RESUMO
In pregnant patients at term undergoing induction of labor, early time-based artificial rupture of membranes (AROM) within 1 hour of Foley bulb expulsion results in a shorter duration of labor by nearly 9 hours with no significant difference in cesarean delivery rates or maternal or neonatal adverse outcomes.1.
Assuntos
Amniotomia , Maturidade Cervical , Gravidez , Feminino , Recém-Nascido , Humanos , Cesárea , Fatores de Tempo , Trabalho de Parto Induzido/métodosRESUMO
PURPOSE: Pharmacists' role in optimizing long-term pharmacotherapy for bariatric surgery patients is detailed. SUMMARY: Bariatric surgery patients provide a difficult challenge in terms of many pharmacotherapy issues, especially in the chronic care setting, where data on long-term effects of bariatric surgery are limited. The most common procedures are Roux-en-Y gastric bypass (RYGB), adjustable gastric banding, and sleeve gastrectomy. Sleeve gastrectomy has become the most common procedure in the United States, primarily because it has less overall chronic malabsorption effects than RYGB. Pharmacotherapy management is complicated by rapid weight loss combined with a number of pharmacokinetic changes, such as decreased absorption of some medications due to altered gastrointestinal tract anatomy and potentially increased concentrations of some medications due to a decreased volume of distribution resulting from weight loss. Nutritional and metabolic supplementation are of the utmost importance in order to limit deficiencies that can lead to a number of conditions. Many chronic diseases, including hypertension, diabetes, gastroesophageal reflux disease, and urinary incontinence, are improved by bariatric surgery but require close monitoring to ensure the effectiveness of maintenance pharmacotherapy and avoidance of adverse effects. Psychotropic medication management is also an important pharmacotherapy concern, as evidenced by antidepressants being the most commonly used medication class among preoperative bariatric surgery patients. CONCLUSION: Pharmacists have an increasing role in the chronic management of the bariatric surgery patient due to their knowledge of medication dosage forms and expertise in disease states affected by bariatric surgery.
Assuntos
Cirurgia Bariátrica/métodos , Obesidade Mórbida/tratamento farmacológico , Obesidade Mórbida/cirurgia , Farmacêuticos , Papel Profissional , Cirurgia Bariátrica/tendências , Humanos , Assistência de Longa Duração/métodos , Assistência de Longa Duração/tendências , Farmacêuticos/tendênciasRESUMO
Acute right ventricular failure post heart transplantation in the pediatric population has not been well documented. Treatment using medical therapies including inotropes and nitric oxide are often inefficient for pediatric patients. Extracorporeal membrane oxygenation has been traditionally used in children until a long-term decision can be made. As a result of the emergence of smaller assist devices, pediatric practitioners now have more options available to treat this patient population. We describe the successful use of the Thoratec CentriMag in a pediatric patient posttransplantation with acute right ventricular failure.
Assuntos
Centrifugação/instrumentação , Circulação Extracorpórea/instrumentação , Transplante de Coração/efeitos adversos , Transplante de Coração/instrumentação , Magnetismo/instrumentação , Disfunção Ventricular Direita/etiologia , Disfunção Ventricular Direita/reabilitação , Adolescente , Desenho de Equipamento , Análise de Falha de Equipamento , Coração Auxiliar , Humanos , Masculino , Pediatria/instrumentação , Resultado do Tratamento , Disfunção Ventricular Direita/diagnósticoAssuntos
Hospitalização/tendências , Hospitais Psiquiátricos/tendências , Metformina/uso terapêutico , Obesidade/tratamento farmacológico , Polimedicação , Redução de Peso/efeitos dos fármacos , Exercício Físico/fisiologia , Humanos , Metformina/farmacologia , Obesidade/psicologia , Esquizofrenia/tratamento farmacológico , Esquizofrenia/fisiopatologia , Fatores de Tempo , Redução de Peso/fisiologiaAssuntos
Hospitalização , Metformina/farmacologia , Polimedicação , Redução de Peso/efeitos dos fármacos , Adulto , Antipsicóticos/efeitos adversos , Feminino , Humanos , Masculino , Metformina/uso terapêutico , Pessoa de Meia-Idade , Sobrepeso/complicações , Sobrepeso/tratamento farmacológico , Sobrepeso/metabolismo , Esquizofrenia/tratamento farmacológico , Esquizofrenia/metabolismo , Aumento de Peso/efeitos dos fármacos , Aumento de Peso/fisiologia , Redução de Peso/fisiologia , Adulto JovemRESUMO
The purpose of this study was to determine whether patient dementia diagnostic type (Alzheimer's Disease/Vascular Dementia) is associated with caregiver burden. A retrospective case review was conducted of patient and caregiver information collected at a university-based dementia clinic. Results showed that primary dementia diagnosis was not associated with burden. Rather, psychotic symptoms paired with poor IADL functioning generated the most burden, while cognitive dysfunction did not significantly influence burden. Additionally, caregiver gender (female), depressive symptoms, and being an adult child of the care recipient were associated with increased caregiver burden. Findings advocate for including tailored designs in caregiver interventions.
