Delivery system for location based information in wireless IP networks

Tämä työ esittelee uuden tarjota paikasta riippuvaa tietoa langattomien tietoverkkojen käyttäjille. Tieto välitetään jokaiselle käyttäjälle tietämättä mitään käyttäjän henkilöllisyydestä. Sovellustason protokollaksi valittiin HTTP, joka mahdollistaa tämän järjestelmän saattaa tietoa perille useimmille käyttäjille, jotka käyttävät hyvinkin erilaisia päätelaitteita. Tämä järjestelmä toimii sieppaavan www-liikenteen välityspalvelimen jatkeena. Erilaisten tietokantojen sisällä on perusteella järjestelmä päättää välitetäänkö tietoa vai ei. Järjestelmä sisältää myös yksinkertaisen ohjelmiston käyttäjien paikantamiseksi yksittäisen tukiaseman tarkkuudella. Vaikka esitetty ratkaisu tähtääkin paikkaan perustuvien mainosten tarjoamiseen, se on helposti muunnettavissa minkä tahansa tyyppisen tiedon välittämiseen käyttäjille.

The specificity of the familial aggregation of early-onset bipolar disorder: A controlled 10-year follow-up study of offspring of parents with mood disorders.

BACKGROUND: Two major sources of heterogeneity of mood disorders that have been demonstrated in clinical, family and genetic studies are the mood disorder subtype (i.e. bipolar (BPD) and major depressive disorder (MDD)) and age of onset of mood episodes. Using a prospective high-risk study design, our aims were to test the specificity of the parent-child transmission of BPD and MDD and to establish the risk of psychopathology in offspring in function of the age of onset of the parental disorder. METHODS: Clinical information was collected on 208 probands (n=81 with BPD, n=64 with MDD, n=63 medical controls) as well as their 202 spouses and 372 children aged 6-17 years at study entry. Parents and children were directly interviewed every 3 years (mean duration of follow-up=10.6 years). Parental age of onset was dichotomized at age 21. RESULTS: Offspring of parents with early onset BPD entailed a higher risk of BPD HR=7.9(1.8-34.6) and substance use disorders HR=5.0(1.1-21.9) than those with later onset and controls. Depressive disorders were not significantly increased in offspring regardless of parental mood disorder subtype or age of onset. LIMITATIONS: Limited sample size, age of onset in probands was obtained retrospectively, age of onset in co-parents was not adequately documented, and a quarter of the children had no direct interview. CONCLUSIONS: Our results provide support for the independence of familial aggregation of BPD from MDD and the heterogeneity of BPD based on patterns of onset. Future studies should further investigate correlates of early versus later onset BPD.

Resilience and unmet supportive care needs in patients with cancer during early treatment: A descriptive study.

PURPOSE: The concept of resilience is gaining increasing importance as a key component of supportive care but to date has rarely been addressed in studies with adult cancer patients. The purpose of our study was to describe resilience and its potential predictors and supportive care needs in cancer patients during early treatment and to explore associations between both concepts. METHODS: This descriptive study included adult cancer patients under treatment in ambulatory cancer services of a Swiss hospital. Subjects completed the 25-item Connor-Davidson-Resilience Scale and the 34-item Supportive Care Needs Survey. Descriptive, correlational and regression analysis were performed. RESULTS: 68 patients with cancer were included in the study. Compared to general population, resilience scores were significantly lower (74.4 ± 12.6 vs. 80.4 ± 12.8, p = .0002). Multiple regression analysis showed predictors ("age", "metastasis", "recurrence" and "living alone") of resilience (adjusted R2 = .19, p < .001). Highest unmet needs were observed in the domain of psychological needs. Lower resilience scores were significantly and strongly associated with higher levels of unmet psychological needs (Rho = -.68, p < .001), supportive care needs (Rho = -.49, p < .001) and information needs (Rho = -.42, p = .001). CONCLUSION: Ambulatory patients with higher levels of resilience express fewer unmet needs. Further work is needed to elucidate the mechanism of the observed relationships and if interventions facilitating resilience have a positive effect on unmet needs.

