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2023 MAY 6 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- New research on cancer is the subject of a new report. According [...]

2023 APR 15 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Current study results on Liver Diseases and Conditions - Chronic Hepatitis C [...]

2023 FEB 4 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Fresh data on blood pressure are presented in a new report. According [...]

A patient monitoring device that clips to the finger can be used to measure blood pressure in women who have hypertension during pregnancy. The equipment can be taken home and the woman can transmit the results to her doctor's office over a fax machine.

Twenty-four-hour ambulatory blood pressure monitoring can detect some pregnant women who will develop a serious complication of pregnancy called preeclampsia. In a study of 286 pregnant women, those who eventually developed preeclampsia were more likely to have high blood pressure between 18 and 30 weeks gestation.

BACKGROUND AND OBJECTIVES: It is generally assumed that delayed diagnosis of acute appendicitis results in higher morbidity but this assumption is not strongly supported in the literature. We attempt to define the effect of patient and physician delay on the outcome of patients with acute appendicitis. PATIENTS AND METHODS: We studied 486 patients admitted between 1980 and 1992. Patient delay in presenting to a physician and surgeon delay from hospital admission to operation were studied in relation to stage of disease at operation as well as to postoperative complications. RESULTS: Postoperative complications occurred in 10% of cases with simple acute appendicitis versus about 20% of cases with gangrenous or perforated appendicitis (P [is less than] 0.001). The mean patient delay from onset of symptoms to presentation to a physician was 1.7 days in simple acute appendicitis versus 2.3 days in gangrenous or perforated appendicitis (P [is less than] 0.001). Mean surgeon delay was 13.6 hours in simple acute appendicitis versus 14.5 hours in advanced appendicitis (P= NS). CONCLUSION: Delay in patient presentation adversely affects the stage of disease in acute appendicitis and leads to increased incidence of infectious complications and to prolonged hospital stay. Conversely, physician delay does not affect the stage of disease. A surgeon's decision to observe patients in hospital in order to clarify the diagnosis is justified, as it does not adversely affect outcome. Am J Surg. 1997;173:194-198. [C] 1997 by Excerpta Medica, Inc.

Home uterine activity monitoring may be more effective in detecting preterm labor, allowing preventive treatment to be given, than intensive prenatal nursing care. Researchers compared the effectiveness of twice a day home uterine activity monitoring to high-risk prenatal nursing care in 339 women with a high risk for preterm labor and delivery. Use of home uterine activity monitoring was associated with longer pregnancies, fewer preterm deliveries, higher birth weights, and fewer admissions to newborn intensive care. The reduction in intensive care use could offset the cost of using home uterine activity monitors.

The prevention of premature birth complications by utilizing home uterine activity monitoring (HUAM) programs reduces the costs of perinatal care. A evaluation of the efficiency of twice-a-day and once-a-day HUAM programs was conducted. Twice-a-day HUAMs did not reduce the frequency of preterm birth and increased the cost of perinatal health care services due to unnecessary physician services. Once-a-day HUAMs have greater risk factors but lower physician interventions., Prevention of preterm birth (birth before 37 weeks gestational age) is a national perinatal care priority because of the serious health consequence of preterm birth and the immense immediate and [...]

PURPOSE: To determine if patients treated with HMG-CoA reductase inhibitors have their LDL cholesterol levels at or below the levels recommended by the National Cholesterol Education Program (NCEP) and if patients on these medications are monitored for potential toxicity. PATIENTS AND METHODS: Ninety patients from the VA Medical Center in San Francisco were randomly selected in this retrospective analysis. All patients were taking a HMG-CoA reductase inhibitor as monotherapy for treatment of high blood cholesterol for a minimum of 1 year. Medical charts and laboratory and pharmacy computer databases were utilized to gather information regarding the patients' medical history, treatment history, relevant laboratory tests, and medication refill profile. RESULTS: The majority of patients, 73%, were secondary prevention patients. Only 33% of the 90 subjects met the LDL cholesterol goal recommended by the NCEP. For the secondary prevention patients, only 24% met goal LDL. Even when the stringency of the NCEP guidelines was reduced by 20% (goal LDL < 120 mg/dL), 50% of the secondary prevention patients were still inadequately treated. Only 2 of the 90 patients were on maximal dosage regimens. Sixty-seven percent of patients had annual lipid panels and 49% had annual liver panels. Forty-five percent of patients followed by nonphysicians met goal LDL while only 29% and 31% of patients followed by attending physicians and residents/fellows met goal LDL, respectively. In addition, patients followed by nonphysicians were monitored more closely for efficacy and toxicity of the medications. CONCLUSIONS: Based on the current NCEP recommendations, patients on monotherapy with HMG-CoA reductase inhibitors are often inadequately treated. Only 33% of the patients evaluated at our institution were at or below the NCEP recommended LDL cholesterol levels and less than half of the patients were adequately monitored for hepatotoxicity. Am J Med. 1996; 100:605-610.

