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Neville, Kristen Ann Women's & Children's Health Faculty of Medicine UNSW. "Hyponatraemia and ADH secretion during intravenous fluid therapy in children." Awarded by:University of New South Wales. Women's & Children's Health, 2009. http://handle.unsw.edu.au/1959.4/44531.
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Antidiuretic hormone (ADH) is a fundamental regulator of fluid and electrolyte homeostasis. Osmotically unregulated ADH secretion during intravenous fluid therapy has been implicated in the development of iatrogenic hyponatraemia. The case report and 3 prospective studies of this thesis provide evidence for this and examine the relative contributions of salinity versus infusion rate of intravenous fluids to the development of hyponatraemia. Two studies of plasma and urinary electrolytes and osmolality during intravenous rehydration of children with gastroenteritis were performed. The first, an observational study of 52 children receiving 0.45% (N/2) saline documented persistently raised plasma ADH concentrations independent of plasma sodium. In both studies, plasma and urinary biochemistry suggested osmotically unregulated ADH action. When N/2 and NS were compared in a randomised study of 102 children, NS emerged as superior in the prevention and correction of hyponatraemia, independent of infusion rate. In the third study, 124 pre-operative children were randomised to receive N/2 or NS intravenously at 100% or 50% of maintenance rates post-operatively. Plasma ADH concentrations increased in all groups, and the plasma and urinary biochemistry indicated persistent non-osmotic ADH activity in some children for up to 24 hours. Baseline urinary tonicity approximated NS. Comparison of urinary tonicity with the infused fluid largely explained changes observed in plasma sodium. The risk of hyponatraemia was decreased by isotonic saline but not fluid restriction; however plasma sodium concentration decreased in the NS 100% group between 8 and 24 hours, suggesting that a decreased rate should be considered during prolonged intravenous fluid administration. Fourteen (23%; 7NS) of those on 50% maintenance were assessed as dehydrated, with hypernatraemia in 3 receiving NS50%. The chloride load associated with NS in the second and third studies was not associated with the development of acidosis. The studies also showed that 2.5% dextrose resolved and prevented hypoglycaemia in children with gastroenteritis but was inadequate to prevent hypoglycaemia and/or ketosis in 38% of children under 6 years when infused at maintenance rates. Non-osmotically regulated ADH activity in hospitalised children is common, in the face of which, isotonic is superior to hypotonic saline in decreasing the risk of hyponatraemia.
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Brady, Patrick W. "Duration of intravenous antibiotics and treatment failure in infants hospitalized with urinary tract infections." University of Cincinnati / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1299169787.
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Srisung, Sujittra. "Reduction of toxicity in the premature neonate associated with aluminum as a contaminant of total parenteral nutrition solution." Diss., St. Louis, Mo. : University of Missouri--St. Louis, 2007. http://etd.umsl.edu/r2241.
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Backhouse, Christopher Morley. "Systematic effects of particulate contaminants of intravenous therapy." Thesis, Imperial College London, 1989. http://hdl.handle.net/10044/1/47344.
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Taylor, Rosemary. "Clinical Practice Guidelines for Home Management of Intravenous Immunoglobulin Therapy." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7342.
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The infusion of intravenous immunoglobulin therapy in the home setting requires a critical nursing assessment and interventions aimed at managing and preventing the escalation of adverse events. Some patients experience side effects that necessitate a rapid response by field nurses, requiring standing orders for nursing administration and the availability of essential medications to alleviate symptoms in the patient's home. The clinical practice issue was that the home health agency did not have a uniform clinical practice nursing guideline to assist field nurses in providing rapid responses for managing infusion-related reactions. The purpose of this project was to develop an evidence-based clinical practice guideline using standing orders for the comprehensive management of immunoglobulin side effects in the patient's home. The practice-focused question centered on whether the use of a nursing practice guideline based on interprofessional collaboration could manage the side effects of patients in the home by decreasing the use of emergent care and improved quality of care for those patients susceptible to significant side effects. An interdisciplinary expert panel experience in IVIG l used Newman's system theory and the reach, effectiveness, adoption, implementation, maintenance framework for interprofessional collaboration in developing a clinical nursing guideline with a standing order for rating side effects. Panelists used the appraisal of guidelines, research, and evaluation II tool to appraise the evidence for the guideline. The use of clinical guideline with standing orders to address the needs of patients in the home setting may lead to positive social change by enabling more rapid management of symptoms, more effective care in the home, and improved patient outcomes
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Morris, John Llewellyn. "Studies on nitrate therapy and on the st-segment after acute myocardia infarction." Thesis, Imperial College London, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.343804.
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Wu, Charlotte Audris. "Qualitative Assessment of Adherence to Antiretroviral Therapy among Chinese Intravenous Drug Users." Yale University, 2008. http://ymtdl.med.yale.edu/theses/available/etd-08282007-153749/.
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Injection drug users (IDUs) account for an estimated 44% of people living with HIV/AIDS in China and are the major driving force behind the expanding epidemic. Developing effective antiretroviral therapy (ART) adherence interventions in the Chinese IDU population is a major challenge. In conjunction with ART scale-up in Yunnan province, our goal was to gather patient perspectives on ART and ideas for feasible adherence support. Between December 2005 and March 2006, eight focus groups with a total of 55 HIV positive IDUs were conducted at three sites in Yunnan to ascertain ART knowledge, barriers to adherence, and acceptable adherence support methods. Focus groups included ART experienced and naïve participants, and HIV positive IDUs in methadone maintenance clinics. Discussions were audiotaped, notes were transcribed and coded for analyses. All participants were former or current IDUs and 31 were from the rural countryside (59.6%), and 19 (36.5%) resided in a small city. ART was viewed positively but the principal barriers for urban IDUs were stigma and discrimination, while geography was the main problem for rural IDUs. Major themes were stratified between four components: knowledge, motivation, cues to action, and access to care. Adherence tools that were spontaneously endorsed included watches, pill boxes, and diaries. Directly observed therapy (DOT) within methadone programs was acceptable but community-based DOT would need to address stigma issues in urban areas. Two separate HIV epidemics exist within IDUs in China, stratified between small-city urban and rural populations. No single model for adherence will work and interventions must be broad-based. This study provides an expanded conceptual framework for ART adherence in the HIV positive IDU population, which includes the unique barriers posed by the ecological context surrounding this doubly-discriminated population.
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Smith, Cameron. "Intravenous Administration of Perfluorocarbon Emulsions as a Non-Recompression Therapy for Decompression Sickness." VCU Scholars Compass, 2008. http://scholarscompass.vcu.edu/etd/1555.
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Decompression sickness (DCS) results from a sudden decrease in ambient pressure leading to super-saturation of tissues with inert gas and subsequent bubble formation within both tissues and blood. Perfluorocarbons (PFC) are able to dissolve vast amounts of non-polar gases. The administration of intravenous (I.V.) PFC emulsions reduce both morbidity and mortality of DCS, but the mechanism of this protective effect has not yet been demonstrated. Juvenile Dorper cross sheep between 16 and 24 kg (n=31) were anaesthetized and instrumented for physiological monitoring, the administration of I.V. fluids and sampling of arterial and mixed venous blood. Animals were placed in a hyperbaric chamber and compressed to 6.0 atmospheres absolute for 30 minutes, then rapidly decompressed. Upon chamber exit animals were randomly assigned to receive 6cc/kg of either PFC or saline control over 5 minutes beginning immediately after chamber exit. They were also randomized to receive one of 4 breathing gases post-chamber: 100% O2, 80/20 N2/O2, 50/50 HeO2, or 80/20 HeO2. Blood samples were drawn at 5, 10, 15, 30, 60, and 90 minutes to examine whole-body oxygenation. Respiratory gases were monitored and recorded in real-time using mass spectroscopy to examine nitrogen washout. PFC administration increased arterial oxygen content (16.30±0.27 vs. 14.75±0.25 mL/dL, p<0.0001), oxygen delivery (14.83±0.28 vs. 13.44±0.25 mL/minute/kg, p=0.0004), and tissue oxygen consumption (3.37±0.14 vs. 2.76±0.13 mL/minute/kg, p=0.0018) over saline control, but did not increase mixed venous oxygen content (12.45±0.26 vs. 11.74±0.24 mL/dL, p=0.0558) or extraction ratio (0.23±0.012 vs. 0.21±0.011, p=0.1869). PFC administration lowered the plateau of the curve, increasing the amount of nitrogen washout vs. saline control (22.22±1.566 vs. 15.98±1.380 mmHg, p= 0.0074). Breathing 80/20 HeO2 increased the decay constant of the curve, increasing the rate of washout vs. breathing 100% O2 (0.03176±0.001044 vs. 0.03096±0.0009402, p=0.5777). PFC improves whole-body oxygenation after severe DCS and increases the amount of nitrogen washout. Although the effects of both PFC and 80/20 HeO2 breathing were statistically significant the magnitude of the nitrogen washout effect is quite small, and unlikely to be clinically significant. Thus it is likely that the improved oxygenation is responsible for the previously-observed therapeutic effects of PFC in treating DCS.
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Kwok, Ka-wai, and 郭嘉慧. "The use of warmed intravenous fluid in reducing hypothermia in patients after major surgery." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B44623616.
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Chang, Mei-yan, and 張美欣. "A Site Maintenance Care (SMC) guideline to reduce the occurrence of phlebitis among the adults with peripheral intravenous therapy." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B44623100.
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Cordel, Claudia. "Pharmacokinetics and in vitro effects of imipramine hydrochloride on the vas deferens in cattle." Diss., University of Pretoria, 2005. http://upetd.up.ac.za/thesis/available/etd-03132006-113241/.
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Zalgaonker, Mustafa. "Intravenous fluid resuscitation : surveillance of penetrating injury in the pre-hospital environment." Thesis, Cape Peninsula University of Technology, 2018. http://hdl.handle.net/20.500.11838/2738.
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Thesis (Master of Emergency Medical Care)--Cape Peninsula University of Technology, 2018.Physical injury is a major cause of premature death and disability worldwide (WHO, 2015). Mortality statistics for South Africa indicate that approximately half of all injury-related deaths were intentionally inflicted, often as a result of sharp-force injuries (Donson 2009). Cape Town is reputed to be a violent city (Nicol et al., 2014). Pre-hospital emergency care providers are often the first medical contact for injured patients. Previously, it was understood that high volume crystalloid administration would improve survival and was standardised in the management of shock (Santry & Alam 2010). However, over-administration of crystalloid fluid can cause patient harm by potentially worsening injuries and can be detrimental to a patients survival. Current evidence supports the practice of lower volume crystalloid intravenous fluid administration- permissive hypotension. Little is known about pre-hospital emergency care providers intravenous fluid management practices for penetrating injury. Injury surveillance data for victims of penetrating injury is also scarce with the majority of current data taken from mortality sources. Surveilling pre-hospital cases may yield opportunities for prevention from premature mortality and morbidity. The aim of this study is to undertake surveillance of penetrating injury and related intravenous fluid resuscitation in the pre-hospital emergency care environment. A prospective observational descriptive survey was conducted in the Cape Metropole1. Over three consecutive months, emergency care providers documented parameters related to mechanism of injury, scene vital signs, hospital vital signs, intravenous fluid resuscitation and basic patient demographic information for patients with penetrating injury. A predetermined inclusion and exclusion criteria was used to sample patients.
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Zakka, Labib. "Clinical outcomes in patients with pemphigus vulgaris receiving a combination rituximab and intravenous immunoglobin therapy protocol." Thesis, Boston University, 2012. https://hdl.handle.net/2144/12694.
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Thesis (M.A.)--Boston University
PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.Pemphigus Vulgaris is a potentially fatal autoimmune blistering disease that affects the skin and mucous membranes. The conventional therapy for this disease is high dose corticosteroids and immunosuppressive agents, which have a marked side effect profile. Therefore, subjects who suffer from this disease are not only affected by the sequelae of the pathology of pemphigus, but also by the treatments given. The advent of intravenous immunoglobulin and rituximab, a monoclonal antibody targeting the CD20 B cell marker, has helped induce a complete remission in subjects off all systemic therapy and decrease the morbidity of the disease. However, a small subset of patients with pemphigus vulgaris is unresponsive to all therapies. The advent of a rituximab and IVIg combination therapy protocol has shown positive preliminary results in inducing complete remission off all systemic therapy in this subset of subjects with recalcitrant pemphigus vulgaris. Moreover, it has shown a favorable side effect profile. However, the data on this combination therapy protocol has been limited. This research paper aimed to describe the clinical outcome of twelve subjects who have received the combination therapy protocol. The main study objective was to describe the duration of clinical remission off all systemic therapy. The secondary objectives were to describe the clinical control of disease, clinical remission on IVIg and rituximab, relapse, and adverse effects on the combination therapy. A chart review was conducted and the results were tabulated and described. The combination therapy was capable of inducing complete remission off all systemic therapy in all subjects that lasted at least two years. Moreover, eight subjects did not relapse, while four subjects relapsed only once and achieved remission after retreatment. No major or unexpected adverse events were seen during the combination therapy. Therefore, the combination therapy has shown positive and promising results in terms of efficacy and safety. This study has also added more information on this protocol to the literature, allowing clinicians to conduct more elaborate studies in the future that would allow the optimization of the protocol. The advent of this new combination protocol has given new hope to a subset of patients in whom the disease and its therapy were a great cause of morbidity and mortality, and research should continue in order to continue in improving the lives of all patients suffering from recalcitrant pemphigus vulgaris.
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Lawrence, Louann W. Delclos George L. "The effectiveness of a needleless intravenous system in prevention of percutaneous injury in two hospitals /." See options below, 1994. http://proquest.umi.com/pqdweb?did=741832391&sid=1&Fmt=2&clientId=68716&RQT=309&VName=PQD.
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Curran, Evonne T. "The system of aseptic preparation of intravenous drugs in clinical care settings." Thesis, University of Stirling, 2010. http://hdl.handle.net/1893/3010.
