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PubMed1998

Zopiclone. An update of its pharmacology, clinical efficacy and tolerability in the treatment of insomnia.

Zopiclone is a non-benzodiazepine hypnotic which was first reviewed in Drugs in 1986. At that time, zopiclone had shown hypnotic efficacy superior to that of placebo, but had not been extensively compared with benzodiazepine hypnotics in patients with insomnia. A much larger body of clinical data is now available, allowing a more detailed evaluation than was previously possible. Together with results from earlier studies, subsequent clinical trials have shown that zopiclone is generally at least as effective as the benzodiazepines (regardless of duration of action) in the treatment of insomnia, although comparisons between zopiclone and flurazepam have produced inconsistent results. Tolerance to the effects of zopiclone was not seen in short term clinical trials (< or = 4 weeks); data from longer term studies are conflicting and the potential for tolerance during long term zopiclone treatment is therefore unclear. Zopiclone has a relatively low propensity to cause residual clinical effects (such as difficulty in waking or reduced morning concentration). Rebound of insomnia to a level below that at baseline can occur after withdrawal of zopiclone, but, on the basis of data from short term studies, does not appear to be common. Data from prescription-event monitoring suggest that zopiclone does not have a high dependence potential (at least in those who are not regular drug abusers/addicts). Zopiclone is well tolerated in both the elderly and younger patients with insomnia. A bitter aftertaste is usually the most common adverse event, but is relatively infrequent (3.6% in the largest available postmarketing study). Thus, zopiclone is now firmly established as an effective and well tolerated hypnotic agent. Although the available data on rebound insomnia and dependence liability are encouraging, potential differences between zopiclone and the benzodiazepines in these respects may have little clinical relevance in the context of short term intermittent use of hypnotics, as it currently recommended. A low propensity for rebound insomnia and dependence might prove valuable during long term hypnotic therapy (which, although not recommended, is a clinical reality). However, the risk-benefit profile of zopiclone in this context remains unknown. Nevertheless, zopiclone is clearly a suitable alternative to the benzodiazepines for the short term treatment of insomnia.

Azabicyclo Compounds↗
PubMed2000

Positron emission tomography in lymphoma: comparison with computed tomography and Gallium-67 single photon emission computed tomography.

With the advent of positron emission tomography (PET), metabolic imaging has become a reality for tumor staging and monitoring response to therapy in lymphoma. Increased Fluorine-18 fluorodeoxyglucose ([(18)F]FDG) uptake in lymphomas has been well documented in the literature; it is based upon elevated glycolysis and longer residence time of FDG in malignant cells compared to most normal tissues. This suggests that in tumor staging, FDG-PET may be more sensitive and specific than the anatomic imaging modalities. Computed tomography (CT) is the standard imaging modality for the staging and restaging of lymphoma, and Gallium-67 ((67)Ga) scintigraphy has played an important role in monitoring response to therapy and follow-up of patients. Published results suggest that FDG-PET is superior to (67)Ga imaging and may be equal or superior to CT for the detection of nodal as well as extranodal involvement in lymphoma.

Aged↗
PubMed1999

Therapists' responses during psychotherapy of holocaust survivors and their second generation.

Human personality contains three layers of identity: the collective, the familial, and the individual, intra-psychic. All three have been directly traumatized and damaged in Holocaust (Shoah) survivors and indirectly through overt and covert transmission in their children. Survivors and the second generation usually contain a few of these identity components in a state of fragmentation, which become central in the therapeutic dialogue between therapists and the patients. When the therapist belongs to the same traumatized population there exists a unique complexity of an a priori countertransference. Sharing the same traumatogenic reality that the patient seeks to alleviate through therapy poses unique difficulties and challenges for the therapist. In working with survivors, pre-war intra-familial traumatizations are of little significance in the face of the massive traumas and death suffered in the Holocaust. In the case of the second generation, "ordinary" developmental impairments and difficulties cannot be fully understood without knowledge of the parents' war experiences and the resultant family atmosphere. Thus, every therapist has to examine both his knowledge and especially his responses not only about the Shoah as a massive trauma but the specific war history of both parents families. Self-knowledge and awareness are necessary to a far greater extent than usual if one is not to be shocked or surprised into acting out. The depth and degree of openness which therapists need when dealing with Holocaust survivors and their children are at least as important as clinical skills.

