Clinical status, monitoring

Sami F. Khalil, Mas S. Mohktar and Fatimah Ibrahim. The Theory and Fundamentals of Bioimpedance Analysis in Clinical Status Monitoring and Diagnosis of Diseases. Sensors 2014, 14, 10895-10928 ... 

Patients with massive cerebral infarction may require ICP monitoring, as this may help to guide therapy and predict outcome. Schwab et al. ° evaluated 48 patients with massive hemispheric infarctions and clinical signs of elevated ICP. They found that ICP measurements correlated well with the patient s clinical status, CT findings and outcome, although they did not find a significant effect of their therapies for elevated ICP on patient outcomes. Multiple methods of monitoring ICP are avail-... 

Patients with hyperthyroidism also must undergo periodic clinical and laboratory monitoring, with more frequent monitoring if there is a change in the patient s clinical status. 

Monitoring Maintain urine output at a level of at least 100 mL every 4 hours. Monitor serum magnesium levels and clinical status to avoid overdosage in preeclampsia. 

Individualize dosage. Monitor the patient s clinical status to avoid toxicity. 

Monitoring Monitor serum magnesium levels and clinical status to avoid overdosage. 

With normal renal function, all that may be necessary is watchful waiting, careful monitoring of the clinical status, and repeated serum lithium determinations. 

With proper pharmacotherapy and optimization of overall clinical status, most patients will be able to overcome the problem of orthopnea for the duration of interventional procedure. Diuretic therapy preintervention may be useful. In the very ill patient with hemodynamic compromise, and where intervention may lead to an improvement in cardiac function, supportive measure, such as intra-aortic balloon counterpulsation, pressure monitoring, or ventilation may be necessary during the acute phase of the illness. 

The AFP level is a good indicator for monitoring therapy and the change in clinical status. Elevated AFP levels after surgery may indicate incomplete removal of the tumor or the presence of metastasis. Falling or rising AFP levels after therapy may determine the success or failure of the treatment regimen. A notable increase of AFP levels in patients considered free of metastatic tumor may indicate the development of metastasis. 

Pharmaceutical care of the hospitalized patient with infection is the most traditional role for infectious diseases pharmacists. Numerous opportunities for proactive interventions in antimicrobial selection, dosing, route of administration, and monitoring of patients with changing clinical status make this a popular practice setting for many individuals. 

A second object of the exercise was to determine if NMR-PR analysis could be used to monitor renal allograft dysfunction as a function of time. With the use of NLM techniques, it is possible to construct a plot of the longitudinal time course variations in the H NMR spectral profile of urine from a patient following transplantation, i.e. a trajectory of the pattern of renal allograft function. These trajectories were constructed using the six descriptors of the spectrum chosen by the NMR-PR method and could be used successfully to predict the clinical status of the patients. 

The fluid and electrolyte complications of diuretic therapy usually occur within the first 2 weeks of diuretic therapy, and repeated monitoring of serum chemistries is generally not necessary in the absence of a change in clinical status, diuretic dose, or dietary intake. 

Direct information seems to be limited to these reports, but the interactions appear to be of clinical importance. Monitor the serum phen5doin levels and increase the dosage appropriately if rifampicin alone is started. Reduce the dosage if the rifampicin is stopped. If both rifampicin and isoniazid are given, the outcome may depend on the isoniazid acetylator status of the patient. Those who are fast acetylators will probably also need an increased phenytoin dosage. Those who are slow acetylators may need a smaller phenytoin dosage if toxicity is to be avoided. All patients should be monitored very closely as, unless acetylator status is known, the outcome is unpredictable. 

These interactions are established. Concurrent use need not be avoided, but it would be prudent to monitor the outcome closely when any is used with clozapine because of the rises in serum clozapine and norclozapine levels that can occur, and because of the rare potential for deterioration in clinical status. Adjust the clozapine dosage as necessary. The authors of one study suggest particularly close monitoring if the daily clozapine dosage exceeds 300 mg or 3.5 mg/kg. The interaction is greatest with fluvoxamine, so other SSRIs may be a more prudent choice, although close monitoring is still required. 

Integration of sensors for monitoring a broader range of patients clinical status in areas such as cardiac hemodynamics and ischemia status. (At least one manufacturer already provides a feature that uses monitoring of transthoracic impedance as a way to assess pulmonary congestion in heart failure patients with a CRT device)... 

Unlike in PKU and MSUD, there are no clear laboratory parameters associated with good metabolic control in PROP and MMA. Monitoring goals need to be individualized based on the patient s phenotype and clinical status. Typically, plasma amino acid profiles are routinely evaluated in patients with PROP and MMA with the goal of preventing deficiency of the restricted amino acids valine, isoleucine, threonine and methionine (Box 20.3). 

On the basis of all the data accumulated, conservative management seems the most adequate in mild or moderate cases. Clinical status and renal function must be monitored closely. In most cases the dilatation will be stable or even resolve. Surgery must be proposed if clinical symptoms appear or if renal function deteriorates. In the more severe cases, spontaneous resolution is less likely and symptoms related to abdominal discomfort are more frequent. For such patients, surgery maybe beneficial (Koff and Campbell 1994 Docimo and Silver 1997 Blachar et al. 1994 Duckett 1993 Arnold and Rickwood 1990 Koff and Campbell 1992 Dowling et al. 1988 Capolicchio et al. 1999 McAlleer and Kaplan 1999 Chertin et al. 1999 Tapia and Gonzalez 1995 Salem et al. 1995). 

A crucial issue for antiviral therapy is the fact that all antiviral substances rapidly select for resistance thus, monitoring and overcoming resistance has become a most important clinical paradigm of antiviral therapy. This calls for cautious use of antiviral drugs and implementation of combination therapies. In parallel, efforts in drug discovery have to be continued to develop compounds with novel mode-of-action and activity against resistant strains. This book reviews the current status of antiviral therapy, from the roads to development of new compounds to their clinical use and cost effectiveness. Individual chapters address in more detail all available drug classes and outline new approaches currently under development. 

The clinical scenario and the severity of the volume abnormality dictate monitoring parameters during fluid replacement therapy. These may include a subjective sense of thirst, mental status, skin turgor, orthostatic vital signs, pulse rate, weight changes, blood chemistries, fluid input and output, central venous pressure, pulmonary capillary wedge pressure, and cardiac output. Fluid replacement requires particular caution in patient populations at risk of fluid overload, such as those with renal failure, cardiac failure, hepatic failure, or the elderly. Other complications of IV fluid therapy include infiltration, infection, phlebitis, thrombophlebitis, and extravasation. 

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