Determining Peritoneal Dialysis Prescriptions by Employing a Patient -Specific Protocol

1993 ◽  
Vol 13 (3) ◽  
pp. 189-193 ◽  
Author(s):  
Paul M. Zabetakis ◽  
Randi Krapf ◽  
Maria v. DeVita ◽  
Gilbert W. Gleim ◽  
Michael F. Michelis
Keyword(s):  
New York ◽  
Peritoneal Dialysis ◽  
Creatinine Clearance ◽  
Treatment Protocol ◽  
Specific Treatment ◽  
Simple Calculation ◽  
Patient Specific ◽  
Specific Protocol ◽  
Continuous Cycling ◽  
Dialysate Volume

Objective To develop a formula that would permit a rapid and simple calculation of required dialysate volume needed to provide a predetermined daily creatinine clearance. Design Prospective study of peritoneal dialysis patients followed for 6 months. Setting A primary care teaching hospital in New York. Patients Twenty-six patients beginning peritoneal dialysis entered and completed the study. Intervention By employing each patient's measured peritoneal equilibration test (PET) and a standard clearance formula, a patient-specific treatment protocol (PSP) was calculated. The PET 2-hour DIP croat was used for continuous cycling peritoneal dialysis (CCPD) and the 4hour DIP patients on continuous ambulatory peritcornoeal dialysis (CAPD) to determine a PSP that would provide a minimum of 6 L of creatinine clearance daily. Main Outcome Measures Patients were followed for 6 months to assess the ability of this approach of maintaining acceptable levels of blood urea nitrogen, creatinine, albumin, and hematocrit over the 6–month period of observation. Results Our study of 26 patients revealed that only 6 patients (23%) could be treated with the standard prescription of 8 L/day on CAPD. The remaining 77% of our patients required 9–13 L/day for CAPD and 12–21 L/day for CCPD. All patients were free of uremic symptoms and demonstrated acceptable biochemical parameters over a 3–6 month period of observation. Conclusions A patient-specific protocol utilizing individually derived PET data provides an acceptable and easy to calculate initial treatment prescription for each patient that avoids the necessity for trial and error that has heretofore been employed.

Effects of Amino Acid Dialysis Compared to Dextrose Dialysis in Children on Continuous Cycling Peritoneal Dialysis

1999 ◽  
Vol 19 (3) ◽  
pp. 237-247 ◽  
Author(s):  
Izhar U. Qamar ◽  
Donna Secker ◽  
Leo Levin ◽  
Judith A. Balfe ◽  
Stanley Zlotkin ◽  
...  
Keyword(s):  
Amino Acids ◽  
Peritoneal Dialysis ◽  
Amino Acid ◽  
Creatinine Clearance ◽  
Single Amino Acid ◽  
Fasting Plasma ◽  
Continuous Cycling Peritoneal Dialysis ◽  
Total Plasma Protein ◽  
Continuous Cycling ◽  
Total Body

Objective To compare the biochemical and nutritional effects of amino acid dialysis with dextrose dialysis in children receiving continuous cycling peritoneal dialysis (CCPD). Design A prospective randomized cross-over study. Setting Nonhospitalized patients. Patients Seven children aged 1.8 to 16.0 years (mean 8.1 years) with end-stage renal disease who were receiving CCPD. Interventions Each patient received nighttime automated CCPD of dextrose, plus a single daytime dwell of either amino acid dialysate or dextrose dialysate. After 3 months, subjects crossed over to the alternative regimen for a subsequent 3 months. Main Outcome Measures Creatinine clearance, ultra-filtration, urea, creatinine, electrolytes, total protein, albumin, fasting plasma amino acids, anthropometrics, total body nitrogen. Results Amino acid dialysis was comparable to dextrose dialysis for creatinine clearance and ultrafiltration. Plasma urea concentrations were higher during amino acid dialysis. No clinical side effects or worsening of metabolic acidosis was observed. Caloric intake increased and protein intake improved. Appetite and total body nitrogen increased in at least half the children during amino acid dialysis. Total plasma protein and albumin concentrations did not change significantly. Fasting plasma concentrations of amino acids after 3 months of amino acid dialysis were comparable to baseline values. For several amino acids, the dose-response curve was blunted after a single amino acid exchange following 3 months of amino acid dialysis, which may, in part, be due to the induction of hepatic enzyme synthesis. Conclusions Amino acid dialysis is an efficient form of peritoneal dialysis that should be considered for children with poor nutritional status for whom enteral nutrition supplementation has been unsuccessful. Further study is needed to determine the optimal amount of amino acids to deliver, the best time to administer the amino acid dialysis fluid, and the benefits of adding dextrose to the amino acid solution.

