Patient Results

QC mechanisms based on patient data provide additional information useful in monitoring the quality of laboratory analyses. These procedures are often time consuming and generally are not sensitive enough to serve as the only means of QC. However, many of the control problems detected with these techniques may not be evident with conventional QC systems. A quality assurance program should make appropriate use of patient data procedures, and both individual and multiple patient results have been used for QC purposes. 

The patient test results are the final product of most laboratory procedures, and the monitoring of these results is the most direct form of QC. Unfortunately, procedures for monitoring results are not very sensitive and have low probabilities for error detection. The most effective procedure is the chnical correlation of test results with other information related to the patient, especially surgical findings, response to therapy, and autopsy data. Less sensitive but easier to implement are comparisons with previous test values and correlation with related test results. The easiest procedure is the comparison of test results with physiological or probabilistic limits. 

Some examples of this approach are the linkage of adverse outcomes of inappropriate anticoagulation (stroke, myocardial infarct, or death widiin 6 days) to the measurement of prothrombin times and the linkage of adverse effects of digoxin therapy (death or hospitalization caused by insufficiency, overdose, or drug reaction) with the measurement of digoxmd  

Correlation with Other Laboratory Tests As in clinical correlation, there are a limited number of situations in which a single test result is plausible, but the combination of several test results is impossible or very unlikely. If the tests involved in these comparisons are performed at the same time, one often can identify errors and correct problems before reporting the test results to the clinicians. Even though very few tests have exact clinical relationships and one often must consider statistical pei centages rather than the results of a single patient to identify malfunctions, several relationships provide some possibilities for monitoring an individual patient s results, at least for purposes of initiating further review  

Blood typing. There is a close association between the ABO blood antigens on erythrocytes and isoantibodies fomid in plasma. Exceptions are found in patients recently transfused with whole blood. 

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The nurse should teach the patient taking naltrexone the impact of therapy. While taking the drug, any use of heroin or other opiate by the patient results in no effect. In fact, large doses of heroin or other opiates can overcome the drug s effect and result in coma or death. 

These hormones cause few adverse reactions when administered as directed. Antibodies to somatropin may develop in a small number of patients, resulting in a failure to experience response to therapy, namely, failure of the drug to produce growth in the child. Some patients may experience hypothyroidism or insulin resistance Swelling, joint pain, and muscle pain may also occur. 

In rheumatoid arthritis the damage that is found in joints may also be a result of the inactivation of a-1-PI due to the oxidation of an essential methionine(s) residue in this protein. It has been found that a-l-PI purified from the synovial fluid of patients with rheumatoid arthritis contained four Met(O) residues and was not able to form a binary complex with elastase89. It is probable that the presence of the Met(Oj residues in a-l-PI from these patients results from a high level of oxidants produced by neutrophils in the inflammed joint. 

Gonzalez G, Sevarino K, Sofuoglu M, et al Tiagabine increases cocaine-free urines in cocaine-dependent methadone-treated patients results of a randomized pilot study. Addiction 98 1625-1632, 2003... 

The study of Anderson and Mitchell (1997) examined whether the AIDS-specific home and community-based waiver program, which was implemented in Florida in 1990 as an alternative to institutional care, was effective in reducing Medicaid expenditures per beneficiary during its first 2 years of operation. Therefore, the authors used Medicaid claims data and country information to estimate the effect of the waiver on expenditures controlling for nonrandom program selection. Their results indicate that persons with AIDS who used waiver services incurred monthly expenditures that were on average 22-27% lower than otherwise similar nonparticipants. The authors concluded that home and community-based care for AIDS patients resulted in lower expenditures per beneficiary. 

After counting the samples and obtaining a printout from the counter the data must be arranged into a standard curve of some type from which patient results can be determined. 

Boccardo F, Rubagotti A, Barichello M, et al. Bicalutamide monotherapy versus flutamide plus gosrelin in prostate cancer patients Results of an Italian Prostate Cancer Project study. J Clin Oncol 1999 17 2027-2038. 

AIDS is associated with aberrant lymphocyte production and it has been proposed that Li+ may have a potential role in reversing this. Additionally, 3 -azido-3"deoxythymidine (AZT, zidovudine), an effective inhibitor of viral reverse transcriptase that reduces mortality in AIDS patients, induces hematopoietic suppression in patients resulting in anemia, neutropenia, and overall bone-marrow failure [220]. In murine AIDS, the coadministration of Li+ effectively moderates this toxicity of AZT in vivo [221,222]. There are several case reports where Li+ has been administered to help reduce the hematopoietic suppression in HIV-infected patients taking AZT (for example, see ref. 223). To date, the use of Li+ has been limited to a few weeks of treatment, and varying degrees of success have been achieved nevertheless the outlook in this field is quite hopeful. 

