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At least 559 records · Page 31Linked to original sources
PubMed1992

High-dose cytosine arabinoside remission induction for acute myelogenous leukemia: comparison of two regimens of remission maintenance.

We report a single institution sequential trial of two maintenance treatment regimens for patients with acute myelogenous leukemia (AML). A total of 175 consecutive patients with AML received initial remission induction therapy with high-dose cytosine arabinoside (ara-C) and glucocorticoids. For the initial 63 patients (group A), the control population, planned maintenance treatment was with conventional-dose ara-C given over 4 days for up to 18 months. The subsequent 107 patients (group B) had planned maintenance therapy of up to 6 courses of daunorubicin, ara-C and prednisone and daily cis-retinoic acid for up to two years. The presenting features of group A and B patients were similar as were the response to remission induction, 60 and 52%, respectively. Severe neurological toxicity was encountered once after high-dose ara-C; no drug-related deaths occurred during maintenance treatment. Median duration of remission for group B patients was 9.9 months compared with 5.5 for group A (p = 0.0685). Median survival duration for the two groups was similar, 9.1 months for group A and 10.4 for group B. Survival of patients in group B who attained a complete remission was significantly better than that of patients in group A (p = 0.0439). The studies confirm our initial experience with remission induction using single agent high-dose ara-C and suggest a positive role for maintenance therapy in AML.

Acute Disease↗
PubMed2003

Choice of maintenance medication for schizophrenia.

Unmedicated schizophrenia patients relapse at a rate of approximately 10% per month. Maintenance treatment with antipsychotic medications can reduce this rate dramatically. Ensuring compliance with medication in the maintenance treatment of schizophrenia encompasses 3 areas of concern: (1) choice of antipsychotic medication, accounting for efficacy and side effects; (2) route of administration of medications, considering the benefits and detriments of long-acting injectable and oral medications; and (3) reducing "doctor noncompliance," the failure of some physicians to perceive the need for long-term treatment for patients with chronic schizophrenia. This article focuses on the selection of the antipsychotic medication that will most likely lead to successful maintenance treatment of schizophrenia. Data from acute trials must be relied upon to evaluate the comparative risks and benefits of these agents as long-term treatments since few double-blind, random-assignment studies have compared the newer-generation antipsychotics for maintenance treatment of schizophrenia. Studies of acute treatment, as well as a small number of studies of maintenance treatment, have shown the newer-generation antipsychotics risperidone and olanzapine to be more efficacious and to have a more favorable side effect profile than conventional-generation antipsychotics. Research on the newer-generation antipsychotics, including ziprasidone, aripiprazole, and quetiapine, shows these agents to be efficacious and safe, although the limited amount of data on these agents precludes a definitive evaluation of their efficacy and safety.

Administration, Oral↗
PubMed2004

Human factors in maintenance: impact on aircraft mishap frequency and severity.

INTRODUCTION: Aviation mishaps caused by maintenance factors vary in severity, but can cost untold sums in lives and equipment lost. This study proposes to demonstrate that certain specific maintenance-related human factors are significantly correlated with both mishap frequency and severity. METHODS: Using information from the Maintenance Error Information Management System (MEIMS), 1,016 aircraft mishaps caused by human factors in maintenance were examined. These mishaps were previously categorized using the Human Factors Analysis and Classification System-Maintenance Extension (HFACS-ME). Frequency analysis was used to determine the most common HFACS-ME factors seen in aircraft mishaps. Logistic regression techniques were used to describe the relationship between the dichotomized outcome of mishap severity and the human factors found in the HFACS-ME. RESULTS: Inadequate supervision, attention/memory errors, and judgment/decision errors were the factors found most often in aircraft mishaps. The factors of inadequate design, inadequate adaptability/flexibility, inadequate lighting/light, confining workspace, and attention/memory error increased odds of being associated with a higher severity mishap. DISCUSSION: Emphasis in training and education placed in the first three factors mentioned may reduce overall number of mishaps. Concentrating resources on the final five factors may decrease the number of severe mishaps.

