Early intervention

Some osteoporosis risk factors (see Table 53-1) are non-modifiable, including family history, age, ethnicity, sex, and concomitant disease states. However, certain risk factors for bone loss may be minimized or prevented by early intervention, including smoking, low calcium intake, poor nutrition, inactivity, heavy alcohol use, and vitamin D deficiency. 

Wilt TJ, Brawer MK. Early intervention or expectant management for prostate cancer. The Prostate Cancer Intervention Versus Observation Trial (PIVOT) A randomized trial comparing radical prostatectomy with expectant management for the treatment of clinically localized prostate cancer. Semin Urol 1995 13 130-136. 

Rapid diagnosis of cardiopulmonary arrest is vital to the success of CPR. Patients must receive early intervention to prevent cardiac rhythms from degenerating into less treatable arrhythmias. 

Aggressive, early intervention with high-dose IV crystalline penicillin G, 50,000 units/kg every 4 hours, is usually recommended for treatment of N. meningitidis meningitis. 

Miller, W. R., Sovereign, R. G., Krege, B. (1988). The check-up A model for early intervention in addictive behaviors. Behavioural Psychotherapy, 16, 251-268. 

In exceptional cases, there may be a risk of individuals developing post-traumatic stress disorder in such circumstances early intervention and professional counselling are essential. 

This is the first phase of illness occurring before the start of overt psychotic symptoms. During this phase, patients so seldom come to clinical attention that we know very little about the appropriateness of various treatment options. It may be that early intervention can alter the course and lessen the ultimate severity of the illness, but this is far ahead of our current knowledge about schizophrenia. 

Continuous monitoring of organ function displays in real-time the clearance profile or concentration of an organ function-specific marker in a pre-deter-mined body compartment. This approach allows the early intervention by clinicians since instantaneous deviation from the established baseline reading may indicate the onset of an anomaly. However, it may not be useful for measuring dynamic functional reserve of the organ because subsequent activities after marker elimination from plasma may not be reflected in the clearance profile. 

As discussed above, in the case of phenylketonuria, early intervention can make the difference between mental retardation and a near normal life course for a newborn. Congenital adrenal hyperplasia and maple syrup urine disease are two examples of neonatal hereditary disorders where early diagnosis and medical intervention can make the difference between life and death for the newborn. In addition, in a number of genetic diseases, early diagnosis and treatment can help ameliorate symptoms these include fragile X syndrome, homocystinuria, sickle cell anemia, cystic fibrosis, and many /1-thalassemias. 

Nair, P., Schuler, M.E., Black, M.M., Kettinger, L. and Harrington, D. (2003) Cumulative environmental risk in substance abusing women early intervention, parenting stress, child abuse potential and child development. Child Abuse and Neglect 27, 997-1017. 

Duffy, A. Toward effective early intervention and prevention strategies for major affective disorders a review of antecedents and risk factors. Can. J. Psychiatry 45(4), 340-348, 2000. 

Wyatt, R.J. Early intervention with neuroleptics may decrease the long-term morbidity of schizophrenia. Schizophr. Res. 5(3), 201-202, 1991—... 

An important implication of this observation is the suggestion that early intervention in schizophrenia could substantially alter the natural course of the illness. To investigate this idea, early-intervention projects have been developed. In one, primary physicians were trained to recognize the early symptoms of a mental disorder and to arrange consultation with an intervention team who assessed and treated the disorder. If early symptoms were present, the functional psychotic disorder was treated with low doses of the appropriate medication, often for a relatively short period of time (i.e., several weeks), and then tapered when symptoms abated while psychosocial intervention was continued. In some patients, symptoms returned and medication was reinstituted. The psychosocial program, social skills training, and social casework were continued for some time, and all patients were monitored for at least 2 years. Epidemiological data established that over the lifetime of this project, 7.5 new cases would be expected for 100,000 patients (227, 228). 

Benefits of early intervention with medication include the following ... 

Falloon IRH, Coverdale JH, Laidlaw TM, et ai. Early intervention for schizophrenic disorders. Implementing optimal treatment strategies in routine clinical services. BrMed J 1998 172(suppl 33) 33-38. 

Education should continue even after the depressive episode has remitted. An explanation of the value of maintenance and prophylactic therapy, as well as when it is appropriate to discontinue treatment, is important. The early signs of relapse should be explained to both the patient and close family members or friends, if appropriate. The goal is to increase the likelihood of early detection in case of recurrence. This is based on the hope that early intervention may prevent or at least shorten the duration or intensity of an episode and lessen its consequences ( 387). 

Andreani, D., Di Mario, U., and Pozzilli, P. (1991). Prediction, prevention, and early intervention in insulin-dependent diabetes. Diabetes/Metab. Rev. 7, 61-77. 

Prevention is better than cure—if this is not possible early intervention is preferable to trying to deal with problems once they have become more severe. 

Yoshihara S et al Effects of early intervention with inhaled sodium cromoglycate in childhood asthma. Lung 2006 184 63. [PMID 16622775]... 

Antimicrobial agents are frequently used before the pathogen responsible for a particular illness or the susceptibility to a particular antimicrobial agent is known. This use of antimicrobial agents is called empiric (or presumptive) therapy and is based on experience with a particular clinical entity. The usual justification for empiric therapy is the hope that early intervention will improve the outcome in the best cases, this has been established by placebo-controlled, double-blind prospective clinical trials. For example, treatment of febrile episodes in neutropenic cancer patients with empiric antimicrobial therapy has been demonstrated to have impressive morbidity and mortality benefits even though the specific bacterial agent responsible for fever is determined for only a minority of such episodes. 

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