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Biomedical subjects

A Laupacis

Publications and source records attributed to A Laupacis.

152 records · Page 9Linked to original sources
PubMed1982

Cyclosporin A: a powerful immunosuppressant.

Cyclosporin A (CyA) is a powerful immunosuppressive agent whose lack of myelotoxicity makes it unique among nonsteroidal drugs currently given for immunosuppression. It has been used with initial success in recipients of kidney, liver, bone marrow and pancreas transplants, and it may also have clinical application in the treatment of autoimmune disorders. In regard to its use in transplant recipients, there are many remaining questions about its mechanism of action, the optimum dose, whether it should be used alone or with other immunosuppressants, whether it can suppress chronic rejection and what its long-term side effects may be. These questions can only be answered by further careful laboratory investigation and controlled clinical trials. Until then, CyA should only be administered in centres experienced in its use.

Chemical Phenomena↗
PubMed1982

The effect of body warming on the ventilatory response to CO2 in the awake dog.

Resting awake dogs breathing CO2 lower body temperature and such a change is reported to decrease the ventilatory response to CO2. Therefore, in 6 awake dogs the ventilatory response to CO2, obtained while body temperature was allowed to decrease spontaneously, was compared to the response obtained during warming of their body surface in an attempt to prevent the fall in temperature during hypercapnia. During warming, rectal temperature was maintained 0.5 to 0.7 degrees C higher than when TR was allowed to fall. In warm studies arterial [HCO-3]a was decreased relative to PaCO2 whereas there was a surprisingly large storage of CO2, 17.3 ml CO2/kg . Torr PaCO2. Ventilation was comparable in the dogs during air control of both experiments and before body warming was initiated. Subsequently, there was no consistent effect of warming on either the slope or threshold of the ventilatory response to CO2 with respect to either PaCO2 or pHa. Therefore, producing a higher and more 'normothermic' TR during hypercapnia in awake dogs had no definitive effect on chemical control of breathing.

Animals↗
PubMedDate not supplied

Patient preference-based treatment thresholds and recommendations: a comparison of decision-analytic modeling with the probability-tradeoff technique.

BACKGROUND: Decision analysis (DA) and the probability-tradeoff technique (PTOT) are patient preference-based methods of determining optimal therapy for individuals. Using aspirin therapy for the primary prevention of stroke and myocardial infarction (MI) in elderly persons as an example, the objective of this study was to determine whether group-level treatment thresholds and individual-level treatment recommendations derived using PTOT are identical to those of DA incorporating the patients' own values. METHODS: Persons in a pilot study of the efficacy of aspirin in the prevention of stroke and MI were asked to participate. Participant values and utilities for pertinent health states (e.g., minor and major stroke, MI, major bleeding episode) were determined. Then, in three hypothetical clinical situations in which the chance of stroke or MI was varied, PTOT was used to directly determine treatment thresholds for aspirin therapy (i.e., the smallest reduction in MI or stroke risk for which participants would be willing to take aspirin). Using DA modeling, with the same probabilities of events as in the PTOT exercise and incorporating participants' own values, treatment thresholds for the three clinical situations were determined. The thresholds determined by the two approaches were compared. Finally, based on these treatment thresholds, using the best estimates of the efficacy of aspirin to prevent first-time stroke and MI, PTOT and DA treatment recommendations for individual participants were compared. RESULTS: The 42 participants reported that a major stroke was the least desirable health state, followed by MI, minor stroke, and major bleeding. The minimum risk reduction required to take aspirin was greater for MI prevention compared with stroke prevention. For the two clinical situations in which the hypothetical efficacy of aspirin to prevent stroke was varied, treatment thresholds for the PTOT versus DA approaches differed (p < 0.04), but this difference was not significant (p = 0.19) for the MI-based clinical situation. Using the best estimate of the efficacy of aspirin to prevent first-time stroke and MI, PTOT and DA treatment recommendations whether or not to take aspirin were discordant for 38% of participants (16 of 42) (p < 0.001). CONCLUSIONS: Patient preference-based group-level treatment thresholds and individual-level treatment recommendations can differ significantly depending on whether PTOT or DA is used, apparently because the two emphasize different aspects of the decision-making process. DA theory assumes that effective therapeutic decision making should maximize both quality and quantity of life; with PTOT, the emphasis for effective clinical decision making allows patients to be fully engaged in the process, thus hopefully leading to fully informed decisions that may result in satisfaction and compliance.

Age Factors↗
PubMedDate not supplied

The Ottawa patient decision aids.

CONTEXT: Shared decision-making programs, or patient decision aids, have been developed for difficult decisions in which patients need to consider benefits versus risks. PRACTICE PATTERN EXAMINED: Decision aids currently used in practice in Ottawa, Ontario, Canada. DATA SOURCES: Published studies of patients faced with decisions about hormone therapy, prenatal testing, lung cancer treatments, and anticoagulation for atrial fibrillation; administrative data on distribution of decision aids; and a survey mailed to pulmonologists and surgeons. RESULTS: Although most patients considering health care options arrive for counseling with strong predispositions toward a particular option, some are uncertain about their choice and express the need for information, clarification of values, and advice about their options. Decision aids prepare patients for decision making by increasing their knowledge about expected outcomes and personal values. The aids are used in our local centers, and more than 6000 kits have been distributed in Canada, the United States, Europe, and Australia. They primarily affect the decisions of patients who are undecided at baseline and sometimes reduce the proportion of patients who choose more intensive options. CONCLUSION: The Ottawa patient decision aids assist patient decision making, particularly among those who are undecided.

Adult↗