Bibliografías temáticas / Down titration

Literatura académica sobre el tema "Down titration"

Autor: Grafiati
Publicado: 4 de junio de 2021
Última modificación: 20 de febrero de 2023

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Artículos de revistas sobre el tema "Down titration"

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Shafer, Steven L. y Donald R. Stanski. "The Titration Paradox Turns Pharmacology Upside Down". Clinical Pharmacology & Therapeutics 110, n.º 2 (14 de abril de 2021): 292–93. http://dx.doi.org/10.1002/cpt.2235.

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van der Maas, Aatke, Wietske Kievit, Bart J. F. van den Bemt, Frank H. J. van den Hoogen, Piet L. van Riel y Alfons A. den Broeder. "Down-titration and discontinuation of infliximab in rheumatoid arthritis patients with stable low disease activity and stable treatment: an observational cohort study". Annals of the Rheumatic Diseases 71, n.º 11 (13 de abril de 2012): 1849–54. http://dx.doi.org/10.1136/annrheumdis-2011-200945.

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Down-titration, or discontinuing infliximab, has proven to be feasible in RA patients. Therefore, our local treatment protocol includes tapering infliximab dose. This observational study describes the prevalence of successful down-titration in daily clinical practice and its effect on costs and quality of life (QoL).MethodsInfliximab was down-titrated with 25% of the original dose (3 mg/kg) every 8–12 weeks without interval change until discontinuation or flare in all RA patients with stable low 28-joint disease activity score (DAS28) and stable treatment for >6 months. During 1 year DAS28, RA medication, outpatient clinic visits, RA related absenteeism and EuroQoL5D (European QoL questionnaire, EQ5D) were documented. Prevalence of successful down-titration and changes in DAS28, QoL and costs were described.ResultsIn 16% (95% CI 6 to 26) and 45% (95% CI 31 to 59), respectively, infliximab could be discontinued or down-titrated. Mean infliximab dose decreased significantly from 224 mg (95% CI 212 to 236 mg) at start, to 130 mg (95% CI 105 to 154 mg) after 1 year. Median DAS28 increased from 2.5 (p25–75=2.0–2.9) to 2.8 (2.2–3.6) (p=0.002). Extra corticosteroids were given in 8% of the visits. Disease modifying antirheumatic drugs were seldom changed. There was no statistical difference in QoL after down-titration. Mean reduction in the costs was €3474 (95% CI 2457 to 4492) per patient.ConclusionIn the majority of patients with stable low DAS28 and stable treatment, infliximab can be down-titrated or discontinued, which results in a considerable reduction in costs without influencing QoL.
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Birch, J. "Micro-titration of depot neuroleptic dosages". Psychiatric Bulletin 20, n.º 11 (noviembre de 1996): 660–61. http://dx.doi.org/10.1192/pb.20.11.660.

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Depot neuroleptic treatments can be compromised by side-effects unacceptable to users or, more seriously, by tardive dyskinesia (TD). Neuroleptic dosages can be lowered to increase acceptability and decrease the Incidence of TD, but with a greater likelihood of relapse. One argument proposes that many patients changing to lower dosages break down because withdrawal from a neuroleptic is stressful in itself. Research suggests that withdrawal regimes should be radically cautious. A computer tool is offered which can aid clinicians in calculating small reductions.
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Omodeo, Pinuccia. "Down-titration of omalizumab in a patient with chronic spontaneous urticaria". Journal of Dermatological Treatment 29, sup4 (14 de diciembre de 2018): 12–13. http://dx.doi.org/10.1080/09546634.2018.1529379.

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Caffrey, Aisling R. y Eric P. Borrelli. "The art and science of drug titration". Therapeutic Advances in Drug Safety 11 (enero de 2020): 204209862095891. http://dx.doi.org/10.1177/2042098620958910.

