Patient status

A diametrically different picture exists in the immature heart The chronic hypoxia to which it is subjected, renders it more resistant against ischemia.17,18 Another intriguing aspect in this state is that ischemic preconditioning is not as effective.19,20 However, it has not been adequately clarified if preconditioning does not really exist or if it is difficult to demonstrate additional protection in an intrinsically resistant heart. 

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Management How is patient status tracked How is visit status tracked How is forms status tracked ... 

The use of electronic-based data collection and management systems allows the easy tracking of patient progress in the trial. Patient, visit, and form status are tracked. Patient status can be in screening, excluded, randomized, withdrew, or completed study. Similarly, status codes can be assigned to protocol scheduled visits to indicate whether the visit occurs or not. Form status depends on the type of the data collection system. For example a form in a distributed data collection system can be incomplete, filled, completed, altered, or transmitted. ... 

Stroke outcomes are measured based on the neurologic status and functioning of the patient after the acute event. The National Institutes of Health Stroke Scale (NIHSS) is a measure of daily functioning and is used to assess patient status following a stroke. 

Determine the follow-up period based on patient status and needs (typically 3 to 6 months). 

Conversion from one dosage form to another or from one opioid to another may be necessary in situations such as ineffective pain control, emergence of side effects, change in patient status, and in formulary restrictions. Equianalgesic doses should be I used when converting from one opioid to another. Clinicians... 

Vigilant monitoring of patient status is essential (Table 75-6). 

Step 6 Revise regimen Adjust regimen based on drug response or change in patient status (including renal function) as warranted... 

Improvement Item Mass casualty plan was not implemented initially due to communication difficulties. Communication of patient status at decontamination was not well-coordinated with Red Cross shelter representatives. Persons at shelters were registered, but if they were sent to the hospital or left with friends/family, their status was unknown. 

Present status Requires arterial blood Performed in a central clinical lab Time delays, changing patient status Complex instrumentation Requites handling of blood (AIDS) Estimated U.S. market 400,000,000 per year... 

The longest follow up to date of patients status postskele-tal myoblast implantation was 12 months (55). Ten patients undergoing CABG with low EFs were treated. Two patients developed NSVT in the postoperative period, necessitating amiodarone infusion, and all subsequent patients were placed on prophylactic amiodarone. Improvement in EF was similar to other studies and was sustained at 12 months. 

Therapeutic treatment can affect disease status without altering the time to reach a burned out steady-state status, Sss. This improvement in patient status would be expected to be transient and dependent on continual drug exposure. Equation 20.13 describes the effect of adding a drug that has a symptomatic effect lEoFF(CeA)] 01 patient status ... 

It is the author s opinion that there are no grounds for using sodium bicarbonate to treat lactic acidosis, irrespective of the arterial (or venous) pH. This contradicts previous recommendations that it should be used when the pH decreases below 7.1 (Divers 1998) or 7.22 (Johnson 1995). The treatment of lactic acidosis with sodium bicarbonate is based on four suppositions low blood pH is directly harmful, sodium bicarbonate is able to increase blood pH when infused i.v., raising the blood pH with sodium bicarbonate improves patient status and any adverse effects of sodium bicarbonate are outweighed by its benefits (Forsythe Schmidt 2000). These suppositions are not supported by the data available currently in horses, humans and experimental animals. 

A series of clinical outcome reports have demonstrated that measures of PD solute removal correlate with patient status and outcome. In particular, a multicenter prospective cohort study of 680 incident CAPD patients [Canada-United States (CANUSA) Study] showed that a decrease of 0.1 in weekly urea clearance (defined by Kt/V ,ea) was associated with a 5% increase in the relative risk of death. Similarly a decrease of 5L/wk/1.73m of total creatinine clearance (Cc,) was associated with a 7% increase in the risk for death. As a consequence of these studies, national guidefines from the United Kingdom, Australia, and the United States " have set standards of dialysis adequacy in terms of small solute removal. An estimate of adequacy is performed in all patients withm 6 to 8 weeks of commencement of dialysis. Further studies should be performed at least annually. ... 

