves after 12 weeks of treatment at an enzyme dose of 15-20 mg/kg. Increasing the dose to 40 mg/kg led, after 72 weeks of treatment, to a reduction of glycogen storage and substantial improvement of muscle architecture in the least affected patient. Not all patients responded equally well, possibly due to differences in degree of glycogen storage and concomitant muscle pathology at the start of treatment. We conclude that intravenous administration of recombinant human alpha-glucosidase from rabbit milk can improve muscle morphology in classic infantile Pompe's disease when treatment is started before irreversible damage has occurred.

  2. Peripheral Blood Eosinophilia and Hypersensitivity Reactions among Patients Receiving Outpatient Parenteral Antibiotics

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    Blumenthal, Kimberly G.; Youngster, Ilan; Rabideau, Dustin J.; Parker, Robert A.; Manning, Karen S.; Walensky, Rochelle P.; Nelson, Sandra B.

    2015-01-01

    Background While drug-induced peripheral eosinophilia complicates antimicrobial therapy, little is known about its frequency and implications. Objective We aimed to determine the frequency and predictors of antibiotic-induced eosinophilia and subsequent hypersensitivity reactions (HSRs). Methods We evaluated a prospective cohort of former inpatients receiving intravenous antibiotic therapy as outpatients with at least one differential blood count. We used multivariate Cox proportional hazards models, with time-varying antibiotic treatment indicators, to assess the impact of demographic data and antibiotic exposures on eosinophilia and subsequent HSR, including documented rash, renal injury, and liver injury. Possible Drug Rash Eosinophilia and Systemic Symptoms (DRESS) syndrome cases were identified and manually validated. Results Of 824 patients (60% male, median age 60 years, median therapy duration 41 days), 210 (25%) developed eosinophilia with median peak absolute eosinophil count of 726/mL [IQR: 594–990/mL]. Use of vancomycin, penicillin, rifampin, and linezolid were associated with a higher hazard of developing eosinophilia. There was subsequent HSR in 64/210 (30%) patients with eosinophilia, including rash (N=32), renal injury (N=31), and liver injury (N=13). Patients with eosinophilia were significantly more likely to develop rash (HR = 4.16 [2.54, 6.83]; peosinophilia is common with parenteral antibiotics. While most patients with eosinophilia do not develop an HSR, eosinophilia increases the hazard rate of developing rash and renal injury. DRESS syndrome was more common than previously described. PMID:25981739

  3. Analysis of the Effects of Breast Reconstruction in Breast Cancer Patients Receiving Radiotherapy after Mastectomy

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    Seong Hwan Kim

    2012-05-01

    Full Text Available BackgroundImmediate breast reconstruction after mastectomy and delayed breast reconstruction with post-supplementary treatment are the two types of breast reconstruction currently performed when treating breast cancer. Post-mastectomy radiation therapy (PMRT not only reduces local recurrence but also improves overall survival. However, the complications and survival rates associated with PMRT need to be clear when determining the timing of breast reconstruction. Accordingly, we investigated the optimal timing of breast reconstruction by observing patients who underwent mastectomy followed by PMRT, based on their overall health and aesthetic satisfaction.MethodsWe retrospectively reviewed 21 patients who underwent breast reconstruction with PMRT between November 2004 and November 2010. We collected data regarding the various methods of mastectomy, and the modality of adjuvant therapy, such as chemotherapy, hormone therapy, and radiotherapy. Telephone interviews were conducted to study the general and aesthetic satisfaction.ResultsPatients who received PMRT after breast reconstruction showed a greater complication rate than those undergoing breast reconstruction after PMRT (P=0.02. Aesthetic satisfaction was significantly higher in the groups undergoing breast reconstruction after PMRT (P=0.03. Patients who underwent breast reconstruction before PMRT developed complications more frequently, but they expressed greater aesthetic satisfaction with the treatment.ConclusionsIt is recommended that the complication rates and aesthetic satisfaction after breast reconstruction be carefully considered when determining the optimal timing for radiotherapy.

  4. Analysis of the Effects of Breast Reconstruction in Breast Cancer Patients Receiving Radiotherapy after Mastectomy

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    Seong Hwan Kim

    2012-05-01

    Full Text Available Background Immediate breast reconstruction after mastectomy and delayed breastreconstruction with post-supplementary treatment are the two types of breast reconstructioncurrently performed when treating breast cancer. Post-mastectomy radiation therapy (PMRTnot only reduces local recurrence but also improves overall survival. However, the complicationsand survival rates associated with PMRT need to be clear when determining the timing ofbreast reconstruction. Accordingly, we investigated the optimal timing of breast reconstructionby observing patients who underwent mastectomy followed by PMRT, based on their overallhealth and aesthetic satisfaction.Methods We retrospectively reviewed 21 patients who underwent breast reconstructionwith PMRT between November 2004 and November 2010. We collected data regarding thevarious methods of mastectomy, and the modality of adjuvant therapy, such as chemotherapy,hormone therapy, and radiotherapy. Telephone interviews were conducted to study the generaland aesthetic satisfaction.Results Patients who received PMRT after breast reconstruction showed a greater complicationrate than those undergoing breast reconstruction after PMRT (P=0.02. Aesthetic satisfactionwas significantly higher in the groups undergoing breast reconstruction after PMRT (P=0.03.Patients who underwent breast reconstruction before PMRT developed complications morefrequently, but they expressed greater aesthetic satisfaction with the treatment.Conclusions It is recommended that the complication rates and aesthetic satisfaction afterbreast reconstruction be carefully considered when determining the optimal timing forradiotherapy.

  5. Receiver Operating Characteristic (ROC to Determine Cut-Off Points of Biomarkers in Lung Cancer Patients

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    Heidi L. Weiss

    2004-01-01

    Full Text Available The role of biomarkers in disease prognosis continues to be an important investigation in many cancer studies. In order for these biomarkers to have practical application in clinical decision making regarding patient treatment and follow-up, it is common to dichotomize patients into those with low vs. high expression levels. In this study, receiver operating characteristic (ROC curves, area under the curve (AUC of the ROC, sensitivity, specificity, as well as likelihood ratios were calculated to determine levels of growth factor biomarkers that best differentiate lung cancer cases versus control subjects. Selected cut-off points for p185erbB-2 and EGFR membrane appear to have good discriminating power to differentiate control tissues versus uninvolved tissues from patients with lung cancer (AUC = 89% and 90%, respectively; while AUC increased to at least 90% for selected cut-off points for p185erbB-2 membrane, EGFR membrane, and FASE when comparing between control versus carcinoma tissues from lung cancer cases. Using data from control subjects compared to patients with lung cancer, we presented a simple and intuitive approach to determine dichotomized levels of biomarkers and validated the value of these biomarkers as surrogate endpoints for cancer outcome.

  6. Reducing stray radiation dose to patients receiving passively scattered proton radiotherapy for prostate cancer

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    Taddei, Phillip J; Fontenot, Jonas D; Zheng Yuanshui; Mirkovic, Dragan; Lee, Andrew K; Titt, Uwe; Newhauser, Wayne D [University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 94, Houston, TX 77030 (United States)], E-mail: wnewhaus@mdanderson.org

    2008-04-21

    Proton beam radiotherapy exposes healthy tissue to stray radiation emanating from the treatment unit and secondary radiation produced within the patient. These exposures provide no known benefit and may increase a patient's risk of developing a radiogenic second cancer. The aim of this study was to explore strategies to reduce stray radiation dose to a patient receiving a 76 Gy proton beam treatment for cancer of the prostate. The whole-body effective dose from stray radiation, E, was estimated using detailed Monte Carlo simulations of a passively scattered proton treatment unit and an anthropomorphic phantom. The predicted value of E was 567 mSv, of which 320 mSv was attributed to leakage from the treatment unit; the remainder arose from scattered radiation that originated within the patient. Modest modifications of the treatment unit reduced E by 212 mSv. Surprisingly, E from a modified passive-scattering device was only slightly higher (109 mSv) than from a nozzle with no leakage, e.g., that which may be approached with a spot-scanning technique. These results add to the body of evidence supporting the suitability of passively scattered proton beams for the treatment of prostate cancer, confirm that the effective dose from stray radiation was not excessive, and, importantly, show that it can be substantially reduced by modest enhancements to the treatment unit.

  7. Caregiver Burden in Patients Receiving Ranibizumab Therapy for Neovascular Age Related Macular Degeneration.

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    Rishma Gohil

    Full Text Available To assess the caregiver burden and factors determining the burden in patients receiving ranibizumab therapy for neovascular AMD (nAMD.This is a cross-sectional questionnaire survey of 250 matched patient caregiver dyads across three large ophthalmic treatment centres in United Kingdom. The primary outcome was the subjective caregiver burden measured using caregiver reaction assessment scale (CRA. Objective caregiver burden was determined by the caregiver tasks and level of care provided. The factors that may predict the caregiver burden such as the patient's visual acuity of the better eye and vision related quality of life, demographics, satisfaction and support provided by the healthcare and the health status of the dyads were also collected and assessed in a hierarchical regression model.The mean CRA score was 3.2±0.5, similar to the score reported by caregivers for atrial fibrillation who require regular hospital appointments for monitoring their thromboprophylaxis. Caregiver tasks including accompanying for hospital appointments for eye treatment and patient's visual acuity in the better eye were the biggest contributors to the caregiver burden hierarchical model explaining 18% and 11% of the variance respectively.Ranibizumab therapy for nAMD is associated with significant caregiver burden. Both disease impact and treatment frequency contributed to the overall burden.

  8. Weight loss in patients receiving radical radiation therapy for head and neck cancer: a prospective study

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    Johnston, C.A.; Keane, T.J.; Prudo, S.M.

    Thirty-one patients receiving radiation therapy for localized cancer of the head and neck areas were systematically assessed before, during, and after treatment. The pathogenesis of weight loss and its association with treatment morbidity and other determinants were sought. The serial data collected consisted of a food frequency questionnaire based on Canada's Food Guide, anthropometric measurements, 10 Linear Analogue Self Assessment questions on morbidity, and biochemical and hematological indices. Twenty of 31 patients (68%) lost over 5% of their presenting weight within one month after completing treatment. The mean weight loss was 10% and the range of weight loss in this group was 5.4 to 18.9%. Pretreatment dietary habits, serum albumin, absolute lymphocyte count, serum creatinine, creatinine height index, and anthropometric measurements did not predict for weight loss. However, weight loss can be predicted on the basis of field size and site irradiated. Treatment-related morbidity involving dysguesia, xerostomia, dysphagia of solids, and mouth pain was greater and of longer duration in patients with weight loss. The sequence of development of these symptoms during treatment and their duration provide a rational basis for the timing and methods of nutritional intervention in this patient population.

  9. Feeding tube-related complications and problems in patients receiving long-term home enteral nutrition

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    Vasileios Alivizatos

    2015-04-01

    Full Text Available Aim: The aim of this study was to evaluate the long-term complications and problems related to gastrostomy and jejunostomy feeding tubes used for home enteral nutrition support and the effect these have on health care use. Materials and Methods: The medical records of 31 patients having gastrostomy (27 patients and jejunostomy (4 feeding tubes inserted in our Department were retrospectively studied. All were discharged on long-term (>3 months enteral nutrition and followed up at regular intervals by a dedicated nurse. Any problem or complication associated with tube feeding as well as the intervention, if any, that occurred, was recorded. Data were collected and analyzed. Results: All the patients were followed up for a mean of 17.5 months (4-78. The most frequent tube-related complications included inadvertent removal of the tube (broken tube, plugged tube; 45.1%, tube leakage (6.4%, dermatitis of the stoma (6.4%, and diarrhea (6.4%. There were 92 unscheduled health care contacts, with an average rate of such 2.9 contacts over the mean follow-up time of 17.5 months. Conclusion: In patients receiving long-term home enteral nutrition, feeding tube-related complications and problems are frequent and result in significant health care use. Further studies are needed to address their optimal prevention modalities and management.

  10. Diabetes and Hypertension among Patients Receiving Antiretroviral Treatment Since 1998 in Senegal: Prevalence and Associated Factors

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    Diouf, Assane; Cournil, Amandine; Ba-Fall, Khadidiatou; Ngom-Guèye, Ndèye Fatou; Eymard-Duvernay, Sabrina; Ndiaye, Ibrahima; Batista, Gilbert; Guèye, Papa Mandoumbé; Bâ, Pape Samba; Taverne, Bernard; Delaporte, Eric; Sow, Papa Salif

    2012-01-01

    Cardiovascular risk factors in people on antiretroviral treatment (ART) are poorly documented in resource-constrained settings. A cross-sectional study was conducted in 2009 to assess prevalence of diabetes and hypertension in a sample of 242 HIV-infected patients who had initiated ART between 1998 and 2002 in Dakar, Senegal (ANRS 1215 observational cohort). World Health Organization (WHO) criteria were applied to diagnose diabetes and hypertension. Multiple logistic regressions were used to identify factors associated with diabetes and hypertension. Patients had a median age of 46 years and had received ART for a median duration of about 9 years. 14.5% had diabetes and 28.1% had hypertension. Long duration of ART (≥119 months), older age, higher body mass index (BMI), and higher levels of total cholesterol were associated with higher risks of diabetes. Older age, higher BMI at ART initiation, and higher levels of triglycerides were associated with higher risk of hypertension. This study shows that diabetes and hypertension were frequent in these Senegalese HIV patients on ART. It confirms the association between duration of ART and diabetes and highlights the need to implement programs for prevention of cardiovascular risk factors in HIV patients from resource-constrained settings. PMID:24052880

  11. Metacognitive Therapy (MCT+ in patients with psychosis not receiving antipsychotic medication: A case study

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    Ryan P. Balzan

    2015-07-01

    Full Text Available Background: Psychotherapies for psychosis typically aim to develop an awareness of the implausible content of a delusion or target the underlying cognitive biases (i.e., problematic thinking styles, such as hasty decisions and illusory control that foster and maintain delusional beliefs. A recently designed individual-based treatment entitled metacognitive therapy (MCT+ combines these two approaches. Emerging evidence suggests individualised MCT+, when used concurrently with antipsychotic medication, may be an effective psychological treatment for reducing delusional symptoms. However, it remains to be tested whether MCT+ can be effective in patients with active delusions who are not currently receiving psychotropic drugs. Method: We present two cases (one patient with schizophrenia and the other with delusional disorder experiencing active delusions who underwent four-weeks of intensive MCT+, without concurrent antipsychotic medication (minimum 6-months unmedicated. Baseline and 6-week follow-up data are presented on a variety of measures assessing delusion symptom severity (i.e., PANSS, PSYRATS, SAPS, clinical insight, and cognitive bias propensity. Results: After 4-weeks of MCT+, both patients showed substantial reduction in delusional symptoms, reported improved clinical insight, and were less prone to making illusory correlations. Conclusions: The presented case studies provide preliminary evidence for the feasibility of MCT+ in treating patients not taking, or resistant to, antipsychotic medication.

  12. Pharmacokinetic assessment in patients receiving continuous RRT: perspectives from the Kidney Health Initiative.

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    Nolin, Thomas D; Aronoff, George R; Fissell, William H; Jain, Lokesh; Madabushi, Rajnikanth; Reynolds, Kellie; Zhang, Lei; Huang, Shiew Mei; Mehrotra, Rajnish; Flessner, Michael F; Leypoldt, John K; Witcher, Jennifer W; Zineh, Issam; Archdeacon, Patrick; Roy-Chaudhury, Prabir; Goldstein, Stuart L

    2015-01-07

    The effect of AKI and modern continuous RRT (CRRT) methods on drug disposition (pharmacokinetics) and response has been poorly studied. Pharmaceutical manufacturers have little incentive to perform pharmacokinetic studies in patients undergoing CRRT because such studies are neither recommended in existing US Food and Drug Administration (FDA) guidance documents nor required for new drug approval. Action is urgently needed to address the knowledge deficit. The Kidney Health Initiative has assembled a work group composed of clinicians and scientists representing academia, the FDA, and the pharmaceutical and dialysis industries with expertise related to pharmacokinetics, AKI, and/or CRRT. The work group critically evaluated key considerations in the assessment of pharmacokinetics and drug dosing in CRRT, practical constraints related to conducting pharmacokinetic studies in critically ill patients, and the generalizability of observations made in the context of specific CRRT prescriptions and specific patient populations in order to identify efficient study designs capable of addressing the knowledge deficit without impeding drug development. Considerations for the standardized assessment of pharmacokinetics and development of corresponding drug dosing recommendations in critically ill patients with AKI receiving CRRT are proposed. Copyright © 2015 by the American Society of Nephrology.

  13. Reduced Use of Emergency Care and Hospitalization in Patients with Traumatic Brain Injury Receiving Acupuncture Treatment

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    Chun-Chuan Shih

    2013-01-01

    Full Text Available Background. Little research exists on acupuncture treatment’s effect on patients with traumatic brain injury (TBI. Methods. Using Taiwan’s National Health Insurance Research Database, we conducted a cohort study to compare the use of emergency care and hospitalization in TBI patients with and without acupuncture treatment in the first year after TBI. The adjusted relative risks (RRs and 95% confidence intervals (CIs of high use of emergency care and hospitalization associated with acupuncture treatment were calculated in multivariate Poisson regression models with generalized estimating equation. Results. The means of medical visits of emergency care and hospitalization were lower in TBI patients with acupuncture treatment than in those without acupuncture treatment. After adjustment, acupuncture treatment was associated with decreased risk of high emergency care visits (beta = −0.0611, P=0.0452 and hospitalization (beta = −0.0989, P<0.0001. The RRs of high medical visits and expenditure for hospitalization associated with acupuncture treatment were 0.62 (95% CI = 0.50–0.76 and 0.66 (95% CI = 0.53–0.83, respectively. Conclusion. Patients with TBI who receive acupuncture treatment have reduced the use of emergency care and hospitalization in the first year after injury. The mechanisms of effects of acupuncture on TBI warrant further investigations.

  14. Longitudinal associations of depressive symptoms and pain with quality of life in patients receiving chronic hemodialysis.

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    Belayev, Linda Y; Mor, Maria K; Sevick, Mary Ann; Shields, Anne Marie; Rollman, Bruce L; Palevsky, Paul M; Arnold, Robert M; Fine, Michael J; Weisbord, Steven D

    2015-04-01

    Depressive symptoms and pain are common in patients on chronic hemodialysis (HD), yet their associations with quality of life (QOL) are not fully understood. We sought to characterize the longitudinal associations of these symptoms with QOL. As part of a trial comparing two symptom management strategies in patients receiving chronic HD, we assessed depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9), and pain using the Short Form McGill Pain Questionnaire (SF-MPQ) monthly over 24 months. We assessed health-related QOL (HR-QOL) quarterly using the Short Form 12 (SF-12) and global QOL (G-QOL) using a single-item survey. We used random effects linear regression to analyze the independent associations of depressive symptoms and pain, scaled based on 5-point increments in symptom scores, with HR-QOL and G-QOL. Overall, 286 patients completed 1417 PHQ-9 and SF-MPQ symptom assessments, 1361 SF-12 assessments, and 1416 G-QOL assessments. Depressive symptoms were independently and inversely associated with SF-12 physical HR-QOL scores (β = -1.09; 95% confidence interval [CI]: -1.69, -0.50, P < 0.001); SF-12 mental HR-QOL scores (β = -4.52; 95% CI: -5.15, -3.89, P < 0.001); and G-QOL scores (β = -0.64; 95%CI: -0.79, -0.49, P < 0.001). Pain was independently and inversely associated with SF-12 physical HR-QOL scores (β = -0.99; 95% CI: -1.30, -0.68, P < 0.001) and G-QOL scores (β = -0.12; 95%CI: -0.20, -0.05, P = 0.002); but not with SF-12 mental HR-QOL scores (β = -0.16; 95%CI: -0.050, 0.17, P = 0.34). In patients receiving chronic HD, depressive symptoms and to a lesser extent pain, are independently associated with reduced HR-QOL and G-QOL. Interventions to alleviate these symptoms could potentially improve patients' HR-QOL and G-QOL. © 2014 International Society for Hemodialysis.

  15. Liver Fibrosis in HIV Patients Receiving a Modern cART

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    Mohr, Raphael; Schierwagen, Robert; Schwarze-Zander, Carolynne; Boesecke, Christoph; Wasmuth, Jan-Christian; Trebicka, Jonel; Rockstroh, Jürgen Kurt

    2015-01-01

    Abstract Liver-related death in human immunodeficiency virus (HIV)-infected individuals is about 10 times higher compared with the general population, and the prevalence of significant liver fibrosis in those with HIV approaches 15%. The present study aimed to assess risk factors for development of hepatic fibrosis in HIV patients receiving a modern combination anti-retroviral therapy (cART). This cross-sectional prospective study included 432 HIV patients, of which 68 (16%) patients were anti-hepatitis C virus (HCV) positive and 23 (5%) were HBsAg positive. Health trajectory including clinical characteristics and liver fibrosis stage assessed by transient elastography were collected at inclusion. Liver stiffness values >7.1 kPa were considered as significant fibrosis, while values >12.5 kPa were defined as severe fibrosis. Logistic regression and Cox regression uni- and multivariate analyses were performed to identify independent factors associated with liver fibrosis. Significant liver fibrosis was detected in 10% of HIV mono-infected, in 37% of HCV co-infected patients, and in 18% of hepatitis B virus co-infected patients. The presence of diabetes mellitus (odds ratio [OR] = 4.6) and FIB4 score (OR = 2.4) were independently associated with presence of significant fibrosis in the whole cohort. Similarly, diabetes mellitus (OR = 5.4), adiposity (OR = 4.6), and the FIB4 score (OR = 3.3) were independently associated with significant fibrosis in HIV mono-infected patients. Importantly, cumulative cART duration protected, whereas persistent HIV viral replication promoted the development of significant liver fibrosis along the duration of HIV infection. Our findings strongly indicate that besides known risk factors like metabolic disorders, HIV may also have a direct effect on fibrogenesis. Successful cART leading to complete suppression of HIV replication might protect from development of liver fibrosis. PMID:26683921

  16. Infection Rates among Acute Leukemia Patients Receiving Alternative Donor Hematopoietic Cell Transplantation.

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    Ballen, Karen; Woo Ahn, Kwang; Chen, Min; Abdel-Azim, Hisham; Ahmed, Ibrahim; Aljurf, Mahmoud; Antin, Joseph; Bhatt, Ami S; Boeckh, Michael; Chen, George; Dandoy, Christopher; George, Biju; Laughlin, Mary J; Lazarus, Hillard M; MacMillan, Margaret L; Margolis, David A; Marks, David I; Norkin, Maxim; Rosenthal, Joseph; Saad, Ayman; Savani, Bipin; Schouten, Harry C; Storek, Jan; Szabolcs, Paul; Ustun, Celalettin; Verneris, Michael R; Waller, Edmund K; Weisdorf, Daniel J; Williams, Kirsten M; Wingard, John R; Wirk, Baldeep; Wolfs, Tom; Young, Jo-Anne H; Auletta, Jeffrey; Komanduri, Krishna V; Lindemans, Caroline; Riches, Marcie L

    2016-09-01

    Alternative graft sources (umbilical cord blood [UCB], matched unrelated donors [MUD], or mismatched unrelated donors [MMUD]) enable patients without a matched sibling donor to receive potentially curative hematopoietic cell transplantation (HCT). Retrospective studies demonstrate comparable outcomes among different graft sources. However, the risk and types of infections have not been compared among graft sources. Such information may influence the choice of a particular graft source. We compared the incidence of bacterial, viral, and fungal infections in 1781 adults with acute leukemia who received alternative donor HCT (UCB, n= 568; MUD, n = 930; MMUD, n = 283) between 2008 and 2011. The incidences of bacterial infection at 1 year were 72%, 59%, and 65% (P < .0001) for UCB, MUD, and MMUD, respectively. Incidences of viral infection at 1 year were 68%, 45%, and 53% (P < .0001) for UCB, MUD, and MMUD, respectively. In multivariable analysis, bacterial, fungal, and viral infections were more common after either UCB or MMUD than after MUD (P < .0001). Bacterial and viral but not fungal infections were more common after UCB than MMUD (P = .0009 and <.0001, respectively). The presence of viral infection was not associated with an increased mortality. Overall survival (OS) was comparable among UCB and MMUD patients with Karnofsky performance status (KPS) ≥ 90% but was inferior for UCB for patients with KPS < 90%. Bacterial and fungal infections were associated with poorer OS. Future strategies focusing on infection prevention and treatment are indicated to improve HCT outcomes. Copyright © 2016 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

  17. Investigation of PON1 activity and MDA levels in patients with epilepsy not receiving antiepileptic treatment

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    Dönmezdil N

    2016-04-01

    Full Text Available Nilüfer Dönmezdil, Mehmet Uğur Çevik, Hasan Hüseyin Özdemir, Muhterem Taşin Department of Neurology, Dicle University, Diyarbakır, Turkey Purpose: There are many studies dedicated to researching the etiopathogenesis of epilepsy. In such research, oxidative and antioxidant indicators of etiopathogenesis have also been examined under the scope. Drawing on a group of patients with epilepsy who were receiving no treatment, we have tried to evaluate whether or not an increase in oxidative indicators is linked directly with the disorder, independent of epileptic medicaments.Methods: Thirty people in good health and 30 newly diagnosed with epilepsy and who received ambulatory treatment in the polyclinic of the Neurology Department took part in the study. The tests relating to serum malondialdehyde (MDA levels and paraoxonase 1 (PON1 activity were carried out in the biochemistry laboratory.Results: Even though the levels of MDA in the patient group (14.34±3.59 nmol/mL were found to be high compared to those of the control group, which consisted of people in good health (13.53±3.56 nmol/mL, there was no statistically significant difference. PON1 activity in the serum taken from people in the patient group (0.65±0.17 was lower in comparison to that observed in the serum of the control group (0.71±0.17 U/L. Nonetheless, it was not so low as to have significance from a statistical point of view.Conclusion: We conclude that such a high level of oxidative parameters should have been related to the disease and that statistically significant findings that emerged in some other studies could have been related to an antiepileptic treatment. Keywords: epilepsy, paraoxonase 1, malondialdehyde, oxidative stress, epilepsy, biochemical marker

  18. COPPER AND MAGNESIUM DEFICIENCIES IN PATIENTS WITH SHORT BOWEL SYNDROME RECEIVING PARENTERAL NUTRITION OR ORAL FEEDING

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    Camila Bitu Moreno BRAGA

    2015-06-01

    Full Text Available Background Patients with short bowel syndrome have significant fluid and electrolytes loss. Objective Evaluate the mineral and electrolyte status in short bowel syndrome patients receiving intermittent parenteral nutrition or oral feeding. Methods Twenty two adults with short bowel syndrome, of whom 11 were parenteral nutrition dependent (PN group, and the 11 remaining had been weaned off parenteral nutrition for at least 1 year and received all nutrients by oral feeding (OF group. The study also included 14 healthy volunteers paired by age and gender (control group. Food ingestion, anthropometry, serum or plasma levels of sodium, potassium, phosphorus, magnesium, calcium, zinc, iron and copper were evaluated. PN group subjects were evaluated before starting a new parenteral nutrition cycle. Results The levels of sodium, potassium, phosphorus, calcium and zinc were similar between the groups. The magnesium value was lower in the PN group (1.0 ± 0.4 mEq /L than other groups. Furthermore, this electrolyte was lower in the OF group (1.4 ± 0.3 mEq /L when compared to the Control group (1.8 ± 0.1 mEq/L. Lower values of copper (69±24 vs 73±26 vs 109±16 µg/dL were documented, respectively, for the PN and OF groups when compared to the control group. Conclusion Hypomagnesemia and hypocupremia are electrolyte disturbances commonly observed in short bowel syndrome. Patients with massive intestinal resection require monitoring and supplementation in order to prevent magnesium and copper deficiencies.

  19. The social context and the need of information from patients with epilepsy: evaluating a tertiary referral service

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    Priscila Freitas-Lima

    2015-04-01

    Full Text Available Objective Characterize the social profile and the need of information from patients with refractory epilepsy. Method A semi-structured questionnaire was applied to 103 patients to investigate sociodemographic aspects, pharmacotherapy and any doubts about epilepsy. Results Patients were highly dependent on having a free and accessible supply of antiepileptic drugs. Sixty-eight percent of the population was unemployed, and 26% confirmed receiving social security benefits due to epilepsy. Twenty-nine percent of the population reached high school. Eighty-five percent of the patients had at least one doubt about epilepsy; treatment and epilepsy aspects in general were the main topics. Conclusion : As observed in developed countries, patients with refractory epilepsy from a developing country also have high rates of unemployment and low educational levels. The results raise a concern about the need of information about epilepsy by patients and their families, urging the necessity to invest in strategies to solve this deficiency in knowledge.

  20. Nutritional status and CD4 cell counts in patients with HIV/AIDS receiving antiretroviral therapy

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    Ana Celia Oliveira dos Santos

    2013-12-01

    Full Text Available Introduction Even with current highly active antiretroviral therapy, individuals with AIDS continue to exhibit important nutritional deficits and reduced levels of albumin and hemoglobin, which may be directly related to their cluster of differentiation 4 (CD4 cell counts. The aim of this study was to characterize the nutritional status of individuals with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS and relate the findings to the albumin level, hemoglobin level and CD4 cell count. Methods Patients over 20 years of age with AIDS who were hospitalized in a university hospital and were receiving antiretroviral therapy were studied with regard to clinical, anthropometric, biochemical and sociodemographic characteristics. Body mass index, percentage of weight loss, arm circumference, triceps skinfold and arm muscle circumference were analyzed. Data on albumin, hemoglobin, hematocrit and CD4 cell count were obtained from patient charts. Statistical analysis was performed using Fisher's exact test, Student's t-test for independent variables and the Mann-Whitney U-test. The level of significance was set to 0.05 (α = 5%. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS 17.0 software for Windows. Results Of the 50 patients evaluated, 70% were male. The prevalence of malnutrition was higher when the definition was based on arm circumference and triceps skinfold measurement. The concentrations of all biochemical variables were significantly lower among patients with a body mass index of less than 18.5kg/m2. The CD4 cell count, albumin, hemoglobin and hematocrit anthropometric measures were directly related to each other. Conclusions These findings underscore the importance of nutritional follow-up for underweight patients with AIDS, as nutritional status proved to be related to important biochemical alterations.

  1. Study of hypothalamic pituitary adrenal axis in patients of membranous nephropathy receiving modified Ponticelli regimen

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    R Ramachandran

    2015-01-01

    Full Text Available Pulse methyl prednisolone followed by oral prednisolone and abrupt switch to chlorambucil/cyclophosphamide (Ponticelli/modified Ponticelli regimen is used in patients with idiopathic membranous nephropathy. This therapy where steroids are stopped abruptly is unphysiologic and expected to have hypothalamic pituitary adrenal (HPA axis suppression; however, this has not been evaluated. A total of 13 consecutive adult patients with idiopathic membranous nephropathy who had completed modified Ponticelli regimen were studied. The regimen included administration of pulse methylprednisolone 1 g for 3 days followed by oral prednisolone 0.5 mg/kg/day for 27 days followed by oral cyclophosphamide at a dose of 2 mg/kg/day for the next month. This was repeated for three courses. Patients who had received corticosteroids prior to therapy were excluded. The HPA axis was evaluated after 1 month of completing the last course of steroid therapy. The evaluation was done using a low-dose adrenocorticotropic hormone stimulation test. A single intravenous bolus dose of synacthen (1 μg was given at 9.00 am and the serum cortisol levels were estimated by radioimmunoassay at 0, 30, and 60 min. A peak cortisol level of 550 nmol/L or higher was considered as normal. Mean baseline cortisol levels was 662.3 ± 294.6 nmol/L and peak cortisol level was 767 ± 304.4 nmol/L. A total of 6 patients (46.2% had low basal cortisol levels, only 3 (23% had both basal and peak cortisol levels < 550 nmol/L suggestive of HPA axis suppression. To conclude, 23% of patients had suppression of HPA axis after modified Ponticelli regimen.

  2. The incidence of dysphagia in patients receiving cerebral reperfusion therapy poststroke.

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    Ribeiro, Priscila W; Cola, Paula C; Gatto, Ana R; da Silva, Roberta G; Luvizutto, Gustavo J; Braga, Gabriel P; Schelp, Arthur O; de Arruda Henry, Maria A C; Bazan, Rodrigo

    2014-07-01

    The high prevalence of dysphagia after stroke leads to increased mortality, and cerebral reperfusion therapy has been effective in reducing neurologic deficits. The aim of this study was to investigate the severity and evolution of dysphagia and the occurrence of pneumonia in patients submitted to cerebral reperfusion therapy. Seventy ischemic stroke patients were evaluated. Of these, 35 patients (group 1) were submitted to cerebral reperfusion therapy and 35 (group 2) did not receive thrombolytic treatment. The following were evaluated: severity of dysphagia by means of videofluoroscopy, evolution of oral intake rate by means of the Functional Oral Intake Scale, and the occurrence of pneumonia by international protocol. The relation between the severity of dysphagia and the occurrence of pneumonia with the treatment was evaluated through the chi-square test; the daily oral intake rate and its relation to the treatment were assessed by the Mann-Whitney test and considered significant if P is less than .05. The moderate and severe degrees of dysphagia were more frequent (P=.013) among the patients who were not submitted to cerebral reperfusion therapy. The daily oral intake evolved independently of the treatment type, without statistical significance when compared between the groups, whereas pneumonia occurred more frequently in group 2 (28%) in relation to group 1 (11%) and was associated with the worst degrees of dysphagia (P=.045). We can conclude that there is improvement in the oral intake rate in both groups, with lower severity of dysphagia and occurrence of pneumonia in ischemic stroke patients submitted to cerebral reperfusion therapy. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  3. Metabolic syndrome in HIV-infected patients receiving antiretroviral therapy in Latin America

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    C Alvarez

    2010-06-01

    Full Text Available OBJECTIVE: To evaluate the prevalence of and the associated factors for metabolic syndrome (MS among Latin American HIV-infected patients receiving antiretroviral therapy (ART using baseline data from the RAPID II study. METHODS: A longitudinal study to evaluate the metabolic profile, cardiovascular disease (CVD risk and associated treatment practices to reduce this risk has been conducted in seven Latin American countries (the RAPID II study. Adult HIV patients with at least six months of RT were enrolled. MS was defined following ATP-III criteria. Demographic and anthropometric data, serum biochemical and clinical parameters were compared in patients with and without MS using bivariate and multivariate analysis. RESULTS: A total of 4,010 patients were enrolled, 2,963 (74% were males. Mean age (SD was 41.9 (10.0 years. The prevalence of MS was 20.2%. Females had higher prevalence of MS than males (22.7% vs. 19.4%, p = 0.02. MS was driven by high triglycerides, low HDL-cholesterol and high blood pressure (HBP. Patients with MS had higher 10year CVD risk: 22.2% vs. 7.4%, p < 0.001. Age (OR: 1.05 per year, female gender (OR: 1.29, family history of CVD (OR: 1.28, CD4 cell count (OR: 1.09 per 100 cell increase, and protease inhibitor based-ART (OR: 1.33 correlated with MS in the multivariate analysis. CONCLUSIONS: Prevalence of MS in this setting was similar to that reported from developed countries. MS was driven by high triglycerides, low-HDL and HBP, and it was associated with higher risk of CVD. Traditional risk factors, female gender, immune reconstitution, and protease inhibitor based-ART correlated with MS.

  4. Perspectives of newly diagnosed advanced cancer patients receiving dignity therapy during cancer treatment.

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    Dose, Ann Marie; Rhudy, Lori M

    2017-07-21

    Dignity therapy is a psychosocial intervention that has been used primarily at the end of life to improve quality of life and other patient outcomes, but many individuals are unable to complete it due to health decline and death. The purpose of this study was to identify what individuals with advanced pancreatic or lung cancer with limited life expectancy, undergoing active cancer treatment describe during the dignity therapy intervention as important to them when not immediately facing end of life. Twenty patients undergoing chemotherapy for advanced cancer participated in a dignity therapy intervention study. Initial interviews were analyzed using descriptive content analysis. Family provided the overall context and background for emerging themes of defining events, accomplishments, and God's plan, which led to lessons learned, and resulted in messages of hope. Interviews were often autobiographical in nature and contained much reminiscence, consistent with dignity therapy's intent. Few participants spoke about their cancer diagnoses during the interview. This study adds unique insight into the use of dignity therapy for those still receiving active cancer treatment, different from work by others in which it was offered only at end of life. As part of supportive care, clinicians need to validate the importance of family to those with advanced cancer and to provide opportunities for patients to share what they have learned throughout life and to impart messages of hope to those closest to them.

  5. Stigma in patients with schizophrenia receiving community mental health care: a review of qualitative studies.

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    Mestdagh, Annelien; Hansen, Bart

    2014-01-01

    The aim of this review is to identify consistent themes among the qualitative literature on stigma as experienced by patients with schizophrenia receiving community mental health care. With the treatment focus of schizophrenia nowadays shifting more and more towards community-based mental health care, professionals need to be aware of the increased vulnerability of their clients in their social environment as a result of stigma towards their disease. In-depth knowledge on stigma is critical in order to offer a dignifying community mental health care. A systematic search of the qualitative literature in Web of Science, PubMed, PsycINFO and Francis was performed to review the subjective experiences and ideas on stigma in outpatients with schizophrenia. Three major themes were identified in 18 studies and need to be taken into consideration when implementing an adequate community mental health care: (i) the continuing existence of stigma inherent in the health care setting, (ii) the importance of relational aspects of stigma encounters in daily life and (iii) the significance of the behavioural aspects related to previous stigma experiences and beliefs among patients. Despite much effort in community treatment, patients still experience stigma and discrimination. Community mental health care professionals should not only be aware of structural problems in mental health care, but should also pay considerable attention towards the relational and behavioural aspects in their clients' life concerning stigma. Furthermore, they have the crucial role in the community to raise awareness about stigma in order to increase their clients' acceptance in society.

