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PubMed1988

Methadone maintenance patients in general medical practice. A preliminary report.

Medical maintenance is the treatment by primary care physicians of rehabilitated methadone maintenance patients who are stable, employed, not abusing drugs, and not in need of supportive services. In this research project, physicians with experience in drug abuse treatment provided both the pharmacologic treatment of addiction as well as therapy for other medical problems, as needed. Decisions regarding treatment were based on the individual needs of the patient and on currently accepted medical practice rather than on explicit regulations. We studied the first 40 former heroin addicts who were transferred to this program from more conventional methadone clinics. At a follow-up visit at 12 to 55 months, 33 (82.5%) of 40 patients had remained in treatment; five (12.5%) had been discharged because of cocaine abuse and two (5%) had been voluntarily discharged. Personal benefits of medical maintenance include the dignity of a standard professional atmosphere and a more flexible reporting schedule. This program has the potential for improving treatment of selected methadone maintenance patients.

Counseling↗
PubMed1988

Toxoplasma gondii maintenance in tissue culture: a new efficient method for culturing RH tachyzoites.

We describe here a new tissue culture method for prolonged laboratory maintenance of tachyzoites of the highly virulent RH strain of Toxoplasma gondii. Using a rapidly proliferating murine tumor cell line (YAC-1), the method described is easy to perform and is as or more efficient (both in terms of yield and cost) than other traditional methods for maintenance of the parasite. Furthermore, upon prolonged maintenance (greater than 160 days) in YAC-1 tissue culture, the pathogenicity of the parasite, as well as its capacity to elicit an immune response, are comparable to that of organisms maintained in mice. We conclude therefore, that the method described herein is a suitable alternative to the traditional method of maintenance of virulent RH strain T. gondii tachyzoites.

Animals↗
PubMed1986

Health maintenance of the elderly.

Health maintenance of the elderly is an attractive concept in both humanitarian and economic terms. However, knowledge of this subject is in its infancy. Available information suggests that effective maintenance for this age group may be difficult, will require a broader range of strategies than with younger adults, and may not be without risk of significant iatrogenic insult from the measures employed. Therefore, this article discusses the principles by which health maintenance measures should be applied to the elderly population, evaluates the role of screening, outlines two health maintenance packages that appear simple safe and effective to apply, and examines briefly the cost implications of the measures described.

Aged↗
PubMed1985

UVB doses in maintenance psoriasis phototherapy versus solar UVB exposure.

A possible increase in the risk of skin cancer in psoriatic patients treated with long-term maintenance UVB phototherapy was assessed by comparing the cumulative doses of UVB with the amount of UVB received from sunlight by normal healthy people. The biologically-effective UVB dose (termed UVB(EE) ) was measured using polysulphone film and worn as a badge by individuals with either an indoor or an outdoor occupation during 4 summer months of 1983 in The Netherlands (52 degrees N). The calculated mean annual UV-B(EE) doses were 5.9 J/cm2 for persons with an indoor occupation and 134 J/cm2 for those with an outdoor occupation. The UVB(EE) doses received by psoriasis patients during an initial course of phototherapy, as well as during maintenance treatment, were also estimated and gave a mean value of 22 J/cm2. Mean annual amounts of solar UVB(EE) exposure were calculated and compared with the administered doses of UVB(EE) during maintenance phototherapy. A dose-response model is described in order to estimate the increased incidence of non-melanoma skin cancer associated with such therapy. The cumulative incidence among patients who received maintenance phototherapy for several decades was calculated to be a factor of 2.5 to 7.5 higher than the incidence among individuals with an outdoor occupation.

Humans↗
PubMedDate not supplied

Biomedical equipment: maintenance factors, units of measurement, and standards.

The scope of biomedical equipment maintenance in health care institutions is typically determined by the available manpower and time resources. This paper reviews 27 factors that influence this maintenance, discusses the units of measurement that have been used to assess maintenance effectiveness, and outlines the steps needed to develop appropriate standards for determining whether the maintenance is effective.

