Risk monitoring, definition

The activities of enforcement laboratories should not be focused on irrelevant problems. Therefore, a clear definition of the relevant residue is needed. In the crops and food sector, procedures are well established to derive the two residue definitions, one for risk assessment and one for monitoring, from metabolism studies. As far as environmental samples are concerned, there is much potential for improvement. There are no clear criteria as to which metabolites should be included in monitoring and control programs. Additionally, the development of criteria for nonpriority pesticides, e.g., naturally occurring compounds or low-risk products, which can be excluded from monitoring exercises would be helpful for laboratories and evaluators. 

Reproductive Effects. It has not been definitively determined whether chloroform exposure induces reproductive effects in humans. No studies were located regarding reproductive effects in humans after inhalation or dermal exposure to chloroform. Only one study was located regarding reproductive effects in humans after oral exposure to chloroform. Bove et al. (1995) studied the effects of drinking-water consumption on birth outcomes and found that exposure to TTHM at levels >0.1 ppm resulted in reduced birth weight and size as well as an increased risk of oral cleft, central nervous system, and neural tube defects. These results should be viewed with caution since the authors did not specifically monitor chloroform levels. The effects seen may be due to exposure to other THMs or non-THM contaminants in the drinking water. 

Thus, the physician must establish with certainty that hypertension is persistent and requires treatment and must exclude secondary causes of hypertension that might be treated by definitive surgical procedures. Persistence of hypertension, particularly in persons with mild elevation of blood pressure, should be established by finding an elevated blood pressure on at least three different office visits. Ambulatory blood pressure monitoring may be the best predictor of risk and therefore of need for therapy in mild hypertension. Isolated systolic hypertension and hypertension in the elderly also benefit from therapy. 

We are working with the Food Quality Control Department of the Ministry of Health to study the contamination of OCPs and PCBs in local fish and chickens. This project is in line with our current effort to assess the health risk arising from consumption of food contaminated with POP chemicals. The health risk assessment of POPs through dietary intakes project involved analyses of OCPs and PCBs in various foodstuff, initially raw materials which will be extended to cooked food. Unfortunately, we do not currently have the capability to analyze PCDD/PCDF in our laboratory but there are two high resolution mass spectrometers in the country that are capable of analyzing PCDD/PCDF. National and international collaborations will definitely improve the country capacity to monitor POPs not only those listed in the Stockholm Convention but other toxic chemicals found in the environment. 

Definitive data are obtained with rigorous analytical methods, such as EPA-approved methods or other standard analytical methods. For the data to be definitive, either analytical or total measurement error must be determined. Definitive data, which are analyte-specific and have a high degree of confidence in analyte identity and concentration, are used for decisions that have consequences for human health and the environment, such as site closure, risk assessment, and compliance monitoring of water effluents and air emissions. Definitive data may be generated at a field (mobile) laboratory or at an off-site (fixed-base) laboratory. 

Finally, do not forget to consider all of the non-liver-related factors about your patient - contraindications to therapy, concomitant disease, age, etc. At the end of this process you should be able to come to some sort of conclusion about the use of a specific drug in your patient. It is often not a definitive answer but an educated guess based on the available evidence. At the very least you should be able to give advice to reduce the risks of side effects and provide guidance on the relevant monitoring parameters. 

Antidepressants are used to treat depressed children and adolescents because no other definitive effective therapies are currently available. Plasma concentration monitoring of TCAs is important to ensure safety. As in the adult population, plasma concentrations above 450 ng/mL are associated with increased risk of serious adverse effects including delirium, seizures, delayed cardiac conduction, and sudden death. ... 

So here is an attempt at a definition. Clinical decision intelligence is the application of IT to help gather, understand, and act on all available data in clinical practice, healthcare management and administration, and medical research, and where appropriate the automatic utilization of data to control certain clinical and research processes. Its aims are to encourage best practices to improve the quality of patient care by enhancing speed and efficiency to reduce safety risks and needless costs in clinical treatment, diagnosis, management, and administration to monitor and log interactions for accountability, culpability, liability and repudiation and to facilitate biomedical research and pharmaceutical development where based on inclusion of clinical and related data. 

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