  6. Evaluation study of treatment outcome in Tuberculosis patients receiving DOTS under RNTCP

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    Mayank Jain

    2016-12-01

    Full Text Available Background: Tuberculosis is a global emergency and its control in community wholly depends on outcome of treatment taken by patient. India has 2nd position in total number of cases in World. Objective: To evaluate the factors which affect treatment outcome? Material & Methods: The study was a follow up study, for treatment outcome of tuberculosis patients receiving DOTS under RNTCP. Data were collected into SPSS version 16 and analyzed using appropriate statistical tests. Results: 241 patients were included in the study. Overall treatment success rate was 87.1%, default rate was 4.6%, failure rate was 2.1% and death rate was 6.2 %. Treatment success rate was 91.2% in category I and 70.2% in category II. Failure rate was 0.5% and 8.5%, default rate was 3.6% and 8.5%, death rate was 4.6% and 12 % for category I and category II respectively. In univariate analysis, variable education, occupation, socio-economic status, overcrowding, habit of tobacco consumption, presence of pre–existing illness and category of tuberculosis significantly affect the treatment outcome but on multiple logistic regression analysis education, occupation, habit of tobacco consumption and category of TB had significant effect on treatment outcome. Conclusion: Treatment success was 87.1% in present study conclude that DOTs is an effective form of tuberculosis treatment. Education, occupation, socio economic status and overcrowding have significant effect on treatment outcome.

  7. Cytokines, Fatigue, and Cutaneous Erythema in Early Stage Breast Cancer Patients Receiving Adjuvant Radiation Therapy

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    Vitaliana De Sanctis

    2014-01-01

    Full Text Available We investigated the hypothesis that patients developing high-grade erythema of the breast skin during radiation treatment could be more likely to present increased levels of proinflammatory cytokines which may lead, in turn, to associated fatigue. Forty women with early stage breast cancer who received adjuvant radiotherapy were enrolled from 2007 to 2010. Fatigue symptoms, erythema, and cytokine levels (IL-1β, IL-2, IL6, IL-8, TNF-α, and MCP-1 were registered at baseline, during treatment, and after radiotherapy completion. Seven (17.5% patients presented fatigue without associated depression/anxiety. Grade ≥2 erythema was observed in 5 of these 7 patients. IL-1β, IL-2, IL-6, and TNF-α were statistically increased 4 weeks after radiotherapy (P<0.05. After the Heckman two-step analysis, a statistically significant influence of skin erythema on proinflammatory markers increase (P = 0.00001 was recorded; in the second step, these blood markers showed a significant impact on fatigue (P = 0.026. A seeming increase of fatigue, erythema, and proinflammatory markers was observed between the fourth and the fifth week of treatment followed by a decrease after RT. There were no significant effects of hormone therapy, breast volume, and anemia on fatigue. Our study seems to suggest that fatigue is related to high-grade breast skin erythema during radiotherapy through the increase of cytokines levels.

  8. Secondary neutron doses received by paediatric patients during intracranial proton therapy treatments.

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    Sayah, R; Farah, J; Donadille, L; Hérault, J; Delacroix, S; De Marzi, L; De Oliveira, A; Vabre, I; Stichelbaut, F; Lee, C; Bolch, W E; Clairand, I

    2014-06-01

    This paper's goal is to assess secondary neutron doses received by paediatric patients treated for intracranial tumours using a 178 MeV proton beam. The MCNPX Monte Carlo model of the proton therapy facility, previously validated through experimental measurements for both proton and neutron dosimetry, was used. First, absorbed dose was calculated for organs located outside the clinical target volume using a series of hybrid computational phantoms for different ages and considering a realistic treatment plan. In general, secondary neutron dose was found to decrease as the distance to the treatment field increases and as the patient age increases. In addition, secondary neutron doses were studied as a function of the beam incidence. Next, neutron equivalent dose was assessed using organ-specific energy-dependent radiation weighting factors determined from Monte Carlo simulations of neutron spectra at each organ. The equivalent dose was found to reach a maximum value of ∼155 mSv at the level of the breasts for a delivery of 49 proton Gy to an intracranial tumour of a one-year-old female patient. Finally, a thorough comparison of the calculation results with published data demonstrated the dependence of neutron dose on the treatment configuration and proved the need for facility-specific and treatment-dependent neutron dose calculations.

  9. Cytokines, fatigue, and cutaneous erythema in early stage breast cancer patients receiving adjuvant radiation therapy.

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    De Sanctis, Vitaliana; Agolli, Linda; Visco, Vincenzo; Monaco, Flavia; Muni, Roberta; Spagnoli, Alessandra; Campanella, Barbara; Valeriani, Maurizio; Minniti, Giuseppe; Osti, Mattia F; Amanti, Claudio; Pellegrini, Patrizia; Brunetti, Serena; Costantini, Anna; Alfò, Marco; Torrisi, Maria Rosaria; Marchetti, Paolo; Enrici, Riccardo Maurizi

    2014-01-01

    We investigated the hypothesis that patients developing high-grade erythema of the breast skin during radiation treatment could be more likely to present increased levels of proinflammatory cytokines which may lead, in turn, to associated fatigue. Forty women with early stage breast cancer who received adjuvant radiotherapy were enrolled from 2007 to 2010. Fatigue symptoms, erythema, and cytokine levels (IL-1β, IL-2, IL6, IL-8, TNF-α, and MCP-1) were registered at baseline, during treatment, and after radiotherapy completion. Seven (17.5%) patients presented fatigue without associated depression/anxiety. Grade ≥2 erythema was observed in 5 of these 7 patients. IL-1β, IL-2, IL-6, and TNF-α were statistically increased 4 weeks after radiotherapy (P treatment followed by a decrease after RT. There were no significant effects of hormone therapy, breast volume, and anemia on fatigue. Our study seems to suggest that fatigue is related to high-grade breast skin erythema during radiotherapy through the increase of cytokines levels.

  10. Whole brain magnetization transfer histogram analysis of pediatric acute lymphoblastic leukemia patients receiving intrathecal methotrexate therapy

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    Yamamoto, Akira [Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto-shi Kyoto 606-8507 (Japan)]. E-mail: yakira@kuhp.kyoto-u.ac.jp; Miki, Yukio [Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto-shi Kyoto 606-8507 (Japan)]. E-mail: mikiy@kuhp.kyoto-u.ac.jp; Adachi, Souichi [Department of Pediatrics, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto-shi Kyoto 606-8507 (Japan)]. E-mail: sadachi@kuhp.kyoto-u.ac.jp (and others)

    2006-03-15

    Background and purpose: The purpose of this prospective study was to evaluate the hypothesis that magnetization transfer ratio (MTR) histogram analysis of the whole brain could detect early and subtle brain changes nonapparent on conventional magnetic resonance imaging (MRI) in children with acute lymphoblastic leukemia (ALL) receiving methotrexate (MTX) therapy. Materials and methods: Subjects in this prospective study comprised 10 children with ALL (mean age, 6 years; range, 0-16 years). In addition to conventional MRI, magnetization transfer images were obtained before and after intrathecal and intravenous MTX therapy. MTR values were calculated and plotted as a histogram, and peak height and location were calculated. Differences in peak height and location between pre- and post-MTX therapy scans were statistically analyzed. Conventional MRI was evaluated for abnormal signal area in white matter. Results: MTR peak height was significantly lower on post-MTX therapy scans than on pre-MTX therapy scans (p = 0.002). No significant differences in peak location were identified between pre- and post-chemotherapy imaging. No abnormal signals were noted in white matter on either pre- or post-MTX therapy conventional MRI. Conclusions: This study demonstrates that MTR histogram analysis allows better detection of early and subtle brain changes in ALL patients who receive MTX therapy than conventional MRI.

  11. Increases in Xu Zheng and Yu Zheng among Patients with Breast Cancer Receiving Different Anticancer Drug Therapies

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    Sheng-Miauh Huang

    2013-01-01

    Full Text Available Aim. The objectives of this study were to compare yang-xu, yin-xu, and yu among patients with breast cancer right before, one month after, and three months after receiving target, chemo, or combined therapy. Method. After recruiting 126 patients from 4 hospitals in northern Taiwan, a longitudinal study was carried out with 61 patients receiving chemotherapy, 30 receiving target therapy, and 35 receiving combined therapy. Yang-xu, yin-xu, and yu were assessed using the Traditional Chinese Medical Constitutional Scale (TCMCS, with higher scores indicating more xu and yu. Results. There were significant increases in yang-xu, yin-xu, and yu at 1 month and 3 months after than before the start of the chemotherapy, target, or combined therapy. Patients receiving combined therapy had significantly higher scores in yang-xu and yin-xu than patients receiving chemo or target therapy. A history of coronary heart disease was associated with more yin-xu. Those patients who had undergone a mastectomy were associated with less yu zheng than those patients who had not. Conclusion and Implications. TCM doctors should focus their treatment on dealing with xu and yu in order to support their patients, as they complete their modern anticancer treatments.

  12. [Endocarditis caused by Trichoderma longibrachiatumin a patient receiving home parenteral nutrition].

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    Rodríguez Peralta, Laura I; Mañas Vera, Ma Reyes; García Delgado, Manuel J; Pérez de la Cruz, Antonio J

    2013-01-01

    Home parenteral nutrition (HPN) improves the quality of life of the patients although it has complications. Catheter-related infections and mechanical complications are the most frequent ones. We report the case of endocarditis over catheter in a man suffering from short bowel and receiving HPN. The special features of the case are firstly the catheter was a remaining fragment on the right atrial and secondly the infection was caused by Trichoderma longibrachiatum, an isolated fact regarding this pathology so far. Conventional surgery was applied to take the catheter out. Staphylococcus epidermidis, Ochrobactrum anthropi and Trichoderma longibrachiatum were isolated from the surgical specimen. The extraction of the infected catheter along with antibiotic therapy led to the complete recovery of the subject. Ochrobactrum anthropi and Trichoderma longibrachiatum are unusual microorganisms but they are acquiring more relevance. Although there is no agreement about intravascular retained catheter management, the most recommended approach consists on monitoring them and removing the device in case of complications.

  13. Skin Abscess due to Serratia marcescens in an Immunocompetent Patient after Receiving a Tattoo

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    J. Diranzo García

    2015-01-01

    Full Text Available The incidence of skin infections caused by Serratia marcescens is extremely low and such infections are typically observed in immunocompromised patients. The clinical manifestations of these infections include cellulitis, abscesses, fluctuant nodules, or granulomatous lesions. Infections caused by S. marcescens are very difficult to treat due to their resistance to many antibiotics, which often leads to specific and prolonged treatment. Infections after receiving a tattoo are very rare and are caused by unhygienic conditions or the inexperience of the tattooist. In this paper we present the case of a 32-year-old male with no comorbidity, who presented an abscess caused by S. marcescens in a area that was tattooed one month earlier. The case was resolved with surgery and antimicrobial therapy that was based on the antibiogram. To our knowledge, this is the first reported case of a S. marcescens skin infection following a tattoo, in the absence of immunosuppression.

  14. FUNCTIONAL ABILITY AND QUALITY OF LIFE IN PATIENTS WITH RHEUMATOID ARTHRITIS RECEIVING TOCILIZUMAB THERAPY

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    Anna Sergeyevna Starkova

    2013-01-01

    Full Text Available Rheumatoid arthritis (RA is a chronic inflammatory joint disease causing joint dysfunction; reduction of quality of life (QoL; loss of work ability, self-care ability, and executing daily routines in most patients 5–10 years after the disease onset.Objective. To study QoL and the functional status (FS of Russian RA patients receiving tocilizumab (TCZ.Material and Methods. The study involved 42 patients with verified RA diagnosis (moderate or high activity who had earlier undergone inefficient therapy with basic anti-inflammatory medications. The limitation of the FS of the RA patients was determined quantitatively using the Russian-language version of the HAQ questionnaire. QoL was evaluated using the EuroQol-5D (EQ-5D Quality of Life questionnaire prior to treatment and after 4, 8, 12, 16, 20, and 24 weeks.Results. TCZ therapy demonstrated a rapid improvement of the FS of RA patients with a 64% decrease in the HAQ index (ΔHAQ=1.12, which corresponded to a 50% improvement of the health status of patients according to the ACR criteria.The median value [25th; 75th percentile] of the EQ-5D index was 0.52 [-0.02; 0.52]; 27.7% patients assessed their QoL as “worse than death”. The index reliably increased by week 8 of therapy; there were no patients with the negative EQ-5D index by week 24. Depending on QoL, all the patients were subdivided into two groups. Group 1 (n=12 comprised the patients with the EQ-5D no higher than 0; in group 2 patients (n=30, it was higher than 0. The groups were comparable in terms of disease duration, age, disease activity indices, and the previous treatment. The low QoL index in all 12 patients in group 1 was attributed to the infeasibility of performing daily activities and the reliably higher pain level (75.0 [61.0; 86.0] and 66.0 [48.0; 71.0] in groups 1 and 2, respectively; p=0.02. Improved QoL and reduced pain level were observed in both groups as early as after the first TCZ infusion. By week 24

  15. Using health-system-wide data to understand hepatitis B virus prophylaxis and reactivation outcomes in patients receiving rituximab

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    Schmajuk, Gabriela; Tonner, Chris; Trupin, Laura; Li, Jing; Sarkar, Urmimala; Ludwig, Dana; Shiboski, Stephen; Sirota, Marina; Dudley, R. Adams; Murray, Sara; Yazdany, Jinoos

    2017-01-01

    Abstract Hepatitis B virus (HBV) reactivation in the setting of rituximab use is a potentially fatal but preventable safety event. The rate of HBV screening and proportion of patients at risk who receive antiviral prophylaxis in patients initiating rituximab is unknown. We analyzed electronic health record (EHR) data from 2 health systems, a university center and a safety net health system, including diagnosis grouper codes, problem lists, medications, laboratory results, procedures codes, clinical encounter notes, and scanned documents. We identified all patients who received rituximab between 6/1/2012 and 1/1/2016. We calculated the proportion of rituximab users with inadequate screening for HBV according to the Centers for Disease Control guidelines for detecting latent HBV infection before their first rituximab infusion during the study period. We also assessed the proportion of patients with positive hepatitis B screening tests who were prescribed antiviral prophylaxis. Finally, we characterized safety failures and adverse events. We included 926 patients from the university and 132 patients from the safety net health system. Sixty-one percent of patients from the university had adequate screening for HBV compared with 90% from the safety net. Among patients at risk for reactivation based on results of HBV testing, 66% and 92% received antiviral prophylaxis at the university and safety net, respectively. We found wide variations in hepatitis B screening practices among patients receiving rituximab, resulting in unnecessary risks to patients. Interventions should be developed to improve patient safety procedures in this high-risk patient population. PMID:28353614

  16. Economic impact of infections among patients with primary immunodeficiency disease receiving IVIG therapy

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    Menzin J

    2014-06-01

    Full Text Available Joseph Menzin,1 Matthew Sussman,1 Michael Munsell,1 Arthur Zbrozek21Boston Health Economics, Inc., Waltham, MA, USA; 2CSL Behring, LLC, King of Prussia, PA, USAPurpose: There are limited data on the cost of infections among patients with primary immunodeficiency disease (PIDD in clinical practice. The purpose of this study was to assess the economic impact, from the US commercial payer perspective, of infections in a cohort of patients with PIDD who were administered intravenous immunoglobulin (IVIG therapy.Methods: This study used administrative claims from the MarketScan® Database. Patients with a PIDD diagnosis, one or more prescription(s for IVIG therapy between January 1, 2008 and February 28, 2010, and one or more prescription(s for IVIG at least 3 months following first IVIG prescription, were selected. The study period consisted of a 7-month window following first IVIG prescription. Study measures included infection-related medical resource use and expenditures. Adjusted infection-related hospitalization expenditures were estimated using a generalized linear model, controlling for demographics, comorbidities, and infection type.Results: A total 1,742 patients with PIDD and consistent IVIG use were identified, with 490 patients (mean age 43; 58.8% female having one or more infection(s during the 7-month study period. Infection-related inpatient hospitalizations were the most expensive component of care (US$38,574 per hospitalized patient. In multivariate modeling, the presence of a blood infection during the hospitalization (versus [vs] no blood infection, having diabetes, and younger age (<18 vs 55–64 were associated with significant increases in infection-related hospitalization expenditures (49.3%, 55.3%, and 76.5%, respectively (P<0.05.Conclusion: Health care expenditures for infections in PIDD patients receiving IVIG therapy can be substantial, particularly for inpatient care. Future evaluations assessing the incremental cost of

  17. Associations of health literacy with dialysis adherence and health resource utilization in patients receiving maintenance hemodialysis.

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    Green, Jamie A; Mor, Maria K; Shields, Anne Marie; Sevick, Mary Ann; Arnold, Robert M; Palevsky, Paul M; Fine, Michael J; Weisbord, Steven D

    2013-07-01

    Although limited health literacy is common in hemodialysis patients, its effects on clinical outcomes are not well understood. Observational study. 260 maintenance hemodialysis patients enrolled in a randomized clinical trial of symptom management strategies from January 2009 through April 2011. Limited health literacy. Dialysis adherence (missed and abbreviated treatments) and health resource utilization (emergency department visits and end-stage renal disease [ESRD]-related hospitalizations). We assessed health literacy using the Rapid Estimate of Adult Literacy in Medicine (REALM) and used negative binomial regression to analyze the independent associations of limited health literacy with dialysis adherence and health resource utilization over 12-24 months. 41 of 260 (16%) patients showed limited health literacy (REALM score, ≤60). There were 1,152 missed treatments, 5,127 abbreviated treatments, 552 emergency department visits, and 463 ESRD-related hospitalizations. Limited health literacy was associated independently with an increased incidence of missed dialysis treatments (missed, 0.6% vs 0.3%; adjusted incidence rate ratio [IRR], 2.14; 95% CI, 1.10-4.17), emergency department visits (annual visits, 1.7 vs 1.0; adjusted IRR, 1.37; 95% CI, 1.01-1.86), and hospitalizations related to ESRD (annual hospitalizations, 0.9 vs 0.5; adjusted IRR, 1.55; 95% CI, 1.03-2.34). Generalizability and potential for residual confounding. Patients receiving maintenance hemodialysis who have limited health literacy are more likely to miss dialysis treatments, use emergency care, and be hospitalized related to their kidney disease. These findings have important clinical practice and cost implications. Copyright © 2013 National Kidney Foundation, Inc. All rights reserved.

  18. Pattern of drug therapy problems and interventions in ambulatory patients receiving antiretroviral therapy in Nigeria

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    Ojeh VB

    2015-06-01

    Full Text Available Objectives: We describe the frequency and types of drug therapy problems (DTPs, and interventions carried out to resolve them, among a cohort of HIV- infected patients on ART in Jos, Nigeria. Methods: A prospective pharmacists’ intervention study was conducted between January and August 2012 at the outpatient HIV clinic of the Jos University Teaching Hospital (JUTH. Pharmacists identified DTPs and made recommendations to resolve them. The main outcome measures were number of DTPs encountered, interventions proposed and acceptance rate of recommendations. Results: A total of 42,416 prescriptions were dispensed to 9339 patients during the eight months study. A total of 420 interventions (Intervention rate of 1 per 100 prescriptions were made to resolve DTPs in 401 (4.3% patients with a mean age of 41 (SD=10 years, and made up of 73% females. DTPs encountered were drug omission (n=89, 21.2%, unnecessary drug (n=55, 13.1% and wrong drug indication (n=55, 13.1%. Recommendations offered included; Addition of another drug to the therapy (n=87, 20.7%, rectification of incomplete prescriptions (n=85, 20.2%, change of drug or dosage (n=67, 16.0%, and discontinuation of the offending drug (n=59, 14.0%. A total of 389 (93% out of 420 of the recommendations were accepted. In all, 50.4% (212 of the problematic prescriptions were changed and dispensed, 22.2% (89 were clarified and dispensed, while wrong identities were corrected in 11.7% (49. However, 7.5% (30 prescriptions were dispensed as prescribed, 5.2% (21 were not dispensed, and 3% (12 were unresolved. Conclusion: Our findings suggest that pharmacists-initiated interventions can ameliorate DTPs in patients receiving ART given the high intervention acceptance rate recorded. The implication of this finding is that pharmacists with requisite training in HIV pharmacotherapy are an excellent resource in detecting and minimizing the effect of antiretroviral drug-related errors.

  19. Management of infections in rheumatic patients receiving biological therapies. The Portuguese Society of Rheumatology recommendations.

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    Teixeira L

    2016-12-01

    Full Text Available Introduction: Infections are a major cause of morbi dity and mortality in systemic inflammatory rheumatic di - seases and the management of infectious complications in patients under biological therapies deserves parti - cular attention. Objective: Develop evidence-based recommendations for the management of infections in rheumatic patients receiving biological therapies. Methods: A search in PubMed (until 10 November 2014 and EMBASE (until 20 December 2014 databases was performed. Patients with systemic inflammatory rheumatic diseases treated with approved biologics in whom infections occurred were included. Search results were submitted to title and abstract selection, followed by detailed review of suitable studies. Information regarding presentation of the infectious complication, its diagnosis, treatment, and outcome, as well as maintenance or discontinuation of the biological agent was extracted and subsequently pooled according to the type of infection considered. Results of literature review were presented and critically reviewed in a dedi - cated meeting by a multidisciplinary panel. Recommendations were then formulated using the Delphi method. Finally, the level of agreement among rheumatologists was voted using an online survey. Results: Fifteen recommendations were issued. Nine general recommendations concerned the assessment of infectious risk before and while on biologics, the procedures in case of suspected infection and the mana - gement of biologics during infectious complications. Six specific recommendations were developed for respiratory, urinary, gastrointestinal, skin, osteoarticular and disseminated infections. Conclusion: These fifteen recommendations are intended to help rheumatologists in the management of infections in patients on biological therapy. They integrate an extensive literature review, expert opinion and inputs from Portuguese rheumatologists.

  20. Clinical correlates of 'BRCAness' in triple-negative breast cancer of patients receiving adjuvant chemotherapy.

    Science.gov (United States)

    Oonk, A M M; van Rijn, C; Smits, M M; Mulder, L; Laddach, N; Savola, S P; Wesseling, J; Rodenhuis, S; Imholz, A L T; Lips, E H

    2012-09-01

    We have previously reported an array comparative genomic hybridization profile that identifies triple-negative breast cancers (TNBC), with BRCA1 dysfunction and a high sensitivity to intensified dose bifunctional alkylating agents. To determine the effect of conventional-dose chemotherapy in patients with this so-called BRCA1-like profile, clinical characteristics and survival were studied in a large group of TNBC patients. DNA was isolated and BRCA1-like status was assessed in 101 patients with early-stage TNBC receiving adjuvant cyclophosphamide-based chemotherapy. Clinical characteristics and survival were compared between BRCA1-like and non-BRCA1-like groups. Results Sixty-six tumors (65%) had a BRCA1-like profile. Patients with BRCA1-like tumors tended to be younger and had more often node-negative disease (P = 0.06 and P = 0.03, respectively). Five-year recurrence-free survival was 80% for the BRCA1-like group and 75% for the non-BRCA1-like group (P = 0.35). T stage was the only variable significantly associated with survival. BRCA1-like tumors share clinical features, like young age at diagnosis and similar nodal status, with breast cancers in BRCA1 mutation carriers. Their prognosis is similar to that of non-BRCA1-like tumors when conventional-dose chemotherapy is administered. TNBCs that are classified as BRCA1-like may contain a defect in homologous recombination and could, in theory, benefit from the addition of poly ADP ribose polymerase inhibitors.

  1. Dose escalation in patients receiving whole-brain radiotherapy for brain metastases from colorectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Heisterkamp, Christine; Rades, Dirk [Dept. of Radiation Oncology, Univ. Hospital Schleswig-Holstein, Luebeck (Germany); Haatanen, Tiina [Dept. of Radiation Oncology, Univ. Hospital Hamburg-Eppendorf, Hamburg (Germany); Schild, Steven E. [Dept. of Radiation Oncology, Mayo Clinic, Scottsdale, AZ (United States)

    2010-02-15

    Background and Purpose: Whole-brain radiotherapy (WBRT) alone is the most common treatment for brain metastases from colorectal cancer, as most patients are not candidates for more aggressive therapies such as resection or radiosurgery. The standard WBRT regimen, 30 Gy in ten fractions (10 x 3 Gy), has generally resulted in poor outcomes. This study investigated whether an escalation of the WBRT dose improves these results. Patients and Methods: Data from 53 patients receiving WBRT alone for brain metastases from colorectal cancer were retrospectively analyzed. 10 x 3 Gy (n = 35) was compared to higher doses (40 Gy/20 fractions or 45 Gy/15 fractions; n = 18) for overall survival (OS) and local control (LC). Additional factors evaluated for prognostic importance included age, gender, performance status, number of metastases, and extracerebral metastases. Results: The OS rates at 6 months were 17% after 10 x 3 Gy and 50% after 20 x 2 Gy/15 x 3 Gy (p = 0.014). On multivariate analysis, improved OS was significantly associated with higher WBRT dose (p = 0.047), Karnofsky Performance Score (KPS) {>=} 70 (p = 0.034), less than four brain metastases (p = 0.036), and lack of extracerebral metastases (p = 0.010). The LC rates at 6 months were 17% after 10 x 3 Gy and 50% after higher doses (p = 0.018). On multivariate analysis of LC, higher WBRT dose was significant (p = 0.028). A trend was observed for KPS {>=} 70 (p = 0.08) and less than four brain metastases (p = 0.06). Conclusion: These data suggest that patients with brain metastases from colorectal cancer treated with WBRT alone appeared to benefit from escalation of the radiation dose beyond 10 x 3 Gy in terms of improved OS and LC. (orig.)

  2. Polypharmacy in elderly patients with type 2 diabetes receiving oral antidiabetic treatment.

    Science.gov (United States)

    Noale, Marianna; Veronese, Nicola; Cavallo Perin, Paolo; Pilotto, Alberto; Tiengo, Antonio; Crepaldi, Gaetano; Maggi, Stefania

    2016-04-01

    Polypharmacy in older diabetics can have detrimental effects linked to poor adherence and the risk of drug interaction or more serious/frequent side effects. The aim of this study was to identify the characteristics associated with polypharmacy in a cohort of elderly diabetic patients being treated with oral hypoglycemic agents. The study population consisted of 1342 diabetic patients consecutively enrolled in 57 diabetes centers in Italy participating in the METABOLIC Study. Patients meeting the following inclusion criteria were enrolled: diagnosis of type 2 diabetes mellitus, age ≥65 years, and receiving oral antidiabetic treatment. Data concerning diabetes duration and complications, the medications the patients were taking, and the number of hypoglycemic events were registered. Multidimensional impairment was assessed using the Multidimensional Prognostic Index. The mean age of the participants was 73.3 ± 5.5 years. Polypharmacy, defined as being prescribed contemporaneously at least five drugs, was found in 57.1 % of the study population. According to a multivariable logistic model, the female gender was significantly associated with polypharmacy, as were living in Northern Italian regions, diabetes duration longer than 4 years, and having a body mass index ≥30 kg/m(2). Comorbidities, diabetes complications, a better cognitive performance on the Short Portable Mental Status Questionnaire, and being malnourished/at risk of malnourishment according to the mini nutritional assessment were associated with polypharmacy. Polypharmacy, a condition that may lead to many potential detrimental outcomes in older diabetic subjects, was significantly associated with some risk factors that may be useful to identify subjects at risk.

  3. Prognostic value of metabolic response in breast cancer patients receiving neoadjuvant chemotherapy

    Directory of Open Access Journals (Sweden)

    Cao Maria D

    2012-01-01

    Full Text Available Abstract Background Today's clinical diagnostic tools are insufficient for giving accurate prognosis to breast cancer patients. The aim of our study was to examine the tumor metabolic changes in patients with locally advanced breast cancer caused by neoadjuvant chemotherapy (NAC, relating these changes to clinical treatment response and long-term survival. Methods Patients (n = 89 participating in a randomized open-label multicenter study were allocated to receive either NAC as epirubicin or paclitaxel monotherapy. Biopsies were excised pre- and post-treatment, and analyzed by high resolution magic angle spinning magnetic resonance spectroscopy (HR MAS MRS. The metabolite profiles were examined by paired and unpaired multivariate methods and findings of important metabolites were confirmed by spectral integration of the metabolite peaks. Results All patients had a significant metabolic response to NAC, and pre- and post-treatment spectra could be discriminated with 87.9%/68.9% classification accuracy by paired/unpaired partial least squares discriminant analysis (PLS-DA (p p = 0.004 after treatment, while survivors (≥ 5 years experienced a decrease in the levels of glycine (p = 0.047 and choline-containing compounds (p ≤ 0.013 and an increase in glucose (p = 0.002 levels. The metabolic responses were not related to clinical treatment response. Conclusions The differences in tumor metabolic response to NAC were associated with breast cancer survival, but not to clinical response. Monitoring metabolic responses to NAC by HR MAS MRS may provide information about tumor biology related to individual prognosis.

  4. Profile of patients receiving medical care at a reference, support, and treatment center for psoriasis patients at a university hospital*

    Science.gov (United States)

    Cordeiro Júnior, Túlio Germano Machado; Andrade, Bruno D' Paula; Palitot, Esther Bastos; Piuvezam, Márcia Regina; Mascarenhas, Sandra Rodrigues

    2016-01-01

    Psoriasis is a chronic, inflammatory, immune-mediated disease affecting 1-3% of the population worldwide. This work seeks to draw a profile of patients with psoriasis, analyzing socioeconomic, anthropometric, and clinical aspects. For this, medical records from 81 individuals who received medical care in a university hospital in 2014 were consulted. It was observed that the patients were mostly dark-skinned black adult men, with a low education level and a low income, who were sedentary, former smokers, obese, with an increase in waist circumference, and who did not consume alcohol. Psoriasis vulgaris predominated, beginning mainly on the scalp, hands, and feet. In addition, many presented some type of associated comorbidity and had relatives with psoriasis. PMID:27828656

  5. Characterization of Enterococcus isolates colonizing the intestinal tract of intensive care unit patients receiving selective digestive decontamination

    NARCIS (Netherlands)

    Bello Gonzalez, Teresita D.J.; Pham, Phu; Top, Janetta; Willems, Rob J.L.; Schaik, van Willem; Passel, van Mark W.J.; Smidt, Hauke

    2017-01-01

    Enterococci have emerged as important opportunistic pathogens in intensive care units (ICUs). In this study, enterococcal population size and Enterococcus isolates colonizing the intestinal tract of ICU patients receiving Selective Digestive Decontamination (SDD) were investigated. All nine

  6. Mixed treatment comparison of prophylaxis against invasive fungal infections in neutropenic patients receiving therapy for haematological malignancies : A systematic review

    NARCIS (Netherlands)

    Pechlivanoglou, Petros; Le, Hoa H; Daenen, Simon; Snowden, John A; Postma, Maarten J

    2014-01-01

    OBJECTIVES: Patients receiving therapy for haematological malignancies have a higher risk of invasive fungal infections (IFIs). Antifungal prophylaxis is an effective strategy against IFIs, but relative effectiveness estimates across agents are inconclusive. A mixed treatment comparison (MTC) was co

  7. Evaluation of vitreoretinal interface changes in patients receiving intravitreal anti-VEGF therapy.

    Science.gov (United States)

    Kinra, Vartika; Singh, Satvir; Khanduja, Sumeet; Nada, Manisha

    2017-03-15

    To study the effects of repeated intravitreal injection of anti-VEGF drug bevacizumab on the vitreoretinal interface (VRI). Patients undergoing intravitreal injection of bevacizumab were enrolled. Eyes with media haze, uveitis, high myopia, history of cataract surgery or laser capsulotomy in last 6 months and complicated pseudophakia were excluded. VRI evaluation was done monthly for a minimum of 6 months. The nature and timing of the change(s) event was recorded. A total of 100 eyes were evaluated. Thirty-seven eyes developed new vitreoretinal interface change event (VICE). Pseudophakia (OR = 5.23, 95% CI = 1.99-14.07, p = 0.001), pre-injection VRI abnormality (OR = 2.63, 95% CI = 1.13-6.14, p = 0.024) and older age at enrollment (62.6 ± 13.9 vs. 56.3 ± 14 years) were risk factors for development of VICE. Eighty percent of interface events occurred in the first 3 months of therapy. Eight needed surgical intervention for consequences of vitreoretinal separation. VICE is not infrequent in eyes receiving anti-VEGF therapy though rarely need surgical intervention. The first 3 months are the critical months to watch out for these events. The treating ophthalmologists must keep the risk factors for development of in mind and monitor and counsel patients accordingly.

  8. Catheter-Related Candidemia Caused by Candida lipolytica in a Patient Receiving Allogeneic Bone Marrow Transplantation

    Science.gov (United States)

    D'Antonio, Domenico; Romano, Ferdinando; Pontieri, Eugenio; Fioritoni, Giuseppe; Caracciolo, Claudia; Bianchini, Stefano; Olioso, Paola; Staniscia, Tommaso; Sferra, Roberta; Boccia, Stefania; Vetuschi, Antonella; Federico, Giovanni; Gaudio, Eugenio; Carruba, Giuseppe

    2002-01-01

    Candida lipolytica was recovered from the blood and the central venous catheter in a patient receiving allogeneic bone marrow transplantation. Two C. lipolytica strains from different geographical areas and the ATCC 9773 strain of C. lipolytica were used as controls. C. lipolytica was identified by standard methods. MICs indicated antifungal susceptibilities to amphotericin B, fluconazole, and itraconazole for all strains. In vitro testing and scanning electron microscopy showed that C. lipolytica was capable of producing large amounts of viscid slime material in glucose-containing solution, likely responsible for the ability of the yeast to adhere to catheter surfaces. Restriction fragment length polymorphisms revealed an identical profile for all clinical isolates, unrelated to those observed for the control strains. This finding suggested the absence of microevolutionary changes in the population of the infecting strain, despite the length of the sepsis and the potential selective pressure of amphotericin B, which had been administered to the patient for about 20 days. The genomic differences that emerged between the isolates and the control strains were indicative of a certain degree of genetic diversity between C. lipolytica isolates from different geographical areas. PMID:11923360

  9. Osteonecrosis of the Jaw in Patients Receiving Bone-Targeted Therapies: An Overview--Part I.

    Science.gov (United States)

    Turner, Bruce; Drudge-Coates, Lawrence; Ali, Sacha; Pati, Jhumur; Nargund, Vinod; Ali, Enamul; Cheng, Leo; Wells, Paula

    2016-01-01

    Urologic patients receiving bone-targeted therapies are at risk of developing osteonecrosis of the jaw (ONJ). ONJ has historically been associated with bisphosphonate therapy. More recently, RANK-Ligand inhibitors (denosumab) have also been used to reduce the risk of skeletal-related events in patients who have advanced cancers with bone metastases. More than 65% of men with metastatic prostate cancer and nearly 75% of women with metastatic breast cancer are affected by bone metastases. The literature has described ONJ associated with bisphosphonate therapy as bisphosphonate-related osteonecrosis of the jaw (BRONJ). However, with evidence also linking the use of RANK-Ligand inhibitors with osteonecrosis of the jaw, we advocate use of the term "anti-bone resorption therapy-related osteonecrosis of the jaw" (ABRT-ONJ). The term "medication-related osteonecrosis of the jaw" (MRONJ) is now becoming more widespread. There is not a universally accepted definition of ABRT-ONJ, which may have hindered recognition and reporting of the condition. In Part I of this article, a review of current knowledge around the etiology of ABRT-ONJ and incidence data are provided. In Part II, we provide an audit of ONJ in a nurse consultant-led bone support clinic. In the article, we refer to zoledronic acid because this is the bisphosphonate of choice for use in men with prostate cancer in the United Kingdom.

  10. The risk of hemorrhagic complications in hospital in-patients who fall while receiving antithrombotic therapy

    Directory of Open Access Journals (Sweden)

    Li Marilyn

    2005-01-01

    therapy, choosing only those who are sufficiently healthy to be at much lower than average risk of suffering fall-related hemorrhagic injuries. This phenomenon may lead to physicians overestimating the potential for fall-related major hemorrhagic injury in persons taking antithrombotic therapy, with the possible denial of warfarin therapy to many of those who would benefit. This perception may contribute to the care gap between the number of patients who would theoretically derive overall benefit from warfarin therapy and those who are actually receiving it.

  11. Pharmacokinetics of cefoperazone/sulbactam in critically ill patients receiving continuous venovenous hemofiltration.

