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Results for “Patient Selection”

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At least 19 recordsLinked to original sources
PubMed1995

Pelvic lymphadenectomy can be omitted in selected patients with carcinoma of the prostate: development of a system of patient selection.

OBJECTIVES: The prevalence of pelvic lymph node metastases in men with clinically localized prostate cancer has decreased dramatically over the past decade, possibly due to efforts at early detection. With a significantly lower incidence of pelvic node involvement, it may be possible to identify a segment of patients for whom pelvic lymph node dissection (PLND) may be omitted. This study was conducted to develop a method to select patients for whom PLND could be omitted. METHODS: We analyzed serum prostate-specific antigen (PSA), clinical stage, biopsy Gleason score, and final pathologic stage in 481 men with clinically localized prostate cancer. These variables were compared to the risk of positive pelvic lymph nodes. RESULTS: Logistic regression analysis determined that combining all three variables provided the best determination of final pathologic stage. A series of probability curves have been created to estimate the risk of positive lymph nodes in a given patient. Based on the distribution of patients in this study and using these probability functions, PLND could be avoided in up to 50% of patients with localized prostate cancer diagnosed by contemporary methods. CONCLUSIONS: In properly selected patients, pelvic lymphadenectomy can be omitted in the staging and treatment of localized prostate cancer.

Humans↗
PubMed1998

Anemia of cancer patients: patient selection and patient stratification for epoetin treatment.

Epoetin alfa is being used to treat patients with symptomatic anemia of cancer and to prevent or postpone chemotherapy-induced anemia in cancer treatment. As only approximately 50% of unselected anemic cancer patients respond sufficiently to epoetin alfa treatment, careful patient selection according to reliable prediction criteria is of great importance. Predictions of response to epoetin alfa treatment are based either on the degree of blunted erythropoietin response to the anemic condition or on indicators of responsiveness during the early treatment phase. The most accurate predictions of responsiveness, however, are derived from combinations of predictive factors. Combinations of synergistically acting hematopoietic growth factors, particularly epoetin alfa and granulocyte colony-stimulating factor, are beneficial to selected patients with myelodysplastic syndrome and may prolong survival in certain cases. Correction of anemia in cancer patients is particularly important because highly significant correlations have been reported between hemoglobin levels and quality of life in these patients.

Anemia↗
PubMed1983

Patient selection and patient satisfaction.

Patient selection is difficult. Modern-day plastic surgeons are becoming increasingly aware that patient selection is an important aspect of a successful surgical practice. Evaluation of the patient as a whole rather than just the deformity is necessary to avoid dissatisfied patients. Surgeons should, during the initial interview, consider the acronym SAFE, asking open-ended questions and evaluating the patient. Patient selection rules for outpatient facilities are an extension of patient selection in general. Either patient or surgeon may have reasons for choosing the hospital over the outpatient facility for the procedure. The importance of patient selection extends to patient management as a whole. Appropriate management is even more important in the office-based setting because the stress may have more of an impact on the patient than for hospitalized procedures. Awareness of the stress state in surgery and the patient's personality style allows for a knowledgeable surgeon and staff to anticipate behaviors and emotions and use appropriately their power and nurturance to lead the patient to the ultimate goal, a feeling of satisfaction with the surgical result.

Ambulatory Surgical Procedures↗
PubMed2006

Patient selection.

Patient selection is the process by which an evaluating surgeon decides whether to accept responsibility for the care and treatment of a potential patient. It is assumed the physician has the requisite knowledge to assess the anatomic disorder and the technical ability to render appropriate care if needed. The aim of this article is to help the less experienced health care professional sort out which patients, either by true psychological disorder or personality and behavioral traits, pose the highest risk of a poor outcome. An unsatisfactory outcome can be measured not only by failure to resolve the disorder but also by expenditure of a disproportionate amount of practice resources in achieving resolution of the problem.

Arm Injuries↗
PubMed2006

Spinal cord stimulation for critical leg ischemia: a review of effectiveness and optimal patient selection.

