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At least 1,153 records · Page 64Linked to original sources

PubMed2006

Multicentric, randomized, controlled trial to evaluate blood glucose control by the model predictive control algorithm versus routine glucose management protocols in intensive care unit patients.

OBJECTIVE: To evaluate a fully automated algorithm for the establishment of tight glycemic control in critically ill patients and to compare the results with different routine glucose management protocols of three intensive care units (ICUs) across Europe (Graz, Prague, and London). RESEARCH DESIGN AND METHODS: Sixty patients undergoing cardiac surgery (age 67 +/- 9 years, BMI 27.7 +/- 4.9 kg/m2, 17 women) with postsurgery blood glucose levels >120 mg/dl (6.7 mmol/l) were investigated in three different ICUs (20 per center). Patients were randomized to either blood glucose management (target range 80-110 mg/dl [4.4-6.1 mmol/l]) by the fully automated model predictive control (MPC) algorithm (n = 30, 10 per center) or implemented routine glucose management protocols (n = 30, 10 per center). In all patients, arterial glucose was measured hourly to describe the glucose profile until the end of the ICU stay but for a maximum period of 48 h. RESULTS: Compared with routine protocols, MPC treatment resulted in a significantly higher percentage of time within the target glycemic range (% median [min-max]: 52 [17-92] vs. 19 [0-71]) over 0-24 h (P < 0.01). Improved glycemic control with MPC treatment was confirmed in patients remaining in the ICU for 48 h (0-24 h: 50 [17-71] vs. 21 [4-67], P < 0.05, and 24-48 h: 65 [38-96] vs. 25 [8-79], P < 0.05, for MPC [n = 16] vs. routine protocol [n = 13], respectively). Two hypoglycemic events (<54 mg/dl [3.0 mmol/l]) were observed with routine protocol treatment. No hypoglycemic event occurred with MPC. CONCLUSIONS: The data suggest that the MPC algorithm is safe and effective in controlling glycemia in critically ill postsurgery patients.

Aged↗

PubMedDate not supplied

Perioperative control of blood glucose in diabetic patients: a two-step protocol.

Perioperative control of blood glucose in patients with diabetes has been difficult due to frequent occurrence of hypoglycemia or hyperglycemia. We developed a two-step protocol for management of insulin-treated patients during general anesthesia. Regular insulin was given intravenously before anesthetic induction according to the step I formula (initial): initial blood glucose - 150/10 = U. Regular insulin was then given during surgery according to the step II formula (hourly): blood glucose 150-250 mg/dl = 2 U; blood glucose greater than 250 mg/dl = 4 U. Fluid replacement of 5% dextrose with lactated Ringer's solution, 3 ml/kg estimated ideal body weight, was given hourly and additional lactated Ringer's solution was given as indicated. Thirty patients received preoperative (long- or intermediate-acting) insulin and were managed by the two-step protocol. Ten patients received preoperative (long- or intermediate-acting) insulin and were managed by a standard method used in the same institution. Thirty patients did not receive preoperative insulin and were managed by the two-step protocol. All patients underwent retinal surgery under general anesthesia. In comparing the two groups pretreated with insulin, patients treated by the standard method had significantly higher (mean) blood glucose levels (360.2 +/- 100.4 mg/dl) than those treated with the two-step protocol (181.2 +/- 50.8 mg/dl) (P = 0.0001) at the end of surgery. Of the two-step protocol patients, those pretreated with one-half the usual morning dose of long- or intermediate-acting insulin had lower (mean) blood glucose levels (225 +/- 87 mg/dl) than patients not pretreated (310 +/- 130.8 mg/dl) (P = 0.0069) the morning after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Diabetes Mellitus↗

PubMed2006

Evaluation of the effects of footwear hygiene protocols on nonspecific bacterial contamination of floor surfaces in an equine hospital.