Costs and Cost Analysis↗
PubMed1984

Cooperative randomized studies on the treatment of adult acute leukemia in Poland. A comparison of two remission induction regimes and two maintenance regimes for AML.

In a prospective study 100 AML cases were randomized in two groups and underwent remission induction treatment in 4 departments with "Ara-C c. inf. from the first to the eight day plus Adr. from the first to the third day" or "Ara-C + 6-TG + Adr., 6 + 6 + 2 days". The CR patients were divided into two subgroups. Subgroup A obtained maintenance therapy with 5 day course of Ara-C s.c. in addition to 6-TG, Vincristine plus Prednisone and Adriamycin sequentially, with each cycle repeated at 6 week intervals. Subgroup B obtained the calf thymus extract (TFX-Polfa) between the cycles additionally. The current results of remission induction treatment are similar to "8 + 3" and "6 + 6" regimens as measured by the CR rate (45% and 44%), survival curves (survival after 24 months - 23% and 28% respectively) and relapse rates (3.5%/pt.mo.obs. and 5.3%/pt.mo.obs.). It is still too early to evaluate the efficacy of this maintenance treatment, because the programme is still open to patient entries. At present 13 patients received maintenance regimen A and 12 patients received maintenance regimen B, with an average survival being equal to 14 and 13.5 months respectively.

Adult↗
PubMed1984

Safety of ranitidine maintenance treatment of duodenal ulcer.

During maintenance treatment with nocturnal ranitidine (150 mg) for 1 year, 38% of duodenal ulcers relapsed. Twenty-one patients whose ulcers remained healed after maintenance treatment for 1 year continued to receive ranitidine (150 mg at night) for a further year, while 26 patients with healed ulcers received placebo in a randomized double-blind study. The rate of recurrence of duodenal ulcers during the 2nd year of follow-up study was 18% in ranitidine-treated individuals and 87% in those receiving placebo. The ulcer recurrences of patients receiving ranitidine tended to be asymptomatic and were clinically mild in the rest. Recurrences in patients receiving placebo were usually symptomatic and significantly more likely to be associated with bleeding. We conclude that ulcers that remain healed after 1 year's maintenance treatment with ranitidine tend to remain healed if maintenance treatment is continued. Moreover, this type of continuous treatment of duodenal ulcer is clinically safer than no treatment of the ulcer disease.

Clinical Trials as Topic↗
PubMed1983

Prediction of lithium maintenance doses using a single point prediction protocol.

Conflicting reports regarding the utility of a previously described single point prediction dosing method for lithium prompted the present study's reexamination of the relationship between a single point lithium concentration and the lithium maintenance dose. Seventeen informed, adult patients with affective illness were studied. The relationship between their 24-hour lithium concentration after a test dose and the maintenance dose was significant, hence confirming earlier reports. In addition, more confident relationships were noted when steady state range concentrations for lithium prophylaxis (0.41 to 0.89 mEq/liter) and for treatment of acute mania (0.9 to 1.27 mEq/liter) were analyzed separately. Maintenance dose predictive equations were generated for these lithium steady state ranges from a 24-hour single point level after a 1200-mg test dose. The clinical usefulness of the new relationships observed for maintenance dose prediction must await prospective testing.

Adult↗
PubMed1983

Leptospirosis and the maintenance host: a laboratory mouse model.

A laboratory mouse model was used to investigate the criteria that have been suggested as differentiating between a maintenance host and an accidental host for a particular leptospiral serovar. The comparative studies were conducted with serovars ballum, pomona, balcanica and hardjo. The relative pathological response, ratio of serological to bacteriological prevalence, level of serological response, age-susceptibility to infection and demonstration of artificial intraspecies transmission were found to be inadequate criteria with which to differentiate maintenance and accidental hosts for a particular serovar. The demonstration of natural intraspecies transmission was considered to be the definitive criterion for differentiating such hosts. In the light of the results obtained from the laboratory mouse model and the results obtained from field studies, a maintenance host may be defined as an animal which is capable of acting as a natural source of leptospiral infection for its own species. A maintenance population may be defined as a population of a species of animal which acts as a continuous reservoir of a serovar in a specific ecosystem.

