612 research outputs found
D-2867: 696 Canyon Road, Logan, Utah, Albert and Frieda S. Zbinden residence
No full textD-2867: 696 Canyon Road, Logan, Utah, Albert and Frieda S. Zbinden residenc
Cardiovascular risk factors impair native collateral development and may impair efficacy of therapeutic interventions
No full textAnimal and early clinical studies of gene therapy for tissue ischaemia suggested that this approach might provide benefit to patients with coronary artery disease not amenable to traditional revascularization. This enthusiasm was then tempered by the subsequent disappointing results of randomized clinical trials and led researchers to develop strategies using progenitor cells as an alternative to improve collateral function. However, the recent publication of several randomized clinical trials reporting either negative or weakly positive results using this approach have led to questions regarding its effectiveness. There are several factors that need to be considered in explaining the discordance between the positive studies of such treatments in animals and the disappointing results seen in randomized patient trials. Aside from the practical issues of arteriogenic therapies, such as effective delivery, vascular remodelling is an extraordinarily complex process, and the administration of a single agent or cell in the hope that it would lead to lasting physiological effects may be far too simplistic an approach. In addition, however, evidence now suggests that many of the traditional cardiovascular risk factors-such as age and hypercholesterolemia-may impair the host response not only to ischaemia but, critically, also to treatment as well. This review discusses the evidence and mechanisms for these observations and highlights future directions that might be taken in an effort to provide more effective therapies
Epidural Fentanyl, Epinephrine and Clonidine as adjuvants to local anesthetics for surgical analgesia: meta-analysis of analgesia and side-effects
No full textA Direct search procedure to optimize combinations of epidural Bupivacaine, Fentanyl and Clonidine for postoperative analgesia
No full textCongruence patients - thérapeutes et dropout en psychiatrie ambulatoire publique
No full textDanielle Goerg, Eric Zbinden, Biaise Duvanel: Patient-therapist congruence and treatment dropouts in public outpatient psychiatry.
This study, which was undertaken in a public outpatient psychiatrie service, concerning new patients and their therapists, shows that the probability of treatment being abandoned is greater when the patients do not share the values of the psychiatrie institution and when there is poor congruence between patients and therapists concerning the definition of the problems and expectations. The findings that a number of patients however do stay in treatment in spite of the absence of congruence should probably be analyzed in terms that are structural rather than cultural.Résumé. L'étude entreprise dans un service de psychiatrie ambulatoire publique auprès de patients nouveaux cas et de leurs thérapeutes montre que les probabilités d'abandon de traitement sont plus grandes lorsque les patients ne partagent pas les valeurs de l'institution psychiatrique et lorsque la congruence est faible entre patients et thérapeutes dans les définitions des problématiques et des attentes. La constatation qu'un certain nombre de patients restent cependant en traitement malgré une absence de congruence devrait s'analyser sans doute en termes plus structurels que culturels.Danielle Goerg, Eric Zbinden, Biaise Duvanel : Congruencia entre pacientes y terapeutas en relación al abandono de la terapéutica en la siquiatría pública ambulatoria.
El estudio realizado en un servicio público de siquiatría, a partir de pacientes considerados como casos nuevos y de sus terapeutas, demuestra que las probabilidades de abandono del tratamiento crecen cuando los pacientes no comparten los valores de la institu- ciôn siquiâtrica y cuando pacientes y terapeutas poco concuerdan en sus definiciones de las problemâticas y expectativas. S in embargo, es probable que el hecho de que un cierto numéro de pacientes siguen el tratamiento aûn cuando no haya congruencia, tenga que ser analizado en términos mâs estructurales que culturales. tas, demuestra que las probabilidades de abandono del tratamiento crecen cuando los pacientes no comparten los valores de la institución siquiátrica y cuando pacientes y terapeutas poco concuerdan en sus definiciones de las problemáticas y expectativas. Sin embargo, es probable que el hecho de que un cierto número de pacientes siguen el tratamiento aún cuando no haya congruencia, tenga que ser analizado en términos más estructurales que culturales.Goerg Danielle, Zbinden Eric, Duvanel Blaise. Congruence patients - thérapeutes et dropout en psychiatrie ambulatoire publique. In: Sciences sociales et santé. Volume 8, n°3, 1990. pp. 49-71
In-host evolution of Staphylococcus epidermidis in a pacemaker-associated endocarditis resulting in increased antibiotic tolerance
No full textTreatment failure in biofilm-associated bacterial infections is an important healthcare issue. In vitro studies and mouse models suggest that bacteria enter a slow-growing/non-growing state that results in transient tolerance to antibiotics in the absence of a specific resistance mechanism. However, little clinical confirmation of antibiotic tolerant bacteria in patients exists. In this study we investigate a Staphylococcus epidermidis pacemaker-associated endocarditis, in a patient who developed a break-through bacteremia despite taking antibiotics to which the S. epidermidis isolate is fully susceptible in vitro. Characterization of the clinical S. epidermidis isolates reveals in-host evolution over the 16-week infection period, resulting in increased antibiotic tolerance of the entire population due to a prolonged lag time until growth resumption and a reduced growth rate. Furthermore, we observe adaptation towards an increased biofilm formation capacity and genetic diversification of the S. epidermidis isolates within the patient
Factors associated with hypotension and bradycardia after extradural block
No full textIn order to identify patient-, anesthesia-, and surgery-related factors influencing the probability of hypotension and bradycardia after epidural blockade, an observational study was conducted on 1050 nonpregnant patients. Backward stepwise logistic regression was performed on the variables hypotension (systolic blood pressure <90 mm Hg) and bradycardia (heart rate <or=to45 bpm). Hypotension and bradycardia occurred in 158 and 24 patients, respectively. The probability of hypotension increased when epidural fentanyl was administered (odds ratio [OR] = 2.18; 95% confidence interval [CI] = 1.16-4.11), with body weight and spread of epidural analgesia, and decreased when a tourniquet was used (OR = 0.01, CI = 0.01-0.02) and bupivacaine instead of carbonated lidocaine was administered (OR = 0.28, CI = 0.14-0.60). Sensitivity and specificity of the model were 89% and 88%, respectively. The probability of bradycardia was less in women (OR = 0.05, CI = 0.01-0.41) and when a tourniquet was used (OR = 0.04, CI = 0.02-0.09). Sensitivity and specificity were 50% and 97%, respectively. In conclusion, our analysis can contribute to identification of patients at high risk to develop hypotension and bradycardia after epidural blockade. If bupivacaine instead of carbonated lidocaine is used and epidural fentanyl is not administered a decrease in the incidence of hypotension may be anticipated
Adaptation to thermally variable environments: capacity for acclimation of thermal limit and heat shock response in the shrimp Palaemonetes varians
No full textIn the context of climate change, there is a sustained interest in understanding better the functional mechanisms by which marine ectotherms maintain their physiological scope and define their ability to cope with thermal changes in their environment. Here, we present evidence that the variable shrimp Palaemonetes varians shows genuine acclimation capacities of both the thermal limit (CTmax) and the heat shock response (hsp70 induction temperature). During cold acclimation to 10°C, the time lag to retune the stress gene expression to the current environmental temperature proved to exceed one week, thereby highlighting the importance of long term experiments in evaluating the species’ acclimation capacities. Cold and warm-acclimated specimens of P. varians can mobilise the heat shock response (HSR) at temperatures above those experienced in nature, which suggests that the species is potentially capable of expanding its upper thermal range. The shrimp also survived acute heat shock well above its thermal limit without subsequent induction of the HSR, which is discussed with regard to thermal adaptations required for life in highly variable environments
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