OBJECTIVE: To evaluate the effects of footwear hygiene protocols on bacterial contamination of floor surfaces in an equine hospital. DESIGN: Field trial. PROCEDURES: Footwear hygiene protocols evaluated included use of rubber overboots with footbaths and footmats containing a quaternary ammonium disinfectant, rubber overboots with footbaths and footmats containing a peroxygen disinfectant, and no restrictions on footwear type but mandatory use of footbaths and footmats containing a peroxygen disinfectant. Nonspecific aerobic bacterial counts were determined via 2 procedures for sample collection and bacterial enumeration (contact plates vs swabbing combined with use of spread plates), and the effects of each footwear hygiene protocol were compared. RESULTS: There were no consistent findings suggesting that any of the protocols were associated with differences in numbers of bacteria recovered from floor surfaces. Although there were detectable differences in numbers of bacteria recovered in association with different footwear hygiene protocols, differences in least square mean bacterial counts did not appear to be clinically relevant (ie, were < 1 log10). CONCLUSIONS AND CLINICAL RELEVANCE: Although cleaning and disinfection of footwear are important aids in reducing the risk of nosocomial transmission of infectious agents in veterinary hospitals, the numbers of aerobic bacteria recovered from floor surfaces were not affected by use of rubber overboots or the types of disinfectant used in this study. Further study is warranted to evaluate the usefulness of footwear hygiene practices relative to their efficacy for reducing transmission of specific pathogens or decreasing nosocomial disease risk.

Animals↗

PubMedDate not supplied

[Study over 10 years of 622 protocols receiving unfavourable reports from 19 research ethics committees].

OBJECTIVE: The aim of this study was to analyse the nature of applications and the criteria for their negative evaluation by 19 ethics committees for the protection of human subjects participating in biomedical research, the French CCPPRB. METHODOLOGY: The committees distinguished between negative opinions that were given from the start of the applications or after amendments were made, and between lost protocols (no answer within more than 1 year) or protocols that were outside of the framework of the Huriet-Sérusclat law. The opinions were analysed by an independent observer over a period of 10 years. RESULTS: Few protocols (1.3% of the total number of files) are rejected on the basis of scientific and ethical criteria. Traceability is a significant problem, which obstructed the study of lost protocols and amendments. For protocols not covered by the law, the committees already work in accordance with the European directive recommending the exclusion of studies consisting only of routine medical procedures.

Ethics Committees, Research↗

PubMed2004

Effect of addition of a progesterone intravaginal insert to a timed insemination protocol using estradiol cypionate on ovulation rate, pregnancy rate, and late embryonic loss in lactating dairy cows.

The objectives of this study were to determine the effects of incorporating a progesterone intravaginal insert (CIDR) between the day of GnRH and PGF2alpha treatments of a timed AI protocol using estradiol cypionate (ECP) to synchronize ovulation on display of estrus, ovulation rate, pregnancy rate, and late embryonic loss in lactating cows. Holstein cows, 227 from Site 1 and 458 from Site 2, were presynchronized with two injections of PGF2alpha on study d 0 and 14, and subjected to a timed AI protocol (100 mixrog of GnRH on study d 28, 25 mg of PGF2alpha on study d 35, 1 mg of ECP on study d 36, and timed AI on study d 38) with or without a CIDR insert. Blood was collected on study d 14 and 28 for progesterone measurements to determine cyclicity. Ovaries were scanned on d 35, 37, and 42, and pregnancy diagnosed on d 65 and 79, which corresponded to 27 and 41 d after AI. Cows receiving a CIDR had similar rates of detected estrus (77.2 vs. 73.8%), ovulation (85.6 vs. 86.6%), and pregnancy at 27 (35.8 vs. 38.8%) and 41 d (29.3 vs. 32.3%) after AI, and late embryonic loss between 27 and 41 d after AI (18.3 vs. 16.8%) compared with control cows. The CIDR eliminated cows in estrus before the last PGF2alpha injection and decreased (P < 0.001) the proportion of cows bearing a corpus luteum (CL) at the last PGF2alpha injection because of less ovulation in response to the GnRH and greater spontaneous CL regression. Cyclic cows had greater (P = 0.03) pregnancy rates than anovulatory cows at 41 d after AI (33.8 vs. 20.4%) because of decreased (P = 0.06) late embryonic loss (16.0 vs. 30.3%). The ovulatory follicle was larger (P < 0.001) in cows in estrus, and a greater proportion of cows with follicles > or = 15 mm displayed estrus (P < 0.001) and ovulated (P = 0.05) compared with cows with follicles <15 mm. Pregnancy rates were greater (P < 0.001) for cows displaying estrus, which were related to the greater (P < 0.001) ovulation rate and decreased (P = 0.08) late embryonic loss for cows in estrus at AI. Cows that were cyclic and responded to the presynchronization protocol (high progesterone at GnRH and CL at PGF2alpha) had the highest pregnancy rates. Incorporation of a CIDR insert into a presynchronized timed AI protocol using ECP to induce estrus and ovulation did not improve pregnancy rates in lactating dairy cows. Improvements in pregnancy rates in cows treated with ECP to induce ovulation in a timed AI protocol are expected when more cows display estrus, thereby increasing ovulation rate.

