Usefulness of Routine Urine Analysis in Medical Outpatients

1994 ◽  
Vol 1 (2) ◽  
pp. 84-87 ◽  
Author(s):  
Sigmund Rüttimann ◽  
Désirée Clémençon
Keyword(s):  
Urine Analysis ◽  
Protein A ◽  
Clinic Visit ◽  
Routine Test ◽  
General Internal ◽  
Outpatient Group ◽  
New Treatment ◽  
New Diagnosis ◽  
Medical Outpatients

Objective— To investigate prospectively the value of routine urine analysis in a university based, medical outpatient clinic providing primary (> 90%) and referral care (< 10%) in general internal medicine, as determined by whether it led to a new diagnosis requiring a change in medical management (new treatment; advice to patient; further follow up appointment). Methods— A dipstick urine analysis was performed in 610 consecutive patients (mean (SD) age 41 (16) years) making their first clinic visit. A urinary sediment of the same specimen was examined in those patients with abnormal results for haemoglobin, leucocytes, or protein. A urine analysis was defined as routine when it was not considered indicated for diagnostic or management purposes by the resident in charge at the patients' initial clinic visit. The main outcome measures were the number and nature of new diagnoses leading to a change in patient management. Results— In 183 patients (30%, 95% confidence interval (CI) 27% to 34%) the urine analysis was performed as an indicated test and in 427 (70%; 95% CI 64% to 73%) as a routine test. Urine analysis was abnormal in 71 of the 427 patients (17%) in whom it had been performed as a routine test. Abnormal findings led to a change in management in three patients only (0·7%; 95% CI 0·2% to 2·2%). Critical assessment makes the value of routine urine analysis debatable even in these three patients. Conclusions— In a middle aged medical outpatient group of a university based, teaching clinic providing predominantly primary care, urine analysis can be restricted to patients in whom it is clinically indicated.

scholarly journals Experience with protein A-immunoadsorption in treatment-resistant adult immune thrombocytopenic purpura

Blood ◽  
1992 ◽  
Vol 79 (9) ◽  
pp. 2237-2245 ◽  
Author(s):  
HW Snyder ◽  
SK Cochran ◽  
JP Balint ◽  
JH Bertram ◽  
A Mittelman ◽  
...  
Keyword(s):  
Side Effects ◽  
Immune Thrombocytopenic Purpura ◽  
Protein A ◽  
Staphylococcal Protein A ◽  
Treatment Resistant ◽  
Thrombocytopenic Purpura ◽  
Specific Serum ◽  
Clinical Responses ◽  
Acute Increase

Abstract Extracorporeal immunoadsorption of plasma to remove IgG and circulating immune complexes (CIC) was evaluated as a therapy for adults with treatment-resistant immune thrombocytopenic purpura (ITP). Seventy-two patients with initial platelet counts less than 50,000/microL who had failed at least two other therapies were studied. They received an average of six treatments of 0.25 to 2.0 L plasma per procedure over a 2- to 3-week period using columns of staphylococcal protein A-silica (PROSORBA immunoadsorption treatment columns; IMRE Corp, Seattle, WA). The treatments caused an acute increase in the platelet count to greater than 100,000/microL in 18 patients and to 50,000 to 100,000/microL in 15 patients. The median time to response was 2 weeks. Responses were transient (less than 1 month duration) in seven of those patients (10%), but no additional relapses were reported over a follow- up period of up to 26 months (mean of 8 months). Clinical responses were associated with significant decreases in specific serum platelet autoantibodies (including anti-glycoprotein IIb/IIIa), platelet- associated Ig, and CIC. Thirty percent of treatments were associated with transient mild to moderate side effects usually presenting as a hypersensitivity-type reaction. Continued administration of failed therapies for ITP, which always included low-dose corticosteroids (less than or equal to 30 mg/d), had no demonstrable influence on the effectiveness of immunoadsorption treatment but did depress the incidence and severity of side effects. The degree of effectiveness of protein A immunoadsorption therapy in patients with treatment-resistant ITP is promising and further controlled studies in this patient population are warranted.

