Clinical high risk

Whereas patients with AT deficiency present clinically with a high risk for thrombosis, HCII-deficient patients do not. 

Most recently, a phase-I-study defined a dose of 13-ris-retinoic acid that was tolerable in patients after myeloablative therapy, and a phase-III-trial showed that postconsolidation therapy with 13-cis-retinoic acid improved EFS for patients with high-risk neuroblastoma [7]. Preclinical studies in neuroblastoma indicate that ATRA or 13-cw-RA can antagonize cytotoxic chemotherapy and radiation, such that use of 13-cis-RA in neuroblastoma is limited to maintenance after completion of cytotoxic chemotherapy and radiation. It is likely that recurrent disease seen during or after 13-cis-RA therapy in neuroblastoma is due to tumor cell resistance to retinoid-mediated differentiation induction. Studies in neuroblastoma cell lines resistant to 13-cw-RA and ATRA have shown that they can be sensitive, and in some cases collaterally hypersensitive, to the cytotoxic retinoid fenretinide. Here, fenretinide induces tumor cell cytotoxicity rather than differentiation, acts independently from RA receptors, and in initial phase-I-trials has been well tolerated. Clinical trials of fenretinide, alone and in combination with ceramide modulators, are in development. 

Design validation, on the other hand, is focussed on assessing if the device in its totality meets the user s needs and intended uses and functions correctly under the intended use conditions. Thus, evaluation will usually be carried out at field sites/(i-sites (hospitals) or, at a minimum, under simulated use conditions. In the case of high-risk devices this will normally involve actual clinical studies. Validation should be performed using initial production lots of the device or their equivalents. 

Qureshi et al." evaluated the timing of deterioration in patients with massive MCA strokes in a multicenter retrospective chart review. They found that 68% of patients manifested clinical deterioration by 48 hours, and nearly another 20% did so by 72 hours. Thus, the first 3-5 days appears to be the most crucial time for detecting patients at high risk for deterioration, although there was a small minority of patients who had deterioration at greater than 5 days from symptom onset. Early impairment in consciousness was also found to be predictive of mortality in one cohort of patients within a randomized chnical trial." One postmortem study of 192 patients found features in 45 patients that they postulate led to mahgnant ... 

List key electrocardiographic and clinical features identifying a patient with non-ST-segment elevation acute coronary syndrome who is at high risk of myocardial infarction or death. 

Step 3 Identify the Presence of Clinical Atherosclerotic Disease That Confers High Risk for CHD Events... 

Individuals with established CHD, other clinical atherosclerotic disease (CAD), or diabetes have a greater than 20% risk over a 10-year period of developing CHD.3 The ATP III guidelines set the target LDL cholesterol level at less than 100 mg/dL (2.59 mmol/L) for high-risk patients who have a history of one or more of the following ... 

Upon stabilization, placement of a pulmonary artery (PA) catheter may be indicated based on the need for more extensive cardiovascular monitoring than is available from non-invasive measurements such as vital signs, cardiac rhythm, and urine output.9,10 Key measured parameters that can be obtained from a PA catheter are the pulmonary artery occlusion pressure, which is a measure of preload, and CO. From these values and simultaneous measurement of HR and blood pressure (BP), one can calculate the left ventricular SV and SVR.10 Placement of a PA catheter should be reserved for patients at high risk of death due to the severity of shock or preexisting medical conditions such as heart failure.11 Use of PA catheters in broad populations of critically ill patients is somewhat controversial because clinical trials have not shown consistent benefits with their use.12-14 However, critically ill patients with a high severity of illness may have improved outcomes from PA catheter placement. It is not clear why this was... 

Many surgical procedures have been employed to reduce the inflammation or remove the strictures that cause pain in chronic pancreatitis. However, most procedures have not been proven effective in clinical trials and carry a high risk of morbidity and mortality.39... 

Clinical judgment should be used to test for diabetes in high-risk patients who do not meet these criteria. 

Clinical features SCD carries a high risk for overwhelming sepsis due to functional asplenia and failure to make antibodies against encapsu lated organisms patients should be evaluated for temperature greater than 38.5°C. A low threshold for empiric therapy is recommended. 

CLL can have a variable clinical course, with survival ranging from months to decades. Low-risk disease is asymptomatic, and median survivals exceed 10 years intermediate risk is associated with lymphadenopathy and has median survivals of about 7 years and high-risk patients with anemia have median survivals of only 3 years.16,17 The typical low-risk patient is an elderly person without symptoms who is diagnosed on routine blood draw. The typical high-risk patient is middle-aged, and symptoms have brought the patient to his or her physician. 

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