Abortion, Veterinary↗

PubMed2004

A comparison of progestin-based protocols to synchronize estrus in postpartum beef cows.

Two progestin-based protocols for estrus synchronization in postpartum beef cows were compared following treatment administration on the basis of estrous response, interval to and synchrony of estrus, and pregnancy. Cows were assigned to one of the two treatment protocols by age, body condition score (BCS), and days postpartum (DPP). The MGA Select-treated cows (MGA Select; n = 109) were fed melengestrol acetate (MGA; 0.5mg x cow-1 x d(-1)) for 14 d, fed carrier for 8 d, GnRH (100 microg of Cystorelin) was injected i.m. 12 d after MGA withdrawal, and PG (25 mg of Lutalyse) was administered i.m. 7 d after GnRH. Cows assigned to the 7-11 Synch protocol (7-11 Synch; n = 111) were fed carrier for 15 d, fed MGA for 7 d, injected with PG on d 22 (d 7 of MGA), injected with GnRH on d 26, and injected with PG on d 33. Mean BCS (4.8 +/- 0.1, MGA Select; 4.7 +/- 0.1, 7-11 Synch) and DPP (40 +/- 1, MGA Select; 40 +/- 1, 7-11 Synch) did not differ between treatments. Blood samples were collected 8 d and 1 d before feeding of MGA or carrier to determine the pretreatment estrous cyclicity (progesterone > or = 1 ng/mL; 10/109 [9%], MGA Select; 12/111 [11%], 7-11 Synch), and again at PG on d 33 to evaluate treatment response (81/109 [74%], MGA Select; 84/111 (76%), 7-11 Synch). Serum concentrations of progesterone at PG on d 33 differed (P < 0.01) between treatments (3.3 +/- 0.3 ng/mL [MGA Select] vs. 1.7 +/- 0.1 ng/mL [7-11 Synch]). HeatWatch was used for 6 d after PG on d 33 to detect estrus, and AI was performed 12 h after the onset of estrus. Estrous response did not differ between treatments (100/109 [92%], MGA Select; 101/111 [91%], 7-11 Synch). Mean interval to estrus (65 +/- 2.7 h, MGA Select; 52 +/- 1.8 h, 7-11 Synch) and synchrony of estrus differed (P < 0.01) between treatments. Synchronized conception and pregnancy rates (61/100 [61%], 61/109 [56%], MGA Select; 71/101 [70%], 71/111 [64%], 7-11 Synch), and final pregnancy rates (94/109 [86%], MGA Select; 99/110 [90%], 7-11 Synch) did not differ between treatments. In summary, estrous response and fertility did not differ among cows assigned to the MGA Select or 7-11 Synch protocols. Synchrony of estrus, defined as the variance in the interval to estrus from PG, however, was improved following treatment with the 7-11 Synch protocol.

Animals↗

PubMed2005

A comparison of progestin-based protocols to synchronize ovulation and facilitate fixed-time artificial insemination in postpartum beef cows.