In this framework, disease progress refers to the evolution of a disease over time, or the disease trajectory, which can be assessed by observing the time course of a biomarker or other clinically relevant endpoint that reflects the status of a disease or is a measure of the clinical status of a patient. The status of the patient is a reflection of the state of the disease at a point in time. Disease status may improve or worsen over time, or may be a cyclical phenomenon such as the seasonal affective disorder component of depression. Therefore, a model of disease progress is a mathematical expression that describes the expected changes in patient status over time either in the absence of treatment or at least in the absence of the treatment being investigated. 

Curative. A curative drug completely halts the progression of a disease and reverses the patient status back to the predisease state. Even after cessation of therapy, the patient status remains at the predisease state. An example of a curative drug is provided in Figure 21.3. As can be seen in this figure, the baseline disease status reverses rapidly to 0 and remains there after removal of drug. 

When building a model for disease progression, it is often best to develop the disease progression model hrst, and then a model for drug effect is added. Typically, several disease progression models will be tested and the one that appears to best describe the time course for the markers of patient status is taken further to evaluate the addition of models for drug effect. 

With a linear model, there are two basic drug effect patterns possible. Symptomatic drug action will improve patient status but has no impact on the rate of progress, or the drug can alter the rate of progress of the disease, resulting in a protective or disease modifying action. 

A symptomatic beneht can easily be described by adding an effect based on drug concentration. In this case, the drug effect, E(t), modifies the patient status by shifting it by a constant amount over time as long as drug is present. 

The Emax model is a simple function to implement in NONMEM and has the advantage of parameterization that is reasonably familiar, making the modeling results relatively easy to interpret by individuals who are not familiar with modeling. The patient status at any time t is described as the sum of the basehne status So and some recovery function that has a maximum of 5n,ax- The time to half maximal recovery is Sso-... 

Assays for plasma prekaUikrein have been available for over 10 years. Since the immunologic assays fail to distinguish between prekallikrein, kallikrein, and kallikrein-inhibitor complexes, a functional assay (clot-endpoint or synthetic substrate), is preferred to monitor the patient status (F4). Functional assays of prekallikrein, however, have encountered technical problems. To measure prekallikrein in plasma, it must be quantitatively converted to kalUkrein. As stated above, this transformation is dependent on the... 

Toxic steam penetrated by inhalation complicates the patient status by pulmonary lesions of the toxic pulmonite and acute respiratory insufficiency type. 

However, the flow cytometers are bulky and expansive, and are available only in large reference laboratories. In addition, the required sample volumes are quite large, usually in the 100 pL range. Many clinical applications require frequent blood tests to monitor patients status and the therapy effectiveness. It is highly desirable to use only small amount of blood samples Ifom patients for each test. Furthermore, it is highly desirable to have affordable and portable flow cytometry instruments for field applications, point-of-care applications and applications in resource-limited locations. To overcome these drawbacks and to meet the increasing needs for versatile cellular analyses, efforts have been made recently to apply microfluidics and lab-on-a-chip technologies to flow cytometric analysis of cells. 

Strain and pressure sensors and also biochemosensors for measuring characteristics of the human skin are particularly interesting for this kind of applications because they could measure a wide set of parameters such as posture, breathing activity body fluids composition, etc. in a totally nonintrusive way. This characteristic is in fact very interesting for practical applications. For instance, it would allow doctors to monitor the patient status in real time, 24 h a day additionally, it would afford a better quality of life to patients for whom they would be perceived as noninvasive monitoring systems. 

Computers similar to those developed to control the flight plans of the Apollo capsule were used to store, process, and cross-check medical records, to monitor patient status in intensive care units, and to provide sophisticated statistical diagnoses of potential diseases correlated with specific sets of patient symptoms. 

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