Accidents, Aviation↗
PubMed2004

Population behaviors and language maintenance--a case of the Korean-speaking community in China.

With the regard to language maintenance, one of the most successful in over fifty of ethno-linguistic communities in China is the Korean community with more than two millions of Korean-speakers, in which there have been Regulations Regarding the Ethnic Language Use, and a maintenance-orientated and bilingual education system. However, language attrition comes to be occurring in the Korean community because more than two hundred thousands of Korean-speaking migrants have streamed from the Korean-rural community to the Chinese-urban community for the last twenty years. This paper, in urban-anthropological and sociolinguistic perspectives, is aiming at an analysis of the cause of population moves and the urbanization process of the Korean community as well as their impact on the language maintenance and bilingual education in the Korean community. It is mainly divided into four sections, namely, (1) the situation of Korean-speaking community; (2) the problem of language maintenance; (3) the impact of Korean-speakers moves on language maintenance; (4) the impact of negative growth of population, and (5) the impact of uneven ratio of female population.

Anthropology, Cultural↗
PubMed2004

Cycloheximide enhances maintenance of methamphetamine-induced conditioned place preference.

Accrued evidence demonstrated the necessity of protein synthesis at acquisition, consolidation and expression stages in conditioning/learning tasks, while the underlying mechanisms of the maintenance of memory remained less explored. This study was designed to characterize the maintenance of methamphetamine-induced conditioned place preference, a drug-induced learning and memory. In addition, cycloheximide, a protein synthesis inhibitor, was used to examine the involvement of protein synthesis in the maintenance of such place preference memory. We found that the maintenance of the rapidly-established methamphetamine (2 mg/kg, i.p.) -induced conditioned place preference could be long-lasting and even over fifty days under the present protocol of extinction. Moreover, it was of interest to note the undulating expression of this conditioned place preference throughout the extinction protocol. Most importantly, as the methamphetamine-induced conditioned place preference was acquired and expressed by mice, the saline-pretreated control mice underwent numbers of intermittent extinction across a long-term retention test period, while cycloheximide-pretreated mice exhibited unaltered methamphetamine-induced conditioned place preference throughout the same retention test period. Taken together, we conclude that [1] methamphetamine-induced conditioned place preference could last for a long period of time, and such place preference memory is reluctant to extinguish even animals' repeated exposure to the previous conditioned environment at a drug-free status, and [2] blockade of protein synthesis may enhance the maintenance of the methamphetamine-induced conditioned place preference.

Animals↗
PubMed2004

Applying an artificial neural network to warfarin maintenance dose prediction.

BACKGROUND: Oral anticoagulation with warfarin can lead to life-threatening events as a result of either over-anticoagulation or undertreatment. One of the main contributors to an undesirable warfarin effect is the need to adjust its daily dose for a specific patient. The dose is adjusted empirically based on the experience of the clinician, a method that is often imprecise. There is currently no other well-accepted method for predicting the maintenance dose of warfarin. OBJECTIVE: To describe the application of an artificial neural network to the problem of warfarin maintenance dose prediction. METHODS: We designed a neural network that predicts the maintenance dose of warfarin. Data on 148 patients attending a large anticoagulant clinic were collected by file review. Using correlational analysis of the patients' data we selected the best input variables. The network was trained by using the back-propagation algorithm on a subset of our data and the results were validated against the rest of the data. We used a multivariate linear regression to create a comparable model. RESULTS: The neural network generated reasonable predictions of the maintenance dose (r = 0.823). The results of the linear regression model were similar (r = 0.800). CONCLUSION: Neural networks can be applied successfully for warfarin maintenance dose prediction. The results are promising, but further investigation is needed.

Adolescent↗
PubMed2005

[Clinical study of vecuronium maintenance speed in trigeminal microvascular decompression surgery].