Age Factors↗
PubMed1981

Photochemotherapy of psoriasis. Clinical study of clearing and long-term maintenance treatment.

PUVA therapy was administered to 140 patients with psoriasis. The results of clearing and long-term maintenance treatment are reported. Clearing requirements were in general similar to those reported by Melski and co-workers. The skin of a majority of the patients (79%) could be kept in a good condition by a maintenance-treatment schedule of once every 2 weeks or less. This result is better than the results reported by other authors. Extra topical treatment for residual lesions during maintenance consisted of small amounts of corticosteroids. The maximum length of the treatment intervals during maintenance showed definite individual variations. Patients who required one treatment a week or more to keep the skin cleared were dropped from the study.

Adolescent↗
PubMedDate not supplied

Trial of Badoe's maintenance solution.

The adult West African on intravenous fluid therapy requires 130 mmol of sodium, 50 mmol of potassium and 3L of water daily. At least 100g of glucose is usually provided. Three liters of Badoe's Maintenance Solution which contains 43.3 mmol of sodium of sodium, 16 mmol of potassium, 0.65 mmol of calcium, 9 mmol of bicarbonate, 51.7 mmol of chloride and 100g of sorbitol per litre, provides all the daily requirements of sodium, potassium and water. It also provides about 5000j of energy, nearly two-thirds of the resting energy expenditure. The trial in seven ill patients from the first day after operation has shown that the serum concentration of sodium and potassium and the urinary output of patients on 3L of Badoe's Maintenance Solution alone daily remain normal. Badoe's Maintenance solution is, therefore, recommended as the standard maintenance solution for patients in balance who need intravenous fluid therapy. It simplifies fluid therapy for medical and nursing staff as only one solution is used.

Adolescent↗
PubMed1995

[Analysis of maintenance of redundant genetic structures in the yeast Saccharomyces cerevisiae: effect of mutations cdc28-srm and srm1].

The effects of nuclear gene mutations cdc28-srm and srm1 on the maintenance of various recombinant facultative genetic structures (FGSs) in Saccharomyces cerevisiae were studied. These structures are ARS1 TRP1 mini-coils, noncentromeric circular plasmids containing various ARS elements, and extended linear yeast artificial chromosomes (YAC). These mutations led to an increase in the mitotic stability of some of the FGS tested and the disturbed maintenance of the others. Mutation srm1 imposed a stabilizing effect on the maintenance of various recombinant FGSs with ARS chromosomal elements. Mutation cdc28-srm destabilized the maintenance of only those recombinant FGS that shared full or detectable homology with sequences of the nuclear genome of the yeast cell.

Chromosomes, Artificial, Yeast↗
PubMedDate not supplied

Computerized health maintenance tracking systems: a clinician's guide to necessary and optional features. A report from the American Cancer Society Advisory Group on Preventive Health Care Reminder Systems.

BACKGROUND: To promote preventive health care by primary care physicians and the development of computerized health maintenance tracking systems, the American Cancer Society sponsored an expert advisory group to define necessary and desirable, but optional features of computer-based health maintenance tracking software for use in primary care practice. METHODS: Systematic literature review and structured consensus development were followed by independent expert critique. RESULTS: Necessary input features include a comprehensive, practice-specific health maintenance protocol, multiple entry codes to indicate the current status of each procedure, and a mechanism for patient-specific exclusion or alteration of procedure frequency. Necessary features of the information management system include a linkage to a demographic data system, optional tracking of all or selected patients, identification of each patient's primary provider, and the ability to provide either a paper or electronic interface for the provider. Necessary outputs include provider reminders, patient reminders sent regularly regardless of visit status, and summary reports of provider and patient compliance. CONCLUSIONS: Although the ideal computer-based health maintenance tracking system is still evolving, knowledge of these necessary and optional features can aid clinicians interested in buying or developing a system for their own practice.