    Science.gov (United States)

    Gao, Chunlu; Tong, Jing; Yu, Kaijiang; Sun, Zhidan; An, Ran; Du, Zhimin

    2016-07-01

    Cefoperazone/sulbactam (CFP/SUL) is a β-lactam/β-lactamase inhibitor combination with little data available for the development of effective dosing guidelines during continuous renal replacement therapy. This study aimed to investigate the pharmacokinetics (PK) of cefoperazone/sulbactam in critically ill patients on continuous venovenous hemofiltration (CVVH). A prospective, single-center, and open-label study was conducted. Critically ill patients receiving CVVH with 3 g cefoperazone/sulbactam (2.0/1.0 g) intravenously every 8 h were recruited. Serial blood and ultrafiltrate samples were paired collected for initial dose (occasion 1) and steady state (occasion 2). PK was assessed by non-compartmental analysis, and pharmacodynamics (PD) was evaluated by the percent of time for which drug concentrations exceed the minimum inhibitory concentration (%T >MIC). Total fourteen patients were enrolled. Volume of distribution at steady state (V ss) of cefoperazone and sulbactam for initial doses (20.8 ± and 28.4 L, respectively) increased significantly compared with those in healthy volunteers (P = 0.009 for CFP, P = 0.030 for SUL). Both cefoperazone and sulbactam showed significantly lower total clearance (CLt) (46.2 and 117.6 mL/min, respectively) compared with healthy volunteers (P = 0.000 for CFP, P = 0.017 for SUL). There is no significant difference in PK between occasion 1 and occasion 2 (P > 0.05). For occasion 1, mean CVVH clearance accounted for 34.3 and 33.9 % for CLt of cefoperazone and sulbactam, respectively. The minimum PD target of 60%T >MIC was achieved in seven of eight patients. For occasion 2, eight of nine patients achieved cefoperazone concentrations that were above the MIC for the entire dosing interval. PK of cefoperazone/sulbactam was altered in critically ill patients undergoing CVVH. Therapeutic drug monitoring would be recommended to individualize the dose regimen.

  12. Population pharmacokinetic/pharmacodynamic modeling of tumor growth kinetics in medullary thyroid cancer patients receiving cabozantinib.

    Science.gov (United States)

    Miles, Dale R; Wada, David R; Jumbe, Nelson L; Lacy, Steven A; Nguyen, Linh T

    2016-04-01

    Nonlinear mixed effects models were developed to describe the relationship between cabozantinib exposure and target lesion tumor size in a phase III study of patients with progressive metastatic medullary thyroid cancer. These models used cabozantinib exposure estimates from a previously published population pharmacokinetic model for cabozantinib in cancer patients that was updated with data from healthy-volunteer studies. Semi-mechanistic models predict well for tumors with static, increasing, or decreasing growth over time, but they were not considered adequate for predicting tumor sizes in medullary thyroid cancer patients, among whom an early reduction in tumor size was followed by a late stabilization phase in those receiving cabozantinib. A semi-empirical tumor model adequately predicted tumor profiles that were assumed to have a net growth rate constant that was piecewise continuous in the regions of 0-110 and 110-280 days. Emax models relating average concentration to average change in tumor size predicted that an average concentration of 79 and 58 ng/ml, respectively, would yield 50% of the maximum possible tumor reduction during the first 110 days of dosing and during the subsequent 110-280 days of dosing. Simulations of tumor responses showed that daily doses of 60 mg or greater are expected to provide a similar tumor reduction. Both model evaluation of observed data and simulation results suggested that the two protocol-defined cabozantinib dose reductions from 140 to 100 mg/day and from 100 to 60 mg/day are not projected to result in a marked reduction in target lesion regrowth.

  13. Quality of pharmacokinetic studies in critically ill patients receiving continuous renal replacement therapy.

    Science.gov (United States)

    Vaara, S; Pettila, V; Kaukonen, K-M

    2012-02-01

    Continuous renal replacement therapy (CRRT) is the preferred renal replacement therapy modality in the critically ill. We aimed to reveal the literature on the pharmacokinetic studies in critically ill patients receiving CRRT with special reference to quality assessment of these studies and the CRRT dose. We conducted a systematic review by searching the MEDLINE, EMBASE, and the Cochrane databases to December 2009 and bibliographies of relevant review articles. We included original studies reporting from critically ill adult subjects receiving CRRT because of acute kidney injury with a special emphasis on drug pharmacokinetics. We used the minimum reporting criteria for CRRT studies by Acute Dialysis Quality Initiative (ADQI) and, second, the Downs and Black checklist to assess the quality of the studies. We calculated the CRRT dose per study. We included pharmacokinetic parameters, residual renal function, and recommendations on drug dosing. Of 182 publications, 95 were considered relevant and 49 met the inclusion criteria. The median [interquartile range (IQR)] number of reported criteria by ADQI was 7.0 (5.0-8.0) of 12. The median (IQR) Downs and Black quality score was 15 (14-16) of 32. None of the publications reported CRRT dose directly. The median (IQR) weighted CRRT dose was 23.7 (18.8-27.9) ml/kg/h. More attention should be paid both to standardizing the CRRT dose and reporting of the CRRT parameters in pharmacokinetic studies. The general quality of the studies during CRRT in the critically ill was only moderate and would be greatly improved by reports in concordant with the ADQI recommendations. © 2011 The Authors Acta Anaesthesiologica Scandinavica © 2011 The Acta Anaesthesiologica Scandinavica Foundation.

  14. Effectiveness of pharmacist dosing adjustment for critically ill patients receiving continuous renal replacement therapy: a comparative study.

    Science.gov (United States)

    Jiang, Sai-Ping; Zhu, Zheng-Yi; Wu, Xiao-Liang; Lu, Xiao-Yang; Zhang, Xing-Guo; Wu, Bao-Hua

    2014-01-01

    The impact of continuous renal replacement therapy (CRRT) on drug removal is complicated; pharmacist dosing adjustment for these patients may be advantageous. This study aims to describe the development and implementation of pharmacist dosing adjustment for critically ill patients receiving CRRT and to examine the effectiveness of pharmacist interventions. A comparative study was conducted in an intensive care unit (ICU) of a university-affiliated hospital. Patients receiving CRRT in the intervention group received specialized pharmacy dosing service from pharmacists, whereas patients in the no-intervention group received routine medical care without pharmacist involvement. The two phases were compared to evaluate the outcome of pharmacist dosing adjustment. The pharmacist carried out 233 dosing adjustment recommendations for patients receiving CRRT, and 212 (90.98%) of the recommendations were well accepted by the physicians. Changes in CRRT-related variables (n=144, 61.81%) were the most common risk factors for dosing errors, whereas antibiotics (n=168, 72.10%) were the medications most commonly associated with dosing errors. Pharmacist dosing adjustment resulted in a US$2,345.98 ICU cost savings per critically ill patient receiving CRRT. Suspected adverse drug events in the intervention group were significantly lower than those in the preintervention group (35 in 27 patients versus [vs] 18 in eleven patients, Pdosing adjustment, which was 8.93 days vs 7.68 days (P=0.26) and 30.10% vs 27.36% (P=0.39), respectively. Pharmacist dosing adjustment for patients receiving CRRT was well accepted by physicians, and was related with lower adverse drug event rates and ICU cost savings. These results may support the development of strategies to include a pharmacist in the multidisciplinary ICU team.

  15. Renal impairment in β thalassemia major patients receiving repeated blood transfusion

    Directory of Open Access Journals (Sweden)

    Riadi Wirawan

    2003-12-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} β-thalassemia major is a disease caused by β polypeptide chain synthesis disorder which is inherited in an autosomal recessive manner from both parents and which is marked by little or no β-globin chain synthesis. Treatment for β-thalassemia major patients is by giving repeated blood transfusions, which causes iron accumulation, leading to hemochromatosis. Iron accumulation can occur in various body organ, including the kidneys. The aim of this study was to investigate the existence of renal impairment in β-thalassemia major patients. The subjects of this study were β-thalassemia major patients aged 15 - 28 years old who had received 6 units of packed red cells or more within 6 months. In this study, urine and serum samples of the subjects were taken and examined. Assay of serum iron was performed with Hitachi 737. Results were that 94.7% patients showed an increase in transferrin saturation and 40% of them had hemochromatosis; 73.4% had microalbuminuria; 1.3% had albuminuria and 21.3% had increased urinary β2- microglobulin (β2-m. A total of 78.6% of patients showed renal impairment. Conclusion of this study suggested that

  16. Implication of chemo-resistant memory T cells for immune surveillance in patients with sarcoma receiving chemotherapy.

    Science.gov (United States)

    Shibayama, Yuji; Tsukahara, Tomohide; Emori, Makoto; Murata, Kenji; Mizushima, Emi; Hirohashi, Yoshihiko; Kanaseki, Takayuki; Nakatsugawa, Munehide; Kubo, Terufumi; Yamashita, Toshihiko; Sato, Noriyuki; Torigoe, Toshihiko

    2017-09-01

    Chemotherapy has improved the prognosis of patients with sarcomas. However, it may suppress anti-tumor immunity. Recently, we reported a novel CD8(+) memory T cell population with a chemo-resistance property, "young memory" T (TYM ) cells. In this study, we investigated the proportion and function of TYM cells in peripheral blood of healthy donors and sarcoma patients who received chemotherapy and those who did not. The proportion of TYM cells was significantly decreased in patients compared with that in healthy donors. In healthy donors, anti-EBV CTLs were induced using mixed lymphocyte peptide culture, from not only TYM cells but also TCM and TEM cells. No CTLs directed to tumor-associated antigens were induced. In sarcoma patients who did not receive chemotherapy, in addition to anti-EBV CTLs, CTLs directed to the tumor-associated antigen PBF were induced from TYM , TCM and TEM cells. In sarcoma patients who received chemotherapy, EBV-specific CTLs were induced from TYM cells but were hardly induced from TEM cells. Interestingly, CTLs directed to the anti-tumor-associated antigen PBF were induced from TYM cells but not from the TCM and TEM cells in sarcoma patients who received chemotherapy. The findings suggest that TYM cells are resistant to chemotherapy and can firstly recover from the nadir. TYM cells might be important for immunological memory, especially in sarcoma patients receiving chemotherapy. © 2017 The Authors. Cancer Science published by John Wiley & Sons Australia, Ltd on behalf of Japanese Cancer Association.

  17. MR predictors of bone cement leakage in patients receiving percutaneous vertebroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Koh, Young Hwan; Han, Dae Hee; Choi, Young Ho; Cha, Joo Hee [Boramae Hospital, Incheon (Korea, Republic of); Jun, Deuk Soo; Jin, Wook; Kim, Hyung Sik [Gachon Medicine School, Gachon (Korea, Republic of)

    2005-07-15

    To identify MR predictors of bone cement leakage in patients receiving percutaneous vertebroplasty. Percutaneous vertebroplasties were performed in 45 vertebras (T7; one, T8; two, T10; two, T11; two, T12; eight, L1; fifteen, L2; eight, L3; five, L4; two) in 35 patients (age 52-83). The procedure was performed using an 11 G Jamshidi needle, which was inserted into the target by the bipedicular approach. Kyphoplasty, unilateral pedicular approach and extrapedicular approach cases were excluded. Shortly after the procedure, all patients underwent a noncontrast CT covering the vertebroplasty sites. A retrospective study was performed to determine whether cement leakage is related to any of following MR findings: presence of cortical disruption of the vertebral body, severity of body compression (proportion of abnormal to normal vertebral body volumes), bone cement amount, bone cement amount/severity of body compression ratio, proportion of low-signal area in a vertebral body on T1 weighted image, presence of either vacuum or cystic portion below a linear dark signal in a fractured vertebra, and the location of dark signal intensity line in a vertebral body. Logisgic discrimination model stepwise method was used in the statistical analysis. On post-vertebroplasty CT scan, bone cement leakage was detected in or around 29 vertebrae (64%), including 11 vertebrae (24%) where leakage was found in the epidural space or radial vein. No patient displayed any neurological symptoms or signs. The most frequent site of bone cement leakage was the anterior external vertebral venous plexus (49%). Endplate cortical bone disruption was related to an increased risk of intervertebral bone cement leakage ({rho} < 0.05). Bone cement leakage tended to occur less frequently when there is a vacuum or cystic change below the dark linear signal intensity in a fractured vertebra ({rho} < 0.05). No other MR findings showed a statistically significant correlation with bone cement leakage. On pre

  18. Are beta-blockers needed in patients receiving spironolactone for severe chronic heart failure? An analysis of the COPERNICUS study.

    Science.gov (United States)

    Krum, Henry; Mohacsi, Paul; Katus, Hugo A; Tendera, Michael; Rouleau, Jean-Lucien; Fowler, Michael B; Coats, Andrew J; Roecker, Ellen B; Packer, Milton

    2006-01-01

    The beneficial effects of beta-blockers and aldosterone receptor antagonists are now well established in patients with severe systolic chronic heart failure (CHF). However, it is unclear whether beta-blockers are able to provide additional benefit in patients already receiving aldosterone antagonists. We therefore examined this question in the COPERNICUS study of 2289 patients with severe CHF receiving the beta1-beta2/alpha1 blocker carvedilol compared with placebo. Patients were divided post hoc into subgroups according to whether they were receiving spironolactone (n = 445) or not (n = 1844) at baseline. Consistency of the effect of carvedilol versus placebo was examined for these subgroups with respect to the predefined end points of all-cause mortality, death or CHF-related hospitalizations, death or cardiovascular hospitalizations, and death or all-cause hospitalizations. The beneficial effect of carvedilol was similar among patients who were or were not receiving spironolactone for each of the 4 efficacy measures. For all-cause mortality, the Cox model hazard ratio for carvedilol compared with placebo was 0.65 (95% CI 0.36-1.15) in patients receiving spironolactone and 0.65 (0.51-0.83) in patients not receiving spironolactone. Hazard ratios for death or all-cause hospitalization were 0.76 (0.55-1.05) versus 0.76 (0.66-0.88); for death or cardiovascular hospitalization, 0.61 (0.42-0.89) versus 0.75 (0.64-0.88); and for death or CHF hospitalization, 0.63 (0.43-0.94) versus 0.70 (0.59-0.84), in patients receiving and not receiving spironolactone, respectively. The safety and tolerability of treatment with carvedilol were also similar, regardless of background spironolactone. Carvedilol remained clinically efficacious in the COPERNICUS study of patients with severe CHF when added to background spironolactone in patients who were practically all receiving angiotensin-converting enzyme inhibitor (or angiotensin II antagonist) therapy. Therefore, the use of

  19. Development of a radioimmunoassay for measuring gonadotrophin releasing hormone in patients receiving treatment

    Energy Technology Data Exchange (ETDEWEB)

    Mobsby, V.A.; Knapp, M.L.; Mayne, P.D. (Charing Cross and Westminster Medical School, Westminster, London (UK)); Fink, R.S. (West Middlesex Univ. Hospital, Isleworth (UK)); Osgood, V.M. (Royal Free Hospital, London (UK))

    1989-05-01

    This gonadotrophin releasing hormone (GnRH) assay showed good precision, recovery, and parallelism over a wide range of GnRH concentrations with a sensitivity of 15 pg/ml. The assay was compared with a commercially available kit (Buhlmann Laboratories). Although the Buhlmann kit showed acceptable precision, recovery, sensitivity, and correlation with the developed GnRH assay for plasma samples, lack of parallelism of serially diluted plasma and urine samples was consistently observed, together with poor correlation with the developed GnRH assay for urine, suggesting a matrix effect with the Buhlmann kit. The developed assay is suitable for measuring GnRH in samples obtained from patients receiving pulsatile infusions of GnRH. In contrast, the commercially available Buhlmann kit was unsuitable for measuring plasma GnRH as the kit had a top standard of only 160 pg/ml, well below peak plasma concentration. It would not be possible to dilute samples for analysis because of lack of parallelism of diluted samples compared with standards obtained with the Buhlmann assay. (author).

  20. Receiving a pharmaceutical care service compared to receiving standard pharmacy service in Sweden--How do patients differ with regard to perceptions of medicine use and the pharmacy encounter?

    Science.gov (United States)

    Montgomery, Anna T; Kälvemark Sporrong, Sofia; Manap, Nila; Tully, Mary P; Lindblad, Asa Kettis

    2010-09-01

    Qualitative research has shown that gaining control of medicine treatment and increased feelings of safety and empowerment are central concepts in patients' perceptions of a pharmaceutical care (PC) service provided in Sweden. However, little is known about any unique differences among patients receiving PC versus standard pharmacy services (SSs) and the impact of these services on patient-perceived outcomes. To describe and compare patients who had previously received a PC service and patients who had received a SS with regard to their perceptions of medicine use and the pharmacy encounter. Cross-sectional survey design comparing matched groups of patients who were previously elected to receive a PC service or who had received SS. Patients who were 60 years or older and used 5 or more prescription medicines concomitantly were included in the survey. Questionnaires included questions about perceptions of safety in drug therapy, general health, drug-related problems (DRPs), medication beliefs, adherence, and experiences of pharmacy encounters. Patients receiving the PC service used more prescription medicines, reported poorer self-reported health, and less perceived safety in their medicine therapy than did patients in SS. PC patients reported that they felt safer with medications, felt a genuine interest from the pharmacist, received important information, and felt more prepared to see the doctor after having spoken to the pharmacist than did patients in SS. DRPs reported to a greater extent by patients receiving the PC service included difficulties opening containers, worries about side effects, experiences of side effects, worries about drug-drug interactions, and inadequate treatment effects. Adherence and medication beliefs showed no statistical difference between groups. Patients receiving a PC service are a worried, vulnerable, and information-seeking group. When compared with patients receiving SS, the PC patients are more insecure about their medicine

  1. Effect of supportive nursing care on self esteem of patients receiving electroconvulsive therapy: a randomized controlled clinical trial.

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    Ebrahimi, Hossein; Navidian, Ali; Keykha, Roghaieh

    2014-06-01

    Self-esteem is an important potential indicator in etiology, diagnosis and treatment of patients with severe mental illness. ECT is a popular treatment for these patients that can effect on their self-esteem and reinforce their problems. The purpose of this study is to determine the effect of supportive nursing care in increasing self esteem of patients receiving ECT. This clinical trial was conducted in the Baharan psychiatric hospital of Zahedan. A total of 70 cases of patients who received ECT were randomly allocated to control (n=35) and intervention (n=35) groups. The data were collected by demographic characteristics questionnaire and Rosenberg Self Esteem Scale (RSES). Intervention group received the supportive nursing care. The control group received only routine treatment. Self esteem level was measured and compared before and after intervention for two groups. The data was analyzed by SPSS using the χ(2), t-test and ANCOVA. RESULTS showed that both groups were homogeneous on the socio- demographic characteristics. The mean self esteem in the intervention group compared with the control group was significantly increased. While controlling the effects of individual and social variables, the result shows significant differences between two groups in the mean scores of self esteem after the intervention. The results suggest that supportive nursing care can have positive effect on self esteem of patients receiving ECT. It is recommended to use this method for increasing self esteem of these patients.

  2. Effect of Supportive Nursing Care on Self Esteem of Patients Receiving Electroconvulsive Therapy: A Randomized Controlled Clinical Trial

    Directory of Open Access Journals (Sweden)

    Hossein Ebrahimi

    2014-06-01

    Full Text Available Introduction: Self-esteem is an important potential indicator in etiology, diagnosis and treatment of patients with severe mental illness. ECT is a popular treatment for these patients that can effect on their self-esteem and reinforce their problems. The purpose of this study is to determine the effect of supportive nursing care in increasing self esteem of patients receiving ECT. Methods: This clinical trial was conducted in the Baharan psychiatric hospital of Zahedan. A total of 70 cases of patients who received ECT were randomly allocated to control (n=35 and intervention (n=35 groups. The data were collected by demographic characteristics questionnaire and Rosenberg Self Esteem Scale (RSES. Intervention group received the supportive nursing care. The control group received only routine treatment. Self esteem level was measured and compared before and after intervention for two groups. The data was analyzed by SPSS using the χ2, t-test and ANCOVA. Results: Results showed that both groups were homogeneous on the socio- demographic characteristics. The mean self esteem in the intervention group compared with the control group was significantly increased. While controlling the effects of individual and social variables, the result shows significant differences between two groups in the mean scores of self esteem after the intervention.Conclusion: The results suggest that supportive nursing care can have positive effect on self esteem of patients receiving ECT. It is recommended to use this method for increasing self esteem of these patients.

  3. Persistence and adherence in multiple sclerosis patients starting glatiramer acetate treatment : assessment of relationship with care received from multiple disciplines

    NARCIS (Netherlands)

    Jongen, Peter Joseph; Lemmens, Wim A.; Hupperts, Raymond; Hoogervorst, Erwin L. J.; Schrijver, Hans M.; Slettenaar, Astrid; de Schryver, Els L.; Boringa, Jan; van Noort, Esther; Donders, Rogier

    2016-01-01

    Background: In multiple sclerosis patients, the persistence of, and adherence to, disease-modifying treatment are often insufficient. The degree of persistence and adherence may relate to the care received from various disciplines. Methods: In an observational study of 203 patients treated with glat

  4. Tuberculosis in hospitalized patients: clinical characteristics of patients receiving treatment within the first 24 h after admission

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    Denise Rossato Silva

    2014-06-01

    Full Text Available Objective: To evaluate clinical characteristics and outcomes in patients hospitalized for tuberculosis, comparing those in whom tuberculosis treatment was started within the first 24 h after admission with those who did not. Methods: This was a retrospective cohort study involving new tuberculosis cases in patients aged ≥ 18 years who were hospitalized after seeking treatment in the emergency room. Results: We included 305 hospitalized patients, of whom 67 (22.0% received tuberculosis treatment within the first 24 h after admission ( ≤24h group and 238 (88.0% did not (>24h group. Initiation of tuberculosis treatment within the first 24 h after admission was associated with being female (OR = 1.99; 95% CI: 1.06-3.74; p = 0.032 and with an AFB-positive spontaneous sputum smear (OR = 4.19; 95% CI: 1.94-9.00; p 24h groups, respectively, the ICU admission rate was 22.4% and 15.5% (p = 0.258; mechanical ventilation was used in 22.4% and 13.9% (p = 0.133; in-hospital mortality was 22.4% and 14.7% (p = 0.189; and a cure was achieved in 44.8% and 52.5% (p = 0.326. Conclusions: Although tuberculosis treatment was initiated promptly in a considerable proportion of the inpatients evaluated, the rates of in-hospital mortality, ICU admission, and mechanical ventilation use remained high. Strategies for the control of tuberculosis in primary care should consider that patients who seek medical attention at hospitals arrive too late and with advanced disease. It is therefore necessary to implement active surveillance measures in the community for earlier diagnosis and treatment.

  5. The impact of body mass index dynamics on survival of patients with advanced pancreatic cancer receiving chemotherapy.

    Science.gov (United States)

    Choi, Younak; Kim, Tae-Yong; Lee, Kyung-hun; Han, Sae-Won; Oh, Do-Youn; Im, Seock-Ah; Kim, Tae-You; Bang, Yung-Jue

    2014-07-01

    High body mass index (BMI) is linked to an increased risk of developing pancreatic cancer (PC). However, in patients with advanced PC (APC), especially those receiving palliative chemotherapy, the impact of BMI on survival has not been investigated fully. To assess changes in BMI during the course of APC and their impact on patient survival, specifically for those receiving palliative chemotherapy. Consecutive patients with APC, all of whom were treated with palliative chemotherapy, were enrolled during 2003-2010. Clinical characteristics and prognoses were analyzed. A total of 425 patients participated (median age, 60.1 years). At diagnosis of APC, patients' BMI distribution of patients was as follow: Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  6. Longitudinal risk of herpes zoster in patients with non-Hodgkin lymphoma receiving chemotherapy: A nationwide population-based study.

    Science.gov (United States)

    Cho, Shih-Feng; Wu, Wan-Hsuan; Yang, Yi-Hsin; Liu, Yi-Chang; Hsiao, Hui-Hua; Chang, Chao-Sung

    2015-09-22

    This study investigated the incidence of and risk factors for herpes zoster in patients with non-Hodgkin lymphoma (NHL) who were receiving anti-lymphoma treatment. The overall incidence density of herpes zoster was 12.21% (472/3865); 11.79% (258/2188) of the patients received conventional chemotherapy and 12.76% (214/1677) of the patients received rituximab-containing chemotherapy. For the patients who received conventional chemotherapy, the risk factors included female gender, multiple courses of chemotherapy and autologous hematopoietic stem cell transplantation. For the patients who received rituximab-containing chemotherapy, the risk factors included female gender, diabetes mellitus, multiple courses of chemotherapy, autologous hematopoietic stem cell transplantation and higher accumulated rituximab dose. The majority of the herpes zoster episodes occurred within the first two years after the diagnosis of NHL. After adjusting for the propensity score matching, rituximab-containing chemotherapy was not associated with a higher overall incidence density of herpes zoster (P = 0.155). However, the addition of rituximab to conventional chemotherapy increased the short-term risk of herpes zoster with adjusted odd ratios of 1.38 (95% confidence intervals (CI) = 1.05-1.81, P = 0.021) and 1.37 (95% CI = 1.08-1.73, P = 0.010) during the 1-year and 2-year follow-up periods, respectively.

  7. The Effects of Acupressure on Meridian Energy as well as Nausea and Vomiting in Lung Cancer Patients Receiving Chemotherapy.

    Science.gov (United States)

    Shen, Chi-Hsiang; Yang, Li-Yu

    2017-03-01

    Nausea and vomiting are the most common side effects of antineoplastic chemotherapy. However, only a small number of studies have been conducted in Taiwan to determine the efficacy of acupressure in treating these side effects in cancer patients receiving chemotherapy. In this quasi-experimental study, we aimed to explore the effects of acupressure on meridian energy as well as nausea and vomiting in 70 lung cancer patients receiving chemotherapy. Patients were assigned to the experimental or control group based on order of hospital admission. The experimental group received acupressure on "Neiguan (PC6)" and "Gongsun (SP4)" points, and the control group received sham acupoint patches on "Houxi (SI3)" point. The results showed that the mean meridian energy in the experimental group after acupressure was significantly higher than in the control group ( F = 28.71, p energy and effectively decreased the severity of nausea and vomiting in lung cancer patients undergoing chemotherapy. We recommend that clinical nurses provide acupressure as an intervention to relieve nausea and vomiting in patients receiving chemotherapy.

  8. Pneumonia due to Cryptococcus neoformans in a patient receiving infliximab: possible zoonotic transmission from a pet cockatiel.

    Science.gov (United States)

    Shrestha, Rabin K; Stoller, James K; Honari, Golara; Procop, Gary W; Gordon, Steven M

    2004-06-01

    The use of humanized antibody against tumor necrosis factor alpha (TNF-alpha) may increase the risk of various opportunistic infections, including tuberculosis and fungal infections. We report a case of cryptococcal pneumonia in a patient who was taking infliximab for rheumatoid arthritis. A temporally related exposure history raised the possibility that our patient acquired the infection from his pet cockatiel. It seems prudent to advise patients receiving infliximab to avoid exposure to pet avian excreta.

  9. Older home nursing patients' perception of social provisions and received care.

    Science.gov (United States)

    Dale, Bjørg; Saevareid, Hans Inge; Kirkevold, Marit; Söderhamn, Olle

    2010-09-01

    Social loneliness and isolation may be some of the consequences that older people experience regarding age-related changes and losses, and nurses should be engaged in identifying social networks and social needs in this group. The aims of this study were to describe perceived social provisions in a group of older home-dwelling care-dependent patients, and to explore the relationship between perceived social provisions, physical functioning, mental state and reception of formal and informal care. The sample consisted of 242 persons aged 75+ years from seven municipalities in southern Norway, all receiving home nursing. Data were collected by means of structured interviews. Social support was assessed using the revised Social Provisions Scale. Physical functioning was assessed using the Barthel Index, and mental state using questions about loneliness, depressive symptoms and anxiety. Types and frequencies of social network contacts and formal and informal care were registered. Descriptive statistics, Mann-Whitney U-tests, Cronbach's alpha coefficient and stepwise multiple regression were used in the analyses. In general, the level of perceived social provisions and togetherness in the study group was high, especially among women and the married. Decreased physical functioning and declined mental state were related to lower level of social provisions. The majority of the individuals had frequently contacts with several types of social networks, like friends, neighbours and religious communities, in addition to close family. Contact with these informal networks was found to be close related to perceived social support and togetherness. Reduced social provisions was related to increased amount of home nursing, which could indicate that demand for home care may work as a strategy to gain social contact. In this sense, dependence in daily life functioning could possibly contribute to social contact rather than reduce it.

  10. Potential radiating effects of misusing substances among medical patients receiving brief intervention.

    Science.gov (United States)

    Gryczynski, Jan; Mitchell, Shannon Gwin; Ondersma, Steven J; O'Grady, Kevin E; Schwartz, Robert P

    2015-08-01

    The societal benefits of substance use interventions are largely driven not by reducing use per se, but by the broader implications of those reductions. This encompasses "potential radiating effects of misusing substances" (PREMiS) such as utilization of high-cost hospital and emergency care, injury, productivity losses, incarceration, and driving while impaired. This study is a secondary analysis from a randomized trial comparing in-person vs. computerized brief intervention among 360 adult community health center patients with moderate-risk illicit drug use (N = 302 with complete data through 12 months of follow-up). This study aims to examine four aspects of PREMiS outcomes in this sample: (1) their frequency; and their association with (2) type of brief intervention received (by random assignment), (3) type of drug misused, and (4) baseline drug problem severity (within the moderate risk range). 12-month prevalence was 18.5% for hospitalization (399 cumulative days), 33.1% for emergency department utilization (166 cumulative visits), 39.1% for injury (1818 injury-days), and 8.3% for incarceration (278 days of detention). There were 729 missed work days among those who reported employment. Fifty percent reported driving under the influence (DUI) of substances. There were no differences in PREMiS outcomes by type of brief intervention. Participants with only marijuana misuse at baseline were not at lower risk of experiencing PREMiS events than participants with other drug misuse. Higher baseline drug problem severity was predictive of future hospitalization (p < .05) and number of hospitalization days (p < .01). This community health center sample with moderate-risk illicit drug use reported considerable high-cost healthcare utilization, injury, missed work, and DUI. Interventions are needed that can reliably lower risk of negative outcomes among drug users. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Assessment of drug-induced torsade de pointes risk for hospitalized high-risk patients receiving QT-prolonging agents.

    Science.gov (United States)

    Jardin, Carla G M; Putney, David; Michaud, Stephen

    2014-02-01

    Although risk factors for torsade de pointes (TdP) are known, identifying hospitalized patients at greatest risk for QTcP who should receive cardiac monitoring is poorly defined. Describe the prevalence of risk for TdP in patients and associations between risk factors and QTc prolongation (QTcP) at a tertiary teaching hospital. This retrospective analysis assessed physiological and pharmacological risk factors for TdP of adult patients receiving ≥1 QTc-prolonging medications (QTcMed) during hospitalization. The QTcMeds were stratified by risk for causing TdP (probable, possible, and conditional). Baseline electrocardiograms (ECGs) were assessed for QTcP associated with risk for TdP. During a 6-month period, 12,401 (51%) hospitalizations received ≥1 QTcMed. A baseline ECG was obtained for 2381 (19%) patients. A total of 386 (16%) patients with a baseline ECG were found to have QTcP. Significant associations for QTcP were found with the following physiological risk factors: female (P = .021), left-ventricular ejection fraction <40% (P < .0001), cardiac arrest (P < .0001), and cardioversion (P = .007). Significantly more patients with QTcP (n = 209, 54%) received probable-risk QTcMeds than those without QTcP (n = 542, 27%; P < .0001). Probable-risk QTcMeds administered alone or concomitantly with other QTcMeds were more frequently associated with QTcP. No documented cases of TdP were identified. Of the population receiving QTcMeds, only a small portion had a baseline ECG, identifying a large population at risk of QTcP without appropriate monitoring. Patients with cardiac disease receiving probable-risk QTcMeds were associated with the highest risk of QTcP and should be monitored closely.

  12. The predictive and prognostic value of the Glasgow Prognostic Score in metastatic colorectal carcinoma patients receiving bevacizumab.

    Science.gov (United States)

    Maillet, Marianne; Dréanic, Johann; Dhooge, Marion; Mir, Olivier; Brezault, Catherine; Goldwasser, François; Chaussade, Stanislas; Coriat, Romain

    2014-11-01

    The Glasgow Prognostic Score (GPS), based on C-reactive protein and albumin levels, has shown its prognostic value in metastatic colorectal carcinoma (mCRC) patients receiving conventional cytotoxic therapy. Bevacizumab, a monoclonal antibody to vascular epidermal growth factor, improves the overall survival in mCRC. The aim of the present study was to assess the prognostic value of GPS in mCRC patients receiving antivascular epidermal growth factor therapy. From August 2005 to August 2012, consecutive patients with mCRC who received chemotherapy plus bevacizumab were eligible for the present analysis. The clinical stage, C-reactive protein, albumin and the Eastern Cooperative Oncology Group performance status were recorded at the time of initiation of bevacizumab. Patients received 5-fluorouracil-based chemotherapy plus bevacizumab in accordance with the digestive oncology multidisciplinary staff proposal and in line with the French recommendations for the treatment of mCRC. Eighty patients were eligible (colon n = 59, rectum n = 21), with a median follow-up of 14 months (range 1-58 months). Chemotherapy given with bevacizumab and 5-fluorouracil was oxaliplatin (n = 41, 51%) or irinotecan (n = 27, 34%). At baseline, 56, 31 and 13% of patients had a GPS of 0 (n = 45), 1 (n = 25) and 2 (n = 10), respectively. The median progression-free survival in these groups was 10.1, 6.5 and 5.6 months (P = 0.16), respectively. The median overall survival was 20.1, 11.4 and 6.5 months, respectively (P = 0.004). Our study confirmed the prognostic value of GPS in mCRC patients receiving chemotherapy plus bevacizumab. Given the poor survival observed in patients with an GPS of 2, studies dedicated to these patients could identify optimal treatment modalities.

  13. Utility of high-sensitivity cardiac troponin T in patients receiving anthracycline chemotherapy

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    Blaes AH

    2015-11-01

    Full Text Available Anne H Blaes,1 Aamer Rehman,2 David M Vock,3,4 Xianghua Luo,3,4 Mark Menge,5 Douglas Yee,3 Emil Missov,6 Daniel Duprez6 1Division of Hematology/Oncology/Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, 2Division of Cardiology, University of Louisville, Louisville, KY, 3Masonic Cancer Center, 4Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, 5Park Nicollet Frauenshuh Cancer Center, St Louis Park, 6Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, USA Background: Anthracycline chemotherapy remains an integral part of the care for curative intent chemotherapy in breast cancer and non-Hodgkin lymphoma patients. Better tools need to be identified to predict cardiac complications of anthracycline chemotherapy. Materials and methods: We investigated the utility of high-sensitivity cardiac troponin T (hscTnT, N-terminal pro-B-type natriuretic peptide, cardiac troponin T and I, and creatine kinase (CK-MB in cancer patients receiving anthracycline-based chemotherapy, in order to determine whether baseline levels or changes in these biomarkers may help predict the onset of congestive heart failure. Results: Eighteen consecutive patients with a pathologic diagnosis of breast cancer or non-Hodgkin lymphoma were enrolled. The median dose of doxorubicin exposure was 240 mg/m2 (range 240–400 mg/m2. After treatment with doxorubicin, the hscTnT increased to 19.1 pg/mL (P<0.001. CKMB and N-terminal pro-B-type natriuretic peptide levels increased to 1.1 ng/mL and 88.3 pg/mL, respectively (P=0.02. When subjects who had a decline in left ventricular ejection fraction (LVEF by equilibrium radionuclide ventriculography were compared to those who did not have a change in LVEF, there was a suggestion that those subjects with an elevated baseline hscTnT were more likely to have a decline in LVEF (2.7 pg/mL and 0.1 pg/mL, respectively; P=0.07. Spearman

  14. Use and Outcomes of Antiarrhythmic Therapy in Patients with Atrial Fibrillation Receiving Oral Anticoagulation: Results from the ROCKET AF Trial

    Science.gov (United States)

    Steinberg, Benjamin A.; Hellkamp, Anne S.; Lokhnygina, Yuliya; Halperin, Jonathan L.; Breithardt, Günter; Passman, Rod; Hankey, Graeme J.; Patel, Manesh R.; Becker, Richard C.; Singer, Daniel E.; Hacke, Werner; Berkowitz, Scott D.; Nessel, Christopher C.; Mahaffey, Kenneth W.; Fox, Keith A.A.; Califf, Robert M.; Piccini, Jonathan P.

    2014-01-01

    Background Antiarrhythmic drugs (AAD) and anticoagulation are mainstays of atrial fibrillation (AF) treatment. Objective We aimed to study the use and outcomes of AAD therapy in anticoagulated AF patients. Methods Patients in the ROCKET AF trial (n=14,264) were grouped by AAD use at baseline: amiodarone, other AAD, or no AAD. Multivariable adjustment was performed to compare stroke, bleeding, and death across groups, as well as across treatment assignment (rivaroxaban or warfarin). Results Of 14,264 patients randomized, 1681 (11.8%) were treated with an AAD (1144 [8%] with amiodarone, 537 [3.8%] with other AADs). Amiodarone-treated patients were less-often female (38% vs. 48%), had more persistent AF (64% vs. 40%), and more concomitant heart failure (71% vs. 41%) than patients receiving other AADs. Patients receiving no AAD more closely-resembled amiodarone-treated patients. Time in therapeutic range was significantly lower in warfarin-treated patients receiving amiodarone versus no AAD (50% vs. 58%, p<0.0001). Compared with no AAD, neither amiodarone (adjusted HR 0.98, 95% CI 0.74–1.31, p=0.9) nor other AADs (adjusted HR 0.66, 95% CI 0.37–1.17, p=0.15) were associated with increased mortality. Similar results were observed for embolic and bleeding outcomes. Rivaroxaban treatment effects in patients not on an AAD were consistent with the overall trial (primary endpoint adjusted HR 0.82, 95% CI 0.68–0.98, pinteraction=0.06; safety endpoint adjusted HR 1.12, 95% CI 0.90–1.24, pinteraction=0.33). Conclusion Treatment with AADs was not associated with increased morbidity or mortality in anticoagulated patients with AF. The influence of amiodarone on outcomes in patients receiving rivaroxaban requires further study. PMID:24833235

  15. Infective endocarditis in patients on haemodialysis - possible strategies for prevention.

    Science.gov (United States)

    Oun, Hadi A; Price, Andrew J; Traynor, Jamie P

    2016-05-01

    Infective endocarditis is an important cause of morbidity and mortality in patients receiving haemodialysis for established renal failure. We carried out a prospective audit of patients developing infective endocarditis in a single renal unit. From 1 January 2000 to 31 December 2013, we collected data on all cases of endocarditis occurring in patients receiving haemodialysis at Monklands Hospital, Airdrie. Twenty-nine patients developed endocarditis during our audit period. Twenty-three (79.3%) of the patients had pre-existing cardiac valve abnormalities such as regurgitation or calcification. Staphylococcus aureus was the most common microorganism cultured from the blood of 22 patients (75.9%). MRSA bacteraemia was identified in eight of these patients and all eight patients died during that first presentation. Different strategies were introduced within the unit during the audit period aiming to reduce the rate of bacteraemia. Since 2011, a successful strategy has been introduced under the auspices of the Scottish Patient Safety Programme. This led to our Staph aureus bacteraemia rate related to non-tunnelled venous catheters going from an average of 15 days between episodes to having had no episodes between 2 December 2011 and the end of the study period (760 days). This also appears to have had a positive impact on reducing the rate of endocarditis. Infective endocarditis remains a devastating consequence of bacteraemia in patients receiving haemodialysis. An effective strategy aimed at reducing the rate of bacteraemia appears to have a similar effect on the rate of endocarditis. © The Author(s) 2016.

