Clinical dependency

Clinical dependency is a vitally important concept in evaluating clinical risk and should be a consideration in the assessment of aU hazards. The term relates to the degree to which clinicians rely upon the system to deliver safe clinical care. The more the system is relied upon, the greater the impact on care should it become unavailable or deliver misleading information. 

It is naive to think that all HIT systems, in aU care settings, influence clinical care to the same extent. The reality is that there is a broad spectrum ranging from those systems which hardly touch clinical business processes to those on which clinicians utterly rely. Similarly, the same system implemented in different settings may influence care to different degrees. Even when one studies individual users there will typically be variability in the significance that a system plays in their day-to-day delivery of care. Whilst one cannot separately evaluate a hazard for each individual 

Co-exists with care delivery Independent of system 

The degree of clinical dependency is strongly influenced by the role that the HIT system plays in a particular clinical business process. The role itself is affected by the functionality provided, the maturity of its implementation and the clinician s ability to access alternative sources of information. Table 14.1 outlines the relationship between a system s influence on care delivery and its ability to affect clinical decision making. 

---

A baseline chest x-ray, lactate dehydrogenase (LDH) level, and computed tomographic (CT) scan of the chest, abdomen, and pelvis may be ordered by the oncologist as indicated clinically, depending on the patient s symptoms, the presence of lymph... 

Enders SJ, Enders JM, Holstad SG. 2002. Drug-information software for Palm operating system personal digital assistants Breadth, clinical dependability, and ease of use. Pharmotherapy 22 1036. 

Successful translation of results from laboratory to clinic depends on ... 

Patients also visit hospitals for out-patient appointments. This is where the patient comes to the hospital to see a specialist, usually in a specific clinic. Depending on the individual circumstances, an out-patient may require a supply of prescribed drugs. This prescribing will usually be the role of the patient s GP, however, as with the prescribing of TTO medication (see Section 4.2.2) it may take time for the details of the medication to be prescribed to reach the patient s GP by letter. 

The lateral spreading of the light distribution due to scattering increases the effective beam diameter by typically about 1-2 5, i.e. by a few mm in the case of red activation. This may or may not be important clinically depending on the proximity of adjacent critical normal tissues. A final point is that, if the beam diameter decreases to less than, say, 55, the fluence at depth will decrease even for the same incident J cm 2, since there is a reduced volume of tissue for backscatter into the beam. 

Whether or not an optimized lead ever becomes a candidate going into the clinic depends on what happens in the next stage, called preclinical or maybe clinical development candidate selection. Although, the term preclinical can be taken to broadly mean any new drug activity done prior to clinical trials (TID, LID, etc.), it normally refers specifically to this stage, which marks the transition to the D in R D. As such, it s the point where many things change. 

III. Patient must have demonstrated 2 years of clinical dependence. 

The risk associated with the issue should be estimated and evaluated in the usual way as outlined in previous chapters. Attention should be paid to the key factors mentioned earlier which influence risk clinical dependency, detectability, presence of workarounds, etc. (see Sect. 14.1). There may however be some thought required when it comes to ascertaining the likelihood component of risk. The question is this, if an issue has already occurred is the likelihood not 100 % This seems a reasonable chain of logic to begin with but it suffers from a couple of complexities. 

Immunosuppression induced by sirolimus (36) appears to be mediated by a mechanism distincdy different from that of either cyclosporin or FK-506. Sirolimus markedly suppresses IL-2 or IL-4-driven T-ceU proliferation. The preclinical studies suggest that sirolimus is a potent immunosuppressive agent in transplantation and autoimmune disease models. The clinical potential of this agent depends on its toxicity profile (80). 

Analytical Applications. Chemiluminescence and bioluminescence are useful in analysis for several reasons. (/) Modem low noise phototubes when properly instmmented can detect light fluxes as weak as 100 photons/s (1.7 x 10 eins/s). Thus luminescent reactions in which intensity depends on the concentration of a reactant of analytical interest can be used to determine attomole—2eptomole amounts (10 to 10 mol). This is especially useful for biochemical, trace metal, and pollution control analyses (93,260—266) (see Trace and residue analysis). (2) Light measurement is easily automated for routine measurements as, for example, in clinical analysis. 

Clinical Pharmacokinetics. Clinical pharmacokinetics attempts to define the relationship between dmg concentration and therapeutic response. The underlying assumption is that response is proportional to dmg concentration at the site of action. This concentration is dependent on many... 

Leishmaniasis affects some 12 million humans aimuaHy ia an area where 350 million are at risk. It is a complex of at least two protozoan diseases, consisting primarily of cutaneous and visceral forms. A mucocutaneous form is considered by some to be another distinct variety. Clinical manifestations of the disease range from an asymptomatic infection to an infection ia which there is considerable destmction of cutaneous tissue and mucous membranes. Leishmaniasis can often be fatal, especially ia the visceral form. The seriousness of the disease depends on the state of the immunological system of the... 

Automated methods are more rehable and much more precise than the average manual method dependence on the technique of the individual technologist is eliminated. The relative precision, or repeatabiUty, measured by the consistency of the results of repeated analyses performed on the same sample, ranges between 1% and 5% on automated analy2ers. The accuracy of an assay, defined as the closeness of the result or of the mean of repHcate measurements to the tme or expected value (4), is also of importance in clinical medicine. 

---