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PubMed2005

Posttraumatic stress disorder symptoms and adherence among women living with HIV.

OBJECTIVES: Posttraumatic stress disorder (PTSD) is an anxiety disorder associated with serious traumatic events. People with PTSD tend to perceive medical interventions as intrusive. Factors such as dose complexity, number of pills, food requirements, patient-health provider relationship, and individual factors influence adherence. This study intends to examine if traumatic experiences affect the way women living with HIV adhere to their medical treatment. METHODS: Adherence to HIV medications was examined with a self-report scale that was administered to a group of women that attend the Maternal Infant Studies Center. Trauma symptoms were measured by using the Trauma Symptom Inventory. RESULTS: A total of 15 women were studied. Of these, 86.6% were found adherent and 13.4% nonadherent. Both the adherent and nonadherent activated the anger/irritability (7.7% vs 50%), sexual concerns (7.7% vs 50%), and tension-reduction clinical (TRB) scales (15.4% vs 100%). The adherent women also activated the anxious arousal, depression, defensive avoidance, and dissociation scales. CONCLUSIONS: This study reveals differences in trauma-related symptoms among adherent and nonadherent patients. Increases in the TRB index of 100% among the nonadherent may reflect a need for psychological treatment. By lowering this index, they might improve their desire to live and adhere better to their treatment. Because of the limited sample size, we cannot generalize these findings. We will continue to collect data on a desired sample size of 85 women.

Adult↗

PubMed2006

Modification of pre-mRNA processing: application to dystrophin expression.

Antisense oligonucleotides are emerging as exciting therapeutic agents with the potential to overcome disease-causing mutations in the dystrophin gene. The size and complexity of the dystrophin gene allows for intervention during pre-mRNA processing, where selected exon excision can remove nonsense mutations or restore the reading frame disrupted by genomic deletions or duplications. This review summarizes some of the events leading up to forthcoming clinical trials in 2006, and speculates on some of the challenges facing targeted exon skipping as a therapy for Duchenne muscular dystrophy.

Animals↗

PubMedDate not supplied

Best practice in management of patients with acute stroke.

The management of the patient with acute stroke is very complex and covers all aspects from acute intervention to ensuring a dignified and pain-free death. Stroke has an increasing profile and with the proposed NICE paper on best practice due out in the next 18 months, the focus will be on the effective running of stroke units and the skills of nurses who work in them. It is essential that nurses keep up to date with developments and know how to provide the best, evidence-based care.

Acute Disease↗

PubMed2006

Terlipressin facilitates transport of septic patients treated with norepinephrine.

BACKGROUND: Transport of hemodynamic unstable septic patients for diagnostic or therapeutic interventions outside the intensive care unit is complex but sometimes contributes to increasing the chance of survival. OBJECTIVES: To report our experience with terlipressin treatment for facilitation of transport to distant facilities for diagnostic or therapeutic procedures in septic patients treated with norepinephrine. METHODS: We conducted a retrospective analysis of the records of our ICU, identifying the patients with septic shock who required norepinephrine for hemodynamic support. RESULTS: Terlipressin was given to 30 septic shock patients (15 females and 15 males) who were on high dose norepinephrine (10 microg/min or more) in order to facilitate their transport outside the ICU. The dose of terlipressin ranged from 1 to 4 mg, with a mean of 2.13+/-0.68 mg. The dose of norepinephrine needed to maintain systolic blood pressure above 100 mmHg decreased following terlipressin administration, from 21.9+/-10.4 microg/min (range 5-52 microg/min) to 1.0+/-1.95 (range 0-10) (P < 0.001). No patients required norepinephrine dose adjustment during transport. No serious complications or overshoot in blood pressure values were observed following terlipressin administration. Acrocyanosis occurred only in eight patients receiving more than 1 mg of the drug. The overall mortality rate was 50%. CONCLUSIONS: Our data suggest that terlipressin is effective in septic shock. Because it is long-acting and necessitates less titration it might be indicated for patient transportation.

Adult↗

PubMed1990

Pain management following trauma and burns.

Effective pain management in trauma patients requires an understanding of both the physiologic responses to injury, and the potential modification of these responses produced by analgesic and anesthetic agents. Complex, multisystem injuries occur frequently and therapeutic intervention for the control of pain must be carefully incorporated within the overall management plan. Pain management strategies for specific injuries are discussed.

Analgesics↗

PubMed1990

The drug abusing adolescent: clinical issues.

Clinical intervention with adolescent substance abusers is a complex issue. Disputes remain regarding the precise nature of the disorder. Treatment of the adolescent is complicated by the normal development tasks of this age, particularly denial of possible consequences and adoption of attendant risk-taking behaviors. Treatment begins with a complete drug history and must not neglect the adolescent's family and other support system. The mental health professional, especially the psychiatrist, can make a unique contribution in this area, despite the "bad press" he has so often received by the rest of the (treatment) community.

Adolescent↗

PubMed1989

Review of invasive treatments of coronary artery disease.