Defense Mechanisms↗
PubMed2001

[Primary study of Gu Dingfang, an imperial doctor of the Ming dynasty and his funerary objects].

Through researching textually the name, alias, life story, family tree, and medical thought, medical activities and unearthed culture relics etc. of an imperial doctor, Gu Dingfang, his remarkable contribution to the reservation of ancient classic medical editions and the reality of a new creative theory on psychological therapy put forward by him are shown. His outstanding achievements not only complement the blank of medical history of the Ming dynasty, but also occupy a position in the world's medical history.

Archaeology↗
PubMedDate not supplied

[ENTERAL NUTRITION IN PERU]

Drawbacks of Nutritional Support diffusion in Peru are presented within current Latin-American technological reality. That reality is compared to widespread use of antibiotic therapy versus a marked lack of use of Nutritional Support. Those factors are against immunity of seriously compromised patients as Enteral Nutrition has positive effects on a patient s immunity.Four patients treated with three kinds of enteral formulas during a prospective study serve as examples to show the suitable consequences of using Enteral Nutrition and why Nutritional Support should be legally enforced and regulated in Peru.

Journal Article↗
PubMed2001

The information revolution reaches pharmaceuticals: balancing innovation incentives, cost, and access in the post-genomics era.

Recent developments in genomics--the science that lies at the intersection of information technology and biotechnology--have ushered in a new era of pharmaceutical innovation. Professor Rai advances a theory of pharmaceutical development and allocation that takes account of these recent developments from the perspective of both patent law and health law--that is, from both the production side and the consumption side. She argues that genomics has the potential to make reforms that increase access to prescription drugs not only more necessary as a matter of equity but also more feasible as a matter of innovation policy. On the production end, so long as patent rights in upstream genomics research do not create transaction cost bottlenecks, genomics should, in the not-too-distant future, yield some reduction in drug research and development costs. If these costs reductions are realized, it may be possible to scale back certain features of the pharmaceutical patent regime that cause patent protection for pharmaceuticals to be significantly stronger than patent protection for other innovation. On the consumption side, genomics should make drug therapy even more important in treating illness. This reality, coupled with empirical data revealing that cost and access problems are particularly severe for those individuals who are not able to secure favorable price discrimination through insurance, militates in favor of government subsidies for such insurance. As contrasted with patent buyouts, the approach favored by many patent scholars, subsidies would take account of, and indeed capitalize on, the institutional realities of health care consumption. These subsidies should, however, be linked to insurance regulation that works to channel innovation in a cost-effective direction by requiring coverage of drugs that provide significant benefit relative to their cost.

Drug Industry↗
PubMed1985

["Turning trouble into virtue"--5 years of cooperation of a psychiatric department with a center for the elderly and home for the aged].

The article describes the cooperation of a Department of Psychiatry with an old people's center or a home for the aged, and the possibilities and difficulties experienced during such cooperation over a period of five years. The starting point of this co-operation was that both institutions required one another for coping with their work. We tried to make a virtue of necessity. Of course it would not be easy to transfer our kind of cooperation to any other institution. However, we would point out the following problems of cooperation and the developments experienced by us: An old people's home with care facilities is suitable as a complementary to a psychiatric hospital for the continuing treatment of very aged patients who are severely psychotic. In an old people's home with nursing facilities it should certainly be possible to translate into reality a comprehensive psychiatric care programme besides drug therapy, if the personnel is properly instructed and the ensuing conflicts are mastered, although the scope is bound to be limited by shortage of personnel. Instructions can consist of team discussions on individual cases, consultation hours, and emergency services; time must be allowed to help the patients as well as to advise the nurses. Such cooperation can be financed (in the Federal Republic of Germany) on the one hand by sickness insurance payments of medical services rendered to the patients, and on the other hand by a lumpsum to be included in the fees charged by the home, although such lumpsums cannot unfortunately cover all the activities and therapy group costs in a satisfactory way. Almost all the inmates of an old people's nursing home display some psychiatric abnormalities, although only about one-half of them require direct psychiatric treatment. The remaining patients can be stabilised by means of comprehensive psychiatric care based on an understanding of their conflicts and difficulties. Development of such cooperation between psychiatric hospital and old people's nursing home is not continuous. It takes place phasewise, frustration alternating with effectivity. The article describes the course of such development in detail.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1995

Orphans of the 'Real': I. Some modern and postmodern perspectives on the neurobiological and psychosocial dimensions of psychosis and other primitive mental disorders.

