Biomedical subjects

R Landau

Publications and source records attributed to R Landau.

At least 19 recordsLinked to original sources

PubMed2006

[Initial training in obstetric anaesthesia].

Obstetric anaesthesia is a "young" discipline, with constant novelties from a clinical, scientific and academic standpoint. While there is still no official sub-specialty in obstetric anesthesia, this field has become more diversified because of the growing maternal request for labor analgesia, a constant and perhaps even increasing rate of caesarean deliveries of 20-30% depending on institutions and countries, and also due to the raise in "high risk" pregnancies in women carrying various medical conditions such as complex congenital cardiopathies. In their anesthesia training, most residents rotate in the delivery room for three months on average, which should allow them to acquire good practical skills when performing regional analgesia and anesthesia for labor and delivery. It has been shown that performing 75 epidurals in the obstetric context is sufficient to provide good technical expertise, when appropriate supervision is provided by a present and devoted staff. General anaesthesia remains the critical point, because this technique is less and less performed in pregnant women. It should be recommended to develop training programs to improve the technical skills for intubation in pregnant women, which is why anaesthesia simulators may have an important role in the future. In terms of the theoretical knowledge, good academic training programs are required. The physiology of pregnancy and the physiopathology of pregnancy-related disorders justify a thorough and rigorous teaching in order to reduce both maternal and neonatal morbidity and mortality.

Analgesia, Epidural↗

PubMed2005

[Recent data on the physiopathology of preeclampsia and recommendations for treatment].

Maternal hypertension and proteinuria after 20 weeks gestation defines preeclampsia. Severe preeclampsia is defined by severe hypertension or massive proteinuria, with or without symptoms or altered laboratory tests. With an incidence of 4-7%, preeclampsia remains a major cause of maternal and neonatal morbidity and mortality. Admission into a hospital is crucial to monitor both mother and fetus. The only treatment is delivery. Management of blood pressure and prevention of eclampsia with magnesium sulfate is indicated in severe preeclampsia. Despite numerous studies attempting to elucidate the exact etiopathogenesis of this complex multifactorial disease, prediction or prevention of preeclampsia is not available. Preeclampsia has been named the "disease of theories" and remains to date a challenging enigma for the scientific community.

Calcium Channel Blockers↗

PubMed2005

Are platelets activated after a rapid, one-step density gradient centrifugation? Evidence from flow cytometric analysis.

This procedure describes the preparation of platelets from whole blood of healthy donors and pregnancy-induced hypertensive (PIH) patients by a rapid, one-step density gradient centrifugation, and the direct immunofluorescence staining of obtained platelets (CD63). Platelets are relatively fragile structures. Consequently, for the investigation of their biochemical properties it is recommended to isolate them by a simple method that does not damage their functional parameters and induce their activation. During platelet activation, several changes occur at the platelet surface. CD63 is the receptor for a lysosomal glycoprotein expressed in activated platelets. Currently, flow cytometry (fluorescence-activated cell sorting) is the most sensitive method to detect increased surface exposure of activation antigens on the platelet surface. The present technical note describes that compared with other whole blood flow cytometric techniques, our one-step density-gradient centrifugation method using OptiPrep can also prevent artificial, sample manipulation-related platelet activation.

Blood Platelets↗

PubMed2005

The digital pen and paper. Evaluation and acceptance of a new data acquisition device in clinical settings.

