Paul E.A. Glaser

A COMPARISON OF INTENSIVE CARE IN THE U.S.A. AND FRANCE

Abstract 1260 emergency admissions to the intensive-care units (ICUs) of five U.S.A. and seven French tertiary-care hospitals were surveyed by means of a standard severity-of-illness classification system. The 586 patients admitted to French ICUs were significantly younger than the 674 U.S.A. patients, more had been transferred from another hospital, and they remained in the ICU twice as long. Although actual death rates, severity of illness, and the amount of treatment were extremely similar, fewer French than U.S.A. patients were admitted for observation and monitoring. Invasive monitoring was used less in French patients than in U.S.A. patients. The mortality predicted for French patients if they had been treated in the U.S.A. was similar to the observed mortality in the three most frequent indications for ICU admission (cardiovascular, respiratory, and neurological organ-system failure) but was lower than the observed death rate for French gastrointestinal patients. These results suggest that future international studies within separate diagnostic groups would provide insights into the value of many services now commonly used in the treatment of acutely ill patients.

Dopamine and Glutamate Interactions in ADHD: Implications for the Future Neuropharmacology of ADHD

In this chapter, we will discuss the interactions between a neurotransmitter that has been heavily implicated in ADHD, dopamine, and a neurotransmitter just beginning to be inves‐ tigated, glutamate. We will examine the literature to reveal how current treatments for ADHD affect these neurotransmitter levels in specific areas of the brain that are thought to be dysfunctional in ADHD. Additionally, we will detail new data on dopamine and gluta‐ mate dysfunction utilizing approaches that are capable of accurately measuring levels of these neurotransmitters in two separate rodent models of ADHD. Finally, we will speculate on the role that the dopamine-glutamate interaction will play in the future neuropharmacol‐ ogy of ADHD and how measuring these neurotransmitter levels in rodent models of ADHD may aid in furthering the future pharmacotherapy of ADHD.

Resistance to sodium nitroprusside in hypertensive patients

Seventeen critically ill patients were studied prospectively to determine the relationship of serum albumin, creatinine-height index (CHI) and weight-height index (WHI) to clinical outcome. Use of the conventional “normal values” as cut-offs failed to discriminate between survivors and nonsurvivors better than chance alone. A serum albumin less than 2.5 g/dl correctly separated 93% of the patients in terms of survival prognosis.

The Neuropsychopharmacology of Stimulants: Dopamine and ADHD

In this chapter we consider the neuropsychopharmacology of ADHD in general and dopamine and the stimulants more specifically. Attention will be given to the various neurotransmitter theories for ADHD. We will consider the theoretical mechanisms of actions for the various medicines used to treat ADHD. We will look at how the stimulants, although often assumed to be similar, actually show evidence of differential mechanisms of action. We will look at new data that utilizes the technique of reverse microdialysis to demonstrate how different the dose-response curves are for dopamine release in the striatum following local application of the different stimulants.

International Use of a Classification System for Evaluation of Outcome of Acutely Ill Patients

There will be a need to determine the impact of the review. After a few months, another study may be undertaken to determine if there has been any significant change for the better in pre-hospital techniques of the individual or the provider. If there is no change, there may have to be a decision to implement some type of further action such as additional in-service classes or counseling from a member of the committee.