To understand and treat patients suffering from psychoses (especially schizophrenia) and from other primitive mental disorders, it has become increasingly important to integrate the "soft science" of psychoanalysis, including its derivate, psychotherapy, with the "hard science" findings of neurobiology, infant development research, and newly emerging trauma research. The author presents such an integrated perspective, and also discusses a paradigmatic change within psychoanalysis itself, one that can be described as a transformation from the one-person ("modern") model to the intersubjective ("postmodern") model. This change is also characterized by a shift from drive theory to that of semiotic meaning and hermeneutics. In light of this transformative change and integration, the author formulates the concept of a generic type of patient, "orphans of the 'Real,'" whose illness can be described as the result of a premature awakening from the protective blanket of innocence because of hypersensitivity and/or traumatic abruption. These patients experience the "Real" without the protective blanket of imagination or symbolization.

Arousal↗
PubMed1996

Pregnancy--procreative process, the "placental paradigm," and perinatal therapy.

Based on extensive clinical experience with childbearing women, a metaphor is suggested depicting psychic reality during pregnancy as a "procreative container," constituted through three intertwining systems--physiological-placental, intrapsychic-familial and socioenvironmental. Psychohistorically predisposed thresholds of tolerance are proposed, with each woman manifesting varying degrees of "permeability" or "psychological immunity" to engagement in the process of emotional gestation. A model illustrates variations in affective quality, fixity, and intensity of preconscious maternal representations underpinning defensive structures. This "placental paradigm" charts seven permutations of the combination of herself as mother to her fantasized baby (in relation to split aspects of herself as baby to her archaic mother) and effects of these imagined dyads on the postnatal exchange. The paper concludes with an exposition of unique features of psychoanalytic treatment during pregnancy and postnatally, and the impact of the procreative psychic reality on patient and analyst.

Female↗
PubMed1999

Antibiotic therapy of childhood pneumonia.

Antibiotic therapy of childhood pneumonia must be based on various factors. Among them, clinical skills, diagnostic studies, knowledge of possible etiologic agents and their in-vitro susceptibility, and avoidance of antibiotic overuse are of greatest importance. The challenge of selective treatment is the reality in developed countries. The equation of pneumonia with antibiotic therapy can no longer be accepted as absolute. If antibiotic therapy is indicated, a new macrolide is usually the drug of choice.

Adolescent↗
PubMed1987

Gaps between expectations and perceived reality of therapists and clients.

This study examines the gaps between role expectations and perceived reality of therapists and clients at two points in time in therapy: In the first and in subsequent sessions. Two subsamples were studied: 66 therapy sessions that were first meetings and 81 sessions at various points during the course of therapy (median = 9 months). Both therapists and clients in therapy dyads filled in the "expectation" and the "descriptions" parts of the Role Expectation and Preference Questionnaire. The main findings were that there was a consistent gap between expectations and perceived reality: Both therapists and clients expected behaviors to occur more than they perceived them to happen. In first sessions, the expectation-reality gap was larger for clients than for therapists. In subsequent sessions, however, the gaps became significantly smaller for clients, but remained almost the same for therapists.

Adult↗
PubMed1991

Prospects of gene therapy for hemoglobinopathies.

Gene therapy offers the promise of a definitive cure of the hemoglobinopathies and thalassemias. The background of gene therapy for these disorders is discussed along with the obstacles that must be overcome before this promise becomes reality.

Forecasting↗
PubMed2004

Enzyme replacement and enhancement therapies for lysosomal diseases.