Preventive Medicine↗
PubMed1995

Use of a single solution for oral rehydration and maintenance therapy of infants with diarrhea and mild to moderate dehydration.

OBJECTIVE: To compare the efficacy of two commonly used solutions in the rehydration of infants with mild to moderate dehydration caused by acute diarrhea in the United States. DESIGN AND SETTING: Double-blind, parallel-group, randomized study performed at Children's Hospital Medical Center. PATIENTS: Sixty infant boys (< or = 2 years old), with mild (< or = 5%) or moderate (6 to 9%) dehydration caused by acute diarrhea of less than 1 week's duration were included in the study. INTERVENTIONS: Infants were randomly assigned to receive treatment with either a glucose-based oral rehydration solution (ORS) (Pedialyte, Ross Laboratories, Columbus, OH) or a rice syrup solids-based ORS (Infalyte, Mead Johnson Nutritional Group, Evansville, IN). After rehydration was achieved, patients entered a maintenance phase during which, in addition to a maintenance ORS, breast milk or a soy-based formula was offered; infants older than 1 year were also given a lactose-free diet. OUTCOME MEASURES: Rehydration was judged clinically. Infants remained on a metabolic bed during the study in to separate and quantitate urine and stool output. Therefore, in addition to clinical outcome, we compared intake, output and apparent absorption and retention of fluid, sodium, and potassium between groups. RESULTS: All patients were successfully rehydrated using an ORS without the use of intravenous fluids. No differences were detected between treatment groups in time to rehydration, percentage of weight gain after rehydration, consumption of ORS to achieve rehydration, or stool output. However, the apparent sodium absorption (net intake less fecal output) was greater in the Infalyte group than the Pedialyte group during the first 24 hours. CONCLUSION: The two maintenance oral electrolyte solutions (Pedialyte and Infalyte) most commonly used in the United States are effective as rehydration solutions for infants with mild to moderate dehydration. We speculate that a strategy for oral rehydration therapy in the United States, based on the use of a single solution during the rehydration and maintenance phase, might gain additional acceptance by practicing pediatricians and family physicians.

Acute Disease↗
PubMed1994

Patient-carried card prompts vs computer-generated prompts to remind private practice physicians to perform health maintenance measures.

BACKGROUND: We compared the efficacy of a computer-generated prompt sheet placed on the front of patients' charts with a patient-carried prompt card to remind physicians to perform selected health maintenance items. METHODS: A randomized prospective single-blind study was performed in private practice offices in rural eastern North Carolina, with 28 family practitioners and nine general internists participating. Twenty-two physicians were randomized to the computer prompt group and 22 to the card prompt group. Four physicians in the computer group did not complete the study because of computer software problems, and three physicians did not complete the study because their limited staff was unable to enter patient data into the computer. Before the intervention, 20 patient charts (10 males and 10 females) from each physician were audited for the performance of influenza vaccinations, stool for occult blood, pap smears, breast examinations performed by the physicians, and mammograms. One year after the intervention was instituted, chart audits for the above five items were done again on 20 different patient charts for each physician. RESULTS: There was a 7% increase in the performance of influenza vaccinations in the card group (17% vs 24%) compared with a 6% increase in the computer group (20% vs 26%). There was a 5% decrease in the performance of stool for occult blood in the card group (28% vs 23%) compared with a 1% increase in the computer group (30% vs 31%). There was an 11% decrease in the performance of pap smears in the card group (26% vs 15%) compared with a 3% increase in the computer group (23% vs 26%). There was a 2% decrease in the performance of breast examinations by the physician in the card group (35% vs 33%) compared with a 3% increase in the computer group (30% vs 33%). Finally, there was a 3% increase in the performance of mammograms in the card group (22% vs 25%) compared with an 11% increase in the computer group (15% vs 26%). CONCLUSIONS: Our data show a greater increase in performance of health maintenance items in the computer-prompted group. The performance of stool for occult blood, pap smears, breast examinations performed by the physician, and mammograms were increased more in the computer-prompted group than in the card group. However, there was not a statistically significant difference after intervention for any of the audited health maintenance items for either the computer group or the card group. Overall, health maintenance measures were performed in only a minority of appropriate patients.