Clinical Evaluation of the Variables associated with Treatment Acceptability and Their Relation to Compliance

1992 ◽  
Vol 18 (1) ◽  
pp. 67-76 ◽  
Author(s):  
Thomas M. Reimers ◽  
David P. Wacker ◽  
Linda J. Cooper ◽  
Agnes O. Deraad
Keyword(s):  
Behavior Problem ◽  
Behavior Management ◽  
Positive Reinforcement ◽  
Treatment Acceptability ◽  
Clinic Visit ◽  
Future Research ◽  
Parental Ratings ◽  
Problem Severity ◽  
The Relationship

The authors examined the acceptability ratings of positive reinforcement procedures recommended to parents seen in a pediatric behavior management outpatient clinic. Parental ratings of acceptability were obtained in the clinic and 1, 3, and 6 months following their initial clinic visit. Acceptability variables were examined by group (parents who rated the acceptability of treatments as high vs. low) and by severity (parents who rated their children's behavior problem as severe vs. mild). The relationship between these variables and reported compliance was also examined. Results show that the acceptability variables were useful in differentiating between parents who rated treatments to be more acceptable and parents who rated treatments to be less acceptable. Differences were also observed as a function of behavior problem severity. Significant correlations occurred between acceptability variables and compliance at each of the follow-up points. Results are discussed in relation to the clinical significance of these findings and the impetus they might serve for future research.

Accuracy and Efficacy for Robotic Assistance in Implanting Responsive Neurostimulation Device Electrodes in Bilateral Mesial Temporal Lobe Epilepsy

2017 ◽  
Vol 14 (3) ◽  
pp. 267-272 ◽  
Author(s):  
Alvin Y Chan ◽  
Lilit Mnatsakanyan ◽  
Mona Sazgar ◽  
Indranil Sen-Gupta ◽  
Jack J Lin ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Focal Epilepsy ◽  
Mesial Temporal Lobe Epilepsy ◽  
Advanced Technology ◽  
Robotic Assistance ◽  
Mesial Temporal Lobe ◽  
Robotic Devices ◽  
New Treatment

Abstract BACKGROUND Responsive neurostimulation (RNS) is a relatively new treatment option that has been shown to be effective for patients with medically refractory focal epilepsy when resection is not possible, especially in bilateral mesial temporal onset. Robotic devices are becoming increasingly popular for use in stereotactic procedures such as stereoelectroencephalography, but have yet to be used when implanting RNS devices. OBJECTIVE To show that these 2 forms of advanced technology were compatible and could be used effectively in patient care. METHODS We implanted RNS devices in 3 patients with bilateral mesial temporal lobe epilepsy. Each patient was placed in the prone position, and electrode trajectories were planned via the robotic navigation system via a transoccipital approach. One lead was placed along each amygdalohippocampal complex. A small craniectomy was then created in the parietal region for RNS generator implantation. Actual and expected target locations and distance were calculated for each depth. There were no complications in this group. RESULTS RNS devices with bilateral leads were successfully implanted in all 3 patients, with bilateral mesial temporal lobe onset. Follow-up ranged from 3 to 6 mo, and there were no complications in this group. The median distance between the estimate and actual targets was 2.18 (range = 1.11-3.27) mm. CONCLUSION We show that implanting RNS devices with robotic assistance is feasible with excellent precision and accuracy. The advantages of using robotic assistance include higher flexibility, accuracy, precision, and consistency.

scholarly journals Qualitative study to explore what patients with heart failure find significant during integrated palliative care sessions in a Danish clinic

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e043955
Author(s):  
Stine Gundtoft Roikjær ◽  
Charlotte Paaske Simonÿ ◽  
Helle Ussing Timm
Keyword(s):  
Heart Failure ◽  
Palliative Care ◽  
Meaning Making ◽  
Interview Study ◽  
Exclusion Criterion ◽  
Semistructured Interview ◽  
Patients With Heart Failure ◽  
New Diagnosis ◽  
Medical Perspective