BACKGROUND: Patients receiving chronic carbamazepine therapy may be resistant to vecuronium. The purpose of this study was to determine maintenance speed of vecuronium in trigeminal microvascular decompression surgery. METHODS: The vecuronium maintenance speed of the patient for microvascular decompression diagnosed as trigeminal neuralgia (group T: n=18) or hemi-facial spasm (group C: n=18) was examined retrospectively. Anesthesia was induced with propofol, ketamine, midazolam and buprenorphine. Vecuronium was given to facilitate tracheal intubation. The patients received balanced anesthesia with infusion of propofol, ketamine, buprenorphine and vecuronium (60-80 microg x kg(-1) x h(-1)), with nitrous oxide. In both groups the scheduled vecuronium maintenance speed was increased if needed, using the TOF-Watch, at the time of body movement or with more than four TOF count. RESULTS: All patients of group T were medicated with carbamazepine before operation. None of C received carbamazepine. With C, vecuronium maintenance speed was as scheduled. With T, however, scheduled vecuronium speed increased in most of the cases. Actual vecuronium speed was significantly faster with T, compared with C. Although actual speed divided by scheduled speed was 1 in group C, it was 1.4 in T. CONCLUSIONS: Vecuronium maintenance speed is 1.4 times of scheduled speed in patients medicated with carbamazepine.

Aged↗
PubMed2005

[A randomized, comparative study of rabeprazole vs. ranitidine maintenance therapies for reflux esophagitis--multicenter study].

BACKGROUND/AIMS: Reflux esophagitis is a recurring condition for which many patients require maintenance therapy. This comparative, randomized multicenter study was designed to evaluate the effect of long-term maintenance treatment comparing proton pump inhibitor, rabeprazole and H2 receptor antagonist, ranitidine. METHODS: Eighty four patients with healed reflux esophagitis confirmed by endoscopy were randomly allocated to receive maintenance treatment with either rabeprazole 10 mg once daily or ranitidine 300 mg once daily for 32 weeks. Patients were seen every 8 weeks or at symptomatic relapse. RESULTS: Of 84 initially treated patients, 73 entered the maintenance study. The percentage of asymptomatic patients after 90-day and 210-day treatment were 97% and 81.5%, for rabeprazole and 74.3% and 62.3%, for ranitidine, respectively. After 32 weeks, the relapse rates of esophagitis were 21.3% in the rabeprazole group and 62.9% in the ranitidine group (RR: 0.405, 95% CI: 0.215-0.766). CONCLUSIONS: Maintenance treatment with rabeprazole (10 mg once daily) is superior to ranitidine (300 mg once daily) in keeping the patients with reflux esophagitis in remission over a 32 week period.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1991

[Prediction of the maintenance dose of vecuronium for continuous infusion].

The purpose of this study is to examine how to predict the optimal maintenance dose of vecuronium for continuous infusion, knowing the recovery time from the block induced by the first bolus injection. All patients studied were undergoing surgical procedures and were anesthetized using thiopental, vecuronium, 50% nitrous oxide and 2% enflurane in oxygen. Mechanical twitch responses of adductor pollicis muscle caused by the stimulation of the ulnar nerve supramaximally were monitored. Vecuronium concentrations in the plasma were measured using high performance liquid chromatography. The experiments consisted of two phases. Phase 1.: To demonstrate the relationship between the recovery time (T0-T25) and the maintenance dose. Thirty patients were studied in this phase. A bolus injection was given as the first dose (1.5 mg.kg-1). During the recovery from the first block, recovery time (T1) was measured and the second dose (2 mg) was injected at the T25 (25% control twitch height). After waiting the recovery until the T25, the third dose (2 mg) was injected. The duration (T2) (min) between the second and the third injection was measured. The maintenance dose-recovery time curve was obtained. Y = 52.70.exp (-17.50 X) + 1224.53.exp (-224.27X), X = recovery time (min), Y = maintenance dose (mg.hr-1). Phase 2.: Thirty patients were studied in this phase. Patients received infusions after the bolus injection. The infusion rates were obtained from the maintenance dose-recovery time curve.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Compliance with maintenance therapy after periodontal treatment.

