PRELIMINARY VALIDATION OF NEW DEVICE FOR STUDYING SLEEP Germain A, Buysse DJ, Kupfer DJ Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Introduction : This study examined the validity of the BodyMedia's SenseWearTM armband as new tool to assess sleep and wakefulness, using polysomnography PSG ; as the gold standard. SenseWear measures body movement, like actigraphy, but also acquires other physiological signals, including surface body temperature, galvanic skin response, and heat flux, that may permit distinctions between NREM and REM sleep. Methods : Twenty-seven participants Mean age 28.7 years, 16 women ; underwent PSG recordings while wearing the armband. PSG and armband data were scored in 20-second epochs. BodyMedia's sleep algorithm was developed using techniques from statistical machine learning. Relevant features that distinguish characteristics of NREM and REM were first identified, including length of inactivity and rate of change in heat-flux. These features were then combined using a method that incorporates the probability of the feature for each sleep state, of each sleep state at each time point, and of different sequences of sleep states. Performance was evaluated using the method of "leave one out" cross-validation, which repeatedly trains the model on all but one of the subjects and tests on the remaining subject. Monte Carlo simulations were used to evaluate the rate of correct sleep stage detection attributable to chance. Results : The algorithm correctly identified 93% of all sleep epochs, and 83% of all wakefulness epochs, for an overall epoch-by-epoch accuracy of 89%. The algorithm correctly identified 65% of all NREM sleep epochs vs. 43.9% by chance ; , and 45.6% of all REM sleep epochs vs.13.9% by chance ; , for an epoch-by-epoch accuracy of 70% vs. 39% by chance ; . Conclusion : BodyMedia's algorithm identified sleep and wakefulness with moderate to high sensitivity, specificity, and accuracy. Detection of NREM and REM substantially exceeds chance levels. Although further improvement is needed, SenseWear appears to be a promising, unobtrusive means for measuring NREM and REM as well as overall sleep and wakefulness. Support optional ; : The present work was support by the Mental Health Research and Intervention Center of the University of Pittsburgh through an NIMH funded grant MH30195 ; , the Fonds de la recherch en Sant du Qubec, and the Canadian Institutes of Health Research.
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Of MAOI prior to elective cardiac surgery.97 There is no literature specifically concerning MAOI and ambulatory anesthesia. MAOI-related drug interactions are possible and have been reported; however, patients continuing to take either classic or selective MAOI remain suitable candidates for ambulatory anesthesia if meperidine, cocaine and indirect-acting catecholamines are avoided. Summary To date much of the research in ambulatory anesthesia has focused on selection of anesthetic techniques to minimize side effects in the healthy outpatient. This series of brief evidence-based reviews highlights what is known and what is yet to be learned regarding selected high-risk patients undergoing ambulatory surgery. For many patient conditions the clinician must base his her practice on case reports or extrapolate conclusions from more invasive inpatient procedures. This need not be so. Level 1 evidence characterizes the incidence and risk factors predicting postoperative apnea in the expremature infant undergoing herniorrhaphy. The clinician can call on randomized controlled trials to inform the choice of regional or general anesthesia and systematic review to summarize the prophylactic use of caffeine. Compare this to our knowledge of outcomes in adult patients with sleep apnea. A single retrospective study of patients with sleep apnea and matched controls undergoing ambulatory surgery is available to guide the clinician. Anesthesiologists should have better answers to these and other questions they are faced with in their ambulatory practice. Research in ambulatory anesthesia should now focus on identifying the risks and benefits of this model of care. Events following discharge in higher risk subgroups of patients should be sought and characterized. Prospective trials to characterize the patient at risk for complications and strategies to reduce these events are required. Ambulatory surgery has moved well beyond the "ASA I and II" patient that is represented in much of our prospective literature. Research in ambulatory anesthesia must follow. Acknowledgements The Canadian Ambulatory Anesthesia Research and Education CAARE ; Group would like to thank Dr. Ramiro Arellano, Dr. Peter Duncan, Dr. Angela Fitzmaurice, Dr. Ken LeDez, Dr. Stuart McCluskey, Dr. Barbara Pask, Dr. Donald Wilson, and Dr. Suntheralingam Yogendran for their participation. Special thanks to Alexandra Davis for her assistance with the literature searches and nexium.
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The markets covered by the agreement represent significant opportunities for Merck and Kos. More than 81 million patients in Europe nearly twice as many as in the United States live with dyslipidemia. The European cholesterol market exceeded USD 3.5 billion in 2001, and is expected to grow to approximately USD 10 billion by 2007. "With our existing capabilities, we believe we are in a position to successfully commercialize these important lipid-modifying products for patients with dyslipidemia. Given that only 40 percent of dyslipidemia patients in the countries outlined in our agreement are diagnosed and even less are adequately drug-treated, we feel these products have extraordinary market potential, " said Wilfried Meyer, Global Head of Merck KGaA's Established Products Business, who will lead commercialization of both products. About Kos Pharmaceuticals: Kos Pharmaceuticals, Inc. kospharm ; is a fully integrated specialty pharmaceutical company engaged in developing, commercializing, manufacturing and marketing proprietary prescription products for the treatment of chronic diseases. The Company's principal product development strategy is to reformulate existing pharmaceutical products with large market potential to improve safety, efficacy, or patient compliance. The Company currently markets Niaspan and Advicor for the Kos is developing additional products and has treatment of cholesterol disorders. inhalation administration. About Niaspan: Available since 1997, Niaspan is the only FDA-approved, once-daily extended-release formulation of niacin for treating abnormal cholesterol levels. Niacin is a B-vitamin that for decades had been known to be an effective cholesterol medication at high doses but was limited by significant side effects. Kos' solid-dose drug delivery technology transformed niacin, the most powerful agent available for increasing HDL High-Density Lipoprotein; "good" cholesterol ; into a highly effective, patient friendly therapy used by thousands of patients with coronary disease.
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Name and description of the medication, the dosage form, route of administration, duration of therapy, special directions and precautions for preparation, administration and use of the prescribed drugs by the patient, common side effects or adverse effects or interactions and therapeutic contraindications that may be encountered, including their avoidance, and the action required if they occur, techniques of self monitoring of drug therapy, proper storage, prescription refill information, action to be taken in case of missed dose. The other published guidelines in the context of patient counseling include the one by Society of Hospital Pharmacists Australia SHPA ; Dooley et al., 1996 ; and American Society of Hospital Pharmacists ASHP ; ASHP, 1976.
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