OBJECTIVES: To evaluate the efficiency and acceptance of digital pen and paper technology for real-time clinical data acquisition. METHODS: A prospective interventional unblinded study involving consecutive patients in two clinical settings during a defined time-frame was proposed. The first trial was designed as a stress test to evaluate acceptance in a workload-intensive environment. Acceptance was assessed using observations and a satisfaction questionnaire. The second trial was intended to determine the reliability of data acquisition in a controlled environment. Reliability was assessed by comparing the performance of the digital pen against scanner analysis and a double human blinded acquisition. RESULTS: Overall, users were satisfied with the use of the digital pen (median 3 on a Likert-scale (-5, 5)). Without any specific user training, successful data acquisition was greater than 80%. Use of this technology required less adaptation than standard computer devices, and was easy to learn and use. Ergonomic problems shaded the perception of the technology by inducing an increased cognitive load. Digitalized data was missing either because of a bug or due to lack of data validation. The reliability obtained with the digital pen was significantly lower to that obtained with the scanner. CONCLUSIONS: Natural technology such as the digital pen proved to be a good tool in stressful clinical environments without interfering with the normal workload or increasing the time for data acquisition. However, in order to improve quality of data acquisition, designing acquisition forms specifically for the use of digital pens is of paramount importance.

Anesthesia, Obstetrical↗

PubMed2004

Posthumous sperm retrieval for the purpose of later insemination or IVF in Israel: an ethical and psychosocial critique.

In October 2003, the Attorney General of the Government of Israel published guidelines allowing posthumous sperm retrieval for the purpose of later insemination or IVF by the surviving female partner. This paper presents an ethical and psycho-social critique of the guidelines, which challenges their basic premise that personal autonomy over-rides any other ethical principle and argues that the autonomy of the adult should not over-ride the well-being of the offspring. It also shows that, despite the centrality of autonomy in the guidelines, they actually infringe on the autonomy of the deceased, and pose challenges to that of the surviving partner. It questions the propriety and very possibility of ascertaining the 'presumed wishes' of the deceased for a posthumous child. Finally, it argues against the document's presentation of posthumous sperm retrieval as a medical procedure and contends that, on the contrary, medicine and science are suborned to the exploitation of the dead.

Cadaver↗

PubMed2004

Sequential combined spinal-epidural anesthesia for cesarean section in a woman with a double-outlet right ventricle.

The number of women with complex cyanotic heart disease reaching childbearing age is continuously increasing. For anesthesiologists, management of this 'new' obstetric population is particularly challenging. We report the case of a parturient with a palliated double-outlet right ventricle, who underwent a cesarean section at 34 weeks with low-dose sequential combined spinal-epidural anesthesia with patient-controlled epidural postoperative analgesia. Anesthetic considerations and specific limitations of invasive monitoring are discussed, along with a review of recent literature on maternal and neonatal complications associated with pregnancies in women with cyanotic congenital heart disease.

Adult↗

PubMed2004

Pain on injection: a double-blind comparison of propofol with lidocaine pretreatment versus propofol formulated with long- and medium-chain triglycerides.

The incidence of pain on injection of propofol has been reported to be 70%. A new propofol formulation with a 10% emulsion of long- and medium-chain triglycerides (LCT/MCT) is associated with less pain on injection. Our goal was to compare the effect of propofol-LCT/MCT on the incidence of pain versus propofol with lidocaine 40 mg IV pretreatment injected as a Bier's block. Two hundred healthy women scheduled for ambulatory gynecological procedures were allocated to 1 of 2 groups in a randomized double-blind fashion. Group LIDO received lidocaine 2% 2 mL injected with a tourniquet 1 min before propofol 1% 2 mg/kg IV; group LCT/MCT received NaCl 0.9% 2 mL with tourniquet 1 min before propofol-LCT/MCT 1% 2 mg/kg IV. Spontaneous verbal expressions of pain, movement of hand, frowning, and moaning during the injection were recorded. The incidence and severity of pain were assessed 30 min and 6 h after surgery. Recall of pain was considered with a visual analog scale (VAS) score >1, and pain was graded as VAS 0-10. More women reported spontaneous verbal expression of pain with propofol-LCT/MCT (47% versus 24%; P = 0.0014; relative risk 1.61 [95% confidence interval, 1.22-2.13]). Among women with a painful injection, there was no difference after surgery regarding the intensity of pain or recall of pain. In contrast to previous reports, we found that propofol-LCT/MCT resulted in a more frequent incidence of pain than propofol 1% with IV lidocaine pretreatment. This may be due to the diversity of pain definitions used in studies or to the lack of premedication in our study.

