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PubMed2001

Algorithm for the treatment of chronic depression.

Chronic depression, which is marked by a course of illness lasting 2 years or more, encompasses 4 subtypes of depressive illness: (1) chronic major depressive disorder, (2) dysthymic disorder, (3) dysthymic disorder with major depressive disorder ("double depression"), and (4) major depressive disorder with poor interepisodic recovery (i.e., in incomplete remission). In the 1990s, chronic depression had a reported prevalence rate of 3% to 5% and accounted for 30% to 35% of all cases of depression in the United States. The authors present an algorithm modified from the Texas Medication Algorithm Project for patients with chronic depression. This treatment algorithm recommends a progression of steps or stages in treating chronic depression. The first stage is monotherapy with the selective serotonin reuptake inhibitors, nefazodone, bupropion sustained release, venlafaxine extended release, mirtazapine, or psychotherapy. Later options include combination therapy, electroconvulsive therapy, atypical antipsychotics, and novel treatments. Utilization of a comprehensive treatment algorithm for chronic major depression should encourage efficient, efficacious treatment.

Algorithms↗
PubMed2001

Educating patients with type 2 diabetes.

The patient is the self-manager of type 2 diabetes. The role of the health care professional is to provide the knowledge, skills, and behavior change support to empower the patient to do so. Recent governmental, financial, and clinical factors influence how health care professionals perform this role. Such factors coupled with a growing body of research evidence are shaping the way diabetes self-management education is provided.

Attitude to Health↗
PubMedDate not supplied

The importance of the sexual health history in the primary care setting.

Nurses often are apprehensive when inquiring about women's sexual health issues. A comprehensive sexual health assessment, however, is an important part of the health history and interview. Ensuring confidentiality and maintaining professionalism will create the trusting, comfortable environment necessary for a thorough evaluation of a client's sexual health risks. Nurses who are familiar with diverse sexual issues can help women deal with the changes that may occur during the life span.

Adolescent↗
PubMedDate not supplied

Vaginal health and infections.

Vaginal infections are one of the most common reasons women seek health care. Nurses play an important role not only in the assessment and management of vaginal infections but also in educating women about vaginal health. Understanding the ecology of the vagina, performing a proper microscopy, and recognizing risk factors associated with infections are key to vaginal health.

Diagnosis, Differential↗
PubMed2001

[Dietary recommendations for dyslipidemic individuals].

Diet prescription is a fundamental first-line element in the management of patients with dyslipidemia. Weight loss should be a primary goal for all overweight patients. A 5 to 10% weight loss is often sufficient to obtain a significant improvement in lipid levels. Dietary fat should not provide more than 30% of total calorie intake. Saturated fatty acids should not exceed 7% and polyunsaturated fatty acids should also be limited to 7 to 10%. For monounsaturated fatty acids the dietary allowance can be a bit wider, up to 15% of total calorie intake. Carbohydrates, particularly complex carbohydrates, should replace the fat calories. Dietary fiber (more than 20g/d) as well as soy protein or phyto-sterols can be helpful in reducing LDL-cholesterol by about 10%. Consumption of fruits and vegetables should also be encouraged because they provide antioxidants that have effects on other cardiovascular risk factors. Long-term education is needed to encourage the patient to comply with this type of diet. Psycho-behavioral strategies can be useful here.

Antioxidants↗
PubMed2001

[Clinical evidence].

Explore the source record for details and available documents.

Evidence-Based Medicine↗
PubMed2001

[Treatment methods for discontinuation of long-term benzodiazepine use].

Treatment strategies for discontinuing long-term benzodiazepine usage can be divided into minimal interventions and gradual discontinuation programs. Minimal interventions invite patients to quit their long-term benzodiazepine usage on their own by making them aware of the adverse effects. This type of intervention is successful in about one fifth of patients. Gradual discontinuation programs are more extensive interventions in order to help those patients who are unable to discontinue benzodiazepine use on their own. These programs are successful in two-thirds of the patients and can be combined with additional pharmacological or psychological treatment. Once the withdrawal symptoms have diminished, most patients have an improved psychological functioning compared to when they were using benzodiazepines. Furthermore, no increase in medical consumption has been found.

Anti-Anxiety Agents↗