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A “one-size-fits-all” approach has been the standard for drug dosing, in particular for agents with a wide therapeutic index. The scientific principles of drug titration, most commonly used for medications with a narrow therapeutic index, are to give the patient adequate and effective treatment, at the lowest dose possible, with the aim of minimizing unnecessary medication use and side effects. The art of drug titration involves the interplay of scientific drug titration principles with the clinical expertise of the healthcare provider, and an individualized, patient-centered partnership between the provider and the patient to review the delicate balance of perceived benefits and risks from both perspectives. Drug titration may occur as up-, down-, or cross-titration depending on whether the goal is to reach or maintain a therapeutic outcome, decrease the risk of adverse effects, or prevent withdrawal/discontinuation syndromes or recurrence of disease. Drug titration introduces additional complexities surrounding the conduct of clinical trials and real-world studies, confounding our understanding of the true effect of medications. In clinical practice, wide variations in titration schedules may exist due to a lack of evidence and consensus on titration approaches that achieve an optimal benefit-harm profile. Further, drug titration may be challenging for patients to follow, resulting in suboptimal adherence and may require increased healthcare-related visits and coordination of care amongst providers. Despite the challenges associated with drug titration, it is a personalized approach to drug dosing that blends science with art, and with supportive real-world outcomes-based evidence, can be effective for optimizing pharmacotherapeutic outcomes and improving drug safety.
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Soldatov, V. S., T. A. Korshunova, E. G. Kosandrovich y P. V. Nesteronok. "Titration of chelating fibrous sorbent in the presence of complex-forming divalent cations". Proceedings of the National Academy of Sciences of Belarus, Chemical Series 57, n.º 3 (5 de septiembre de 2021): 263–69. http://dx.doi.org/10.29235/1561-8331-2021-57-2-263-269.

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Titration curves of H-forms of the fibrous chelating sorbent with iminodiacetic groups based on industrial polyacrylonitrile fiber Nitron with potassium hydroxide in 1M KCl solution in the presence of Ni2+, Co2+, Cu2+ and Ca2+ chlorides were obtained. The method used made it possible to simultaneously measure the pH of the solution and the concentration of the divalent cation at each point of the titration curve. From these data, the dependences of their sorption values on the pH of the equilibrium solution were calculated. The curves of direct and back titration practically coincided in all cases. As the pH changed during titration, precipitation was observed at pH values of precipitation of the corresponding hydroxides. In this case, the increase in pH was suspended or greatly slowed down by adding alkali to the titration cell. The formation of a precipitate occurred mainly in a solution for Co2+ and Ni2+ (pH 8), when the ion exchanger was saturated with a metal ion. In the case of Cu2+ (precipitate formation pH 4), Cu2+ sorption occurs at both lower and higher pH due to ionization of carboxyl groups and partial dissolution of the precipitate. In all cases, the maximum sorption of Ni2+, Co2+, Cu2+, Ca2+ corresponded to the formation of sorption complexes of the R–N(CH2COO-)2Me2+ type.
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Laires, Pedro A., Jackson Tang, Chun Po Steve Fan, Zhiyi Li, Ying Qiu y Kristy Iglay. "Impact of hypoglycemic events and HbA1c level on sulfonylurea discontinuation and down-titration". Expert Review of Pharmacoeconomics & Outcomes Research 17, n.º 2 (30 de junio de 2016): 213–20. http://dx.doi.org/10.1080/14737167.2016.1203259.

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Al Kasab, Sami, Rachael A. Dawson, Jorge L. Jaramillo y Jonathan J. Halford. "Correlation of seizure frequency and medication down-titration rate during video-EEG monitoring". Epilepsy & Behavior 64 (noviembre de 2016): 51–56. http://dx.doi.org/10.1016/j.yebeh.2016.08.026.

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Piaserico, S., P. Gisondi, C. Simone, E. Marinello, A. Conti, P. Amerio y A. Peserico. "Down-titration of Adalimumab and Etanercept in Psoriatic Patients: A Multicentre Observational Study". Acta Dermato Venereologica 96, n.º 2 (2016): 251–52. http://dx.doi.org/10.2340/00015555-2209.

