The aim of the present study was to analyze the relations between the serum anti-erythropoietin antibody (AEAb) levels and the antibodies' neutralizing activity in 20 patients with renal anemia and ...rhEPO-induced antibodies. AEAb levels were determined by the enzyme-linked immunosorbent assay (ELISA, double antigen-bridging) and by radioimmunoprecipitation assay (RIPA). The bone marrow neutralization test was used to determine the neutralizing activity of the antibodies. RIPA and ELISA data resulted in closely correlated measurements. The relations between AEAb levels and the neutralizing activity of the antibodies are variable as shown by follow-up and cross-sectional evaluations of the data. Serum samples with a high antibody level (>1000 ng/ml) are associated with 100% neutralizing activity, whereas serum samples with lower AEAb levels show partial neutralizing activities or have no effect. Determining the neutralizing activity might be helpful when it comes to deciding of whether or not rhEPO therapy should be continued, specifically in patients who have low antibody levels. The apparent affinity of the AEAb as defined by inhibition of the binding of rhEPO (IC50) did not change in the course of the disease, nor did it correlate to the AEAb levels or the neutralizing activities.
Symptom Incongruence Trajectories in Lung Cancer Dyads Lyons, Karen S., PhD; Lee, Christopher S., RN, PhD; Bennett, Jill A., RN, PhD ...
Journal of pain and symptom management,
12/2014, Letnik:
48, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Abstract Context There is little known about the pattern of change in patient-family member symptom incongruence across the lung cancer trajectory. Objectives This study examined trajectories of ...patient-family member incongruence in perceptions of patient physical function, pain severity, fatigue, and dyspnea in lung cancer dyads and explored the association with family member grief after patient death. Methods Lung cancer patients and their family members providing care ( n = 109 dyads) rated patient symptoms and physical function five times over 12 months. Symptom incongruence trajectories were analyzed using multilevel modeling. Results Patient-family member incongruence did not significantly change over time, on average, except in the case of patient physical function where incongruence significantly declined. There was significant variability around trajectories of incongruence for all symptoms except fatigue. Exploratory analysis on a subsample of 22 bereaved family members found that incongruence regarding patient fatigue was associated with family member grief two months after patient death. Conclusion Findings suggest the importance of modeling symptom incongruence over time and taking a dyadic approach to the illness context to identify interventions that promote adjustment and quality of life for both patient and family member.
An abstract of the study by Fromme et al implementing advance care planning practices across an academic medical center, is presented. Describing barriers and facilitators when implementing advance ...care planning practices in academic medical center, discussing strategies to implement advance care planning practices in engaging all team members from various disciplinary background, roles and functions and on how to promote cultural shift to incorporate advance care planning into the routine practice of every healthcare provider are mentioned. Also noted the challenges of the initiative's steering group has faced include reluctance of clinicians to embrace ACP in their practice because of their confusion or misunderstanding about ACP and different views, needs, and practice patterns associated with ACP among clinicians and staff in various disciplines.
A high-performance liquid chromatographic (HPLC) assay has been developed for the determination of the anticancer drug doxorubicin and the metabolites doxorubicinol, doxorubicinone, ...7-deoxydoxorubicinone, doxorubicinolone and 7-deoxydoxorubicinolone in plasma of AIDS patients. Samples can be heated at 60 degrees C for 30 min to inactivate the human immunodeficiency virus. The sample pre-treatment involves a liquid-liquid extraction of the buffered plasma sample (pH 9) with a chloroform-1-propanol (4:1, v/v) mixture. The chromatographic analysis is performed on a Lichrosorb RP-8 (5 microns) column and by isocratic elution with a mobile phase of acetonitriletetrahydrofuran-phosphate buffer (pH 2.2) (800:5:200, w/w/w) with fluorescence detection (excitation wavelength: 460 nm; emission wavelength: 550 nm). The proposed method has been validated and, subsequently, implemented in a pharmacokinetic study of doxorubicin in AIDS patients with Kaposi's sarcoma who are treated with the combination regimen doxorubicin, vincristine and bleomycin.
Abstract We report the challenges of the Working to Improve Discussions About Defibrillator Management trial, our novel, multicenter trial aimed at improving communication between cardiology ...clinicians and their patients with advanced heart failure (HF) who have implantable cardioverter defibrillators (ICDs). The study objectives are (1) to increase ICD deactivation conversations, (2) to increase the number of ICDs deactivated, and (3) to improve psychological outcomes in bereaved caregivers. The unit of randomization is the hospital, the intervention is aimed at HF clinicians, and the patient and caregiver are the units of analysis. Three hospitals were randomized to usual care and three to intervention. The intervention consists of an interactive educational session, clinician reminders, and individualized feedback. We enroll patients with advanced HF and their caregivers, and then we regularly survey them to evaluate whether the intervention has improved communication between them and their HF providers. We encountered three implementation barriers. First, there were institutional review board concerns at two sites because of the palliative nature of the study. Second, we had difficulty in creating entry criteria that accurately identified an HF population at high risk of dying. Third, we had to adapt our entry criteria to the changing landscape of ventricular assist devices and cardiac transplant eligibility. Here we present our novel solutions to the difficulties we encountered. Our work has the ability to enhance conduct of future studies focusing on improving care for patients with advanced illness.
Abstract A clinical problem may arise when caring for patients or their surrogates who prefer continued aggressive care based on the belief that a miracle will occur, despite a clinician's belief ...that further medical treatment is unlikely to have any meaningful benefit. An evidence-based approach is provided for the clinician by breaking this complex clinical problem into a series of more focused clinical questions and subsequently answering them through a critical appraisal of the existing medical literature. Belief in miracles is found to be common in the United States and is an important determinant of how decisions are made for those with advanced illness. There is a growing amount of evidence that suggests end-of-life outcomes improve with the provision of spiritual support from medical teams, as well as with a proactive approach to medical decision making that values statements given by patients and family members.
An abstract of a study by Furuno et al quantifying the frequency and documentation of medication orders for patients discharged from acute care to hospice care is presented. Among 1,499 discharges to ...hospice, the mean (standard (deviation) number of medications patients were receiving was 7.2 (4.8) and this number increased by 0.34 mediations/year over the study period, P < 0.001. Review of 96 discharge summaries (4 were excluded because of missing data) identified 1,466 medication decisions (mean=15.3 decisions per discharge summary) of which 441 (30%) were to continue medications without changes, 103 (7%) were to continue medications but with changes, 458 (31%) were to start new medications, and 464 (32%) were to discontinue existing medications. Among medications that were initiated or changed, morphine was the most frequent new medication (7%) and aspirin was the most frequently discontinued medication (5%). Only 38% of medication changes had a documented rationale for the change.
In this paper we present a software whiteboard for multimedia conferences. The whiteboard is specialised to load and share high-resolution colour images while using colour management functions to ...provide an accurate colour representation. The whiteboard is used in the telemedicine project INTER-FACE, which builds a virtual environment for tele-consultations between specialists in pre-operative treatment and the planning of the cranio-maxillofacial surgery for patients with facial abnormalities.
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