Prophylactic intervention

Studies using flow surveillance in AVG have shown 87-100% positive predictive value in detecting hemodynamically significant stenosis. However, prophylactic intervention has failed to show a reduction in thrombosis and prolongation of AVG survival. Flow surveillance has shown benefit in reducing thrombosis with a trend towards increased longevity in AVF [16]. 

I agree with your comment. The main reason for the concern in relation with 1311 stems from the extrapolation down from higher doses. It is for instance clearly established that external radiation to the thyroid in children will cause th)n oid cancer. This is universally accepted, at least at certain dose rates Concerning the problem of low dose rates, the calculation is more difficult it is extrapolated down from a high dose rate to low dose rates and ends up with some radiation numbers those numbers are our real concern and explain why different groups have considered it important to propose massive prophylactic interventions. I suspect that the most conservative position is the one that is desirable, but one should remember that people are greatly concerned about this issue. 

GPIIb/IIIa antagonists have to be administered parenterally. They are currently used prophylactically during intracoronary interventions such as percutaneous transluminal revascularization with balloon angioplasty or intracoronary stenting, as well as to treat acute coronary syndromes like unstable angina and acute myocardial infarction. The main complications... 

Interaction with Other Cascade Systems. Interactions between the complement system, the kinin, and the coagulation and fibrinolytic systems have repeatedly been reported (S37, PI9). Activation of one system induces activation of the other systems. The reciprocal activation of the various cascade systems may have an important role in the pathogenesis of ARDS and MODS as complications of sepsis. Nevertheless, until now no convincing prophylactic or therapeutic effects of intervention in the complement cascade system on the severity of septic complications have been reported. 

XVb.3.2. Prophylaxis. There is little evidence to justify prophylactic endoscopic or surgical intervention in patients with varices which have not yet bled. Available trials have often been small and assumptions based upon aggregation may not be well justified. Non-selective beta-blockade with propanolol appears however to halve the risk of bleeding. 

The prototypes of modem psychopharmaceuticals were discovered between 1952 and 1958. Since that time the effective treatment of schizophrenic psychoses, depressions, anxiety syndromes and other mental disorders has become possible and a new, multidisciplinary science biological psychiatry has developed. Clinical psychiatry has changed dramatically in the past 50 years fewer patients are hospitalized long term, psychiatric care and treatment have largely shifted to outpatient departments and private practices, and new models of combined pharmacological and non-drug-based prophylactic and therapeutic interventions have been developed. 

The course of an illness also dictates the need for and the duration of maintenance and prophylactic therapy. In particular, prophylaxis may not be indicated for an uncomplicated first episode depending on the specific disorder and the patient s response to standard interventions. Conversely, patients with histories of multiple... 

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). 

Among patients with advanced kidney disease (mean creatinine clearance, 26 mL/min), an increase in SCr levels of at least 25% was significantly less common in patients randomly assigned to prophylactic hemofiltration before and after the administration of CM than in those assigned to receive fluid alone (5% vs. 50%, p < 0.001) (75), In-hospital death was also significantly less frequent in the hemofiltration group, However, the SCr level is directly altered by the intervention, and the relationship between the intervention and the reduced mortality rate is unclear. Thus, the role of hemodialysis in patients at high risk for CIN remains uncertain. 

Prophylactic measures with regard to the hepatorenal syndrome are of decisive and vital importance. It must be borne in mind that the water balance is extremely sensitive in cirrhotic patients. The cause can almost always be found in an enormous iatrogenic intervention in the volumetric balance (aggressive diuresis, imbalance in the tapping of ascitic fluid, excessive restriction of fluid). For this reason, it is important to avoid all substances which could worsen renal function (e.g. nonsteroidal antirheumatics, aminoglycoside antibiotics) and all measures which could lead to a reduction in the effective plasma volume. Furthermore, care should be taken to apply the principles of prophylaxis and therapy... 

Of 256 patients with myeloma randomized to thahdomide or not, 221 received no prophylactic anticoagulation and 35 received low-dose warfarin 1 mg/day (31). The incidence of deep venous thrombosis was higher in those who took thahdomide (hazard ratio 4.5). Warfarin did not reduce the risk, and prophylactic subcutaneous enoxa-parin 40 mg/day was therefore introduced in 68 patients of a subsequent group of 130 patients who received thalidomide. This intervention eliminated the difference in the incidence of deep venous thrombosis between those who took thalidomide and those who did not. 

The CIN Consensus Working Panel considered that hemofiltration deserves further investigation using end points unaffected by the experimental intervention, but the high cost and need for intensive care unit admission will also limit the utdity of this prophylactic approach. [149]. 

A pharmaceutical organization has to determine which medical area has an unmet clinical need for an effective prophylactic or therapeutic intervention. 

Sudowe S, Ludwig-Portugall I, Montermann E, et al. (2006). Prophylactic and therapeutic intervention in IgE responses by biolistic DNA vaccination primarily targeting dendritic cells. J. Allergy Clin. Immunol. 117 196-203. 

There is no chemically specific prophylactic or postexposure therapy for NOX inhalational injury. Current therapy consists of intervention directed at specific symptoms (see the earlier discussion titled General Therapeutic Considerations). Pneumonitis appears to complicate the initial pulmonary edema relatively early nevertheless, the use of prophylactic antibiotics is not indicated. 

Models are also useful because they can help us with experimental design of laboratory studies by predicting appropriate doses, exposure times, or sampling intervals. They can help us develop and test hypotheses about a disease or normal process or about actions of a specific biological component. A valid model is useful for interpolation within experimental parameters or extrapolation to simations that are difficult to observe experimentally. Ultimately, they can be used to improve the risk assessment process and assist in the design of prophylactic or therapeutic interventions. 

Both prophylactic naps and caffeine helped to maintain alertness and performance. In the real world, however, naps and caffeine have separate advantages and disadvantages that help dictate their use. Prophylactic naps clearly had the advantage of a long-lasting effect and could probably be used with some frequency without the development of tolerance, dependency, withdrawal or side effects. On the other hand, naps must be planned and may consume a substantial amount of time. Caffeine clearly can be used when time is insufficient for a nap, but carries the potential risks of most pharmacological interventions. One strategy that may be superior to either the use of caffeine or prophylactic naps may be the use of both. This was tested in the second study. 

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