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A review of the literature on blood stream infections caused by contaminated intravenous infusates which are prepared in clinical care settings found that this common nursing procedure poses at times a significant and life-threatening risk to patients. The guidance and regulations surrounding the preparation of intravenous drugs in clinical care settings suggests that this procedure is extremely complex and poses many different potential hazards to patients. This thesis set out to determine how the infection risks are being addressed in practice by asking the questions: ‘What is the system of intravenous drug preparation in clinical care settings in NHS Scotland?’ and, ‘How does it work in practice?’ Several data sources were utilised: six locations, in specialities where the literature identified significant outbreaks had occurred, were examined for potential contamination risk. Observations (78) of infusate preparations were undertaken and, where available, written procedures were compared with observed practices. Finally, analyses were made of 71 questionnaires, completed by the nurses who prepare intravenous drugs, regarding their opinions of the procedures’ safety and when they perform redundancy checks. The conclusion of this study is that the system of preparing intravenous drugs in clinical care settings by nurses is, as a consequence of potential infusate contamination, error-prone and unreliable. The reasons for this conclusion are now detailed. o Due to a lack of mandatory environmental standards, and the provision of poor environments, there is a risk of infusate contamination from environmental sources and consequently, a risk to patients of infusate-related blood stream infections (IR-BSI). o Some in use equipment poses contamination risks to patients’ infusates. Equipment that could reduce the contamination risk is not always available and in some instances such safety-enhancing equipment has been removed. o There are no complete written procedures which mirror what is done in practice. At present, from a human-factors perspective, it is not easy for the nurse to do the right thing, or to be sure exactly what is the right thing to do. o The procedure, in practice, has the required elements of an aseptic procedure, but the execution of the procedure is more often not performed aseptically. o The procedure of intravenous drug preparation as observed is mainly an interrupted aseptic procedure and as such the recommencement of the aseptic procedure requires repeated hand hygiene. o The nurses’ opinions of safety vary, as did their assessment of the infection risk to their patients, but it is clear that intravenous drug preparation is not a much-loved nursing procedure and some nurses find it very stressful. o There is no asepsis quality control built into the system. Aseptic steps are the least likely to be performed as a redundancy check compared to the mandatory checks of ‘right patient, right drug and right dose’. o The information available to the nurses, from the drug companies, from the makers of equipment and from national agencies does not identify with sufficient clarity the infection risks, or detail how to negate them. Suggestions for improvement to the six procedures and environments are clear once the procedure steps are colour-coded as either aseptic or non-aseptic; validity testing of these improvements is however, still needed. The systems’ vulnerabilities observed in this research appear to stem from a chain of external influences including an underestimation of the problem size and the actions needed to prevent it in evidence-based guidelines and mandatory guidance. This leads to poor recognition of the risk of IR-BSI in clinical practice. The problem of infusate contamination causing IR-BSIs is further compounded by the fact that it is not caused by a single organism and does not always present as a disease in real time, that is, over the lifetime of the infusion. As a consequence, this presents surveillance difficulties in terms of definitions, data collection and analysis. Finally, although the diagnosis of a blood stream infection for an individual patient remains relatively easy, it is not easy to recognise a contaminated infusate as the origin of the problem. All these challenges make both the recognition of the problem and agreement on prevention strategies, extremely challenging. In summary, the main conclusion of this thesis is that the preparation of infusates in clinical care settings, which occurs approximately 3,000,000 times a year in NHSScotland, is from an aseptic perspective, error-prone and unreliable. Recommendations to optimise patient safety include, changing the procedure locally and, with the utmost urgency, the production of minimum environmental standards. The results of this study are relevant to all hospitals in Scotland and throughout the United Kingdom where the current regulations apply and similar procedures are performed.
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Lopes, Marco A. F. "Hydration of Colonic Ingesta and Feces in Horses Fed Large Grain Meals or Treated with Enteral Fluid Therapy, Saline Cathartics and Intravenous Fluid Therapy." Diss., Virginia Tech, 2002. http://hdl.handle.net/10919/29338.
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Systemic hydration, plasma electrolytes, ingesta and fecal hydration and gastrointestinal passage of cobalt (after CoEDTA administration via nasogastric tube) in horses fed large grain meals or treated with enteral fluid therapy, IV fluid therapy and enteral laxatives were investigated. In the first study, 0.9% NaCl (10 L/h/8h) was administered slowly via a small-bore nasogastric tube or as 10 L boluses via a large-bore nasogastric tube to four normal horses. In the other studies, horses with a right dorsal colon fistula were used. To create the right dorsal colon fistula, a cannula with 5 cm internal diameter was implanted 2 to 6 weeks after a right dorsal colopexy had been created. Six horses with the right dorsal colostomy were alternately used to test three feeding regimes for 48 h: 1- hay free choice; 2- hay free choice plus 4.5 kg of sweet feed twice daily after a period of 5 days of adaptation; 3- sudden change from hay to hay plus sweet feed. Seven horses with the right dorsal colostomy were alternately used to test 6 experimental conditions while fasted for 24 h: 1- control (no treatment), 2- enteral MgSO4 (1 g/kg), 3- enteral Na2SO4 (1 g/kg), 4- IV lactated Ringer's solution (5 L/h/12 h), 5- enteral water (5 L/h/12 h), 6- enteral electrolyte solution (5 L/h/12 h). In the last study, four horses with the right dorsal colostomy were alternately treated with enteral electrolyte solution (10 L/h/6h) and enteral MgSO4 (1 g/kg) plus IV fluid therapy (10 L/h/6h). Despite the administration regimen, enteral administration of 0.9% NaCl produced diarrhea, hypernatremia and hyperchloremia. Colostomy allowed serial collection of large ingesta samples. Grain ingestion did not change PCV or plasma protein, but affected plasma electrolytes and produced dehydration of ingesta and formation of frothy ingesta. Fasting delayed gastrointestinal transit. Enteral fluid therapy was the most effective treatment in promoting ingesta hydration. Enteral water, MgSO4, Na2SO4, IV fluid therapy and enteral MgSO4 plus IV fluid therapy were either ineffective in promoting ingesta hydration or produced marked plasma electrolyte imbalance. These findings support the use of enteral fluid therapy in horses with gastrointestinal impaction.Ph. D.
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Gallo, Maria L. "Nursing advocacy and the accuracy of intravenous to oral opioid conversion at discharge in the cancer patient." [Tampa, Fla] : University of South Florida, 2009. http://purl.fcla.edu/usf/dc/et/SFE0003235.
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Veldsman, Lizl. "The impact of intravenous fluid and electrolyte administration on total fluid, electrolyte and energy intake in critically ill adult patients." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/85659.
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Thesis (MNutr)--Stellenbosch University, 2013.ENGLISH ABSTRACT: Objectives: The objectives of this study were to determine the nutritional content/ contribution of intravenous (IV) fluid and electrolyte administration on the total feeding prescription of intensive care unit (ICU) patients. Methods: Retrospective review of ICU charts of consecutive patients (>18 years) with APACHE II scores ≥10 and on ≥72 hours nutrition therapy (NT) admitted to a medical/surgical ICU. Total fluid, electrolyte, energy and macronutrient intake from nutritional and non-nutritional sources were reviewed from ICU admission until discharge, discontinuation of NT or death for ≤7 days. Energy and protein delivery were compared to calculated targets of 25.4 – 28.6kCal/kg and 1.3 – 1.5g/kg respectively. Summary statistics, correlation coefficients and appropriate analysis of variance were used to describe and analyse the data. Results: A total of 71 patients (49% male), average age 49.2 ± 17.1, average APACHE II score 21.0 ± 6.1, 68% medical and 32% surgical, were included. Fluid and nutrient intake were reviewed over a mean of 5.7 ± 1.1 days. Mean daily fluid delivery was 3.2 ± 0.6L. IV fluid therapy (IVFT) contributed 32.0 ± 12.0% to total fluid delivery (TFD), whereas IV drug administration, including fluids used for reconstitution and dilution purposes, contributed 20.7 ± 8.1% to TFD. Balanced electrolyte solutions (BES) were the crystalloid of choice, prescribed in 91.5% of patients with a mean daily volume (MDV) of 0.5 ± 0.4L. Hypertonic low molecular weight (LMW) 130/0.4kD hydroxyethyl starch (HES) was the colloid of choice, prescribed in 78.9% of patients with a MDV of 0.2 ± 0.1L. Potassium salts were the most frequently prescribed IV electrolyte supplement (IVES), prescribed in 91% of patients (±20 – 60mmol per administration). NT was initiated within 14.5 ± 14.1 hours. The majority (80%) received enteral nutrition (EN). The mean daily energy delivered was 1613 ± 380kCal (25.1kCal/kg), meeting 93.6 ± 17.7% of mean target range (MTR). Mean daily protein delivery (PD) was 72 ± 22g (1.1g/kg), meeting 82.8 ± 19.9% of MTR. Non-nutritional energy sources (NNES), mostly derived from carbohydrate-containing IV fluids, contributed 10.1 ± 7.5% to total energy delivered (156kCal/d). Mean cumulative energy and protein balance was -674.0 ± 1866.1kCal and -86.0 ± 106.9g respectively. The majority (73%) received >90% of the minimum energy target but only 49% >90% of minimum protein target; 59% of those with energy intake 90-110% of target had adequate protein intake. A significant negative correlation was found between cumulative energy/protein balance and the time to initiation of NT (energy: r=-0.28, p=0.02; protein: r=-0.32, p=0.01). Conclusion: In this ICU BES are the crystalloid of choice and hypertonic LMW 130/0.4kD HES the colloid of choice for IVFT. Potassium salts are the most frequently prescribed IVES. NNES added significantly to energy delivery and should be included in the calculation of feeding prescriptions to avoid the harmful effects of overfeeding. Early initiation of EN with conventional products which are energy rich is insufficient to achieve adequate PD. EN formulae with a more favorable nitrogen to non-protein energy ratio could help to optimise PD during the first week of ICU care.
AFRIKAANSE OPSOMMING: Doelwitte: Die doelwit van hierdie studie was om die voedingswaarde/ bydrae van intraveneuse (IV) vog en elektroliet toediening tot die totale voedings voorskrif van pasiënte in ‘n intensiewe sorg eenheid (ISE) te bepaal. Metodes: Retrospektiewe bestudering van die ISE kaarte van agtereenvolgende pasiënte (>18 jaar) opgeneem in ‘n mediese/chirurgie ISE en met APACHE II tellings ≥10 en ≥72 ure voedingsterapie (VT). Totale vog, elektroliet, energie en makronutriënt inname vanaf voedingsverwante en nie-voedingsverwante bronne is vanaf ISE opname tot en met ontslag, staking van VT of sterfte, vir ≤7 dae hersien. Energie en proteiën inname is vergelyk met berekende doelwitte van 25.4 – 28.6kKal/kg en 1.3 – 1.5g/kg onderskeidelik. Beskrywende statisitiek, korrelasie koeffisiënte en toepaslike analises van variansie is gebruik vir data analise. Resultate: 71 pasiënte (49% mans), gemiddelde ouderdom 49.2 ± 17.1, gemiddelde APACHE II telling 21.0 ± 6.1, 68% medies en 32% chirurgie, is ingesluit. Vog en voedingstof inname is hersien oor ‘n gemiddelde tydperk van 5.7 ± 1.1 dae. Gemiddelde vog inname was 3.2 ± 0.6L/dag. IV vog terapie (IVVT) het 32.0 ± 12.0% bygedra tot totale vog inname (TVI). IV medikasie toediening, insluitende die herkonstruksie en verwatering van medikasie, het 20.7 ± 8.1% bygedra tot TVI. Die mees voorgeskrewe kristalloiëd en kolloiëd vir IVVT was gebalanseerde elektroliet oplossings (GEO), voorgeskryf in 91.5% van pasiënte (gemiddeld 0.5 ± 0.4L/dag), en hipertoniese lae molekulêre gewig (LMG) 130/0.4kD hidroksie-etiel stysel (HES), voorgeskryf in 78.9% van pasiënte (gemiddeld 0.2 ± 0.1L/dag), onderskeidelik. Die mees voorgeskrewe IV elektroliet supplement was kalium soute, voorgeskryf in 91% van pasiënte (±20 – 60 mmol per toediening). VT is binne 14.5 ± 14.1 ure geinisieër. Die meerderheid (80%) het enterale voeding (EV) ontvang. Die gemiddelde daaglikse energie inname van 1613 ± 380kCal (25.1kKal/kg) het 93.6 ± 17.7% van die gemiddelde doelwit rykwydte (GDR) bereik. Die gemiddelde daaglikse proteiën inname van 72 ± 22g (1.1g/kg) het 82.8 ± 19.9% van die GDR bereik. Nie voedings-verwante energie bronne (NVEB), meestal vanaf koolhidraat-bevattende IV vloeistowwe, het 10.1 ± 7.5% tot totale energie inname (TEI) bygedra (156kKal/d). Die gemiddelde kumulatiewe energie en proteiën balans was -674.0 ± 1866.1kKal en -86.0 ± 106.9g onderskeidelik. Die meerderheid (73%) het >90% van die minimum energie doelwit (ED) bereik. Slegs 49% het >90% van die minimum proteiën doelwit (PD) bereik. Opsomming: Die kristalloiëd en kolloiëd van keuse vir IVT is GEO en hipertoniese LMG 130/0.4kD HES onderskeidelik. Kalium soute word mees algemeen voorgeskryf. NVEB dra beduidend by tot TEI en moet inaggeneem word tydens die berekening van voedingsvoorskrifte ten einde oorvoeding te voorkom. Vroeë inisiëring van EV met konvensionele energie-ryke EV produkte is onvoldoende om genoegsame proteiën inname te verseker. EV produkte met ‘n gunstiger stikstof tot nie-proteiën energie verhouding sal help om proteiën inname gedurende die eerste week van intensiewe sorg te optimaliseer.Slegs 59% van pasiënte met genoegsame energie inname (90-110% van ED) het hul minimum PD bereik. Daar was ‘n beduidende negatiewe korrelasie tussen kumulatiewe energie/proteiën balans en die tyd tot inisiëring van VT (energie: r=-0.28, p=0.02; proteiën: r=-0.32, p= 0.01).
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Van, Niekerk Anida. "Implementation of intravenous to oral antibiotic switch therapy guidelines in the general medical wards of a tertiary level hospital." Thesis, Nelson Mandela Metropolitan University, 2010. http://hdl.handle.net/10948/1325.
