Case studies long term success

When the first edition of this book was written in 1993, data were not available on the long-term success of the behavioral approach. The two case studies that follow show that the process can be long lasting and help support a sustained level of safety performance for long periods of time. 

Earlier small observational reports found some response to atropine in asystole or pulseless idioventricular rhythm but little evidence to suggest that long-term outcomes were altered. In a retrospective case-control study, Stueven and colleagues found a 14% (6 of 43) success rate with atropine compared with a 0% (0 of 41) rate... 

Hypothetical Illustration. Since observations of carcinogenic response arise from chronic (i.e., long term) studies, it will be appropriate to illustrate the existence of a pharmacokinetic threshold based on changes in the steady state level of a parent chemical and one of its metabolites at successively increasing dose levels. We will then investigate the cases where either the parent chemical or its metabolite is the carcinogenic entity. 

At present, bioremediation is receiving a lot of interest as it appears sustainable, low cost, and low energy and therefore meets the needs of a remediation solution that will both benefit the environment directly and also have a relatively low carbon footprint. In practice, it often needs to be combined with other approaches to achieve an effective solution. This requirement is frequently driven by the need to remediate over a short timescale, in the case of ex situ bioremediation, or the need to promote long-term effectiveness under a regime such as monitored natural attenuation or permeable reactive barriers. The engineering of bioremediation to enhance its effectiveness has been studied for the last few decades with considerable success. It has become a mainstream part of the toolbox for contaminated sites. 

A brief report deseribes 2 patients who developed torsade de pointes when they were given amiodarone with disopyramide. Their QT intervals be-eame markedly prolonged to somewhere between 500 and 600 milliseeonds. In another study, 2 patients who had been taking disopyramide 300 mg daily for a number of months developed prolonged QT intervals from 450 to 640 milliseconds and from 390 to 680 milliseconds respectively, and developed torsade de pointes 2 and 5 days respectively, after starting amiodarone 800 mg daily. However, one early report also described the successful and apparently safe use of amiodarone 100 to 600 mg daily with disopyramide 300 to 500 mg dailyalthough the results on long-term follow-up were not reported in all cases. 

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