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Ioachimescu, Adriana Gabriela, Richard Joseph Auchus, Wenyu Huang, Joanna L. Spencer-Segal, Kevin Choong Ji Yuen, Kelley C. Dacus, William Henry Ludlam et al. "LBMON177 Dosing And Titration Of Osilodrostat In A Real-world Cohort Of US Patients With Endogenous Cushing's Disease: Analysis Of The ILLUSTRATE Study". Journal of the Endocrine Society 6, Supplement_1 (1 de noviembre de 2022): A473—A474. http://dx.doi.org/10.1210/jendso/bvac150.983.

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Abstract Background Osilodrostat, a potent oral inhibitor of 11β-hydroxylase, demonstrated efficacy in normalizing urinary free cortisol (UFC) in Cushing's disease (CD) patients; however, information describing its use in clinical practice is limited. We present osilodrostat dosing and titration information from a real-world cohort of endogenous Cushing's syndrome (CS) patients, focused on CD. Methods ILLUSTRATE, a retrospective chart review study analyzed confirmed endogenous CS patients who initiated osilodrostat treatment May 1, 2020 - October 29, 2021. Forty-two adult patients with endogenous CS and a prescription for osilodrostat were included in this real-world study. We describe the experience with initial osilodrostat dose, dose titration, and persistence in the CD subset (n=34, 81%). Results In patients with CD (n=34) the mean total daily starting dose was 3.4 mg (SD 1; median 4 mg; range 1-6 mg/day). Twenty-one patients (62%) were initiated on 2 mg BID, 9 (27%) on 1 mg BID, and 1 each (3%) on 1 mg QD, 2 mg QD, 3 mg BID and 4 mg QD. In CD patients with multiple documented clinical encounters (n=26), 16 initiated at 4 mg/day, of which the dose was interrupted or down-titrated in 4 patients (25%) within 71 days of treatment initiation; 2/4 of these patients experienced hypocortisolism related symptoms and permanently discontinued. Five of the 16 patients (31%) were maintained on 4 mg/day throughout the observation period, with a mean (SD) treatment duration of 273 (median 278 days; SD 92) days. Seven of 16 patients (44%) had a dose up-titration; in 6/7 patients, initial dose increase was incremental (1-2 mg BID), and the mean (SD) time to up-titration was 78 (SD 25; median 83; range 40-108) days. In the 10 of 26 CD patients who initiated therapy at <2 mg BID, 6 (60%) did not require dose reduction or interruption, all of which had up-titration in small increments (1-2 mg/day) and/or first titration at ≥80 days. Treatment persistence for those enrolled ≥ 6 months prior to study end was 95.8%, mean (SD) duration of therapy was 339.2 (106.8) days. Osilodrostat was generally well tolerated. Symptoms related to decreased cortisol levels were reported in 10/26 patients (38%), including 3 patients with adrenal insufficiency and 7 patients with glucocorticoid withdrawal symptoms. Conclusion ILLUSTRATE captures real-world US data describing the experience of CD patients treated with osilodrostat. Importantly, one-third (11/34) of patients were initiated on a dose lower than 4 mg/day (lower than starting dose previously used in clinical trials). Of 16 patients initiated at 4 mg/day, 4 (25%) required interruption or down-titration and 5 (31%) remained on the initial dose throughout the observation period. Overall, consistent with prior research data, patients with a gradual dose up-titration (i. e., prolonged titration interval) tended to have greater persistence with therapy. There were no new safety findings. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
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Tesis sobre el tema "Down titration"

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Sothirajah, Shobana. "Clinical Algorithms for Maintaining Asthma Control". Thesis, The University of Sydney, 2008. http://hdl.handle.net/2123/3546.