Background: Hospital computing systems play an important part in the communication of clinical information to physicians. We sought to determine whether computer-based alerts for hospitalized patients can affect physicians' behavior and improve patients' outcomes. Methods: We performed a prospective time-series study to determine whether computerized alerts to physicians about rising creatinine levels in hospitalized patients receiving nephrotoxic or renally excreted medications led to more rapid adjustment or discontinuation of those medications, and to determine whether such alerts protected renal function. Results: Laboratory data were observed for 20 228 hospitalizations, with documentation of 1573 events (instances of rising creatinine levels during treatment a nephrotoxic or renally excreted drug). During treatment intervention period, doses were adjusted or medications discontinued an average of 21.6 hours sooner after such an event (P

The modified biophysical profile, used to identify patients at risk for adverse perinatal outcome and small for gestational age infants, may be even more effective than the contraction stress test. The modified biophysical profile consists of a fetal heart rate nonstress test and an amniotic fluid index, and was conducted twice a week with 2,774 high-risk patients. It takes half as long to perform as does the contraction stress test, and is associated with fewer false-positive or false-negative results and fewer interventions. The overall childbirth death rate for patients undergoing the modified biophysical profile was 2.9 per 1000, and the rate of adverse outcome for the infants was 7%.

Outpatient monitoring of women with gestational hypertension may result in shorter periods of hospitalization and contribute to good outcomes for mothers and infants. Gestational hypertension is persistent high blood pressure in pregnancy that is often associated with decreased blood flow to the fetus. Gestational hypertension is usually managed in the hospital with bed rest and monitoring. A total of 592 women with mild hypertension at an average of 32 weeks' gestation were given a device to monitor their blood pressure. The women also monitored their weight, protein in their urine, rest periods and fetal movements on an outpatient basis. The pregnancies of these women were prolonged an average of 27 days, which is similar to pregnancies of women with hypertension managed in the hospital. The outpatient group had significantly less hospitalization time than women monitored as inpatients. Eighty-four percent of the infants weighed more than 2,000 grams, and only 13% had nursery stays of longer than one week.

Background. To determine the validity and predictive accuracy of the Acute Physiology and Chronic Health Evaluation (APACHE II) scoring system for severity of illness by comparing the actual hospital mortality with the predicted mortality for patients with breast cancer admitted to the intensive care unit (ICU). Methods. APACHE II scores were calculated based on retrospective evaluation of the medical records of 52 patients with breast cancer who received ICU care. The relationship between hospital mortality and APACHE II scores, number of sites of metastatic disease, duration of metastatic disease, number of chemotherapeutic regimens given for metastatic disease, presence of neutropenia or thrombocytopenia, age, reason for ICU admission, and length of ICU stay were assessed. Results. Twenty-two patients (42%) died during the hospital stay during in which they were admitted to the ICU. Predicted mortality based on a logistic regression model using APACHE II scores was 21 patients (40%). APACHE II specificity was 87%; sensitivity was 54%. There were significantly relationships between presence of metastatic disease, number of metastatic sites, reason for ICU admission, and length of ICU stay. Patients with more than two site of metastatic disease and those with respiratory failure had particularly poor chances of survival. Regression analysis incorporating the number of sites of metastatic disease, reason for ICU admission (whether for a pulmonary or a cardiovascular problem), and APACHE II score suggested that APACHE II could predict hospital survival. Conclusions. This retrospective study showed that APACHE II scores were associated with hospital morality in patients with breast cancer who were admitted to ICU. The number of metastatics sites and the type of major organ system failure were also associated with outcome. Regression analysis suggested that APACHE II scores were independently associated with survival outcome. Cancer 1992; 70:497-503.

