Clinical practice, patient

Stimulants induce both tolerance and sensitization to their behavioral effects. Tolerance develops to the anorectic and euphoric effects of stimulants (Schuster 1981) however, chronic intermittent use of low doses of stimulants delays the development of tolerance. With the doses commonly used in clinical practice, patients treated for narcolepsy or for depressive or apathetic states find that the stimulant properties usually persist without development of tolerance however, the persistence of antidepressant effects remains a matter of controversy. Sensitization has been linked to the development of amphetamine-induced psychosis (Yui et al. 1999). Sensitization to the induction of psychosis is suggested because psychosis is induced by progressively lower doses and shorter periods of consumption of amphetamine following repeated use over time (Sato 1986). Sensitization for amphetamine-induced psychosis may persist despite long periods of abstinence. 

Withdrawal symptoms from SSRIs can be very severe and lasting. In a few cases in my clinical practice, patients have chosen to remain on very low doses for sustained periods of time because they were unable to... 

In clinical practice patients with ACS and narrow QRS maybe classified in two groups ACS with persistent ST-segment elevation (typical and atypical patterns) and ACS without ST-segment elevation that also includes cases of normal, near-normal (pseudonormal) or unchanged ECG. We will briefly comment on the clinical characteristics and prognostic implications of these two types of clinical ECG syndromes. 

The tension between the conflicting goals of validity in efficacy trials and generalizability in effectiveness trials is illustrated in Fig. 9-2. For example, in an efficacy trial, subjects are selected using narrowly defined eligibility criteria and are monitored closely to ensure that they use or are exposed to the intervention in the manner defined in the trial s protocol and are cooperative with medical advice. In clinical practice, patients are not selected, and the manner in which the patient uses the intervention may vary widely from the intended use for which it was approved. Clinical outcomes among RCT subjects often are better than in nontrial patients. Trials to evaluate therapeutic effectiveness in clinical practice are difficult or expensive for researchers. If results from an effectiveness study are inconclusive, such results could be due to a lack of the intervention s efficacy, patient behavior (such as lack of patient adherence), or both. 

Initial daily doses of 10-40 and 100-600 mg are recommended in clinical practice for MMI and PTU, respectively [1, 2]. Several studies have shown that treatment of hyperthyroidism with single daily doses of 10-40 mg of MMI is effective in the induction of euthyroidism in 80-90% of patients within 6 weeks [2]. The aim of the further antithyroid therapy is to maintain euthyroidism with the lowest necessary diug dose. Intrathyroidal diug accumulation is one cause for the efficiency of a single daily dose regimen. Moreover, a once daily dose yields better patients compliance. Single daily doses of PTU have been shown to be less effective in achieving euthyroidism than administration of three divided doses a day. If a once daily... 

Anxiety disorders are common in the population of opioid-addicted individuals however, treatment studies are lacking. It is uncertain whether the frequency of anxiety disorders contributes to high rates of illicit use of benzodiazepines, which is common in methadone maintenance programs (Ross and Darke 2000). Increased toxicity has been observed when benzodiazepines are co-administered with some opioids (Borron et al. 2002 Caplehorn and Drummer 2002). Although there is an interesting report of clonazepam maintenance treatment for methadone maintenance patients who abuse benzodiazepines, further studies are needed (Bleich et al. 2002). Unfortunately, buspirone, which has low abuse liability, was not effective in an anxiety treatment study in opioid-dependent subjects (McRae et al. 2004). Current clinical practice is to prescribe SSRIs or other antidepressants that have antianxiety actions for these patients. Carefully controlled benzodiazepine prescribing is advocated by some practitioners. 

Villa et al. 1996). Recent reports from Japan suggest that daily IFN-p administration is highly effective in patients with low or moderate HCV RNA levels (Horiike and Onji 2003 Shiratori et al. 2000). Twice-daily administration of IFN-P as induction therapy has also been reported to be effective (Kim et al. 2005 Naka-jima et al. 2003). It is unlikely, however, that IFN-p will be used in routine clinical practice unless it is pegylated or otherwise modified, and until specific clinical trials are done. 

Pare D, Freed M. Clinical practice guidelines for quality patient outcomes. Nurs Clin North Am 1995 30 183-96. 

Limited Knowledge of Exposure and Reporting Rates in Postmarketing Data. Unlike clinical trials and electronic medical records in clinical practice, postmarketing voluntarily reported data contain limited information about the total number of patients exposed and the duration of exposure. This problem is compounded by the fact that adverse events are often underreported [2,9]. 

Randomized, controlled clinical trials reduce bias and variability by a process of selection, randomization and standardization of treatment, and often take place under artificial conditions isolated from those of routine clinical practice (Freemande et al, 1993 Simon et al, 1995b). Yet it is the uncontrolled interactions of a dmg technology with patients, health-care workers and the system of health care that ultimately lead to much of the variability in outcomes and expenditures in clinical practice. Thus the value of RCTs in evaluating cost-effectiveness in clinical practice maybe limited (Reeder, 1995 Simon et al, 1995b Hotopf et al, 1996). 

Another approach uses a synthesis of RCTs and naturalistic studies, while addressing the limitations of both (Simon et al, 1995b Hotopf et al, 1996). In such studies the treatment setting is routine primary-care clinical practice selection criteria are limited to those affecting safety and treatment is normal , i.e. provided under conditions where differences in clinical practice and patient behaviour can emerge freely. However, participants are randomized to initial treatment, and accurate diagnosis and baseline assessments are recorded. This approach is... 

The mood stabilizers were so called because they prevent recurrences of mood swings in people with bipolar disorder. The evidence for this is best with lithium, but is based on smdies carried out more than 20 years ago. However, recent naturalistic surveys tend to find that lithium is far less useful in general clinical practice than in research settings. Many patients discontinue lithium... 

Thomas SH, Orf J, Wedel SK, Conn AK. Hyperventilation in traumatic brain injury patients inconsistency between consensus guidelines and clinical practice. J Trauma 2002(l) 52 47-52. 

Videoconferencing in real-time clinical practice has yielded high levels of patient and physician satisfaction in most specialties. A study dedicated to the assessment of telemedicine-based neurology reported high levels of physician and patient... 

Each of these properties may be exploited to some extent when prescribing a P-blocker, while others (membrane stabilization activity and ISA) are more of theoretical interest, with less relative value in clinical practice. For example, consider a patient with mild asthma, chronic obstructive... 

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