Classification models for neurocognitive impairment in HIV infection based on demographic and clinical variables

Objective: We used demographic and clinical data to design practical classification models for prediction of neurocognitive impairment (NCI) in people with HIV infection. Methods: The study population comprised 331 HIV-infected patients with available demographic, clinical, and neurocognitive data collected using a comprehensive battery of neuropsychological tests. Classification and regression trees (CART) were developed to btain detailed and reliable models to predict NCI. Following a practical clinical approach, NCI was considered the main variable for study outcomes, and analyses were performed separately in treatment-naïve and treatment-experienced patients. Results: The study sample comprised 52 treatment-naïve and 279 experienced patients. In the first group, the variables identified as better predictors of NCI were CD4 cell count and age (correct classification [CC]: 79.6%, 3 final nodes). In treatment-experienced patients, the variables most closely related to NCI were years of education, nadir CD4 cell count, central nervous system penetration-effectiveness score, age, employment status, and confounding comorbidities (CC: 82.1%, 7 final nodes). In patients with an undetectable viral load and no comorbidities, we obtained a fairly accurate model in which the main variables were nadir CD4 cell count, current CD4 cell count, time on current treatment, and past highest viral load (CC: 88%, 6 final nodes). Conclusion: Practical classification models to predict NCI in HIV infection can be obtained using demographic and clinical variables. An approach based on CART analyses may facilitate screening for HIV-associated neurocognitive disorders and complement clinical information about risk and protective factors for NCI in HIV-infected patients.

An evaluation of the Swiss staging model for hypothermia using case reports from the literature.

BACKGROUND: Core body temperature is used to stage and guide the management of hypothermic patients, however obtaining accurate measurements of core temperature is challenging, especially in the pre-hospital context. The Swiss staging model for hypothermia uses clinical indicators to stage hypothermia. The proposed temperature range for clinical stage 1 is <35-32 °C (95-90 °F), for stage 2, <32-28 °C (<90-82 °F) for stage 3, <28-24 °C (<82-75 °F), and for stage 4 below 24 °C (75 °F). However, the evidence relating these temperature ranges to the clinical stages needs to be strengthened. METHODS: Medline was used to retrieve data on as many cases of accidental hypothermia (core body temperature <35 °C (95 °F)) as possible. Cases of therapeutic or neonatal hypothermia and those with confounders or insufficient data were excluded. To evaluate the Swiss staging model for hypothermia, we estimated the percentage of those patients who were correctly classified and compared the theoretical with the observed ranges of temperatures for each clinical stage. The number of rescue collapses was also recorded. RESULTS: We analysed 183 cases; the median temperature for the sample was 25.2 °C (IQR 22-28). 95 of the 183 patients (51.9 %; 95 % CI = 44.7 %-59.2 %) were correctly classified, while the temperature was overestimated in 36 patients (19.7 %; 95 % CI = 13.9 %-25.4 %). We observed important overlaps among the four stage groups with respect to core temperature, the lowest observed temperature being 28.1 °C for Stage 1, 22 °C for Stage 2, 19.3 °C for Stage 3, and 13.7 °C for stage 4. CONCLUSION: Predicting core body temperature using clinical indicators is a difficult task. Despite the inherent limitations of our study, it increases the strength of the evidence linking the clinical hypothermia stage to core temperature. Decreasing the thresholds of temperatures distinguishing the different stages would allow a reduction in the number of cases where body temperature is overestimated, avoiding some potentially negative consequences for the management of hypothermic patients.

Efficient installed base information management and utilization in global after sales service business

This Master´s thesis explores how the a global industrial corporation’s after sales service department should arrange its installed base management practices in order to maintain and utilize the installed base information effectively. Case company has product-related records, such as product’s lifecycle information, service history information and information about product’s performance. Information is collected and organized often case by case, therefore the systematic and effective use of installed base information is difficult also the overview of installed base is missing. The goal of the thesis study was to find out how the case company can improve the installed base maintenance and management practices and improve the installed base information availability and reliability. Installed base information management practices were first examined through the literature. The empirical research was conducted by the interviews and questionnaire survey, targeted to the case company’s service department. The research purpose was to find out the challenges related to case company´s service department’s information management practices. The study also identified the installed base information needs and improvement potential in the availability of information. Based on the empirical research findings, recommendations for improve installed base management practices and information availability were created. Grounding of the recommendations, the case company is suggested the following proposals for action: Service report development, improving the change management process, ensuring the quality of the product documentation in early stages of product life cycle and decision to improve installed base management practices.

The role of business information and knowledge in sales steering

The objective of this study is to find out how sales management can be optimally supported with business information and knowledge. The first chapters of the study focus on theoretical literature about sales planning, sales steering, business intelligence, and knowledge management. The empirical part of the study is a case study for which the material was collected through interviews with the selected people of the company. The findings from the interviews were analyzed, and possible suggestions for solving the problems were made. The case study revealed that sales management requires a multitude of metrics and reports to steer the sales to the desired direction. The information sources can be internal and external, and the optimal solution for satisfying the information needs is a combination of both of these. The simple information should be turned into knowledge by merging the intellectual assets with the information from the firm’s transaction processing systems, in order to promote organizational learning and effective decision-making.