The experimental objective was to compare pregnancy rates after fixed-time AI in postpartum suckled beef cows following administration of two progestin-based protocols to synchronize ovulation. Cows (n = 424) at three locations (n = 208, 122, and 92 per location) were stratified by age, BCS, and days postpartum (DPP) and assigned randomly to one of the two treatment protocols. The MGA Select-treated cows (MGA Select; n = 213) were fed melengestrol acetate (MGA, 0.5 mg x cow(-1) x d(-1)) for 14 d and carrier for 8 d, and then GnRH (100 microg i.m. Cystorelin; d 26) was injected 12 d after MGA withdrawal, and PG (25 mg i.m. Lutalyse) was administered 7 d after GnRH. Cows assigned to the 7-11 Synch protocol (7-11 Synch; n = 209) were fed carrier for 15 d and MGA for 7 d, and then injected with PG on d 22 (d 7 of MGA), GnRH on d 26, and PG again on d 33. Artificial insemination was performed at fixed times for cows in both treatments at 60 or 72 h after d 33 PG for 7-11 Synch and MGA Select groups, respectively. All cows were injected with GnRH (100 microg of i.m. Cystorelin) at AI. There was no treatment x location interaction for age (P = 0.90), BCS (P = 0.64), or DPP (P = 0.93), and the results were therefore pooled for the respective treatments (age [7-11 Synch, 5.5 +/- 0.2; MGA Select, 5.5 +/- 0.2], BCS [7-11 Synch, 5.7 +/- 0.1; MGA Select, 5.6 +/- 0.1], and DPP [7-11 Synch, 41.1 +/- 1.1; MGA Select, 42.1 +/- 1.1]). Blood samples were collected 8 and 1 d before MGA or carrier to determine pretreatment estrous cyclicity (progesterone >or=1 ng/mL; 7-11 Synch, 59/209 [28%]; MGA Select, 54/213 [25%]; P = 0.50) and again on d 33 PG to evaluate treatment response as a percentage of cows with progesterone concentrations in serum >or=1ng/mL (7-11 Synch, 184/209 [88%]; MGA Select, 177/213 [83%]; P = 0.15). Pregnancy rates resulting from fixed-time AI did not differ (P = 0.25) between treatments (7-11 Synch, 128/209 [61%]; MGA Select, 142/213 [67%]), nor did pregnancy rates (P = 0.77) at the end of the breeding season (7-11 Synch, 198/208 [95%]; MGA Select, 204/213 [96%]). These data indicate that pregnancy rates were comparable after fixed-time AI, following administration of the 7-11 Synch and MGA Select protocols. Both protocols provide opportunities for beef producers to use AI and eliminate the need to detect estrus.

Animals↗

PubMed1995

Evaluation of different ovarian stimulation protocols for in vitro fertilization.

In this study we evaluated retrospectively the efficacy of five different ovarian stimulation protocols in an in vitro fertilization program, in which 512 women were involved. Ovulation was induced by the following protocols: group I (271 cycles): buserelin short protocol (1 mg/day, intranasally) with human menopausal gonadotropin/human chorionic gonadotropin (hMG/hCG); group II (45 cycles): buserelin (short protocol) with pure follicle stimulating hormone (p-FSH)/hMG/hCG; group III (24 cycles): clomiphene citrate (100 mg/day) with hMG/hCG; group IV (122 cycles): hMG (3 ampules/day) and hCG; group V (113 cycles): hMG/hCG and prednisolone (7.5 mg/day) after cycle programming with oral contraceptives. The lowest cancellation rate (3.3%) was noted in group I, followed by group V (9.7%). The highest number of follicles was observed in groups I (8.3 +/- 0.3; mean +/- SEM) and V (7.8 +/- 0.5). Also, more oocytes were retrieved in group I (7.2 +/- 0.3, p < 0.001), which were of good quality based on oocyte maturity as well as on the fertilization rate, and more embryos (4.5 +/- 0.3, p < 0.05) were developed. The correlation between estradiol and the total follicular volume on the day of hCG administration was also examined in the five groups. The best correlation (r = 0.6502) was found in group I, followed by group V (r = 0.5810). Significant differences were observed in the five groups with regard to the number of hMG ampules administered (p < 0.0001, F = 15.393) and the stimulation days (p < 0.0001, F = 35.32). Sixty-six clinical pregnancies were achieved: 37 (17.5%) in group I, seven (25.9%) in group II, one (10%) in group III, ten (15.6%) in group IV and 11 (15.5%) in group V (differences were not statistically significant). In conclusion, all five protocols were satisfactory in ovarian stimulation for in vitro fertilization, and gonadotropin releasing hormone (GnRH) analogs seemed to be more advantageous by reducing the cancellation rate, enhancing the number of oocytes retrieved and embryos developed and by improving the pregnancy rates.

Adult↗

PubMed1995

Strategies to accelerate the applicability of gene amplification protocols for pathogen detection in meat and meat products.