Adolescent↗

PubMed2001

Complications with 25-gauge and 27-gauge Whitacre needles during combined spinal-epidural analgesia in labor.

Needle size and shape may influence the incidence of paresthesias, post-dural puncture headache and other complications during combined spinal-epidural (CSE) procedures. We have noted a relatively high incidence of transient paresthesias during placement of the spinal needle during CSE for labor analgesia. The purpose of this study was to compare the occurrence of paresthesia and post-dural puncture headache in parturients who received CSE analgesia with either a 25-gauge or 27-gauge Whitacre needle. In a prospective observational study, data were gathered from 478 consecutive women receiving labor analgesia. Incidence, duration, and character of any paresthesias upon spinal needle placement and the incidence and treatment of headache were recorded. The incidence of paresthesia with the two needles was similar (16% with 25-gauge vs 15.4% with 27 gauge) but the incidence of post-dural puncture headache was higher with the 25-gauge needle (4% vs 0.7% with 27 gauge, P < 0.05). Our data suggest that with Whitacre needles, 27-gauge might be preferable to 25-gauge needles to reduce the rate of post-dural puncture headache in parturients but that they do not alter the incidence of transient paresthesias.

Journal Article↗

PubMed2001

New insights in hypertensive disorders of pregnancy.

Research reported during the past year has enhanced our understanding of conditions that lead to the complex changes that are observed in hypertensive disorders of pregnancy. An association between placental pathology and a multisystem disorder that is characterized by endothelial dysfunction which involves genetic and immunological investigations has been identified. On the basis of these findings, promising screening tools for early detection of pre-eclampsia were identified. No marked changes in anaesthetic approach to hypertensive disorders of pregnancy occurred during the period of review, apart from a reappraisal of spinal anaesthesia as a safe technique in caesarean section, even in patients with severe pre-eclampsia. A multidisciplinary approach to management and therapy is needed and the right balance must be sought between the needs of the mother and baby, both of which are jeopardized by the hypertensive disorders of pregnancy.

Journal Article↗

PubMed2001

Arg389Gly beta 1-adrenoceptor polymorphism varies in frequency among different ethnic groups but does not alter response in vivo.

There are marked interethnic differences in beta 1-adrenoceptor-mediated responsiveness, with sensitivity decreased in African-Americans and increased in Chinese compared with Caucasians. Therefore, the frequency of a common naturally occurring polymorphism of the human beta 1-adrenoceptor gene (Arg389Gly), which has functional importance in vitro, was determined in 194 African-Americans, 316 Caucasian-Americans, 221 Hispanic-Americans and 142 Chinese. African-Americans were found to have a significantly lower frequency of the Arg389 allele than the other three ethnic groups (all P < 0.01). In the populations studied, the order of the distribution of the Arg389 allele was: Chinese (74%) > Caucasians (72%) > Hispanics (67%) > African-Americans (58%). To determine the functional significance of the Arg389Gly beta 1-adrenoceptor polymorphism, in-vivo heart rate responses to exercise were compared in healthy subjects homozygous for the Arg (n = 9) and Gly (n = 8) alleles. Heart rate response to exercise was not affected by genotype (P = 0.4). Although ethnic differences in the frequency of the beta 1-adrenoceptor Arg389Gly polymorphism exist, the polymorphism does not appear to have functional significance in healthy subjects and therefore may not contribute to ethnic differences in response to drugs acting through the beta 1-adrenoceptor.

Alleles↗

PubMed2001

Subjective well-being among the old-old: the role of health, personality and social support.