Patients suffering from inoperable critical leg ischemia (CLI) ultimately face a major amputation. Spinal cord stimulation (SCS) has been introduced as a possible treatment option. This paper presents the best available evidence from a systematic review on the effectiveness of SCS in these patients and discusses the indications for SCS therapy. A meta-analysis of six controlled trials, including 444 patients, showed 11% (95% confidence interval: -0.02 to -0.20) lower amputation rate after 12 months compared to those treated with optimum medical treatment. In addition, SCS patients required significantly fewer analgesics and showed a significant clinical improvement. These positive effects have to be weighed against the higher costs and (generally minor) complications of SCS. TcpO(2) measurements were found to be useful in selecting the most respondent patients, yielding a 12-month limb salvage up to 83%. Hence, SCS should be considered as a possible treatment option in patients with CLI, particularly if their foot TcpO(2) is between 10 and 30 mmHg.

Acute Disease↗
PubMed1985

Mitral valve prolapse and hyperthyroidism: effect of patient selection.

Patients with mitral valve prolapse and hyperthyroidism have common symptoms; the most outstanding symptom is palpitation. To determine whether or not common symptoms contributed to the reported association of these conditions, we evaluated 220 patients with symptomatic mitral valve prolapse and 216 first-degree relatives in 72 families; 65 relatives with mitral valve prolapse and 151 relatives without mitral valve prolapse, all greater than or equal to 16 years of age. Thirty subjects, aged 49 +/- 13 years (p less than 0.025 vs entire study group), had thyroid disease (23 subjects had definite thyroid disease, seven subjects had probable); 27 of 30 subjects with thyroid disease (90%) were female (p less than 0.005). The age- and sex-adjusted prevalence of hyperthyroidism was significantly higher in probands with mitral valve prolapse than in family members without mitral valve prolapse (3.5% vs 0%, p = 0.03), while an intermediate prevalence of hyperthyroidism (2.2%) was observed in family members with mitral valve prolapse. Thus, the prevalence of hyperthyroidism is increased among symptomatic patients with mitral valve prolapse as compared to family members without mitral valve prolapse, but the prevalence of thyroid conditions is similar among family members with or without this condition. These findings are explained by the effect of common symptoms on clinical detection of both mitral valve prolapse and hyperthyroidism.

Adolescent↗
PubMed2004

VAD with or without subsequent high-dose melphalan followed by autologous stem cell support in AL amyloidosis: Japanese experience and criteria for patient selection.

Patients with AL amyloidosis were treated with VAD (vincristine, doxorubicin and dexamethasone) with or without high-dose melphalan followed by auto-PBSCT according to eligibility criteria based on disease severity, and prospectively investigated the therapeutic benefits and complications. Thirty-one patients were enrolled in this study. VAD and subsequent high-dose melphalan with auto-PBSCT were performed only in patients who met all of the eligibility criteria. Among patients ineligible for this treatment, VAD alone was performed in those with satisfactory general status. Eleven patients met the eligibility criteria, and of these, 7 were treated with VAD and subsequent high-dose melphalan with auto-PBSCT. Seven patients received VAD alone, and the remaining 17 were treated with the supportive therapy. Among the 14 patients treated with chemotherapy, 9 (5 of the 7 treated with VAD and high-dose melphalan, and 4 of the 7 treated with VAD alone) showed complete hematological response with apparent improvement of amyloidosis-related clinical symptoms. Serious complications of chemotherapy were cytomegalovirus infection and pneumocystis carinii pneumonia seen in 1 and 2 patients, respectively. These chemotherapies may be effective for reduction of M-protein and are also useful in improving of amyloidosis-induced organ dysfunction. In patients who cannot tolerate high-dose melphalan, VAD alone is a potent therapeutic option, although there are possible harmful effects on the heart and peripheral nerve.

Adult↗
PubMed1992

Patient selection for treatment with conservative surgery and radiation therapy.

There is now general agreement that treatment with conservative surgery and radiation therapy yields survival equal to mastectomy with the advantage of organ preservation for properly selected patients. When competently performed, such treatment gives highly satisfactory cosmetic results and acceptably low rates of local tumor recurrence. However, there remain numerous controversies concerning patient selection for this treatment option. The factors involved in patient selection may be grouped into three categories: patient factors; clinical factors; and pathologic factors. This article reviews their use. Because breast cancer has a long natural history, long follow up of patients is required for ultimate proof of the relative merits of different selection or treatment policies. However, due to the increasing numbers of patients being treated with conservative surgery and radiotherapy, it appears likely that many of these questions will be answered within the next decade.