Traditionally, microbiological testing of meat products has involved isolating microorganisms and performing specific biochemical, and in some cases serological, tests to confirm the presence or absence of suspected food-borne pathogens. Given the public attention meat products have received as sources of food-borne disease, there has been considerable interest in the application of rapid detection techniques that require hours rather than days for completion. Theoretically, rapid detection methods could reduce the time from the initial sampling to confirmation so that conclusive results would be available by the time to process the meat product. Both direct gene probe hybridization as well as gene amplification methods show promise as rapid detection techniques. At present, direct gene probe hybridization are being commercially utilized to confirm the presence of a suspected pathogen. A number of gene amplification protocols for detecting food-borne bacterial pathogens have been published. However, many of these studies have utilized spiked samples rather than naturally contaminated samples and many of them have involved extended template extraction/purification methodologies. There is still only a very limited amount of information on the efficacies of the various protocols in detecting bacterial pathogens, especially toxigenic Escherichia coli, Salmonella spp., Campylobacter spp., and Listeria spp., in naturally contaminated food samples. In order to develop gene amplification protocols that have relevance to the meat industry, there must be a concerted effort to utilize naturally contaminated samples in the development and evaluation of protocols, as well as to initiate multilaboratory round robin evaluations of select protocols. Availability of multilaboratory tested methodologies would provide a means to design pathogen detection strategies at the quality control level rather than an end product confirmatory response to an already documented outbreak.

Animals↗

PubMed2001

An alternative AI breeding protocol for dairy cows exposed to elevated ambient temperatures before or after calving or both.

Our objective was to determine if a timed artificial insemination (AI) protocol (Ovsynch) might produce greater pregnancy rates than AI after a synchronized, detected estrus during summer. Lactating Holstein cows (n = 425) were grouped into breeding clusters and then assigned randomly to each of two protocols for AI between 50 and 70 days in milk. All cows were treated with GnRH followed 7 d later by PGF2alpha. Ovsynch cows then were treated with a second injection of GnRH 48 h after PGF2alpha and inseminated 16 to 19 h later. Controls received no further treatment after PGF2alpha and were inseminated after detected estrus. Pregnancy was diagnosed once by transrectal ultrasonography (27 to 30 d after AI) and again by palpation (40 to 50 d). Based on concentrations of progesterone in blood collected before each hormonal injection, only 85.4% of 425 cows were considered to be cycling. Although conception rates were not different between protocols at d 27 to 30, AI submission rates and pregnancy rates were greater after Ovsynch (timed AI) than after detected estrus. A temperature-humidity index > or = 72 was associated with fewer controls detected in estrus with lower conception than for controls detected in estrus when index values were < 72, whereas the reverse was true for cows after the Ovsynch protocol. We concluded that a timed AI protocol increased pregnancy rates at d 27 to 30 because its success was independent of either expression or detection of estrus. However, because of poorer embryonic survival in Ovsynch cows during heat stress only (39.5 vs. 69.2% survival for Ovsynch and control, respectively), pregnancy rates were not different by d 40 to 50 after timed AI.

Animals↗

PubMed2005

Pregnancy rates in lactating dairy cows after presynchronization of estrous cycles and variations of the Ovsynch protocol.

Our objectives were to determine pregnancy rates after altering times of the second GnRH injection, insemination, or both in a combined Presynch + Ovsynch protocol, to accommodate once-daily lockup of dairy cows. Lactating dairy cows (n = 665) from 2 dairy herds in northeastern Kansas were studied. Cows ranged from 24 to 44 d in milk (DIM) at the start of the Pre-synch protocol, which consisted of 2 injections of PGF(2alpha) 14 d apart, with the second injection given 12 d before initiating the Ovsynch protocol. Cows were blocked by lactation number and assigned randomly to 3 treatments consisting of variations of the Ovsynch protocol. Cows in 2 treatments received injections of GnRH 7 d before and 48 h (G48) after the PGF(2alpha) injection. Timed AI (TAI) was conducted at the time of the second GnRH injection (G48 + TAI48) or 24 h later (G48 + TAI72). Cows in the third treatment received the injections of GnRH 7 d before and at 72 h after PGF(2alpha) and were inseminated at the time of the second GnRH injection (G72 + TAI72). Pregnancy was diagnosed weekly by palpation per rectum of uterine contents on d 40 or 41 after TAI. Pregnancy rates differed between herds, but they were consistently greater for G72 + TAI72 than for G48 + TAI48 and G72 + TAI72. Subsequent calving rates were consistent with differences in initial TAI pregnancy rates. Pregnancy loss was least for cows on the G72 + TAI72 treatment. Body condition scores (BCS) ranged from 1.0 to 4.0 when assessed on Monday of the breeding week. An interaction of BCS and herd was detected in which cows in herd 1 having poorer BCS (<2.25) had greater pregnancy rates than cows of greater BCS (>/=2.25), whereas the reverse was true in herd 2 in which overall pregnancy rates were greater. We concluded that inseminating at 48 or 72 h after PGF(2alpha), when GnRH was administered at 48 h after PGF(2alpha), produced fewer pregnancies than inseminating and injecting GnRH at 72 h after PGF(2alpha) for cows whose estrous cycles were synchronized before initiating this variant of the Ovsynch protocol.