  16. Increased Chromogranin A Cell Density in the Large Intestine of Patients with Irritable Bowel Syndrome after Receiving Dietary Guidance

    Directory of Open Access Journals (Sweden)

    Tarek Mazzawi

    2015-01-01

    Full Text Available The large intestine contains five types of endocrine cells that regulate its functions by sensing its luminal contents and releasing specific hormones. Chromogranin A (CgA is a common marker for the gastrointestinal endocrine cells, and it is abnormal in irritable bowel syndrome (IBS patients. Most IBS patients relate their symptoms to certain food elements. The present study investigated the effect of dietary guidance on the total endocrine cells of the large intestine as detected by CgA in 13 IBS patients. Thirteen control subjects were also included. Each patient received three sessions of dietary guidance. Colonoscopies were performed on controls and patients (at baseline and at 3–9 months after receiving guidance. Biopsy samples from the colon and rectum were immunostained for CgA and quantified by computerized image analysis. The densities of CgA cells in the total colon (mean ± SEM among the controls and the IBS patients before and after receiving dietary guidance were 83.3±10.1, 38.6±3.7, and 64.7±4.2 cells/mm2, respectively (P=0.0004, and were unchanged in the rectum. In conclusion, the increase in CgA cell density after receiving dietary guidance may reflect a change in the densities of the large intestinal endocrine cells causing an improvement in the IBS symptoms.

  17. A feasibility study of dignity therapy in patients with stage IV colorectal cancer actively receiving second-line chemotherapy.

    Science.gov (United States)

    Vergo, Mazwell T; Nimeiri, Halla; Mulcahy, Mary; Benson, Al; Emmanuel, Linda

    2014-12-01

    Randomized controlled trials support the use of dignity therapy (DT) in palliative care patients late in the course of their disease, but little is known about the feasibility of DT earlier in the course in patients with incurable malignant disease who are still receiving chemotherapy. To assess the feasibility of DT relatively early in the disease trajectory (primary endpoint) and the effect on death acceptance, distress, symptoms, quality of life, peacefulness, and advanced care planning (secondary outcome endpoint). Stage IV colorectal cancer patients who progressed on first-line chemotherapy were enrolled. Patients received DT over 2 visits and had outcome measures assessed pre-DT, immediately post-DT and 1 month post-DT. 15 of 17 patients (88%) who were approached enrolled in the study. Most of the patients who completed DT reported being satisfied and felt it was helpful, that it increased their sense of meaning, that it would be helpful to their family, and that it increased their sense of dignity, their sense of purpose, and their will to live. This is a small study that lacks power for statistical significance of findings. There is no control group for comparison. DT is a highly feasible, satisfying, and meaningful intervention for advanced colorectal cancer patients who are receiving chemotherapy earlier in the course of their and may result in an understanding of disease and goals of care at the end of life. Larger feasibility and exploratory studies are warranted in advanced cancer patients. ©2014 Frontline Medical Communications.

  18. The effect of structured education to patients receiving oral agents for cancer treatment on medication adherence and self-efficacy

    Directory of Open Access Journals (Sweden)

    Gamze Tokdemir

    2017-01-01

    Full Text Available Objective: This study was conducted to examine the effect of structured education on medication adherence and self-efficacy through the use of the MASCC Oral Agent Teaching Tool (MOATT for patients receiving oral agents for cancer treatment. Methods: This quasi-experimental study has been conducted at two hospitals; 41 patients were included in the study. Data were obtained using a questionnaire, medication adherence self-efficacy scale (MASES, memorial symptom assessment scale, and a follow-up form (diary. Patients were educated through the use of the MOATT at a scheduled time; drug-specific information was provided along with a treatment scheme and follow-up diary. Phone interviews were completed 1 and 2 weeks after the educational session. At the next treatment cycle, the patients completed the same questionnaires. Results: Majority of the patients were receiving capecitabine (90.2%; n = 37 as an oral agent for breast (51.2%; n = 21 and stomach cancer (24.6%; n = 10 treatment. About 90.2% of patients (n = 37 stated that they did not forget to take their medication and experienced medication-related side effects (78%; n = 32. The total score of MASES was increased after the education (66.39 vs. 71.04, P < 0.05. Conclusions: It was shown that individual education with the MOATT and follow-up for patients receiving oral agents for cancer treatment increased patient medication adherence self-efficacy.

  19. High-quality chronic care delivery improves experiences of chronically ill patients receiving care

    NARCIS (Netherlands)

    J.M. Cramm (Jane); A.P. Nieboer (Anna)

    2013-01-01

    markdownabstract__Abstract__ Objective. Investigate whether high-quality chronic care delivery improved the experiences of patients. Design. This study had a longitudinal design. Setting and Participants. We surveyed professionals and patients in 17 disease management programs targeting patients wi

  20. Optimization of antiaggregant therapy in rheumatoid arthritis and coronary heart disease patients receiving nonsteroidal anti-inflammatory drugs

    Directory of Open Access Journals (Sweden)

    Tatyana Vladimirovna Kropotina

    2012-01-01

    Full Text Available Objective: to study coagulative and vascular-thrombocytic hemostases in patients with rheumatoid arthritis (RA and coronary heart disease (CHD depending on therapy with different nonsteroidal anti-inflammatory drugs (NSAIDs alone and in combination with low-dose aspirin. Subjects and methods. The trial enrolled 58 patients (43 women and 15 men with a valid diagnosis of RA. The patients' mean age was 61.2 years; the disease duration averaged 10 years. All the patients received therapy with disease-modifying antirheumatic drugs (DMARDs and NSAIDs. All had CHD; 52 of the 58 patients presented with arterial hypertension; 30 had noncoronary atherosclerosis. Cardiovascular diseases were first identified in 18 patients. All took heart medications. Coagulative and vascular-thrombocytic hemostases were studied in all the patients and the results were compared depending on to the taken NSAID (diclofenac, tenoxicam, nimesulide, meloxicam. Thirty-seven patients who had not previously received antiaggregant therapy were given aspirin in a dose of 100 mg when they were found to have platelet hyperaggregation and aggregation was restudied on aspirin therapy days 7-8. A control group consisted of 26 healthy men (mean age 55 years who received no medications. Results. In patients with RA and CHD, activated coagulative hemostasis was identified in 65.5% of cases. The signs of hypercoagulation were observed in 35 of the 58 patients. When different NSAIDs were used, the coagulative hemostatic changes were unidirectional and no statistically significant differences were found between the groups. The patients taking diclofenac, nimesulide, or meloxicam were found to have activated vascular-thrombocytic hemostasis. Those receiving tenoxicam showed a tendency towards decreased adrenaline-induced platelet aggregation (the drug's aspirin-like effect; however, no statistical processing was made because of few cases. The use of aspirin in the patients taking diclofenac

  1. Effectiveness of Cognitive Behavioral Therapy for Depression in Patients Receiving Disability Benefits: A Systematic Review and Individual Patient Data Meta-Analysis

    NARCIS (Netherlands)

    S. Ebrahim (Shanil); L. Montoya (Luis); W. Truong (Wanda); S. Hsu (Sandy); M. Kamal el Din (Mostafa); A. Carrasco-Labra (Alonso); J.W. Busse (Jason); S.D. Walter (Stephen); D. Heels-Ansdell (Diane); R. Couban (Rachel); I. Patelis-Siotis (Irene); M. Bellman (Marg); L.E. de Graaf (Esther); D.J.A. Dozois (David); P.J. Bieling (Peter); G.H. Guyatt (Gordon)

    2012-01-01

    textabstractObjectives: To systematically summarize the randomized trial evidence regarding the relative effectiveness of cognitive behavioural therapy (CBT) in patients with depression in receipt of disability benefits in comparison to those not receiving disability benefits. Data Sources: All rele

  2. A Randomized Controlled Trial of Lorazepam to Reduce Liver Motion in Patients Receiving Upper Abdominal Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Tsang, Derek S.; Voncken, Francine E.M.; Tse, Regina V. [Princess Margaret Cancer Centre, University Health Network, Department of Radiation Oncology, University of Toronto, Toronto (Canada); Sykes, Jenna [Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto (Canada); Wong, Rebecca K.S.; Dinniwell, Rob E.; Kim, John; Ringash, Jolie; Brierley, James D.; Cummings, Bernard J.; Brade, Anthony [Princess Margaret Cancer Centre, University Health Network, Department of Radiation Oncology, University of Toronto, Toronto (Canada); Dawson, Laura A., E-mail: laura.dawson@rmp.uhn.on.ca [Princess Margaret Cancer Centre, University Health Network, Department of Radiation Oncology, University of Toronto, Toronto (Canada)

    2013-12-01

    Purpose: Reduction of respiratory motion is desirable to reduce the volume of normal tissues irradiated, to improve concordance of planned and delivered doses, and to improve image guided radiation therapy (IGRT). We hypothesized that pretreatment lorazepam would lead to a measurable reduction of liver motion. Methods and Materials: Thirty-three patients receiving upper abdominal IGRT were recruited to a double-blinded randomized controlled crossover trial. Patients were randomized to 1 of 2 study arms: arm 1 received lorazepam 2 mg by mouth on day 1, followed by placebo 4 to 8 days later; arm 2 received placebo on day 1, followed by lorazepam 4 to 8 days later. After tablet ingestion and daily radiation therapy, amplitude of liver motion was measured on both study days. The primary outcomes were reduction in craniocaudal (CC) liver motion using 4-dimensional kV cone beam computed tomography (CBCT) and the proportion of patients with liver motion ≤5 mm. Secondary endpoints included motion measured with cine magnetic resonance imaging and kV fluoroscopy. Results: Mean relative and absolute reduction in CC amplitude with lorazepam was 21% and 2.5 mm respectively (95% confidence interval [CI] 1.1-3.9, P=.001), as assessed with CBCT. Reduction in CC amplitude to ≤5 mm residual liver motion was seen in 13% (95% CI 1%-25%) of patients receiving lorazepam (vs 10% receiving placebo, P=NS); 65% (95% CI 48%-81%) had reduction in residual CC liver motion to ≤10 mm (vs 52% with placebo, P=NS). Patients with large respiratory movement and patients who took lorazepam ≥60 minutes before imaging had greater reductions in liver CC motion. Mean reductions in liver CC amplitude on magnetic resonance imaging and fluoroscopy were nonsignificant. Conclusions: Lorazepam reduces liver motion in the CC direction; however, average magnitude of reduction is small, and most patients have residual motion >5 mm.

  3. Multicenter Retrospective Study of the Risk Factors of Hemorrhage After Tooth Extraction in Patients Receiving Antiplatelet Therapy.

    Science.gov (United States)

    Yanamoto, Souichi; Hasegawa, Takumi; Rokutanda, Satoshi; Komori, Sayaka; Tachibana, Akira; Kojima, Yuka; Koyama, Yoshito; Shibuya, Yasuyuki; Kurita, Hiroshi; Komori, Takahide; Umeda, Masahiro

    2017-07-01

    To identify the risk factors affecting hemorrhage after tooth extraction in patients receiving antiplatelet therapy, this study investigated the relation between various factors and hemorrhage events after tooth extraction. The records of 264 patients receiving antiplatelet therapy who underwent tooth extraction were retrospectively reviewed from 6 institutions belonging to the Japanese Study Group of Cooperative Dentistry with Medicine. Demographic information, hemorrhage events after tooth extraction, the presence or absence of comorbidities, antiplatelet agent, the use of preoperative antibiotics or nonsteroidal anti-inflammatory drugs, number of teeth extracted, serum creatinine level, estimated glomerular filtration rate, and alanine transaminase level were assessed. Risk factors for hemorrhage after tooth extraction were evaluated by univariate and multivariate analyses. The study population of 264 patients consisted of 153 men and 111 women with a mean age of 73.6 years (range, 24 to 96 yr). Six hundred ninety-four teeth were extracted (mean, 2.6 ± 2.3 teeth per patient). In patients receiving antiplatelet therapy, the frequency of hemorrhage after tooth extraction, including mild and self-controlled hemorrhages, was 17.4%. Univariate analysis showed that serum creatinine level and dual antiplatelet therapy were correlated with hemorrhage after tooth extraction (P = .001 and P = .049, respectively). Only serum creatinine was identified as an independent risk factor for hemorrhage after tooth extraction in patients receiving antiplatelet therapy (P = .037). The risk of hemorrhage after tooth extraction is increased in patients receiving dual antiplatelet therapy with or without chronic kidney disease. Local hemostatic treatments, such as at least suturing, are recommended. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  4. Effectiveness of pharmacist dosing adjustment for critically ill patients receiving continuous renal replacement therapy: a comparative study

    Directory of Open Access Journals (Sweden)

    Jiang SP

    2014-06-01

    Full Text Available Sai-Ping Jiang,1 Zheng-Yi Zhu,2 Xiao-Liang Wu,3 Xiao-Yang Lu,1 Xing-Guo Zhang,1 Bao-Hua Wu1 1Department of Pharmacy, the First Affiliated Hospital, 2Department of Pharmacy, Children’s Hospital, College of Medicine, Zhejiang University, Hangzhou, 3Intensive Care Unit, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China Background: The impact of continuous renal replacement therapy (CRRT on drug removal is complicated; pharmacist dosing adjustment for these patients may be advantageous. This study aims to describe the development and implementation of pharmacist dosing adjustment for critically ill patients receiving CRRT and to examine the effectiveness of pharmacist interventions. Methods: A comparative study was conducted in an intensive care unit (ICU of a university-affiliated hospital. Patients receiving CRRT in the intervention group received specialized pharmacy dosing service from pharmacists, whereas patients in the no-intervention group received routine medical care without pharmacist involvement. The two phases were compared to evaluate the outcome of pharmacist dosing adjustment. Results: The pharmacist carried out 233 dosing adjustment recommendations for patients receiving CRRT, and 212 (90.98% of the recommendations were well accepted by the physicians. Changes in CRRT-related variables (n=144, 61.81% were the most common risk factors for dosing errors, whereas antibiotics (n=168, 72.10% were the medications most commonly associated with dosing errors. Pharmacist dosing adjustment resulted in a US$2,345.98 ICU cost savings per critically ill patient receiving CRRT. Suspected adverse drug events in the intervention group were significantly lower than those in the preintervention group (35 in 27 patients versus [vs] 18 in eleven patients, P<0.001. However, there was no significant difference between length of ICU stay and mortality after pharmacist dosing adjustment, which

  5. Epstein-Barr virus DNA loads in adult human immunodeficiency virus type 1-infected patients receiving highly active antiretroviral therapy

    Science.gov (United States)

    Ling, Paul D.; Vilchez, Regis A.; Keitel, Wendy A.; Poston, David G.; Peng, Rong Sheng; White, Zoe S.; Visnegarwala, Fehmida; Lewis, Dorothy E.; Butel, Janet S.

    2003-01-01

    Patients with human immunodeficiency virus type 1 (HIV-1) infection are at high risk of developing Epstein-Barr virus (EBV)-associated lymphoma. However, little is known of the EBV DNA loads in patients receiving highly active antiretroviral therapy (HAART). Using a real-time quantitative polymerase chain reaction assay, we demonstrated that significantly more HIV-1-infected patients receiving HAART than HIV-1-uninfected volunteers had detectable EBV DNA in blood (57 [81%] of 70 vs. 11 [16%] of 68 patients; P=.001) and saliva (55 [79%] of 68 vs. 37 [54%] of 68 patients; P=.002). The mean EBV loads in blood and saliva samples were also higher in HIV-1-infected patients than in HIV-1-uninfected volunteers (P=.001). The frequency of EBV detection in blood was associated with lower CD4+ cell counts (P=.03) among HIV-1-infected individuals, although no differences were observed in the EBV DNA loads in blood or saliva samples in the HIV-1-infected group. Additional studies are needed to determine whether EBV-specific CD4+ and CD8+ cells play a role in the pathogenesis of EBV in HIV-1-infected patients receiving HAART.

  6. Acute diarrhea in HIV infected patient receiving antiretroviral therapy:is there any role of microscopic stool examination at present?

    Institute of Scientific and Technical Information of China (English)

    Beuy Joob; Viroj Wiwanitkit

    2014-01-01

    Objective:To reassess the usefulness of microscopic stool examination for theHIV infected patients with acute diarrhea.Methods:Overall100HIV-infected patients receiving standard antiretroviral therapy who visited to a primary care center(for privacy reason, the name is hereby blinded) with compliant of acute diarrhea were reviewed.In all patients, the standard microscopic stool examination was performed.Results:Of interest, from overall100 indexed cases, there is no case with determined parasite in stool samples.Conclusions:Based on our setting, it seems that there is diagnostic role of using microscopic stool examination for determining possible parasitic infestation inHIV infected patients receiving standard antiretroviral therapy who present with acute diarrhea.

  7. Fluconazole dosing predictions in critically-ill patients receiving prolonged intermittent renal replacement therapy: a Monte Carlo simulation approach.

    Science.gov (United States)

    Gharibian, Katherine N; Mueller, Bruce A

    2016-07-01

    Fluconazole is a renally-eliminated antifungal commonly used to treat Candida species infections. In critically-ill patients receiving prolonged intermittent renal replacement therapy (PIRRT), limited pharmacokinetic (PK) data are available to guide fluconazole dosing. We used previously-published fluconazole clearance data and PK data of critically-ill patients with acute kidney injury to develop a PK model with the goal of determining a therapeutic dosing regimen for critically-ill patients receiving PIRRT. Monte Carlo simulations were performed to create a virtual cohort of patients receiving different fluconazole dosing regimens. Plasma drug concentration-time profiles were evaluated on the probability of attaining a mean 24-hour area under the drug concentration-time curve to minimum inhibitory concentration ratio (AUC24h : MIC) of 100 during the initial 48 hours of antifungal therapy. At the susceptibility breakpoint of Candida albicans (2 mg/L), 93 - 96% of simulated subjects receiving PIRRT attained the pharmacodynamic target with a fluconazole 800-mg loading dose plus 400 mg twice daily (q12h or pre and post PIRRT) regimen. Monte Carlo simulations of a PK model of PIRRT provided a basis for the development of an informed fluconazole dosing recommendation when PK data was limited. This finding should be validated in the clinical setting.

  8. A clinically prognostic scoring system for patients receiving highly active antiretroviral therapy: results from the EuroSIDA study

    DEFF Research Database (Denmark)

    Lundgren, Jens Dilling; Mocroft, Amanda; Gatell, Jose M

    2002-01-01

    The risk of clinical progression for human immunodeficiency virus (HIV)-infected persons receiving treatment with highly active antiretroviral therapy (HAART) is poorly defined. From an inception cohort of 8457 HIV-infected persons, 2027 patients who started HAART during prospective follow-up wer...

  9. Incidence of tuberculosis among HIV-infected patients receiving highly active antiretroviral therapy in Europe and North America

    NARCIS (Netherlands)

    Costagliola, D; Dabis, F; Monforte, AD; de Wolf, F; Egger, M; Fatkenheuer, G; Gill, J; Hogg, R; Justice, A; Ledergerber, B; Lundgren, J; May, M; Phillips, A; Reiss, P; Sabin, C; Staszewski, S; Sterne, J; Weller, H.H.; May, M; Beckthold, B; Yip, B; Dauer, B; Fusco, J; Grabar, S; Lanoy, E; Junghans, C; Lavignolle, V.; van Leth, F; Pereira, E; Pezzotti, P; Phillips, A; Sabin, C; Schmeisser, N; Billaud, E; Boue, F; Duval, J.; Duvivier, C; Enel, P; Fournier, S; Gasnault, J; Gaud, C; Gilquin, J; Grabar, S; Khuong, MA; Lang, JM; Mary-Krause, M; Matheron, S; Meyohas, MC; Pialoux, G; Poizot-Martin, I.; Pradier, C; Rouveix, E; Salmon-Ceron, D; Sobel, A; Tattevin, P; Tissot-Dupont, H; Yasdanpanah, Y; Aronica, E; Tirard-Fleury, V.; Tortay, I.; Abgrall, S; Guiguet, M; Leneman, H; Lievre, L; Potard, V.; Saidi, S; Matheron, S; Vilde, JL; Leport, C; Yeni, P; Bouvet, E; Gaudebout, C; Crickx, B; Picard-Dahan, C; Weiss, L; Tisne-Dessus, D; Sicard, D; Salmon, D; Auperin, A; Viard, JP; Roudiere, L; Delfraissy, JF; Goujard, C; Lesprit, P; Jung, C; Meyohas, MC; Meynard, JL; Picard, O; Desplanque, N; Cadranel, J; Mayaud, C; Rozenbaum, W; Bricaire, F; Katlama, C; Herson, S; Simon, A; Decazes, JM; Molina, JM; Clauvel, JP; Gerard, L; Widal, GHLF; Sellier, P; Diemer, M; Dupont, C; Berthe, H; Saiag, P; Mortier, L; Mortier, E; Chandemerle, C; de Truchis, P; Bentata, M; Honore, P; Tassi, S; Jeantils, V.; Mechali, D; Taverne, B; Laurichesse, H; Gourdon, F; Lucht, F; Fresard, A; Faller, JP; Eglinger, P; Bazin, C; Verdon, R; Peyramond, D; Boibieux, A; Touraine, JL; Livrozet, JM; Trepo, C; Cotte, L; Ravaux, I.; Delmont, JP; Moreau, J; Gastaut, JA; Soubeyrand, J; Retornaz, F; Blanc, PA; Allegre, T; Galinier, A; Ruiz, JM; Lepeu, G; Granet-Brunello, P; Pelissier, L; Esterni, JP; Nezri, M; Cohen-Valensi, R; Laffeuillade, A; Chadapaud, S; Reynes, J; May, T; Rabaud, C; Raffi, F; Pugliese, P; Michelet, C; Arvieux, C; Caron, F; Borsa-Lebas, F; Lang, JM; Fraisse, P; Massip, P; Cuzin, L; Arlet-Suau, E; Legrand, MFT; Yasdanpanah, Y; Sobesky, M; Pradinaud, R; Guyon, F; Contant, M; Montroni, M; Scalise, G; Braschi, MC; Aviano, AR; Tirelli, U; Cinelli, R; Pastore, G; Ladisa, N; Minafra, G; Suter, F; Arici, C; Chiodo, F; Colangeli, V.; Fiorini, C; Coronado, O; Carosi, G; Cadeo, GP; Torti, C; Minardi, C; Bertelli, D; Rizzardini, G; Melzi, S; Manconi, PE; Catanzaro, PP; Cosco, L; Scerbo, A; Vecchiet, J; D'Alessandro, M; Santoro, D; Pusterla, L; Carnevale, G; Citterio, P; Vigano, P; Mena, M; Ghinelli, F; Sighinolfi, L; Leoncini, F; Mazzotta, F; Pozzi, M; Lo Caputo, S; Angarano, G; Grisorio, B; Saracino, A; Ferrara, S; Grima, P; Tundo, P; Pagano, G; Cassola, G; Alessandrini, A; Piscopo, R; Toti, M; Chigiotti, S; Soscia, F; Tacconi, L; Orani, A; Perini, P; Scasso, A; Vincenti, A; Chiodera, F; Castelli, P; Scalzini, A; Palvarini, L; Moroni, M; Lazzarin, A; Cargnel, A; Vigevani, GM; Caggese, L; Monforte, AD; Repetto, D; Galli, A; Merli, S; Pastecchia, C; Moioli, MC; Esposito, R; Mussini, C; Abrescia, N; Chirianni, A; Izzo, CM; Piazza, M; De Marco, M; Viglietti, R; Manzillo, E; Nappa, S; Colomba, A; Abbadessa, V.; Prestileo, T; Mancuso, S; Ferrari, C; Pizzaferri, P; Filice, G; Minoli, L; Bruno, R; Novati, S; Baldelli, F; Tinca, M; Petrelli, E; Cioppi, A; Alberici, F; Ruggieri, A; Menichetti, F; Martinelli, C; De Stefano, C; La Gala, A; Ballardini, G; Rizzo, E; Magnani, G; Ursitti, MA; Arlotti, M; Ortolani, P; Cauda, R; Dianzani, F; Ippolito, G; Antinori, A; Antonucci, G; D'Elia, S; Narciso, P; Petrosillo, N; Vullo, V.; De Luca, A; Bacarelli, A; Zaccarelli, M; Acinapura, R; De Longis, P; Brandi, A; Trotta, MP; Noto, P; Lichtner, M; Capobianchi, MR; Carletti, F; Girardi, E; Pezzotti, P; Rezza, G; Mura, MS; Mannazzu, M; Caramello, P; Di Perri, G; Soranzo, ML; Orofino, GC; Arnaudo, I.; Bonasso, M; Grossi, PA; Basilico, C; Poggio, A; Bottari, G; Raise, E; Ebo, F; De Lalla, F; Tositti, G; Resta, F; Loso, K; Lepri, AC; Battegay, M; Bernasconi, E; Boni, J; Bucher, H; Burgisser, P; Cattacin, S; Cavassini, M; Dubs, R; Egger, M; Elzi, L; Erb, P; Fantelli, K; Fischer, M; Flepp, M; Fontana, A; Francioli, P; Furrer, H; Gorgievski, M; Hirschel, B; Kaiser, L; Kind, C; Klimkait, T; Lauper, U; Ledergerber, B; Opravil, M; Paccaud, F; Pantaleo, G; Perrin, L; Piffaretti, JC; Rickenbach, M; Rudin, C; Schmid, P; Schupbach, J; Speck, R; Telenti, A; Trkola, A; Vernazza, P; Weber, R; Yerly, S; Bronsveld, W; Hillebrand-Haverkort, ME; Prins, JM; Bos, JC; Schattenkerk, JKME; Geerlings, SE; Godfried, MH; Lange, JMA; van Leth, FC; Lowe, SH; van der Meer, JTM; Nellen, FJB; Pogany, K; van der Poll, T; Reiss, P; Ruys, TA; Sankatsing, S; Steingrover, R; van Twillert, G; van der Valk, M; van Vonderen, MGA; Vrouenraets, SME; van Vugt, M; Wit, FWMN; Kuijpers, TW; Pajkrt, D; Scherpbier, HJ; van Eeden, A; ten Veen, JH; van Dam, PS; Roos, JC; Brinkman, K; Frissen, PHJ; Weigel, HM; Mulder, JW; van Gorp, ECM; Meenhorst, PL; Mairuhu, ATA; Ziekenhuis, S; Veenstra, J; Danner, SA; van Agtmael, MA; Claessen, FAP; Perenboom, RM; Rijkeboer, A; van Vonderen, M; Richter, C; van der Berg, J; van Leusen, R; Vriesendorp, R; Jeurissen, FJF; Kauffmann, RH; Koger, ELW; Bravenboer, B; ten Napel, CHH; Kootstra, GJ; Sprenger, HG; Miesen, WMAJ; Doedens, Rienus; Scholvinck, EH; ten Kate, RW; van Houte, DPF; Polee, M; Kroon, FP; Broek, van den; van Dissel, JT; Schippers, EF; Schreij, G; de Geest, SV; Verbon, A; Koopmans, PP; Keuter, M; Post, F; van der Ven, AJAM; van der Ende, Marchina E.; Gyssens, IC; van der Feltz, M; den Hollander, JG; de Marie, S; Nouwen, JL; Rijnders, BJA; de Vries, TEMS; Driessen, G; de Groot, R; Hartwig, N; Juttmann, J.; van de Heul, C; van Kasteren, MEE; Schneider, MME; Bonten, MJM; Borleffs, JCC; Ellerbroek, PM; Hoepelman, IM; Jaspers, CAJJ; Schouten, M.C.; Schurink, CAM; Geelen, SPM; Wolfs, TFW; Blok, WL; Tanis, AA; Groeneveld, PHP; Back, NKT; Bakker, MEG; Berkhout, B; Jurriaans, S; Cuijpers, T; Rietra, PJGM; Roozendaal, KJ; Pauw, W; van Zanten, AP; von Blomberg, BME; Savelkoul, P; Swanink, CMA; Franck, PFH; Lampe, AS; Hendriks, R; Schirm, J; Veenendaal, D; Storm, H; Weel, J; van Zeijl, H; Kroes, ACM; Claas, HCJ; Bruggeman, CAMVA; Goossens, VJ; Galama, JMD; Melchers, WJG; Poort, YAG; Doornum, GJJ; Niesters, MG; Osterhaus, ADME; Schutten, M; Buiting, AGM; Swaans, CAM; Boucher, CAB; Boel, E; Jansz, AF; Losso, M; Duran, A; Vetter, N; Karpov, A.; Vassilenko, A; Clumeck, N; De Wit, S; Poll, B; Colebunders, R; Machala, L; Rozsypal, H; Sedlacek, D; Nielsen, J; Lundgren, J; Benfield, T; Kirk, O; Gerstoft, J; Katzenstein, T; Hansen, ABE; Skinhoj, P; Pedersen, C; Zilmer, K; Katlama, C; Girard, PM; Viard, JP; Saint-Marc, T; Vanhems, P; Pradier, C; Dietrich, M; Manegold, C; van Lunzen, J; Stellbrink, HJ; Staszewski, S; Bickel, M; Goebel, FD; Fatkenheuer, G; Rockstroh, J; Schmidt, R; Kosmidis, J; Gargalianos, P; Sambatakou, H; Perdios, J; Panos, G; Filandras, A; Karabatsaki, E; Banhegyi, D; Mulcahy, F; Yust, I.; Turner, D; Burke, M; Pollack, S; Hassoun, G; Sthoeger, Z; Maayan, S; Chiesi, A; Esposito, R; Borghi, R; Arici, C; Pristera, R; Mazzotta, F; Gabbuti, A; Lichtner, M; Chirianni, A; Montesarchio, E; Iacomi, F; Lazzarin, A; Finazzi, R; Viksna, L; Chaplinskas, S; Hemmer, R; Staub, T; Reiss, P; Bruun, J; Maeland, A; Ormaasen, V.; Knysz, B; Gasiorowski, J; Horban, A; Prokopowicz, D; Wiercinska-Drapalo, A; Boron-Kaczmarska, A; Pynka, M; Beniowski, M; Mularska, E; Trocha, H; Antunes, F; Valadas, E; Mansinho, K; Matez, F; Duiculescu, D; Babes, V.; Streinu-Cercel, A; Vinogradova, E; Rakhmanova, A; Jevtovic, D; Mokras, M; Stanekova, D; Gonzalez-Lahoz, J; Sanchez-Conde, M; Garcia-Benayas, T; Martin-Carbonero, L; Soriano, Joan B.; Clotet, B; Jou, A; Conejero, J; Tural, C; Gatell, JM; Miro, JM; Blaxhult, A; Karlsson, A; Pehrson, P; Ledergerber, B; Weber, R; Francioli, P; Telenti, A; Hirschel, B; Soravia-Dunand, V.; Furrer, H; Kravchenko, E; Chentsova, N; Barton, S; Johnson, AM; Mercey, D; Phillips, A; Johnson, MA; Mocroft, A; Murphy, M; Weber, J; Scullard, G; Fisher, M; Brettle, R; Loveday, C; Clotet, B; Antunes, F; Blaxhult, A; Clumeck, N; Gatell, J; Horban, A; Johnson, A; Katlama, C; Ledergerber, B; Loveday, C; Phillips, A; Reiss, P; Vella, S; Gjorup, N; Kirk, O; Friis-Moeller, N; Mocroft, A; Cozzi-Lepri, A; Bannister, W; Mollerup, D; Podlevkareva, D; Olsen, CH; Kjaer, J; Raffanti, S; Dieterch, D; Justice, A; Becker, S; Scarsella, A; Fusco, G; Most, B; Balu, R; Rana, R; Beckerman, R; Ising, T; Fusco, J; Irek, R; Johnson, B; Hirani, A; DeJesus, E; Pierone, G; Lackey, P; Irek, C; Johnson, A; Burdick, J; Leon, S; Arch, J; Staszewski, S; Helm, EB; Carlebach, A; Muller, A; Haberl, A; Nisius, G; Lennemann, T; Rottmann, C; Muller, A; Haberl, A; Nisius, G; Lennemann, T; Rottmann, C; Wolf, T; Stephan, C; Bickel, M; Mosch, M; Gute, P; Locher, L; Lutz, T; Klauke, S; Knecht, G; Doerr, HW; Sturmer, M; Dauer, B; von Hentig, N; Jennings, B; Beylot, J; Chene, G; Dabis, F; Dupon, M; Longy-Boursier, M; Pellegrin, JL; Ragnaud, JM; Salamon, R; Dabis, F; Chene, G; Thiebaut, R; Lewden, C; Lawson-Ayayi, S; Dupon, M; Mercie, P; Moreau, JF; Moriat, P; Pellegrin, JL; Ragnaud, JM; Bernard, N; Lacoste, D; Malvy, D; Neau, D; Blaizeau, MJ; Decoin, M; Delveaux, S; Hannapier, C; Labarrere, S; Lavignolle-Aurillac, V.; Uwamaliya-Nziyumvira, B; Palmer, G; Touchard, D; Balestre, E; Alioum, A; Jacqmin-Gadda, H; Thiebaut, R; Beylot, J; Morlat, P; Bernard, N; Bonarek, M; Bonnet, F; Coadou, B; Gellie, P; Lacoste, D; Nouts, C; Dupon, M; Bocquentin, F; Dutronc, H; Lafarie, S; Longy-Boursier, M; Mercie, P; Aslan, A; Malvy, D; Pistonne, T; Thibaut, P; Vatan, R; Ragnaud, JM; Chambon, D; De La Taille, C; Cazorla, C; Neau, D; Ocho, A; Pellegrin, JL; Castera, L; Fleury, H; Lafon, ME; Masquelier, B; Pellegrin, E.; Breilh, D; Moreau, JF; Blanco, P; Loste, P; Caunegre, L; Bonnal, F; Farbos, S; Ferrand, M; Ceccaldi, J; Tchamgoue, S; De Witte, S; Buy, E; Alexander, C; Barrios, R; Braitstein, P; Brumme, Z; Chan, K; Cote, H; Gataric, N; Geller, J; Guillemi, S; Harrigan, K.; Harris, M; Hogg, R; Joy, R; Levy, A; Montaner, J; Montessori, V.; Palepu, A; Phillips, E; Phillips, P; Press, N; Tyndall, M; Wood, E; Yip, B; Ballinger, J; Bhagani, S; Breen, R; Byrne, P; Carroll, A; Cropley, Mark; Cuthbertson, Z; Drinkwater, T; Fernandez, T; Geretti, AM; Murphy, G; Ivens, D; Johnson, M; Kinloch-de Loes, S; Lipman, M; Madge, S; Prinz, B; Bell, DR; Shah, S; Swaden, L; Tyrer, M; Youle, M; Chaloner, C; Gumley, H; Holloway, J; Puradiredja, D; Sweeney, J; Tsintas, R; Bannister, W; Bansi, L; Cozzi-Lepri, A; Fox, Z; Lampe, F; Mocroft, A; Phillips, A; Sabin, C; Smith, C; Amoah, E; Clewley, G; Dann, L; Gregory, B; Jani, I.; Janossy, G; Kahan, M; Loveday, C; Thomas, M; Gill, MJ; Read, R; Fatkenheuer, G; Rockstroh, J; Schmeisser, V.; Voigt, K; Wasmuth, JC; Wohrmann, A

    2005-01-01

    Background. We obtained estimates of the incidence of tuberculosis (TB) among patients receiving HAART and identified determinants of the incidence. Methods. We analyzed the incidence of TB during the first 3 years after initiation of HAART among 17,142 treatment-naive, AIDS- free persons starting H

  10. Prediabetic increase in hemoglobin A1c compared with impaired fasting glucose in patients receiving antipsychotic drugs

    NARCIS (Netherlands)

    Manu, Peter; Correll, Christoph U.; Wampers, Martien; van Winkel, Ruud; Yu, Weiping; Mitchell, Alex J.; De Hert, Marc

    2013-01-01

    Background: In 2010, the American Diabetes Association recommended that individuals with hemoglobin A1c 5.7-6.4% be classified as prediabetic even in the absence of impaired fasting glucose (IFG). Aim of study: To compare the clinical and metabolic characteristics of patients receiving antipsychotic

  11. Antioxidant activity of ginger extract as a daily supplement in cancer patients receiving adjuvant chemotherapy: a pilot study

    Science.gov (United States)

    Danwilai, Kwanjit; Konmun, Jitprapa; Sripanidkulchai, Bung-orn; Subongkot, Suphat

    2017-01-01

    Purpose The aim of this study was to examine the antioxidant activity of ginger extract oral supplement in newly diagnosed cancer patients receiving adjuvant chemotherapy compared to placebo. Patients and methods Newly diagnosed cancer patients receiving moderate-to-high emetogenic potential adjuvant chemotherapy were randomized to receive either a ginger extract (standardized 6-gingerol 20 mg/day) or a placebo 3 days prior to chemotherapy, which they continued daily. Oxidant/antioxidant parameters, including the activities of superoxide dismutase (SOD) and catalase (CAT) and levels of glutathione peroxidase (GPx), total glutathione (GSH/GSSG), lipid peroxidation products detected as malondialdehyde (MDA) and NO2−/NO3−, were measured at baseline and at days 1, 22, 43 and 64 after undergoing chemotherapy. Two-sided statistical analysis, with P ginger group and placebo group, respectively. Antioxidant activity parameters, including SOD, CAT, GPx and GSH/GSSG, were significantly increased at day 64 in the ginger group compared to those in the placebo group, while MDA and NO2−/NO3− levels were significantly decreased (P ginger extract started 3 days prior to chemotherapy has been shown to significantly elevate antioxidant activity and reduce oxidative marker levels in patients who received moderate-to-high emetogenic potential chemotherapy compared to placebo. PMID:28203106

  12. A clinically prognostic scoring system for patients receiving highly active antiretroviral therapy: results from the EuroSIDA study

    DEFF Research Database (Denmark)

    Lundgren, Jens Dilling; Mocroft, Amanda; Gatell, Jose M;

    2002-01-01

    The risk of clinical progression for human immunodeficiency virus (HIV)-infected persons receiving treatment with highly active antiretroviral therapy (HAART) is poorly defined. From an inception cohort of 8457 HIV-infected persons, 2027 patients who started HAART during prospective follow-up wer...

