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Background: In diabetic patients, the glycemic control is usually represented by hemoglobin A1c (HbA1c), fasting plasma glucose (FPG) and postprandial glucose (PPG), which are usually referred as the “glucose triad”. Apart from these three, “glucose variability” (GV) has been considered as an additional marker, and may be equally important. Materials and methods: The study was a prospective observational study conducted in critical care unit of NRI General Hospital. The study has included all the critically ill neurological patients admitted in the study setting during the study period. A total of 114 participants were included in the study. All critically ill neurological patients were included in the study and were assessed with hourly Glucometric random blood sampling (GRBS) for 6 hours for initial 15 days of admission. Glycemic Pasha SA, Pasha SA, Kusuma B, T. Suhasini. Association between the glycemic variability and mortality in critically ill neurological patients - A hospital based observational study. IAIM, 2016; 3(7): 42-49. Page 43 variables have been recorded including Mean blood glucose (MBG), Glycemic liability index (GLI), Standard deviation of blood glucose. APACHE II scores were also recorded. Results: The mean age of the study participants was 51.69 (±20.21) years. Males constituted 57% and females constituted 43% of study population. The proportion of subjects with diabetes was 51.8%.The mean days of ICU stay was 8.19 (±3.86) days. The morality risk in study population was 28%. Univariate logistic regression analysis showed highest mortality in < 30 year age group. When compared to below 30 year age group, the risk of mortality in 30 to 49 year group was 44%, was 27.6% in 50 to 69 years age group and 71.4% in above 70 years age group. The mortality was almost similar in both genders. The mean APACHE II score was 4 units higher in mortality group, compared to non-mortality group (95% CI 1.64 to 6.37, p value 0.001). Even though the mean GLI, SD GLI values were 39.24 and 73.67 times higher in people with mortality these differences were statistically not significant. The differences in the mean values of mean blood glucose and SDBG were very negligible between the subjects with and without mortality. Conclusion: The study findings reveal that though, APACHE II scores seem to positively associated with mortality among critically ill neurological patients, the glycemic variability though positively influenced the mortality, it is not significant. Further studies assessing the role of GV specifically among such patient groups with a larger sample might reveal the true influence of such interaction.
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Background: Drug-drug interaction (DDI) is a potential cause of adverse drug reactions. This study estimates the rate and factors associated with potential DDI in cardiac and neurological prescriptions from the out-patient department of various hospitals. Methods: A cross-sectional study was conducted from February to April, 2014 in various outpatients department of different hospitals in Indore. Total 60 prescriptions of cardiac and 60 prescriptions of neuro patients were collected from different hospitals. All the prescriptions were analyzes by various pharmaceutical and medical books, drug interaction checker software, and journals, etc. Results: Prescriptions having moderate drug interactions are more than that of severe and minor interactions and severity of the interaction found moderate in both type of prescriptions. Among cardiac patients 75% are male and 25% are females including all age groups, and in neuro patients, 58.33% are male, and 41.66% are females including all age groups. Types of drug interaction found in prescriptions are as follow, severe interaction (13% in cardiac, 8% in neuro), and moderate interaction (45% in cardiac, 37% in neuro), minor interaction (17% in cardiac, 25% in neuro), interaction not found (25% in cardiac, 30% in neuro patients). Conclusion: The hazards of prescribing many drugs, including side-effects, DDI and difficulties of compliance have long been recognized as particular problems when prescribing. Proper emphasis should be given to drug information center and training of clinical pharmacy across the country, which can play an important role in minimizing DDIs.