The purpose of this study was to devise and test a path model that explains how background variables, physical capacity, and psychosocial resources (locus of control and social network supportiveness) affect three well-being outcome measures--self-rated health, mental health, and life satisfaction--among the old-old in Israel. A sample of European-born persons aged seventy-five and over, drawn randomly from the population registry in the greater Tel Aviv area, was administered a structured questionnaire in personal interviews (N=194). The findings confirm that the relationship between background variables, physical capacity and well-being is differentially mediated by the psychosocial resources, with different variable combinations predicting each of the respective facets of well-being. Moreover, the relative strength of the relationships between locus of control and social network supportiveness and well-being indicate that among the old-old, personality factors may be more consequential than social resources for one's well-being.

Aged↗

PubMed2000

The effects of extreme early stress in very old age.

This article examines a community-based sample of Holocaust survivors aged 75 and over, in comparison to persons of similar age and sociocultural background who did not personally experience the Holocaust. The analysis compares respondents' sociodemographic characteristics, interpersonal resources (locus of control and social network), and vulnerability, stratified by gender (n = 194). Assessments of vulnerability (physical health, mental health, and posttraumatic stress disorder--PTSD) are compared across groups. The results reveal almost no differences regarding the sociodemographic and interpersonal variables. Nevertheless, survivors are found to be more vulnerable than the others in the comparison group: (a) male survivors demonstrate a higher prevalence of PTSD, and (b) female survivors indicate greater health-related difficulties and poorer self-rated health.

Aged↗

PubMed2000

Ethical dilemmas in general hospitals: differential perceptions of direct practitioners and directors of social services.

Two distinct groups of social workers in general hospitals, fourteen directors of social work services and eighteen direct practitioners, were interviewed concerning their perception, ranking and resolution patterns of ethical dilemmas. The reverse order of importance and somewhat different content of ethical dilemmas identified by the two groups reflect their differential position in the hierarchy of hospitals and the difference in their experience in dealing with ethical dilemmas vis-à-vis clients. The directors tended to depend more on internal loci of authority, and were far more concerned with how to interpret and apply the relevant laws than the direct practitioners. Their decision making patterns seemed to be more virtues focused in contrast to the utilitarian and rights based focus of the direct practitioners. The findings emphasize the need for social workers' knowledge of ethical theories, rules and principles, and ethical self-knowledge. They also point out the need for written protocols of debates and/or detailed descriptions of applications of ethical decision making models to case situations in practice. The latter may provide guidelines for social workers in similar situations in the future, and at the same time be used as material for teaching and supervision.

Adult↗

PubMed2000

Ethical dilemmas in general hospitals: social workers' contribution to ethical decision-making.

Thirty-two hospital social workers, fourteen of them directors of social work services and eighteen direct practitioners, were interviewed about their perception of the factors influencing social workers' contribution to the resolution of ethical dilemmas in general hospitals in Israel. Findings revealed that while ethical decision-making in hospitals is an interdisciplinary process, social workers' contribution to the process is affected by rivalry between social workers and other members of the health team, personality differences, type of ward and the nature of the ethical dilemma. Participants of the study had quite a clear perception of their role and of the unique knowledge-base social work can offer, including knowledge of the individual and family life course, understanding and skills in coping with diseases, and systems thinking. In order to increase their influence in ethical decision-making, the hospital social workers felt they must put more effort into developing their relationships with the other professionals involved in ethical decision-making both by making themselves more indispensable and by making their contribution explicit through greater documentation of their activities. The findings also implied that in order to gain more power and be accepted as equal partners in multidisciplinary teams, hospital social workers should improve their communication skills when interacting with representatives of other heath care professions.

Decision Making↗

PubMed1999

Planned orphanhood.