ObjectiveIn the field of palliative care (PC) as it is integrated into heart failure (HF) treatment, it is essential to explore the patient experience and build on this knowledge for the further development of PC practice and policy. Based on an intervention study, this paper explores what patients with HF find significant in integrated sessions using a narrative S’ approach.DesignWe conducted a semistructured interview study with a qualitative analysis focused on meaning making. The study follows the guidelines of Consolidated Criteria for Reporting Qualitative Research.Participants and settingThe inclusion criteria for the PC intervention were (1) a new diagnosis of HF, (2) follow-up treatment at this local Danish HF clinic and (3) informed consent to participate in the integrated PC intervention. The only exclusion criterion was if the patient was already engaged in a PC programme. 20 patients agreed to participate in the intervention, and 12 of these completed the S’ approach sessions and participated in this interview study.ResultsOverall, the analysis showed that the integrated S’ approach sessions were successful in joining an embodied patient perspective with a medical perspective. The thematic analysis resulted in three themes supporting the overall findings: sessions bring comfort, telling your story provides a sense of meaningfulness, and integrating perspectives of HF into everyday life.ConclusionThe method using the S’ approach in integrated PC and HF sessions was significant in various ways. First, patients experienced a calm and safe atmosphere and perceived that the nurse was truly interested in them. Second, the integrated sessions based on the S’ approach were able to bring comfort to lived physical, psychosocial and existential issues. Last, it allowed patients to combine their embodied understanding of HF with a medical perspective, thereby finding meaning in the sense of how everything is connected.

Vascular access types in patients starting hemodialysis after failed kidney transplant: does close nephrology follow-up matter?

2016 ◽  
Vol 18 (1) ◽  
pp. 22-25 ◽  
Author(s):  
Naveed Ul Haq ◽  
Mohamed Said Abdelsalam ◽  
Mohammed Mahdi Althaf ◽  
Abdulrahman Ali Khormi ◽  
Hassan Al Harbi ◽  
...  
Keyword(s):  
Vascular Access ◽  
Clinic Visit ◽  
Study Data ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Early Referral ◽  
Period Data ◽  
Stage Renal Disease ◽  
End Stage

Background Native arteriovenous fistulae (AVFs) are preferred while central venous catheters (CVCs) are least suitable vascular access (VA) in patients requiring hemodialysis (HD). Unfortunately, around 80% of patients start HD with CVCs. Late referral to nephrologist is thought to be a factor responsible for this. We retrospectively analyzed the types of VA at HD initiation in renal transplant recipients followed by nephrologists with failed transplant. If early referral to nephrologist improves AVF use, these patients should have higher prevalence of AVF at HD initiation. Methods All patients who failed their kidney transplants from January 2002 to April 2013 were included in the study. Data regarding planning of VA by nephrologist, documented discussion about renal replacement therapy (RRT), estimated glomerular filtration rate (eGFR) at 6 months and last clinic visit before HD initiation, time of VA referral, and subsequent VA at dialysis initiation were gathered and analyzed. Results Eighty-three patients failed their transplants during study period. Data were inaccessible in six patients. Eleven patients started peritoneal dialysis (PD) while 66 started HD. Thirty-two had previous functioning VA while 34 needed VA. There were 11/34 patients (32%) with eGFR <15 mL/min at six months while 21/34 (61%) had eGFR <15 mL/min at last clinic visit before HD initiation. Only 11/34 (32%) had documented RRT discussion, 8/34 (24%) had VA referral, and 7/34 (21%) had vein mapping. A total of 30/34 (88.3%) started HD with CVC while 4/34 (11.3%) started HD with AVF (p<0.0001). Conclusions Early referral to nephrologist by itself may not improve VA care amongst patient with end-stage renal disease.