  13. Comparison of Adsorbed Skin Dose Received by Patients in Cone Beam Computed Tomography, Spiral and Conventional Computed Tomography Scanninng

    Directory of Open Access Journals (Sweden)

    Rahimi A

    2011-12-01

    Full Text Available Background and Aims: The evaluation of absorbed dose received by patients could give useful information for radiation risk estimation. This study was performed to compare the entrance skin dose received by patients in cone beam computed tomography (CBCT, conventional and spiral computed tomography (CT.Materials and Methods: In this experimental study, 81 calibrated TLD chips were used. the TLD chips were placed on facial, thyroid and end of sternum skin surface in patients referred for CT of the paranasal sinuses(3 TLD chips for each area to estimate the absorbed dose received by central part of radiation field, thyroid and out of field areas, respectively. The data were analyzed using one-way ANOVA and Tukey tests. Results: The dose delivered to the center of irradiated field was about 0.79±0.09 mGy in CBCT technique compared with 16.31±3.71 and 18.84±4.12 mGy for spiral and conventional CT, respectively. The received dose by the out of field areas was about 54 percent of central area dose. There was statistical significant relationship between the imaging modalities and absorbed dose received by patients (P=0.016. The least absorbed dose was for CBCT and the greatest dose was for conventional CT imaging technique.Conclusion: The dose delivered to central area of irradiated field in conventional and spiral CT imaging modalities was about 24 times greater than of that in CBCT. Also, the highest received dose was for central area of radiated field and the lowest dose was for the out of field areas.

  14. The study of external dose rate and retained body activity of patients receiving 131I therapy for differentiated thyroid carcinoma.

    Science.gov (United States)

    Zhang, Haiying; Jiao, Ling; Cui, Songye; Wang, Liang; Tan, Jian; Zhang, Guizhi; He, Yajing; Ruan, Shuzhou; Fan, Saijun; Zhang, Wenyi

    2014-10-21

    Radiation safety is an integral part of targeted radionuclide therapy. The aim of this work was to study the external dose rate and retained body activity as functions of time in differentiated thyroid carcinoma patients receiving 131I therapy. Seventy patients were stratified into two groups: the ablation group (A) and the follow-up group (FU). The patients' external dose rate was measured, and simultaneously, their retained body radiation activity was monitored at various time points. The equations of the external dose rate and the retained body activity, described as a function of hours post administration, were fitted. Additionally, the release time for patients was calculated. The reduction in activity in the group receiving a second or subsequent treatment was more rapid than the group receiving only the initial treatment. Most important, an expeditious method was established to indirectly evaluate the retained body activity of patients by measuring the external dose rate with a portable radiation survey meter. By this method, the calculated external dose rate limits are 19.2, 8.85, 5.08 and 2.32 μSv·h-1 at 1, 1.5, 2 and 3 m, respectively, according to a patient's released threshold level of retained body activity <400 MBq. This study is beneficial for radiation safety decision-making.

  15. Molecular Mechanism of the Additive Effects of Leukotriene Modifier in Asthmatic Patients Receiving Steroid Therapy

    Directory of Open Access Journals (Sweden)

    Kazuto Matsunaga

    2009-01-01

    Conclusions: LM caused a greater improvement in pulmonary function and airway inflammation in asthmatics with AR. The RANTES-mediated pathway may be involved in the improvement of the airflow limitation and airway lability by LM additive therapy in asthmatics receiving steroid therapy.

  16. Factors affecting willingness to receive a kidney transplant among hemodialysis patients in West China: A cross-sectional survey.

    Science.gov (United States)

    Tan, Qiling; Song, Turun; Jiang, Yamei; Qiu, Yang; Liu, Jingpeng; Huang, Zhongli; Wang, Xianding; Lin, Tao

    2017-05-01

    Many factors are associated with the willingness of ESRD patients to receive a kidney transplant. No data are available for patients in China. The study aim was to describe the attitudes toward transplantation in a cohort of patients at a single dialysis center in China.A study questionnaire derived from previously published literature was completed by 239 hemodialysis outpatients. Factors associated with willingness to receive a transplant were identified by univariate and multivariate logistic regression analyses.The respondents were primarily men 50.7 ± 15.1 years of age; 46.4% were willing to receive a transplant. Younger age (OR = 0.928, 95% CI: 0.898-0.959), good self-reported health (OR = 0.203, 95% CI: 0.081-0.51), and awareness of the benefits of transplantation (OR = 0.195, 95% CI: 0.083-0.456) were less likely to deny the transplant. Patients ≤60 years of age were about 13 times more likely to favor transplantation than those >60 years of age (OR = 12.99, 95% CI: 3.75-45.45). For every 10 years under 60, participants were 2.16 times more willing to receive a kidney transplant (OR = 2.16, 95% CI: 1.53-3.02). Older patients were also less likely to be referred for evaluation (OR = 0.955, 95% CI: 0.923-0.989, P = .009).The percentage of ESRD patients in China, particularly older patients, who are willing to accept a transplant, is relatively low. A better understanding of the benefits of transplantation is needed to increase their acceptance.

  17. Review of cancer pain management in patients receiving maintenance methadone therapy.

    LENUS (Irish Health Repository)

    Rowley, Dominic

    2011-05-01

    Methadone is commonly used in the treatment of heroin addiction. Patients with a history of opioid misuse or on methadone maintenance therapy (MMT) with cancer often have difficult to manage pain. We studied 12 patients referred to the palliative care service with cancer pain who were on MMT. All had difficult to control pain, and a third required 5 or more analgesic agents. Two patients had documented \\'\\'drug-seeking\\'\\' behavior. Methadone was used subcutaneously as an analgesic agent in 1 patient. We explore why patients on MMT have difficult to manage pain, the optimal management of their pain, and the increasing role of methadone as an analgesic agent in cancer pain.

  18. Improving the service for patients receiving extracorporeal photopheresis using Lean principles.

    Science.gov (United States)

    Rushton, Cherie; Robertson, Leeah; Taylor, Tracie; Taylor, Peter; Button, Paul; Alfred, Arun

    2016-09-08

    The photopheresis unit where the authors work has seen an increased demand both locally and as an outreach service. A Lean assessment of the unit was undertaken to improve processing time and productivity, which in turn would improve the availability of treatment and improve patient care. The assessment indicated that there were excellent nursing standards and patient care; however, patient waiting times and treatment times were prolonged in comparison with other units. The unit reviewed the patient pathway and identified where delays occurred and consequently changed patient scheduling.

  19. Patients' statements and experiences concerning receiving mechanical ventilation: a prospective video-recorded study.

    Science.gov (United States)

    Karlsson, Veronika; Lindahl, Berit; Bergbom, Ingegerd

    2012-09-01

    Prospective studies using video-recordings of patients during mechanical ventilator treatment (MVT) while conscious have not previously been published. The aim was to describe patients' statements, communication and facial expressions during a video-recorded interview while undergoing MVT. Content analysis and hermeneutics inspired by the philosophy of Gadamer were used. The patients experienced almost constant difficulties in breathing and lost their voice. The most common types of communication techniques patients used were nodding or shaking the head. Their expressions were interpreted as stiffened facial expression, tense body position and feelings of sadness and sorrow. Nursing care for patients' conscious during MVT is challenging as it creates new demands regarding the content of the care provided. In caring for patients undergoing MVT while conscious, establishing a caring relationship, making patients feel safe and helping them to communicate seem to be most important for alleviating discomfort and instilling hope.

  20. Lactate dehydrogenase and body mass index are prognostic factors in patients with recurrent small cell lung cancer receiving amrubicin.

    Science.gov (United States)

    Inomata, Minehiko; Hayashi, Ryuji; Tokui, Kotaro; Taka, Chihiro; Okazawa, Seisuke; Kambara, Kenta; Ichikawa, Tomomi; Yamada, Toru; Miwa, Toshiro; Kashii, Tatsuhiko; Matsui, Shoko; Tobe, Kazuyuki

    2016-12-01

    Amrubicin monotherapy can be an effective treatment option for patients with recurrent small cell lung cancer (SCLC). We conducted this retrospective study to investigate the prognostic factors in patients with recurrent SCLC receiving amrubicin monotherapy. The associations between survival and clinical data, including the performance status, body mass index (BMI), plasma lactate dehydrogenase (LDH) level, and plasma neuron-specific enolase level, were evaluated in patients with recurrent SCLC, and a subset analysis of patients with platinum-resistant disease was conducted. In all, 37 patients were evaluated. The median survival from the date of initiation of amrubicin monotherapy was 9.1 months (95% confidence interval 4.7-12.0 months). Multivariate analysis using a Cox proportional hazard model identified the plasma LDH level (p = 0.049), BMI (p = 0.031), and platinum resistance (p = 0.032) as independent factors associated with survival. The same associations were also observed in the subset of patients with platinum-resistant disease. Our findings suggest that the plasma LDH level and BMI may be useful prognostic factors in patients with SCLC receiving amrubicin monotherapy, including patients with platinum-resistant disease.

  1. An analysis of the incidence and related factors for radiation dermatitis in breast cancer patients who receive radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sun Young; Kwon, Hyoung Cheol; Kim, Jung Soo [Dept. of Radiation Oncology, Chonbuk National University Hospital, Jeonju (Korea, Republic of); Lee, Heui Kwan [Prebyterian Medical Center, Jeonju (Korea, Republic of)

    2010-11-15

    We analyzed the incidence and related factors of radiation dermatitis; at first, to recognize whether a decrease in radiation dermatitis is possible or not in breast cancer patients who received radiation therapy. Of 338 patients, 284 with invasive breast cancer who received breast conservation surgery with radiotherapy at Chonbuk National University Hospital from January 2007 to June 2009 were evaluated. Patients who also underwent bolus, previous contralateral breast irradiation and irradiation on both breasts were excluded. For patients who appeared to have greater than moderate radiation dermatitis, the incidence and relating factors for radiation dermatitis were analyzed retrospectively. A total of 207 and 77 patients appeared to have RTOG grade 0/1 or above RTOG grade 2 radiation dermatitis, respectively. The factors found to be statistically significant for the 77 patients who appeared to have greater than moderate radiation dermatitis include the presence of lymphocele due to the stasis of lymph and lymph edema which affect the healing disturbance of radiation dermatitis (p=0.003, p=0.001). Moreover, an allergic reaction to plaster due to the immune cells of skin and the activation of cytokine and concomitant hormonal therapy were also statistically significant factors (p=0.001, p=0.025). Most of the breast cancer patients who received radiation therapy appeared to have a greater than mild case of radiation dermatitis. Lymphocele, lymphedema, an allergy to plaster and concomitant hormonal therapy which affect radiation dermatitis were found to be significant factors. Consequently, we should eliminate lymphocele prior to radiation treatment for patients who appear to have an allergic reaction to plaster. We should also instruct patients of methods to maintain skin moisture if they appear to have a greater than moderate case of radiation dermatitis.

  2. Effect of Pre-treatment Education Programs on the Anxiety of Patients Receiving Radiotherapy: An Integrative Literature Review

    Directory of Open Access Journals (Sweden)

    Fatemeh Heshmati Nabavi

    2016-04-01

    Full Text Available Background: Stress and anxiety in cancer patients are caused by disease diagnosis, unfamiliar experiences, and therapy-related problems. In addition to the short duration of radiotherapy, receiving and understanding of the information about this treatment could be difficult for patients due to anxiety, fatigue, and mental pressure. Training of cancer patients about radiotherapy via educational programs could reduce pre-treatment anxiety. Aim: This systematic review aimed to integrate the information regarding the effects of pre-treatment educational training on the level of anxiety and distress symptoms of cancer patients receiving RT. Method: This systematic review was conducted to identify the studies comparing different methods of pre-treatment patient education before radiotherapy via searching in databases such as MEDLINE, PsycINFO, Web of Science, ClinicalKey, ProQuest, and PubMed. Selected studies included clinical reports on the effects of educational interventions on the anxiety of patients receiving radiotherapy. Excluded samples were commentaries and studies without intervention. Results: In total, we reviewed eight articles assessing the effect of educational interventions before radiotherapy on the anxiety of cancer patients. Educational interventions used in these studies included face-to-face consultation with a radiotherapist, group instructions with routine individual training using visual materials (e.g., brochures, booklets, videotapes, and PowerPoint presentations, group discussions, electronic instructions, written materials, and phone contact with a nurse. Implications for Practice: According our findings, pre-treatment education could reduce the anxiety of cancer patients before radiotherapy. These educational programs could be performed using written, visual, electronic, or face-to-face instructions. However, considering the condition of cancer patients and their treatment, selection of the appropriate training method

  3. Schizophrenia symptoms and functioning in patients receiving long-term treatment with olanzapine long-acting injection formulation

    DEFF Research Database (Denmark)

    Peuskens, Joseph; Porsdal, Vibeke; Pecenak, Jan;

    2012-01-01

    ABSTRACT: BACKGROUND: This analysis of pooled data evaluates maintenance treatment outcomes of patients with schizophrenia receiving maintenance treatment with olanzapine long-acting injection (OLAI) by means of a categorical approach addressing the symptomatic and functional status of patients...... at different times. METHODS: Patients were grouped into 5 categories at baseline, 6 months, and 12 months. Shifts between categories were assessed for individual patients and factors associated with improvement were analyzed. 1182 patients from 3 clinical trials were included in the current analysis. RESULTS......: At baseline, 434 (36.8%) patients had minimal Positive and Negative Syndrome Scale (PANSS) symptoms but seriously impaired Heinrich Carpenter's Quality of Life Scale (QLS) functioning; 303 (25.6%) had moderate to severe symptoms and seriously impaired function; 208 (17.6%) had mild to moderate symptoms...

  4. Evaluation of the Glasgow Prognostic Score in patients receiving chemoradiotherapy for stage III and IV esophageal cancer.

    Science.gov (United States)

    Kimura, J; Kunisaki, C; Makino, H; Oshima, T; Ota, M; Oba, M; Takagawa, R; Kosaka, T; Ono, H A; Akiyama, H; Endo, I

    2016-11-01

    High Glasgow Prognostic scores (GPSs) have been associated with poor outcomes in various tumors, but the values of GPS and modified GPS (mGPS) in patients with advanced esophageal cancer receiving chemoradiotherapy (CRT) has not yet been reported. We have evaluated these with respect to predicting responsiveness to CRT and long-term survival. Between January 2002 and December 2011, tumor responses in 142 esophageal cancer patients (131 men and 11 women) with stage III (A, B and C) and IV receiving CRT were assessed. We assessed the value of the GPS as a predictor of a response to definitive CRT and also as a prognostic indicator in patients with esophageal cancer receiving CRT. We found that independent predictors of CRT responsiveness were Eastern Cooperative Oncology Group (ECOG) performance status, GPS and cTNM stage. Independent prognostic factors were ECOG performance status and GPS for progression-free survival and ECOG performance status, GPS and cTNM stage IV for disease-specific survival. GPS may be a novel predictor of CRT responsiveness and a prognostic indicator for progression-free and disease-specific survival in patients with advanced esophageal cancer. However, a multicenter study as same regime with large number of patients will be needed to confirm these outcomes. © 2015 International Society for Diseases of the Esophagus.

  5. Measurement of the Radiation Dose Rates of Patients Receiving Treatment with I-131 Using Telescopic Radiation Survey Meter

    Directory of Open Access Journals (Sweden)

    Yehia Lahfi

    2016-03-01

    Full Text Available Introduction In order to discharge the patients receiving treatment with large radiation doses of 131I for thyroid cancer, it is necessary to measure and evaluate the external dose rates of these patients. The aim of the study was to assess a new method of external dose rate measurement, and to analyze the obtained results as a function of time. Materials and Methods In this study, a telescopic radiation survey meter was utilized to measure the external dose rates of a sample population of 192 patients receiving treatment with high-dose 131I at one, 24, and 48 hours after dose administration. Results The proposed technique could reduce the occupational radiation exposure of the physicist by a factor of 1/16. Moreover, the external dose rates of both genders rapidly decreased with time according to bi-exponential equations, which could be attributed to the additional factors associated with iodine excretion, as well as the physiology of the body in terms of 131I uptake. Conclusion According to the results of this study, telescopic radiation survey meter could be used to measure the external dose rates of patients receiving treatment with 131I. Furthermore, the average difference in the radiation exposure between female and male patients was calculated to be less than 17%.

  6. Training with inspiratory pressure support in patients with severe COPD.

    NARCIS (Netherlands)

    Hul, A. van 't; Gosselink, R.; Hollander, P.; Postmus, P.; Kwakkel, G.

    2006-01-01

    This study evaluates the effects of training with noninvasive ventilatory support in patients with chronic obstructive pulmonary disease in a randomised, controlled, observer-blinded trial. Twenty-nine patients with chronic obstructive pulmonary disease and with a ventilatory limited exercise

  7. Patients Receiving Prebiotics and Probiotics Before Liver Transplantation Develop Fewer Infections Than Controls: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Sawas, Tarek; Al Halabi, Shadi; Hernaez, Ruben; Carey, William D; Cho, Won Kyoo

    2015-09-01

    Among patients who have received liver transplants, infections increase morbidity and mortality and prolong hospital stays. Administration of antibiotics and surgical trauma create intestinal barrier dysfunction and microbial imbalances that allow enteric bacteria to translocate to the blood. Probiotics are believed to prevent bacterial translocation by stabilizing the intestinal barrier and stimulating proliferation of the intestinal epithelium, mucus secretion, and motility. We performed a meta-analysis to determine the effects of probiotics on infections in patients receiving liver transplants. We searched PubMed and EMBASE for controlled trials that evaluated the effects of prebiotics and probiotics on infections in patients who underwent liver transplantation. Heterogeneity was analyzed by the Cochran Q statistic. Pooled Mantel-Haenszel relative risks were calculated with a fixed-effects model. We identified 4 controlled studies, comprising 246 participants (123 received probiotics, 123 served as controls), for inclusion in the meta-analysis. In these studies, the intervention groups received enteric nutrition and fiber (prebiotics) with probiotics, and the control groups received only enteric nutrition and fiber without probiotics. The infection rate was 7% in groups that received probiotics vs 35% in control groups (relative risk [RR], 0.21; 95% confidence interval [CI], 0.11-0.41; P = .001). The number needed to treat to prevent 1 infection was 3.6. In subgroup analyses, only 2% of subjects in the probiotic groups developed urinary tract infections, compared with 16% of controls (RR, 0.14; 95% CI, 0.04-0.47; P prebiotics before, or on the day of, liver transplantation reduces the rate of infection after surgery. These agents also reduced the amount of time spent in the hospital or intensive care unit and the duration of antibiotic use. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

  8. Frequency of the bleeding risk in patients receiving warfarin submitted to arthrocentesis of the knee

    Directory of Open Access Journals (Sweden)

    S. Todesco

    2011-09-01

    Full Text Available Objective: To evaluate the potential bleeding risks of arthrocentesis in patients with different arthropathies and taking oral anticoagulants. Materials and methods: Fifteen consecutive patients, 8 males and 7 females, treated with anticoagulant therapy for atrial fibrillation (9 pts, deep venous thrombosis (4 pts and replacement of cardiac valves (3 pts were submitted to arthrocentesis for synovial fluid effusion due to different arthropathies. In all patients INR was ≤ 5. Nine of them were assuming AINS for the joint pain. Results: Two of fifteen patients have hemarthrosis, the first only lightly, the second more frankly. Both the patients were in therapy with AINS and INR was 3,8 and 5, respectively. Conclusions: The hemarthrosis or bleeding frequency associated with intraarticular injections in patients taking anticoagulant therapy seems not very high. Therefore the therapy with oral anticoagulans would not be an absolute controindication to the arthrocentesis execution.

  9. Ketogenic diet also benefits Dravet syndrome patients receiving stiripentol: a prospective pilot study.

    Science.gov (United States)

    Nabbout, Rima; Copioli, Cristiana; Chipaux, Mathilde; Chemaly, Nicole; Desguerre, Isabelle; Dulac, Olivier; Chiron, Catherine

    2011-07-01

    We aimed to test the efficacy of ketogenic diet (KD) in patients with Dravet syndrome (DS) not satisfactorily controlled by antiepileptic drugs (AEDs). We included prospectively 15 DS patients aged >3 years with partial response to AEDs including stiripentol. All patients had a seizure diary and clinical examination with Conners and Achenbach scales before KD, at 1 month following onset and every 3 months thereafter. At 1 month, 10 patients (66%) had a decrease of seizure frequency ≥75%. Efficacy was maintained in eight responders at 3 and 6 months and in six responders at 9 months. Five patients (33%) remained on KD over 12 months, and one was seizure-free. In addition to efficacy on seizure frequency, KD was beneficial on behavior disturbances including hyperactivity. This effect was reported in all responders and in a few nonresponders. KD might have a double effect, on seizure control and on hyperactivity and behavior disturbances in patients with DS.

  10. Odontostomatologic management of patients receiving oral anticoagulant therapy: a retrospective multicentric study.

    Science.gov (United States)

    Inchingolo, Francesco; Tatullo, Marco; Abenavoli, Fabio M; Marrelli, Massimo; Inchingolo, Alessio D; Scacco, Salvatore; Papa, Francesco; Inchingolo, Angelo M; Dipalma, Gianna

    2011-07-19

    Today, we frequently find patients taking oral anticoagulant therapy (OAT), a prophylaxis against the occurrence of thromboembolic events. An oral surgeon needs to know how to better manage such patients, in order to avoid hemorrhagic and thromboembolic complications. A group of 193 patients (119 men aged between 46 and 82 and 74 women aged between 54 and 76) undergoing OAT for more than 5 years were managed with a standardized management protocol and a 2-months follow-up. The aim of the present study was to apply a protocol, which could provide a safe intra- and postoperative management of patients on OAT. Among the 193 patients, only 2 had postoperative complications. We think that the protocol used in the present study can be used for complete safety in the treatment of this type of patients.

  11. Odontostomatologic management of patients receiving oral anticoagulant therapy: a retrospective multicentric study

    Directory of Open Access Journals (Sweden)

    Scacco Salvatore

    2011-07-01

    Full Text Available Abstract Introduction Today, we frequently find patients taking oral anticoagulant therapy (OAT, a prophylaxis against the occurrence of thromboembolic events. An oral surgeon needs to know how to better manage such patients, in order to avoid hemorrhagic and thromboembolic complications. Materials and methods A group of 193 patients (119 men aged between 46 and 82 and 74 women aged between 54 and 76 undergoing OAT for more than 5 years were managed with a standardized management protocol and a 2-months follow-up. The aim of the present study was to apply a protocol, which could provide a safe intra- and postoperative management of patients on OAT. Results Among the 193 patients, only 2 had postoperative complications. Conclusions We think that the protocol used in the present study can be used for complete safety in the treatment of this type of patients.

  12. Timing of Hospice Referral: Assessing Satisfaction While the Patient Receives Hospice Services*

    OpenAIRE

    Adams, Carolyn E.; Bader, Julia; Horn, Kathryn V.

    2009-01-01

    Generally, satisfaction with timing of hospice referral was measured in mortality follow back surveys of patients who died in hospice. In contrast in this study, investigators assessed timing of the hospice referral in patients/families enrolled in hospice for a minimum of two weeks. About 1/3 of patients/families identified it would have been easier if they started hospice earlier. Barriers to early hospice access were associated primarily with access to the healthcare system.

  13. Odontostomatologic management of patients receiving oral anticoagulant therapy: a retrospective multicentric study

    OpenAIRE

    Scacco Salvatore; Inchingolo Alessio D; Marrelli Massimo; Abenavoli Fabio M; Tatullo Marco; Inchingolo Francesco; Papa Francesco; Inchingolo Angelo M; Dipalma Gianna

    2011-01-01

    Abstract Introduction Today, we frequently find patients taking oral anticoagulant therapy (OAT), a prophylaxis against the occurrence of thromboembolic events. An oral surgeon needs to know how to better manage such patients, in order to avoid hemorrhagic and thromboembolic complications. Materials and methods A group of 193 patients (119 men aged between 46 and 82 and 74 women aged between 54 and 76) undergoing OAT for more than 5 years were managed with a standardized management protocol a...

  14. Decreased Heart Rate Variability in HIV Positive Patients Receiving Antiretroviral Therapy: Importance of Blood Glucose and Cholesterol

    DEFF Research Database (Denmark)

    Askgaard, Gro; Kristoffersen, Ulrik Sloth; Mehlsen, Jesper

    2011-01-01

    whether autonomic dysfunction is present in an ART treated HIV population and if so to identify factors of importance. METHODS: HIV patients receiving ART for at least 12 months (n¿=¿97) and an age-matched control group of healthy volunteers (n¿=¿52) were included. All were non-diabetic and had never...... received medication for hypertension. Following a 10 min resting period a 15 min ECG recording was performed. Heart-rate variability (HRV) analysis was performed in accordance with current guidelines and data reported as mean [interquartile range]. RESULTS: Mean normal-to-normal (NN) and total HRV measured...

  15. Predictors of Radiation Pneumonitis in Patients Receiving Intensity Modulated Radiation Therapy for Hodgkin and Non-Hodgkin Lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Pinnix, Chelsea C., E-mail: ccpinnix@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Smith, Grace L.; Milgrom, Sarah; Osborne, Eleanor M.; Reddy, Jay P.; Akhtari, Mani; Reed, Valerie; Arzu, Isidora; Allen, Pamela K.; Wogan, Christine F. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Fanale, Michele A.; Oki, Yasuhiro; Turturro, Francesco; Romaguera, Jorge; Fayad, Luis; Fowler, Nathan; Westin, Jason; Nastoupil, Loretta; Hagemeister, Fredrick B.; Rodriguez, M. Alma [Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); and others

    2015-05-01

    Purpose: Few studies to date have evaluated factors associated with the development of radiation pneumonitis (RP) in patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL), especially in patients treated with contemporary radiation techniques. These patients represent a unique group owing to the often large radiation target volumes within the mediastinum and to the potential to receive several lines of chemotherapy that add to pulmonary toxicity for relapsed or refractory disease. Our objective was to determine the incidence and clinical and dosimetric risk factors associated with RP in lymphoma patients treated with intensity modulated radiation therapy (IMRT) at a single institution. Methods and Materials: We retrospectively reviewed clinical charts and radiation records of 150 consecutive patients who received mediastinal IMRT for HL and NHL from 2009 through 2013. Clinical and dosimetric predictors associated with RP according to Radiation Therapy Oncology Group (RTOG) acute toxicity criteria were identified in univariate analysis using the Pearson χ{sup 2} test and logistic multivariate regression. Results: Mediastinal radiation was administered as consolidation therapy in 110 patients with newly diagnosed HL or NHL and in 40 patients with relapsed or refractory disease. The overall incidence of RP (RTOG grades 1-3) was 14% in the entire cohort. Risk of RP was increased for patients who received radiation for relapsed or refractory disease (25%) versus those who received consolidation therapy (10%, P=.019). Several dosimetric parameters predicted RP, including mean lung dose of >13.5 Gy, V{sub 20} of >30%, V{sub 15} of >35%, V{sub 10} of >40%, and V{sub 5} of >55%. The likelihood ratio χ{sup 2} value was highest for V{sub 5} >55% (χ{sup 2} = 19.37). Conclusions: In using IMRT to treat mediastinal lymphoma, all dosimetric parameters predicted RP, although small doses to large volumes of lung had the greatest influence. Patients with relapsed

  16. [Management of patients receiving home respiratory care with tracheostomy and positive-pressure ventilation].

    Science.gov (United States)

    Aoki, Masashi

    2013-01-01

    On March 11, 2011, the Great East Japan Earthquake occurred and a massive tsunami hit the northeastern coast of Japan. In Miyagi prefecture in Tokoku district, 49 patients with amyotrophic lateral sclerosis were supported by home respiratory care with tracheostomy and positive-pressure ventilation at that time. Among them, two patients were died in the tsunami and 25 patients were forced to evacuate to hospitals. We should hurry to submit a guideline for medical transportation for patients with neuromuscular diseases requiring artificial ventilation. We also should research the disaster medicine in the field of neurology.

  17. Characteristics of patients receiving pharmaceutical samples and association between sample receipt and out-of-pocket prescription costs.

    Science.gov (United States)

    Alexander, G Caleb; Zhang, James; Basu, Anirban

    2008-04-01

    Pharmaceutical samples are widely used for promotion and marketing, yet little is known about who receives samples or how their use is associated with patient's prescription costs. To examine the characteristics of those receiving samples and the relationship between sample receipt and out-of-pocket prescription costs. DESIGN, SUBJECTS, AND MEASURES: We divided the 2002-2003 Medical Expenditure Panel Survey, a nationally representative, panel-design longitudinal study, into baseline and analysis periods. We conducted logistic and generalized linear regression analysis of 5709 individuals in the analysis period who did not receive samples during the baseline period. The primary outcome measures were sample receipt and prescription expenditures. Fourteen percent of individuals received at least 1 sample during the analysis period. On multivariate analyses sample receipt was greater among those who were younger and those not on Medicaid. In generalized linear regressions controlling for demographic characteristics and health care utilization, the predicted 180-day out-of-pocket prescription expenditures were $178 [standard error (SE), $3.9] for those never receiving samples. Among those receiving samples, the corresponding out-of-pocket expenditures were $166 (SE, $8.9) for periods before sample receipt (P = 0.16 for comparison with those not receiving samples), $244 (SE, $9.2) for periods during sample receipt (P < 0.001 for comparison with periods before sample receipt) and $212 (SE, $12.4) for periods following sample receipt (P = 0.008 for comparison with periods before sample receipt). Results were qualitatively similar when total prescription costs were examined. Individuals receiving samples have higher prescription expenditures than their counterparts. These findings suggest that sample recipients remain disproportionately burdened by prescription costs even after sample receipt.

  18. The Use of Intravenous Antibiotics at the Onset of Neutropenia in Patients Receiving Outpatient-Based Hematopoietic Stem Cell Transplants

    Science.gov (United States)

    Hamadah, Aziz; Schreiber, Yoko; Toye, Baldwin; McDiarmid, Sheryl; Huebsch, Lothar; Bredeson, Christopher; Tay, Jason

    2012-01-01

    Empirical antibiotics at the onset of febrile neutropenia are one of several strategies for management of bacterial infections in patients undergoing Hematopoietic Stem Cell Transplant (HSCT) (empiric strategy). Our HSCT program aims to perform HSCT in an outpatient setting, where an empiric antibiotic strategy was employed. HSCT recipients began receiving intravenous antibiotics at the onset of neutropenia in the absence of fever as part of our institutional policy from 01 Jan 2009; intravenous Prophylactic strategy. A prospective study was conducted to compare two consecutive cohorts [Year 2008 (Empiric strategy) vs. Year 2009 (Prophylactic strategy)] of patients receiving HSCT. There were 238 HSCTs performed between 01 Jan 2008 and 31 Dec 2009 with 127 and 111 in the earlier and later cohorts respectively. Infection-related mortality pre- engraftment was similar with a prophylactic compared to an empiric strategy (3.6% vs. 7.1%; p = 0.24), but reduced among recipients of autologous HSCT (0% vs. 6.8%; p = 0.03). Microbiologically documented, blood stream infections and clinically documented infections pre-engraftment were reduced in those receiving a prophylactic compared to an empiric strategy, (11.7% vs. 28.3%; p = 0.001), (9.9% vs. 24.4%; p = 0.003) and (18.2% vs. 33.9% p = 0.007) respectively. The prophylactic use of intravenous once-daily ceftriaxone in patients receiving outpatient based HSCT is safe and may be particularly effective in patients receiving autologous HSCT. Further studies are warranted to study the impact of this Prophylactic strategy in an outpatient based HSCT program. PMID:23029441

  19. The use of intravenous antibiotics at the onset of neutropenia in patients receiving outpatient-based hematopoietic stem cell transplants.

    Directory of Open Access Journals (Sweden)

    Aziz Hamadah

    Full Text Available Empirical antibiotics at the onset of febrile neutropenia are one of several strategies for management of bacterial infections in patients undergoing Hematopoietic Stem Cell Transplant (HSCT (empiric strategy. Our HSCT program aims to perform HSCT in an outpatient setting, where an empiric antibiotic strategy was employed. HSCT recipients began receiving intravenous antibiotics at the onset of neutropenia in the absence of fever as part of our institutional policy from 01 Jan 2009; intravenous Prophylactic strategy. A prospective study was conducted to compare two consecutive cohorts [Year 2008 (Empiric strategy vs. Year 2009 (Prophylactic strategy] of patients receiving HSCT. There were 238 HSCTs performed between 01 Jan 2008 and 31 Dec 2009 with 127 and 111 in the earlier and later cohorts respectively. Infection-related mortality pre- engraftment was similar with a prophylactic compared to an empiric strategy (3.6% vs. 7.1%; p = 0.24, but reduced among recipients of autologous HSCT (0% vs. 6.8%; p = 0.03. Microbiologically documented, blood stream infections and clinically documented infections pre-engraftment were reduced in those receiving a prophylactic compared to an empiric strategy, (11.7% vs. 28.3%; p = 0.001, (9.9% vs. 24.4%; p = 0.003 and (18.2% vs. 33.9% p = 0.007 respectively. The prophylactic use of intravenous once-daily ceftriaxone in patients receiving outpatient based HSCT is safe and may be particularly effective in patients receiving autologous HSCT. Further studies are warranted to study the impact of this Prophylactic strategy in an outpatient based HSCT program.

  20. Assessment of adenosine deaminase levels in rheumatoid arthritis patients receiving anti-TNF-alpha therapy.

    Science.gov (United States)

    Erer, Burak; Yilmaz, Gulsen; Yilmaz, Fatma Meric; Koklu, Seyfettin

    2009-04-01

    Anti-TNF-alpha agents are increasingly used in rheumatoid arthritis (RA) treatment and that is known to increase the risk of tuberculosis (TB) reactivation. Adenosine deaminase (ADA) levels are shown to increase to high levels in TB patients. Our aim is to investigate the serum ADA levels in RA patients being treated with anti-TNF-alpha and to compare the results with the patients on DMARD therapy. The study groups comprised of 56 RA patients (45 female, mean age 49) who were treated either with two or three DMARDs, 32 RA patients with anti-TNF-alpha treatment (26 female, mean age 46) and 20 healthy controls (10 female, mean age 48). All patients fulfilled the 1987 ACR criteria for RA. DAS28 score was calculated for all subjects. When compared to healthy controls, ADA levels were measured statistically higher both in patient groups (P = 0.046, 0.002). ADA levels in anti-TNF-alpha group were similar to conventional therapy (11.3 +/- 2.7, 10.9 +/- 4.01; P = 0.76). PPD was positive in 17 RA patients in the anti-TNF-alpha treatment group (%53). The ADA levels were found to be similar in the anti-TNF-alpha group when compared according to the PPD positivity (positive, 12.4 +/- 3.7; negative, 10.5 +/- 2.1; P = 0.02). No correlation was found between the ADA levels and age, disease duration, ESR, CRP, DAS 28 and HAQ score. In this study, we observed that RA patients at remission taking DMARD or anti-TNF-alpha therapy have similar levels of serum ADA. Although serum ADA levels during TB infection increase much higher, in our study, ADA levels of all RA patients were lower than 15 IU/L. Elevated ADA levels may be a clue for diagnosis of TB in patients who were on anti-TNF-alpha therapy.

  1. HER2-Positive Metastatic Breast Cancer Patients Receiving Pertuzumab in a Community Oncology Practice Setting: Treatment Patterns and Outcomes.

