Compliance and resistance

Key elements to be covered in the medication followup visit include (2) a change in target symptoms from baseline, (2) a review of side effects, (3) compliance and resistance, and (4) discussion of the concerns of the child and the parents (see Table 31.1). The medication follow-up visit also includes dosage adjustment and laboratory monitoring. Guidelines for specific disorders and medications are contained in the relevant chapters in this text. 

Processing of Display Values of Pressure, Volume, Compliance, and Resistance... 

The AT-cut quartz resonator can be modeled mechanically as a body containing mass, compliance, and resistance. Figurel-a) shows the mechanical vibration motion depicting the vibration of the quartz resonator. An electrical network called an equivalent electrical circuit consisting of inductive, capacitive and resistive components can represent this mechanical model. Figure... 

There is a second penalty to this type of control it is slow. Passive exhalation cannot proceed any faster than allowed by the recoil pressure and airway resistance. Flow rate is exponential in shape, which means initially high and slowing with time (see Section 4.2.3), with a time constant given by the product of capacity (or compliance) and resistance of the system. 

When two compartments have different time constants due to differences in resistance or compliance, gas can be flowing out of one at the same time as it is flowing into the other. This pendelluft phenomenon reduces effective tidal volume results in frequency dependence of dynamic compliance and resistance measurements, and again makes prediction of aerosol distribution in the presence of disease highly complex (269) (Fig. 18). 

When providing support, a ventilator can control four primary variables during inspiration pressure, volume, flow, and time. If a ventilator controls a given variable, then the waveform of this variable during inspiration will ideally remain unchanged from breath to breath regardless of how the load (compliance and resistance) changes (1). Most modem home ventilators are either pressure or flow controllers. 

Ventilators of new generation also allow the clinician to choose either a volume-targeted or pressure-targeted approach. The use of volume-targeted approach is guaranteed by a minimum minute volume, even as the patient s compliance and resistance are changing. During CMV mode and... 

Compliance is essential to ensure efficacy of a particular agent. Patients may stop taking their antibiotics once the symptoms subside and save them for a future infection. If the patient does not complete the course of therapy, the infection may not be eradicated, and resistance may emerge. Self-medication of saved antibiotics may be inappropriate and harmful and may select for resistant organisms. Poor patient adherence maybe due to adverse effects, tolerability, cost, and lack of patient education. 

The electric properties of polymers are also related to their mechanical behavior. The dielectric constant and dielectric loss factor are analogous to the elastic compliance and mechanical loss factor. Electric resistivity is analogous to viscosity. Polar polymers, such as ionomers, possess permanent dipole moments. These polar materials are capable of storing... 

Unfortunately, none of the seven randomized trials that have compared radiation therapy alone vs neoadjuvant cisplatin-containing chemotherapy plus radiation therapy demonstrated an improvement in overall or disease-free survival with combined-modality therapy (Table 2). Two studies actually demonstrated poorer survival with neoadjuvant chemotherapy. Souhami et al. (15) reported a significantly poorer survival rate with neoadjuvant chemotherapy in a small trial of patients with stage IIIB disease. This outcome was partly due to increased toxicity and poor compliance in patients who received chemotherapy. Another trial of neoadjuvant epirubicin and cisplatin was closed early when interim analysis revealed a significantly higher recurrence rate in the chemotherapy arm (16). These trials fail to provide any evidence that sequential cisplatin-containing chemotherapy and radiation therapy are of benefit. Possible explanations for the disappointing results include the effects of chemotoxicity, altered compliance, and possible accelerated repopulation of resistant clones after neoadjuvant chemotherapy. 

Empirically it is known that effective drug concentrations are needed for at least 3 parasite-life cycles (=6 days) to obtain cure without recrudescence. By combining a drug with a fast action but short half life such as artemether and an agent with a slow action and long half life the treatment course can be short (2-3 days) which will benetit compliance, the patients condition will improve fast and resistance-development might be delayed. 

In critically ill patients who have ventilatory failure from various causes (eg, severe bronchospasm, pneumonia, chronic obstructive airway disease), it may be necessary to control ventilation to provide adequate gas exchange and to prevent atelectasis. In the ICU, neuromuscular blocking drugs are frequently administered to reduce chest wall resistance (ie, improve thoracic compliance) and ineffective spontaneous ventilation in intubated patients. 

In a study supported by Eli Lilly and Company it was concluded that olanzapine may be effective in a significant number of neuroleptic drug-resistant schizophrenic patients (19). However, of 25 patients who entered an open trial for 6 months, 14 discontinued olanzapine, one because of an adverse effect (depression), two because of lack of compliance, and 11 because of lack of efficacy. 

In utilizing the collaborative model in the management of bipolar disorder, as well as depression, the psychotherapist supports the inherent coping skills of the patient, assesses progress and resistance, and tracks medication compliance. The psychotherapist can then inform the psychiatrist of any changes that have occurred and/or are required, and vice versa, thereby resulting in a more comprehensive and quality-driven level of care. 

In followup experiments, the pulmonary effects of JP-8 inhalation in mice were evaluated (Robledo and Witten 1998 Robledo et al. 2000 Wang et al. 2001). Groups of C57BL/6 and B6.A.D. (Ahrd/Nats knockout) mice were exposed 1 hr/day for 7 days to ambient air or aerosolized JP-8 at 0-118 mg/ m3. JP-8 vapor was also present however, the concentration of the vapor in the exposure atmosphere was not reported. Exposure had no effect on dynamic compliance or resistance. Lung epithelial permeability, as determined with 99mTcDTPA, was affected in C57BL/6 mice exposed at 50 and 113... 

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