The aim of this study was to investigate the degree of compliance with a post treatment maintenance programme and to establish whether compliance could be related to the clinical assessment parameters before treatment or at the end of the initial phase of treatment. The study was carried out on 231 individuals who had been referred for periodontal therapy. Initial and post treatment plaque and gingivitis levels and pocket depth measurements were evaluated, in order to establish if postoperative compliance could be related to any of the pretreatment clinical parameters, or the changes which took place in these parameters as a result of treatment. It was found that more females tended to comply with the prescribed maintenance programme. Highly significant differences in the clinical parameters were noted for the compliant and non-compliant groups before treatment and at the end of the initial phase of treatment. 42% of individuals did not comply with the prescribed maintenance treatment. It is concluded that the degree of postoperative compliance with maintenance therapy is unrelated to the clinical parameters evaluated. The clinician must therefore recognise that a large percentage of individuals may not comply with the postoperative maintenance programme, although it is not possible to anticipate which individuals are less likely to be compliant from assessment of the clinical assessment parameters routinely used in clinical practice.

Adult↗
PubMed1991

[Motivation and maintenance in periodontal therapy. Experiences of a periodontal practitioner in Brussels].

Periodontal disease is often a chronic and recurrent disease and therapy success is influenced by the quality of oral hygiene, professionally delivered maintenance and compliance of patients towards regular recall programs. In this paper the significance, objectives and organisation of maintenance in the periodontal practice are discussed and guidelines to minimize noncompliance are given. The responsibility of the dental corps in the organisation of maintenance in a qualitative and economically acceptable way is discussed. In order to provide our patients with important maintenance care, auxiliary dental personal, such as hygienists, should legally be allowed to work in the Belgian dental office. In a retrospective study, compliance of patients towards maintenance in a periodontal specialist practice in Brussels was investigated. Of 274 patients enrolled in a recall program only 65% reacted after receiving a recall reminder. Patients treated surgically responded in 76.5% and 47.2% of the patients treated by non-surgical means returned; there was a slight but statistically significant difference in compliance between Dutch (67.5%) and French (59%) speaking patients.

Belgium↗
PubMed1990

Cardiac allograft function with corticosteroid-free maintenance immunosuppression.

Potent prophylactic immunosuppressive protocols promote the safe withdrawal of corticosteroid maintenance. The benefits of corticosteroid-free maintenance immunosuppression include the absence of the cushingoid habitus, fewer infections, less obesity, and lower serum cholesterol. The incidence of allograft coronary artery disease is not increased by corticosteroid-free maintenance. To assess the long-term effects of corticosteroid-free immunosuppression on allograft function, we compared results of hemodynamic study and noninvasive evaluation over the 2-year follow-up of 57 patients on corticosteroid-free maintenance to 40 patients who required corticosteroid. Age and pretransplantation diagnoses were similar, but a greater percentage of those who required corticosteroid maintenance were female (28% versus 2%, p less than 0.001). Indexes of allograft function were similar in both groups and these indexes included ejection fraction, right atrial pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac index, left ventricular end-diastolic dimension, and posterior wall thickness. Patient survival was identical in the two groups (98%). These data indicate that corticosteroids can be safely withdrawn with the subsequent early benefits and without compromising long-term allograft function.

Antibodies, Monoclonal↗
PubMed1990

Influence of corticosteroid-free maintenance immunosuppression on allograft coronary artery disease after cardiac transplantation.