Diabetes mellitus is a condition that is caused by a deficiency of insulin. Insulin is a hormone made in the pancreas, is released into the blood following a meal, and functions to remove glucose (sugar) from the blood so that it can be stored in liver and muscle. Insulin is thus responsible for maintaining fairly constant levels of glucose in the blood. Since diabetes is a serious condition that can cause damage to the kidneys, eyes, blood vessels and nerves, patients with diabetes are given insulin and should have their blood glucose levels monitored closely. Blood measurements are more accurate predictors of glucose levels than urine tests because kidney function may be impaired in patients with diabetes. Blood glucose levels can be monitored using a device called a blood glucose monitor (BGM). A BGM is inexpensive, easy to use, provides reliable results and can be used in the home. This gives the patient more freedom and reduces visits to the hospital laboratory for testing. There are two different methods for measuring blood glucose with a BGM, reflectance photometry and electrochemistry. Both methods use test strips that are chemically treated to interact with a drop of blood (from a finger prick). In reflectance photometry the drop of blood is placed on the test strip, the strip is incubated, the blood is wiped off, the strip changes color depending on the amount of glucose in the drop of blood, and is then inserted into the monitor to determine the glucose level. In electrochemistry, the drop of blood is placed on the strip, the strip is inserted into the monitor and the glucose level in the blood is determined. Problems with accurate measurements can arise if not enough blood is placed on the test strip, if the patient's hematocrit (volume of red blood cells) is too low or too high, if the test strip is incubated for too long or too short a time, or if the blood is not wiped off the strip properly. Also, chemicals such as ascorbic acid (vitamin C) can cause blood glucose levels to appear 5 to 30 percent lower than they really are. BGMs should not be used in patients who are taking large doses of ascorbic acid. Proper patient training on how to use a BGM is important to ensure accurate results. (Consumer Summary produced by Reliance Medical Information, Inc.)

An electrocardiogram (ECG) is a recording of the electrical activity of the heart that reveals the conduction of the heart beat through the various parts of the heart. The ECG is of value for diagnosing abnormal heart rhythms (arrhythmias) or heart damage. When blood flow to the heart decreases (ischemia), as in a heart attack, one segment of the ECG called the S-T segment is changed and reflects the heart damage. In the 1960s, a portable ECG machine called a Holter monitor was developed. It is worn by the patient during the day and night, and records the patient's ECG for up to 24 hours. It is of value for obtaining a record of heart rhythm that would not be discovered by a conventional ECG of only a few minutes duration. This study evaluated the effectiveness of the Holter monitor and developed guidelines for its use. The Holter ECG results can be highly variable and caution should be used in their interpretation. This type of heart monitoring can provide useful information about the prognosis of a patient after a heart attack, especially when combined with a diary of the patient's daily activities. This allows the timing of the patient's activities to be compared with the development of any arrhythmia. If the patient does not have daily symptoms, then the usefulness of this type of ECG monitoring is questionable. The Holter monitor can also be used to assess the effectiveness of drugs that prevent heart rhythm disturbances (anti-arrhythmic drugs), but data about its effectiveness in this and other conditions is sparse. Since results concerning S-T segment changes can be highly variable, the presence or absence of heart blood vessel disease cannot be accurately determined. Although the Holter monitor can provide useful information about the diagnosis and prognosis of certain heart conditions and the possible therapeutic effectiveness of anti-arrhythmic drugs, better, more accurate methods exist to obtain such information. (Consumer Summary produced by Reliance Medical Information, Inc.)