    Science.gov (United States)

    Robert, Nicholas J; Goertz, Hans-Peter; Chopra, Pooja; Jiao, Xiaolong; Yoo, Bongin; Patt, Debra; Antao, Vincent

    2017-03-01

    Pertuzumab (Perjeta(®)), a HER2/neu receptor antagonist, was approved by the US Food and Drug Administration in June 2012 for use in the first-line setting for patients with HER2-positive metastatic breast cancer (mBC). This retrospective study investigated the clinical and demographic characteristics, treatment patterns, safety, and clinical outcomes for patients with HER2-positive mBC who received pertuzumab in the first-line setting in US community oncology practices. Patients with HER2-positive mBC, who initiated pertuzumab within 60 days of mBC diagnosis between June 2012 and June 2014, followed through December 2014, had ≥2 visits within the McKesson Specialty Health/US Oncology Network, and were not on clinical trials during the study period, were eligible. This study utilized iKnowMed electronic health records, Claims Data Warehouse, and Social Security Death Index. Progression-free survival (PFS) was assessed by Kaplan-Meier methods. A total of 266 patients met the selection criteria. A vast majority of the patients (249/266, 93.6%) received a trastuzumab + pertuzumab + taxane (H + P + T) regimen. The number of patients with prior adjuvant/neoadjuvant therapy was higher than the CLEOPATRA trial, but age (median 57 years) and percentage of visceral disease (74.8%) were similar. The most common adverse events were fatigue (50.8%), diarrhea (44.7%), nausea (35.3%), peripheral neuropathy (33.5%), neutropenia (24.9%), and rash (24.4%). The median PFS was 16.9 months (95% CI 14.2-19.7). In this retrospective study of patients with HER2-positive mBC receiving pertuzumab in the first-line setting, most patients were treated with H + P + T. The safety and PFS of H + P + T were consistent with those observed in the pivotal trial.

  2. Lack of benefit of early protocol biopsies in renal transplant patients receiving TAC and MMF: a randomized study.

    Science.gov (United States)

    Rush, D; Arlen, D; Boucher, A; Busque, S; Cockfield, S M; Girardin, C; Knoll, G; Lachance, J-G; Landsberg, D; Shapiro, J; Shoker, A; Yilmaz, S

    2007-11-01

    We conducted a randomized, multicenter study to determine whether treatment of subclinical rejection with increased corticosteroids resulted in beneficial outcomes in renal transplant patients receiving tacrolimus (TAC), mycophenolate mofetil (MMF) and prednisone. One hundred and twenty-one patients were randomized to biopsies at 0,1,2,3 and 6 months (Biopsy arm), and 119 to biopsies at 0 and 6 months only (Control arm). The primary endpoint of the study was the prevalence of the sum of the interstitial and tubular scores (ci + ct)> 2 (Banff) at 6 months. Secondary endpoints included clinical and subclinical rejection and renal function. At 6 months, 34.8% of the Biopsy and 20.5% of the Control arm patients had a ci + ct score >or= 2 (p = 0.07). Between months 0 and 6, clinical rejection episodes were 12 in 10 Biopsy arm patients and 8 in 8 Control arm patients (p = 0.44). Overall prevalence of subclinical rejection in the Biopsy arm was 4.6%. Creatinine clearance at 6 months was 72.9 +/- 21.7 in the Biopsy and 68.90 mL/min +/- 18.35 mL/min in the Control arm patients (p = 0.18). In conclusion, we found no benefit to the procurement of early protocol biopsies in renal transplant patients receiving TAC, MMF and prednisone, at least in the short term. This is likely due to their low prevalence of subclinical rejection.

  3. Blood pressure changes in African American patients receiving chiropractic care in a teaching clinic: a preliminary study.

    Science.gov (United States)

    McMasters, Kim L; Wang, Joe; York, Jennifer; Hart, John; Neely, Cheneir; Delain, Rochelle J

    2013-06-01

    The purpose of this preliminary study was to determine if a course of chiropractic care would change blood pressure measurements in African American patients and to determine if a study was feasible in a chiropractic teaching clinic. Twenty-four African American patients received chiropractic care in a chiropractic teaching clinic over a study period that spanned 23 visits for each patient. Inclusion criteria consisted of patients having a diagnosis of prehypertension (120-139/80-89) or hypertension stage 1 (140-159/90-99). The mean values of 3 baseline blood pressure readings were compared with the mean values of blood pressure readings taken on visits 21, 22, and 23. For the entire sample, reductions for both systolic and diastolic blood pressures were not statistically significant (P > .07). When 4 patients having body mass index values that were considered as outliers were excluded, a statistically significant decrease in diastolic blood pressure was observed (P = .004). By group, a statistically significant reduction occurred in the hypertension stage 1 group for systolic and diastolic blood pressures. This study showed that research of this nature may be feasible in chiropractic teaching clinics. The preliminary findings of this study showed that, for a subgroup of African American patients receiving chiropractic care, blood pressure decreased for (a) hypertension stage 1 patients and (b) the sample when those with excessive body mass index were excluded.

  4. Remission and rheumatoid arthritis: Data on patients receiving usual care in twenty-four countries

    DEFF Research Database (Denmark)

    Sokka, Tuulikki; Hetland, Merete Lund; Mäkinen, Heidi

    2008-01-01

    OBJECTIVE: To compare the performance of different definitions of remission in a large multinational cross-sectional cohort of patients with rheumatoid arthritis (RA). METHODS: The Questionnaires in Standard Monitoring of Patients with RA (QUEST-RA) database, which (as of January 2008) included 5...

  5. Should patients receive general anesthesia prior to extubation at the end of life?.

    Science.gov (United States)

    Truog, Robert D; Brock, Dan W; White, Douglas B

    2012-02-01

    Billings has proposed that any potentially conscious and imminently dying patient who is undergoing withdrawal of ventilator support should be offered general anesthesia to fully protect against suffering. Here we examine whether his proposal is compatible with the doctrine of double effect, a philosophical construct that is generally in accord with the legal requirements for palliative care in the United States. We review the essential elements of the doctrine of double effect, and emphasize the importance of pre-medicating patients before ventilator withdrawal (anticipatory dosing) and of titrating medications to the needs of the patient. The doctrine of double effect requires physicians to balance the risk of the patient suffering against the risk of hastening the patient's deathwhen titrating the medications used to provide comfort. We argue that the values and preferences of the patient should determine how these risks are balanced. We therefore agree with Billings that general anesthesia may be indicated for patients who prefer to minimize the risk of suffering while accepting a greater risk of having their death hastened. This approach would not be appropriate, however, for patients who place a higher value upon avoiding the risk of hastening death, even when this involves a greater risk of potential suffering.

  6. Changes in the pattern of patients receiving surgical-orthodontic treatment

    Science.gov (United States)

    Proffit, William R.; Jackson, Tate H.; Turvey, Timothy A.

    2014-01-01

    Introduction The characteristics of patients who seek and accept orthognathic surgery appear to be changing over time but have not been well documented in the 21st century. Methods Records for patients who had orthognathic surgery at the University of North Carolina from 1996 to 2000 and from 2006 to 2010 were reviewed to collect data for changes in the prevalence of patients with mandibular deficiency (Class II), maxillary deficiency or mandibular prognathism (Class III), long face, and asymmetry problems. The changes were compared with those in previous time periods and at other locations. Results Between 1996 and 2000 and between 2006 and 2010, the percentage of Class III patients increased from 35% to 54%, and the percentage of Class II patients decreased from 59% to 41%, while the percentages for long face and asymmetry showed little change. The decrease in Class II patients was accentuation of a long-term trend; the increase in Class III patients occurred only after the turn of the century. Conclusions A similar but less-marked change has been noted at some but not all other locations in the United States. It appears to be related primarily to an increase in the numbers of African Americans, Native Americans, Hispanics, and Asians who now are seeking surgical treatment, but it also has been affected by changes in where orthognathic surgery is performed, decisions by third-party payers (insurance and Medicaid) about coverage for treatment, and the availability of nonsurgical orthodontic treatment options for Class II patients. PMID:23726329

  7. The impact of cancer treatment on the diets and food preferences of patients receiving outpatient treatment.

    Science.gov (United States)

    Coa, Kisha I; Epstein, Joel B; Ettinger, David; Jatoi, Aminah; McManus, Kathy; Platek, Mary E; Price, Wendy; Stewart, Meghan; Teknos, Theodoros N; Moskowitz, Bruce

    2015-01-01

    Patients undergoing cancer treatment experience a multitude of symptoms that can influence their ability to complete treatment as well as their quality of life during and after treatment. This cross-sectional study sought to describe the dietary changes experienced by cancer patients and to identify associations between these changes and common treatment symptoms. A convenience sample of 1199 cancer patients aged 18 yr and older undergoing active treatment were recruited from 7 cancer centers to complete a self-administered paper-and-pencil survey. Descriptive analyses were conducted to estimate prevalence of dietary changes and chi-squared tests were used to examine associations between dietary changes and health outcomes. Approximately 40% of patients reported a decreased appetite since beginning treatment, and 67.2% of patients reported at least 1 chemosensory alteration. Increased taste sensitivities were more common than decreased taste sensitivities, with increased sensitivity to metallic being the most common taste sensitivity (18.6%). Patients also had increased sensitivities to certain smells including cleaning solutions (23.4%), perfume (22.4%), and food cooking (11.4%). Patients reported a wide range of food preferences and aversions. Patients who had less energy or lost weight since beginning treatment were more likely than others to report treatment-related dietary changes.

  8. An easy tool to predict survival in patients receiving radiation therapy for painful bone metastases

    NARCIS (Netherlands)

    Westhoff, P.G.; Graeff, A. de; Monninkhof, E.M.; Bollen, L.; Dijkstra, S.P.; Steen-Banasik, E.M. van der; Vulpen, M. van; Leer, J.W.H.; Marijnen, C.A.; Linden, Y.M. van der; Study, G.

    2014-01-01

    PURPOSE: Patients with bone metastases have a widely varying survival. A reliable estimation of survival is needed for appropriate treatment strategies. Our goal was to assess the value of simple prognostic factors, namely, patient and tumor characteristics, Karnofsky performance status (KPS), and p

  9. The Impact of Cancer Treatment on the Diets and Food Preferences of Patients Receiving Outpatient Treatment

    Science.gov (United States)

    Coa, Kisha I.; Epstein, Joel B.; Ettinger, David; Jatoi, Aminah; McManus, Kathy; Platek, Mary E.; Price, Wendy; Stewart, Meghan; Teknos, Theodoros N.; Moskowitz, Bruce

    2015-01-01

    Patients undergoing cancer treatment experience a multitude of symptoms that can influence their ability to complete treatment as well as their quality of life during and after treatment. This cross-sectional study sought to describe the dietary changes experienced by cancer patients and to identify associations between these changes and common treatment symptoms. A convenience sample of 1199 cancer patients aged 18 yr and older undergoing active treatment were recruited from 7 cancer centers to complete a self-administered paper-and-pencil survey. Descriptive analyses were conducted to estimate prevalence of dietary changes and chi-squared tests were used to examine associations between dietary changes and health outcomes. Approximately 40% of patients reported a decreased appetite since beginning treatment, and 67.2% of patients reported at least 1 chemosensory alteration. Increased taste sensitivities were more common than decreased taste sensitivities, with increased sensitivity to metallic being the most common taste sensitivity (18.6%). Patients also had increased sensitivities to certain smells including cleaning solutions (23.4%), perfume (22.4%), and food cooking (11.4%). Patients reported a wide range of food preferences and aversions. Patients who had less energy or lost weight since beginning treatment were more likely than others to report treatment-related dietary changes. PMID:25664980

  10. Analysis of Local Control in Patients Receiving IMRT for Resected Pancreatic Cancers

    Energy Technology Data Exchange (ETDEWEB)

    Yovino, Susannah; Maidment, Bert W. [Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD (United States); Herman, Joseph M. [Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD (United States); Pandya, Naimish; Goloubeva, Olga [Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD (United States); Wolfgang, Chris; Schulick, Richard; Laheru, Daniel [Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD (United States); Hanna, Nader; Alexander, Richard [Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD (United States); Regine, William F., E-mail: wregine@umm.edu [Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD (United States)

    2012-07-01

    Purpose: Intensity-modulated radiotherapy (IMRT) is increasingly incorporated into therapy for pancreatic cancer. A concern regarding this technique is the potential for geographic miss and decreased local control. We analyzed patterns of first failure among patients treated with IMRT for resected pancreatic cancer. Methods and Materials: Seventy-one patients who underwent resection and adjuvant chemoradiation for pancreas cancer are included in this report. IMRT was used for all to a median dose of 50.4 Gy. Concurrent chemotherapy was 5-FU-based in 72% of patients and gemcitabine-based in 28%. Results: At median follow-up of 24 months, 49/71 patients (69%) had failed. The predominant failure pattern was distant metastases in 35/71 patients (49%). The most common site of metastases was the liver. Fourteen patients (19%) developed locoregional failure in the tumor bed alone in 5 patients, regional nodes in 4 patients, and concurrently with metastases in 5 patients. Median overall survival (OS) was 25 months. On univariate analysis, nodal status, margin status, postoperative CA 19-9 level, and weight loss during treatment were predictive for OS. On multivariate analysis, higher postoperative CA19-9 levels predicted for worse OS on a continuous basis (p < 0.01). A trend to worse OS was seen among patients with more weight loss during therapy (p = 0.06). Patients with positive nodes and positive margins also had significantly worse OS (HR for death 2.8, 95% CI 1.1-7.5; HR for death 2.6, 95% CI 1.1-6.2, respectively). Grade 3-4 nausea and vomiting was seen in 8% of patients. Late complication of small bowel obstruction occurred in 4 (6%) patients. Conclusions: This is the first comprehensive report of patterns of failure among patients treated with adjuvant IMRT for pancreas cancer. IMRT was not associated with an increase in local recurrences in our cohort. These data support the use of IMRT in the recently activated EORTC/US Intergroup/RTOG 0848 adjuvant pancreas

  11. Factors affecting survival in advanced chronic kidney disease patients who choose not to receive dialysis.

    Science.gov (United States)

    Wong, C F; McCarthy, M; Howse, M L P; Williams, P S

    2007-01-01

    Non-dialytic treatment (NDT) has become a recognized and important modality of treatment in end stage renal disease (ESRD) in certain groups of chronic kidney disease (CKD) patients. However, little is known about the prognosis of these NDT patients in terms of hospitalization rates and survival. We analyzed our experience in managing these NDT with a multidisciplinary team (MDT) approach over a three-year period. The Renal Unit at the Royal Liverpool University Hospital set up a dedicated MDT clinic to manage NDT patients in January 2003. Patients approaching end stage chronic kidney disease who chose not to dialyse were recruited from other nephrologists. The study group was classified according to age band (80 years), estimated glomerular filtration rate (eGFR) (20 ml/min) according to the Modified Diet In Renal Disease formula and Stoke comorbidity grade (SCG). The SCG is a validated scoring system for the survival of patients on renal replacement therapy. We also used the ERA-EDTA primary renal diagnosis codes. As there are no existing standards for NDT patients, we used the U.K. national set for haemodialysis patients as a reference and target for our NDT patients. Data was collected prospectively. The median age was 79 years and the male: female ratio was approximately 1. The most common primary cause of kidney disease in the NDT study population was chronic renal failure of unknown cause n = 22 (31%), but the most common identifiable cause was diabetic nephropathy, n = 20 (28%). The most common comorbidity was ischaemic heart disease n = 25 (34%). Those achieving the standards for anaemia were 78% at referral. Only 30% of the NDT patients achieved the standard for blood pressure (managing their chosen modality to achieve the best possible quality of life. There should be integrated services with primary care, community nurses, and palliative care teams to enable the majority of the patient's treatment to be carried out at home and to allow a dignified death

  12. Emergency patients receiving anaesthesiologist-based pre-hospital treatment and subsequently released at the scene

    DEFF Research Database (Denmark)

    Højfeldt, S G; Sørensen, L P; Mikkelsen, Søren

    2014-01-01

    BACKGROUND: The Mobile Emergency Care Unit in Odense, Denmark consists of a rapid response car, manned with an anaesthesiologist and an emergency medical technician. Eleven per cent of the patients are released at the scene following treatment. The aim of the study was to investigate which...... with the Mobile Emergency Care Unit within 24 h. Of the 143 victims of traffic accidents, 19 (13%) required renewed contact with the emergency department and one required admission to hospital (0.7%). Of all 1609 patients, four died within 24 h of contact (0.2%). CONCLUSION: Patients treated and released...... investigated. In each patient, diagnosis as well as any renewed contact with the Mobile Emergency Care Unit or the hospital within 24 h was registered. RESULTS: ONE THOUSAND SIX HUNDRED NINE: patients were released at the scene. Diagnoses within the category 'examination and investigation' [International...

  13. CHANGES OF CLINICAL AND RADIOGRAPHIC PARAMETERS DURING DENOSUMAB THERAPY IN RHEUMATOID ARTHRITIS PATIENTS RECEIVING GLUCOCORTICOIDS: PRELIMINARY RESULTS

    Directory of Open Access Journals (Sweden)

    P. S. Dydykina

    2015-01-01

    Full Text Available When treating rheumatoid arthritis (RA, it is important not only to suppress inflammation, but also to prevent local and generalized bone loss, particularly in patients receiving glucocorticoids (GC. Denosumab is a fully human monoclonal antibody that binds receptor activator of nuclear factor kappa B ligand (RANKL, prevents its interaction with receptor on osteoclasts, reduces their activity, and inhibits bone resorption.Objective: to evaluate the effect of 12-month therapy with denosumab on bone mineral density (BMD of the axialand peripheral skeleton and destructive changes in the hand and foot joints of RA patients receiving GC.Subjects and methods. Fifty-two postmenopausal women with RA concurrent with osteoporosis received subcutaneous denosumab 60 mg twice: at baseline and 6 months later. BMD was measured before drug administration and after 12 months of a follow-up, by applying dual-energy X-ray absorptiometry of three sections: the lumbar spine (LI–IV, femoral neck (FN, and distal forearm (DF. Radiographic changes in the hand and foot joints were assessed using the Sharp method modified by van der Heijde (SVH at baseline and 12 months later.Results and discussion. The patients’ mean age was 58.4±6.4 years; the mean RA duration – 19.0±10.9 years. Antiinflammatorytherapy was performed in all the patients, including 30 (57.7% who received GC. The mean BMD during follow-up increased from 0.814±0.101 to 0.848±0.103 g/cm2 in LI–IV (p<0.001, from 0.629±0.089 to 0.641±0.090 g/cm2 in FN (p=0.02, and from 0.497±0.094 to 0.502±0.091 g/cm2 in DF (р=0.34. The patients receiving and not  receiving GC showed a significant increase in LI–IV BMD and a tendency for its rise in FN and DF. There was a significant increase of X-ray changes in the hand and foot joints. Seven of the 52 patients were found to have a larger number of erosions: 33.0 [4.0; 78.0] at baseline and 39.0 [5.0; 90.0] after 12 months (p=0.017; 5 patients had

  14. Changes in small intestinal chromogranin A-immunoreactive cell densities in patients with irritable bowel syndrome after receiving dietary guidance.

    Science.gov (United States)

    Mazzawi, Tarek; El-Salhy, Magdy

    2016-05-01

    Chromogranin A (CgA) is a common marker for enteroendocrine cells in the gut, and CgA-immunoreactive cell densities are abnormal in patients with irritable bowel syndrome (IBS). The majority of patients with IBS report that their symptoms develop after consuming certain foodstuffs. In the present study, we investigated the effects of dietary guidance on the total enteroendocrine cell densities in the small intestine, as detected by CgA. A total of 14 patients with IBS underwent a gastroscopy with duodenal biopsies and 11 of them also underwent a colonoscopy, with biopsy samples obtained from the ileum. Fourteen control subjects were also included. Each patient received 3 sessions of dietary guidance. Gastroscopies and colonoscopies were performed on both the controls and patients with IBS (at baseline and at 3-9 months after receiving guidance). Biopsy samples obtained from the duodenum and ileum were immunostained for CgA using the avidin-biotin complex (ABC) method and were quantified using computerized image analysis. The density of CgA-immunoreactive cells in the duodenum (mean ± SEM values) in the control subjects was 235.9 ± 31.9 cells/mm2; in the patients with IBS, the density was 36.9 ± 9.8 and 103.7 ± 16.9 cells/mm2 before and after they received dietary guidance, respectively (P=0.007). The density of CgA-immunoreactive cells in the ileum in the control subjects was 47.4 ± 8.3 cells/mm2; in the patients with IBS, the density was 48.4 ± 8.1 and 17.9 ± 4.4 cells/mm2, before and after they received dietary guidance, respectively (P=0.0006). These data indicate that changes in CgA-immunoreactive cell densities in patients with IBS after receiving dietary guidance may reflect a change in the densities of the small intestinal enteroendocrine cells, which may contribute to an improvement in the IBS symptoms.

  15. Stereotactic Radiosurgery for Melanoma Brain Metastases in Patients Receiving Ipilimumab: Safety Profile and Efficacy of Combined Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Kiess, Ana P. [Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (United States); Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Wolchok, Jedd D. [Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Barker, Christopher A. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Postow, Michael A. [Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Tabar, Viviane [Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Huse, Jason T. [Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Chan, Timothy A.; Yamada, Yoshiya [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Beal, Kathryn, E-mail: bealk@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2015-06-01

    Purpose: Ipilimumab (Ipi), a monoclonal antibody against cytotoxic T-lymphocyte antigen-4, has been shown to improve survival in patients with metastatic melanoma. In this single-institution study, we investigated the safety and efficacy of stereotactic radiosurgery (SRS) for patients with melanoma brain metastases (BMs) who also received Ipi. Methods and Materials: From 2005 to 2011, 46 patients with melanoma received Ipi and underwent single-fraction SRS for BMs. A total of 113 BMs (91% intact, 9% postoperative) were treated with a median dose of 21 Gy (range, 15-24 Gy). Ipi was given at 3 mg/kg (54%) or 10 mg/kg (46%) for a median of 4 doses (range, 1-21). Adverse events were recorded with the use of the Common Terminology Criteria for Adverse Events 3.0. Kaplan-Meier methods were used to estimate survival, and Cox regression was used to investigate associations. Results: Fifteen patients received SRS during Ipi, 19 received SRS before Ipi, and 12 received SRS after Ipi. Overall survival (OS) was significantly associated with the timing of SRS/Ipi (P=.035) and melanoma-specific graded prognostic assessment (P=.013). Patients treated with SRS during or before Ipi had better OS and less regional recurrence than did those treated with SRS after Ipi (1-year OS 65% vs 56% vs 40%, P=.008; 1-year regional recurrence 69% vs 64% vs 92%, P=.003). SRS during Ipi also yielded a trend toward less local recurrence than did SRS before or after Ipi (1-year local recurrence 0% vs 13% vs 11%, P=.21). On magnetic resonance imaging, an increase in BM diameter to >150% was seen in 50% of patients treated during or before Ipi but in only 13% of patients treated after Ipi. Grade 3 to 4 toxicities were seen in 20% of patients. Conclusion: Overall, the combination of Ipi and SRS appears to be well tolerated. Concurrent delivery of Ipi and SRS is associated with favorable locoregional control and possibly longer survival. It may also cause a temporary increase in tumor size, possibly

  16. The Study of External Dose Rate and Retained Body Activity of Patients Receiving 131I Therapy for Differentiated Thyroid Carcinoma

    Directory of Open Access Journals (Sweden)

    Haiying Zhang

    2014-10-01

    Full Text Available Radiation safety is an integral part of targeted radionuclide therapy. The aim of this work was to study the external dose rate and retained body activity as functions of time in differentiated thyroid carcinoma patients receiving 131I therapy. Seventy patients were stratified into two groups: the ablation group (A and the follow-up group (FU. The patients’ external dose rate was measured, and simultaneously, their retained body radiation activity was monitored at various time points. The equations of the external dose rate and the retained body activity, described as a function of hours post administration, were fitted. Additionally, the release time for patients was calculated. The reduction in activity in the group receiving a second or subsequent treatment was more rapid than the group receiving only the initial treatment. Most important, an expeditious method was established to indirectly evaluate the retained body activity of patients by measuring the external dose rate with a portable radiation survey meter. By this method, the calculated external dose rate limits are 19.2, 8.85, 5.08 and 2.32 μSv·h−1 at 1, 1.5, 2 and 3 m, respectively, according to a patient’s released threshold level of retained body activity <400 MBq. This study is beneficial for radiation safety decision-making.

  17. Prothrombotic SERPINC1 gene polymorphism may affect heparin sensitivity among different ethnicities of Chinese patients receiving heart surgery.

    Science.gov (United States)

    Wang, Jiang; Ma, Hai-Ping; Ti, Ai Lai Ti Ta Lai; Zhang, Yong-Qiang; Zheng, Hong

    2015-11-01

    The purpose of this study was to investigate a possible correlation between single-nucleotide polymorphisms (SNPs) of the antithrombin (gene, SERPINC1, and perioperative sensitivity to heparin in patients receiving heart surgery. The SERPINC1 genotype and allele frequency, coagulation parameters 24 hours before and after surgery, and clinical findings were compared among 3 ethnic groups, Han, Uighur, and Kazakh, patientswho received heart surgery. In Han patients, longer coagulation time as well as higher heparin and protamine dosage was observed. SERPINC1 gene sequencing identified 2 mutations in exon 5, g.981A>G (rs5877) and g.1011A>G (rs5878). The minor allele frequency of allele (A>G) for rs5877 and rs5878 was higher in the Han patients and was significantly different among the ethnic groups (P = .004 and P = .006, respectively). The increased SERPINC1 SNP frequency among Han patients receiving heart surgery might contribute to the differences in their perioperative sensitivity to heparin.

  18. Family nutritional support improves survival, immune restoration and adherence in HIV patients receiving ART in developing country.

    Science.gov (United States)

    Serrano, Charlotte; Laporte, Remi; Ide, Moussa; Nouhou, Yacouba; de Truchis, Pierre; Rouveix, Elisabeth; Adamou, Adiza; Pauly, Vanessa; Mattei, Jean-François; Gastaut, Jean-Albert

    2010-01-01

    In developing countries, access to antiretroviral treatment for persons living with HIV is still in progress. Malnutrition represents another cause of acquired immunodeficiency and premature death. This evaluation program estimated the impact of family nutritional support during the first year of antiretroviral treatment in West Africa's sub-Sahara region. Family nutritional support was proposed to patients with CD-4 cell count patients receiving support was compared to 118 patients who had only received antiretroviral treatment the year before. Average body mass index, CD-4 cell count were 20.7 and 20.5, 217 and 191/mm3 respectively in supported and control groups (NS). Twenty-two (36%) and 56 (48%) were WHO stage III/IV (NS) respectively in supported and control groups. One patient who received support and twelve controls died (Mortality Ratio=0.19; pnutritional support for persons living with HIV initiating antiretroviral treatment in a developing country showed a positive impact after six months. This family intervention could be integrated into AIDS interventions as an effective and comprehensive community-based primary care.

  19. Therapeutic drug monitoring of piperacillin-tazobactam using spent dialysate effluent in patients receiving continuous venovenous hemodialysis.

    Science.gov (United States)

    Connor, Michael J; Salem, Charbel; Bauer, Seth R; Hofmann, Christina L; Groszek, Joseph; Butler, Robert; Rehm, Susan J; Fissell, William H

    2011-02-01

    Sepsis and multisystem organ failure are common diagnoses affecting nearly three-quarters of a million Americans annually. Infection is the leading cause of death in acute kidney injury, and the majority of critically ill patients who receive continuous dialysis also receive antibiotics. Dialysis equipment and prescriptions have gradually changed over time, raising concern that current drug dosing recommendations in the literature may result in underdosing of antibiotics. Our research group directed its attention toward antibiotic dosing strategies in patients with acute renal failure (ARF), and we sought data confirming that patients receiving continuous dialysis and antibiotics actually were achieving therapeutic plasma drug levels during treatment. In the course of those investigations, we explored "fast-track" strategies to estimate plasma drug concentrations. As most antimicrobial antibiotics are small molecules and should pass freely through modern high-flux hemodialyzer filters, we hypothesized that continuous renal replacement therapy (CRRT) effluent could be used as the medium for drug concentration measurement by reverse-phase high-pressure liquid chromatography (HPLC). Here we present the first data demonstrating this approach for piperacillin-tazobactam. Paired blood and dialysate trough-peak-trough samples were drawn from 19 patients receiving piperacillin-tazobactam and continuous venovenous hemodialysis (CVVHD). Total, free, and dialysate drug concentrations were measured by HPLC. Dialysate drug levels predicted plasma free drug levels well (r(2) = 0.91 and 0.92 for piperacillin and tazobactam, respectively) in all patients. These data suggest a strategy for therapeutic drug monitoring that minimizes blood loss from phlebotomy and simplifies analytic procedures.

  20. [Actual questions about the prevention of venous thromboembolism in cancer patients receiving chemotherapy].

    Science.gov (United States)

    Losonczy, Hajna; Nagy, Ágnes; Tar, Attila

    2016-02-07

    Cancer patients have a 2-7 fold increased risk of venous thromboembolism compared with the general population and, since 1990, this is associated with significant morbidity and mortality. This review summarizes the current knowledge on venous thromboembolism and cancer. Notably, the risk of venous thromboembolism varies depending on the type and stage of cancer. For instance, pancreatic and brain cancer patients have a higher risk of venous thromboembolism than breast and prostate cancer patients. Moreover, patients with metastatic disease have a higher risk than those with localized tumors. Tumor-derived procoagulant factors, cytokines and growth factors may directly and indirectly enhance venous thromboembolism. Chemotherapy produces ~6,5 fold increase in venous thromboembolism incidence in cancer patients compared to the general population. Prevention of this complication is challenging. The authors review the development of guidelines concerning venous thromboembolism prevention in hospitalized and also in ambulatory cancer patients treated with chemotherapy. Current guidelines recommend the use of low-molecular-weight heparin. Understanding the underlying mechanisms may allow the development of new therapies to safely prevent venous thromboembolism in cancer patients.

  1. PREVALENCE OF PULMONARY FUNCTION DEFECTS IN PSORIASIS PATIENTS RECEIVING METHOTREXATE IN A TERTIARY CARE HOSPITAL IN TAMIL NADU, INDIA

    Directory of Open Access Journals (Sweden)

    Allwyn Vijay

    2015-10-01

    Full Text Available Methotrexate is an anti - metabolite widely used in malignancy, rheumatoid arthritis and refractory cases of psoriasis . 1 The value of low dose methotrexate is well established . 2 - 4 There are evidences of pulmonary function defects in patients on long term low dose methotrexate in rheumatoid arthritis patients. Because methotrexate is frequently used in patients suffering from conditions such as RA, dermatomyositis or sarcoidosis, which can be associated wi th interstitial lung disease, determining the exact role of methotrexate in the development of pulmonary complications in these patients seems to be difficult. Therefore, we conducted a cross - sectional study to analyse the findings found on chest x - rays, h igh resolution computed tomography (HRCT and pulmonary function tests (PFT in a cohort of patients without previous recognized interstitial lung disease who were taking methotrexate as a treatment for psoriatic arthritis, a condition not associated with pleuro pulmonary disease. RESULTS: In this study 154 patients from the outpatient department of psoriasis clinic of dermatology department of government general hospital, Chennai who were receiving methotrexate for psoriasis were screened. Out of which 30 patients who were eligible as per inclusion criteria were included in the study. In this study 9 patients showed normal radiology and pulmonary function test. 21 patients had pulmonary function abnormalities. In this study there were 13(43% patients with restrictive pulmonary function defect. Belzenegui . 14 et al reported 2 cases with mild restriction among 27 patients in a similar study. There were 10(33% patients with diffusion defect in this study. Belzenegui et al reported 2 cases among 27 patients in a similar study. There were 5(16% patients with small airway disease as suggested by decrease in mean mid expiratory flow. Belzenegui et al reported 5 cases among 27 patients in a similar study. There were 3(3% patients with

  2. Effects of melatonin on physical fatigue and other symptoms in patients with advanced cancer receiving palliative care

    DEFF Research Database (Denmark)

    Lund Rasmussen, Charlotte; Klee Olsen, Marc; Thit Johnsen, Anna

    2015-01-01

    BACKGROUND: Patients with advanced cancer often experience fatigue and other symptoms that negatively impact their quality of life. The current trial investigated the effect of melatonin on fatigue and other symptoms in patients with advanced cancer. METHODS: Patients who were aged ≥18 years, had...... a histologically confirmed stage IV cancer (TNM Classification), and who reported feeling significantly tired were recruited from the palliative care unit at the study institution. The study was a double-blind, randomized, placebo-controlled crossover trial. Patients received 1 week of melatonin at a dose of 20 mg...... the placebo and melatonin periods were found for physical fatigue, secondary outcomes, or explorative outcomes. CONCLUSIONS: In the current study, oral melatonin at a dose of 20 mg was not found to improve fatigue or other symptoms in patients with advanced cancer....

  3. Quality of life assessment in patients with chronic pancreatitis receiving antioxidant therapy

    Institute of Scientific and Technical Information of China (English)

    Nehal; S; Shah; Alistair; J; Makin; Aali; J; Sheen; Ajith; K; Siriwardena

    2010-01-01

    AIM:To undertake a baseline study comparing quality of life(QoL) in patients with chronic pancreatitis(CP) on Antox to those with CP,matched for disease duration,who were not on this medication.METHODS:CP was defined according to the Zurich classification.Sixty eight consecutive patients with CP who were taking Antox(antioxidants) were compared with 69 consecutive control CP patients not on Antox.European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core questions 30 and P...

  4. High incidence of bloodstream infection due to gram-negative bacilli in patients with pulmonary hypertension receiving intravenous treprostinil.

    Science.gov (United States)

    López-Medrano, Francisco; Fernández-Ruiz, Mario; Ruiz-Cano, María José; Barrios, Elvira; Vicente-Hernández, María; Aguado, José María; Escribano, Pilar

    2012-12-01

    An excessive risk for bacteremia has recently been reported in patients with pulmonary arterial hypertension (PAH) treated with intravenous treprostinil. We aimed to assess this association in a cohort of patients from a Spanish referral center. We performed a retrospective cohort study that included 55 patients diagnosed with PAH who received a continuous intravenous infusion of a prostanoid (epoprostenol or treprostinil) for ≥1month at our center between January 1991 and December 2011. The risk factors associated with the incidence of bacteremia were analyzed with the log-rank test. After a total follow-up of 64,453 treatment days, we found 12 episodes of bacteremia: Staphylococcus aureus (5 episodes), non-fermenting gram-negative bacilli (4 episodes), other gram-positive cocci (2 episodes), and Enterobacter cloacae (one episode). The incidence of bacteremia was 0.118 episodes per 1,000 treatment days in patients receiving epoprostenol versus 0.938 episodes per 1,000 treatment-days in patients receiving treprostinil (P=.0037). All episodes of bacteremia due to Gram-negative bacilli were diagnosed in patients on treprostinil. In the univariate analysis the treatment with intravenous treprostinil was associated with the incidence of bacteremia (hazard ratio: 4.09; 95% confidence interval: 1.24-14.53), although the low number of events prevented us from performing a multivariate analysis. Therapy with intravenous treprostinil is associated with a higher risk for bacteremia, especially due to non-fermenting Gram-negative bacilli. This association should be taken in consideration when choosing empirical antibiotic therapy for patients with PAH and sepsis. Copyright © 2012 SEPAR. Published by Elsevier Espana. All rights reserved.

  5. Effects of aerobic exercise on cancer-related fatigue in breast cancer patients receiving chemotherapy: a meta-analysis.

    Science.gov (United States)

    Zou, Ling-Yun; Yang, Liu; He, Xiao-Ling; Sun, Ming; Xu, Jin-Jiang

    2014-06-01

    Increasing scientific evidences suggest that aerobic exercise may improve cancer-related fatigue in breast cancer patients, but many existing studies have yielded inconclusive results. This meta-analysis aimed to derive a more precise estimation of the effects of aerobic exercise on cancer-related fatigue in breast cancer patients receiving chemotherapy. The PubMed, CISCOM, CINAHL, Web of Science, Google Scholar, EBSCO, Cochrane Library, and CBM databases were searched from inception through July 1, 2013 without language restrictions. Crude standardized mean difference (SMD) with 95 % confidence interval (CI) was calculated. Twelve comparative studies were assessed with a total of 1,014 breast cancer patients receiving chemotherapy, including 522 patients in the aerobic exercise group (intervention group) and 492 patients in the usual care group (control group). The meta-analysis results revealed that the Revised Piper Fatigue Scale (RPFS) scores of breast cancer patients in the intervention group were significantly lower than those in the control group (SMD=-0.82, 95% CI=-1.04 ∼ -0.60, Pintervention and control groups (SMD=0.09, 95% CI=-0.07 ∼ 0.25, P=0.224). Subgroup analysis by ethnicity indicated that there were significant differences in RPFS and FACIT-F scores between the intervention and control groups among Asian populations (RPFS: SMD=-1.08, 95% CI=-1.35 ∼ -0.82, P0.05). The current meta-analysis indicates that aerobic exercise may improve cancer-related fatigue in breast cancer patients receiving chemotherapy, especially among Asian populations.

  6. Decreased risk of stroke in patients with traumatic brain injury receiving acupuncture treatment: a population-based retrospective cohort study.

    Directory of Open Access Journals (Sweden)

    Chun-Chuan Shih

    Full Text Available BACKGROUND: Patients with traumatic brain injury (TBI face increased risk of stroke. Whether acupuncture can help to protect TBI patients from stroke has not previously been studied. METHODS: Taiwan's National Health Insurance Research Database was used to conduct a retrospective cohort study of 7409 TBI patients receiving acupuncture treatment and 29,636 propensity-score-matched TBI patients without acupuncture treatment in 2000-2008 as controls. Both TBI cohorts were followed until the end of 2010 and adjusted for immortal time to measure the incidence and adjusted hazard ratios (HRs with 95% confidence intervals (CIs of new-onset stroke in the multivariable Cox proportional hazard models. RESULTS: TBI patients with acupuncture treatment (4.9 per 1000 person-years had a lower incidence of stroke compared with those without acupuncture treatment (7.5 per 1000 person-years, with a HR of 0.59 (95% CI = 0.50-0.69 after adjustment for sociodemographics, coexisting medical conditions and medications. The association between acupuncture treatment and stroke risk was investigated by sex and age group (20-44, 45-64, and ≥65 years. The probability curve with log-rank test showed that TBI patients receiving acupuncture treatment had a lower probability of stroke than those without acupuncture treatment during the follow-up period (p<0.0001. CONCLUSION: Patients with TBI receiving acupuncture treatment show decreased risk of stroke compared with those without acupuncture treatment. However, this study was limited by lack of information regarding lifestyles, biochemical profiles, TBI severity, and acupuncture points used in treatments.