Although the etiology of allograft coronary artery disease, a major limiting factor in long-term survival after cardiac transplantation, is poorly understood, it is undoubtedly in part immune mediated and not detected by routine endomyocardial biopsy. Therefore it is possible that withdrawal of maintenance corticosteroids, although providing other short- and long-term benefits, could increase the prevalence of allograft coronary artery disease by permitting undetected immune-mediated vascular injury to occur. To assess whether corticosteroid-free maintenance immunosuppression increased the prevalence of allograft coronary artery disease, we reviewed serial angiograms of 102 patients (49% not receiving corticosteroid maintenance therapy) who underwent heart transplantation after March 7, 1985. Multiple variables including serum cholesterol, recipient and donor age, sex, blood pressure, rejection frequency and severity, early rejection prophylaxis protocol (polyclonal versus monoclonal T-cell agents), and corticosteroid use were examined in relation to allograft coronary artery disease by univariate and multivariate analyses. Allograft coronary artery disease was identified in 21 patients (seven severe, four moderate, and 10 mild). The prevalence by Kaplan-Meier life-table analysis was 17% at 1 year and 25% at 2 years. No further allograft coronary artery disease was detected among patients undergoing angiography at three years. Increased allograft coronary artery disease was not noted in patients withdrawn from maintenance corticosteroids when compared with their corticosteroid-requiring counterparts. In fact, with each 1 gm increment in cumulative corticosteroid use, a slightly increased risk (1.04, p less than 0.05) of allograft coronary artery disease was noted (Cox regression model). None of the other variables correlated with the prevalence of allograft coronary artery disease. Thus withdrawal of maintenance corticosteroids is not associated with an increased risk of early allograft coronary artery disease and minimization of corticosteroids may lead to a decreased long-term incidence of coronary artery disease in cardiac transplant recipients.

Adrenal Cortex Hormones↗
PubMed1989

[Osseointegrated implants in clinical dentistry. Follow up maintenance phase].

The aim of this study is to determine the method of maintenance care for support the functional condition during long period. The present paper reports on the result of osseointegrated titanium fixture in four complete denture patients. The marginal soft tissue reactions were investigated at the 1st, 3rd, 6th, 12th and 18th month after prothetic restrations by clinical examination and microbiological observations. All abutments were surrounded by clinically in healthy gingiva, however most individuals with the implant fixture had used as a complete denture for many years, without oral hygiene. For a favorable prognosis of the implant-recipients, self plaque control should be acquired for the patients shortly after prothetic restration. Before the healing phase, it is necessary to recall frequently for maintenance marginal soft tissue and prothetic restoration. After healing and remodeling phase, the interval of maintenance care was decided on each 3rd months. The interval seemed practically reasonable because the 18th month later the prognosis was satisfactory. This report presents two cases of complications during the maintenance phase of osseointegrated implants. Case I: A 72-year-old female patient presented gingival hyperplasia formation around the abutment after 19th months on abutment setting. We performed excision of the hyperplastic gingiva and apically positioned flap. Probing depth (PD) could not be determined because of gingival hyperplasia formation before operation, but there was marking reduction of probing depth after operation. The gingival bleeding index (GBI) was improved and the amount of gingival crevicular fluid (GCF) was reduced after operation. In pre-operative anaerobic culture, the proportions of Capnocytophaga species and Haemophilus actinomycetemcomitans were found. Post-operatively, Capnocytophaga sp. was not found, but H. actinomycetemcomitans was unchanged. Case II: A 47-year-old male patient presented gingivitis around the abutment after 13th months on abutment setting. We performed cleaning of the abutment surface with the flap procedure. Furthermore, a joint screw between the fixture and abutment was adapted due to loosening after operation, PD was unchanged, GBI was improved and GCF was slightly reduced. In pre-operative anaerobic culture, Bacteroides intermedius was rich. Post-operatively, B. intermedius was not found. In conclusion, we advocate that maintenance care of osseointegrated implants is the most important factor in the procedure.

Aged↗
PubMed1989

Maintenance of weight loss with recovery of resting metabolic rate following 8 weeks of very low calorie dieting.