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Objetivo: determinar el riesgo de úlceras por presión en el paciente neurológico postrado, mediante la aplicación de la escala Braden en el Servicio de Neurología 13 A del Hospital Nacional Edgardo Rebagliati Martins. Material y métodos: el diseño fue de tipo descriptivo de corte transversal y se realizó durante los meses de octubre a diciembre de 2012, la población estuvo conformada por 120 pacientes postrados al mes y la muestra se obtuvo con la fórmula para estimar proporción poblacional finita, obteniéndose 75 pacientes postrados a través del muestreo aleatorio simple, quienes cumplieron con los criterios de inclusión y exclusión. Para la recolección de datos se utilizó una ficha conjuntamente con la escala de Braden, los datos recolectados fueron procesados y tabulados en una base de datos para el respectivo análisis. Resultados: el estudio mostró que el mayor porcentaje de pacientes evaluados presentaron riesgo moderado con 49%, riesgo bajo con 31% y alto riesgo con 20%. Conclusiones: la escala Braden, dada su sensibilidad y especificidad, permitió reconocer el nivel de riesgo a úlcera por presión en los pacientes neurológicos.
Objetive: Of this study was to predict the pressure ulcers risk in bedridden neurological patients by using the Braden scale in the Neurology 13 A Edgrdo Rebagliati Martins Public Hospital. Material and methods: The desing was descriptive cross-sectional and was executed durig the months of October to December in 2012, the population consisted by 120 bedridden neurological patients per monthand the samples was obtained with the formula for estimating finite population proportion obtaining 75 bedridden patients throughsimple random sampling, who meet the criteria for inclusion and exclusion. The data was collected by using data collection sheet jointly with the Braden scale, the data collected were processed and tabulated in a database for examination. Results: The study showed that the highest percentage of patients evaluated presented with 49% moderate risk, low risk with 31% and 20% high risk. Conclusions: The Braden scale given its sensitivity and specificity allowed us to recognize the level of pressure ulcer risk in neurological patients.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Risk Factors , Mobility Limitation , Pressure Ulcer , Epidemiology, Descriptive , Cross-Sectional Studies , PeruABSTRACT
Se describe el sistema de valores en cuidadores familiares de pacientes neurológicos y se compara por género y etapas del ciclo vital. Se utilizó un diseño de investigación ex post facto. Se administraron a 238 cuidadores el Cuestionario Sociodemográfico y Datos del Cuidado y el Inventario de Valores. Todos los cuidadores acordaron un sistema jerárquico de valores, aunque el sensitivo-afectivo fue mejor evaluado por mujeres, el intelectual por adultos jóvenes, y el estético por adultos mayores. Se apoya la estabilidad del sistema de valores y su relativa flexibilidad según el género y las etapas del ciclo vital, lo cual aporta evidencia empírica para las perspectivas basadas en la fortaleza frente a la adversidad.
The article describes the value system in family caregivers of neurological patients, comparing them by gender and life cycle stage. An ex post facto research design was used. The Socio-Demographic and Care Data Questionnaire and the Values Inventory were administered to 238 caregivers. All of them agreed on a hierarchical value system; however, the sensitive-affective component was better evaluated by women, the intellectual component, by young adults, and the aesthetic component by older adults. Results support the stability of the value system and its relative flexibility depending on gender and life cycle stages, which provides empirical evidence for perspectives based on strength in the face of adversity.
Descreve-se o sistema de valores em cuidadores familiares de pacientes neurológicos e compara-se por gênero e etapas do ciclo vital. Utilizou-se um desenho de pesquisa ex post facto. Foram entregues a 238 cuidadores o Questionário Sociodemográfico e Dados do Cuidado e o Inventário de Valores. Todos os cuidadores combinaram um sistema hierárquico de valores, embora o Sensitivo-Afetivo tenha sido o mais bem avaliado por mulheres, o Intelectual por adultos jovens, e o Estético por adultos mais velhos. Apoia-se a estabilidade do sistema de valores e sua relativa flexibilidade segundo o gênero e as etapas do ciclo vital, o que dá evidência empírica para as perspectivas baseadas na fortaleza diante da adversidade.
Subject(s)
Caregivers , Psychology, Applied , Psychology, Medical , Family , Life Change Events , Life Cycle StagesABSTRACT
A clínica com pacientes neurológicos apresenta especificidades técnicas relativamente aos procedimentos e tipos de intervenção. Em função das perdas cognitivas desses pacientes, um dos trabalhos principais do analista consiste em construir, junto com o paciente, um campo transfero-contratransferencial que privilegie a comunicação afetiva como ferramenta clínica, o que possibilita a atualização de questões anteriores e permite abordar outras surgidas com e após o adoecimento. Nosso objetivo é investigar a importância do trabalho de construção realizado a partir da contratransferência, características do atendimento desses casos. Para isso, após investigarmos os conceitos de construção e de contratransferência, utilizaremos vinhetas de um caso clínico, a fim de tecer considerações sobre as exigências que esse tipo de clínica demanda da presença do analista durante as sessões.
