Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Clinical Considerations”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 73 records · Page 4Linked to original sources
PubMedDate not supplied

Magnesium: clinical considerations.

Magnesium is gaining recognition as a clinically important electrolyte. Hypomagnesemia has been associated with a variety of disorders including seizures, malignant ventricular dysrhythmias, and sudden death. The emergency department patients who are most likely to be magnesium deficient include alcoholics, patients who take diuretics, and those in diabetic ketoacidosis. Hypokalemia and hypocalcemia may represent unrecognized hypomagnesemia. Clinical trials and case reports also document increasing interest in magnesium as an effective therapeutic agent for potentially life-threatening problems such as torsade de pointes, digitalis toxicity, bronchospasm, and alcohol withdrawal. We present an overview of hypomagnesemia, review the current literature, and focus on the role of magnesium in the acute care setting and the implications for the emergency physician.

Acute Disease↗
PubMed1996

Pharmacokinetic interactions between antiepileptic drugs. Clinical considerations.

Antiepileptic drug interactions represent a common clinical problem which has been compounded by the introduction of many new compounds in recent years. Most pharmacokinetic interactions involve the modification of drug metabolism; the propensity of antiepileptic drugs to interact depends on their metabolic characteristics and action on drug metabolic enzymes. Phenobarbital, phenytoin, primidone and carbamazepine are potent inducers of cytochrome P450 (CYP), epoxide hydrolase and uridine diphosphate glucuronosyltransferase (UDPGT) enzyme systems; oxcarbazepine is a weak inducer of CYP enzymes, probably acting on a few specific isoforms only. All stimulate the rate of metabolism and the clearance of the drugs which are catabolised by the induced enzymes. Valproic acid (valproate sodium) inhibits to different extents many hepatic enzyme system activities involved in drug metabolism and is able to significantly displace drugs from plasma albumin. Felbamate is an inhibitor of some specific CYP isoforms and mitochondrial beta-oxidation, whereas it is a weak inducer of other enzyme systems. Topiramate is an inducer of specific CYP isoforms and an inhibitor of other isoforms. Ethosuximide, vigabatrin, lamotrigine, gabapentin and possibly zonisamide and tiagabine have no significant effect on hepatic drug metabolism. Apart from vigabatrin and gabapentin, which are mainly eliminated unchanged by the renal route, all other antiepileptic drugs are metabolised wholly or in part by hepatic enzymes and their disposition may be altered by metabolic changes. Some interactions are clinically unremarkable and some need only careful clinical monitoring, but others require prompt dosage adjustment. From a practical point of view, if valproic acid is added to lamotrigine or phenobarbital therapy, or if felbamate is added to phenobarbital, phenytoin or valproic acid therapy, a significant rise in plasma concentrations of the first drug is expected with a corresponding increase in clinical effects. In these cases a concomitant reduction of the dosage of the first drug is recommended to avoid toxicity. Conversely, if a strong inducer is added to carbamazepine, lamotrigine, valproic acid or ethosuximide monotherapy, a significant decrease in their plasma concentrations is expected within days or weeks, with a possible reduction in efficacy. In these cases a dosage increase of the first drug may be required.

Anticonvulsants↗
PubMed1984

Exercise-induced asthma. Physiologic and clinical considerations.

This article discusses the physiologic and clinical aspects of exercise-induced asthma. Alterations in heat and water exchange in the respiratory tract appear to be important in initiating exercise-induced asthma, which can be reproduced by isocapneic hyperventilation with cold dry air. These pulmonary responses are also closely related to the level of non-specific airways hyperreactivity. Proposed mechanisms by which airways cooling and drying produce bronchospasm are reviewed and therapeutic approaches are discussed.

Anaphylaxis↗
PubMed1994

Toward reconceptualising transference: theoretical and clinical considerations.

Two fundamentally different models of transference have emerged, designated herein as the displacement and organisation models. The purpose of this paper is to compare the fundamental features of these two models and to contribute to the development and cohesiveness of the organisation model through the consideration of certain theoretical and clinical issues. Transference is defined here to refer to the primary organising patterns or schemas with which the analysand constructs and assimilates his or her experience of the analytic relationship. While repetitive pathological transferential organisations that are based on traumatogenic experiences variably impede a person developmentally and in conflict-resolution, other transferential organisations are forward-looking crystallisations of developmentally-needed experiences (selfobject transferences). Transference (and countertransference) is viewed as variably co-determined by analysand and analyst. Clinical issues are delineated concerning the process of illuminating the transference in light of the variable contributions of the analyst to the transference, implications for extra-transference, and the differentiation of process and content to determine the meaning of the transference.

Countertransference↗
PubMed1984

Quality assurance in radiation therapy: clinical considerations.

Efforts to develop a Quality Assurance Program at the Joint Center for Radiation Therapy will be described. This will include defining the clinically relevant considerations, describing acceptable goals and allowable variation, developing mechanisms for determining compliance with these goals, and educational approaches toward common understanding. Consideration toward the development of regional and national Quality Assessment Programs will also be discussed concerning auditing techniques, developing a satisfactory reporting format, and creating a worthwhile learning experience for all involved.

Boston↗
PubMed1980

Divorce at midlife: psychic dangers of the liminal period. Part II. Clinical considerations.