UNALTERED IMAGE OF HEALTH MAINTENANCE: AN OBSERVATION OF NON-PARTICIPANTS IN A SWEDISH COHORT STUDY OF 85 TO 86 YEAR OLDS

2015 ◽  
pp. 1-7
Author(s):  
H.-J. DONG ◽  
E. WRESSLE ◽  
J. MARCUSSON
Keyword(s):  
Home Visit ◽  
Hospital Admissions ◽  
Clinic Visit ◽  
Old People ◽  
Related Factors ◽  
Health Maintenance ◽  
Very Old ◽  
Significant Difference ◽  
Sheltered Accommodation

Background: Selection bias is often inevitable in epidemiologic studies. It is not surprising that study conclusions based on participants’ health status are frequently questioned. Objective: This study aimed to assess whether the non-participants affected the characteristics of a general population of the very old people. Design, Setting and Participants: Prospective, cross-sectional (N=650, aged 85 years old) analysis and 1-year follow-up (n=273), in Linköping, Sweden. Measurements: We analysed data on health-related factors from a postal questionnaire, a home visit and a clinic visit at baseline and at the 1-year follow-up. We calculated the effect size to evaluate the degree of differences between the groups. Results: A greater proportion of non-participants resided in sheltered accommodation or nursing homes (participants vs non-response vs refusal, 11% vs 22% vs 40, P<0.001, φ=0.24). During the home visit or clinic visit, a higher proportion of dropouts reported mid-severe problems in EQ-5D domains (mobility and self-care) and limitations in personal activities of daily living, but the differences between participants and dropouts were very small (φ<0.2). No significant difference was found between the groups with regard to emergency room visits or hospital admissions, despite the fact that more participants than dropouts (φ=0.23) had multimorbidities (≥2 chronic diseases). Living in sheltered accommodation or a nursing home (odds ratio (OR), 2.8; 95% confidence interval (CI), 1.5-5), female gender (OR, 1.8; 95% CI, 1.1-3.1) and receiving more home visits in primary care (OR, 1.03; 95% CI, 1-1.06) contributed positively to drop out in the data collection stages over the study period. Conclusion: Non-participants were not considered to be a group with worse health. Mobility problems may influence very old people when considering further participation, which threatens attrition.

scholarly journals Pipeline embolization device retraction and foreshortening after internal carotid artery blister aneurysm treatment

2017 ◽  
Vol 23 (6) ◽  
pp. 614-619 ◽  
Author(s):  
Jeremy J Heit ◽  
Nicholas A Telischak ◽  
Huy M Do ◽  
Robert L Dodd ◽  
Gary K Steinberg ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
High Morbidity ◽  
Case Description ◽  
Digital Subtraction ◽  
Pipeline Embolization Device ◽  
Aneurysm Occlusion ◽  
New Treatment

Background Subarachnoid hemorrhage (SAH) secondary to rupture of a blister aneurysm (BA) results in high morbidity and mortality. Endovascular treatment with the pipeline embolization device (PED) has been described as a new treatment strategy for these lesions. We present the first reported case of PED retraction and foreshortening after treatment of a ruptured internal carotid artery (ICA) BA. Case description A middle-aged patient presented with SAH secondary to ICA BA rupture. The patient was treated with telescoping PED placement across the BA. After 5 days from treatment, the patient developed a new SAH due to re-rupture of the BA. Digital subtraction angiography revealed an increase in caliber of the supraclinoid ICA with associated retraction and foreshortening of the PED that resulted in aneurysm uncovering and growth. Conclusions PED should be oversized during ruptured BA treatment to prevent device retraction and aneurysm regrowth. Frequent imaging follow up after BA treatment with PED is warranted to ensure aneurysm occlusion.

scholarly journals Febrile Neutropenia and Long-term Risk of Infection Among Patients Treated With Chemotherapy for Malignant Diseases