Intrapartum (during delivery) fetal monitoring has become an accepted clinical technique, but there is no documentation that shows that it actually improves the incidence of major disability or cerebral palsy (a nonprogressing disorder involving inability to control muscle movements). The scientific data are evaluated regarding the effectiveness of intrapartum fetal monitoring in low-risk deliveries. Three main methods are used: cardiotocography (fetal heart rate monitoring, or FHR), fetal blood sampling, and sampling of amniotic fluid (the fluid surrounding the fetus). Heart rate and the variation from beat to beat are detected by FHR. This approach is subject to technical and interpretative errors, and well-controlled studies to objectively evaluate this test have not been performed. Fetal blood sampling, which samples blood from the presenting part of the fetus (portion of the fetus accessible by vaginal or rectal examination), is an adjunct to FHR when blood pH (acidity) is suspected to be abnormal. This test is also prone to technical error. Moreover, not all hospitals can evaluate fetal blood pH. Meconium (the material present in the fetus's digestive tract before birth) staining can indicate severe stress, but is not necessarily associated with neurological damage. A problem in evaluating intrapartum monitoring is the lack of agreement on what should be considered a sign of effectiveness: mortality is rarely reported, and other measures, such as resuscitation and Apgar scores (a way of evaluating the infant's physical condition immediately after birth) are not well correlated with each other. Children's abilities should be assessed at four or five years of age. (Most children with cerebral palsy appear normal at birth.) Results from several studies of FHR and pH monitoring are presented and discussed briefly. Overall, FHR monitoring appears to be associated with an increase in deliveries in which physicians intervene (cesarean section), but is not associated with a reduction in death or disability. Further controlled studies are necessary to appropriately evaluate intrapartum fetal monitoring. New techniques that are currently under development should be carefully tested before being put to use. (Consumer Summary produced by Reliance Medical Information, Inc.)

In order to evaluate the effectiveness of follow-up in detecting potentially curable recurrences after radical surgery for colorectal cancer, we compared the results in 368 patients undergoing regular follow-up with those in 139 patients outside the follow-up program. The cancer-related 5-year survival rate was 72% in the follow-up group and 62% in the non-follow-up group (difference not significant). Cancer recurrences were more common in the follow-up group than in the group that was not followed (32% versus 21%; p It is concluded that regular follow-up detects more recurrent cancers, enabling radical reoperations significantly more often than when there is no follow-up. The outcome after curative reoperations is encouraging. These aspects favor regular followup of patients with colorectal carcinoma after curative operations., Approximately one-third of all patients who undergo radical surgery for colorectal cancer (cancer of the colon and rectum) experience a recurrence of cancer, and many of these patients can be helped by additional surgery. The success of this procedure, however, is greatest if the recurrence is detected early. To learn more about optimal follow-up procedures, recurrence rates for 368 Finnish patients who made regularly scheduled follow-up visits to the hospital were compared with rates for 139 patients who either did not come to scheduled visits, or who had some check-ups by private physicians according to a schedule not known to the investigators. The patients had been part of a larger group of 709 individuals treated for colorectal cancer at one institution in Finland between 1976 and 1985. Five-year survival for the follow-up group was 72 percent, and in the non-follow-up group it was 62 percent, a difference that was not statistically significant. The cancer recurrence rate was 32 percent for the follow-up group, and disease was diagnosed for the majority (83 percent) during scheduled visits. Among the patients who did not have regularly scheduled follow-up visits, the recurrence rate was 21 percent. Curative reoperation could be undertaken for 25 patients (7 percent) among the follow-up group, but for only two (7 percent) in the other group. After such reoperation, the five-year survival rate was 47 percent, and the disease-free five-year survival rate, 41 percent. The factor that most affected survival was the Dukes' classification (a method of ranking cancer severity) of the initial cancer. It had been anticipated that the recurrence rates would be similar for the follow-up and non-follow-up groups; the higher rate among followed-up patients could have been due to earlier detection, often by laboratory tests. Overall, the results support a follow-up program for the early detection of colorectal cancer recurrence, in order to improve survival rates. (Consumer Summary produced by Reliance Medical Information, Inc.)

Regular blood testing appears to minimize the risk from hematologic side effects in patients taking the antipsychotic drug clozapine. Researchers in Australia monitored 4,061 patients taking the drug and enrolled in a central monitoring program. Only 3% of patients developed a blood disorder, and 1% developed agranulocytosis. Most complications occurred in the first 18 weeks of treatment, and no patient died.