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The overuse of antibiotics and consequent resistance is a common problem in medical practice worldwide. Switch therapy is a technique that can be applied to streamline antibiotic therapy reducing unnecessary prolonged Intravenous (IV) antibiotic therapy. Antibiotic switch therapy has several other benefits such as: decreasing length of hospital stay; decreasing the incidence of adverse events associated with the administration of IV antibiotics; decreasing direct and indirect hospitalisation costs while improving patients’ comfort and mobility; and decreasing the risk of acquiring nosocomial infections. Certain elements are required to make the implementation of any guideline, including a switch therapy guideline, a success and probably one of the most important is the support from a motivated multidisciplinary team. The role of such a team, in the South African context, would be filled by the Pharmacy and Therapeutics Committee (PTC). In addition, to make a guideline successful it should be continuously implemented. This responsibility traditionally falls to a pharmacist. In the United Kingdom (UK) and the United States of America (USA) pharmacists are used to promote the appropriate use of antibiotics in hospitals as this has shown to have several economic advantages. The objectives of the study were: to determine, by means of a survey, whether guidelines for IV to oral switch were employed in South African regional, tertiary and national government hospitals; to design and implement an IV to oral antibiotic switch therapy (IVOST) guideline for a local public sector tertiary level hospital; to evaluate the effectiveness of guideline implementation; and to capture, via a questionnaire, the perceptions of prescribers regarding antibiotic prescribing, including switch therapy. The Survey of Current IV Switch Therapy Practice Questionnaire was distributed to Responsible Pharmacists at regional, provincial tertiary and national central government hospitals to determine whether IVOST guidelines were employed in South African government hospitals. Following the survey, an IVOST Guideline was designed by the researcher in consultation with the Department of Medicine and the Department of Pharmacy. The IVOST Guideline was implemented following approval by the PTC at a local tertiary level government hospital. A presentation was held for prescribers, guideline documents were distributed, posters were placed in the medical wards and the ward pharmacist/researcher integrated the guideline into daily practice by placing “reminder stickers” in patient medical folders. A pre-implementation audit and two post-implementation audits, each consisting of 150 patient medical records, were conducted and compared to determine the effect of IVOST guideline implementation on prescribing patterns and to determine whether any changes could be sustained. The Prescriber Antibiotic Survey was then conducted to capture the perceptions of prescribers regarding antibiotic therapy, including switch therapy.
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Dastmalchi, Maryam. "Studies of immunopathogenic mechanisms and treatment of chronic, inflammatory myopathies, myositis /." Stockholm : Karolinska institutet, 2007. http://diss.kib.ki.se/2007/978-91-7357-323-8/.
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Ramalho, Cláudia Sofia Agua. "Estudo comparativo entre diferentes vias de administração de fluidos em equinos : endovenosa, oral e rectal." Bachelor's thesis, Universidade Técnica de Lisboa. Faculdade de Medicina Veterinária, 2010. http://hdl.handle.net/10400.5/2598.
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Dissertação de Mestrado Integrado em Medicina VeterináriaA fluidoterapia é uma prática frequente em clínica de equinos, essencialmente em patologias capazes de induzir uma alteração hemodinâmica como em casos de choque endotoxémico. Em clínica de equinos as vias mais utilizadas são a intravenosa e a oral. A via intravenosa é a via de eleição quando é pretendido um efeito rápido, por haver deposição de fluido directamente na corrente sanguínea. É, no entanto, a mais dispendiosa. Pode também recorrer-se à via oral, menos invasiva e útil em impactações ou deslocamentos de cólon. A presença de refluxo enterogástrico ou diminuição da motilidade gastrointestinal são contra-indicação absoluta para esta via. O objectivo do presente estudo realizado neste trabalho é comparar os efeitos sistémicos da fluidoterapia oral, IV e rectal, para determinar se esta ultima é ou não uma alternativa viável à via oral. Um grupo de seis cavalos recebeu três sessões de fluidoterapia por vias de administração diferentes, com intervalo mínimo de cinco dias entre elas. Os parâmetros avaliados foram o hematócrito, a concentração de proteínas plasmáticas e a frequência cardíaca, medidos com intervalos de 15 minutos. Foi feita também uma avaliação subjectiva da quantidade de urina produzida e da frequência de defecação e consistência das fezes. A solução utilizada foi o NaCl 0,9 % para as três vias de administração. Nas vias oral e rectal foram administrados 4 litros com intervalo de 20 minutos durante os primeiros 80 minutos e 4 litros com intervalo de 30 minutos até perfazer os 40 litros. Na via intravenosa foi usada uma taxa de administração contínua e 5 litros/hora. Nas três vias utilizadas os valores de hematócrito diminuíram ao longo da experiência. Na via oral e na rectal as alterações foram semelhantes, enquanto que na via endovenosa a descida foi mais rápida e profunda. Não se verificaram alterações estatisticamente significativas na concentração de proteínas plasmáticas. A via rectal revelou-se uma via de hidratação eficaz e uma alternativa viável à via de administração oral.
ABSTRACT - Analogy between different methods of administrating fluids in horses: Intravenous, Enteric and Rectal. - Fluid Therapy is a regular practice in horse clinic, essentially regarding pathologies capable of inducing a hemodynamic change, as seen in cases of endotoxic shock. In horse clinic, the most recurring methods of fluid administration are the intravenous and the oral. The intravenous method is the favoured one when a fast effect is pretended, due to the direct deposition of fluid in the blood flow. However, it is the most expensive. The oral method may also be utilized, less invasive and useful for impactions or colon displacement. The presence of enterogastric reflux or the decrease of gastrointestinal motility is an absolute contraindication for the use of this method. The goal of the analysis carried out in this work is to compare the systemic effects of the oral, intravenous and rectal fluid therapy, in order to determine if the latter is a consistent alternative to the oral method. A group of six horses has received three sessions of fluid therapy using different methods, with a minimum time gap of five days in between. The evaluated parameters were the haematocrit, the concentration of plasma proteins and the heart-rate, measured every 15 minutes. A subjective evaluation has also been done of the amount of produced urine, the frequency of defecation and the consistency of the faeces. The solution applied was the NaCl 0,9 % for the three methods of administration. Regarding the oral and rectal methods, 4 litres were given with 20-minute intervals during the first 80 minutes and 4 litres with the 30-minute interval until completing the 40 litres. For the intravenous method, a continuous rate of administration was used and 5 litre per hour. In the three methods, the haematocrit values have decreased throughout the experience. In the oral and rectal method, the changes were similar, whereas the decrease was faster and deeper in the intravenous method. There have not been any statistically significant changes on the concentration of plasma proteins. The rectal method has been proved to be an effective hydration method and a viable alternative to the oral administration.
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Zerna, Charlotte, Timo Siepmann, Kristian Barlinn, Jessica Kepplinger, Lars-Peder Pallesen, Volker Pütz, and Ulf Bodechtel. "Association of time on outcome after intravenous thrombolysis in the elderly in a telestroke network." Sage, 2016. https://tud.qucosa.de/id/qucosa%3A35636.
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Background: Recent studies showed that the safety and benefit of early intravenous (IV) thrombolysis on favourable outcomes in acute ischemic stroke are also seen in the elderly. Furthermore, it has shown that age increases times for pre- and in-hospital procedures. We aimed to assess the applicability of these findings to telestroke.
Methods: We retrospectively analysed 542 of 1659 screened consecutive stroke patients treated with IV thrombolysis in our telestroke network in East-Saxony, Germany from 2007 to 2012. Outcome data were symptomatic intracranial hemorrhage (sICH) by ECASS-2-criteria, survival at discharge and favourable outcome, defined as a modified Rankin scale (mRS) of 0–2 at discharge.
Results: Thirty-three percent of patients were older than 80 years (elderly). Being elderly was associated with higher risk of sICH (p¼0.003), less favourable outcomes (p¼0.02) and higher mortality (p¼0.01). Using logistic regression analysis, earlier onsetto-treatment time was associated with favourable outcomes in not elderly patients (adjusted odds ratio (OR) 1.18; 95% CI 1.03–1.34; p¼0.01), and tended to be associated with favourable outcomes (adjusted OR 1.13; 95% CI 0.92–1.38; p¼0.25) and less sICH (adjusted OR 0.88; 95% CI 0.76–1.03; p¼0.11) in elderly patients. Age caused no significant differences in onset-to-doortime (p¼0.25), door-to-treatment-time (p¼0.06) or onset-to-treatment-time (p¼0.29).
Conclusion: Treatment time seems to be critical for favourable outcome after acute ischemic stroke in the elderly. Age is not associated with longer delivery times for thrombolysis in telestroke.
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Mancha, Dora Alexandra Inácio. "Fluidoterapia entérica versus fluidoterapia endovenosa em casos de síndrome de abdómen agudo em equinos." Bachelor's thesis, Universidade Técnica de Lisboa. Faculdade de Medicina Veterinária, 2009. http://hdl.handle.net/10400.5/1266.
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Dissertação de Mestrado Integrado em Medicina VeterináriaO Síndrome de Abdómen Agudo é uma patologia muito frequentemente encontrada na prática clínica de equinos. A hidratação dos cavalos com dor abdominal aguda é extremamente importante. Por este motivo, a abordagem terapêutica médica destes animais inclui quase invariavelmente a administração de fluidos. O médico veterinário pode recorrer à fluidoterapia entérica e à fluidoterapia endovenosa para o tratamento destes animais, podendo utilizá-las isoladamente ou em conjunto. A elaboração de um plano de fluidoterapia, seja entérica e/ou endovenosa, deve ser baseada na alteração clínica apresentada pelo animal. Nos casos de maior gravidade, nos quais os pacientes se apresentam com um grau de desidratação moderado a grave, a administração de fluidos por via endovenosa é imprescindível. Nestes casos, e também de modo a diminuir os custos económicos associados à fluidoterapia endovenosa, a fluidoterapia entérica pode ser considerada como um complemento sempre que não se verifique a presença de refluxo enterogástrico. A presença de refluxo enterogástrico é indicadora de disfunção gastrointestinal grave associada com o comprometimento das funções de secreção e absorção do intestino ou com alterações de trânsito intestinal, e constitui uma contra-indicação absoluta para a administração de fluidos por via entérica. A fluidoterapia entérica deve ser reservada para os casos de SAA associados com alterações hidroelectrolíticas ligeiras. Esta via de administração de fluidos representa um método rápido e económico para promover a hidratação dos conteúdos intestinais. Recentemente têm vindo a surgir cada vez mais evidências da eficácia da administração de fluidos por via entérica em casos de obstruções simples de intestino grosso (impactações e deslocamentos de cólon maior). De facto, nos casos de impactações intestinais não complicadas, faz mais sentido promover a hidratação da ingesta através de fluidoterapia entérica, provocando assim efeitos mínimos ao nível da circulação sistémica. Apesar de não se poderem substituir uma à outra, estas duas formas de administração de fluidos são fundamentais na abordagem médica aos casos de SAA em equinos pela sua complementaridade.
ABSTRACT - Enteral Fluid Therapy versus Intravenous Fluid Therapy in Equine Acute Abdomen - The acute abdomen is a very common feature in equine practice. The hydration of the horse with acute abdominal pain is extremely important, thus the treatment of these animals includes very often fluids administration. The equine practitioner can use enteral fluid therapy or intravenous fluid therapy alone or together for acute abdominal pain treatment. The fluid plan elaboration, whether enteral and/or intravenous, should be based on the animal clinical condition. In more serious cases the intravenous fluids administration is essential. Also in these cases, to reduce the costs associated to intravenous fluid therapy, enteral fluids can be used as a complement when there is no gastric reflux, which indicates a serious gastrointestinal dysfunction associated with motility disorders or impaired intestinal absorption and secretion mechanisms. So, gastric reflux is an absolute contraindication for the use of enteral fluids. The enteral fluid therapy should be reserved for acute abdomen cases associated with mild hydroelectrolyte disorders. The administration of enteral fluids represents a quick and economical method to promote the hydration of intestinal contents. There are some recent scientific reports that support the efficacy of enteral fluid therapy in mild cases of large intestinal obstruction (impactions and displacements). In fact, in uncomplicated impactions, it makes more physiological sense to promote direct ingesta hydration while having minimal effects on the systemic circulation. Although one can not replace the other, these fluid administration routes are essential and complementar in the medical management of equine acute abdomen cases.
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Brugada, Vilà Pau. "Boosting intravenous administration of therapeutic viral vectors using an oligopeptide-modified poly(β-aminoester)s-based coating technology." Doctoral thesis, Universitat Ramon Llull, 2018. http://hdl.handle.net/10803/664008.
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En els últims anys, l’ús terapèutic de virus pel tractament de malalties genètiques i càncer ha esdevingut una realitat. La millor demostració és l’aprovació regulatoria, la comercialització i l’ús clínic d’alguns productes basats en virus. No obstant, encara no s’ha aconseguit desplegar tot el seu potencial. La inherent promiscuïtat dels virus per infectar cèl·lules indesitjades, la seva alta immunogenicitat i la alta seroprevalença de la població ha limitat el seu ús a tractaments administrats localment per garantir la seva seguretat i eficàcia. S’han explorat moltes estratègies per tal de solucionar aquests inconvenients, des de la enginyeria genètica dels genomes virals fins al desenvolupament de complexos procediments d’administració. Entre aquestes estratègies s’hi troben els vectors híbrids formats per components virals i biomaterials avançats que emmascaren les partícules virals I milloren la seva acumulació en zones desitjades després de l’administració sistèmica.
Recentment, els poly(β-amino ester)s (pBAEs) han despuntat com a vectors no virals per aplicacions en teràpia gènica. El nostre grup n’ha incrementat el potencial generant vectors amb especificitat cel·lular incorporant oligopèptids (OM-pBAEs) a la seva estructura i millorant l’estabilitat dels complexes DNA/pBAEs per aplicacions in vivo. En el present treball descrivim el seu potencial millorant l’administració intravenosa de virus sense embolcall, com els virus adeno-associats (AAV) i els adenovirus (Ad). Hem demostrat que els OM-pBAEs catiònics interaccionen amb les càpsides virals i serveixen per recobrir les partícules. A més a més, hem demostrat que es possible incorporar en el recobriment components que dirigeixin la infecció a cèl·lules concretes, així com incorporar polímers que evitin interaccions indesitjades modificant el tropisme natural dels virus. Com a conseqüència, s’ha desenvolupat una tecnologia de recobriment específica per millorar la farmacocinètica, la seguretat i l’eficàcia d’adenovirus administrats per via intravenosa. Aquest treball ha culminat en la producció del SAG101, un adenovirus oncolític recobert, amb gran potencial pel tractament de l’adenocarcinoma ductal de pàncreas (PDAC). Per últim, hem explorat la biodistribució física dels adenovirus recoberts a través del marcatge radioactiu mitjançant modificacions genètico-químiques dels virus.
