Clinical practice, techniques

Carson, P.A. and Dent, N. (eds) (1994) Good laboratory and clinical practices Techniques for the quality assurance professional, Butterworth-Heinemann, Canada. 

Broad, R.D. Dent, N.J. An introduction to good laboratory practice 3-16. In Good Laboratory and Clinical Practices Techniques for the QA Professional Carson, P.A., Dent, N.J., Eds. 

Reduction in temperature to above 0°C is the common denominator to all techniques for inhibiting warm ischaemic damage. However, hypothermia alone can only delay the onset of irreversible damage and not prevent it. Furthermore, cold can itself be damaging. Kidneys for transplantation are in clinical practice cooled to 0°-10°C either after they have been removed from... 

Franklin Martin, the pioneer of the electrochemical treatment (ECT) of tumors,2 became a major force in the development of surgery in America however, towards the end of his life, he regretted that treatments with electricity had fallen into the hands of quacks and charlatans and therefore into disrepute.7 As was stated in 1991 by Watson 7 Even today this area of research is not favoured by grant-giving bodies and is viewed from the same perspective of disbelief. Also, the lack of easy availability of well-controlled and calibrated power supplies, ammeters and voltmeters—and thus the definition of optimum electrolytic conditions—at the end of nineteenth century, caused electrolytic burns and other failures in some patients so that the technique was never integrated into the routine clinical practice. 

The rediscovery of this technique in clinical practice can be traced to the work of Nordenstrom11 in Sweden, about a quarter of... 

Provision of adequate competent medical staff is essential for the safe and ethical conduct of studies in humans. Decisions about whether a volunteer fulfils the entry criteria for a healthy subject or should be withdrawn from a study, how to respond to an unexpected adverse event and when to discontinue a study can prove challenging to the most experienced physician. Similarly, research nurses need many organisational and other skills over and above those that they acquired during their basic clinical training. Scientific staff must be competent in the techniques that will provide the essential data. All must be properly briefed about what will be required of them during the course of a study, and must be fully familiar with local standard operating procedures (SOPs) in compliance with good clinical practice (GCP). 

Clearly we cannot use techniques like these in routine clinical practice to measure the rate of input of drug into the plasma after oral or parenteral administration. Similar arguments apply to measuring drug loss - it is comparatively easy if it s only through the kidney, but very difficult if loss through the biliary system needs to be measured as well. 

With just a few relatively simple techniques it is possible to get all the important information needed to devise appropriate dosing schedules. We will only look at the simplest of these, which are of everyday, practical importance in clinical practice. All of these, and several others, are carried out in the process of drug development, and their results must be reported to regulatory authorities before a new drug may be registered for use. 

R. Kumar, S. Jana, Positron emission tomography An advanced nuclear medicine imaging technique from research to clinical practice. Methods Enzymol. 385 (2004) 3-19. 

The weighting factors, W, as introduced above, aim to be a pragmatic approach to harmonize prescription and reporting of radiation treatments. They are based on actual clinical practice, current techniques, and available radiobiological data. Their use should be limited to the technical treatment modality for which they were designed. They are not universally applicable factors, and they should not be multiplied or combined between each other. 

Marks, J. Techniques of benzodiazepine withdrawal in clinical practice. Med. Toxicol. 3, 324-333. 1988. 

Finally, there are two experimental methods which have not yet been applied in ordinary or even specialized clinical practice. For a long time there has been interest in the prospect of vaccination, and while a variety of techniques have been used, the basic principle is that limited exposure to cocaine produces antibodies which then prevent fiill distribution of the drug into the brain if it is taken (Kantak 2003). The other approach, less researched, is to enhance drug excretion, to reduce the acute reinforcing effects of cocaine (Donovan et al. 2005). 

Several methods are available in the literature for the measurement of aliphatic amines in biological samples [28]. Problems with specificity and separation and cumbersome derivatisation and/or extraction procedures have limited the use of these techniques on a larger scale in clinical practice. The lack of a simple analytical method may have led to an underestimation of the incidence of the fish odour syndrome. For diagnosing the syndrome, an analytical technique should be used that is able to simultaneously and quantitatively measure TMA and its N-oxide in the complex matrix of human urine. Two such methods are currently available for this purpose proton nuclear magnetic resonance (NMR) spectroscopy and head-space gas analysis with gas chromatography or direct mass spectrometry (see below). 

Supramolecular chemistry is now at the forefront of clinical practice. By linking lanthanide metal-macrocyclic complexes to tissue selective receptors the use of magnetic resonance imaging has become far more useful and widespread. This technique, which relies on the receptor-spacer-reporter motif, has become one of the most powerful medical diagnostics tools available in hospitals worldwide. 

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