Patients selection

Careful patient selection is important if diaphragmatic pacing is to be effective. The main indications are SCI above C3, central alveolar hypoventilation, which may be idiopathic or secondary to brain stem injury, or other conditions that affect daytime or nocturnal ventilatory control. Whereas patients with high SCI require 24-hour ventilation, those with hypoventilation may only require support for part of this cycle. 

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Since about 85% of the administered dose is passed unchanged in the feces of the patient, selective toxicity of the dmg can be attributed primarily to poor absorption. Side effects include abdominal pain, nausea, vomiting, diarrhea, loss of appetite, headaches, and vertigo or drowsiness. Skin rashes can also develop. Pyrantel pamoate is produced by Pfi2er, Inc., New York, New York. 

Wildermuth S, Knauth M, Brandt T, Winter R, Sartor K, Hacke W. Role of CT angiography in patient selection for thrombolytic therapy in acute hemispheric stroke. Stroke 1998 29 935-938 [see comment]. 

A combined analysis of the ATLANTIS, ECASS-11, and NINDS rt-PA study data found that females had a greater benefit from rt-PA than males (p = 0.04), despite similar initial stroke severity and rates of slCH." This finding may not be relevant to the clinical, FDA-approved use of rt-PA, because most of the analyzed subjects from ATLANTIS and ECASS-11 were randomized greater than 3 hours after stroke onset. Therefore, sex should not be a criterion for patient selection for thrombolysis. 

The relevant subgroup analyses therefore provide no additional criteria for patient selection for IV rt-PA. Subgroup analyses, however, must be interpreted... 

The Stroke-Thrombolytic Predictive Instrument (Stroke-TPI) has recently been developed in order to provide patient-specific estimates of the probability of a more favorable outcome with rt-PA, and has been proposed as a decision-making aid to patient selection for rt-PA." The estimates from this tool should, however, be treated with caution. The prediction rule is dependent on post hoc mathematical modeling, uses clinical trial data from subjects randomized beyond 3 hours who are not rt-PA-eligible according to FDA labeling and current best practice, and has not been externally validated. It is, therefore, not appropriate to exclude patients from rt-PA treatment based solely on Stroke-TPI predictions. 

The timing of CEA after ischemic stroke has been a controversial issue. In 1969, the Joint Study of Extracranial Arterial Occlusion reported 42% mortality after CEA in patients with neurological deficits of less than 2 weeks duration, compared with 5% mortality in patients with more than 2 weeks of symptoms. Early evidence also demonstrated an increased risk of intracerebral hemorrhage after early CEA in patients with acute stroke. This led to the conclusion that most complications occurred with early surgical intervention, and resulted in a traditional 4-6 week delay for CEA after an acute stroke. In retrospect, however, there were major problems with patient selection in these earlier reports. Many of the patients... 

Bullectomy, lung volume reduction surgery, and lung transplantation are surgical options for very severe COPD. These procedures may result in improved spirometry, lung volumes, exercise capacity, dyspnea, health-related quality of life, and possibly survival. Patient selection is critical because not all patients benefit. Refer to the ATS/ERS COPD standards for a detailed discussion of appropriate selection of surgical candidates.1... 

The intensity of the daily chronic maintenance regimen varies based on patient age, baseline lung function, other organ system involvement, and social factors such as time available for therapy and patient-selected care choices. Generally, with more severe lung disease and multi-organ system involvement, therapies become more complicated and time intensive. Additionally, therapy is intensified when pulmonary symptoms are increased with acute exacerbations or even mild viral upper respiratory illness such as the common cold. The approach to treatment is best described by the organ system affected. 

Because alosetron has been associated with ischemic colitis, it may be prescribed only under strict guidelines, including signing of a consent form by both patient and physician. Patients selected for therapy should exhibit chronic IBS symptoms and have failed to respond to conventional therapy. 

As with all medications, there are potential adverse effects with combined oral contraceptives (COCs). Many side effects can be minimized or avoided by adjusting the estrogen and/or progestin content of the oral contraceptive. It is also important to have proper patient selection for oral contraceptives because some women are at increased risk for potentially serious side effects. 

In AIT, patient selection is critical. The allergic cause of AR should be verified by history and skin or blood tests. Additionally, the responsible antigen(s) must be identified. Patients who may benefit from AIT include those who do not tolerate traditional drug therapy (e.g., nosebleeds with intranasal steroids and sedation with antihistamines), suffer from severe symptoms, have comorbid conditions (e.g., asthma and sinusitis), fail drug therapy, or prefer not to take long-term medication.11 22"24... 

Based on the information provided, what are the goals of therapy for this patient Select and recommend a therapeutic plan for treatment of this patient s TB infection. What drugs, dose, schedule, and duration of therapy are best for this patient How should any contacts infected by this patient be evaluated and treated Select and recommend a therapeutic plan. What drugs, dose, and schedule of therapy are best for his close contacts ... 

Alternative first-line regimen Addition of IP therapy. Patient selection is critical Must have optimally debulked disease (less than or equal to 2 cm), no significant comorbidities, younger patients tolerate better. 

To better understand managed care and the reasons for its growth, it is useful to discuss the evolution of payment mechanisms for health care from no insurance, to traditional indemnity insurance, to managed care. In the no-insurance model, the patient selects a health care provider and then pays the provider directly for health care goods and services. The choice of health care provider and the type and number of services provided are limited only by the financial constraints of the patient. The problem with this model is that the patient is exposed to potentially catastrophic health care expenses. Health insurance was developed as a way to protect patients against this risk. Health insurance often is provided through the employer and prior to the mid-1980s was likely to be indemnity fee-for-service insurance. In this traditional insurance... 

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