Breast Neoplasms↗
PubMed1996

Prospective optimization of patient selection for emergency cranial computed tomography: univariate and multivariate analyses.

RATIONALE AND OBJECTIVES: To determine if the clinical variables that are important for selecting patients for emergency cranial computed tomography (CT) are population dependent. METHODS: Prior to obtaining scans, physicians working in an emergency department in a level II trauma center completed a form describing the indication for the CT examination. These data were matched to the CT scan results and analyzed statistically using univariate and multivariate methods. These results were compared with a prior study at a level I trauma center. RESULTS: Of 551 patients having cranial CT, neurologic examination was positive in 340 and CT scan was positive in 122. The neurologic examination correlated strongly with the results of the CT scan (P < 0.00001). In this patient population, the most important clinical predictors of 17 abnormal CT scans from the 211 patients without positive neurologic examinations were seizure and a history of neoplasm. These high-yield variables differ from our prior retrospective study in which intoxication and amnesia were the important predictors in patients with negative examinations. The difference in predictors between the populations most likely results from different prevalences of trauma and ischemic disease. CONCLUSIONS: Abnormal neurologic examination is the most important criterion available to select patients for emergency cranial CT. Other variables (eg, seizure, amnesia, intoxication, and history of neoplasm) that help select patients without neurologic findings appear to be population dependent.

Brain↗
PubMed1988

Criteria used for patient selection for nursing students' hospital clinical experience.

This study investigated the criteria used by nurse educators when selecting patients for students' hospital clinical experience. Criteria were defined as individual elements or characteristics considered when selecting patients. Factors were defined as broad categories of related criteria. The sample consisted of 54 nurse educators from college and university nursing programs. A researcher-developed questionnaire was used. The three most important criteria for patient selection were: students' individual learning needs, patients' nursing care needs, and matching patients' needs with students' learning needs. One-way ANOVA was performed on the factors by subjects' demographic variables. Teacher-student clinical ratio, program in which teaching, and age most influenced the factors considered (p less than .05).

Clinical Clerkship↗
PubMed1992

Treatment of caliceal diverticular calculi with extracorporeal shock wave lithotripsy: patient selection and extended followup.

We treated 19 selected patients with calculi in 21 caliceal diverticula with extracorporeal shock wave lithotripsy (ESWL). By limiting this treatment to patients with relatively small (less than 1.5 cm.) calculi associated with a radiographically patent diverticular neck, a stone-free state was initially achieved in 11 patients (58%). Of 14 patients with flank pain before ESWL 12 (86%) were rendered symptom-free or markedly improved, often independent of a stone-free state. Extended followup in 13 patients for 12 to 49 months (mean 23.8 months) after ESWL revealed recurrent stones or stone growth in only 1. Although pain relief has remained constant for those initially rendered symptom-free, recurrent infection has been documented in 6 (67%) of 9 patients with infection before ESWL. We conclude that ESWL for selected patients with calculi in caliceal diverticula can achieve a relatively high initial stone-free rate and that recurrent stones may not be inevitable. Treatment in this setting also may provide long-term symptomatic relief that is often independent of a stone-free state. However, recurrent infection is not unusual, especially when associated with residual calculi. Considering the relatively noninvasive nature of this approach, ESWL should be considered an acceptable form of primary management for selected patients with calculi in caliceal diverticula.

Adult↗
PubMed2006

[Echocardiographic evaluation to select patients for cardiac resynchronization therapy].

Wide QRS complex and asynchronous myocardial contraction in heart failure are associated with poor prognosis. Resynchronization can be achieved by biventricular pacing (BVP), which leads to hemodynamic and clinical improvement and reverse remodeling, and may improve survival. However, there is a substantial subset of patients with wide QRS complexes in the electrocardiogram who does not improve despite BVP, and there are findings which suggest that resynchronization therapy may be also beneficial for heart failure patients with normal QRS duration. QRS width predicts the benefit of BVP only with limitation and only correlates weakly with echocardiographically determined myocardial asynchrony. Determination of asynchrony by tissue Doppler echocardiography seems to be the best predictor for improvement after BVP, although no consensus on the optimal method to assess asynchrony has yet been achieved. To date, most studies evaluating tissue Doppler echo in BVP were performed retrospectively and only one prospective study with patient selection for BVP according to echocardiography and electrocardiography criteria of asynchrony has been published. These new echocardiographic tools will help to prospectively select patients for BVP, help to guide implantation and to optimize device programming.

