33 research outputs found
Modelling of impaired cerebral blood flow due to gaseous emboli
Bubbles introduced to the arterial circulation during invasive medical
procedures can have devastating consequences for brain function but their
effects are currently difficult to quantify. Here we present a Monte-Carlo
simulation investigating the impact of gas bubbles on cerebral blood flow. For
the first time, this model includes realistic adhesion forces, bubble
deformation, fluid dynamical considerations, and bubble dissolution. This
allows investigation of the effects of buoyancy, solubility, and blood pressure
on embolus clearance.
Our results illustrate that blockages depend on several factors, including
the number and size distribution of incident emboli, dissolution time and blood
pressure. We found it essential to model the deformation of bubbles to avoid
overestimation of arterial obstruction. Incorporation of buoyancy effects
within our model slightly reduced the overall level of obstruction but did not
decrease embolus clearance times. We found that higher blood pressures generate
lower levels of obstruction and improve embolus clearance. Finally, we
demonstrate the effects of gas solubility and discuss potential clinical
applications of the model
What’s in a Name? Use of Brand versus Generic Drug Names in United States Outpatient Practice
BACKGROUND: The use of brand rather than generic names for medications can increase health care costs. However, little is known at a national level about how often physicians refer to drugs using their brand or generic names. OBJECTIVE: To evaluate how often physicians refer to drugs using brand or generic terminology. DESIGN AND PARTICIPANTS: We used data from the 2003 National Ambulatory Medical Care Survey (NAMCS), a nationally representative survey of 25,288 community-based outpatient visits in the United States. After each visit, patient medications were recorded on a survey encounter form by the treating physician or transcribed from office notes. MEASUREMENTS: Our main outcome measure was the frequency with which medications were recorded on the encounter form using their brand or generic names. RESULTS: For 20 commonly used drugs, the median frequency of brand name use was 98% (interquartile range, 81–100%). Among 12 medications with no generic competition at the time of the survey, the median frequency of brand name use was 100% (range 92–100%). Among 8 medications with generic competition at the time of the survey (“multisource” drugs), the median frequency of brand name use was 79% (range 0–98%; P < .001 for difference between drugs with and without generic competition). CONCLUSIONS: Physicians refer to most medications by their brand names, including drugs with generic formulations. This may lead to higher health care costs by promoting the use of brand-name products when generic alternatives are available
Report of Seminar on Estate Planning
Reports from the UK/CLE Seminar on Estate Planning held July 19-20, 1974
Report of Third Annual Seminar on Estate Planning
Reports from the UK/CLE Third Annual Seminar on Estate Planning held July 23-24, 1976