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Rationale: Asthma management aims to achieve optimal control on the minimal effective dose of medication. We assessed the effectiveness of two algorithms to guide ICS dose in well-controlled patients on ICS+LABA in a double-blind study, comparing dose adjustment guided by exhaled nitric oxide (eNO) to clinical care algorithm(CCA) based on symptoms and lung function. Methods: We randomised non-smoking adult asthmatics on minimum FP dose 100μgs daily +LABA to ICS adjustment using eNO or CCA, assessed over 5 visits during 8 months treatment. Primary endpoints were asthma-free days and asthma related quality of life (QOL). Analysis was by mixed model regression and generalised estimating equations with log link. Results: 69 subjects were randomised (eNO:34, CCA:35) and 58 completed the study. At baseline mean FEV1 was 94% pred., mean eNO (200ml/sec) 7.1 ppb, median ACQ6 score 0.33. Median ICS dose was 500 μg (IQR 100-500) at baseline and 100 μg on both eNO (IQR 100-200) and CCA arms (IQR 100–100) at end of study. There were no significant differences between eNO and CCA groups in asthma-free days (RR=0.92, 95% CI 0.8–1.01), AQL (RRAQL
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Sothirajah, Shobana. "Clinical Algorithms for Maintaining Asthma Control". University of Sydney, 2008. http://hdl.handle.net/2123/3546.

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Master of Science in Medicine
Rationale: Asthma management aims to achieve optimal control on the minimal effective dose of medication. We assessed the effectiveness of two algorithms to guide ICS dose in well-controlled patients on ICS+LABA in a double-blind study, comparing dose adjustment guided by exhaled nitric oxide (eNO) to clinical care algorithm(CCA) based on symptoms and lung function. Methods: We randomised non-smoking adult asthmatics on minimum FP dose 100μgs daily +LABA to ICS adjustment using eNO or CCA, assessed over 5 visits during 8 months treatment. Primary endpoints were asthma-free days and asthma related quality of life (QOL). Analysis was by mixed model regression and generalised estimating equations with log link. Results: 69 subjects were randomised (eNO:34, CCA:35) and 58 completed the study. At baseline mean FEV1 was 94% pred., mean eNO (200ml/sec) 7.1 ppb, median ACQ6 score 0.33. Median ICS dose was 500 μg (IQR 100-500) at baseline and 100 μg on both eNO (IQR 100-200) and CCA arms (IQR 100–100) at end of study. There were no significant differences between eNO and CCA groups in asthma-free days (RR=0.92, 95% CI 0.8–1.01), AQL (RRAQL
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Patout, Maxime. "Evaluation des techniques pour la prise en charge diagnostique et thérapeutique de l'insuffisance respiratoire chronique A Randomized controlled trial on the effect of needle gauge on the pain and anxiety experienced during radial arterial puncture Long term survival following initiation of home non-invasive ventilation : a European study Neural respiratory drive predicts long-term outcome following admission for exacerbation of COPD : a post hoc analysis Neural respiratory drive and cardiac function in patients with obesity hypoventilation syndrome following initiation of non-invasive ventilation Polysomnography versus limited respiratory monitoring and nurse-led titration to optimise non-invasive ventilation set-up a pilot randomised clinical trial Chronic ventilator service Step-down from non-invasive ventilation to continuous positive airway pressure : a better phenotyping is required AVAPS-AE versus ST mode : a randomized controlled trial in patients with obesity hypoventilation syndrome Technological advances in home non-invasive ventilation monitoring : reliability of data and effect on patient outcomes Efficacy of a home discharge care bundle after acute exacerbation of COPD Prediction of severe acute exacerbation using changes in breathing pattern of COPD patients on home noninvasive ventilation Charasteristics and outcome of patients set up on high-flow oxygen therapy at home Trial of portable continuous positive airway pressure for the management of tracheobronchomalacia". Thesis, Normandie, 2019. http://www.theses.fr/2019NORMR115.