This paper presents the results of a clinical investigation into middle divorce. The second of a two part series, it explores the impact of liminality: the "betwixt and between" state often found among a newly-separated of all ages. This state may occur at more than one point in the divorce process, and is associated with heightened trauma. A therapeutic intervention procedure, the divorce ritual, is suggested as a means of ameliorating the effects of liminality.

Adult↗
PubMed2002

Resin-retained bridges re-visited. Part 2. Clinical considerations.

Resin-retained bridges have been used clinically since the 1970s, and offer a more conservative approach to the restoration of edentulous spaces than conventional bridgework. They are easy to place, cheap to fabricate and have been shown to be cost-effective. Despite this, they are not frequently used in general dental practice and they have an undeserved reputation for failure. Since their initial introduction, they have undergone a number of changes to their method of retention, and the materials used in their construction. This has resulted in a predictable, aesthetic restoration which, barring the use of implants, is often the treatment of choice where teeth adjacent to an edentulous space are minimally or not restored. This article hopes to show the clinical techniques required to produce predictable resin-retained bridgework in general practice.

Bruxism↗
PubMedDate not supplied

[Paget disease of the jaws. Review of the subject. Clinical-therapeutic considerations].

Clinical and diagnostic findings of Paget's disease of the jaws are reported; up to date etiological and pathogenical hypotheses are presented. Laboratory data of increased P.A. as a marker of disease evolution is pointed out, particularly the relationship increasing hydroxyprolinuria, because the increase of a malignant transformation. Surgery, always modeling, is limited to cases of severe facial dysmorphosis associated or not with the local disturbance due to compression; in any case it is suggested to perform the surgery in the phases of inactivity of disease, to avoid local complications, such as hemorrhage a infection.

Adolescent↗
PubMed1989

[Cystic lesions of the mucosa of the maxillary sinus. Clinical considerations and differential diagnosis].

The various pathogenic, radiological and clinical aspects of cystic lesions of the maxillary sinus mucosa (pseudocysts, retention cysts, mucocells) are examined together with related problems of differential diagnosis. Such lesions are sometimes found accidentally in the course of routine X-rays or on the basis of clinical indications not directly attributable to the presence of a cyst. Often they are completely asymptomatic so that they are less often recognised than their true incidence and are sometimes confused with maxillary sinus lesions of a totally different origin. In the personal experience described sinusoscopy proved a valuable adjunct to clinical and radiological investigations for the purposes of differential diagnosis and may in some cases form the first stage of treatment. The value of sinusoscopy is also enhanced by the possibility it offers for targeted biopsies at the same time.

Cysts↗
PubMed1996

Clinical considerations for optimal dentinal bonding.

A review of current clinical research has demonstrated that successful attachment with resin-based bonding systems is achieved through brief acidic conditions of dentin, followed by thorough coverage with resin priming and bonding agents. This article discusses factors of clinical relevance in achieving optimal results. Effective priming, using multiple coats to enhance resin penetration to the full depth of dentinal demineralization, is crucial. A thin, uniform layer of bonding resin is a critical, elastic intermediary for absorbing stresses of polymerization shrinkage. An air stream should be used only for evaporation of solvent and not for spreading bonding resin, because use of an air stream causes uneven thinning of this valuable intermediate layer. Contamination of the dentinal surface with excessive moisture or solvent or the presence of air voids will make bonding unpredictable under clinical conditions. Adequate etching of peripheral enamel continues to be an important factor in the long-term retention of adhesive restorations.

Acid Etching, Dental↗
PubMed1993

Clinical considerations in the conjoint use of the Rorschach and the MMPI.

Contemporary clinical and research findings concerning the Rorschach and the Minnesota Multiphasic Personality Inventory (MMPI) indicate that (a) objectivity and subjectivity are relative and not categorical dimensions of these two instruments; (b) apparent contradictions between Rorschach and MMPI results are generative and not invalidating; (c) within limits, false negative findings are not cause for concern in the clinical application of Rorschach and MMPI variables; and (d) differences between the Rorschach and the MMPI in how they are structured and what they measure demonstrate considerable advantage in using them in complementary fashion to support clinical inferences.

Journal Article↗
PubMed2004

Neurosurgical interventions during pregnancy and the puerperium: clinical considerations and management.

Neurosurgical interventions during pregnancy represent a special clinical challenge and require a meticulously selected treatment strategy. A thorough understanding of the underlying pathophysiological mechanisms involving mother and fetus is mandatory. We report our experience with neurosurgical procedures during pregnancy and the puerperium and summarize the difficulties encountered. The emerging diagnostic as well as therapeutic implications in these complex cases are also discussed.

Adult↗
PubMed2006

Bereavement in cognitively impaired older adults: case series and clinical considerations.

The intersection of bereavement and cognitive impairment presents unique clinical challenges that have been overlooked in the literature. Cognitive impairment can interfere with normal ways of coping in the aftermath of loss. Elderly persons with cognitive impairment may have difficulty processing their loss and may even forget that their loved one has died, repeatedly asking other family members when the deceased is coming to visit. This can prove devastating for such individuals and their families, who are forced to keep reexperiencing their grief. This article examines the phenomenology of bereavement-related distress in older adults with cognitive impairment and dementia through a case series gathered from a large geriatric facility. The dilemmas in caring for bereaved elderly with cognitive difficulties and their families are highlighted, drawing attention to a vulnerable population. The purpose of this undertaking is to present a novel classification of a clinically relevant but overlooked issue as well as provide strategies for management and suggestions for future research.

Aged, 80 and over↗