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At least 325 records · Page 18Linked to original sources
PubMed2004

Going with the (patient) flow. JCAHO's 'watered down' ER patient-management standard relieves hospital executives, disappoints docs.

It started as a proposed JCAHO standard to address emergency room overcrowding. But after a lobbying blitz from hospitals, its focus was transformed to managing patient flow throughout a facility. ER doctors charge the standard was watered down. JCAHO officials disagree, saying the initial document focused too much attention on the ER.

Attitude of Health Personnel↗
PubMed2003

[Orthognathic surgery and facial asymmetry: successes and disappointments].

Used alone, Lefort I procedures and surgical mandibular reduction and de-rotation do not always restore facial symmetry; but by first correcting mesiodistal disharmonies, the orthodontist makes it possible for the surgeon to achieve the best results. Sometimes, long term stability of these improvements is jeopardized when the occlusal plane gradually begins to tilt again and asymmetry reappears in the mandible. By using electromyographic analysis in a series of patients with severe transverse facial disharmony she has treated, the author shows the important role played by the muscles of mastication in such relapses.

Adolescent↗
PubMed2004

[New anti-arrhythmics--hope or disappointment?].

The new anti-arrhythmic agents studied in the last decade have mostly come from research orientated towards determining the compounds which block the electrical currents implicated in the process of repolarisation (class III action). To this must be added dronedarone, which is related to amiodarone and as such displays the 4 classes of anti-arrhythmic properties. Pure class III agents prolong the cardiac action potential and therefore the refractory period and QT interval. The conduction velocity is unaltered. These agents act best on re-entry arrhythmias. Dofetilide is a prototype. The class III action is linked to blockade of the Ikr current and can paradoxically lower it at increased heart rates. Dofelitide has not shown a harmful effect on the survival of high risk ischaemic patients. The conversion of atrial tachyarrhythmias into sinus rhythm can be obtained in one to two thirds of cases. As for the prevention of these arrhythmias, its success rate can exceed 60%. On the other hand, the occurrence of torsades de pointe is in the order of 3%, justifying the initiation of treatment under hospital conditions. Ibutilide acts by blocking the Ikr and INa-s currents. Used only intravenously, this agent is capable of converting back to sinus rhythm a third of atrial fibrillation episodes and two thirds of flutter. The risk of torsades de pointe is 3.5% so this treatment must also be commenced in the hospital setting. Azimilide blocks multiple Iks channels as well as Ikr, Ica and Ina. The electrophysiological effect is sustained at rapid heart rates. When evaluated in patients with paroxysmal atrial fibrillation, azimide prolonged the interval until recurrence, associated with an excellent tolerance (torsades de pointe in 0.55% of cases). In a survival study, azimide demonstrated a neutral effect in high risk subjects with diminished ejection fraction and sinusal variability. Unlike the previous agents, dronedarone is a benzofurane with a similar structure to amiodarone but without iodine. The 800 mg dose is associated with the best risk-benefit ratio. In patients with left ventricular dysfunction, the administration of this agent has been associated with excess mortality. Two recent studies on the prevention of atrial fibrillation have demonstrated that dronedarone is moderately effective with an excellent general tolerance.

Anti-Arrhythmia Agents↗
PubMed2005

[Pneumology. Treatment of idiopathic pulmonary fibrosis: hopes and disappointment].

Idiopathic pulmonary fibrosis (IPF) is now recognized as a separate nosological entity. Despite the progresses in understanding the basic mechanisms of the disease, its prognosis remains poor. The classical treatment combines prednisone with a cytotoxic agent. Interferon gamma has the in vitro capacity of inhibiting fibroblasts proliferation. A pilot study showed positive results, but a more recent randomized double blind trial was unable to demonstrate a clear benefit to the patients. On the other hand there are many evidences for an oxydant-antioxydant imbalance in the pathogenesis of IPF. In a human controlled study N-acetylcysteine (NAC) at high doses (1800 mg per day orally) improved the pulmonary function tests when given on top of a combined therapy with prednisone and azathioprine.

Humans↗