Amb aquesta tesi demostrem que el recobriment de virus amb OM-pBAEs es una eina amb un gran potencial per millorar la seguretat i eficàcia dels agents terapèutics vírics administrats per via intravenosa.En los últimos años, el uso terapéutico de virus para el tratamiento de enfermedades genéticas y cáncer se ha convertido en una realidad. La mejor demostración es la aprobación regulatoria, la comercialización y el uso clínico de algunos productos basados en virus. No obstante, todavía no se ha logrado desplegar todo su potencial. La inherente promiscuidad de los virus para infectar células indeseadas, su alta immunogenicidad y la alta seroprevalencia entre la población ha limitado su uso a tratamientos administrados localmente para así garantizar la seguridad y eficacia de dichos tratamientos. Se han explorado muchas estrategias para solucionar estos inconvenientes, yendo desde la ingeniería genética de los genomas virales al desarrollo de complejos procedimientos de administración. Entre estas estrategias se encuentran los vectores híbridos formados por componentes virales y no virales usando biomateriales avanzados que enmascaran las partículas virales y mejoran la acumulación de las mismas en las zonas deseadas después de su administración sistémica. Recientemente, los poly(β-amino ester)s (pBAEs) han despuntado como vectores no virales para aplicaciones en terapia génica. Su potencial se ha incrementado generando vectores con especificidad celular incorporando oligopeptidos (OM-pBAEs) en su estructura y mejorando la estabilidad de los complejos DNA/pBAEs para aplicaciones in vivo. En el presente trabajo descubrimos su potencial para mejorar la adminsitracion intravenosa de virus sin envoltura, como los virus adeno-associados (AAV) y los adenovirus (Ad). Hemos demostrado que los OM-pBAEs catiónicos interaccionan con las capsides virales y sirven para recubrir las partículas virales. Además, hemos demostrado que es posible incorporar en el recubrimiento componentes que dirijan la infección a células concretas, así como incorporar polímeros que eviten interacciones indeseadas modificando el tropismo natural de los virus. Como consecuencia, se ha desarrollado una tecnología de recubrimiento específica para mejorar la farmacocinética, la seguridad y la eficacia de adenovirus administrados por vía intravenosa. Este trabajo ha culminado en la producción del SAG101, un adenovirus oncolítico recubierto, con gran potencial para el tratamiento del adenocarcinoma ductal de páncreas (PDAC). Por último, hemos explorado la biodistribución física de los adenovirus recubiertos a través del marcaje radiactivo mediante la modificación genético-químicas de los adenovirus. Con esta tesis se demuestra que el recubrimiento de virus con OM-pBAEs es una herramienta con enorme potencial para mejorar la seguridad y eficacia de los agentes terapéuticos víricos administrados por vía intravenosa.
The use of viruses as therapeutic agents has become a reality for the treatment of inherited genetic diseases and cancer in the recent years. The regulatory approval, commercialization and clinical use of some virus-based products is the best demonstration of their applicability. However, their potential is far from being completely exploited. Their inherent promiscuity to infect non-target cells, their intrinsic immunogenicity and the high seroprevalence within the population pose serious risks regarding their safety and minimize their efficacy when systemically administered. Several strategies have been attempted in order to circumvent these drawbacks, from genetic engineering of viral genomes to the development of complex delivering procedures. The generation of hybrid viral/non-viral vectors using novel biomaterials aiming to hinder viral capsids and enhance virus accumulation in target sites is one among these strategies. Recently, newly developed poly(β-amino ester)s (pBAEs) have emerged as an interesting choice as non-viral gene delivery vectors. Terminal modified pBAEs with oligopeptides (OM-pBAEs) have been used to produced cell-specific vectors and slightly hydrophobic backbones have improved their in vivo applicability. Here, we present their use as coating agents to boost the intravenous administration of non-enveloped viral vectors such as adeno-associated viruses (AAV) and adenoviruses (Ad). We demonstrate that cationic OM-pBAEs efficiently interact with viral capsids serving as an electrostatic anchorage to physically modify them. Furthermore, we demonstrate that targeting moieties and shielding polymers such as polyethylene glycol can be incorporated into the coating structure modifying the viruses’ natural tropisms. In addition, we have developed an OM-pBAEs-based coating technology able to improve pharmacokinetics, safety and efficacy of intravenously administered Ads. Furthermore, this work culminates with the production of SAG101, a combination of the coating technology with the AdNuPARE1A, resulting in a coated oncolytic adenovirus with great potential for the treatment of pancreatic ductal adenocarcinoma (PDAC). Finally, we have explored the use of combined genetic and chemical viral capsid modifications as a minimally invasive radiolabelling tool for biodistribution studies of electrostatically coated Ads. In conclusion, this thesis demonstrates that coating of viral vectors with OM-pBAEs is a valuable tool to improve intravenous administration of non-enveloped viruses boosting their efficacy and safety for specific therapeutic applications.
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Dryburgh, Leslie Irene. "A retrospective study of the diagnostic and treatment practices of health care professionals for patients receiving out-patient intravenous antibiotic therapy for cellulitis." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/MQ56120.pdf.
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Dufaÿ, Amélie. "Conception et évaluation d'un vecteur ciblé de thérapie génique anticancéreuse destiné à la voie intraveineuse." Thesis, Paris 11, 2012. http://www.theses.fr/2012PA114818/document.
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L’administration intraveineuse d’ADN thérapeutique rencontre de nombreux obstacles liés à sa dégradabilité, ainsi qu’à sa difficulté à pénétrer les cellules en raison de sa taille importante et de son hydrophilie. Des lipoplexes conjugués à de l’acide hyaluronique (HA) de haut poids moléculaire ont été développés afin de délivrer de l’ADN plasmidique à l’intérieur de cellules cancéreuses exprimant le récepteur membranaire CD44, récepteur clé du développement tumoral. L’emploi d’HA conjugué au phospholipide DOPE (HA-DOPE) et d’un plasmide modèle GFP a permis d’obtenir des lipoplexes d’environ 250 nm, chargés négativement, protégeant efficacement l’ADN contre les nucléases et activant peu la fraction C3 du système du complément. Dans un modèle cellulaire exprimant CD44, la transfection optimale a été obtenue par l’utilisation de lipides avec 10% d’HA-DOPE complexés à de l’ADN selon un rapport 2:1. Ces lipoplexes sont internalisés par la voie des cavéoles et de façon dépendante du récepteur CD44. Cette formulation a été appliquée à la vectorisation d’un gène thérapeutique, codant pour le récepteur des estrogènes β (ERβ), qui est un potentiel suppresseur de tumeur. Sur un modèle in vivo de xénogreffes de cellules humaines de cancer du sein estrogéno-dépendant et exprimant CD44, la diminution du volume tumoral, ainsi que de l’indice de prolifération Ki67 ont permis de montrer l’effet anticancéreux par voie intraveineuse des lipoplexes conjugués à l’HAIntravenous administration of therapeutic DNA faces many obstacles related to its degradability and its difficulty to penetrate into the cells due to its large size and its hydrophilicity. Lipoplexes conjugated with high molecular weight hyaluronic acid (HA) have been designed in order to deliver plasmid DNA inside cancer cells expressing the membrane receptor CD44, a key receptor in the development of tumors. The use of HA conjugated to the phospholipid DOPE (HA-DOPE) and of the GFP model plasmid lead to obtain lipoplexes around 250 nm, negatively charged, which efficiently protect the DNA against nucleases and slightly stimulate the C3 fraction of the complement system. In a cellular model expressing CD44, the optimal transfection was obtained by using lipids containing 10% of HA-DOPE complexed to DNA at a 2:1 ratio. Internalization of these lipoplexes is mediated by the caveolae pathway and involves the CD44 receptor. This formulation was applied to the delivery of a therapeutic gene encoding the estrogen receptor β (ERβ), which is a potential tumor suppressor. On an in vivo xenograft model of estrogen-dependent breast cancer cells expressing CD44, decrease of the tumor volume, as well as decrease of the Ki67 proliferation index, have shown the anticancer activity of the lipoplexes conjugated to HA following intravenous administration
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Narciso, João Henrique Fagundes Bastos. "Uso de IL-2 humana recombinante em pacientes com imunodeficiência comum variável." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/5/5146/tde-31072008-120053/.
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Na imunodeficiência comum variável (ICV) têm sido descritas alterações de linfócitos T, incluindo a produção diminuída da interleucina-2 (IL-2). Desde que a IL-2 pode promover a produção de imunoglobulinas in vitro, nosso principal objetivo foi investigar os efeitos in vivo do tratamento com IL-2 recombinante (IL-2r) em pacientes com ICV. Foram selecionados 4 pacientes que apesar de tratamento adequado com imunoglobulina EV apresentavam infecções recorrentes. Após um período de observação de 12 meses, os pacientes receberam doses crescentes de IL-2r durante 16 semanas com reposição de imunoglobulina apenas se a IgG sérica atingisse níveis menores do que 400mg/dL. A seguir, permaneceram em observação por mais 12 meses recebendo imunoglobulina . A gravidade das infecções foi avaliada segundo um \"score\" numa escala de 3 a 10. A avaliação in vitro incluiu: quantificação dos níveis de IgG, IgA e IgM séricas; resposta linfoproliferativa à PHA; populações linfocitárias CD4+, CD8+, CD19+ e CD25+ no sangue periférico. As reações adversas à IL-2r foram leves e localizadas. Houve redução aparente do número e gravidade das infecções durante os 12 meses subseqüentes ao término da IL-2r. Os níveis da IgG sérica e das células CD4+, CD8+ e CD19+ mantiveram-se estáveis durante todo o estudo. Em 3 pacientes houve relação entre melhora clínica e aumento da proporção de linfócitos T CD25+. Isto permite supor que a remissão de infecções em alguns pacientes com ICV , sob terapêutica com IL-2r associada ou não à imunoglobulina EV, esteja parcialmente relacionada à melhora da imunidade celular. Adicionalmente, nossos dados indicam que a IL-2r pode ser utilizada de modo seguro nas dosagens e período utilizados como terapêutica adjuvante em alguns pacientes com ICV que apresentam infecções recorrentes e má resposta terapêutica à imunoglobulina endovenosaIn Common Variable Immunodeficiency (CVID) T cell function may be impaired and interleukin-2 (IL-2) production diminished. Since IL-2 stimulates immunoglobulin production in vitro, the aim of this study was to determine the in vivo effects of recombinant interleukin-2 (rIL-2) in patients with CVID. We selected four CVID patients, who despite intravenous immunoglobulin infusion (IVIG) had recurrent infections. After a twelve-month run-in period, escalating dosages of rIL-2 were administered during 16 weeks, during which rescue IVIG treatment was performed whenever serum IgG levels dropped below 400 mg/dL. During follow-up (12 months), patients were observed and treated with IVIG. Infection severity was assessed using a 3 to 10 infection score. In vitro analysis included: measurement of serum levels of IgG, IgA and IgM; lymphocyte proliferative responses to phytohaemaglutinin (PHA); CD4+, CD8+,CD19+ and CD25+ lymphocyte populations in peripheral blood. Few local side-effects were observed in 2 patients. In the follow-up period after rIL-2 treatment, patients experienced reduction of the number and severity of infections. Levels of serum IgG, CD4+, CD8+ and CD19+ were stable throughout the study. In 3 patients we observed a relation between improvement of clinical parameters and number of T CD25+ cells. These findings suggest that remission of infections in some CVID patients treated with rIL-2, in combination or not with IVIG is, in part, associated with the improvement of cell immunity. Additionally, our results indicate that rIL-2 administration is safe and may serve as adjuvant therapy in some CVID patients with recurrent infections and poor response to IVIG treatment
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Mestre, Sandrine. "Etude biomécanique in vivo de la fonction veineuse et lymphatique normale et pathologique." Thesis, Montpellier, 2017. http://www.theses.fr/2017MONT4002.
