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PubMed1990

Disappointment.

Explore the source record for details and available documents.

Diagnostic Errors↗
PubMed1989

Total joint replacement: both a miracle and a disappointment.

Total joint arthroplasty has become a successful therapy for patients with debilitating arthritis of the major weight-bearing joints. However, by current standards, the life of a total joint implant is approximately 10 to 15 years. Older, more sedentary patients enjoy greater and longer-term success than younger, active patients. Eventually, most implants fail because of component loosening. Currently, efforts to obtain longer-term implant stability are focused on achieving bone growth into the implanted components. A new process of plasma-spraying hydroxyapatite--an entirely biocompatible, bioceramic material--onto porous, titanium alloy components promotes bone ingrowth into the components resulting in implant fixation, which is superior to current methods of cemented or cementless fixation. Early results suggest that hydroxyapatite-bioingrowth fixation may be the start of a new era in joint implant surgery.

Arthritis↗
PubMed1985

The new generation antidepressants: promising innovations or disappointments?

"New generation" antidepressants are generally considered to include all agents introduced in recent years which are neither tricyclic in structure nor monoamine oxidase inhibitors. They include the tetracyclics (mianserin and maprotiline), the bicyclic serotonergic compounds (fluoxetine and citalopram), and the unicyclics (bupropion), as well as the triazolobenzodiazepine derivatives (alprazolam), the triazolopyridines (trazodone) and the tetrahydroisoquinolines (nomifensine). Methodologic and economic considerations have hampered attempts to develop agents with significantly greater specificity or safety than traditional agents. Traditional agents, while lacking specificity, do have extensive records of efficacy and long-term safety and are usually less expensive than new agents. Patients not responding to traditional agents often have medical or characterologic problems that exclude them from participating in controlled studies of new agents. These problems are discussed and potential approaches to the development of new agents are presented.

Alprazolam↗
PubMed1988

Denial, delay and disappointment: discovering and overcoming the causes of drug errors and missed appointments.

Although the medical management of epilepsy is possible with effective therapeutics, such management is complicated by patient errors of self-medication. Efforts to improve adherence to prescribed regimens of anticonvulsant medication have not been extensively studied, although several promising results have been obtained. Research on adherence to medication regimens has been more extensive in other chronic conditions, such as hypertension, that have similarities to epilepsy in their demand for long-term treatment, often in the absence of symptoms, with drugs that may produce side effects. From the combined research on factors associated with drug errors, we have analyzed characteristics of the patient, of the regimen, of the illness, and of the patient - provider relationship. The most promising areas for improving compliance appear to be the influence of family and friends, the complexity of the treatment regimen, the patient's belief in severity of the illness, and the patient - provider relationship. Strategies to improve compliance can target 3 sets of factors: predisposing factors including patients' motivation and perception, factors that enable patients to comply more easily, and factors that reinforce compliance. Physician-directed interventions tailored to each of these categories of factors, taken together, can make up a comprehensive health education program. A model for the interventions and their evaluations is presented.

Anticonvulsants↗
PubMedDate not supplied

Peripheral artery thrombolysis with urokinase-lys-plasminogen. A disappointing experience.

Thirty-five patients with peripheral arterial occlusion were treated by intra-arterial infusion of low dose urokinase associated with bolus of lys-plasminogen. Systemic fibrinolysis was moderate, thrombolysis was achieved in 26 patients (74%). Only one patient required blood transfusion, five patients (14%) had distal emboli. Infection at the catheter entry site occurred in 2 patients, 3 patients experienced proximal embolism. Six patients required leg amputation, 4 died, in 2 of them deaths were related to arterial catheterization. Local thrombolysis with limited systemic fibrinolysis is associated to a high rate of catheter-related complications.

Adult↗
PubMed1986

[Therapy of cholelithiasis. Advances and disappointments in the last 50 years].

For many decades cholecystectomy has been the standard treatment for symptomatic cholecystolithiasis. In asymptomatic patients a waiting attitude can be taken. In recent years, non-surgical therapies have been developed for selected patients. Thus, in patients with mild or no symptoms medical dissolution of gallstones with ursodeoxycholic acid, chenodeoxycholic acid or a combination of these two bile acids can be tried if radiolucent stones with diameters below 15 mm are present in a functioning gallbladder (not more than half full of stones). Besides this therapy, cholelithotripsy with extracorporeal shock waves represents a new procedure, which, together with percutaneous or retrograde instillation of methyl tert-butyl ether, needs further evaluation. For elimination of stones from the common bile duct, endoscopic sphincterotomy and stone extraction have proved valuable non-surgical procedures. For choledochal stones not amenable to endoscopic extraction or dissolution by instillation of solvents, treatment by extracorporeal shock waves represents a valuable alternative to surgery. Thus, the past decades have not only brought progress in knowledge of gallstone disease but have also broadened the therapeutic armoury. Therefore, it is essential to select the most appropriate method for each situation.

Bile Acids and Salts↗
PubMed1986

[The report "Care of the Aged" is disappointing].

In the recent report 'Care of the elderly' the government outlines the structural and organizing premises for old age policy in the future. Control of the development of expenses is considered the crux of the matter. Much attention is being paid to homes for the elderly and nursing homes. Although priority in the policy of the government is given to reinforcement of community (non-institutional) care, not much light is thrown upon this echelon. In the report few changes in the existing policy are proposed. Especially provincial and local authorities, representative organizations of different professions and people active in the field of local welfare facilities are asked to stimulate and renew the area of old age policy by means of experiments and co-operation. The critic regrets the lack of prospect of additional finances.

Aged↗