Routine outpatient L-dopa monitoring in elderly patients with Parkinson's disease.

In an attempt to improve the therapeutic drug management of patients with Parkinson's disease, plasma L-dopa concentrations were measured by high-performance liquid chromatography and related to the post-dose time with reference to an established therapeutic range of 0.3-1.6 mg/l. The response to treatment was also assessed. One hundred and three samples were obtained at morning clinics from 53 elderly patients (mean age 72.5 years) taking an L-dopa/decarboxylase inhibitor combination. L-Dopa concentrations ranged from 0.01 to 3.6 mg/l. Fifty-nine values were within, 39 values were below and five values were above the therapeutic range. Three values were at or below the lower limit of the assay and probably indicated poor compliance. L-Dopa concentration was significantly negatively correlated with post-dose time for the dosage groups of 50 mg (p = 0.04), 100 mg (p = 0.0013), 200-250 mg (p = 0.055) and for the combined data (p = 0.005). Post-dose times were from 35 to 400 min, with the majority greater than 90 min, and it is likely that most of these corresponded to the post-peak phase of L-dopa absorption. There was a tendency for a good response to treatment to occur with values within and above the therapeutic range and for dyskinesia to be more common above the therapeutic range. It was concluded that plasma L-dopa measurement at known post-dose time, 90-360 minutes after the morning dose, can identify non-compliance, patients at risk of dose related side-effects and give useful information about the suitability of the L-dopa dose.

Measuring L-dopa in plasma and urine to monitor therapy of elderly patients with Parkinson disease treated with L-dopa and a dopa decarboxylase inhibitor.

We have established a method for measuring L-dopa in plasma and urine, including the metabolites dopamine and L-dopac, using separation by ion-pair reversed-phase HPLC and quantification with an electrochemical detector. The assay was applied to the therapeutic monitoring of elderly patients with established Parkinson disease being treated with L-dopa plus a dopa decarboxylase inhibitor. Plasma L-dopa was evaluated in relation to dosage and postdose sampling time in 71 outpatients with Parkinson disease. L-Dopa concentrations were greatest in the patients taking the highest dosages prescribed and decreased significantly with increasing time after postdose sampling. Comparison of plasma L-dopa concentrations with a published therapeutic range established by intravenous administration of L-dopa was helpful in assessing the suitability of each patient's drug dosage, assessing patients' compliance, and avoiding overdosage but was not useful in the overall clinical assessment of progression of disease or of the long-term therapeutic response. Urine measurements confirmed the plasma concentrations but showed no further advantage. The recommended time for sample collection is between 1.5 and 3 h after the first morning dose. Plasma is the preferred matrix but if blood sampling is difficult, particularly from elderly/infirm individuals, an untimed urine collection could be used.

Parental perceptions and support strategies in caring for a child with a chronic condition.

The purpose of this article is to compare fathers' and mothers' perceptions of a child's chronic condition and to compare strategies used by fathers and mothers to support themselves during critical times. Analysis of data focused on questionnaires from 38 fathers and mothers (19 paired parents) who had children with chronic conditions. Results showed that, although parental perceptions of the child's chronic condition were similar, their responses to the situation were not the same. Fathers and mothers relied on different strategies to support themselves during critical times.

Is there a place for Phil Donahue in the classroom?

The novel approach of using the Phil Donahue television talk show model in the classroom was successful for us. The model worked well with a panel of guests providing content and the faculty member moderating and directing the discussion by targeting questions and limiting and/or expanding responses as dictated by the objectives for the class. We hypothesize that the Johnny Carson format, where a single guest speaker is interviewed by a faculty member, also would produce excellent results. We encourage colleagues to be creative and experiment in the classroom.

Critical times for families with a chronically ill child.

Parents identified difficult times in caring for their chronically ill children. A model describing these critical times was developed through an analysis of parent interviews. Predicting these critical times enables the health care team to optimize and maximize the effectiveness of their interventions.