Economic Burden of Psoriasis

Psoriasis may cause a substantial economic burden to patients, health service providers, third parties, and the society as a whole. However, all of these costs may not be adequately considered when assessing the treatment costs for psoriasis. Psoriasis may negatively affect work productivity as psoriasis has a relatively high incidence in working age people that lead to possible costs because of lost productivity. The aims of this thesis were to estimate the economic burden of psoriasis particularly from patients’ and health service providers’ perspectives and to estimate the background factors (e.g., severity of psoriasis) that may have led to high costs. Another aim was to estimate the total medication costs and to estimate psoriasis’ proportion of health-related productivity losses. The patient sample was based on patients with psoriasis who visited the Department of Dermatology in Turku University Hospital during a one-year study period. These patients were sent a questionnaire. From the patients who gave consent, medication information, clinical information, and number of visits to Turku University Hospital were collected. This data was linked to the information from the questionnaire. Overall psoriasis was estimated to cause a substantial economic burden for the patient, health service provider, health insurance system, employer, and the society as a whole. The direct costs represented only a small proportion of the overall financial burden of psoriasis, whereas indirect costs were significant. The estimated annual costs for patients and employers were almost twice the costs to health service providers or the Social Insurance Institution of Finland. In conclusion, the cost contribution of patients and employers should be considered when assessing the costs of different treatments, in addition to commonly studied direct costs of medications and costs to health service providers. Methods used to assess these costs should be well justified and be described clearly to allow comparisons between studies and to evaluate the quality of the results.

Reading Instruction and Instructors’ Perceptions of Learners’ Needs in LINC Level 1-3 Classes

This study investigates instructors’ perceptions of reading instruction and difficulties among Language Instruction for Newcomers to Canada (LINC) Level 1-3 learners. Statistics Canada reports that 60% of immigrants possess inadequate literacy skills. Newcomers are placed in classes using the Canadian Language Benchmarks but large, mixed-level classes create little opportunity for individualized instruction, leading some clients to demonstrate little change in their reading benchmarks. Data were collected (via demographic questionnaires, semi-structured interviews, teaching plans, and field study notes) to create a case study of five LINC instructors’ perceptions of why some clients do not progress through the LINC reading levels as expected and how their previous experiences relate to those within the LINC program. Qualitative analyses of the data revealed three primary themes: client/instructor background and classroom needs, reading, strategies, methods and challenges, and assessment expectations and progress, each containing a number of subthemes. A comparison between the themes and literature demonstrated six areas for discussion: (a) some clients, specifically refugees, require more time to progress to higher benchmarks; (b) clients’ level of prior education can be indicative of their literacy skills; (c) clients with literacy needs should be separated and placed into literacy-specific classes; (d) evidence-based approaches to reading instruction were not always evident in participants’ responses, demonstrating a lack of knowledge about these approaches; (e) first language literacy influences second language reading acquisition through a transfer of skills; and (f) collaboration in the classroom supports learning by extending clients’ capabilities. These points form the basis of recommendations about how reading instruction might be improved for such clients.

Contribution à l'étude de la construction des concepts scientifiques au cours de l'apprentissage par problèmes en médecine

