Monitoring patient outcomes

Microarrays have become important tools in assessing gene expression responses in chemotherapy, development of drug resistance, pharmaco-dynamics, and transcriptional profiling to monitor patient outcomes and drug efficacy. 

Serum ALD determinations have been of some clinical interest in primary diseases of skeletal muscle. Some researchers believe that increased ALD activity is useful in distinguishing neuromuscular atrophies from myopathies in combination with the CK/AST ratio. In general, however, measurement of ALD activity in serum does not add information to that available more readily from measurement of other enzymes, such as AST, LD, and especially CK. A recent study, assessing the utility of ALD determination by monitoring patient outcome, showed no clinical benefit when ALD was used in addition to CK in evaluatmg patients with suspected muscle disease. ... 

Hawkins RC. Assessment of the utility of aldolase determination in serum by monitoring patient outcomes. Biochim Clin 2001 25 331-5. 

Nuclear pharmacy seeks to improve and promote public health through the safe and effective use of radioactive drugs for diagnosis and therapy. A nuclear pharmacist, as a member of the nuclear medicine team, specializes in procurement, compounding, quality assurance, dispensing, distribution, and development of radiopharmaceuti-cals. In addition, the nuclear pharmacist monitors patient outcomes and provides information and consultation regarding health and safety issues. 

The MOS was a 2-year observational study designed to help understand how specific components of the health care system affected the outcomes of care. One of the two original purposes of the MOS was to develop more practical tools for monitoring patient outcomes, and their determinants, in routine practice using state-of-the-art psychometric techniques. The study and its many implications and conclusions are discussed in detail elsewhere and mentioned here for completeness. 

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-... 

Newer techniques include monitors capable of performing microdialysis, or measuring brain oxygenation and lactate, which may be useful in monitoring penumbral tissue adjacent to a large area of infarction. No randomized studies have been performed to clearly document their impact on patient outcomes to date. 

Develop a plan for monitoring therapeutic outcomes, focusing on the individual symptom profile and level of function of each patient. Include a plan for dosage adjustments or alternate therapy if the patient fails to respond adequately. Include serum drug concentration monitoring as appropriate. 

It is important to carefully document core ADHD symptoms at baseline to provide a reference point from which to evaluate effectiveness of treatment. Improvement in individualized patient outcomes are desired, such as (1) family and social relationships, (2) disruptive behavior, (3) completing required tasks, (4) self-motivation, (5) appearance, and (6) self-esteem. It is very important to elicit evaluations of the patient s behavior from family, school, and social environments in order to assess the preceding. Using standardized rating scales (e.g., Conners Rating Scales-Revised, Brown Attention-Deficit Disorder Scale, and IOWA Conners Scale) in both children and adults with ADHD helps to minimize variability in evaluation.29 After initiation of therapy, evaluations should be done every 2 to 4 weeks to determine efficacy of treatment, height, weight, pulse, and blood pressure. Physical examination or liver function tests may be used to monitor for adverse effects. 

Based on the information presented, create a care plan to treat this patient s ankle injury. Your plan should include (1) the goals of therapy and desired outcomes, (2) a patient-specific therapeutic plan, including nonpharmacologic therapy, and (3) a plan to monitor the outcome of therapy to determine if goals of therapy have been met and adverse effects avoided. 

Continually monitor patient parameters to ensure optimal therapy to maximize outcomes. 

Objective measurements of airflow obstruction with a home peak flow meter may not necessarily improve patient outcomes. The NAEPP advocates use of PEF monitoring only for patients with severe persistent asthma who have difficulty perceiving airway obstruction. 

The purpose of pharmacy administration course work is to teach pharmacy students how to design and manage medication use systems that produce optimal results for patients. In pharmacy administration courses, students learn how to conduct medication use evaluations that measure patient outcomes. They are taught how to communicate effectively with patients and with other health care providers. Pharmacy administration courses also teach ethical and legal responsibilities to monitor drug therapy and to protect patients from problems with drug therapy. 

To monitor fetal outcomes of pregnant women exposed to bupropion, the manufacturer maintains a bupropion pregnancy registry. Health care providers are encouraged to register patients by calling (800) 336-2176. 

Heart failure Do not administer doses greater than 5 mg/kg to patients with moderate to severe heart failure. Infliximab has been associated with adverse outcomes in patients with heart failure use in patients with heart failure only after considering other treatment options. Monitor patients closely infliximab must not be continued in patients who develop new or worsening symptoms of heart failure. 

Neuron-specific enolase (NSE). NSE is useful for monitoring the outcome of treatment and the course of disease in patients with neuroendocrine tumors, in particular small cell lung cancer and neuroblastoma. The test is not suitable as a screening or adjunct to diagnosis because of low clinical sensitivity and specificity. Elevated serum NSE concentrations are found in patients with ... 

The main patient outcome measures of interest to the pharmacists at Care-Rite Pharmacy are clinical outcomes, patient knowledge, and patient satisfaction. Also, the pharmacists were interested in monitoring physician response to their clinical recommendations. The information collected would be kept in the patient chart. An electronic database was created to store... 

The medication use process is a complex system intended to optimize patient outcomes within organizational constraints. Quality medication use involves selection of the optimal drug, avoidance of adverse medication events, and completion of the therapeutic objective. Safe medication practices focus on the avoidance of medication errors. Medication use review and ongoing medication monitoring activities focus on optimizing medication selection and use. These two approaches are important means of assessing and optimizing the quality of medication use. 

Current phase I/II trials in PP-MS are underw ay and include evaluation of rituximab, a synthetic antibody that binds to and induces lyses of B cells. The trial is scheduled to enroll over 430 patients for 30m and will monitor clinical outcomes as well as immunologic and MRI measures. Rationale for the trial is based on a efficacy in use with worsening Devic s disease or neuromyelitis optica (Cree et al., 2005). 

In 17 patients aged over 18 years with severe acute community-acquired pneumonia trovafloxacin concentrations were persistently high in the sputum, bronchial secretions, bronchoalveolar lavage fluid, and epithelial lining fluid, with no significant difference between these compartments (16). The authors proposed that measurement of sputum concentrations could be used to monitor the outcome of treatment. 

---