Context: The Collaborative Home Infant Monitoring Evaluation (CHIME) study enrolled healthy term infants and 3 groups of infants considered to be at increased risk for sudden infant death syndrome to evaluate apnea and bradycardia events in the home. Mother-infant pairs without a telephone were ineligible for enrollment. Objective: To determine whether mother-infant pairs who were offered a telephone subsidy would agree to enroll in CHIME and achieve protocol compliance rates comparable with those of matched subjects able to afford telephones. Design: Thirty-one telephone subsidy subjects were retrospectively compared with 55 control subjects matched for study group, site, birth weight, and maternal race, age, and education. Setting: Collaborative Home Infant Monitoring Evaluation clinical research centers in Honolulu, Hawaii, and Toledo, Ohio. Intervention: Provision of telephone subsidy to otherwise eligible enrollees for CHIME. Main Outcome Measures: Frequency of compliance with protocol requirements for follow-up evaluations and for extent of home monitoring. Results: Subsidy subjects achieved protocol completion rates that were comparable with those of control subjects, for developmental assessments at 56 and 92 weeks postconceptional age (PCA), and for the polysomnogram. Unexpectedly, however, subsidy subjects were more likely to have a developmental assessment at 44 weeks PCA (P = .02), as well as a cry analysis (P = .04). They were also more likely to use the CHIME home monitor for more hours during weeks 2 through 5 (P = .004), have a higher percentage using the monitor for 10 or more hours per week during weeks 2 through 5 (P = .009), and have a higher total number of days of monitor use throughout 6 months (P [is less than] .001). Mean cost of the subsidy was $3.25 per day of monitor use, and monitor use per day was directly related to total cost of the subsidy (P = .02). Conclusions: Telephone subsidy is an effective financial incentive. At least within the context of the CHIME study, telephone subsidy enhanced access to health care, and in some categories it resulted in enhanced protocol compliance. Arch Pediatr Adolesc Med. 2001;155:954-959

ORLANDO, FLA. -- Diabetic patients routinely self-monitor their blood glucose level to improve glycemic control. Similarly, hypertensive patients measure their own blood pressure, and some warfarin-treated patients do the same [...]

Purpose: To evaluate the efficacy of various ambulatory electrocardiographic monitors for the diagnosis of arrhythmia-related disorders and to provide recommendations for their use in clinical practice. Data Sources: Studies published since 1988 were identified through search of the MEDLINE database. Study Selection: Studies that met methodologic criteria for minimal bias and had clinical relevance were selected. Data Extraction: Descriptive and analytic data from each study. Data Synthesis: Ambulatory electrocardiographic monitors, specifically transtelephonic continuous-loop event recorders, are highly effective for establishing a diagnosis in patients with palpitations but are less effective for establishing a diagnosis in patients with syncope. Clinicians may use these devices to monitor for nonsustained ventricular tachycardia in patients at potentially high risk for sudden arrhythmic death; however, few data are available to support this practice. Ambulatory monitors are useful for assessment of the safety and efficacy of antiarrhythmic medications and the recurrence of symptomatic supraventricular arrhythmias. New ambulatory arrhythmia monitoring devices are being developed that may facilitate outpatient management of chronic cardiac disease. Conclusions: Ambulatory electrocardiographic monitors, particularly transtelephonic continuous-loop event recorders, aid in the diagnosis of symptomatic arrhythmias. These devices are also useful for monitoring the effectiveness and safety of antiarrhythmic medications. Guidelines are lacking for use of these devices to assess prognosis in patients at potential risk for sudden arrhythmic death., Ambulatory electrocardiographic monitors may be useful in detecting arrhythmias. These devices are monitors that are worn on the body with packs that can be carried around. An analysis of studies in the medical literature show that they are effective in diagnosing arrhythmias, especially the transtelephonic continuous-loop event recorders. They can also be used to evaluate anti-arrhythmia drugs. It is still not clear whether they can help patients at risk of sudden death.