Methylene blue and other reducible dyes were shown to enhance the activity of NADPHa-linked MHbR (K8, K9). This is confirmed by the finding that intravenous injections of methylene blue in methemo-globinemic patients result in a striking decrease of MHb levels (e.g., B14, K9, K10). This seems to be paradoxical, since methylene blue is capable of reacting with Hb with formation of MHb, but the dye reacts much more effectively as an artificial electron carrier in the NADPH2-MHbR Systran (B14). It has been stated (K10) that methemoglobin reduction is associated with the formation of pyruvate in equivalent amounts, but that in reactions accelerated by reducible dyes no correlation between pyruvate formation and MHb reduction could be found. 

H3. Highsmith, W. E., Chong, G. L., Orr, H. T., Perry, T. R., Shaid, D., Farber, R., Wagner, K., and Thibodeau, S. N., Frequency of the delta Phe508 mutation and correlation with XV.2c/KM-19 haplotypes in an American population of cystic fibrosis patients Results of a collaborative study. Clin. Chem. (Winston-Salem, NC) 36, 1741-1746 (1990). 

In addition to the greater risk in patients, results in patients are frequently confounded by the effects of disease, concomitant medication, age and other variables. By contrast, healthy subjects are much more homogeneous and subjects are studied under standardised conditions. It is sometimes argued that healthy volunteers are not representative of the patient population and therefore that the studies are of less... 

The short chain fatty acids include butyrate derivatives Hke phenylbu-tyrate, AN-9 (pivaloyloxymethyl butyrate) and valproate. Unfortimately, these compounds have poor potency and pharmacokinetic properties, including short half-life. Numerous Phase I studies with phenylbutyrate, in various oral and intravenous schedules [118-120] have been performed, with neurological toxicity at higher doses being reported. AN-9 showed initial promise in a Phase I study, where the MTD was not reached [121]. The subsequent Phase II study in nonsmall cell lung cancer in 47 patients resulted in fatigue, nausea and dysgeusia as common toxicities. Three partial responses (PR)... 

Hypersensitivity pneumonitis - Hypersensitivity pneumonitis usually appears earlier in the course of therapy, and rechallenging these patients results in a more rapid recurrence of greater severity. 

Coadministration with anakinra in RA patients resulted in a 7% rate of serious infection. 

Sohn TA, et al. Resected adenocarcinoma of the pancreas-616 patients results, outcomes, and prognostic indicators. J Gastrointest Surg 2000 4(6) 567-579. 

Its growth and differentiation-inducing effects on early haematopoietic progenitor cells forms the basis of clinical interest in IL-3. Its administration to healthy patients results in increased blood leukocyte counts, although the concentration of all white blood cell types is not equally increased. 

Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA et al. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med 1991 324(6) 377-84. 

Guelfi JD, Pichot P, Dreyfus JF Efficacy of tianeptine in anxious depressed patients results of a multi-center trial versus amitriptyline. Neuropsychobiology 22 41-48, 1989... 

Wells KB, Stewart A, Hays RD, et al The functioning and well-being of depressed patients results from the Medical Outcome Study. JAMA 262 914-919, 1989 Wells KB, Burnam A, Rogers W, et al The course of depression in adult outpatients. Results from the Medical Outcomes study. Arch Gen Psychiatry 49 788-801, 1992... 

Ottevanger EA. Fluvoxamine and clomipramine in depressed hospitalized patients results from a randomized, double-blind study. Encephale 1995 21 317-321. 

Reiter A, Schrappe M, Ludwig WD et al. Chemotherapy in 998 unselected childhood acute lymphoblastic leukemia patients results and conclusions of the multicenter trial ALL-BFM 86. Blood 1994 84 3122-3133. 

Physicians need improved tools for selecting treatments for individual patients. For example, many cancer treatments benefit only a minority of the patients to whom they are administered. Being able to predict which patients are most likely to benefit would not only save patients from uimecessary toxicity and inconvenience, but might facilitate their receiving drugs that are more likely to help them. In addition, the current over-treatment of patients results in major expense for individuals and society, an expense that may not be indefinitely sustainable. In this discussion we will address some key issues in the validation of pharmacogenomic classifiers. 

Beclomethasone dipropionate, triamcinolone acetonide, budesonide, flunisolide, and mometasone furoate are available as nasal sprays for the topical treatment of allergic rhinitis. They are effective at doses (one or two sprays one, two, or three times daily) that in most patients result in plasma levels that are too low to influence adrenal function or have any other systemic effects. 

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