RESUMO
This review discuss several studies published in 2007 that will modify current therapeutic attitudes. New evidence confirm that antipsychotics increase mortality in demented elderly persons with behavioral symptoms. Unfortunately, donepezil was no more effective than placebo to treat agitation in these patients. Aspirine, nonsteroidal anti-inflammatories, as well as supplementation with folate, vitamines B6 and B12 did not prove beneficial to prevent cognitive decline. Hormonal substitution with DHEA, testosterone, and growth hormone is ineffective as anti-aging medicine, while calcium and vitamin d'effectiveness was confirmed in fracture prevention. Finally, several studies report prognostic information that will prove important to improve preparation plan for future heat wave.
Assuntos
Geriatria , Idoso , HumanosRESUMO
In older persons, insomnia is a frequent problem with significant functional and psychological consequences. Use of over-the-counter medications is frequent and increases the risk of adverse events. Management of insomnia is based on a systematic evaluation that leads to targeted etiologic treatment when feasible. Non-pharmacological approach, including sleep hygiene and cognitive-behavioral therapy, remains effective in older persons. Hypnotics use remains nevertheless highly prevalent among elderly patients and withdrawal should be attempted after informing these patients of these drugs numerous side-effects.
Assuntos
Distúrbios do Início e da Manutenção do Sono/terapia , Idoso , Envelhecimento/fisiologia , Envelhecimento/psicologia , Controle Comportamental , Terapia Cognitivo-Comportamental , Humanos , Hipnóticos e Sedativos/efeitos adversos , Hipnóticos e Sedativos/uso terapêutico , Medicamentos sem Prescrição/efeitos adversos , Medicamentos sem Prescrição/uso terapêutico , Qualidade de Vida , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Distúrbios do Início e da Manutenção do Sono/psicologia , Tranquilizantes/efeitos adversos , Tranquilizantes/uso terapêuticoRESUMO
this paper develops and tests a mathematical model for Na+ kinetics applied to standard hemodialysis. The volume of distribution of exchangeable Na+, dialyzer surface area, blood and dialysis fluid flow rate, target weight loss, treatment duration and the Na+ diffusibility constant are taken into account. The model is used to compute the optimal hour by hour dialysis fluid Na+ concentration required to achieve the prescribed end-dialysis natremia and maintain a constant end-dialysis body Na+ pool, while providing a nearly uniform removal of Na+ over dialysis. The model was preliminary tested on 10 consecutive dialyses in a single patient using special dialyzer which generates a part of ultrafiltrate uncontaminated by dialysate.