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La prise en charge de l’insuffisance veineuse chronique (IVC) et du lymphœdème repose, traditionnellement, sur des méthodes de compression fondées sur des concepts généralement admis mais insuffisamment éprouvés. Le Projet « Phlébosthène », initié en 2010, comporte le développement et l’application d’outils d’étude biomécanique quantitative de l’œdème et des troubles fonctionnels veineux. Les études n°1 et 2 reposaient sur la volumétrie par mesures étagées de circonférence du membre supérieur chez des patientes présentant un lymphœdème. Elles ont montré la valeur prédictive des variations de volume obtenues par la phase intensive du traitement décongestif quant à l’évolution du lymphœdème à moyen terme et au risque de phénomène de rebond. L’étude n°3 a validé la volumétrie de membre par caméra laser 3D chez des sujets sains et des patients souffrant d’insuffisance veineuse chronique du membre inférieur, en comparaison à la volumétrie par déplacement d’eau, méthode de référence, avec l’avantage majeur de quantifier le volume du pied et de la main. L’étude n°4 comportait, au membre inférieur, la mesure des pressions d’interface, intraveineuse, et intramusculaire sans et avec orthèse de compression dégressive de force 2 et 3, et avec orthèse de compression progressive, au repos, lors d’une manœuvre de flexion-extension du pied en position allongée, et lors d’une manœuvre de haussement sur la pointe des pieds en position debout. L’échographie avec mesure de la force d’appui sur la sonde et analyse automatique d’image calculant l’aire veineuse permettait de déterminer la courbe force / aire d’une veine superficielle et d’une veine profonde du mollet en position allongée et debout. Nous avons inclus 57 patients souffrant d’IVC (21 au stade C1s, 18 au stade C3, et 18 au stade C5 selon la classification CEAP), et 54 sujets sains témoins (18 sédentaires, 18 actifs, 18 sportifs) appariés. Les mesures de pression intraveineuse et intramusculaire ont été réalisées chez un tiers des patients et sujets sains. Le traitement des données échographiques (1776 séquences) étant en cours, nous ne pouvons présenter que des résultats préliminaires et partiels. Les pressions d’interface évoluaient conformément aux attentes, atteignant des valeurs plus élevées sous compression de force 2 que sans compression, sous compression de force 3 que de force 2, et sous compression progressive que sous compression de force 2 ou 3. La compression progressive ne se distinguait nettement des compressions dégressives qu’au niveau du mollet et non de la cheville. Les pressions d’interface étaient généralement plus élevées, sous compression, chez les témoins et les patients au stade C5, et, à un moindre degré, au stade C3, que chez les patients au stade C1s. La pression intraveineuse variait en fonction de la posture et du mouvement et était corrélée à la taille du sujet et sa longueur de jambe en orthostatisme ainsi qu’avec le stade clinique d’IVC. La pression intramusculaire évoluait parallèlement à la compression. Les boucles force / aire veineuse montraient une hystérésis caractéristique, décrivant donc la viscoélasticité des veines examinées. L’analyse complète des résultats permettra de comparer les différentes orthèses de compression et leur effet sur la biomécanique veineuse des sujets sains et pathologiques, avec des données quantitatives sur les caractéristiques viscoélastiques des veines. Nous pourrons évaluer l’effet de l’activité physique en comparant les sujets sédentaires, actifs, et sportifs. L’objectif est, à terme, de produire un modèle mathématique permettant, à partir d’un ensemble limité de données obtenues de façon non-vulnérante, de prédire l’effet des différentes modalités de compression sur la biomécanique veineuse de façon à pouvoir déterminer, grâce à la description géométrique tridimensionnelle du membre, les paramètres individuels optimaux de compressionThe conventional treatment of chronic venous insufficiency (CVI) and lymphedema is based upon mechanical compression, relying on generally admitted but insufficiently proven concepts. The " Phlebosthene " project, initiated in 2010, involves the development and implementation of innovative tools for the quantitative biomechanical evaluation of edema and venous disorders. Studies #1 and #2 were based on the calculation of the upper limb volume by serial circumference measurements in patients with lymphedema. They demonstrated the predictive value of volume variations during the intensive phase of decongestive therapy as for the medium-term outcome and the risk of rebound phenomenon. Study #3 validated segmental limb volumetry by 3D laser scanning in healthy subjects and in patients with lower limb CVI, in comparison with water displacement (reference method), with the major advantage of quantifying the volume of the foot and toes. Study #4 included the measurement, at the lower limb, of interface, intravenous, and intramuscular pressure without and with compression stockings, comparing force 2 and force 3 graduated stockings with so-called progressive compression. Measurements were performed at rest, during flexion-extension movements of the foot while the subject was lying supine, and during a tip-toe test in the standing position. Synchronously recorded B-mode sonography with automatic image analysis allowed calculating the venous area and provided force / area curves of superficial and deep calf veins in the supine and in the standing position. We included 57 patients with CVI (21 at the C1s, 18 at the C3 and 18 at the C5 stage of CVI according to the CEAP classification), and 54 matched healthy controls (18 sedentary, 18 active, 18 sportive). Intravenous and intramuscular pressure measurements were performed in one third of patients. As the processing of the 1776 B-mode sonographic sequences is still underway, we can only offer here partial and preliminary results. Interface pressures evolved as expected, reaching higher values under graduated force 2 compression stockings than without compression, under graduated force 3 than force 2 compression, and under progressive than under graduated compression. Progressive compression clearly distinguished itself from graduated compression only at the calf but not at the ankle level. Interface pressures were generally higher, under compression, in controls and in patients with IVC at the C5 stage, and, to a lesser degree, at the C3 stage, than in patients at the C1s stage. Intravenous pressure varied with posture and movement and correlated with the subject’s size and leg length in orthostatic position, and with the CVI stage. The force / area curves of superficial and deep calf veins exhibited a characteristic hysteresis, yielding viscoelasticity information. When the database will be complete and consolidated, we will be able to compare different compression stockings and their effect on the venous biomechanics of healthy and pathological subjects, providing quantitative data on the viscoelastic characteristics of superficial and deep veins. We will also be able to assess the effect of physical activity on venous biomechanics by comparing sedentary, active, and sportive subjects. The confrontation of interface, intravenous, and intramuscular pressures with these biomechanical data will provide a mathematical model using a limited set of data obtained by simple and non-invasive measurements to predict the effect of compression stockings on the biomechanics of superficial and deep veins, in order to determine, with the help of 3D laser scanning, the optimal individual compression settings
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Varescon, Jean-Pascal Marie Dieudonné [Verfasser], Thomas O. F. [Akademischer Betreuer] Wagner, Thomas O. F. [Gutachter] Wagner, and Stefan [Gutachter] Zielen. "Comparison of surrogate parameters of prognosis (BMI, FEV1 and need of intravenous antibiotic therapy) between CF-patients with and without P. aeruginosa in Frankfurt and Moscow from 1990 to 2015 / Jean-Pascal Marie Dieudonné Varescon ; Gutachter: Thomas O. F. Wagner, Stefan Zielen ; Betreuer: Thomas O. F. Wagner." Frankfurt am Main : Universitätsbibliothek Johann Christian Senckenberg, 2021. http://d-nb.info/1239143818/34.
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Paula, Débora Holanda Gonçalves de. "Eventos adversos relacionados ao acesso intravenoso na terapia da endocardite infecciosa no Instituto Nacional de Cardiologia de 2009 a 2010." reponame:Repositório Institucional da FIOCRUZ, 2010. https://www.arca.fiocruz.br/handle/icict/5587.
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Submitted by Anderson Silva (avargas@icict.fiocruz.br) on 2012-09-27T17:08:04Z
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Instituto Nacional de Cardiologia. Rio de Janeiro, RJ, Brasil
Eventos Adversos (EAs) são complicações indesejadas que podem decorrer durante os cuidados prestados ao paciente, não atribuídas à evolução natural da doença de base, podendo resultar em seqüela, prolongando a permanência no hospital ou mesmo levar ao óbito. A utilização do acesso intravenoso no tratamento medicamentoso da endocardite infecciosa (EI) pode trazer EAs ao paciente, com riscos de desfechos desfavoráveis. O objetivo deste estudo é identificar os EAs infecciosos e não infecciosos relacionados à utilização do acesso intravenoso no tratamento da EI no Instituto Nacional de Cardiologia (INC) nos anos de 2009 e 2010. Trata-se de estudo observacional, analítico, e prospectivo, a partir do diagnóstico possível e definitivo para EI, pelos critérios de Duke modificados, através do preenchimento de instrumentos de coleta de dados adaptados de outros estudos primários [International Collaboration on Endocarditis (ICE) e de um estudo piloto de terapia intravenosa (INC)] dos acessos intravenosos [periférico, profundo, hemodiálise, e catéter central de inserção periférica (PICC)]. Foram incluídos 37 episódios de EI, que ocorreram em 35 pacientes. A idade média foi 44,32 ± 15,32 anos; sendo 22 (63%) pacientes do sexo masculino e 13 (37%) do sexo feminino. A amostra estudada totalizou 253 acessos intravenosos sendo 148 acessos periféricos, 85 acessos intravenosos (21 de hemodiálise) profundos de curta permanência não tunelizado (CVP), e 20 cateteres centrais de inserção periférica (PICC). “Hiperemia” e “infiltração” foram os eventos mais frequentes nos acessos periféricos; “febre” foi o evento mais frequente nos acessos profundos; “obstrução” e “exteriorização” mais frequente no PICC. A análise estatística relacionando os EAs com cada tipo de acesso intravenoso mostrou significância estatística para febre (p<0,005), bacteremia (p<0,05), saída acidental e exteriorização (p<0,001), e obstrução (p<0,001). Com relação ao tempo de permanência dos cateteres, o número de cateteres-dia foi 360 para periféricos, 1156 para CVP e 420 para PICC. A construção de curvas de Kaplan Meyer para CVP e PICC mostrou diferença estatística para obstrução (p<0,001) e manuseio (saída acidental, mais exteriorização mais obstrução, p<0,001), sendo estes eventos mais comuns na PICC. Houve mais bacteremias no CVP, mas sem diferença estatística (p=0,23). Observa-se que os eventos descritos decorrem do manuseio inadequado e de possíveis falhas nas técnicas assépticas. Deste modo, é necessário implementação mais rigorosa de medidas efetivas de controle de infecções relacionadas a acessos e ações educativas para evitar complicações mecânicas.
Adverse events (AEs) are undesirable complications that may occur during patient care that cannot be attributed to the natural history of the underlying disease. They may result in incapacity, lengthening of hospital stay or even death. The use of intravenous access in the medical treatment of infective Endocarditis (IE) may result in AE to the patient, with unfavorable outcomes. The goal of the present study was to identify the infectious and non-infectious AEs related to the use of intravenous access sites for IE treatment at national Institute of Cardiology (INC) in the years from 2009 to 2010. This is an observational, analytic and prospective study based on cases of IE diagnosed as possible or definite by the modified Duke criteria. A case report form was created for data collection on intravenous lines (peripheral, central vascular, haemodyalisis and peripherally inserted central catheter/ PICC), based on data collection forms from other primary studies[International Collaboration on Endocarditis (ICE), and a pilot study on intravenous therapy (INC)].Thirty-seven episodes of IE in 35 patients were studied. Patients’ mean age was 44.32 ± 15.2 years; 22 patients (63%) were male, and 13 (37%) female. A total of 253 vascular catheters were studied, 148 were peripheral catheters, 85 were short term, non tunneled central venous catheters (21 of which were for haemodyalisis) and 20 were PICC. “Erythema” and “infiltration” were the most frequently observed AEs in the peripheral catheters, while “fever” was the most frequent AEs for CVPs, and “obstruction”, and “externalization” were more frequent in PICCs. Statistical analysis relating AEs with venous catheters type showed significance for fever (p<0.005), bacteraemia (p<0.05), accidental extrusion and externalization (p<0.001), and obstruction (p<0.001). As to the time catheters remained, the number of catheter-days was 360 for peripheral catheters, 1,156 for CVP and 420 for PICC. Kaplan Meyer curves for CVP and PICC showed statistical difference for obstruction (p<0.001) and “manipulation” (accidental extrusion, externalization, and obstruction, p<0.001), and these events were more common in PICC. More bacteraemia occurred in CVP, but this was of no statistical significance (p=0.23). The described adverse events resulted from inadequate handling and breakdown in aseptic techniques. Therefore, it is important that stricter implementation of infection control measures to prevent catheter related infections and educational measures to minimize mechanical complications are implemented.
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Fornaguera, Puigvert Cristina. "Development of multifunctional polymeric nanoparticles by nano-emulsion templating as advanced nanocarriers targeting the blood-brain barrier." Doctoral thesis, Universitat de Barcelona, 2015. http://hdl.handle.net/10803/285368.
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Multifunctional polymeric nanoparticles (NP) represent a promising alternative for the treatment of neurodegenerative diseases using the intravenous route (i.v.). In current treatments, the effects of the intravenously injected drugs are systemic, requiring high drug doses to achieve therapeutic effects, thus causing severe side effects. NP can act specifically in a tissue provided that they are properly designed. An interesting approach is the preparation of NPs by nano-emulsion templating. Nano-emulsions (NE) are fine emulsions, with droplet sizes typically between 20 – 200nm. They can be prepared by the phase inversion composition (PIC) method, a low-energy emulsification method appropriate for pharmaceutical applications, since it can be performed at mild process conditions. Nanoparticles are obtained from nano-emulsions by solvent evaporation. To target the central nervous system (CNS), a specific targeting moiety on the nanoparticle surface is required to cross the blood-brain barrier (BBB), which is a current key goal under intense investigations. The aim of this work was to obtain multifunctional polymeric NP as advanced delivery systems able to cross the BBB. O/W polymeric NE were prepared by the PIC method and polymeric NPs were obtained by solvent evaporation. Polymeric NP with appropriate sizes for the i.v. administration (<1milimicron) were obtained. With the aim to design imaging systems, a model fluorescent dye and magnetic nanoparticles were encapsulated in polymeric NPs. An analgesic and an antiapoptotic drugs were also encapsulated into PLGA NP for therapeutic purposes. High encapsulation efficiencies were found for all tested compounds, attributed to the method of nanoparticle preparation as well as to low solubility of the components in the aqueous dispersion media. In addition, a sustained and controlled release of fluorescent dyes / drugs was achieved. NP surface was functionalized using various elements. On the one hand, it was functionalized with a monoclonal antibody against the transferring receptor, overexpressed in the BBB, to achieve an active targeting to the BBB. On the other hand, NPs were functionalized with oligonucleotides, to be used as non-viral gene delivery systems. Firstly, carbosilane cationic dendrons were covalently attached to nanoparticle surface to achieve a cationic surface. In a further step, antisense oligonucleotides, siRNA and plasmids were electrostatically bound to cationized nanoparticles. In vitro tests showed that the formulated NP did produce neither cytoxicity nor hemolysis. In addition, they were weak activators of the immune system and produced only a slight adsorption of blood proteins. Therefore, they are appropriate to be used by the i.v. route. NPs functionalized with oligonucleotides enhanced gene transfection in cell cultures, up to values comparable to those of commercial values (up to 90%). These NPs are advantageous in terms of toxicity issues over the commercial formulations. Therefore, they represent promising non-viral gene delivery systems. In vivo tests, which measured the central analgesia produced by an encapsulated drug into nanoparticles (loperamide) that is not able to cross the BBB, confirmed a central analgesic effect, reaching a potency of analgesia comparable to positive controls when nanoparticles were functionalized with the antibody. Therefore, the antibody functionalized nanoparticles efficiently crossed the BBB. In conclusion, the designed polymeric nanoparticles, functionalized with the antitransferrin receptor antibody, are able to cross the BBB with high efficiency. These nanoparticles represent promising nanosystems to deliver actives to the central nervous system.Les nanopartícules polimèriques multifuncionals (NPs) representen una alternativa prometedora pel tractament de malalties neurodegeneratives, a través de l’administració intravenosa (i.v.), ja que els tractaments actuals provoquen molts efectes secundaris. Les NPs, en canvi, si estan correctament dissenyades, poden actuar específicament en el teixit diana. Ja que l’òrgan diana és el cervell, és necessari un element de vectorització per poder creuar la barrera hemato-encefàlica (BBB). En aquest context, l’objectiu de la present tesi és l’obtenció de NPs com a sistemes avançats d’alliberament de principis actius que travessin la BBB. Es van obtenir NPs a partir de nano-emulsions (NE) plantilla, emprant l’àcid poli-(làctic-co-glicòlic) com a polímer i el mètode d’inversió de fases a temperatura constant per emulsionar, seguit d’evaporació de solvent per obtenir NPs. Les NPs obtingudes tenen mides apropiades per l’administració i.v.. Es va aconseguir encapsular un fluorescent i NPs magnètiques dins les NPs polimèriques, per fer-les servir com a sistemes d’imatge. També es van encapsular fàrmacs per usar-les com a sistemes terapèutics. En tots els casos, es van aconseguir eficiències d’encapsulació molt elevades i un alliberament del fàrmac controlat i prolongat en el temps. A més, es va aconseguir funcionalitzar la superfície de les NPs amb diferents elements. Es van unir covalentment dendrons catiònics per posteriorment unir oligonucleòtids electrostàticament. També es va afegir una coberta exterior de polietilenglicol per protegir el material genètic. Per altra banda, es va funcionalitzar la superfície de les NPs amb un anticòs específic contra el receptor de la transferrina, sobreexpressat a la BBB. A continuació, es van fer assajos in vitro, que van posar de manifest que les NPs no són citotòxiques ni hemolítiques. També es va estudiar l’eficiència de transfecció cel•lular del material genètic, arribant a eficiències de transfecció equivalents a les dels vectors comercials. Assajos in vivo van permetre confirmar el pas a través de la BBB, sobretot de les NPs funcionalitzades amb l’anticòs. Els resultats obtinguts permeten concloure que s’ha aconseguit dissenyar noves NPs polimèriques a partir de NE, apropiades per l’administració i.v. i amb capacitat de travessar la BBB.