L’approche d’apprentissage par problèmes (APP) a vu le jour, dans sa forme contemporaine, à la Faculté de médecine de l’Université MacMaster en Ontario (Canada) à la fin des années 1960. Très rapidement cette nouvelle approche pédagogique active, centrée sur l’étudiant et basée sur les problèmes biomédicaux, va être adoptée par de nombreuses facultés de médecine de par le monde et gagner d’autres disciplines. Cependant, malgré ce succès apparent, l’APP est aussi une approche controversée, notamment en éducation médicale, où elle a été accusée de favoriser un apprentissage superficiel. Par ailleurs, les étudiants formés par cette approche réussiraient moins bien que les autres aux tests évaluant l’acquisition des concepts scientifiques de base, et il n’a jamais été prouvé que les médecins formés par l’APP seraient meilleurs que les autres. Pour mieux comprendre ces résultats, la présente recherche a voulu explorer l’apprentissage de ces concepts scientifiques, en tant que processus de construction, chez des étudiants formés par l’APP, à la Faculté de médecine de l’Université de Montréal, en nous appuyant sur le cadre théorique socioconstructivisme de Vygotski. Pour cet auteur, la formation des concepts est un processus complexe de construction de sens, en plusieurs étapes, qui ne peut se concevoir que dans le cadre d’une résolution de problèmes. Nous avons réalisé une étude de cas, multicas, intrasite, les cas étant deux groupes de neuf étudiants en médecine avec leur tuteur, que nous avons suivi pendant une session complète de la mi-novembre à la mi-décembre 2007. Deux grands objectifs étaient poursuivis: premièrement, fournir des analyses détaillées et des matériaux réflectifs et théoriques susceptibles de rendre compte du phénomène de construction des concepts scientifiques de base par des étudiants en médecine dans le contexte de l’APP. Deuxièmement, explorer, les approches de travail personnel des étudiants, lors de la phase de travail individuel, afin de répondre à la question de recherche suivante : Comment la dynamique pédagogique de l’APP en médecine permet-elle de rendre compte de l’apprentissage des concepts scientifiques de base? Il s’agissait d’une étude qualitative et les données ont été recueillies par différents moyens : observation non participante et enregistrement vidéo des tutoriaux d’APP, interview semi-structuré des étudiants, discussion avec les tuteurs et consultation de leurs manuels, puis traitées par diverses opérations: transcription des enregistrements, regroupement, classification. L’analyse a porté sur des collections de verbatim issus des transcriptions, sur le suivi de la construction des concepts à travers le temps et les sessions, sur le role du tuteur pour aider au développement de ces concepts Les analyses suggèrent que l’approche d’APP est, en général, bien accueillie, et les débats sont soutenus, avec en moyenne entre trois et quatre échanges par minute. Par rapport au premier objectif, nous avons effectivement fourni des explications détaillées sur la dynamique de construction des concepts qui s'étend lors des trois phases de l'APP, à savoir la phase aller, la phase de recherche individuelle et la phase retour. Pour chaque cas étudié, nous avons mis en évidence les représentations conceptuelles initiales à la phase aller, co-constructions des étudiants, sous la guidance du tuteur et nous avons suivi la transformation de ces concepts spontanés naïfs, lors des discussions de la phase retour. Le choix du cadre théorique socio constructiviste de Vygotski nous a permis de réfléchir sur le rôle de médiation joué par les composantes du système interactif de l'APP, que nous avons considéré comme une zone proximale de développement (ZPD) au sens élargi, qui sont le problème, le tuteur, l'étudiant et ses pairs, les ressources, notamment l'artefact graphique carte conceptuelle utilisée de façon intensive lors des tutoriaux aller et retour, pour arriver à la construction des concepts scientifiques. Notre recherche a montré qu'en revenant de leurs recherches, les étudiants avaient trois genres de représentations conceptuelles: des concepts corrects, des concepts incomplets et des concepts erronés. Il faut donc que les concepts scientifiques théoriques soient à leur tour confrontés au problème concret, dans l'interaction sociale pour une validation des attributs qui les caractérisent. Dans cette interaction, le tuteur joue un rôle clé complexe de facilitateur, de médiateur, essentiellement par le langage. L'analyse thématique de ses interventions a permis d'en distinguer cinq types: la gestion du groupe, l'argumentation, les questions de différents types, le modelling et les conclusions. Nous avons montré le lien entre les questions du tuteur et le type de réponses des étudiants, pour recommander un meilleur équilibre entre les différents types de questions. Les étudiants, également par les échanges verbaux, mais aussi par la construction collective des cartes conceptuelles initiales et définitives, participent à une co-construction de ces concepts. L'analyse de leurs interactions nous a permis de relever différentes fonctions du langage, pour souligner l'intérêt des interactions argumentatives, marqueurs d'un travail collaboratif en profondeur pour la co-construction des concepts Nous avons aussi montré l'intérêt des cartes conceptuelles non seulement pour visualiser les concepts, mais aussi en tant qu'artefact, outil de médiation psychique à double fonction communicative et sémiotique. Concernant le second objectif, l’exploration du travail personnel des étudiants, on constate que les étudiants de première année font un travail plus approfondi de recherche, et utilisent plus souvent des stratégies de lecture plus efficaces que leurs collègues de deuxième année. Ceux-ci se contentent, en général, des ouvrages de référence, font de simples lectures et s’appuient beaucoup sur les résumés faits par leurs prédécesseurs. Le recours aux ouvrages de référence essentiellement comme source d'information apporte une certaine pauvreté au débat à la phase retour avec peu d'échanges de type argumentatif, témoins d'un travail profond. Ainsi donc, par tout ce soutien qu'elle permet d'apporter aux étudiants pour la construction de leurs connaissances, pour le type d'apprentissage qu'elle offre, l’APP reste une approche unique, digne d’intérêt. Cependant, elle nécessite d'être améliorée par des interventions au niveau du tuteur et des étudiants.