Animals↗

PubMed1999

Optimization of an automated DNA purification protocol for neonatal screening.

CONTEXT: Collection of blood from newborns is a standard clinical procedure used for genetic screening. Typically, blood from a heel prick is absorbed onto standard collection paper and dried before analysis of metabolites, proteins, hormones, and more recently DNA. OBJECTIVE: To evaluate strategies to purify DNA for use with automated workstations. DESIGN: Two factors were used to evaluate several DNA purification protocols: residual heme contamination and amplification yield. The protocol that produced DNA with the lowest heme content and the highest amplification yield was selected. In combination with those two performance factors, the protocol with the fewest number of steps was chosen to reduce reagent use and processing time. SETTING: Industrial research and development laboratory. RESULTS: Robust amplification of DNA isolated from dried blood spots was demonstrated using both fluorescence and agarose gel-based detection methods. In addition, the samples had consistent DNA volumes and had no detectable cross-contamination. Suggested instrument settings, equipment, and supplies were included for automated processing of DNA from dried blood spots. CONCLUSION: A 4-step DNA processing protocol was developed for dried blood spots. The protocol could be performed in either a manual or automated format, making it possible to process hundreds of samples in 1 day.

Blood Chemical Analysis↗

PubMed1998

[Two-phase helical hepatic CT. Contrast-injection protocol, optimal timing and its usefulness in clinical cases].

The usefulness of two-phase helical computed tomography (CT) of the liver was evaluated in clinical cases. First, an optimal scanning protocol was determined using time-attenuation analysis. Monophasic dynamic CT was performed with 100 ml of contrast media (iodine 300 mg/ml) injected either at 3 ml/s or at 2 ml/s. Aortic, hepatic and portal time-attenuation curves were made for each protocol. The results showed that these two different injection protocols produce equivalent enhancements and that the injection rate of 2 ml/s is satisfactorily applicable to clinical cases. The first scanning (arterial phase) must be started 40-45 s after the beginning of the injection of contrast media and the second scanning (delayed phase) 80-120 s after the beginning of injection. Using these CT protocols, 327 cases were examined. In this study 83 hepatic lesions (hepatocellular carcinoma : HCC, n = 29; suspected HCC, n = 30; hemangioma, n = 24) were evaluated. There were 15 HCCs smaller than 30 mm in diameter (71.4%) detected by either arterial phase or delayed phase alone. This result indicates that two-phase helical hepatic CT is very useful in the detection of small HCC. Particularly, four of 5 HCCs of less than 10 mm in size (80%) showed a hyperattenuation area in the arterial phase alone. HCCs which have sufficient vascularity were also easily demonstrated. However, this two-phase helical hepatic CT could not demonstrate 11 lesions (13.3%) with almost normal blood supply. In such cases the complementary role of ultrasound (US) seems to be important. Hence as a screening of hepatic mass lesions both CT and US are necessary. Most HCC could be differentiated from hemangioma by an enhancement pattern using this protocol. But the small liver lesions of less than 15 mm in size with homogeneous hyperattenuation in the arterial phase and isoattenuation in the delayed phase included HCC, hemangioma and metastatic tumors.

Angiography↗

PubMedDate not supplied

The outcome of implant-supported fixed prostheses from the prosthodontic perspective: proposal for a classification protocol.

PURPOSE: This article proposes a classification protocol for reporting the outcome of implant-supported fixed partial dentures. MATERIALS AND METHODS: A review of the literature revealed a contrast between the accepted criteria for assessing and presenting the outcome of osseointegrated implants and the deficient and misleading assessment and presentation of the outcome of the prostheses supported by these implants. A classification protocol comprising 6 well-defined fields with objective standards that accounts for retreatment as well as failure is proposed. This protocol has been applied where possible to reports on the outcome of fixed partial dentures in several published articles. RESULTS: In all cases there was a stark difference between the authors' claims of success and the outcome according to the 6-field protocol. It is accepted that the outcome of a given prosthesis does not necessarily correspond to the outcome of the overall prosthodontic treatment, as the latter also involves an assessment of outcome as perceived by the patient and accounts for planned revisions. CONCLUSION: If adopted, the proposed protocol would allow meaningful comparisons between prosthesis designs and between different implant systems' capacities to support such designs. It would also assist in evaluating the cost-effectiveness of implant-supported treatments.