scholarly journals An update on unilateral sporadic small vestibular schwannoma

2012 ◽  
Vol 33 (3) ◽  
pp. E1 ◽  
Author(s):  
Jai Deep Thakur ◽  
Anirban Deep Banerjee ◽  
Imad Saeed Khan ◽  
Ashish Sonig ◽  
Cedric D. Shorter ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Therapeutic Option ◽  
Treatment Protocol ◽  
Specific Treatment ◽  
Maximum Diameter ◽  
Patient Specific ◽  
Hypothetical Case ◽  
Level Of Evidence ◽  
Advantages And Disadvantages ◽  
Clinical Scenarios

Advances in neuroimaging have increased the detection rate of small vestibular schwannomas (VSs, maximum diameter < 25 mm). Current management modalities include observation with serial imaging, stereotactic radiosurgery, and microsurgical resection. Selecting one approach over another invites speculation, and no standard management consensus has been established. Moreover, there is a distinct clinical heterogeneity among patients harboring small VSs, making standardization of management difficult. The aim of this article is to guide treating physicians toward the most plausible therapeutic option based on etiopathogenesis and the highest level of existing evidence specific to the different cohorts of hypothetical case scenarios. Hypothetical cases were created to represent 5 commonly encountered scenarios involving patients with sporadic unilateral small VSs, and the literature was reviewed with a focus on small VS. The authors extrapolated from the data to the hypothetical case scenarios, and based on the level of evidence, they discuss the most suitable patient-specific treatment strategies. They conclude that observation and imaging, stereotactic radiosurgery, and microsurgery are all important components of the management strategy. Each has unique advantages and disadvantages best suited to certain clinical scenarios. The treatment of small VS should always be tailored to the clinical, personal, and social requirements of an individual patient, and a rigid treatment protocol is not practical.

scholarly journals Treatment of Gunshot-Related Mandibular Fracture with Splint-Guided Reduction: Case Report

2021 ◽  
Vol 25 (3) ◽  
pp. 188-192
Author(s):  
Demet Kaya ◽  
Ersoy Konaş ◽  
İlken Kocadereli ◽  
Mehmet Emin Mavili
Keyword(s):  
Case Report ◽  
Treatment Protocol ◽  
Specific Treatment ◽  
Fracture Site ◽  
Mandibular Fracture ◽  
Open Bite ◽  
Gunshot Injury ◽  
Patient Specific ◽  
Mandibular Fractures ◽  
Intermaxillary Fixation

Summary Background/Aim: Gunshot injury-related mandibular fractures often have a complex pattern, characterized by comminution, bone loss, and soft-tissue avulsion. The management is difficult and varies between individual cases. Case Report: A 41-year-old male patient presented with marked swelling and ecchymosis in the left mandibular region. Intraorally, he had a deviated open bite on the left side. A unilateral comminuted mandibular fracture was diagnosed by panoramic radiograph and computed tomography. An acrylic dental splint-guided open reduction and internal fixation, including intermaxillary fixation through brackets and intermaxillary elastics, was planned. No complications were observed throughout the healing period, and healing at the fracture site was satisfactory. The occlusion returned to the preinjury position and was stable. Conclusions: This case report shows that successful functional and esthetic results can be achieved with a strict patient-specific treatment protocol for a comminuted mandibular fracture due to gunshot injury.

scholarly journals Non-convulsive Status Epilepticus in Children, Electro-Clinical Profile and Response to a Specific Treatment Protocol

1970 ◽  
Vol 33 (3) ◽  
pp. 90-99
Author(s):  
Selina Husna Banu ◽  
Mostafa Mahbub ◽  
AZM Moshiul Azam ◽  
Shipra Rani ◽  
Naila Z Khan
Keyword(s):  
Status Epilepticus ◽  
De Novo ◽  
Involuntary Movement ◽  
Treatment Protocol ◽  
Specific Treatment ◽  
Convulsive Status Epilepticus ◽  
Daily Routine ◽  
Related Information ◽  
Specific Protocol ◽  
Long Time