Although first suggested by de Duve in 1964, enzyme replacement therapy (ERT) for lysosomal storage diseases did not become a reality until the early 1990s when its safety and effectiveness were demonstrated in type 1 Gaucher disease. Today, ERT is a reality for Gaucher disease, Fabry disease and mucopolysaccharidosis type I (MPS I), and clinical trials with recombinant human enzymes are ongoing in Pompe disease, MPS II and MPS VI, and are about to begin in Neimann-Pick B disease. In addition to ERT, enzyme enhancement therapy (EET) offers a novel therapeutic strategy to increase the residual function of mutant proteins. EET employs small molecules as 'pharmacological chaperones' to rescue misfolded and/or unstable mutant enzymes or proteins that have residual function. EET also offers the possibility of treating neurodegenerative lysosomal disorders since these small therapeutic molecules may cross the blood-brain barrier. The current status of ERT and the prospects for EET for lysosomal storage diseases are reviewed.

Enzyme Therapy↗
PubMed2006

Other medications for aerosol delivery.

Although aerosol therapy is most commonly used to treat asthma and COPD, there are a large number of aerosol medications now used or in development for other diseases. Mucoactive agents have long been available by aerosol, but now we have truly effective drugs to improve effective airway clearance including dornase alfa, hyperosmolar saline, and aerosol surfactant. Inhaled antibiotics are available for the treatment of cystic fibrosis, bronchiectasis and other chronic airway infections. With the development of devices that can target aerosol to the deep lung, the opportunity to deliver medications systemically by the aerosol route has become a reality. Insulin, recently approved in the US as aerosol therapy, and other peptides are systemically absorbed from the distal airway and alveolus. Aerosol gene transfer therapy to correct abnormalities associated with cystic fibrosis, primary ciliary dyskinesia and other airway diseases also holds great potential.

Administration, Inhalation↗
PubMed2004

Stroke and neurodegenerative disorders. 3. Stroke: rehabilitation management.

UNLABELLED: This self-directed learning module highlights common rehabilitation issues in stroke survivors. Topics include spasticity, constraint-induced movement therapy, partial body weight-supported treadmill training, virtual reality training, vestibular retraining, aphasia treatment, and cognitive retraining. It is part of the study chapter on stroke and neurodegenerative disorders in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. OVERALL ARTICLE OBJECTIVES: (a) To identify and review the treatment options for poststroke spasticity; (b) to review the use of body weight-supported treadmill training in stroke patients; (c) to describe virtual reality training as an adjunct in stroke rehabilitation; (d) to review vestibular rehabilitation; (e) to discuss advances in aphasia treatment; (f) to discuss cognitive retraining; and (g) to provide an update on treatment of neglect syndromes.

Activities of Daily Living↗
PubMed1999

[Transfusion medicine: debate, field of application, the stakes].

Transfusion medicine has aroused much controversy as to the definition of its field of application, as the Etablissement Français du Sang (EFS) is being set up. One argument put forward by supporters of transfusion medicine in hospital--including nominal attribution and clinical immunohematology--is the possible influence of blood component producers on the decisions of prescribers. The EFS considers transfusion medicine as the rationale underlying a therapeutic chain applied to blood products and possibly to cell therapy products, within a coherent structure. Any disruption in the chain would result in reduced visibility at each stage of the chain, diluted responsibilities, and less efficient communication between blood collection and actual needs. It is, however, extremely important to clearly distinguish between the activities related to the production of biological products for therapeutic use from the activities of evaluation, in the setting of clinical protocols, which are the clinicians' responsibility. The EFS views the production of blood components as one of the various aspects of its missions as a transfusion medicine operator. The involvement of blood transfusion centers in the development of biotechnologies is a historical reality which justifies EFS's ambition to integrate cell therapy activities within its field of competence. The EFS, with its 18 blood transfusion centers, will have to play a part in health care, research and teaching networks, at the regional or inter-regional level. Irrespective of the progress achieved in substitution products and the evolution to be expected in transfusion-related jobs, transfusion as a discipline must maintain its coherence to be able to better assume its responsibilities.

Biological Products↗
PubMed1980

The objective evaluation of dysmenorrhea therapy.

Past attempts to obtain objective evaluation of dysmenorrhea therapy have been severly limited by the lack of accurate, reliable intrauterine pressure data. The development of the catheter-tip microtransducer has made accurate, error- and artifact-free intrauterine pressure recording a reality. This information has made assessment of uterine effects of drug therapy feasible. The combination of this type of information with the use of mathematical processing of data has finally made truly objective assessment attainable. A description of the current technique and the findings made possible by its use are presented.

Clinical Trials as Topic↗