L'information professionnelle pour préparer la relation professionnelle dans une salle d'attente de médecine familiale

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Die Wirkungen von Extensivierungs- und Vertragsnaturschutzprogrammen auf die Entwicklung einer "gerade noch aktuellen Agrarlandschaft"

Erfolgskontrollen für Agrarumweltprogramme bezogen sich bisher meistens auf einzelne Flächen oder auf programmbezogene, großräumige Evaluationen. Es wurde jedoch kaum untersucht, wie sich die Maßnahmen auf die Entwicklung einzelner Naturräume auswirken. Auch gab es keine Studien, welche die Wechselwirkungen zwischen den Beweggründen der Landnutzer auf der ei-nen- sowie Landnutzung und Vegetation auf der anderen Seite interpretierten. Die Dissertation Wirkungen von Extensivierungs- und Vertragsnaturschutzprogrammen auf die Entwick-lung einer »gerade noch aktuellen Agrarlandschaft« hat diese Lücke geschlossen. Sie erklärt, welche Bedeutung die hessischen Programme HELP und HEKUL für den hohen Anteil naturschutzfachlich wertvollen Grünlands im Rommeroder Hügel-land westlich des Meißner haben. Untersuchungsgegenstand waren die Grünlandvegetation und die landwirtschaftlichen Betriebe mit ihren Menschen und deren Beweggründen. Diese Inhalte er-forderten eine Vorgehensweise, die sowohl sozialwissenschaftliche als auch naturwissenschaftliche Methoden einbindet, um Bezüge zwischen Betrieben und Grünlandvegetation zu er-kennen. Umfangreiche pflanzensoziologische Untersuchungen und Interviews der Betriebsleiter waren Grundlage für eine Schlagdatenbank und weitergehende Auswertungen. Die Interpretation vegetationskundlicher Erhebungen im Kontext betrieblicher Entscheidungen und Beweggründe erforderte es, althergebrachte Ansätze in neuer Form zu verknüpfen. Die Bewertung der Programmwirkungen stützte sich auf die Schlagdatenbank und auf vier Szena-rien zur zukünftigen Gebietsentwicklung bei unterschiedlichen Programmfortschreibungen. Zur Darstellung von Erhebungen und Ergebnissen entstand eine Vielzahl thematischer Karten. Der überdurchschnittlich hohe Anteil naturschutzfachlich bedeutsamer Grünlandtypen auf den Programmflächen und die Interpretation der Szenarien belegten eine hohe Wirksamkeit von HELP und HEKUL im Gebiet. Nicht nur auf den Vertragsnaturschutzflächen des HELP, sondern auch auf dem HEKUL-Grünland sind naturschutzfachlich bedeutende Vegetationstypen überproportional vertreten. Die vier Szenarien ließen erkennen, dass eine Beschränkung des HELP auf Schutzgebiete, eine Abschaffung der HEKUL-Grünlandextensivierung oder gar eine ersatzlose Strei-chung beider Programme zu erheblichen Verschlechterungen der naturschutzfachlichen Situation führen würde. Gleichzeitig war festzustellen, dass es ohne die landwirtschaftlich schwierigen natur-räumlichen Verhältnisse sowie eine eher großteilige Agrarstruktur mit überdurchschnittlich flächen-starken und wirtschaftlich stabilen Vollerwerbsbetrieben keine so deutlichen Programmwirkungen gegeben hätte. Auch die Tatsache, dass viele Landwirte eine intensive Landwirtschaft aus innerer Überzeugung ablehnen und mit einer erheblich geringeren Stickstoffintensität wirtschaften als es HEKUL verlangt, wirkte verstärkend. Die große Bedeutung individueller Beweggründe einzelner Betriebsleiter wurde auch in den engen Beziehungen einzelner Grünland-Pflanzengesellschaften zu bestimmten Betriebstypen und sogar einzelnen Höfen sichtbar, deren Beschreibung und Interpretation wichtige Erkenntnisse zu den so-zioökonomischen Voraussetzungen verschiedener Vegetationstypen lieferte. Für die zukünftige Entwicklung der hessischen Agrarumweltförderung empfiehlt die Dissertation eine Einführung und bevorzugte Anwendung ergebnisorientierter Honorierungsverfahren, eine bessere Berücksichtigung des gering gedüngten Grünlands über eine differenzierte Förderung sehr extensiver Düngeregime, eine stärkere Modularisierung des Gesamtprogramms und eine Durchführung aller Maßnahmen im Vertragsverfahren. Die betriebszweigbezogene Grünlandextensivierung sollte zukünftig in Kulissen angeboten werden, in denen ein verstärktes Wechseln von Betrieben in die Mindestpflege nach DirektZahlVerpflV zu erwarten ist.