2018 ◽  
Vol 5 (10) ◽  
Author(s):  
Josefine Nordvig ◽  
Theis Aagaard ◽  
Gedske Daugaard ◽  
Peter Brown ◽  
Henrik Sengeløv ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Mortality Rates ◽  
Risk Of Infection ◽  
Increased Risk ◽  
Competing Events ◽  
Adjusted Incidence Rate ◽  
New Treatment ◽  
Rate Ratios

Abstract Background Febrile neutropenia (FN) is a common complication to chemotherapy, associated with increased short-term morbidity and mortality. However, the long-term outcomes after FN are poorly elucidated. We examined the long-term risk of infection and mortality rates in cancer patients with and without FN. Methods Patients aged &gt;16 years treated with firstline chemotherapy were followed from 180 days after initiating chemotherapy until first infection, a new treatment with chemotherapy, death, or end of follow-up. Risk factors for infections were analyzed by competing risks regression, with death or another treatment with chemotherapy as competing events. Adjusted incidence rate ratios (aIRRs) of infection and death were analyzed using Poisson regression. In analyses of mortality, infection was included as a time-updated variable. Results We included 7190 patients with a median follow-up (interquartile range) of 0.58 (0.20–1.71) year. A total of 1370 patients had an infection during follow-up. The aIRRs of infection were 1.86 (95% confidence interval [CI], 1.56–2.22) and 2.19 (95% CI, 1.54–3.11) for patients with 1 or &gt;1 episode of FN compared with those without FN. Mortality rate ratios were 7.52 (95% CI, 6.67–8.48) &lt;1 month after, 4.24 (95% CI, 3.80–4.75) 1–3 months after, 2.33 (95% CI, 1.63–3.35) 3–6 months after, and 1.09 (95% CI, 0.93–1.29) &gt;6 months after an infection, compared with the time before infection. Conclusions FN during chemotherapy is associated with a long-term increased risk of infection. Mortality rates are substantially increased for 6 months following an infection.

Retention rates in two naltrexone programmes for heroin addicts in Vitoria, Spain

1995 ◽  
Vol 10 (4) ◽  
pp. 183-188 ◽  
Author(s):  
M Gutiérrez ◽  
J Ballesteros ◽  
R González-Oliveros ◽  
J Ruíz de Apodaka
Keyword(s):  
Retention Rate ◽  
Time Lag ◽  
Total Sample ◽  
Retention Rates ◽  
Concomitant Treatment ◽  
Heroin Addicts ◽  
Opiate Addicts ◽  
New Treatment ◽  
Hospital Sample

SummaryThe main finding of a former Spanish multicenter study (SMS) on the effectiveness of naltrexone maintenance in heroin addicts, was the high retention rate achieved at 24 weeks of follow-up since naltrexone induction (40%). The authors claimed this rate was one of the highest ever reported in the literature for a non-selected sample of opiate addicts and discussed the possible relevance of a set of variables — like motivations and expectations due to a new treatment — on the findings. To assess the possible effects of these variables, we have compared the retention rates in two similar naltrexone programmes. The first programme (hospital sample) included 56 individuals who were also included in the SMS where they accounted for 37% of the total sample. That programme was developed formerly to the naltrexone marketing. The second sample (ambulatory sample) included 67 individuals who were recruited at least a year apart since naltrexone marketing was approved by the Spanish Health Boards. The time-lag between the beginnig of both studies was in the range of 15 to 25 months.The subjects in both programmes had similar distributions regarding age (p = 0.27), sex (p = 0.79), weeks on treatment after naltrexone induction (p = 0.20), and program compliance (p = 0.78). The retention rates evaluated over a period of 24 weeks were also similar (p = 0.45). The only difference appeared at 12 weeks of follow-up, showing in higher retention the hospital sample than the ambulatory sample (+23%; p < 0.05). The results are discussed according to other studies and it is concluded that findings reported in the former SMS and in this study are not unusual but compatible with recent research. Also underlined is the potential importance of naltrexone as a concomitant treatment for extinguishing high risk behaviours and the conditional stimuli associated with treatment relapse in heroin addicts.

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