Assuntos
Doença de Alzheimer/diagnóstico , Cuidadores , Efeitos Psicossociais da Doença , Demência Vascular/diagnóstico , Família , Atividades Cotidianas , Filhos Adultos/psicologia , Idoso , Doença de Alzheimer/epidemiologia , Análise de Variância , Cuidadores/psicologia , Cuidadores/estatística & dados numéricos , Demência Vascular/epidemiologia , Família/psicologia , Feminino , Avaliação Geriátrica , Humanos , Masculino , Entrevista Psiquiátrica Padronizada , Pessoa de Meia-Idade , Testes Neuropsicológicos , New Jersey , Prevalência , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores SexuaisRESUMO
OBJECTIVE: Depression is a major problem in long-term care (LTC) as is the lack of related empirically supported psychological treatments. This small study addressed a variant of cognitive behavioral therapy, GIST (group, individual, and staff therapy), against treatment as usual (TAU) in long-term care. METHOD: 25 residents with depression were randomized to GIST (n = 13) or TAU (n = 12). Outcome measures included geriatric depression scale-short form (GDS-S), life satisfaction index Z (LSI-Z), and subjective ratings of treatment satisfaction. The GIST group participated in 15 group sessions. TAU crossed over to GIST at the end of the treatment trial. RESULTS: There were significant differences between GIST and TAU in favor of GIST on the GDS-S and LSI-Z. The GIST group maintained improvements over another 14 sessions. After crossover to GIST, TAU members showed significant improvement from baseline. Participants also reported high subjective ratings of treatment satisfaction. DISCUSSION: This trial demonstrated GIST to be more effective for depression in LTC than standard treatments.
Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo/terapia , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Feminino , Humanos , Assistência de Longa Duração/métodos , Masculino , Satisfação do Paciente , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
This study set out to clarify the association of apathy and depression in dementia as well as apathy's association with basic (ADLs) and instrumental (IADLs) activities of daily living and quality of life. 68 outpatients with mild dementia were assessed on apathy, depression, global cognition, traditional ADLs/IADLs, complex daily living activities requiring intact executive functioning (DAD: Disability Assessment for Dementia Scale), and quality of life. The sample was stratified into high and low global cognition groups and compared. While no relationship was found between scores on apathy and depression in the high cognition group, there was a significant relationship between apathy and depression in the low cognition group. Further, high and low cognition groups differed in the relationship between apathy and ability to perform basic and complex activities of daily living. Specifically, in the high cognition group, increased apathy was correlated with diminished ability to perform traditional IADLs as well as those activities requiring intact executive functioning (i.e., DAD). In the low cognition group, increased apathy was associated with poor performance on traditional ADLs and IADLs, but was not related to performance on independent daily activities demanding good executive functioning. Finally, increased apathy was significantly associated with worse quality of life, but this held for the high cognition group only, suggesting that dementia patients with better cognition have insight into their deficits and, perhaps, experience poor quality of life as a result.
Assuntos
Demência/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Transtornos do Humor/epidemiologia , Qualidade de Vida/psicologia , Idoso , Humanos , Testes Neuropsicológicos , Índice de Gravidade de Doença , Inquéritos e QuestionáriosRESUMO
Eighteen males condemned to death in Texas for homicides committed prior to the defendants' 18th birthdays received systematic psychiatric, neurologic, neuropsychological, and educational assessments, and all available medical, psychological, educational, social, and family data were reviewed. Six subjects began life with potentially compromised central nervous system (CNS) function (e.g., prematurity, respiratory distress syndrome). All but one experienced serious head traumas in childhood and adolescence. All subjects evaluated neurologically and neuropsychologically had signs of prefrontal cortical dysfunction. Neuropsychological testing was more sensitive to executive dysfunction than neurologic examination. Fifteen (83%) had signs, symptoms, and histories consistent with bipolar spectrum, schizoaffective spectrum, or hypomanic disorders. Two subjects were intellectually limited, and one suffered from parasomnias and dissociation. All but one came from extremely violent and/or abusive families in which mental illness was prevalent in multiple generations. Implications regarding the ethics involved in matters of culpability and mitigation are considered.