Objective: Non-convulsive status epilepticus (NCSE) is an under-diagnosedneurological condition. We report the electroclinical profile and treatment outcome ofchildren diagnosed with NCSE.Methods: Total 45 children were identified with NCSE at the EEG laboratory fromSeptember 2004 to January 2009. Their presenting complaints, past clinical andbirth related information were meticulously recorded. On diagnosis the referringphysicians were requested to repeat the test after starting treatment. Later they weretreated with a specific protocol on admission at the Neurology Unit of Dhaka ShishuHospital. Two lines of treatment with daily routine EEGs were introduced. Electroclinicaloutcome were recorded on discharge. The children are still on regular followup to record the long-time result of the protracted treatment.Results: Motor regression and postural problem were the primary complaints in themajority (37/45, 82%) followed by involuntary movement, muscle twitching, jerks orfrequent fall (31/45, 69%), speech regression (29, 64%) and change of usual behavior(25/45, 56%). Prior major seizures (generalized tonic clonic, tonic or clonic) wasreported in 32/45, 71%, within 1 week to 1 year. Initial diagnosis was multiple includinghysteric conversion reaction, post-ictal regression or neuro-degenerative disorder.None was suspected with NCSE. Diagnosis was confirmed by the EEG finding ofcontinuous generalized (82%) or localized (18%) slow spike-wave complexes. Onprotracted treatment, 82% achieved the target.Conclusion: NCSE is common in children, may occur de-novo. The variable phenotypemay lead to erroneous diagnosis. A protracted treatment protocol is suggested. Furtherreporting on this issue will help to assist the clinicians for early-diagnosis and treatment.Key words: non-convulsive status epilepticus; electro-clinical diagnosis; motorfunctional regression; speech regression; behavioural changes.DOI: 10.3329/bjch.v33i3.5689Bangladesh Journal of Child Health 2009; Vol.33(3): 90-99

Patient-specific treatment allocation for carotid artery disease

2009 ◽  
Vol 1 (1) ◽  
pp. 41-49
Author(s):  
Marc Bosiers ◽  
Koen Deloose ◽  
Jurgen Verbist ◽  
Patrick Peeters
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Disease ◽  
Specific Treatment ◽  
Patient Specific ◽  
Treatment Allocation ◽  
Artery Disease

scholarly journals Systems biology informed neural networks (SBINN) predict response and novel combinations for PD-1 checkpoint blockade

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Michelle Przedborski ◽  
Munisha Smalley ◽  
Saravanan Thiyagarajan ◽  
Aaron Goldman ◽  
Mohammad Kohandel
Keyword(s):  
Neural Networks ◽  
Systems Biology ◽  
Clinical Data ◽  
Treatment Protocol ◽  
Response Prediction ◽  
Clinical Findings ◽  
Patient Specific ◽  
Patient Response ◽  
Triple Combination Therapy ◽  
Parameter Values

AbstractAnti-PD-1 immunotherapy has recently shown tremendous success for the treatment of several aggressive cancers. However, variability and unpredictability in treatment outcome have been observed, and are thought to be driven by patient-specific biology and interactions of the patient’s immune system with the tumor. Here we develop an integrative systems biology and machine learning approach, built around clinical data, to predict patient response to anti-PD-1 immunotherapy and to improve the response rate. Using this approach, we determine biomarkers of patient response and identify potential mechanisms of drug resistance. We develop systems biology informed neural networks (SBINN) to calculate patient-specific kinetic parameter values and to predict clinical outcome. We show how transfer learning can be leveraged with simulated clinical data to significantly improve the response prediction accuracy of the SBINN. Further, we identify novel drug combinations and optimize the treatment protocol for triple combination therapy consisting of IL-6 inhibition, recombinant IL-12, and anti-PD-1 immunotherapy in order to maximize patient response. We also find unexpected differences in protein expression levels between response phenotypes which complement recent clinical findings. Our approach has the potential to aid in the development of targeted experiments for patient drug screening as well as identify novel therapeutic targets.