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L’insuffisance respiratoire chronique est un syndrome défini par une défaillance monoviscéralerespiratoire. Sa principale origine est aujourd’hui le syndrome obésité-hypoventilation qui concerne 4 à 5% des patients obèses. L’IRC est aussi le stade évolutif terminal de la bronchopneumopathie chronique obstructive qui touche 6 à 8% de la population adulte. L’incidence de ces pathologies et donc de l’insuffisance respiratoire est en augmentation constante. Dans cette thèse, nous avons évalué les nouvelles modalités diagnostiques et thérapeutiques qui pourraient améliorer la prise en charge des patients atteints d’insuffisance respiratoire chronique.Concernant la prise en charge diagnostique, nous avons montré que les données fournies par l’électromyographie de surface des muscles intercostaux, outil qui évalue le travail respiratoire, constituent un marqueur pronostique indépendant chez les patients atteints de bronchopneumopathie chronique obstructive. Nous avons également montré leur pertinence pour prédire l’efficacité clinique et l’observance à la ventilation non-invasive à domicile.Concernant la prise en charge thérapeutique, nous avons montré que l’utilisation d’un mode semi-automatisé de ventilation non-invasive a la même efficacité que celle de modes classiques en permettant une mise en place plus rapide du traitement. Nous avons également rapporté l’intérêt de l’oxygénothérapie à haut débit au domicile alors que ce traitement était utilisé jusque-là dans le seul cadre des soins intensifs. Enfin, nous avons rapporté les bénéfices de la pression positive continue au cours de l’effort chez les patients ayant une trachéobronchomalacie. Concernant le suivi des patients, nous avons montré que les données des logiciels de ventilation non invasive permettent de prédire la survenue d’une exacerbation sévère de BPCO mais que l’utilisation de la télémédecine chez les patients insuffisants respiratoires chroniques ne peut être encore pleinement intégrée dans la pratique clinique. Au cours de cette thèse, nous avons identifié de nouveaux outils physiologiques, de nouvelles modalités d’administration des traitements et de nouveaux outils de suivi à domicile, à même d’améliorer la prise en charge des patients insuffisants respiratoires chroniques
Single-organ respiratory failure defines chronic respiratory failure. Obesity hypoventilation syndrome is the main cause of chronic respiratory failure and occurs in 4 to 5% of obese patients. Chronic respiratory failure is also the end-stage evolution of chronic obstructive pulmonary disease that has a prevalence of 6 to 8% in the adult population. The incidence of these diseases increases so does the incidence of chronic respiratory failure. In this thesis, we will evaluate novel diagnostic and therapeutic modalities that could improve the care of patients with chronic respiratory failure. Regarding diagnostic modalities, we have seen that evaluating the work of breathing with surface parasternal electromyography was an independent prognostic marker in patients with chronic obstructive pulmonary disease. We have also seen that it was a relevant tool to predict the clinicalefficacy and compliance to home non-invasive ventilation. Regarding therapeutic modalities, we have shown that the use of a semi-automatic mode of non-invasive ventilation had the same efficacy of a standard mode with a shorter length of stay for its setup. We have shown the relevance and feasibility of the use of high-flow oxygen therapy in the home setting whilst it was only used in intensive care units. Finally, we have shown the benefits of continuous positive airway pressure during exertion in patients with tracheobronchomalacia. Regarding patients’ follow-up, we have shown that the use of data from built-in software could predict the onset of a severe exacerbation of chronic obstructive pulmonary disease. However, we also show that the implementation of tele-medicine in patients with chronic respiratory failure cannot be included in daily clinical practice yet. In this thesis, we have identified novel physiological tools, novel ways to administer treatments and novel follow-up tools that can improve the management of patients with chronic respiratory failure
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Capítulos de libros sobre el tema "Down titration"

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"of an of slowing down the". En The Grand Titration, 24–28. Routledge, 2013. http://dx.doi.org/10.4324/9781315018867-7.

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Malecek, Kathryn y Alexander Ruthenburg. "Validation of Histone-Binding Partners by Peptide Pull-Downs and Isothermal Titration Calorimetry". En Methods in Enzymology, 187–220. Elsevier, 2012. http://dx.doi.org/10.1016/b978-0-12-391940-3.00009-3.