Arrhythmias, Cardiac↗
PubMed2006

Selecting patients for cardiac resynchronization therapy: electrical or mechanical dyssynchrony?

Cardiac resynchronization therapy (CRT) markedly reduces morbidity and mortality in patients with heart failure and prolonged QRS duration. Landmark trials have included over 4000 patients based on their electrocardiogram. A few small, observational, non-randomized, single centre studies of short duration have suggested that echocardiographic measurement of mechanical dyssynchrony may better identify patients likely to benefit from CRT. We objectively review the meaning and measurement of electrical and mechanical dyssynchrony, the strengths and weaknesses of echocardiographic indices of dyssynchrony, and the controversial issue of predicting response to treatment. We conclude that proposals to alter current guidelines for patient selection, and include echocardiography, are misguided. Echocardiographic assessment will only become credible and applicable to clinical practice once used to select patients for large prospective randomized trials which show an improvement in clinical outcome.

Arrhythmias, Cardiac↗
PubMed2001

Patient selection for oral chemotherapy.

Oral chemotherapy has evolved with several new agents such as capecitabine and UFT in active clinical trials or already approved for use in the western world. Several distinct issues, apart from the usual criteria for selecting patients for intravenous chemotherapy, dictate patient selection for these drugs. This article discusses these issues, which include patient preference, selection, and compliance.

Administration, Oral↗
PubMed1991

Results of resection and proposed guidelines for patient selection in instances of non-colorectal hepatic metastases.

Resection of hepatic metastases from carcinomas of the colon and rectum appears to extend the survival time in appropriately selected patients. Selection criteria have been widely published. Similar data for patients with hepatic metastases from primary sites other than the colon and rectum are lacking. To determine which, if any, patients in the latter category benefit from resections, we reviewed ten such instances treated at our institution plus 141 instances of resection for noncolorectal hepatic metastases previously reported. The over-all five year survival rate after resection of noncolorectal hepatic metastases is 20 per cent. When Wilms' tumor is excluded, the five year survival rate is 15 per cent. Approximately four of ten patients with metastases to the liver from Wilms' tumor or carcinoid survived five years after resection. Similar benefit is rarely obtained after resection of hepatic metastases of the breast, kidney, adrenal gland and carcinomas of the stomach; malignant melanoma, and leiomyosarcoma. No extension of survival is apparent for resection of hepatic metastases of gynecologic malignancies or carcinoma of the pancreas. Specific guidelines for selection are discussed in view of the limited prognosis when tumors other than carcinomas of the colon and rectum metastasize to the liver. Careful patient selection and minimization of complications are required.

Adult↗
PubMed2005

Thrombolysis in acute ischaemic stroke: a guide to patient selection.

Thrombolysis should be a routine treatment for selected patients with acute ischaemic stroke and shows promise in a much larger group of patients. This recommendation is based on data from two completed meta-analyses: the Cochrane Library and the rt-PA Study Group individual patient meta-analysis. In patients with ischaemic stroke, treatment with alteplase (recombinant tissue plasminogen activator; rt-PA) is associated with a non-significant excess of deaths, equivalent to about 19 extra deaths per 1000 treated. Furthermore, thrombolysis, regardless of which drug is used, definitely increases the odds of fatal intracranial haemorrhage by 4-fold. However, despite these risks, thrombolysis with alteplase reduces the odds of death or disability, with the benefit being equivalent to about 55 extra independent survivors per 1000 treated. Unfortunately, there are currently too few data to provide a comprehensive guide to patient selection. The available data suggest that younger patients (<80 years of age) who can be treated with alteplase within 3 hours of stroke onset have the most to gain, equivalent to about 100 more independent survivors per 1000 treated. The role of thrombolysis beyond 3 hours, in those with more extensive CT scan ischaemic change, and patients >80 years of age needs further evaluation. In summary, thrombolysis with alteplase is now an established treatment for acute ischaemic stroke, but clinicians need to cooperate in terms of enrolling more patients in further trials if we are to get the most out of this important treatment.

Drug Administration Routes↗