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Wu, Chun-Yu, and 吳峻宇. "Intravenous Fluid Therapy for Surgical Conditions: From Bench to Bedside." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/83evca.
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博士國立臺灣師範大學
生命科學系
105
Intravenous fluid therapy is considered the first-line drug treatment for hypovolemia, which is common in surgical patients. Appropriate intravenous fluid therapy comprises three aspects: the correct type of fluid, correct timing of fluid infusion, and correct amount of fluid infusion. If even one of these aspects is not achieved, intravenous fluid infusion may become injurious instead of being therapeutic. The aim of intravenous infusion therapy is to improve circulation during hypovolemia or hemorrhaging. Recent studies have demonstrated that microcirculatory (blood vessels <100 µm in diameter) improvement is more strongly associated with favorable outcomes than are traditional macrocirculatory indicators (e.g., mean arterial pressure and heart rate). Splanchnic microcirculatory impairment during hypovolemia may not only vary among organs (e.g., the liver, kidneys, and intestine) but is also associated with the development of multiple organ dysfunction syndrome. Only those fluid infusion therapies that improve splanchnic microcirculation can actually prevent irreversible organ damage during resuscitation from hypovolemic shock. Therefore, the first part of the first section of this dissertation addresses the development of a method for the real-time simultaneous observation of splanchnic microcirculatory changes during hemorrhagic shock by using laser speckle contrast imaging and tissue oxygen saturation in a rat model. We found that although the tissue oxygen saturation decreased homogeneously in multiple splanchnic organs, the microcirculatory blood flow was more vulnerable to hemorrhaging in the intestinal mucosa than in the liver, kidneys, and skeletal muscles. In the second part of the first section of this dissertation, we describe an exploration of the microcirculatory therapeutic effects of several common clinical intravenous fluid products, including crystalloid solutions (e.g., 0.9% saline), colloidal solutions (e.g., starch and gelatin products), and hypertonic solutions (e.g., 3% saline) during resuscitation from hemorrhagic shock. The use of different types of resuscitation fluids not only may result in variations in the extent of microcirculatory improvement but may also be associated with varying degrees of ischemia-reperfusion injury, expressed as oxidative stress. Among the abdominal organs, the kidneys are the most vulnerable to ischemia-reperfusion injury. In the clinical scenario, resuscitation from shock in critically ill patients by using colloidal fluids is associated with an increased risk of acute renal injury after treatment. This phenomenon is closely related to ischemia-reperfusion injury and oxidative stress. Because the products of oxidative stress have a very short half-life, we used an in vivo method to accurately quantitatively measure the amount of renal reactive oxygen species in rats during fluid resuscitation from hemorrhagic shock. We found that fluid resuscitation with a crystalloid solution could not restore microcirculatory blood flow in the intestinal mucosa. Instead, only colloidal and hypertonic solutions improved the microcirculatory blood flow in the intestinal mucosa. However, colloidal solutions, including starch and gelatin products, produce a considerably larger amount of renal reactive oxygen species than do crystalloid and hypertonic solutions. This phenomenon may be associated with acute renal injury after colloidal fluid resuscitation, as reported in the clinical literature. In the first section of this dissertation, we conclude that the microcirculatory blood flow in the intestinal mucosa is most vulnerable to hemorrhagic shock. Furthermore, both colloidal and hypertonic solutions can restore the intestinal microcirculatory blood flow during hemorrhagic shock. However, fluid resuscitation with colloidal solutions may result in significant ischemic-reperfusion injury, which is indicated by the production of a large number of renal reactive oxygen species. The accurate determination of the time for administering an intravenous infusion is clinically challenging. At present, the most precise indicators of the time for administering fluid infusion may be dynamic fluid responsiveness parameters. These indicators reflect the interaction between the heart and lungs during mechanical ventilation. The lower the blood volume, the greater the variations in hemodynamic parameters during the respiratory cycle are. Therefore, when the dynamic fluid responsiveness parameters are higher than their threshold values, a fluid challenge is likely to considerably increase the cardiac output (this phenomenon is called “fluid responsiveness”), thereby improving the circulation. However, the threshold values of the dynamic fluid responsiveness parameters are based on patients with normal vascular tones. Certain patient groups are characterized by an abnormal vascular tone, for instance, patients with live cirrhosis have reduced vascular resistance because vasodilation-inducing substances cannot be metabolized as a result of end-stage liver disease. In the second section of this dissertation, we describe an investigation on the accuracy of three dynamic fluid responsiveness parameters, namely pulse pressure variation, stroke volume variation, and the plethysmographic variability index, in patients with liver cirrhosis. We found that although these three indicators were less accurate for predicting fluid responsiveness in common surgical patients, they were sufficiently precise to predict fluid responsiveness in patients with liver cirrhosis. Therefore, clinicians can determine the correct time for fluid administration to patients with liver cirrhosis using these indicators. In the final section of this dissertation, we clarify how to determine the correct amount of intravenous fluid for infusion, particularly with regard to vital organs. If a vital organ does not have the risk of ischemia and although intravenous infusion can improve cardiac output, excessive fluid infusion may lead to tissue edema and injury. For brain surgery, such a clinical judgment is challenging because the brain tissue has high metabolic and perfusion demands, particularly during surgery. However, excessive fluid infusion may also result in brain edema, poor outcomes, and neuronal injury. Dynamic fluid responsiveness parameters are characterized with a “gray zone.” In this interval, the lower and upper limit cutoffs respectively represent a high specificity and high sensitivity of fluid responsiveness. In an intraoperative fluid strategy targeting the upper cutoff of the gray zone, the fluid challenge highly specifically increases cardiac output without the risk of tissue edema, but the sensitivity is low; hence, a restrictive fluid balance may exist. By contrast, in a fluid strategy targeting the lower cutoff of the gray zone, a higher intraoperative cardiac output may be achieved after the fluid challenge, but the risk of tissue edema simultaneously increases. With regard to brain surgery, we investigated whether different amounts of fluid infused during intraoperative fluid challenges favored the upper or lower cutoffs in the gray zone. The results revealed that patients receiving a fluid strategy targeting the lower cutoff of the gray zone had a shorter intensive care unit stay, fewer postoperative neurological events, a superior discharge functional status, less intraoperative lactate accumulation, and lower postoperative serum neuronal injury protein expression than did patients receiving a fluid strategy targeting the upper cutoff of the gray zone. We confirmed that for patients undergoing brain surgery, the intraoperative fluid strategy should aim to maintain and increase cardiac output as much as possible. The importance of intravenous fluid therapy to surgical conditions is being increasingly emphasized in modern medicine. In summary, we investigated the pathological microcirculatory changes in multiple splanchnic organs during hemorrhagic shock in a rat model and confirmed the therapeutic effects of hypertonic saline and colloidal solutions on the restoration of intestinal mucosal microcirculatory blood flow. In addition, in vivo induction of renal reactive oxygen species by colloid solutions is reported for the first time, and this phenomenon may be associated with acute kidney injury in critically ill patients after fluid resuscitation with colloidal solutions. For further clinical applications, we observed that dynamic fluid responsiveness parameters enable clinicians to accurately determine the timing of fluid infusion not only for general surgical patients but also for patients with liver cirrhosis with altered vascular tones. Finally, we confirmed that an intraoperative fluid strategy targeting the elevation of cardiac output may be more beneficial than a restrictive strategy to patients undergoing brain tumor resection surgery. As long as the fluid therapy is based on the concept of administering the correct type of fluid at the correct time and in the correct amount, opportunities to further improve the clinical care of surgical patients are numerous. Our research begins from this perspective, and we would like to further investigate fluid therapy. Key words: splanchnic microcirculation、colloid solution、hypertonic solution、oxidative stress、liver cirrhosis、dynamic fluid responsiveness parameter、brain surgery
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Rocheleau, Danielle. "Reduction in maternal autoantibodies with intravenous immunoglobulin therapy during pregnancy." Thesis, 2019. https://hdl.handle.net/2144/38679.
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The prevalence of autoimmune lupus has increased with the onset of disease typically occurring during the women’s reproductive years. As a result, many women are experiencing obstetric complications associated with lupus, including neonatal lupus (NL) syndrome. In particular, pregnant women who have elevated anti-Ro/SSA antibodies carry an increased risk of developing NL syndrome with the most serious complication being congenital complete heard block (CHB). Currently, there is no effective treatment for CHB and affected children often require cardiac pacemakers if they survive past delivery.
Recent studies have shown an association between the concentration of anti-Ro/SSA antibodies and risk of fetal cardiac damage in NL. While the exact etiology of CHB is unknown, a therapeutic intervention aimed at reducing the concentration of these pathogenic antibodies may prevent the progression of cardiac NL in high risk pregnancies.
This proposal is a pilot, double-blind, placebo-controlled randomized study assessing the effect of IVIG therapy on the change in concentration of maternal autoantibodies throughout pregnancy. Secondary outcomes will include 2nd and 3rd degree CHB. This study could potentially add to current evidence supporting the use of IVIG therapy in anti-Ro/SSA positive mothers to prevent the development of cardiac NL. If efficacious, it would also provide clinicians a safe and cost-effective option for women at risk of delivering a child with CHB.
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Smith, Cameron Reid. "Intravenous administration of perfluorocarbon emulsions as a non-recompression therapy for decompression sickness /." 2008. http://hdl.handle.net/10156/2220.
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Chang, Hsiao-Wei, and 張曉維. "Outcomes of adjunctive aerosolized aminoglycosides in intravenous antibiotics therapy for Pseudomonas aeruginosa pneumonia." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/te654w.
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碩士高雄醫學大學
藥學系碩士在職專班
103
Background: It is common that pneumonia of the ICU in Taiwan is caused by Pseudomonas aeruginosa. Due to the abuse of antibiotic prescription, the resistance of Pseudomonas aeruginosa is increasing. The previous study shows that when treating pulmonary infection, inhaled antibiotics yields higher pulmonary concentrations than intravenous administration. Whether the follow up efficacy also increased with the higher pulmonary antibiotic concentration is yet to be proven by evidence. Study design, location and subjects: This study was conducted south of a regional teaching hospital for the single-center, retrospective study of medical records. The study objects are those age between 20 and 99 years old, infected with Pseudomonas aeruginosa pneumonia in ICU and confirmed by bacterial culture from January 1st 2010 to December 31th 2013. Based on treatment methods, patients are divided into two groups, one is given antibiotics by intravenous route only and the other group is given intravenous and inhaled antibiotics in combination. Methods: All patients’ basic information and clinical data are collected by chart review. Clinical data are divided by timeline and recorded days of patients’ ICU stay, days of ventilation patient use, improvement of clinical symptoms of pneumonia and the incidence of drug-resistant bacteria, etc. Use Acute Physiology and Chronic Health Evaluation Score and Clinical Pulmonary Infection Score as assessment tool. The endpoint is mortality of 30 days after infection and all data undergo statistical analysis and comparison. Statistical analysis includes chi-square test (χ2 test), T test (t-test), and Fisher exact test (Fisher''s exact test). Results: During the study period from January 1st 2010 to December 31th 2013, a total of 67 patients were included, 44 of them used monotherapy (intravenous antibiotics alone) and 23 of then used combination therapy(intravenous and inhaled antibiotics). The patients information showed that the average age was 76.5 years old(standard deviation 13.9), male to female ratio was 71.6% to 28.4%. In comparison between the two group, other than male percentage in monotherapy group (p-0.047), there were no significant differences between the two group before treatment in age, Acute Physiology and Chronic Health Evaluation score, Clinical Pulmonary Infection Score, renal function, other infection site. More than 80 percent of patients'' age in both groups were over 60. After treatment, there were no significant difference in days of ICU stays (p= 0.452), days or ventilator use (p= 0.061), days of intravenous injection of antibiotics(p= 0.066), Acute Physiology and Chronic Health Evaluation score (p= 0.589), difference of Clinical Pulmonary Infection Scale before and after treatment (p= 0.078), ratio of elevated creatinine value more than 1(p= 0.523), re-cultured Pseudomonas aeruginosa (p= 0.46), cultured drug-resistance Pseudomonas aeruginosa(p= 0.603), or 30-day mortality(p= 0.308). Conclusions: In comparison of monotherapy with combination therapy, the latter posed no effect on renal function but yielded not significantly difference regarding symptoms of pneumonia, days of intravenous injection, days of ICU stays, Acute Physiology and Chronic Health Evaluation score when leaving ICU, re-infected rate of Pseudomonas aeruginosa, or drug resistance strains. Due to our study was a chart review retrospective one, there were more limitation comparing to prospective study with respect to strict protocol. Therefore our study was not representative of the entire patient populations. To clear all predictive variables, the best method was still prospective trials available to control various of confounding factors.
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Figueiredo, Carlyn. "Interleukin-11 is a Key Mediator of Intravenous Immunoglobulin Therapy in Experimental Autoimmune Encephalomyelitis." Thesis, 2013. http://hdl.handle.net/1807/42837.
Full textAbstract:
Intravenous immunoglobulin (IVIg) has been used to treat a variety of autoimmune disorders including multiple sclerosis (MS); however, its mechanism of action remains elusive. Our results demonstrate a novel finding wherein IVIg treatment induces a dramatic surge (>1000-fold increase) in the levels of IL-11 in the circulation and that the liver is the organ of increased IL-11 transcription. Furthermore, we show that IL-11Rα knockout mice, although initially protected, become resistant to protection by IVIg during experimental autoimmune encephalomyelitis (EAE) and develop disease with a similar incidence and severity as control-treated IL-11Rα-/- mice. The inability of IVIg to prevent EAE in IL-11Rα-/- mice correlated with a failure of this agent to decrease IL-17 production by myelin-reactive T-cells in the draining lymph nodes. Finally, we show that IL-11 can directly inhibit IL-17 production by lymph node cells in culture. Together, these results implicate IL-11 as an important immune effector of IVIg in the amelioration of EAE.