scholarly journals The effect of beta-blockers on hemodynamic parameters in patient-specific blood flow simulations of type-B aortic dissection: a virtual study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mohammad Amin Abazari ◽  
Deniz Rafieianzab ◽  
M. Soltani ◽  
Mona Alimohammadi
Keyword(s):  
Aortic Dissection ◽  
Clinical Decision Making ◽  
Beta Blockers ◽  
False Lumen ◽  
Specific Treatment ◽  
Left Ventricular ◽  
Patient Specific ◽  
Type B ◽  
Windkessel Model ◽  
Computed Tomography Images

AbstractAortic dissection (AD) is one of the fatal and complex conditions. Since there is a lack of a specific treatment guideline for type-B AD, a better understanding of patient-specific hemodynamics and therapy outcomes can potentially control the progression of the disease and aid in the clinical decision-making process. In this work, a patient-specific geometry of type-B AD is reconstructed from computed tomography images, and a numerical simulation using personalised computational fluid dynamics (CFD) with three-element Windkessel model boundary condition at each outlet is implemented. According to the physiological response of beta-blockers to the reduction of left ventricular contractions, three case studies with different heart rates are created. Several hemodynamic features, including time-averaged wall shear stress (TAWSS), highly oscillatory, low magnitude shear (HOLMES), and flow pattern are investigated and compared between each case. Results show that decreasing TAWSS, which is caused by the reduction of the velocity gradient, prevents vessel wall at entry tear from rupture. Additionally, with the increase in HOLMES value at distal false lumen, calcification and plaque formation in the moderate and regular-heart rate cases are successfully controlled. This work demonstrates how CFD methods with non-invasive hemodynamic metrics can be developed to predict the hemodynamic changes before medication or other invasive operations. These consequences can be a powerful framework for clinicians and surgical communities to improve their diagnostic and pre-procedural planning.

Five years' experience with continuous ambulatory or continuous cycling peritoneal dialysis in children

1987 ◽  
Vol 111 (4) ◽  
pp. 513-518 ◽  
Author(s):  
Tassilo von Lilien ◽  
Isidro B. Salusky ◽  
Ines Boechat ◽  
Robert B. Ettenger ◽  
Richard N. Fine
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Cycling Peritoneal Dialysis ◽  
Continuous Cycling

Continuous Cycling Peritoneal Dialysis Wet Is Better Than Dry

1990 ◽  
pp. 259-263 ◽  
Author(s):  
J. A. Diaz-Buxo ◽  
C. D. Farmer ◽  
J. T. Chandler ◽  
P. J. Walker ◽  
W. P. Burgess
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Cycling Peritoneal Dialysis ◽  
Continuous Cycling ◽  
Better Than

scholarly journals Injury-related falls from bicycles, skateboards, roller skates, and non-motorized scooters in the United States: 2005 - 2014

2017 ◽  
Vol 4 (1) ◽  
pp. 16
Author(s):  
William Milczarski ◽  
Peter Tuckel ◽  
Richard Maisel
Keyword(s):  
Public Health ◽  
New York ◽  
Negative Binomial ◽  
Local Level ◽  
Specific Treatment ◽  
Negative Binomial Regression ◽  
The United States ◽  
Treatment Modalities ◽  
Public Health Officials ◽  
National Databases

Purpose: To provide an updated and comparative analysis of injury-related falls from bicycles, skateboards, roller skates and non-motorized scooters.Methods: The study uses two national databases – the Nationwide Emergency Department Sample and the Nationwide Inpatient Sample  – and subnational databases for New York, California, and Maryland.  Univariate and multivariate analyses (negative binomial regression) are performed to identify effects of age, gender, racial-ethnic background, and region on the incidence of injury-related falls from each of the four devices.Results: The rate of injuries due to falls from bicycles far surpasses the rates due to falls from the other devices.  When a measure of “exposure” is taken into consideration, however, the rate of injuries from skateboards outstrips the rates from bicycles or roller skates.  The profile of patients who are injured from falls from each of the four devices is distinctive.  Asian-Americans are greatly underrepresented among those who suffer a fall-related injury from any of the four devices.  The incidence of injuries attributable to falls varies considerably by geographic region.Conclusions: Public health officials need to be mindful that while certain activities such as scootering might be gaining in popularity, the number of injuries sustained from bicycles still dwarfs the number attributable to falls from skateboards, roller skates, and scooters combined.  Thus special attention needs to be paid to both prevent falls from bicycles and specific treatment modalities.  It is important for public health officials to gather injury data at the local level to allocate prevention and treatment resources more efficiently.

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