ABSTRACT
BACKGROUND: Pain in sickle cell disease (SCD) is often joined by other affective disorders such as depression and/or sleep impairment that can impact pain levels and quality of life (QoL). AIM: To develop a guideline to improve the process of assessment and treatment of depression and sleep impairment in patients admitted with SCD. METHOD: An interdisciplinary team used the Stetler model to create the Guideline for the Evaluation and Treatment of Depression and Sleep Impairment in Sickle Cell Disease. Patients were assessed, offered treatments and reassessed during the project period. RESULTS: Both depression and QoL scores showed significant improvement by the end of the project. Significant correlations were found between pain, depression and sleep; depression, pain, sleep and QoL; sleep, pain and depression; and QoL and depression. CONCLUSIONS: Interdisciplinary teams are effective in creating a guideline to assess and treat depression and sleep impairment and their effects on pain and QoL in patients with SCD.
Subject(s)
Anemia, Sickle Cell/nursing , Anemia, Sickle Cell/psychology , Palliative Care , Practice Guidelines as Topic , Quality of Life , Adult , Depression/psychology , Female , Humans , Male , Pain Measurement , Sleep Wake Disorders/psychologySubject(s)
Acquired Immunodeficiency Syndrome/therapy , HIV Infections/therapy , Homosexuality, Male , Acquired Immunodeficiency Syndrome/diagnosis , Acquired Immunodeficiency Syndrome/prevention & control , Civil Rights , Complementary Therapies , HIV Infections/diagnosis , HIV Infections/prevention & control , Homosexuality, Male/psychology , Humans , Interpersonal Relations , Male , Patient Participation , Physician-Patient Relations , Politics , Social EnvironmentABSTRACT
Between January of 1981 and June of 1984, 53 infants and children with the diagnosis of AIDS were seen at our institution. Twenty-one of these patients have required 35 operations to determine or administer the proper therapy. We have taken every precaution to minimize the risks of exposure of all health care personnel.
Subject(s)
Acquired Immunodeficiency Syndrome/surgery , Acquired Immunodeficiency Syndrome/prevention & control , Acquired Immunodeficiency Syndrome/transmission , Biopsy , Child , Child, Preschool , Humans , Infant , New York City , Personnel, HospitalABSTRACT
Compartmentalization of the lateral ventricle may prevent adequate functioning of ventriculoperitoneal shunts. We recently treated a patient with postinfectious hydrocephalus who required bilateral shunts. In addition, the left ventricle was shown to contain a large noncommunicating cyst. Prior to placement of the shunt, ventriculoscopy was performed and a channel established surgically between the cyst and the remainder of the ventricular system. Application of this new interventional technique may be indicated in complicated cases of compartmentalized hydrocephalus.
Subject(s)
Cerebrospinal Fluid Shunts/methods , Endoscopy , Humans , Hydrocephalus/diagnostic imaging , Hydrocephalus/surgery , Male , RadiographySubject(s)
Megacolon/surgery , Age Factors , Attitude of Health Personnel , Black People , Child, Preschool , Colostomy , Enterocolitis, Pseudomembranous/etiology , Female , General Surgery , Humans , Infant , Male , Megacolon/complications , Megacolon/genetics , Methods , Pediatrics , Postoperative Complications , Sex Ratio , Time Factors , White PeopleSubject(s)
Tracheal Stenosis/therapy , Tracheotomy , Child, Preschool , Dilatation , Electrocoagulation , Female , Granuloma/surgery , Histiocytoma, Benign Fibrous/surgery , Humans , Infant , Infant, Newborn , Intubation, Intratracheal/adverse effects , Male , Steroids/therapeutic use , Tracheal Neoplasms/surgery , Tracheal Stenosis/congenital , Tracheal Stenosis/etiology , Tracheoesophageal Fistula/surgery , Tracheotomy/adverse effectsABSTRACT
Between 1973 and 1976, laparoscopy was performed on 50 girls aged 12 to 18 years old for evaluation of abdominal pain severe enough to warrant hospitalization. In nine patients, a pelvic mass was suspected on physical examination or ultrasonography. Twenty-three patients had histories of previous episodes of salpingitis, but negative cultures at time of admission. Eighteen patients had no significant past medical history and normal physical findings. Laparoscopy established a diagnosis in 28 of the 50 patients, and in the 32 patients in whom a specific preoperative diagnosis was entertained, laparoscopy proved it to be incorrect in 15. In all cases where laparoscopy resulted in specific treatment, the symptoms were relieved. There was no morbidity or mortality.
