Prophylaxis predictive

The pretreatment of MH-susceptible patients with oral or intravenous dantrolene prior to surgery in order to avoid a crisis is controversial. Most physicians do not recommend prophylactic pretreatment except in patients who have had a previously documented episode. However, if pretreatment is desired, it is recommended that therapy be begun with intravenous dantrolene in a dose of 2 mg/Kg just prior to induction of anesthesia. This prevents the uncertainty of predictive blood values associated with the use of the oral route. The adverse effects of intravenous dantrolene prophylaxis include phlebitis and tissue necrosis. Patients who receive prophylactic treatment with oral dantrolene often complain of incapacitation, gastrointestinal irritation, prolonged drowsiness, and clinically significant respiratory muscle weakness. 

For prophylaxis when undertaking activities that predictably precipitate attacks, nitroglycerin 0.3 to 0.4 mg sublingually may be used about 5 minutes prior to the time of the activity. Nitroglycerin spray may be useful when inadequate saliva is produced to rapidly dissolve sublingual nitroglycerin or if a patient has difficulty opening the tablet container. The response usually lasts about 30 minutes. 

Some patients should also receive indefinite prophylaxis due to the high likelihood of recurrence. Because it is difficult to accurately predict which patients will have subsequent episodes, however, clinicians may be reluctant to expose those who will not experience a recurrence to the adverse effects of long-term therapy. 

The correlates of attitudes toward lithium compliance in bipolar patients were studied by Cochran and Gitlin (189). This questionnaire study was part of a larger design looking at factors in lithium prophylaxis. The questionnaire packets were sent to 146 patients, 48 of whom were ultimately included in the analysis. This study evaluated the usefulness of Ajzen and Fishbein s Theory of Reasoned Action to explain the relationships among lithium-related beliefs and attitudes, normative beliefs, behavioral intentions, and self-reported compliance with treatment. According to the model, lithium patients normative beliefs (i.e., beliefs that other relevant people such as family, friends, personal psychiatrist, and lithium experts want the patient to take lithium) predict their subjective norms, which is the expectation that others want them to take lithium. Subsequently, both the subjective norm and the evaluative behavioral attitudes (i.e., positive nature of treatment) were predictive of the patients reported intent to take lithium. This, in turn, was predictive of concurrent self-reported compliance with the medication regimen. These results underscore the importance of the patient-physician relationship in lithium compliance. 

In poultry and porcine husbandry in particular, the use of AMDs in feed or in drinking water for prophylaxis, metaphylaxis (or control in the United States) or therapy is widely practiced (see Section 2.73.2). Prophylaxis involves administration of AMDs to healthy animals known to be at risk (as a consequence, e.g., of close proximity of animals housed together or predictable stresses caused by transport or adverse weather conditions). Metaphylaxis involves... 

In most patients with diffuse PAVMs, improvement of dyspnea, oxygenation, and shunt fraction is not complete [12]. The residual shunt is believed to represent the shunt through small PAVMs [12]. Even if clinical and radiological evaluation is necessary, oxygen saturation tests are equally important to predict recurrence. It is recommended that patients with diffuse or non treated PAVMs be given antibiotic prophylaxis before dental and surgical procedures to avoid seeding of PAVMs and subsequent development of brain abscess. 

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