Information for the diagnosis and treatment of root resorption due to tooth replantation

A favorable prognosis after tooth avulsion depends on some variables, such as the extra-alveolar period and storage medium. Vitality of the periodontal ligament cells is considered a critical factor for a successful outcome without root resorption. The dental surgeon is provided with clinical information and radiographic findings to establish a diagnosis and may rely on current available guidelines. Once trauma has occurred, treatment must be quick and effective, and periodic follow-up must be performed. Clinical, radiographic, and histologic characteristics for each type of root resorption due to tooth replantation are presented, with the aim to provide information for the diagnosis and treatment of healing complications.

Sole infection by human metapneumovirus among children with radiographically diagnosed community-acquired pneumonia in a tropical region

Background Limited information is available on the role of human metapneumovirus (HMPV) as the unique pathogen among children hospitalized for community-acquired pneumonia (CAP) in a tropical region. Objective We aimed to describe HMPV infection among children with CAP investigating bacterial and viral co-infections. Patients and methods A prospective study was carried out in Salvador, North-East Brazil. Overall, 268 children aged <5 years hospitalized for CAP were enrolled. Human metapneumovirus RNA was detected in nasopharyngeal aspirates (NPA) by reverse transcription polymerase chain reaction. Sixteen other bacterial and viral pathogens were investigated by an expanded panel of laboratory methods. Chest X-ray taken on admission was read by an independent paediatric radiologist unaware of clinical information or the established aetiology. Results Human metapneumovirus RNA was detected in NPAs of 11 (4.1%) children, of which 4 (36%) had sole HMPV infection. The disease was significantly shorter among patients with sole HMPV infection in comparison with patients with mixed infection (4 +/- 1 versus 7 +/- 2 days, P = 0.03). Three of those four patients had alveolar infiltrates. Conclusion Sole HMPV infection was detected in children with CAP in Salvador, North-East Brazil. HMPV may play a role in the childhood CAP burden.

Beta-bloqueadores em anestesiologia: aspectos farmacológicos e clínicos

JUSTIFICATIVA E OBJETIVOS: Informações experimentais e clínicas têm sugerido que os b-bloqueadores apresentam efeitos hemodinâmicos importantes e protetores durante o ato anestésico-cirúrgico. O objetivo deste trabalho é revisar as informações farmacológicas e clínicas dos b-bloqueadores para sua utilização adequada na medicina per-operatória. CONTEÚDO: Os b-bloqueadores seletivos inibem preferencialmente os b1-receptores reduzindo a freqüência e inotropismo cardíacos e determinando redução no consumo de oxigênio do miocárdio. Os b-bloqueadores não seletivos inibem também os b2-receptores, aumentando a resistência bronquiolar e vascular periférica. Alguns b-bloqueadores são, também, vasodilatadores. O tratamento prolongado com os b-bloqueadores aumenta a densidade dos b-receptores na membrana celular, o que pode explicar a hiperatividade simpática que pode ocorrer durante a parada do tratamento desses medicamentos. em cirurgia não cardíaca, os efeitos benéficos do b-bloqueadores em pacientes hipertensos ou nos que apresentam doença coronariana têm sido demonstrados, com redução da incidência de isquemia miocárdica no pós-operatório e da mortalidade durante o período de dois anos que se segue à operação. CONCLUSÕES: O tratamento com b-bloqueadores deve ser mantido até o período da manhã da operação, exceto nos pacientes com sinais de intolerância à droga, como hipotensão ou bradicardia importante. Os b-bloqueadores exercem efeito benéfico na recuperação pós-operatória de pacientes com doenças cardiovasculares ou nos que apresentam fatores de risco. Por isso, o emprego desses medicamentos é importante na medicina per-operatória e deve ser ampliado.