  7. Evaluation of the walking pattern in clubfoot patients who received early intensive treatment

    DEFF Research Database (Denmark)

    Alkjaer, T; Pedersen, E N; Simonsen, E B

    2000-01-01

    joint in the clubfeet could possibly be owing to weaker plantar flexors. In conclusion, gait analysis can be an important tool when evaluating treatment for clubfoot. However, further investigation is needed to determine whether the higher hip and knee joint moments observed in subjects with clubfoot......The walking pattern in a group of nine adult male subjects who had received early intensive treatment for congenital clubfoot was evaluated and compared to the walking pattern in a control group of 15 adult healthy male subjects. All subjects were filmed with a five-camera video system...

  8. Rate and Time of Ovarian Function Restoration in Menopausal Breast Cancer Patients Who Received Letrozole Following Chemotherapy

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    Shapour Omidvari

    2015-01-01

    Full Text Available Background: The present study aimed to investigate the rate and time of ovarian function restoration in breast cancer patients between 40 and 60 years of age who were in menopause (biochemically documented and received letrozole after chemotherapy. We intended to further clarify the management strategy for breast cancer patients with different menopausal status. Methods: We prospectively measured the effects of replacing tamoxifen with letrozole on ovarian function recovery in 90 women from two age groups (40-50 and 51-60 years. All had breast cancer and were treated by chemotherapy. Patients had laboratory documentation of menopause (FSH >40 mIU/ml and estradiol <20 pg/mL. Patients did not have menstruation for at least one year. Study patients received letrozole. At three month intervals, we checked their FSH and estradiol levels. Results:At three months after beginning letrozole, 12 patients in the younger age group had laboratory ovarian function restoration, among which three had vaginal bleeding. In the older group, 8 patients had increased estradiol levels; however, there was no evidence of vaginal bleeding in this group. At 6, 9 and 12 months, no ovarian function restoration was seen in the older group. However in younger patients, 4 had laboratory evidence of ovarian function restoration at 6 months, 2 at 9 months and 1 patient showed laboratory ovarian function restoration at 12 months of follow-up. Totally, there was a significant difference in the occurrence of ovarian function restoration between the two groups (P=0.03. Conclusion: A remarkable portion of women with chemotherapy-induced amenorrhea may develop ovarian function restoration. Therefore, endocrine therapy using aromatase inhibitors in patients with chemotherapy-induced amenorrhea should be followed by a regular hormonal study.

  9. Perioperative management of hemophilia patients receiving total hip and knee arthroplasty: a complication report of two cases

    Directory of Open Access Journals (Sweden)

    Tateiwa T

    2015-09-01

    Full Text Available Toshiyuki Tateiwa,1 Yasuhito Takahashi,1,2 Tsunehito Ishida,1 Kosuke Kubo,1 Toshinori Masaoka,1 Takaaki Shishido,1 Keiji Sano,1 Kengo Yamamoto11Department of Orthopedic Surgery, 2Department of Bone and Joint Biomaterial Research, Tokyo Medical University, Tokyo, JapanAbstract: It has been recognized that perioperative hemostasis management after joint-replacement surgery for hemophilia patients is complicated and cumbersome, due to the necessity of rigorous monitoring for clotting-factor levels throughout the infusion. Between 2005 and 2014, we examined seven patients with hemophilia A (ten joints: six hips and four knees receiving total hip or knee arthroplasty (THA or TKA for hemophilic arthropathy. One male patient (31 years old showed an intra-articular hematoma formation after THA (case 1. In another male patient (46 years old receiving TKA, the postoperative trough factor VIII level became lower significantly than reference levels (80%–100% for the 5–10 postoperative days recommended by the guidelines from the Japanese Society on Thrombosis and Hemostasis, despite sufficient coagulant based on the guidelines being administered (case 2. In the latter patient, deep infection and hematoma formation were observed postoperatively. In this article, we provide a detailed clinical report regarding these two complication cases at the early postoperative periods, and the management of bleeding control for hemophilia patients is discussed.Keywords: hemophilia A, arthroplasty, clotting factor VIII levels, hematoma, infection

  10. Antimicrobial dosing concepts and recommendations for critically ill adult patients receiving continuous renal replacement therapy or intermittent hemodialysis.

    Science.gov (United States)

    Heintz, Brett H; Matzke, Gary R; Dager, William E

    2009-05-01

    Infectious diseases and impaired renal function often occur in critically ill patients, and delaying the start of appropriate empiric antimicrobial therapy or starting inappropriate therapy has been associated with poor outcomes. Our primary objective was to critically review and discuss the influence of chronic kidney disease (CKD) and acute kidney injury (AKI) on the clinical pharmacokinetic and pharmacodynamic properties of antimicrobial agents. The effect of continuous renal replacement therapies (CRRTs) and intermittent hemodialysis (IHD) on drug disposition in these two populations was also evaluated. Finally, proposed dosing strategies for selected antimicrobials in critically ill adult patients as well as those receiving CRRT or IHD have been compiled. We conducted a PubMed search (January 1980-March 2008) to identify all English-language literature published in which dosing recommendations were proposed for antimicrobials commonly used in critically ill patients, including those receiving CRRT or IHD. All pertinent reviews, selected studies, and associated references were evaluated to ensure their relevance. Forty antimicrobial, antifungal, and antiviral agents commonly used in critically ill patients were included for review. Dosage recommendations were synthesized from the 42 reviewed articles and peer-reviewed, evidence-based clinical drug databases to generate initial guidance for the determination of antimicrobial dosing strategies for critically ill adults. Because of the evolving process of critical illness, whether in patients with AKI or in those with CKD, prospective adaptation of these initial dosing recommendations to meet the needs of each individual patient will often rely on prospectively collected clinical and laboratory data.

  11. Rheumatoid Arthritis vs Osteoarthritis in Patients Receiving Total Knee Arthroplasty: Perioperative Outcomes

    Science.gov (United States)

    Stundner, Ottokar; Danninger, Thomas; Chiu, Ya-Lin; Sun, Xuming; Goodman, Susan M; Russell, Linda A; Figgie, Mark; Mazumdar, Madhu; Memtsoudis, Stavros G

    2013-01-01

    There is a paucity of data available on perioperative outcomes of patients undergoing total knee arthroplasty (TKA) for rheumatoid arthritis (RA). We determined differences in demographics and risk for perioperative adverse events between patients suffering from osteoarthritis (OA) versus RA using a population-based approach. Of 351,103 entries for patients who underwent TKA, 3.4% had a diagnosis of RA. RA patients were on average younger [RA: 64.3 years vs OA: 66.6 years; p<0.001] and more likely female [RA: 79.2% vs OA: 63.2%; P<0. 001]. The unadjusted rates of mortality and most major perioperative adverse events were similar in both groups, with the exception of infection [RA: 4.5% vs. OA: 3.8%; P<0.001]. RA was not associated with increased adjusted odds for combined adverse events. PMID:23764034

  12. Cost Effectiveness of Integrated Medicine in Patients With Cancer Receiving Anticancer Chemotherapy

    OpenAIRE

    Coriat, Romain; Boudou-Rouquette, Pascaline; Durand, Jean-Philippe; Forgeot d'Arc, Priscille; Martin, Idalie; Mir, Olivier; Ropert, Stanislas; Alexandre, Jérôme; Goldwasser, François

    2012-01-01

    The hospital-home monitoring program is a cost-effective strategy for offering ambulatory chemotherapy treatment to patients with cancer and has become the authors' standard procedure for ambulatory chemotherapy.

  13. THE PROBLEM OF THE USE OF NEW ORAL ANTICOAGULANTS IN CANCER PATIENTS RECEIVING CHEMOTHERAPY

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    A. A. Rumyantsev

    2014-01-01

    Full Text Available Despite large number of known risk factors of venous thromboembolism (VTE in cancer patients existing prediction models do not allow definite identification of cancer patients that have indications for anticoagulant prevention. Besides, heparin and warfarin use for VTE prevention in cancer is accompanied by some problems. New oral anticoagulants (NOAC are promising drugs for use in oncology practice; however their use is complicated by the lack of data on efficacy and safety in these patients, potential drug interactions and the possibility of unpredictable changes in effect during chemotherapy. Widespread use of NOAC for the prevention and treatment of tumor-associated VTE prior to phase III trials is not recommended. However, the criteria for selection of patients for whom the study of the efficacy and safety of NOAC is a priority can now be developed.

  14. Variability in heparin sensitivity of appt reagents in heparinized plasma in vitro and patients receiving heparin

    National Research Council Canada - National Science Library

    Fernanda Daniela Serralvo; Jacinta Ludovico Zamboti; Maria Emilia Favero; José Wander Bregano

    2015-01-01

    ... used for its determination. Objective: To evaluate the sensibility to heparin in the different reagents used to determine APPT in samples of heparinized plasma in vitro and in patients using non-fractioned heparin (NFH...

  15. Do advanced cancer patients in Denmark receive the help they need?

    DEFF Research Database (Denmark)

    Johnsen, Anna Thit; Petersen, Morten Aagaard; Pedersen, Lise;

    2013-01-01

    The aim of the study was to investigate the adequacy of help delivered by the healthcare system for 12 symptoms/problems in a national, randomly selected sample of advanced cancer patients in Denmark....

  16. Increased financial burden among patients with chronic myelogenous leukaemia receiving imatinib in Japan: a retrospective survey

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    Kodama Yuko

    2012-04-01

    Full Text Available Abstract Background The financial burden of medical expenses has been increasing for cancer patients. We investigated the relationship between household income and financial burden among patients with chronic myelogenous leukaemia (CML who have been treated with imatinib. Methods A questionnaire was distributed to 1200 patients between May and August 2009. We retrospectively surveyed their household incomes, out-of-pocket medical expenses, final co-payments after refunds, and the perceived financial burden of their medical expenses in 2000, 2005 and 2008. Results A total of 577 patients completed the questionnaire. Their median age was 61 years (range, 15–94. A financial burden was felt by 41.2 % (28 of 68 of the patients treated with imatinib in 2000, 70.8 % (201 of 284 in 2005, and 75.8 % (400 of 528 in 2008. Overall, 182 patients (31.7 % considered its discontinuation because of the financial burden and 15 (2.6 % temporarily stopped their imatinib prescription. In 2000, 2005 and 2008, the patients’ median annual household incomes were 49,615 US Dollars (USD, 38,510 USD and 36,731 USD, respectively, with an average currency exchange rate of 104 Yen/USD in 2008. Their median annual out-of-pocket expenses were 11,548, 12,067 and 11,538 USD and their median final annual co-payments were 4,375, 4,327 and 3,558 USD, respectively. Older patients (OR = 0.96, 95 % CI: 0.95–0.98, p ≪ 0.0001 for 1-year increments, and patients with higher household incomes (OR = 0.92, 95 % CI: 0.85–0.99, p = 0.03 for 10,000 USD-increments were less likely to have considered discontinuing their imatinib treatment. Conversely, patients with higher annual final co-payments (OR = 2.21, 95 % CI: 1.28–4.28, p = 0.004 for 10,000 USD-increments were more likely to have considered discontinuing their imatinib treatment. Conclusions The proportion of CML patients who sensed a financial burden increased between 2000 and 2008

  17. An Easy Tool to Predict Survival in Patients Receiving Radiation Therapy for Painful Bone Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Westhoff, Paulien G., E-mail: p.g.westhoff@umcutrecht.nl [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands); Graeff, Alexander de [Department of Medical Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Monninkhof, Evelyn M. [Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht (Netherlands); Bollen, Laurens; Dijkstra, Sander P. [Department of Orthopedic Surgery, Leiden University Medical Center (Netherlands); Steen-Banasik, Elzbieta M. van der [ARTI Institute for Radiation Oncology Arnhem, Arnhem (Netherlands); Vulpen, Marco van [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands); Leer, Jan Willem H. [Department of Radiotherapy, University Medical Center Nijmegen, Nijmegen (Netherlands); Marijnen, Corrie A.; Linden, Yvette M. van der [Department of Clinical Oncology, Leiden University Medical Center, Leiden (Netherlands)

    2014-11-15

    Purpose: Patients with bone metastases have a widely varying survival. A reliable estimation of survival is needed for appropriate treatment strategies. Our goal was to assess the value of simple prognostic factors, namely, patient and tumor characteristics, Karnofsky performance status (KPS), and patient-reported scores of pain and quality of life, to predict survival in patients with painful bone metastases. Methods and Materials: In the Dutch Bone Metastasis Study, 1157 patients were treated with radiation therapy for painful bone metastases. At randomization, physicians determined the KPS; patients rated general health on a visual analogue scale (VAS-gh), valuation of life on a verbal rating scale (VRS-vl) and pain intensity. To assess the predictive value of the variables, we used multivariate Cox proportional hazard analyses and C-statistics for discriminative value. Of the final model, calibration was assessed. External validation was performed on a dataset of 934 patients who were treated with radiation therapy for vertebral metastases. Results: Patients had mainly breast (39%), prostate (23%), or lung cancer (25%). After a maximum of 142 weeks' follow-up, 74% of patients had died. The best predictive model included sex, primary tumor, visceral metastases, KPS, VAS-gh, and VRS-vl (C-statistic = 0.72, 95% CI = 0.70-0.74). A reduced model, with only KPS and primary tumor, showed comparable discriminative capacity (C-statistic = 0.71, 95% CI = 0.69-0.72). External validation showed a C-statistic of 0.72 (95% CI = 0.70-0.73). Calibration of the derivation and the validation dataset showed underestimation of survival. Conclusion: In predicting survival in patients with painful bone metastases, KPS combined with primary tumor was comparable to a more complex model. Considering the amount of variables in complex models and the additional burden on patients, the simple model is preferred for daily use. In addition, a risk table for survival is

  18. Fatigue in patients receiving maintenance dialysis: a review of definitions, measures, and contributing factors.

    Science.gov (United States)

    Jhamb, Manisha; Weisbord, Steven D; Steel, Jennifer L; Unruh, Mark

    2008-08-01

    Fatigue is a debilitating symptom or side effect experienced by many patients on long-term dialysis therapy. Fatigue has a considerable effect on patient health-related quality of life and is viewed as being more important than survival by some patients. Renal providers face many challenges when attempting to reduce fatigue in dialysis patients. The lack of a reliable, valid, and sensitive fatigue scale complicates the accurate identification of this symptom. Symptoms of daytime sleepiness and depression overlap with fatigue, making it difficult to target specific therapies. Moreover, many chronic health conditions common in the long-term dialysis population may lead to the development of fatigue and contribute to the day-to-day and diurnal variation in fatigue in patients. Key to improving the assessment and treatment of fatigue is improving our understanding of potential mediators, as well as potential therapies. Cytokines have emerged as an important mediator of fatigue and have been studied extensively in patients with cancer-related fatigue. In addition, although erythropoietin-stimulating agents have been shown to mitigate fatigue, the recent controversy regarding erythropoietin-stimulating agent dosing in patients with chronic kidney disease suggests that erythropoietin-stimulating agent therapy may not serve as the sole therapy to improve fatigue in this population. In conclusion, fatigue is an important and often underrecognized symptom in the dialysis population. Possible interventions for minimizing fatigue in patients on long-term dialysis therapy should aim at improving health care provider awareness, developing improved methods of measurement, understanding the pathogenesis better, and managing known contributing factors.

  19. Pulmonary artery rupture in a patient receiving an orthotopic heart transplant after total artificial heart explant.

    Science.gov (United States)

    Nomoto, Koichi; Weiner, Menachem M; Evans, Adam

    2014-02-01

    Our case illustrates a patient who suffered a pulmonary artery rupture despite previous total artificial heart implantation and replacement with orthotopic heart transplant. Pulmonary artery rupture during or following cardiac surgery has been reported to occur due to both pulmonary artery catheter use and surgical technique. Our case is the first to demonstrate the occurrence of this complication in the total artificial heart patient population.

  20. Significances and meanings of the musical identity of patients and relatives receiving oncological palliative care

    OpenAIRE

    Vladimir Araujo Silva; Neide Aparecida Titonelli Alvim; Sonia Silva Marcon

    2014-01-01

    This phenomenological study was structured on Heidegger’s theoretical-philosophical framework, with the objective of unveiling the significances and meanings of the musical identity of patients and relatives under oncological palliative care. Individual interviews were performed with 12 clients (seven patients and five relatives) staying at the support residence of the Maringa Female Network Against Cancer. A total of eight musical meetings were performed between January and February of 2011....

  1. Dental management of patients receiving anticoagulant and/or antiplatelet treatment

    OpenAIRE

    Mingarro de León, Ana; Chaveli López, Begonya; Gavaldá Esteve, Carmen

    2014-01-01

    Introduction: Adequate hemostasis is crucial for the success of invasive dental treatment, since bleeding problems can give rise to complications associated with important morbidity-mortality. The dental treatment of patients who tend to an increased risk of bleeding due to the use of anticoagulant and/or antiplatelet drugs raises a challenge in the daily practice of dental professionals. Adequate knowledge of the mechanisms underlying hemostasis, and the optimized management of such patients...

  2. Outcomes in COPD patients receiving tiotropium or salmeterol plus treatment with inhaled corticosteroids

    OpenAIRE

    Hodder, Richard; Kesten, Steven; Menjoge, Shailendra; Viel, Klaus

    2007-01-01

    Patients with COPD are frequently prescribed inhaled corticosteroids (ICS); however, it is unclear whether the treatment with ICS might modify responses to inhaled bronchodilators. Two 6-month, randomized, placebo-controlled, double-blind, double-dummy, parallel-group studies of tiotropium 18 μg once daily, compared with salmeterol, 50 μg bid, had been conducted in patients with moderate-to-severe COPD. Efficacy was assessed by spirometry, transition dyspnea index (TDI), St. George’s Respirat...

  3. Patient identified needs for chronic obstructive pulmonary disease versus billed services for care received

    Directory of Open Access Journals (Sweden)

    Jill Heins-Nesvold

    2008-09-01

    Full Text Available Jill Heins-Nesvold1, Angeline Carlson2, Leslie King-Schultz3, Kenneth E Joslyn41American Lung Association of Minnesota, St. Paul, MN, USA; 2Data Intelligence Consultants, LLC, Eden Prairie, MN, USA; 3Mayo Medical School, Rochester, MN, USA; 4Medica Health Plan, Minnetonka, MN, USAAbstract: The American Lung Association of Minnesota (ALAMN was granted access to a 2004 administrative claims data from an upper mid-Western, independent practice association model health plan. Claims information, including demographics, prevalence, medication and oxygen therapy, and health care utilization, was extracted for 7,782 patients with COPD who were 40 years of age and older. In addition, ALAMN conducted a survey of 1,911 patients from Minnesota diagnosed with COPD. The survey queried the patients about demographics, treatment, medications, limitations, wants, and needs. This article compares and contrasts the information gained through the health plan administrative claims database with the findings from the COPD patient survey in areas of age, gender, types of provider primarily responsible for COPD care, spirometry use, medication therapy, pulmonary rehabilitation, oxygen therapy, and health care utilization. Primary care practitioners provided a majority of the COPD-related care. The claims evidence of spirometry use was 16%–62% of COPD patients had claims evidence of COPD-related medications. 25% of patients reported, and 23% of patients had claims evidence of, a hospitalization during the observation year. 16% of patients reported using pulmonary rehabilitation programs. The results indicate there is an opportunity to improve COPD diagnosis and management.Keywords: chronic obstructive pulmonary disease, oxygen therapy, medication therapy, spirometry, chronic care, assessment

  4. Reduced Use of Emergency Care and Hospitalization in Patients with Traumatic Brain Injury Receiving Acupuncture Treatment

    OpenAIRE

    Chun-Chuan Shih; Hsun-Hua Lee; Ta-Liang Chen; Chin-Chuan Tsai; Hsin-Long Lane; Wen-Ta Chiu; Chien-Chang Liao

    2013-01-01

    Background. Little research exists on acupuncture treatment's effect on patients with traumatic brain injury (TBI). Methods. Using Taiwan's National Health Insurance Research Database, we conducted a cohort study to compare the use of emergency care and hospitalization in TBI patients with and without acupuncture treatment in the first year after TBI. The adjusted relative risks (RRs) and 95% confidence intervals (CIs) of high use of emergency care and hospitalization associated with acupunct...

  5. Levodopa Withdrawal Presenting as Fever in a Critically Ill Patient Receiving Concomitant Enteral Nutrition.

    Science.gov (United States)

    Whitman, Craig B; Ablordeppey, Enyo; Taylor, Beth

    2016-12-01

    Nutritional protein may decrease levodopa absorption and has resulted in withdrawal and neuroleptic malignant-like syndromes in critically ill patients. A 72-year-old male was admitted with shortness of breath. His medical history included Parkinson's disease for over 30 years for which he took carbidopa/levodopa 5 times daily. The patient's home medications were continued. On day 2, he was intubated and transferred to the intensive care unit (ICU). He was extubated the next day and reintubated on day 4. Enteral nutrition was initiated at 85 mL/h overnight. The patient's carbidopa/levodopa was administered to limit coadministration with nutrition. Throughout his ICU stay, the patient did not demonstrate changes in mental status. Despite resolution of his pneumonia, he developed fever after administration of one dose overlapping with nutrition, with defervescence throughout the rest of the day. On hospital day 10, that dose was empirically increased. After this dosing change, the patient failed to develop fever during the rest of his hospital stay. On day 16, the patient was discharged to a long-term care facility without any other complications. Our case highlights the interaction between levodopa and enteral nutrition and the potential of fever as the sole sign of withdrawal.

  6. Incidence and impact of dysphagia in patients receiving prolonged endotracheal intubation after cardiac surgery.

    Science.gov (United States)

    Barker, Jennifer; Martino, Rosemary; Reichardt, Beatrix; Hickey, Edward J; Ralph-Edwards, Anthony

    2009-04-01

    Cardiac surgery is frequently associated with prolonged endotracheal intubation. Because oral feeding is an important component of patient recovery after high-risk surgery, we sought to examine the contribution of dysphagia in the recuperation process after prolonged endotracheal intubation. All 254 adult patients who survived cardiac surgery between 2001 and 2004 at the Toronto General Hospital and in whom endotracheal intubation lasted for 48 hours or longer were eligible for our retrospective review. We used multivariate regression analysis and parametric modelling to identify patient-specific characteristics associated with postextubation dysphagia and the subsequent resumption of normal oral feeding. Dysphagia was diagnosed in 130 (51%) patients. Incremental factors associated with an increased risk for postextubation dysphagia included duration of endotracheal intubation (p index procedural characteristics were influential factors. The occurrence of dysphagia (p endotracheal intubation (p endotracheal intubation (p endotracheal intubation events (p endotracheal intubation after cardiac surgery than has previously been reported. The duration of postoperative endotracheal intubation is a strong predictor of subsequent dysphagia that both prolongs the return to normal oral feeding and delays subsequent hospital discharge. Patient-or procedure-specific factors are not good predictors. To accelerate discharge of high-risk patients, aggressive nutritional supplementation should pre-empt extubation and swallowing surveillance should follow.

  7. Adherence and Risk Behaviour in Patients with HIV Infection Receiving Antiretroviral Therapy in Bangkok.

    Science.gov (United States)

    Clarke, Amanda; Kerr, Stephen; Honeybrook, Adam; Cooper, David A; Avihingsanon, Anchalee; Duncombe, Chris; Phanuphak, Praphan; Ruxrungtham, Kiat; Ananworanich, Jintanat; Kaldor, John

    2012-01-01

    It could be postulated that due to lifestyle factors, patients with poor antiretroviral therapy (ART) adherence may also have risky sexual behaviour potentially leading to HIV transmission. There are limited data regarding unprotected sex risk and ART adherence in resource limited settings and our study set out to investigate these in an HIV clinic in Bangkok. Patients completed an anonymous questionnaire regarding their relationship details, ART adherence, sexual behaviour, alcohol and drug use and HIV transmission beliefs. Laboratory findings and medical history were also collected. Unprotected sex risk (USR) was defined as inconsistent condom use with a partner of negative or unknown HIV status. Five hundred and twelve patients completed the questionnaire. Fifty seven per cent of patients reported having taken ARV >95% of the time in the last month and 58% had been sexually active in the previous 30 days. Only 27 patients (5%) were classified as having USR in our cohort. Multivariate analysis showed USR was associated with female gender (OR 2.9, 95% CI 1.2-7.0, p0.02) but not with adherence, age, type or number of partners, recreational drug or alcohol use nor beliefs about HIV transmission whilst taking ART. Levels of USR in this resource limited setting were reassuringly low and not associated with poor ART adherence; as all USR patients had undetectable viral loads onward HIV transmission risk is likely to be low but not negligible. Nonetheless condom negotiation techniques, particularly in women, may be useful in this group.

  8. [Clinical benefit of HCV core antigen assay in patients receiving interferon and ribavirin combination therapy].

    Science.gov (United States)

    Higashimoto, Makiko; Takahashi, Masahiko; Jokyu, Ritsuko; Saito, Hidetsugu

    2006-02-01

    A highly sensitive second generation HCV core antigen assay has recently been developed. We compared viral disappearance and kinetics data between commercially available core antigen assays, Lumipulse Ortho HCV Ag, and a quantitative HCV RNA PCR assay, Cobas Amplicor HCV Monitor Test, Version 2 to estimate the predictive benefit of sustained viral response (SVR) and non-SVR in 59 patients treated with interferon and ribavirin combination therapy. We found a good correlation between HCV core Ag and HCV RNA level regardless of genotype. Although the sensitivity of the core antigen assay was lower than PCR, the dynamic range was broader than that of the PCR assay, so that we did not need to dilute the samples in 59 patients. We detected serial decline of core Ag levels in 24 hrs, 7 days and 14 days after interferon combination therapy. The decline of core antigen levels was significant in SVR patients compared to non-SVR as well as in genotype 2a, 2b patients compared to 1b. Core antigen-negative on day 1 could predict all 10 SVR patients (PPV = 100%), whereas RNA-negative could predict 22 SVR out of 25 on day 14 (PPV = 88.0%). None of the patients who had detectable serum core antigen on day 14 became SVR(NPV = 100%), although NPV was 91.2% on RNA negativity. An easy, simple, low cost new HCV core antigen detecting system seems to be useful for assessing and monitoring IFN treatment for HCV.

  9. Orofacial pain and predictors in oral squamous cell carcinoma patients receiving treatment.

    Science.gov (United States)

    Chen, Shu-Ching; Liao, Chun-Ta; Chang, Joseph Tung-Chien

    2011-02-01

    Surgical and radiation therapy for oral squamous cell carcinoma (OSCC) may generate orofacial pain. The aims of this study were to (1) characterize the pain experienced by people with orofacial pain, and (2) determine the factors associated with changes in orofacial pain in OSCC patients during the postoperative and post-radiation therapy periods. The study had a prospective longitudinal design with consecutive sampling. Seventy-two eligible patients were recruited from the outpatient department of otolaryngology, head and neck cancer, and radiation therapy of a medical center in northern Taiwan. A set of questionnaires was used for patient assessment, including the University of California San Francisco Oral Cancer Pain Questionnaire, Symptom Severity Scale, Hospital Anxiety and Depression Scale, and Karnofsky's Performance Status Index. Patients were assessed at two time points: 1 month after surgery (T1) and 1 month after completion of radiation treatment (T2). The findings showed that (1) patients reported moderate orofacial pain at both time points; (2) orofacial pain, oral function-related symptoms, and psychological distress were significantly higher at T1 than at T2; and (3) older age, eating difficulty, speech difficulty, and depression were significant predictors of orofacial pain. Oral rehabilitation and relaxation training may reduce orofacial pain in this patient population.

  10. HLA Immunogenotype Determines Persistent Human Papillomavirus Virus Infection in HIV-Infected Patients Receiving Antiretroviral Treatment.

    Science.gov (United States)

    Meys, Rhonda; Purdie, Karin J; de Koning, Maurits N C; Quint, Koen D; Little, Ann-Margaret; Baker, Finnuala; Francis, Nick; Asboe, David; Hawkins, David; Marsh, Steven G E; Harwood, Catherine A; Gotch, Frances M; Bunker, Christopher B

    2016-06-01

    A proportion of human immunodeficiency virus (HIV)-infected patients develop persistent, stigmatizing human papillomavirus (HPV)-related cutaneous and genital warts and anogenital (pre)cancer. This is the first study to investigate immunogenetic variations that might account for HPV susceptibility and the largest to date to categorize the HPV types associated with cutaneous warts in HIV-positive patients. The HLA class I and II allele distribution was analyzed in 49 antiretroviral (ART)-treated HIV-positive patients with persistent warts, 42 noninfected controls, and 46 HIV-positive controls. The allele HLA-B*44 was more frequently identified in HIV-positive patients with warts (P = .004); a susceptible haplotype (HLA-B*44, HLA-C*05; P = .001) and protective genes (HLA-DQB1*06; P = .03) may also contribute. Cutaneous wart biopsy specimens from HIV-positive patients harbored common wart types HPV27/57, the unusual wart type HPV7, and an excess of Betapapillomavirus types (P = .002), compared with wart specimens from noninfected controls. These findings suggest that HLA testing might assist in stratifying those patients in whom vaccination should be recommended. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  11. A new system for continuous and remote monitoring of patients receiving home mechanical ventilation

    Science.gov (United States)

    Battista, L.

    2016-09-01

    Home mechanical ventilation is the treatment of patients with respiratory failure or insufficiency by means of a mechanical ventilator at a patient's home. In order to allow remote patient monitoring, several tele-monitoring systems have been introduced in the last few years. However, most of them usually do not allow real-time services, as they have their own proprietary communication protocol implemented and some ventilation parameters are not always measured. Moreover, they monitor only some breaths during the whole day, despite the fact that a patient's respiratory state may change continuously during the day. In order to reduce the above drawbacks, this work reports the development of a novel remote monitoring system for long-term, home-based ventilation therapy; the proposed system allows for continuous monitoring of the main physical quantities involved during home-care ventilation (e.g., differential pressure, volume, and air flow rate) and is developed in order to allow observations of different remote therapy units located in different places of a city, region, or country. The developed remote patient monitoring system is able to detect various clinical events (e.g., events of tube disconnection and sleep apnea events) and has been successfully tested by means of experimental tests carried out with pulmonary ventilators typically used to support sick patients.

  12. Assessing treatment motivation among patients receiving antiretroviral therapy: a multidimensional approach.

    Science.gov (United States)

    Houston, Eric; McKirnan, David J; Cervone, Daniel; Johnson, Matthew S; Sandfort, Theo G M

    2012-01-01

    Using multidimensional scaling (MDS) analysis, this study examined how patient conceptualisations of treatment motivation compare with theoretically based assumptions used in current assessment approaches. Patients undergoing antiretroviral therapy for HIV/AIDS (n=39) rated for similarity between all possible pairings of 23 treatment descriptions, including descriptors of intrinsic, extrinsic, approach and avoidance motivation. MDS analyses revealed that patient perceptions of intrinsic and extrinsic motivations often differ from those based on definitions derived from common interpretations of self-determination theory. Findings also showed that patients reported motivation for avoiding treatment when they associated their medication regimens with side effects and other negatively valenced outcomes. The study describes new applications of MDS in assessing how patients perceive the relationship between treatment behaviours and specific forms of motivation, such as intrinsic and extrinsic motivations. In addition, the study suggests how MDS may be used to develop behavioural strategies aimed at helping patients follow their regimens consistently by identifying treatment conceptualisations and contexts that facilitate or impede adherence.

  13. Costs of terminal patients who receive palliative care or usual care in different hospital wards.

    Science.gov (United States)

    Simoens, Steven; Kutten, Betty; Keirse, Emmanuel; Berghe, Paul Vanden; Beguin, Claire; Desmedt, Marianne; Deveugele, Myriam; Léonard, Christian; Paulus, Dominique; Menten, Johan

    2010-11-01

    In addition to the effectiveness of hospital care models for terminal patients, policy makers and health care payers are concerned about their costs. This study aims to measure the hospital costs of treating terminal patients in Belgium from the health care payer perspective. Also, this study compares the costs of palliative and usual care in different types of hospital wards. A multicenter, retrospective cohort study compared costs of palliative care with usual care in acute hospital wards and with care in palliative care units. The study enrolled terminal patients from a representative sample of hospitals. Health care costs included fixed hospital costs and charges relating to medical fees, pharmacy and other charges. Data sources consisted of hospital accountancy data and invoice data. Six hospitals participated in the study, generating a total of 146 patients. The findings showed that palliative care in a palliative care unit was more expensive than palliative care in an acute ward due to higher staffing levels in palliative care units. Palliative care in an acute ward is cheaper than usual care in an acute ward. This study suggests that palliative care models in acute wards need to be supported because such care models appear to be less expensive than usual care and because such care models are likely to better reflect the needs of terminal patients. This finding emphasizes the importance of the timely recognition of the need for palliative care in terminal patients treated in acute wards.

  14. Patients Undergoing Substance Abuse Treatment and Receiving Financial Assistance for a Physical Disability Respond Well to Contingency Management Treatment.

    Science.gov (United States)

    Burch, Ashley E; Morasco, Benjamin J; Petry, Nancy M

    2015-11-01

    Physical illness and disability are common in individuals with substance use disorders, but little is known about the impact of physical disability status on substance use treatment outcomes. This study examined the main and interactive effects of physical disability payment status on substance use treatment. Participants (N = 1,013) were enrolled in one of six prior randomized clinical trials comparing contingency management (CM) to standard care; 79 (7.8%) participants reported receiving disability payments, CM improved all three primary substance use outcomes: treatment retention, percent negative samples and longest duration of abstinence. There was no significant main effect of physical disability payment status on treatment outcomes; however, a significant treatment condition by physical disability status interaction effect emerged in terms of retention in treatment and duration of abstinence achieved. Patients who were receiving physical disability payments responded particularly well to CM, and their time in treatment and durations of drug and alcohol abstinence increased even more markedly with CM than did that of their counterparts who were not receiving physical disability assistance. These findings suggest an objectively defined cohort of patients receiving substance use treatment who respond particularly well to CM.

  15. Retrograde ureteroscopic holmium laser endopyelotomy in a selected population of patients with ureteropelvic junction obstruction

    DEFF Research Database (Denmark)

    Stilling, Nicolaj; Jung, Helene; Nørby, Bettina;

    2009-01-01

    follow-up 110 weeks). Success criteria were defined as symptom relief and improved or preserved renal function. Results. Twenty-nine patients (66%) experienced complete symptom resolution and 10 patients (23%) had significant symptom improvement (i.e. no need for pain-killing medication). Five patients...

  16. A retrospective characterization of worsening renal function in patients with acute decompensated heart failure receiving nesiritide

    Directory of Open Access Journals (Sweden)

    Starr JA

    2009-09-01

    Full Text Available Nesiritide is approved by Food and Drug Administration (FDA for the treatment of patients with acute decompensated heart failure (ADHF due its ability to rapidly reduce cardiac filling pressures and improve dyspnea. Numerous studies have shown that renal dysfunction is associated with unfavorable outcomes in patients with heart failure. In addition, there have been reports suggesting that nesiritide may adversely affect renal function and mortality. Objective: The purpose of this retrospective analysis was to assess the effect of dose and duration of nesiritide use and the dose and duration of diuretic therapy on worsening renal function and increased in-hospital mortality in this patient population.Methods: Seventy-five patients who were hospitalized for ADHF and who were treated with nesiritide for at least 12 hours were reviewed retrospectively. Results: The mean increase in SCr was 0.5 mg/dL (range 0 – 4.4 mg/dL. Thirty-six percent of patients (27/75 met the primary endpoint with an increase in SCr>0.5 mg/dL. Treatment dose and duration of nesiritide did not differ between those patients who had an increase in SCr>0.5 mg/dL and those who did not (p=0.44 and 0.61. Concomitant intravenous diuretics were used in 85% of patients with an increase in SCr >0.5 mg/dL compared to 90% of patients without an increase in SCr>0.5 mg/dL (p=0.57. The in-hospital mortality rate was also higher at 35% in those patients with an increase in creatinine >0.5 mg/dL compared to 11% in those without (p=0.01. Conclusion: Nesiritide was associated with an increase in SCr > 0.5 mg/dL in approximately one-third of patients. The increase occurred independently of dose, duration of nesiritide therapy, blood pressure changes, and concomitant intravenous diuretic use. However, the increase in SCr was associated with an increase in hospital stay and in hospital mortality consistent with previous reports in the literature.

  17. [L-carnitine levels in critical septic patients receiving parenteral nutrition].