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Tu, An-Hsiu, and 杜安琇. "Early Switch from Intravenous to Oral Antibiotic Therapy in Hospitalized Adults with Uncomplicated Acute Pyelonephritis." Thesis, 2005. http://ndltd.ncl.edu.tw/handle/00712750620547416936.
Full textAbstract:
碩士國立成功大學
臨床藥學研究所
93
BACKGROUND: Antimicrobials make up an important part of hospitalization cost. As healthcare resources remain limited, cost-containment maneuver becomes attractive. Timely switch or sequential from initial intravenous to subsequent oral antibiotic treatment is better tolerated, and results in comparable efficacy and may reduce healthcare cost. However, few studies of early switch therapy focus on acute pyelonephritis. OBJECTIVE: To determine whether early switch from intravenous to oral antibiotic therapy in hospitalized patients with uncomplicated acute pyelonephritis could provide equivalent clinical efficacy, while reducing length of stay and cost. METHODS: Adult patients with discharge diagnosis of acute pyelonephritis admitted to National Cheng-Kung University Hospital between January 2003 and December 2004 were eligible for this retrospective cohort study. Enrolled patients were those with fever, flank pain and pyuria, and without any complicating factors. These patients were categorized according to if the time of switch to oral antibiotic were within 48 hours after afebrile. The primary outcomes were cure rate and recurrence rate. The secondary outcomes were length of stay and cost. RESULTS: Of the 40 patients enrolled, 22 were in the early switch group and 18 in the late switch group. No significant difference was found in clinical cure rate (73% vs. 72%, P > 0.95) and 3-month recurrence rate (5% vs. 11%, P = 0.579) between the two groups. The duration of intravenous therapy were shorter in the early switch group (79.0 hours vs. 105.5 hours, P = 0.032), and they were discharged earlier (4.5 days vs. 6.0 days, P = 0.006). Hospitalization cost was higher in the late switch group (NT$12,301 vs. NT$14,674 P = 0.025). Total antibiotic cost was lower in the early switch group, but the difference was not significant (NT$2,153 vs. NT$3,454, P = 0.221). CONCLUSIONS: Timely switch strategy resulted in reduction of the duration of intravenous antibiotic therapy, length of stay, and hospitalization cost, without compromising clinical outcomes in hospitalized patients with uncomplicated acute pyelonephritis.
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He, Shien-Chin, and 何憲欽. "The cost effect of thrombolytic therapy for ischemic stroke using intravenous rt-PA in Taiwan." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/38281717740669279864.
Full textAbstract:
碩士長榮大學
醫務管理學系碩士班
99
Objective: Thrombolytic agent - recombinant tissue plasminogen activator (rt-PA) has been shown to improve the treatment outcome of ischemic stroke. 80% of the type of stroke is ischemic in Taiwan, therefore, the effective application of rt-PA should be able to reduce the consumption of follow-up health care costs, providing benefits for both personal and national medical resources. This study is to assess the effectiveness of the interventional therapy of rt-PA for ischemic stroke. Materials and methods: The sampling archive of million populations from the 2005 National Health Insurance Research Database was used. The patients with ischemic stroke from 2005 to 2008 for the first time were selected as the study subjects, which were divided into two groups of receiving treatment with rt-PA and non-receiving treatment with rt-PA. The number of rt-PA treatment was 23, and the number of non-rt-PA treatment was 1035. Patients in the non-rt-PA treatment group were controlled based on age, gender, triage, rt-PA contraindications, while 44 paired patients were established. The treatment outcomes and medical expenses, including survival, re-stroke rate, complications, degree of disability, one year follow-up medical care utilization, rehabilitation care costs, impact on employment were compared in the two groups. Moreover, the effects of hospital and physician factors on rt-PA treatment were investigated. Results: The rt-PA treatment rate was 2.1%, and the rt-PA treatment proportion for patients with emergency stroke who were entered into the cerebral stroke registry system from 2006 to 2008 was 1.5%. For the treatment outcomes, the mortality within 30 days (0.0%) and one year (0.0%), the re-stroke rate within six months to one year in the rt-PA group were better than in the non-rt-PA group. The proportion of complications during hospitalization was the same in rt-PA group with in the non-rt-PA group (31.8%), but the numbers and types of complications in the rt-PA group were less than in the rt-PA group. For the disability after discharge, the proportion using the middle to severe rehabilitation in 40.9% of patients of the rt-PA group was less than in non-rt-PA group, but the proportion of three was higher than in the non-rt-PA group. The cost analysis found that the total number of days of hospitalization for this time of 19.4 days (SD = 13.2) in the rt-PA treatment group was longer than 14.5 days (SD = 10.5) in the non-rt-PA group due to the longer ICU days in the rt-PA group. With the highest of ward fees, medicine fees in the cost structure, the 139,011.2 yuan of hospital costs in the rt-PA group was higher than 85,653.4 yuan in the non-rt-PA group, and there was significant difference in the rt-PA group. There was no significant difference in rehabilitation costs. The rt-PA treatment can save 4.47QALY, and only 4.29 QALY for non-rt-PA treatment. In addition, the QALY costs were lower in the rt-PA group, and the QALY costs were respectively 100,834.3 yuan / QALY and 138,605.7 yuan / QALY. Moreover, it was shown that the local hospitals and the physicians with the more qualifications used a higher proportion of rt-PA treatment. In the regression model, the greatest influencing factors of rt-PA treatment were the hospital grade, years of physician, and patient gender. For the mortality, re-stroke rate, and complications, the rt-PA treatment and age had the greatest impacts. For days of hospitalization, the patient age was the greatest influencing factor, and was significant. Conclusion: Under the long-term observation, rt-PA has a good effectiveness for the status of disability, and can achieve a higher QALY. The effect of reducing the re-stroke rate can also save indirectly social and economic costs caused by stroke. However, for the health care providers and during the stroke, it may be required to pay a higher cost of medical and care.
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Kaufmann, Anthony Michael. "Intravenous mannitol therapy in a vasogenic cerebral edema model : quantitative measurements of tissue concentrations and effect." 1996. http://hdl.handle.net/1993/19251.
Full text
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"Photodynamic therapy (PDT) in malignant glioma: is intra-tumoural injection of the photosensitizer by stereotactic technique superior to conventional intravenous administration?" Chinese University of Hong Kong, 1996. http://library.cuhk.edu.hk/record=b5888749.
Full textAbstract:
Chan Yung.Publication date from spine.
Thesis (M.Phil.)--Chinese University of Hong Kong, 1995.
Includes bibliographical references (leaves 80-95).
Acknowledgement --- p.3
Abstract --- p.4
Chapter Chapter 1 --- Introduction --- p.7
Chapter "1,1" --- Current status in treatment of gliomas --- p.7
Chapter 1.1.1 --- Surgery of gliomas --- p.7
Chapter 1.1.2 --- Radiation therapy of gliomas --- p.9
Chapter 1.1.3 --- Chemotherapy for gliomas --- p.10
Chapter 1.1.4 --- New modalities --- p.11
Chapter 1.2 --- Basic principle of photodynamic therapy --- p.13
Chapter 1.2.1 --- Photosensitizer --- p.13
Chapter 1.2.2 --- Photosensitising effect of HpD --- p.13
Chapter 1.2.3 --- Mechanism of selectivity in PDT --- p.15
Chapter 1.2.4 --- Selective localization and the blood brain barrier --- p.16
Chapter 1.2.5 --- Cytotoxic effect of PDT --- p.18
Chapter 1.2.6 --- PDT on normal brain --- p.19
Chapter 1.3 --- Photodynamic therapy in clinical neurosurgery --- p.21
Chapter 1.4 --- The aims of the study --- p.26
Chapter Chapter 2 --- Materials and methods --- p.28
Chapter 2.1 --- Patient population --- p.28
Chapter 2.2 --- Photosensitizer --- p.28
Chapter 2.3 --- Administration of HpD --- p.29
Chapter 2.4 --- Measurement of HpD --- p.30
Chapter 2.5 --- Fluorescence microscopic examination --- p.32
Chapter 2.6 --- Confocal laser scanning microscopic examination --- p.33
Chapter Chapter 3 --- Results --- p.38
Chapter 3.1 --- HpD measurement --- p.38
Chapter 3.2 --- Fluorescence microscope examination --- p.40
Chapter 3.3 --- Confocal laser scanning microscope (CLSM) examination --- p.41
Chapter Chapter 4 --- Discussion --- p.56
Chapter 4.1 --- Quantifying HpD level --- p.58
Chapter 4.2 --- Quantifying HpD in the intravenous administration group --- p.59
Chapter 4.3 --- Quantifying HpD in the intratumoural injection group --- p.63
Chapter 4.4 --- Flourescence microscopic study of HpD distribution of malignant gliomas --- p.67
Chapter 4.5 --- Confocal laser scanning microscopy (CLSM) study of HpD localization of malignant gliomas --- p.72
Chapter 4.6 --- Conclusion --- p.74
Chapter Chapter 5 --- Summary --- p.76
Chapter Chapter 6 --- References --- p.80
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Huang, JingChuen, and 黃靖淳. "Impact of intravenous omeprazole on Helicobacter pylori eradication by triple therapy in patients with peptic ulcer bleeding." Thesis, 2000. http://ndltd.ncl.edu.tw/handle/31849992531908377592.
Full textAbstract:
碩士國立成功大學
臨床藥學研究所
88
Background Bleeding is a common but serious complication of peptic ulcer disease. The lethality of the first ulcer bleeding is 0.5-4 %, and an increase of 16-29 % has been observed in cases of rebleeding. There are two options to diminish the rebleeding risk of ulcer: the first, medical prevention with omeprazole, H2-antagonists, and antacid use; the second, prophylaxis of recurrent bleeding episodes by H. pylori eradication. However, there is still a lack of therapeutic options for H. pylori infection during acute ulcer bleeding, which could be started with intravenous route immediately after endoscopic diagnosis. Objective This prospective trial aimed to investigate the impact of intravenous omeprazole on H. pylori eradication by triple therapy in patients with peptic ulcer bleeding. Methods Fifty-eight UGI bleeding patients with H. pylori infection, proven by positive histology and CLO test, were randomized into two therapeutic groups, the Omeprazole and Ranitidine groups. In omeprazole group, each patient received a 3-day course of intravenous omeprazole (80 mg loading then 40 mg q12h), after that, plus 7-day triple therapy (Amoxicillin 1 g, Omeprazole 20 mg, and Clarithromycin 500 mg b.i.d). In Ranitidine group, each patient followed the protocol as that for Omeprazole group, except the 3-day intravenous course of omeprazole was replaced by ranitidine (50 mg q8h). Four to six weeks after the completion of triple therapy, 13C-urea breath test (UBT) was performed in each patient to evaluate the success of H. pylori eradication. The endoscopic appearance of stigmata of recent hemorrhage (SRH) and the bleeding severity of each patient were both reviewed. Results There were no significant difference between the H. pylori eradication rate as 95.2 % (20/21, PP analysis) for Omeprazole group and 77.4 % (24/31) for Ranitidine group (p = 0.12.). In contrast to patients with gastric ulcer patients, the eradication rate between the two subgroups of duodenal ulcer patients had a wider difference (Omeprazole vs. Ranitidine group: 91.7 % vs. 73.68 %). The endoscopic features of the ulcer (SRH), predictive to the risk of recurrent bleeding, showed significant difference between two groups (Omeprazole vs. Ranitidine group: 16/24 vs. 4/34, p < 0.001). However, over a one-month follow-up period, the rebleeding rates of these two groups were not significantly different. Conclusions Omeprazole can reduce the rebleeding risk obviously, especially SRH major subgroup. Moreover, intravenous omeprazole, as well as ranitidine, has no negative impact on the H. pylori eradication, and suggests that it may enhance the eradication rate of patients with duodenal ulcers.
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Lin, En-Zu, and 林恩如. "The Effect of Intravenous Thrombolytic Therapy on Ischemic Stroke with the Intervention of Case Management Care Model." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/qc658n.
Full textAbstract:
碩士中國醫藥大學
醫務管理學系碩士班
102
Objective: Stroke stands the third among the top ten leading causes of death and in causing disabilities. It’s a heavy burden to a family and social medical expenses. Facing the fast-changing medical care environment, case management care model has become an indispensable tool of promoting the care quality and controlling medical treatment cost. This research wanted to investigate the effect of using the intervention of Case Management Care Model and the “Breakthrough Series System” of quality control in intravenous thrombolytic therapy in order to promote the quality and effect of stroke care and the recovery degree after hospital discharge. Methods: The resources are from the “Stroke Registered Database” of years 2007~2013 of a certain medical center, Study samples are ICD-9-CM 433 to 437 stroke patients receiving intravenous thrombolytic therapy. Investigating the intervention of Case Management Care Model on these patients since 2010, and analyzing the reasons of delaying the intravenous thrombolytic therapy before and after this care model, and the communication and negotiation with other divisions to make an improvement plan in order to use the “Breakthrough Series System” to supervise the intravenous thrombolytic therapy and continue to evaluate it. Results: From 2007 to 2009, before the intervention of “Case Management Care Model”, there were 66 patients who received intravenous thrombolytic therapy. Their average age 63.5 years old, among them 69.7% were male. From 2010 to 2013, after the intervention, the patients received the therapy were 139, their average age was 62.9 years old, and 66.2% were male. Among them, the comorbidities of diabetes was 27.3% and 42.6% respectively, and the dyslipidemia was 41.5% and 59.0% respectively, both have reached a significant difference. The effects of intravenous thrombolytic therapy: ≤15minutes from the arrival time to the received neurologists was 68.2% and 87.1% respectively; ≤25minutes to the time of receiving CT-Scan was 56.1% and 85.6% respectively; ≤60minutes to the time of receiving intravenous thrombolytic therapy was 28.8% and 60.4%respectively; all have reached the significant differences. The improvemenet grades after discharge (NIHSS Scale) were 5.83 points and 5.47 points, the whole disability degree was mostly moderate to severe ( mRS Scale: 3~5ponits), and the death at discharge (6 points) were 7.58% and 3.60 % respectively, There was a declining tendency , but not significant. Conclusion: The use of “Case Management Care Model” during the procedure of “Intravenous Thrombolytic Therapy” accompanied a long term supervision and evaluation with the” Breakthrough Series System “(BTS) can promote the rate of receiving intravenous thrombolytic therapy, reach the standard time of every treatment, reduce the death rate when discharge and decline the delay rate of treatment procedure.