The psychoanalytic treatment of neurological patients presents specific techniques with regard to the procedures and types of intervention. Due to the cognitive impairments of these patients, one of the major tasks of the analyst is to construct, with the patient, a transferencial-countertransferencial field that privileges the affective communication as a clinical tool, allowing the updating of previous questions and the addressing of others emerging with and after the illness. Our goal is to investigate the importance of the construction work carried out from the countertransference. To do so, after investigating the concepts of construction and countertransference, we will use parts of a clinical case in order to make considerations about the ways in which the analyst´s presence is required in this kind of clinical practice.
La clínica psicoanalítica con pacientes neurológicos presenta especificidades técnicas relativas a los procedimientos y tipos de intervención. A causa de las pérdidas cognitivas de estos pacientes, una de las principales tareas del analista es construir, con el paciente, un campo transfero-contratransferencial que privilegie la comunicación afectiva como herramienta clínica, lo que permite la actualización de cuestiones anteriores y abordar otras surgidas con y después de la enfermedad. Nuestro objetivo es investigar la importancia del trabajo de construcción realizado a partir de la contratransferência, característica del tratamiento de estos casos. Para ello, después de investigar los conceptos de construcción y de contratransferencia, se utiliza partes de un caso clínico con el propósito de tejer consideraciones acerca de las exigencias que este tipo de clínica pide de la presencia del analista durante las sesiones.
Subject(s)
Psychoanalysis , Countertransference , Psychology, ClinicalABSTRACT
Ultrapassados os limites de uma técnica fundamentalmente interpretativa, a psicanálise deixa de se restringir ao âmbito do sofrimento neurótico e passa a intervir em outros campos da patologia do mental, quer nos quadros de origem psicogênica, quer nos quadros em que alterações de natureza orgânica engendram sofrimentos subjetivos ? como acontece com muitos pacientes portadores de lesões cerebrais. No entanto, tais modalidades de intervenção exigem investigação teórica e técnica, já que as exigências deste tipo de clínica diferem em pontos consideravelmente importantes das encontradas na clínica psicanalítica clássica. O principal objetivo deste artigo é fornecer subsídios ? por meio da articulação entre as formulações winnicottianas sobre dependência, confiança no ambiente, sentimento de continuidade espaço-temporal, e o conceito de normatividade postulado por Canguilhem ? para uma abordagem teórica e prática que oriente a clínica psicanalítica com pacientes portadores de distúrbios neurológicos. A realização desta tarefa exige, primeiramente, uma investigação dos conceitos de plasticidade cerebral, epigênese e normatividade. De posse destes conceitos, finalmente, tecermos algumas considerações sobre a clínica psicanalítica com pacientes neurológicos.
Once exceeded the limits of a fundamentally interpretative technique, psychoanalysis cannot be restricted to the sphere of neurotic suffering and moves its scope on to other s of mental pathology, be them from a psychogenic origin or from disturbances of organic nature that may cause suffering to the subject ? as is frequently the case with bearers of brain lesions. The ways in which this can be done demand technical and theoretical investigations since this type of clinic differs considerably in many points from the classical psychoanalytical practice.. The main purpose of this paper is to provide subsidies ? through articulation of Winnicott´s concepts such as dependence, reliability on the environment, feeling of space-time continuity, and the concept of ?normativeness? as postulated by Canguilhem ? for a theoretical and practical approach that may give bearings to a psychoanalytical practice with patients that carry neurological disturbances. The completion of this task demands, in first place, an investigation into the concepts of cerebral plasticity, epigenesis and ?normativeness?. After this is accomplished we will finally make some considerations about psychoanalytical practice with neurologically impaired patients.