    Science.gov (United States)

    Garnacho Montero, J; Ortiz Leyba, C; Jiménez Jiménez, F; Monterrubio Villar, J; Fernández Vega, M D; García Garmendia, J L

    1998-01-01

    Septicemia causes multiple and often not very well understood metabolic alterations. In this sense it is controversial whether or not carnitine is decreased, which may have several implications. Our objective is to measure the plasma carnitine levels in septicemic patients, and to find out whether this is modified if there is a multi-organ dysfunction syndrome (MODS), or if it is dependent on the lipid source. For this we carried out a prospective study in septicemic patients with MODS. These were given exclusively parenteral nutrition (PN) without any carnitine supplementation. The PN of 16 patients contained long chain triglycerides (LCT's), while that of another 12 contained a 1:1 mixture of long and medium chain triglycerides (LCT's and MCT's). We measured the plasma carnitine level at the baseline, after 5 days and after 10 days, using an enzymatic method that measures the total carnitine level (free and esterified). The normal values lie between 35 and 70 mumol/l. We included 28 septicemic patients whose ages were 53.41 +/- 16.51 years, and whose APACHE II on admission was 17 +/- 4. The carnitine levels were: baseline: 60.4 +/- 23.7; 5th day 57.7 +/- 22.9; 10th day 55.7 +/- 21.2 (p = n.s.). Of these patients, 10 had an MODS of septic origins with their baseline levels being: 65.3 +/- 30.9; 5th day 60.3 +/- 23.2; 10th day 61.5 +/- 15.5; while the levels of the 18 septicemic patients without MODS, the baseline levels were 61.9 +/- 13.8; 5th day 58.6 +/- 19.1; 10th day 56.6 +/- 19.3 (p = n.s.). In the patients who were given LCT's the baseline carnitine level was 60.7 +/- 23.1, 5th day 60.1 +/- 23.8; 10th day 58.6 +/- 12.8; while those patients who were given LCT/MCT showed baseline levels of 64.3 +/- 19.5; 5th day 58.6 +/- 19.1; 10th day 57.8 +/- 10.7 (p = n.s.). In our septicemic patients the serum carnitine levels we found were within the normal range, and these remained unchanged during the ten days in those patients with MODS or with the lipid mixture used.

  18. [Nosocomial infection in patients receiving a solid organ transplant or haematopoietic stem cell transplant].

    Science.gov (United States)

    Moreno Camacho, Asunción; Ruiz Camps, Isabel

    2014-01-01

    Bacterial infections are the most common infections in solid organ transplant recipients. These infections occur mainly in the first month after transplantation and are hospital-acquired. Nosocomial infections cause significant morbidity and are the most common cause of mortality in this early period of transplantation. These infections are caused by multi-drug resistant (MDR) microorganisms, mainly Gram-negative enterobacteria, non-fermentative Gram-negative bacilli, enterococci, and staphylococci. The patients at risk of developing nosocomial bacterial infections are those previously colonized with MDR bacteria while on the transplant waiting list. Intravascular catheters, the urinary tract, the lungs, and surgical wounds are the most frequent sources of infection. Preventive measures are the same as those applied in non-immunocompromised, hospitalized patients except in patients at high risk for developing fungal infection. These patients need antifungal therapy during their hospitalization, and for preventing some bacterial infections in the early transplant period, patients need vaccinations on the waiting list according to the current recommendations. Although morbidity and mortality related to infectious diseases have decreased during the last few years in haematopoietic stem cell transplant recipients, they are still one of the most important complications in this population. Furthermore, as occurs in the general population, the incidence of nosocomial infections has increased during the different phases of transplantation. It is difficult to establish general preventive measures in these patients, as there are many risk factors conditioning these infections. Firstly, they undergo multiple antibiotic treatments and interventions; secondly, there is a wide variability in the degree of neutropenia and immunosuppression among patients, and finally they combine hospital and home stay during the transplant process. However, some simple measures could be

  19. Systemic and localized infection by Candida species in patients with rheumatic diseases receiving anti-TNF therapy

    Directory of Open Access Journals (Sweden)

    Nadia E. Aikawa

    Full Text Available ABSTRACT Objective: To evaluate the prevalence of systemic and localized infection by Candida species and its possible association with demographic, clinical and laboratory manifestations and therapy in patients with rheumatic diseases taking TNF blockers. Methods: Consecutive patients with rheumatic diseases receiving anti-TNF agents were included. The following risk factors up to four weeks prior to the study were analyzed: use of antibiotics, immunosuppressant drugs, hospitalization and invasive procedures. All subjects were evaluated for clinical complaints; specific blood cultures were obtained for fungi and blood samples were collected for Candida spp. detection by polymerase chain reaction. Results: 194 patients [67 with rheumatoid arthritis (RA, 47 with ankylosing spondylitis (AS, 36 with juvenile idiopathic arthritis (JIA, 28 with psoriatic arthritis and 16 with other conditions] were included. The average age of patients was 42 ± 16 years, with 68 (35% male and mean disease duration of 15 ± 10 years. Sixty-four (33% patients were receiving adalimumab, 59 (30% etanercept and 71 (36% infliximab. Eighty-one percent of patients were concomitantly taking immunosuppressant drugs. At the time of the study, only one (0.5% patient had localized fungal infection (vaginal candidiasis. None of the patients included had systemic candidiasis with positive blood cultures for fungi or PCR positive for Candida spp. in peripheral blood sample. Conclusions: This was the first study to assess the prevalence of invasive and localized fungal disease by Candida in a significant number of patients with rheumatic diseases on anti-TNF therapy, and demonstrated low risk of candidiasis, despite the high prevalence of immunosuppressive drug use.

  20. Risk factors associated with postoperative seizures in patients undergoing cardiac surgery who received tranexamic acid: A case-control study

    Directory of Open Access Journals (Sweden)

    Felix R Montes

    2012-01-01

    Full Text Available Antifibrinolytic agents are used during cardiac surgery to minimize bleeding and reduce exposure to blood products. Several reports suggest that tranexamic acid (TA can induce seizure activity in the postoperative period. To examine factors associated with postoperative seizures in patients undergoing cardiac surgery who received TA. University-affiliated hospital. Case-control study. Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB between January 2008 and December 2009 were identified. During this time, all patients undergoing heart surgery with CPB received TA. Cases were defined as patients who developed seizures that required initiation of anticonvulsive therapy within 48 h of surgery. Exclusion criteria included subjects with preexisting epilepsy and patients in whom the convulsive episode was secondary to a new ischemic lesion on brain imaging. Controls who did not develop seizures were randomly selected from the initial cohort. From an initial cohort of 903 patients, we identified 32 patients with postoperative seizures. Four patients were excluded. Twenty-eight cases and 112 controls were analyzed. Cases were more likely to have a history of renal impairment and higher preoperative creatinine values compared with controls (1.39 ± 1.1 vs. 0.98 ± 0.02 mg/dL, P = 0.02. Significant differences in the intensive care unit, postoperative and total lengths of stay were observed. An association between high preoperative creatinine value and postoperative seizure was identified. TA may be associated with the development of postoperative seizures in patients with renal dysfunction. Doses of TA should be reduced or even avoided in this population.

  1. Restless legs syndrome augmentation among Japanese patients receiving pramipexole therapy: Rate and risk factors in a retrospective study

    Science.gov (United States)

    Takahashi, Masayoshi; Nishida, Shingo; Nakamura, Masaki; Kobayashi, Mina; Matsui, Kentaro; Ito, Eiki; Usui, Akira; Inoue, Yuichi

    2017-01-01

    To investigate the rate of and risk factors for restless legs syndrome (RLS) augmentation in Japanese patients receiving pramipexole (PPX) treatment. Records of 231 consecutive patients with idiopathic RLS who received PPX therapy for more than one month in a single sleep disorder center were analyzed retrospectively. Augmentation was diagnosed based on the Max Planck Institute criteria; associated factors were identified by logistic regression analysis. Mean age at PPX initiation was 60.6 ± 14.9 years and mean treatment duration was 48.5 ± 26.4 months. Augmentation was diagnosed in 21 patients (9.1%). Daily PPX dose and treatment duration were significantly associated with augmentation. By analyzing the receiver operating characteristic curve, a PPX dose of 0.375 mg/day was found to be the optimal cut-off value for predicting augmentation. After stratifying patients according to PPX treatment duration, at median treatment duration of 46 months, optimal cut-off values for daily doses were 0.375 and 0.500 mg/day for <46 months and ≥46 months of treatment, respectively. The RLS augmentation with PPX treatment in Japanese patients was occurred at rate of 9.1%, being quite compatible with previously reported rates in Caucasian patients. The symptom could appear within a relatively short period after starting the treatment in possibly vulnerable cases even with a smaller drug dose. Our results support the importance of keeping doses of PPX low throughout the RLS treatment course to prevent augmentation. PMID:28264052

  2. Effects of remifentanil versus nitrous oxide on postoperative nausea, vomiting, and pain in patients receiving thyroidectomy: Propensity score matching analysis.

    Science.gov (United States)

    Kim, Min Kyoung; Yi, Myung Sub; Kang, Hyun; Choi, Geun-Joo

    2016-10-01

    Remifentanil and nitrous oxide (N2O) are 2 commonly used anesthetic agents. Both these agents are known risk factors for postoperative nausea and vomiting (PONV). However, remifentanil and N2O have not been directly compared in a published study. Remifentanil can induce acute tolerance or hyperalgesia, thus affecting postoperative pain. The objective of this retrospective study is to compare the effects of remifentanil and N2O on PONV and pain in patients receiving intravenous patient-controlled analgesia (IV-PCA) after thyroidectomy.We analyzed the electronic medical records of 992 patients receiving fentanyl-based IV-PCA after thyroidectomy at Chung-Ang University Hospital from January 1, 2010 to April 30, 2016. We categorized the patients according to anesthetic agents used: group N2O (n = 745) and group remifentanil (n = 247). The propensity score matching method was used to match patients in the 2 groups based on their covariates. Finally, 128 matched subjects were selected from each group.There were no differences between groups for all covariates after propensity score matching. The numeric rating scale for nausea (0.55 ± 0.88 vs 0.27 ± 0.76, P = 0.01) was higher and complete response (88 [68.8%] vs 106 [82.8%], P = 0.001) was lower in group N2O compared with group remifentanil on postoperative day 0. However, the visual analog scale score for pain (3.47 ± 2.02 vs 3.97 ± 1.48, P = 0.025) was higher in group remifentanil than group N2O on postoperative day 0.In patients receiving IV-PCA after thyroidectomy, postoperative nausea was lower but postoperative pain was higher in group remifentanil.

  3. Coefficient of glucose variation is independently associated with mortality in critically ill patients receiving intravenous insulin.

    Science.gov (United States)

    Lanspa, Michael J; Dickerson, Justin; Morris, Alan H; Orme, James F; Holmen, John; Hirshberg, Eliotte L

    2014-04-30

    Both patient- and context-specific factors may explain the conflicting evidence regarding glucose control in critically ill patients. Blood glucose variability appears to correlate with mortality, but this variability may be an indicator of disease severity, rather than an independent predictor of mortality. We assessed blood glucose coefficient of variation as an independent predictor of mortality in the critically ill. We used eProtocol-Insulin, an electronic protocol for managing intravenous insulin with explicit rules, high clinician compliance, and reproducibility. We studied critically ill patients from eight hospitals, excluding patients with diabetic ketoacidosis and patients supported with eProtocol-insulin for coefficient of variation (standard deviation/mean), Charlson comorbidity score, acute physiology score, presence of diabetes, and occurrence of hypoglycemia Coefficient of variation was independently associated with 30-day mortality (odds ratio 1.23 for every 10% increase, P < 0.001), even after adjustment for hypoglycemia, age, disease severity, and comorbidities. The association was higher in non-diabetics (OR = 1.37, P < 0.001) than in diabetics (OR 1.15, P = 0.001). Blood glucose variability is associated with mortality and is independent of hypoglycemia, disease severity, and comorbidities. Future studies should evaluate blood glucose variability.

  4. Use of identification wristbands among patients receiving inpatient treatment in a teaching hospital.

    Science.gov (United States)

    Hoffmeister, Louíse Viecili; de Moura, Gisela Maria Schebella Souto

    2015-01-01

    to evaluate the use of identification wristbands among patients hospitalized in inpatient units. quantitative, descriptive and transversal research, with a sample of 385 patients. Data collection occurred through the observational method through the filling out of a structured questionnaire which aimed to check the presence of the identification wristband and the identifiers used. Descriptive statistics with absolute and relative frequencies was used for analysis. it was obtained that 83.9% of the patients were found to have the correctly identified wristband, 11.9% had a wristband with errors, and 4.2% of the patients were without a wristband. The main nonconformities found on the identification wristbands were incomplete name, different registration numbers, illegibility of the data and problems with the physical integrity of the wristbands. the study demonstrated the professionals' engagement in the process of patient identification, evidencing a high rate of conformity of the wristbands. Furthermore, it contributed to identify elements in the use of wristbands which may be improved for a safe identification process.

  5. Use of identification wristbands among patients receiving inpatient treatment in a teaching hospital

    Directory of Open Access Journals (Sweden)

    Louíse Viecili Hoffmeister

    2015-02-01

    Full Text Available OBJECTIVE: to evaluate the use of identification wristbands among patients hospitalized in inpatient units.METHOD: quantitative, descriptive and transversal research, with a sample of 385 patients. Data collection occurred through the observational method through the filling out of a structured questionnaire which aimed to check the presence of the identification wristband and the identifiers used. Descriptive statistics with absolute and relative frequencies was used for analysis.RESULTS: it was obtained that 83.9% of the patients were found to have the correctly identified wristband, 11.9% had a wristband with errors, and 4.2% of the patients were without a wristband. The main nonconformities found on the identification wristbands were incomplete name, different registration numbers, illegibility of the data and problems with the physical integrity of the wristbands.CONCLUSION: the study demonstrated the professionals' engagement in the process of patient identification, evidencing a high rate of conformity of the wristbands. Furthermore, it contributed to identify elements in the use of wristbands which may be improved for a safe identification process.

  6. Dental implant status of patients receiving long-term nursing care in Japan.

    Science.gov (United States)

    Kimura, Toru; Wada, Masahiro; Suganami, Toru; Miwa, Shunta; Hagiwara, Yoshiyuki; Maeda, Yoshiobu

    2015-01-01

    The increase in implant patients is expected to give rise to a new problem: the changing general health status of those who have had implants placed. The aim of this present study was to find out the needs of and proper measures for elderly implant patients in long-term care facilities. A questionnaire was sent by mail to 1,591 long-term care health facilities, daycare services for people with dementia, and private nursing homes for the elderly in the Osaka area, which is in the middle area of Japan, in order to extract patients with cerebrovascular disease or dementia who were possibly at risk of inadequate oral self-care, as well as patients with implants. Approximately half of all facilities responded that they cannot recognize implants, and many facilities did not know anything about oral care for implant patients. Residents with implants were reported at 19% of all facilities. Also, the facilities pointed out problems with implants relating to the difference in oral care between implants and natural teeth. There are people with implants in some 20% of caregiving facilities, and there is a low level of understanding regarding implants and their care among nurses and care providers who are providing daily oral care. © 2013 Wiley Periodicals, Inc.

  7. Minimizing bleeding risk in patients receiving direct oral anticoagulants for stroke prevention

    Directory of Open Access Journals (Sweden)

    Habert JS

    2016-10-01

    Full Text Available Jeffrey Steven Habert Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada Abstract: Many primary care physicians are wary about using direct oral anticoagulants (DOACs in patients with nonvalvular atrial fibrillation (AF. Factors such as comorbidities, concomitant medications, and alcohol misuse increase concerns over bleeding risk, especially in elderly and frail patients with AF. This article discusses strategies to minimize the risk of major bleeding events in patients with AF who may benefit from oral anticoagulant therapy for stroke prevention. The potential benefits of the DOACs compared with vitamin K antagonists, in terms of a lower risk of intracranial hemorrhage, are discussed, together with the identification of reversible risk factors for bleeding and correct dose selection of the DOACs based on a patient’s characteristics and concomitant medications. Current bleeding management strategies, including the new reversal agents for the DOACs and the prevention of bleeding during preoperative anticoagulation treatment, in addition to health care resource use associated with anticoagulation treatment and bleeding, are also discussed. Implementing a structured approach at an individual patient level will minimize the overall risk of bleeding and should increase physician confidence in using the DOACs for stroke prevention in their patients with nonvalvular AF. Keywords: anticoagulants, atrial fibrillation, bleeding, primary care

  8. Minimizing bleeding risk in patients receiving direct oral anticoagulants for stroke prevention

    Science.gov (United States)

    Habert, Jeffrey Steven

    2016-01-01

    Many primary care physicians are wary about using direct oral anticoagulants (DOACs) in patients with nonvalvular atrial fibrillation (AF). Factors such as comorbidities, concomitant medications, and alcohol misuse increase concerns over bleeding risk, especially in elderly and frail patients with AF. This article discusses strategies to minimize the risk of major bleeding events in patients with AF who may benefit from oral anticoagulant therapy for stroke prevention. The potential benefits of the DOACs compared with vitamin K antagonists, in terms of a lower risk of intracranial hemorrhage, are discussed, together with the identification of reversible risk factors for bleeding and correct dose selection of the DOACs based on a patient’s characteristics and concomitant medications. Current bleeding management strategies, including the new reversal agents for the DOACs and the prevention of bleeding during preoperative anticoagulation treatment, in addition to health care resource use associated with anticoagulation treatment and bleeding, are also discussed. Implementing a structured approach at an individual patient level will minimize the overall risk of bleeding and should increase physician confidence in using the DOACs for stroke prevention in their patients with nonvalvular AF.

  9. Obesity in multiracial schizophrenia patients receiving outpatient treatment in a regional tertiary hospital in malaysia.

    Science.gov (United States)

    Norlelawati, A T; Kartini, A; Ramli, M; Norsidah, K; Wan Azizi, W S; Tariq, A R

    2012-06-01

    OBJECTIVES. Obesity is an issue of concern among patients with schizophrenia as it is a co-morbid condition that is closely related to metabolic syndrome. The present study assessed the correlation of body mass index with antipsychotic use among multiracial schizophrenia outpatients. The study also compared the patients' body mass index with Malaysian Adult Nutrition Survey (MANS) data. METHODS. A total of 216 participants were recruited into a cross-sectional study conducted over 5 months, from December 2010 to April 2011. Body weight and height were measured using the standard methods. Demographic data and treatment variables were gathered through interview or review of the medical records. RESULTS. There were differences in mean body mass index between men and women (p = 0.02) and between Malay, Chinese and Indian races (p = 0.04). Stratified by sex, age, and race, the body mass index distributions of the patients were significantly different to those of the reference MANS population. The prevalence of obesity among patients was more than 2-fold greater than among the reference population in all variables. Although body mass index distribution was related to antipsychotic drugs (χ(2) = 33.42; p = 0.04), obesity could not be attributed to any specific drug. CONCLUSION. The prevalence of obesity among patients with schizophrenia was significantly greater than that in the healthy Malaysian population, and affects the 3 main races in Malaysia.

  10. Misperceptions of patients vs providers regarding medication-related communication issues.

    Science.gov (United States)

    Lapane, Kate L; Dubé, Catherine E; Schneider, Karen L; Quilliam, Brian J

    2007-11-01

    To test the hypothesis that there is little concordance in perceptions of medication-related communication between patients and providers, with providers estimating greater frequency of such discussions than patients; and to determine whether discordance is less apparent among patients who received e-prescriptions. Data are from a convenience sample of 96 providers practicing in 6 states and 1100 of their patients. Twenty-nine practices used e-prescribing, and 3 practices were initiating e-prescribing. Patients' and providers' perceptions regarding discussions with their providers or patients regarding medication costs, adherence, and potential adverse effects were collected by survey. Relative to patients, providers estimated more frequent discussions of medication issues with patients. Most patients (83%) reported that they would never tell their physician if they did not plan on picking up a prescription. Patients receiving electronic prescriptions were more likely than patients with paper prescriptions (54% vs 43%) to report that their provider always checks the accuracy of their medication list. Although e-prescribing may not change the extent to which patients and physicians discuss medication issues, patients of e-prescribing providers more frequently report provider verification of medication lists.

  11. Outcomes in Newly Diagnosed Elderly Glioblastoma Patients after Concomitant Temozolomide Administration and Hypofractionated Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Nguyen, Ludovic T. [Neurology Department, CHU Hautepierre, rue Molière, Strasbourg 67000 (France); Touch, Socheat [Radiation Oncology University Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065 (France); Radiation Oncology Department, Soviet-Khmer Friendship Hospital, Pnom-Pehn 12400 (Cambodia); Nehme-Schuster, Hélène [Oncology Geriatric Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065 (France); Antoni, Delphine [Radiation Oncology University Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065 (France); Eav, Sokha [Radiation Oncology Department, Soviet-Khmer Friendship Hospital, Pnom-Pehn 12400 (Cambodia); Clavier, Jean-Baptiste; Bauer, Nicolas; Vigneron, Céline [Radiation Oncology University Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065 (France); Schott, Roland [Oncology Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065 (France); Kehrli, Pierre [Neurosurgery Department, CHU Hautepierre, rue Molière, Strasbourg 67000 (France); Noël, Georges, E-mail: gnoel@strasbourg.unicancer.fr [Radiation Oncology University Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065 (France); Laboratoire EA 3430, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg 67000 (France)

    2013-09-24

    This study aimed to analyze the treatment and outcomes of older glioblastoma patients. Forty-four patients older than 70 years of age were referred to the Paul Strauss Center for chemotherapy and radiotherapy. The median age was 75.5 years old (range: 70–84), and the patients included 18 females and 26 males. The median Karnofsky index (KI) was 70%. The Charlson indices varied from 4 to 6. All of the patients underwent surgery. O{sub 6}-methylguanine–DNA methyltransferase (MGMT) methylation status was determined in 25 patients. All of the patients received radiation therapy. Thirty-eight patients adhered to a hypofractionated radiation therapy schedule and six patients to a normofractionated schedule. Neoadjuvant, concomitant and adjuvant chemotherapy regimens were administered to 12, 35 and 20 patients, respectively. At the time of this analysis, 41 patients had died. The median time to relapse was 6.7 months. Twenty-nine patients relapsed, and 10 patients received chemotherapy upon relapse. The median overall survival (OS) was 7.2 months and the one- and two-year OS rates were 32% and 12%, respectively. In a multivariate analysis, only the Karnofsky index was a prognostic factor. Hypofractionated radiotherapy and chemotherapy with temozolomide are feasible and acceptably tolerated in older patients. However, relevant prognostic factors are needed to optimize treatment proposals.

  12. Long term outcome and side effects in patients receiving low-dose I125 brachytherapy: a retrospective analysis

    Directory of Open Access Journals (Sweden)

    Pieter Logghe

    Full Text Available ABSTRACT Objectives: To retrospectively evaluate the disease free survival (DFS, disease specific survival (DSS,overall survival (OS and side effects in patients who received low-dose rate (LDR brachytherapy with I125 stranded seeds. Materials and methods: Between july 2003 and august 2012, 274 patients with organ confined prostate cancer were treated with permanent I125 brachytherapy. The median follow-up, age and pretreatment prostate specific antigen (iPSA was 84 months (12-120, 67 years (50-83 and 7.8 ng/mL (1.14-38, respectively. Median Gleason score was 6 (3-9. 219 patients (80% had stage cT1c, 42 patients (15.3% had stage cT2a, 3 (1.1% had stage cT2b and 3 (1.1% had stage cT2c. The median D90 was 154.3 Gy (102.7-190.2. Results: DSS was 98.5%.OS was 93.5%. 13 patients (4.7% developed systemic disease, 7 patients (2.55% had local progression. In 139 low risk patients, the 5 year biochemical freedom from failure rate (BFFF was 85% and 9 patients (6.4% developed clinical progression. In the intermediate risk group, the 5 year BFFF rate was 70% and 5 patients (7.1% developed clinical progression. Median nPSA in patients with biochemical relapse was 1.58 ng/mL (0.21 – 10.46, median nPSA in patients in remission was 0.51 ng/mL (0.01 – 8.5. Patients attaining a low PSA nadir had a significant higher BFFF (p<0.05. Median D90 in patients with biochemical relapse was 87.2 Gy (51 – 143,1. Patients receiving a high D90 had a significant higher BFFF (p<0.05. Conclusion: In a well selected patient population, LDR brachytherapy offers excellent outcomes. Reaching a low PSA nadir and attaining high D90 values are significant predictors for a higher DFS.

  13. Delusional infestation is typically comorbid with other psychiatric diagnoses: review of 54 patients receiving psychiatric evaluation at Mayo Clinic.

    Science.gov (United States)

    Hylwa, Sara A; Foster, Ashley A; Bury, Jessica E; Davis, Mark D P; Pittelkow, Mark R; Bostwick, J Michael

    2012-01-01

    Delusional infestation, which encompasses both delusions of parasitosis and delusions of infestation with inanimate objects (sometimes called Morgellons disease), has been said to represent a distinct and encapsulated delusion, that is, a stand-alone diagnosis. Anecdotally, we have observed that patients with delusional infestation often have one or more psychiatric comorbid conditions and that delusional infestation should not be regarded as a stand-alone diagnosis. The purpose of this study was to identify whether patients with delusional infestation have psychiatric comorbid conditions. We therefore identified patients who had been formally evaluated in the Department of Psychiatry during their visit to Mayo Clinic. We retrospectively searched for and reviewed the cases of all patients with delusional infestation seen from 2001 through 2007 at Mayo Clinic, Rochester, Minnesota, and who underwent psychiatric evaluation. The diagnoses resulting from psychiatric evaluation were analyzed. During the 7-year study period, 109 patients seen for delusional infestation at Mayo Clinic were referred to the Department of Psychiatry, 54 (50%) of whom actually followed through with psychiatric consultation. Of these 54 patients, 40 (74%) received additional active psychiatric diagnoses; 14 patients (26%) had delusional infestation alone. Abnormal personality traits were rarely documented. Most patients with delusional infestation have multiple coexisting or underlying psychiatric disorders. Therefore, evaluation by a psychiatrist, when possible, is advised for all patients with delusional infestation. Copyright © 2012 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

  14. Patients receiving opioid maintenance treatment in primary care: successful chronic hepatitis C care in a real world setting

    Directory of Open Access Journals (Sweden)

    Seidenberg André

    2013-01-01

    Full Text Available Abstract Background Injection drug users (IDUs represent a significant proportion of patients with chronic hepatitis C (CHC. The low treatment uptake among these patients results in a low treatment effectiveness and a limited public health impact. We hypothesised that a general practitioner (GP providing an opioid maintenance treatment (OMT for addicted patients can achieve CHC treatment and sustained virological response rates (SVR comparable to patients without drug dependency. Methods Retrospective patient record analysis of 85 CHC patients who received OMT for more than 3 months in a single-handed general practice in Zurich from January 1, 2002 through May 31, 2008. CHC treatment was based on a combination with pegylated interferon and ribavirin. Treatment uptake and SVR (undetectable HCV RNA 6 months after end of treatment were assessed. The association between treatment uptake and patient characteristics was investigated by multiple logistic regression. Results In 35 out of 85 CHC patients (52 males with a median (IQR age of 38.8 (35.0-44.4 years, antiviral therapy was started (41.2%. Median duration (IQR of OMT in the treatment group was 55.0 (35.0-110.1 months compared to the group without therapy 24.0 (9.8-46.3 months (p Conclusion In addicted patients a high CHC treatment and viral eradication rate in a primary care setting in Switzerland is feasible. Opioid substitution seems a beneficial framework for CHC care in this “difficult to treat” population.

  15. Aspergillosis in a Patient Receiving Temozolomide for the Treatment of Glioblastoma

    Directory of Open Access Journals (Sweden)

    Rodrigo Ramella Munhoz

    2013-08-01

    Full Text Available Leukopenia and selective CD4+ lymphopenia represent major adverse events associated with the use of temozolomide (TMZ, an oral alkylating agent incorporated in the treatment of glioblastoma (GBM. The increased risk of opportunistic infections, including those caused by Pneumocystis jiroveci and cytomegalovirus, has been previously described in the literature. Here we report the case, the first to our knowledge, of a patient with pulmonary invasive aspergillosis immediately after the completion of chemoradiation with TMZ for GBM. Diagnosis was confirmed through a CT-guided lung biopsy, and the patient had excellent response to systemic voriconazole. This case illustrates that TMZ can be associated with severe opportunistic infections, presumably associated with T lymphocyte immune dysfunction, and patients exposed to this agent should be carefully monitored.

  16. Increase in international normalized ratio after smoking cessation in a patient receiving warfarin.

    Science.gov (United States)

    Evans, Mark; Lewis, Geoffrey M

    2005-11-01

    A 58-year-old man who was taking warfarin at a stable dosage was admitted to the hospital with a diagnosis of bacterial meningitis. Although he had previously been a smoker, after this admission, he decided to give up smoking. He was continued on his previous warfarin maintenance dosage when discharged, and his international normalized ratio (INR) soon began to climb substantially. When questioned, the patient reported no diet or lifestyle changes other than his smoking cessation. The patient's INR was stabilized at a warfarin dosage 23% lower than the maintenance dosage before he stopped smoking. This case report illustrates the potential for an interaction between warfarin and cigarette smoking and further suggests that the effect could be significant if a patient starts or stops smoking during warfarin therapy.

  17. Psychiatric diagnoses and psychoactive medication use among nonsurgical critically ill patients receiving mechanical ventilation

    DEFF Research Database (Denmark)

    Wunsch, Hannah; Christiansen, Christian Fynbo; Johansen, Martin B

    2014-01-01

    in 2006-2008 with follow-up through 2009, and 2 matched comparison cohorts from hospitalized patients and from the general population. EXPOSURES: Critical illness defined as intensive care unit admission with mechanical ventilation. MAIN OUTCOMES AND MEASURES: Adjusted prevalence ratios (PRs......IMPORTANCE: The relationship between critical illness and psychiatric illness is unclear. OBJECTIVE: To assess psychiatric diagnoses and medication prescriptions before and after critical illness. DESIGN, SETTING, AND PARTICIPANTS: Population-based cohort study in Denmark of critically ill patients......) of psychiatrist-diagnosed psychiatric illnesses and prescriptions for psychoactive medications in the 5 years before critical illness. For patients with no psychiatric history, quarterly cumulative incidence (risk) and adjusted hazard ratios (HRs) for diagnoses and medications in the following year, using Cox...

  18. Health care needs of Jordanian caregivers of patients with cancer receiving chemotherapy on an outpatient basis.

    Science.gov (United States)

    Al-Jauissy, M S

    2010-10-01

    This descriptive exploratory study was conducted to describe the health care needs and identify unmet needs of the caregivers of cancer patients in Jordan. A total of 82 caregivers accompanying patients to an outpatient chemotherapy clinic completed the 90-item caregiver need scale. Caregivers reported 75.6% of scale items as needs and rated these as "very important" needs on all 6 areas of the caregivers' need scale: personal care, activity management, involvement with health care, work, interpersonal interaction and finance. Unmet needs of caregivers were a higher proportion of identified needs (76.4%) than in similar studies elsewhere. The education and support needs of caregivers need to be considered when designing care plans for cancer patients.

  19. Hypervitaminosis B12 in maintenance hemodialysis patients receiving massive supplementation of vitamin B12.

    Science.gov (United States)

    Mangiarotti, G; Canavese, C; Salomone, M; Thea, A; Pacitti, A; Gaido, M; Calitri, V; Pelizza, D; Canavero, W; Vercellone, A

    1986-11-01

    We have administered routinely a multivitamin preparation containing a megadose of B12 to 106 hemodialysis patients after dialysis treatments. We found that these patients had very high levels of serum vitamin B12 which returned to original values only after a period of three years after stopping the vitamin. Discontinuing therapy had no effect on hemoglobin, mean erythrocyte corpuscular volume, or motor nerve conduction velocity. It is not known whether maintaining a prolonged high level of vitamin B12 is harmful. However, animal and epidemiologic studies have suggested that both cobalamin and cobalt may be potentially toxic. In view of the absence of demonstrable benefit and the possible risk of toxicity, we believe that the use of such megadose vitamin compounds in dialysis patients should be re-evaluated.

  20. Nutritional status in patients with chronic respiratory failure receiving home mechanical ventilation: impact on survival.

    Science.gov (United States)

    Hitzl, Andre P; Jörres, Rudolf A; Heinemann, Frank; Pfeifer, Michael; Budweiser, Stephan

    2010-02-01

    In patients with chronic respiratory diseases body mass index (BMI) is a predictor of long-term survival, whereas the prognostic value of body composition, especially fat-free mass index (FFMI), is unknown. In a prospectively collected cohort of 131 patients (50 females, 81 males; 71% chronic obstructive pulmonary disease, 29% severe restrictive disorders) undergoing home mechanical ventilation (HMV) due to chronic hypercapnic respiratory failure (CHRF), the prognostic value of nutritional composition assessed by bioelectrical impedance analysis was evaluated during a 4-year follow-up and compared to that of BMI, anthropometrics, and functional parameters. After follow-up, 53 patients (40.5%) had died. Regarding all-cause mortality cumulative survival percentages after 1, 2 and 3 years were 89.3, 76.3 and 67.9%, respectively. In univariate analyses, FFMI, BMI, sex, age, leukocyte number, FEV1 and 6-min walking distance were associated with survival (pNutrition and Metabolism. All rights reserved.

  1. Effect of olanzapine treatment on INR of a patient receiving warfarin therapy

    Directory of Open Access Journals (Sweden)

    Derya Arslan

    2016-06-01

    Full Text Available Olanzapine is an atypical antipsychotic drug, commonly used in the management of psychotic symptoms in patients with schizoprenia and bipolar affective disorder. Deep venous thrombosis is a manifestation of venous thromboembolism. It is very well known that use of antipsychotic drugs increase the risk of thrombosis in a patient with schizophrenia. It has been reported in many studies the effects of olanzapine on thrombosis but there isn't any report about the effect of olanzapine on international normalized ratio (INR. in the medical literature. In this paper, a patient with schizophrenia and also family history of deep venous thrombosis who emerged deep venous thrombosis after being started on olanzapine treatment and effect of olanzapine treatment on INR has been reported. [Cukurova Med J 2016; 41(2.000: 370-373

  2. Intubated Trauma Patients Receiving Prolonged Antibiotics for Pneumonia despite Negative Cultures: Predictors and Outcomes.

    Science.gov (United States)

    Loftus, Tyler J; Brakenridge, Scott C; Moore, Frederick A; Lemon, Stephen J; Nguyen, Linda L; Voils, Stacy A; Jordan, Janeen R; Croft, Chasen A; Smith, R Stephen; Efron, Phillip A; Mohr, Alicia M

    2016-12-01

    Despite the excellent negative predictive value of sterile respiratory cultures, antibiotics often are continued after negative endotracheal aspirate (ETA) or bronchoalveolar lavage (BAL) for critically ill trauma patients. We hypothesized that persistent elevation of the Clinical Pulmonary Infection Score (CPIS) would predict continued antibiotic therapy after a negative respiratory culture for intubated trauma patients, and that prolonged antibiotics would provide no benefit. We performed a four-year retrospective cohort analysis (May 1, 2011-September 30, 2015), including patients from our trauma database with ETA or BAL, excluding patients with any infection other than pneumonia or bacteremia. Cultures with predictors of long-term antibiotic therapy. A series of 106 patients with negative cultures were included, of whom 61 had ≤5 d of antibiotics and 45 had >5 d of antibiotics. There were no differences in injury severity, head or chest trauma, initial CPIS, or subsequent culture results between the groups. Long-term antibiotic therapy did not affect intensive care unit (ICU) length of stay (LOS), ventilator days, hospital LOS, or death. Factors predicting long-term antibiotic therapy included development of a localized chest radiograph infiltrate (odds ratio [OR] 6.8; 95% confidence interval [CI] 1.7-28), CPIS >5 five days after culture (OR 6.1; 95% CI 1.2-32), and a colonized culture (OR 3.3; 95% CI 1.3-8.3). Long-term antibiotic therapy for intubated trauma patients with negative respiratory cultures provided no benefit and was predicted by development of a localized chest radiograph infiltrate, persistently elevated CPIS, and a contaminated/colonized culture. Although long-term antibiotic use did not worsen outcomes, better strategies are needed to diagnose pneumonia accurately and ensure timely discontinuation of antibiotics when appropriate.

  3. Morphological changes of ulcerative plaque in patients received carotid angioplasty and stenting (CAS)

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    Sadikin, Cindy [Department of Radiology, Dokter Soetomo Hospital, Surabaya (Indonesia); Department of Radiology, Taipei Veteran General Hospital, Taipei, Taiwan (China)], E-mail: cindysadikin@walla.com; Teng, Michael Mu Huo [Department of Radiology, Taipei Veteran General Hospital, Taipei, Taiwan (China); School of Medicine, National Yang Ming University, Taipei, Taiwan (China)], E-mail: mhteng@mail2000.com.tw; Yeh, C.-C. [Department of Radiology, Taipei Veteran General Hospital, Taipei, Taiwan (China)], E-mail: ccyeh@vghtpe.gov.tw; Chang, F.-C. [Department of Radiology, Taipei Veteran General Hospital, Taipei, Taiwan (China)], E-mail: fcchang@vghtpe.gov.tw; Luo, C.-B. [Department of Radiology, Taipei Veteran General Hospital, Taipei, Taiwan (China); School of Medicine, National Yang Ming University, Taipei, Taiwan (China)], E-mail: cbluo@vghtpe.gov.tw

    2008-03-15

    Background: Carotid ulceration plaque is a strong risk factor for stroke and systemic vascular events. The purpose of this study was to assess immediate and follow-up ulcer morphology after carotid angioplasty and stenting (CAS). Methods and results: A total of 124 patients were included in the study. Ulcerative plaques were identified in 92 arteries from 81 patients (21% were asymptomatic and 79% symptomatic). The ulcer disappeared immediately after stenting in 36 (39%) of 92 arteries in 50 patients. Patients with initial mild degree of stenosis (50-69% stenosis) prior to stent, Type-3 and Type-4 ulcers were more prone to have residual ulcers immediate after stenting procedure. Ulcers located distal and proximal to the site of maximal stenosis, and ulcers extending outside of the imaginary line connecting the distal and proximal normal borders of the carotid artery were also more likely to have residual ulcers (