Classification↗

PubMed1998

Peak expiratory flow rate guided protocol did not improve outcome in emergency room asthma.

UNLABELLED: BACKGROUND AND AIMS OF STUDY: All current international practice guidelines recommend that treatment of acute asthma in the emergency room (ER) should be guided by the peak expiratory flow rate (PEFR). The aim of this study was to assess the efficacy of a PEFR guided protocol in treating ER asthma. METHODS: We compared two different management protocols in adult asthmatics who presented to the ER with acute exacerbations. The routine protocol (RP) assessed and dispensed patients according to overall subjective and clinical response without predetermined criteria. The peak protocol (PP) used serial measurements of PEFR to guide intensity of bronchodilator treatment and fitness for hospital discharge. On the PP, a threshold PEFR of > or = 60% predicted had to be achieved before the patient could be discharged from the ER. RESULTS: There were 79 patients in the RP group and 70 in the PP group. There was no significant difference between the two groups in baseline PEFR, PEFR after treatment and percentage increase in PEFR with treatment. The PP resulted in a higher hospital admission rate than RP. CONCLUSION: We conclude that in the management of acute asthma in the ER, a PEFR guided protocol neither improved overall PEFR response to treatment nor reduced admission rates when compared with current management as it is practised in Singapore.

Acute Disease↗

PubMed1998

A short standardized protocol for measuring the QKD interval: comparison with 24 h monitoring and reproducibility.

BACKGROUND: Ambulatory measurement for the QKD interval is a new method for evaluation of the rigidity of large arterial trunks. Reliable indices of arterial rigidity can be distilled from the large number of measurements (usually around 100) obtained during 24 h monitoring. OBJECTIVE: To describe a shorter standardized protocol (4 h) including a 15 min effort test on an ergometric bicycle designed to reduce examination time and generate a wider range of heart rates and blood pressures, to test the equivalence of this short protocol with 24 h monitoring and to test its reproducibility. DESIGN: The results of the short protocol were compared with 24 h monitoring results for 15 subjects. The reproducibility of the short protocol for 15 subjects examined twice within 7 days was studied. RESULTS: We found a good correlation between the values obtained with this method and those from 24 h recordings, with comparable reproducibilities in the determination of QKD for systolic blood pressure 100 mmHg and heart rate 60 beats/min. CONCLUSION: A short (4 h) standardized protocol including an exercise test could replace 24 h ambulatory monitoring to assess arterial distensibility through QKD measurement.

Journal Article↗

PubMed1981

Respiratory care protocol: an approach to in-hospital respiratory therapy.

The difficulty of delivering respiratory therapy according to currently accepted standards is an important problem in many hospitals. As a result of this problem in our hospital, we developed a new therapy delivery system--the Respiratory Care Protocol. In response to an order for Respiratory Care Protocol from an attending physician, a senior respiratory therapist evaluates the patient, prescribes specific respiratory therapy according to a protocol, and then daily re-evaluates the patient and makes appropriate therapeutic changes, including discontinuing respiratory therapy when appropriate. The Respiratory Care Protocol has been well-accepted by patients, physicians, and respiratory therapists, and by Joint Commission on Accreditation of Hospitals evaluation teams. We believe that our use of the Respiratory Care Protocol has led to improved quality and to the reduced cost of our in-hospital respiratory care.

Colorado↗

PubMed1999

[A trial of new protocol of rush immunotherapy with standardized mite antigen].

The objective of the present study was (1) to establish a new protocol of rush immunotherapy (IT) using a purified mite antigen for the treatment of house-dust-mite-sensitive bronchial asthma. Ten adult asthmatics were enrolled in the initial trial which was based on a 7-day protocol using a house-dust antigen, to determine the optimal maintenance dose of mite antigen. No systemic side effects were observed when the antigen dose was lower than 50 AU. Consequently, the duration of rush IT was shortened to 5 days, and the maintenance dose was determined as 50 AU in the new protocol. To confirm its safety, another ten asthmatics were enrolled in a second trial. Rush IT using the new protocol was able to be performed without any systemic side effects in all patients except one who showed urticaria at 40 AU. These results suggest that the 5-day protocol of rush IT using the mite antigen is safe in patients with house-dust-mite-sensitive asthma.

Adolescent↗