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Cheng-YangHsieh and 謝鎮陽. "Safety and Effectiveness of Intravenous Thrombolytic Therapy for Acute Ischemic Stroke Patients with Renal Dysfunction in Taiwan." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/79964558346532971440.
Full textAbstract:
博士國立成功大學
臨床藥學與藥物科技研究所
103
Background: Stroke is the third leading cause of death and first leading cause of adult disability, while acute ischemic stroke (AIS) is the most common type of stroke in Taiwan. Intravenous thrombolytic therapy with recombinant tissue-type plasminogen activator (rtPA) is currently the only approved effective treatment for AIS worldwide. Partly due to concern of the devastating symptomatic intracranial hemorrhage (SICH), rtPA is underutilized in Taiwanese AIS patients. However, the exact utilization pattern has not been determined. Furthermore, renal dysfunction, a common comorbidity of stroke patients, might be associated with SICH after treatment with rtPA in AIS patients. However, such association is controversial and increases the uncertainty when deciding rtPA treatment. Objective: We aimed to determine the real utilization rate, and factors predicting utilization of rtPA in all Taiwanese AIS patients from 2003 through 2010. Then we aimed to determine the safety and effectiveness of rtPA in our AIS patients with renal dysfunction. Method: Firstly, the nationwide survey of intravenous rtPA for AIS patients was done using the National Health Insurance Research Database from 2003 through 2010. Then we used a multicenter stroke registry database to determine the association of renal dysfunction and SICH in AIS patients treated with intravenous rtPA, and the effect of renal dysfunction and rtPA, as well as their interaction on poor outcome (modified Rankin Scale 3-6 at 3 months) for all AIS patients admitted within 4.5 hours of onset. Results: Firstly, of the 394,988 AIS admission from 2003 through 2010, only 0.60% received rtPA. The utilization rate increased from 0.03% in 2003 to 1.51% in 2010. Patients with more comorbidities were less likely to receive rtPA (adjusted odds ratio [OR] for Charlson comorbidity index [CCI] = 1: 0.45; 95% CI: 0.40-0.50; OR for CCI ≥ 2: 0.30; 95% CI: 0.26-0.34, compared to those with CCI = 0). After multivariable analysis of 657 AIS patients treated with rtPA, renal dysfunction was not associated with SICH (OR: 1.03; 95% confidence interval [CI]: 0.55-1.92). In another analysis for 929 AIS patients within 4.5 hours of onset, the OR for rtPA and renal dysfunction on poor outcomes were 0.70 (95% CI: 0.51-0.96) and 0.97 (95% CI: 0.71-1.33), respectively, without significant interaction (p = 0.218). Conclusion: Intravenous thrombolytic therapy was underutilized in our AIS patients, partly due to concern of increased bleeding risk under certain comorbidity. From our practice-based data, renal dysfunction neither increased the risk of SICH after rtPA nor modified the effectiveness of rtPA for AIS. Renal dysfunction alone should not be a reason for withholding treatment from otherwise-eligible AIS patients.
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Webster, Nicole. "Use of the NONMEM computer program to predict an oral cyclosporin dose when changing over from intravenous therapy." Thesis, 2014.
Find full textAbstract:
The introduction of cyclosporin has brought about a new era in drug
therapy for transplantation and other immune-related diseases.
However, cyclosporin therapy has been associated with large interindividual
differences in drug absorption, distribution, metabolism and
elimination making it impossible to establish fixed dose regimens based
on body weight. Recently, a new oral formulation called Sandimmune
Neoral, also known as Neoral, was introduced showing a more
consistent absorption profile, improved dose linearity and enhanced
relevance of cyclosporin blood levels.
This is a retrospective pilot study conducted at the Garden City Clinic on
13 de novo renal transplant patients and the aims were:
® to establish the relative bioavailability between the IV and the oral
dose of cyclosporin,
» to calculate population pharmacokinetic parameters from routinely
taken trough levels using the NONMEM program,
» to investigate the influence of factors such as weight and gender
on pharmacokinetic parameters.
This information could then be applied to arrive at a formula for the
smooth changeover from IV to oral therapy.
For the IV cyclosporin doses population mean values of total body
clearance (Cl) and volume of distribution (Vd) were estimated to be
22.4 L/h and 167 L respectively, with an inter-individual variation (n) of
48% and 44% respectively. The residual error was 10%. For the oral
cyclosporin, they were 52.6 L/h (q = 10%) and 339 L (q = 48%)
respectively with a fixed absorption constant (ka) of 0.7 h'1. The residual
error was 10%. Consequently, the relative bioavailability was estimated
to be around 43%. More data is needed to confirm this result
Although this study included only a small number of patients a significant
correlation was found between total body clearance of cyclosporin and
creatinine clearance. This should be investigated further in a more indepth
study.
Due to the power of NONMEM, we were able to show that it is possible
to calculate pharmacokinetic parameters from only cyclosporin trough
levels without the need for the extra expense and morbidity of multiple
blood level monitoring. This study showed us that it is possible to arrive
at a formula to calculate what oral dose is needed for the smooth
changeover from IV cyclosporin therapy using NONMEM if more data is
available.
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Dryburgh, Leslie Irene. "A retrospective study of the diagnostic and treatment practices of health care professionals for patients receiving out-patient intravenous antibiotic therapy for cellulitis." 2000. http://hdl.handle.net/1993/2564.
Full textAbstract:
The purpose of this study was to determine if there were a significant number of clients with cellulitis that were diagnosed with an infection other than cellulitis, or whose treatment was misdiagnosed and, to determine where discrepancies may have occurred. The research questions addressed were: (1) What is the proportion of CITP clients who initially have been diagnosed with an infection other than cellulitis? (2) What is the proportion of clients with cellulitis who were not trialed on oral antibiotic therapy prior to receiving parenteral antibiotic therapy? (3) What is the proportion of clients with cellulitis who were not prescribed the appropriate oral antibiotic? (4) What is the proportion of clients with cellulitis who did not remain on oral antibiotic therapy for a specific period of time prior to their doctor requesting they be placed on intravenous antibiotic therapy? (5) Does the incidence of cellulitis increase with certain underlying medical conditions, age group or gender? The research designwas a retrospective study that reviewed the computer database/charts located at The Winnipeg Community Intravenous Therapy Program. (Abstract shortened by UMI.)
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"Risk perceptions, cognitive behavioral models and HIV-related risk behaviors among non-institutionalized male injecting drug users in China." Thesis, 2010. http://library.cuhk.edu.hk/record=b6074869.
Full textAbstract:
Conclusion. The significance of risk perception in predicting behavioral intention, hence actual future behaviors, is therefore evident. Conditional measures need to be used. HIV prevention can employ conditional risk perception approaches. Health behavioral theories can be strengthened by using such conditional measures on risk perceptions. The results add to this new and growing area of risk behavior research.Introduction. Risk perception, a core element of key health behavioral theories and health interventions, is assumed to motivate people to avoid risk behaviors. Mixed findings however prevail in the literature due to methodological issues. Many of such studies are cross-sectional, using global risk perception measures that do not condition on type of risk behavior or partnership which may affect the level of risk.
Male injecting drug users (IDU) are driving the HIV epidemic in China and bridge HIV transmission to non-IDU female populations; they may be at risk of both unprotected sex and syringe sharing. HIV prevention targeting male IDU is greatly warranted and would benefit from understanding of the relationships between risk perceptions and behaviors, in the context of health behavioral theories such as the Health Action Process Approach (HAPA) model, which had not been applied to studies targeting IDU.
Objectives. This study refined the concepts and measures of HIV-related risk perception, conditioning on different types of behaviors and partners, and extended it to include others-directed risk perceptions. The relationship between such conditional risk perception measures and both prior risk behaviors and behavioral intention to avoid sex-related and drug-related risk behaviors in the future were investigated and were compared to those involving global unconditional risk perception measures. The nature of the aforementioned relationships, being motivational or reflective was investigated. A longitudinal component validated the predictive power of behavioral intention over actual future behaviors.
Results. Almost 90% of the respondents had had unprotected sex though <20% shared syringes with others in the last 6 months. Prior syringe sharing but not unprotected sex in the last 6 months was significantly associated with global unconditional risk perception measures. The picture is totally different when risk perception measures conditioned on type of sex partner and unprotected sex or syringe sharing were used instead of the global measures---higher levels of the conditional risk perception measures were significantly associated with higher levels of behavioral intention for consistent condom use and avoidance of syringe sharing, thus supporting the motivational hypothesis. Conditional others-directed risk perceptions (perceived risk of transmitting HIV to others via unprotected sex and syringe sharing) were also associated with the aforementioned behavioral intentions to avoid risk behaviors. A pilot longitudinal study showed that behavioral intentions strongly predict actual future behaviors. Other HAPA-based variables such as self-efficacy and outcome expectancies had predictive effects on behavioral intentions, independent from those of risk perceptions.
Subjects and methods. A total of 456 sexually active male IDU were recruited from Dazhou, Sichuan and Hengyang, Hunan, via snowball sampling. With informed consent, anonymous face-to-face interviews were conducted by trained and experienced staff of the local CDC in privacy settings.
Tsui, Hi Yi.
Adviser: Joseph Lau.
Source: Dissertation Abstracts International, Volume: 72-04, Section: B, page: .
Thesis (Ph.D.)--Chinese University of Hong Kong, 2010.
Includes bibliographical references (leaves 118-130).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstract also in Chinese; appendix in Chinese.
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Koch, Gerhardus George Visser. "Knowledge, clinical competencies and medico legal responsibilities required for the administration of intravenous contrast media by radiographers." Thesis, 2017. http://hdl.handle.net/10321/2553.
Full textAbstract:
Submitted in fulfillment of the requirements for the Degree of Master of Health Sciences in Radiography, Durban University of Technology, 2017.Background The current scope of practice for diagnostic radiographers, does not allow them to administer intravenous contrast media (IVCM) since there are no formal training guidelines accredited by the Health Professions Council of South Africa (HPCSA) (Koch 2014: 26). In selected countries abroad, radiographers are allowed to administer IVCM and have thus received the necessary and accredited training to do so. In view of this, the South African radiographer’s scope of practice is not on par with the selected countries. The radiologists in South Africa (SA) who are currently responsible for the administration of IVCM have issued a position statement which supports, in principle, the idea of radiographers administering IVCM should they receive the necessary and appropriate training to do so (RSSA 2011: 1-2). The aim of this research study was, therefore, to investigate the radiologists’ perspectives regarding the theoretical knowledge, clinical competencies and medico legal responsibilities required by radiographers in order to effectively administer IVCM. This research study provides input for the development of national training guidelines for radiographers to administer IVCM. Research Methodology A quantitative, descriptive study was conducted by targeting qualified radiologists residing and practicing within the province of KwaZulu Natal (KZN). Ethical approval was obtained from the Durban University of Technology’s (DUT) Institutional Research and Ethics Committee (IREC). All the participants were contacted in their personal capacity. The research tool was an online survey administered through SurveyMonkey which included questions and statements relating to the administration of IVCM and was structured so as to meet the study objectives. The research tool was evaluated and amended by an expert focus group to ensure reliability and validity. Confidentiality was maintained and all the data obtained during this research study was password protected. Results and discussion Fifty-nine radiologists (60.8 percent) participated in this study. Twelve respondents, however, were excluded due to incomplete surveys. The final response rate, therefore, was 48.5 percent (n=47) of which 72.3 percent of the respondents were from the private sector. Results illustrated the radiologists’ agreement regarding the theoretical, clinical/practical and medico legal training components for inclusion in the further training of radiographers to administer IVCM. Most respondents supported the inclusion of three assessments: theoretical (87.2 percent), clinical (93.6 percent) and a record of clinical competencies (95.7 percent). The assessments were considered equally important in terms of percentage weighting. The overall results compared favorably to the current international trends and practice standards of radiographers administering IVCM. Conclusion and Recommendations The study, in providing key data for the development of training guidelines for radiographers to administer IVCM, has demonstrated the importance of higher education (HE) and training in addressing transformation in health services with particular reference to professional scopes of practice. Furthermore, it reinforces the need for local research that will inform HE and training and hence a scope of practice that meets local needs. It was recommended that future studies should include those HE institutions offering training in Radiography as well as their stakeholders for the design and transformation of a national curriculum for radiographers to administer IVCM.
M
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Martin, Leah J. "Outcomes of antiretroviral therapy in northern Alberta the impact of Aboriginal ethnicity and injection drug use /." Phd thesis, 2009. http://hdl.handle.net/10048/574.
Full textAbstract:
Thesis (Ph.D.)--University of Alberta, 2009.A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Doctor of Philosophy, Department of Public Health Sciences. Title from pdf file main screen (viewed on September 20, 2009). Includes bibliographical references.
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Mbhenyane, Tinyiko Iris. "Knowledge and practices of professional nurses with regards to the monitoring of parents on intravenous fluids in selected hospitals of Vhembe District; Limpopo Province." Diss., 2017. http://hdl.handle.net/11602/999.
Full text
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PROKŠOVÁ, Michaela. "Vnímání zdravotních rizik intravenózní aplikace psychoaktivních látek ve skupině drogově závislých." Master's thesis, 2010. http://www.nusl.cz/ntk/nusl-47661.
Full textAbstract:
The addiction psychoactive substances currently represents a major problem. The number of users of such substances has been increasing. The intravenous application of psychoactive substances is associated with many health risks. Transmission and spreading of infection is associated mainly with frequent sharing and use of needles, syringes and other instruments among the users. In recent years the spreading of hepatitides (particularly VHC) has been reported as one of serious consequences of addiction to psychoactive substances, particularly in case of intravenous application. Protection against the spreading of diseases consist mainly in the prevention. The objective of the thesis is to verify whether the people addicted to psychoactive substances are aware of risks of transmission and spreading of infectious diseases (particularly VHC) as a result of intravenous application. The research was conducted on a group of drug addicts intercepted in the network of contact center and on a group of drug addicts in a therapeutic program of a psychiatric facility. I have used the method of inquiry in the form of questionnaires. In the thesis I set five hypotheses. The first, the third and the fifth hypotheses have been confirmed. The second and the fourth hypotheses have not been confirmed. The results of the research may be used by facilities providing low-threshold services as a part of secondary and tertiary prevention and harm reduction. It may also serve as source of information for workers dealing with anti-drug issues.