The challenge to maintain lost weight is particularly relevant for advocates of VLCD, since these induce a high rate of weight loss. It has been argued that excessive lean body mass is lost with very restricted energy intake regimens which compromises metabolic rate and sabotages weight maintenance. Thirty-nine subjects who had lost an average of 12.3 +/- 2 kg during an 8-week VLCD trial were transferred immediately to a 1500 kcal per day maintenance formula which included solid foods. RMR was determined at four intervals: (1) before dieting; (2) after 2 weeks of VLCD; (3) end of 8 weeks dieting; (4) end of 8 weeks maintenance period. It was observed that the metabolic rate dropped to 86 per cent of original by the end of the 8 weeks of VLCD. Metabolic rate recovered to 93 per cent of prediet values by the end of 8 weeks of weight maintenance on 1500 kcal/day. Following an average 2 kg weight regain within the first week of maintenance, there was no further weight regain. VLCD did not produce losses of RMR beyond that expected from the loss of weight. No difficulty was observed in maintaining weight for 8 weeks on 1500 kcal/day.

Basal Metabolism↗
PubMed1977

Remission maintenance therapy in acute myelogenous leukemia.

Because no conclusive evidence as to the efficacy of maintenance chemotherapy in acute myelogenous leukemia (AML) existed, a study to obtain such information was done. Twenty-six adult patients with AML in whom complete remission had been achieved following induction chemotherapy were randomly assigned to receive either maintenance chemotherapy consisting of cytarabine and 6-thioguanine for two days each month or to receive no maintenance therapy. The data showed a significant difference in remission duration between the two groups, with median remission lengths for the maintained and unmaintained groups being 10.3 and 6.7 months, respectively (p<.05). In 46 percent of the maintained patients there were remissions lasting longer than 11 months, whereas in none of the unmaintained patients was there such a prolonged remission. No significant drug-induced toxicity was observed. That the prolonged exposure to these chemotherapeutic agents, which were also used in our induction program, did not adversely affect the rate of successful reinduction therapy was shown by identical 50 percent complete remission rates for second inductions in both groups. In patients with palpable splenomegaly at the time of diagnosis, there was no prolongation of remission with maintenance therapy. These data indicate the potential utility of maintenance chemotherapy for prolonging remission duration in acute myelogenous leukemia.

Adolescent↗
PubMed1988

Implementation of a microcomputer-based opportunistic health maintenance programme in a general practice teaching clinic.

The general practice teaching clinic at the Chinese University of Hong Kong uses a microcomputerbased medical record system. To implement a uniform and up-to-date health maintenance programme, a set of protocols has been written for a list of health maintenance items, and the computer has been programmed to identify the items which should be carried out at each patient encounter. Over a period of 16 months, after the start of this programme, 99% of the 1120 clinic patients had a minimum of two items performed. Of a selected sample of 203 patients 119 attended the clinic more than once in the same period and 47% of these patients had all of the health maintenance items recommended for their age and sex group completed. Abnormal screening results led to action by the general practice team. The process of implementing a health maintenance programme has helped the team to discuss current recommendations and to agree on standards. The programme has also helped with undergraduate teaching. The automated opportunistic health maintenance programme is a practical tool for improving patient care.

Adolescent↗
PubMed1988

Methadone maintenance in pregnancy: consequences to care and outcome.

A retrospective analysis was conducted on the outcomes of the pregnancies of 26 narcotic-addicted women who were enrolled in a methadone maintenance program. Of these women, 88% continued to use other drugs during their pregnancy, with opiates the most frequently used, and 56% of these women had urine toxicology screens positive for either heroin, cocaine, or benzodiazepines when they presented in labor. When these women were compared with a similar group of 37 pregnant polydrug users who were not in the methadone maintenance program and who delivered during the same 12-month period, there was no difference in the birth weights or in the infants' one- and five-minute Apgar scores. However, the women in the methadone maintenance program had more prenatal visits, more adequate prenatal care, and less anemia than the non-methadone maintenance program drug users. When these two drug-using groups were compared with a control group of pregnant women who delivered within the same time period, there was a significant difference in the birth weights of these two groups. This raises the question of the effectiveness of methadone maintenance programs in promoting fetal growth and well-being and in reducing polydrug use during pregnancy.

Adult↗