Adult↗
PubMed1993

[Treatment of polycythemia with 32P with or without hydroxyurea maintenance therapy. Preliminary results in 237 elderly and high vascular risk subjects studied since 1980].

Between 1980 and 1992, 237 polycythaemic patients aged 65 or more, or with high vascular risk factors were treated with 32P according to a protocol using, or not, maintenance therapy with low-dose hydroxy-urea (500 mg/day). The present follow-up covers 1448 years/patient. Maintenance therapy was seldom discontinued because of blood toxicity or gastrointestinal intolerance, but it was stopped in 20 percent of the cases because monitoring was difficult in very old patients. Maintenance therapy reduced the mean annual 32P dose by at least 50 percent. However, the actual risk of malignant blood diseases (myelodysplasia, acute leukaemia, lymphoma) was similar in the two arms of the protocol: 14 percent at the 10th year. Compared with the French population of the same age-groups, there was no excess of epithelial cancers in both arms. Maintenance therapy did not control platelet counts perfectly. The risk of severe vascular events was identical in both arms; probably no higher than expected at that age and significantly lower than in previously published data. The actuarial survival curves in both groups showed a 50 percent survival of about 11 years, i.e. very near to that of the reference French population (12.5 years) of similar sex and age.

Age Factors↗
PubMedDate not supplied

Six-month maintenance treatment of duodenal ulcer with sucralfate: influence on antral gastritis and Helicobacter pylori antral colonization--a prospective uncontrolled study.

Fifty-four patients (41 men, 13 women), aged 17 to 78 years (mean +/- SD, 48.13 +/- 13.5 years), with endoscopically confirmed healing of their duodenal ulcer after treatment with sucralfate (2 gm BID for 4 to 8 weeks) were recruited for this study. They were started on a 6-month maintenance treatment with sucralfate 1 gm BID. Endoscopy was done at the end of the 6-month period or whenever there was any evidence of ulcer relapse. Helicobacter pylori antral colonization (CLO test) and antral gastritis were estimated from biopsy samples taken before, and at the end of, the healing treatment, as well as at the end of the maintenance treatment. Cumulative relapse rate after 6 months was 15% (8 of 54). No patient discontinued treatment because of side effects. No influence of sucralfate on H pylori antral colonization or antral gastritis was observed after the healing or maintenance treatment. It is concluded that sucralfate 1 gm BID for 6 months is an effective maintenance treatment for duodenal ulcer, but has no beneficial effect on either H pylori antral colonization or antral gastritis.

Adolescent↗
PubMed1993

Antidepressant maintenance medications: when to discontinue and how to stop.

Most depressive disorders, once developed, have a lifetime course. For the majority of patients, the risk for future episodes increases as the number of past episodes increases. The length of the well interval between episodes becomes progressively shorter with each new episode. Those who are older at onset often have higher probabilities of relapse during future years if not maintained on treatment. As the number of episodes grows larger and the patient becomes older, severity often intensifies, treatment responsivity to conventional antidepressants may diminish or even disappear, and the destructive consequences of the disorder progressively worsen. This destructive lifetime pattern can be prevented in many if not most patients since antidepressant and other maintenance medications are being shown to be efficacious in preventing most future episodes of depression, maintaining euthymia, and preserving quality of life. On the basis of these and other still-developing findings (and with the recognition that maintenance strategies have been inadequately tested in depressed children and adolescents), reasonable clinical wisdom might suggest that lifetime pharmacologic maintenance may be indicated for patients 50 years or older at first episode, 40 years or older with two or more prior episodes, or for those with three or more prior episodes. "Maintenance" dosages need to be comparable to established "treatment" dosages until it is proven that lower doses are efficacious; such data now are lacking. When medication is selected for long-term treatment, strong considerations should be given to the agent's side effect profile, since compliance is essential for success.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