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Initial Enthusiasm (initial + enthusiasm)
Selected AbstractsPharmacological treatment of negative symptoms of schizophrenia: therapeutic opportunity or Cul-de-sac?ACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2007P. F. Buckley Objective:, Negative symptoms of schizophrenia are debilitating and they contribute to poor outcome in schizophrenia. Initial enthusiasm that second-generation antipsychotics would prove to be powerful agents to improve negative symptoms has given way to relative pessimism that the effects of current pharmacological treatments are at best modest. Method:, A review of the current ,state-of-play' of pharmacological treatments for negative symptoms in schizophrenia. Results:, Treatment results to date have been largely disappointing. The evidence for efficacy of second-generation antipsychotics is reviewed. Conclusion:, The measurement and treatment trials methodology for the evaluation of negative symptoms need additional refinement before therapeutic optimism that better treatments for negative symptoms can be realized. [source] Distortion of Right Superior Pulmonary Vein Anatomy by Balloon Catheters as a Contributor to Phrenic Nerve InjuryJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 10 2009YASUO OKUMURA M.D. Introduction: Cryothermal, HIFU, and laser catheter-based balloon technologies have been developed to simplify ablation for AF. Initial enthusiasm for their widespread use has been dampened by phrenic nerve (PN) injury. The interaction between PN and pulmonary vein (PV) geometry contributing to PN injury is unclear. Methods and Results: After right thoracotomy, the PN course along the epicardial right atrial surface was mapped directly in 10 dogs. The location of the PN and its relationship with the right superior (RS) PV, and potential RSPV surface distortions after balloon inflation were established by electroanatomic mapping. In 5 dogs, the PN was captured within the RSPV, but could not be stimulated in the remaining 5 dogs. The distance between the RSPV and the PN was significantly shorter in the captured group than in the noncaptured group (6.3 ± 3.1 mm vs 10.2 ± 3.2 mm, P < 0.001). Importantly, 96% of the captured sites within the RSPV were observed at a distance >5 mm into the PV. The inflated balloon surface anteriorly extended 5.6 ± 3.7 mm outside the PV diameter, with distortion of anatomy narrowing the distance from the balloon surface to the PN to 4.8 ± 2.3 mm. (Distance of the original RSPV-to-PN: 9.4 ± 2.7 mm, P < 0.001.) Conclusion: PN injury with balloon technologies may stem from anatomic distortion of the PV orifice/PN relationship, through increasing contact or shortening the relative distance between the ablation site and the PN, even without displacement of the balloon into the PV. These data are important in the refinement of these technologies to improve procedural safety. [source] Delivery of magic bullets: on the still rocky road to gene therapyBRITISH JOURNAL OF PHARMACOLOGY, Issue 2 2009K. Takeda In this issue, the promises, problems and current progress towards gene therapy are examined in a themed set of six reviews. These cover the major methodologies deployed over the last twenty to thirty years to deliver a gene or other potentially therapeutic molecules into an organism. Initial enthusiasm and optimism concerning the prospects for gene therapy and more generally, the delivery of magic bullets, arose after the pioneering discoveries of monoclonal antibodies and retroviral infection during the 1970's and were fuelled by strategies to make synthetic viruses and the advent of chemical vectors over the succeeding twenty years. However, despite significant advances, to date, the early hopes of widespread gene therapy still remain largely unfulfilled. This article is part of a themed section on Vector Design and Drug Delivery. For a list of all articles in this section see the end of this paper, or visit: http://www3.interscience.wiley.com/journal/121548564/issueyear?year=2009 [source] Management of patients with decompensated hepatitis B virus associated cirrhosisLIVER TRANSPLANTATION, Issue S2 2008Fabien Zoulim Key Points 1Hepatitis B virus replication is associated with a severe outcome in patients with decompensated cirrhosis. 2Viral suppression induced by antivirals results in a clinical improvement that allows liver transplantation to be delayed or avoided. 3Early treatment intervention is mandatory in patients with decompensated cirrhosis because of the delay in the restoration of liver functions. 4Lamivudine is no longer the drug of choice because the initial enthusiasm has been tempered by the high rate of resistance development. 5Early add-on therapy with adefovir allows us to rescue lamivudine resistance, but its use may be limited by nephrotoxicity. 6Studies are ongoing with the newer generation of antivirals (telbivudine, tenofovir, entecavir, and emtricitabine) in monotherapy or in combination to determine the best strategy for achieving rapid and prolonged suppression of viral replication. These improved strategies should enhance treatment success enough to obtain clinical stabilization, to delay or prevent the need for transplantation, and to reduce the risk of hepatitis B virus recurrence on the graft. Liver Transpl 14:S1,S7, 2008. © 2008 AASLD. [source] A survey of staff attitudes to increasing medical undergraduate education in a district general hospitalMEDICAL EDUCATION, Issue 7 2005John Macdonald Introduction, Medical student numbers in Britain are increasing rapidly, beyond the capacity of most teaching hospitals, with more clinical teaching taking place in district general hospitals (DGHs). Surveys show that students value the intensive clinical teaching, smaller student numbers and perceived greater friendliness in DGHs. This paper explores DGH staff attitudes to teaching , their level of initial enthusiasm, their attitudes to current teaching, its effect on the hospital and to the sustainability of DGH undergraduate teaching , as both student numbers and service workloads continue to rise. Methods, Semi-structured interviews with 6 key informants were used to generate themes for a 19-question pre-piloted anonymous postal questionnaire sent to all 68 staff involved in undergraduate medical teaching in Northampton General Hospital. Results, The total response included 85% of consultants. Responses in the 3 staff groups were similar. Most respondents felt enthusiastic at the prospect of medical students, although they realised that this would be intellectually challenging and increase time pressures. These predictions were largely fulfilled. Respondents felt that in comparison to teaching hospitals the DGH teaching was more clinically based and consultant-led, with more approachable staff. Currently 41 respondents (82%) felt that they had inadequate teaching time. A majority felt that the arrival of students had improved patient care and that their department had benefited. Thirty-seven responders (74%) felt that the planned doubling of student numbers would impose an unsustainable departmental load, and would compromise teaching quality. The change felt most necessary to support additional teaching was increased clinical medical staff. Better co-ordination between the DGH and the medical school was also felt necessary. The most popular choice for the distribution of extra teaching finance was to the teacher's directorate, i.e. speciality [33 (66%)]. Forty-four (86%) felt that increased student numbers would have a significant impact on the character of the hospital. The 108 free-text comments (2.1 per respondent) centred on hospital character and the benefits of students. Conclusions, This study shows a considerable initial enthusiasm for teaching in DGH staff, which is persisting despite increasing student numbers. However, the current teaching load is seen to be substantial. Teaching more students is likely to produce major problems, based on lack of teaching time and increasingly heavy service commitments rather than lack of patients. This is likely to be a widespread problem for DGHs. Failure to ensure adequate teaching staff and facilities as well as co-ordination could threaten the sustainability of this potentially valuable teaching initiative. [source] | ||||||||||