Medical technology, which today makes it possible to bear a child after death, enables planned orphanhood. The first part of this paper will discuss the medical innovations in human conception, the psycho-social aspects of the wish for children from the genes of someone who is no longer alive, and the ensuing orphanhood and its implications. The second part will discuss the ethical issues relating to planned orphanhood: Who are involved in the matter of planned orphanhood? Is the decision to produce a planned orphan a private or public matter? Whose responsibility is the birth and bringing up of the planned orphan? To whom does society have more responsibility - the children who already exist or future children? And can planned orphanhood be regarded as a justification for wrongful conception? The last part of the paper will examine the judicial aspects of planned orphanhood in Israel and elsewhere and discuss the application of the principles of human dignity, human welfare, and justice. The paper argues for discouraging planned orphanhood so as to avoid violating the principles of human dignity and liberty, human welfare, and human justice, from the perspectives of both those who are involved in the process in general and the orphan who is the target of the medical intervention in particular. Its aim is to encourage deep and comprehensive public discussion of this issue in all its aspects.

Adult↗

PubMed1998

The management of genetic origins: secrecy and openness in donor assisted conception in Israel and elsewhere.

Donor assisted conception provides new opportunities for achieving parenthood but at the same time raises issues of secrecy, anonymity, and the management of the offspring's genetic origins. As with adoption, the child's right to a genetic identity is at stake. The first part of this paper examines bio-psychosocial evidence indicating that maintaining secrecy and anonymity regarding genetic parents may be detrimental to the well-being of the donor offspring, the donor, and the nurturing, social parents. The second part discusses different approaches to the disclosure of genetic origins. The third part presents the case of Israel, as reflected mainly in the Report of the Israeli Ministry of Justice (1994). The paper shows that the Committee, yielding to the medical profession in the country, preferred the interests of the adults involved in donor assisted conception to those of the offspring and made no sincere attempts to protect the child's basic right to genetic identity. In doing so, it turned its back on the well established policy of openness in the field of adoption and on the emerging trend to similar openness in donor assisted conception in other countries.

Adoption↗

PubMed1998

Secrecy, anonymity, and deception in donor insemination: a genetic, psycho-social and ethical critique.

The number of medically assisted conceptions involving donors is increasing. At the same time, due to advances in medicine, greater emphasis has been placed on an individual's genetic origins. This trend places individuals who have no access to information on their genetic origins in a vulnerable position. Because of the secrecy and anonymity that has surrounded donor inseminations, many individuals who were so conceived are irreversibly cut off from any possible contact with or even knowledge about their genetic fathers, who will also never have the opportunity to meet their offspring. In view of the accumulated evidence concerning the detrimental effect of secrecy, anonymity and deception in donor insemination, this paper argues that these practices are not only psychologically and socially harmful but also ethically unacceptable.

Choice Behavior↗

PubMed1997

Patients unaware of their HIV status present to inner city accident and emergency department with respiratory complications.

OBJECTIVE: To examine the clinical presentations and management of patients presenting to an accident and emergency (A&E) department with an AIDS defining illness (ADI). METHODS: Presentations of patients in the A&E department with ADI were reviewed retrospectively. The age, sex, ethnic origin, risk factor for HIV infection, route of referral to hospital, presenting complaint, triage category, referral from A&E, admission under medical specialists, diagnosis, and survival from ADI were noted for each patient. RESULTS: 133 patients were registered at St Mary's Hospital in London with ADI during 1994. A significant minority of these patients (25/133) presented to the hospital without prior knowledge of their HIV positive status. Thirty two patients presented to the A&E department with their ADI. Of these, 13/32 (41%) were unaware of the HIV serostatus. All 13 patients had an acute respiratory disease (Pneumocystis carinii pneumonia or pulmonary tuberculosis). In contrast, patients aware of their HIV positive status (19/32) presented to the A&E department with a wide range of non-pulmonary ADI. CONCLUSIONS: The study emphasises the importance of respiratory complications in patients who present with a ADI to emergency departments but are unaware of their HIV positivity. These patients presented solely with Pneumocystis carinii pneumonia or pulmonary tuberculosis, conditions in which early diagnosis and treatment significantly reduce morbidity and mortality.

AIDS-Related Opportunistic Infections↗