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"where K = kelvin. Because of the low temperature elevation in the low dose range, radiation calorimetry is limited in practice to the dose range above 3 kGy. This small temperature elevation is the gross result of the complex process of radiation interaction with matter. The individual steps of this process depend on the type of radiation used. Another type of physical dose meter, one that is used more and more in research and in industrial practice, is the alanine/electron spin resonance (ESR) system. Stable free radicals produced by irradiation in a concentration propor­ tional to the radiation dose in samples of pure, dry alanine are measured by ESR spectroscopy. The alanine is usually mixed 4:1 with paraffin (26) or 1:1 with polystyrene (27) of analytical grade quality. Reproducible dose response curves are obtained in the extremely wide dose range of 1 Gy to 100 kGy. In principal, any reproducible change caused by irradiation of a medium can be used to measure the absorbed radiation dose. In practice, only those changes can be evaluated which are stable for a reasonable length of time and which can be reliably measured by standard procedures such as titration or spectrophotometry. The chemical change is usually expressed as the G value, which is a measure of the number of atoms, molecules, or ions produced ( + G) or destroyed ( -G ) by 100 eV of absorbed energy. In the new SI system of units the G value is expressed as per J instead of per 100 eV. An important reference dose meter in food irradiation is the ferrous sulfate or Fricke dose meter. It is based on the radiation-induced oxidation of ferrous ions (Fe + ) to ferric ions (Fe + ) and consists of measuring the increased optical absorbance of the ferric ions at the absorption peak of 305 nm. For 60Co gamma rays the G value for ferric ion yield is 15.6 Fe3+ ions per 100 eV, or 9.74 X 1017 ions/J; the yield for electrons at a dose rate of 108 Gy/sec is 13.0. Fricke dosimetry is useful in the range 3 Gy. The upper limit can be extended into the kGy range by adding CuS04, which reduces the G value from 15.6 to 0.65. There are many other systems, such as the ethanol-chlorobenzene dose meter, which is based on the formation of hydrochloric acid from chlorobenzene. The hydrochloric acid can be measured by titration or by its effect on the dielectric constant. The useful dose range of this system is 1-400 Gy. In the low dose range, down to 5 Gy, radiochromic dye dosimetry can be used. When the colorless solution of pararosaniline cyanide in 2-methoxyethanol and glacial acetic acid is irradiated, an intense red color develops with an absorption maximum at 549 nm. More recently proposed methods belonging to the group of liquid dose meter systems are listed in Table 3. PMA (polymethyl methacrylate) dose meters belong to the group of solid phase dose meters. Irradiation of PMMA (e.g., Perspex) induces an absorption". En Safety of Irradiated Foods, 50. CRC Press, 1995. http://dx.doi.org/10.1201/9781482273168-39.

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Actas de conferencias sobre el tema "Down titration"

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Cavallaro, Alberto y Laxman Saggere. "Picoliter Fluidic Flow Characterization Using Ion-Selective Measurement". En ASME 2005 International Mechanical Engineering Congress and Exposition. ASMEDC, 2005. http://dx.doi.org/10.1115/imece2005-82646.

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Techniques for accurate measurement of liquid flows involving volumes on the order of nanoliters and picoliters are critical for advancement of microfluidics applications. Although several techniques for measurement of microfluidic flows where a liquid is dispensed on to a target are available today, no proven techniques currently exist for measurement of microfluidic flows where a liquid is injected into a liquid media. Motivated by such a measurement need in a current project, this paper presents a novel experimental technique to measure bulk-flow of a liquid dispensed into another liquid medium with sensitivity down to picoliter range. This technique is based on the principle of titration of two liquids and measurement of hydrogen ions in the resulting solution. The critical components of the system that enable the proposed technique are: A highly sensitive hydrogen ion concentration (pH) sensor and a device to dispense very small, calibrated, volumes of liquid. Since commercially available hydrogen ion sensors are bulky for use in the proposed technique, a hydrogen ion sensor element that provides a sensing tip dimension on the order of a few microns is fabricated from a glass capillary for the current study. Dispensing of calibrated volumes of liquid is accomplished by means of a calibrated syringe for volumes in nanoliter range and a glass capillary for volumes in picoliter range, the latter serving as a dispensing port of a diameter of about 2 μm. The paper includes details of experiments where the proposed technique is first applied to precisely predict injections of 20 and 40 nL volumes and then extended to demonstrate the sensitivity of the sensor element to injections of volumes in the picoliter range. The preliminary experimental results presented generally validate the principle involved in this technique and suggest that the technique is virtually scalable to any volume flows typically encountered in the microfluidics applications.
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