Coronary artery disease is a difficult clinical entity to manage, and all forms of current therapy are palliative in nature. Results from the large randomized studies have clearly demonstrated the superiority of surgical versus medical therapy in subsets of patients previously described herein. As patients with severely compromised ventricles are demonstrated to fare better with bypass procedures, the number of patients that should be operated upon continues to grow. With refinements in operative and perioperative care and increased use of the internal mammary artery as the bypass conduit, it is inevitable that more subgroups will be determined to be best managed by surgical revascularization. For the present time, medical treatment is preferred for the vast majority of patients who were shown by randomized trials not to benefit significantly from surgical intervention. However, caution must be used in excluding patients based on trial results that used surgical techniques and conduits that are ten years old. The role of angioplasty in the invasive treatment of ischemic cardiac disease is still in evolution. Although not yet proved by vigorous trials, it is a procedure that most likely will continue to be used in many clinical applications. The high rate of restenosis after angioplasty, which is a formidable problem, may be a factor that will limit the application of angioplasty to patients with acute myocardial infarction or to those who do not desire surgical intervention. The answers to these and other complex problems of patient management must await well-designed prospective trials comparing angioplastic with surgical revascularization. Clinical use of some of the experimental procedures mentioned is certain; the efficacy and role of these procedures in the treatment of ischemic cardiac disease must also be defined with future studies.

Angioplasty, Balloon↗

PubMedDate not supplied

[Ultrasonic diagnosis of ureterocele].

Diagnostic ultrasonic investigation has found many applications in routine urologic practices. The use of ultrasound for the investigation of 19 patients with ureterocele is reported. High diagnostic value, simplicity and noninvasiveness of echographic diagnosis of this congenital malformation of distal ureteral portions and related complications are pointed out. Its advantages over conventional means of ureterocele diagnosis, such as excretory urography and cystoscopy, are demonstrated, while their shortcomings are avoided. Echography is particularly effective in cases of impaired renal activity, doubled upper urinary tract and segmentary ureterohydronephrosis. Ultrasound makes it possible to choose the type of surgical intervention, and exclude angiography from the diagnostic complex in some cases. Follow-up echographic examination after surgery for ureterocele provides adequate information on treatment results.

Adult↗

PubMed1977

[Conservative periodontal therapy and its indication in stomatological general practice].

The term of "conservative periodontal therapy" covers all therapeutical measures with the exception of surgical interventions. Since each periodontal therapy constitutes a complex of various measures, it seems to be more favourable to subdivide it, on principle, into continuous phases, which results in advantages for the methodics of treatment planning and performance. The contents of the hygienizing, correcting and stabilizing phase of periodontal therapy are expressed in words and tables.

Dental Prophylaxis↗

PubMed1988

Multiple vitamins and vitamins with iron: accidental poisoning in children.

To insure adequate nutrition, parents and pediatricians often advocate vitamin and mineral supplementation in young children. A retrospective review of 275 pediatric cases (6 mo-6 yr) involving multiple vitamins and vitamins with iron was conducted. Six cases with co-ingestants were excluded. The product ingested was the child's own dietary supplement in 93% of the cases. Fifty-six percent were children's multiple vitamins and 44% were children's multiple vitamins with iron. Adult vitamin preparations accounted for 7% of the ingestions. The average amount of vitamin A ingested by history was 43,300 IU (1,500-225,000) while the mean ingestion of iron was 16.8 mg/kg (0.9-77.5 mg/kg). Fifty ingestions (18.2%) involved more than one child. The mean time since ingestion was 15.8 min (0-150 min). Management data showed 246 (89.5%) being treated in the home setting with dilution (83%) or syrup of ipecac induced-emesis (10%). Medical intervention including emesis, serum iron/TIBC, and oral complexation was needed in 10.5% of the cases. The mean serum iron levels were 204.6 mcg/dl (81-414 mcg/dl). No patient needed admission. This review revealed 100% of patients showed no significant toxic effects. We conclude that early recognition and prompt treatment of pediatric overdoses involving multiple vitamins with and without iron significantly reduces morbidity.

Child↗

PubMed1981

The long-term treatment of victims of child abuse.

Child abuse is defined as physical, emotional, verbal, or sexual injury inflicted upon children. It is a complex problem requiring a systematic approach to intervention and treatment. All family members are victims of child abuse. Because child abuse tends to be a cyclic problem, rooted in several generations of parenting, long-term treatment in the community must be available for abusing families, both adults and children. At the core of all successful treatment are the significant relationships which must be established between parents and the case worker and the abused child and the case worker. These relationships must be based on mutual trust, respect, and support-characteristics that are lacking in the relationships of most victims of child abuse. The nurse who works with abusing families in the community brings empathy, a knowledge and understanding of child development, and a holistic approach to health, growth, and change to the relationship. Nurses have a significant role on the child abuse treatment team as primary workers with the family, case managers, and liaisons in a multi-agency interventional effort.

Adult↗

PubMed1994

Rhinitis.

Rhinitis is a problem causing significant morbidity. The etiology of rhinitis is varied. The pathophysiology of rhinitis is just beginning to be elucidated. Allergic rhinitis is primarily understood as an inflammatory disease with a neurogenic component. Disease states such as responses to cold dry air are primarily considered to be neurogenic in origin, but inflammatory cells and mediators play a significant role in the development of symptoms in these patients. Our understanding of these complex interactions is reflected in the pharmacologic interventions currently available. Most rhinitis therapy addresses the symptoms of rhinitis not the underlying disease state. Future research in the field of rhinitis should increase our knowledge of the pathophysiology and therefore assist in new drug development.

Humans↗

PubMed1993

Breast cancer control programme in developing countries.

Breast cancer is a very important health problem in developing countries, where its incidence has increased in the last decades. Mortality rates due to breast cancer have also increased, and the main reason for this is late diagnosis. The authors demonstrate that organizing programmes for early breast cancer detection is possible by making use of simple resources. A set of tiered interventions is proposed, stratified in levels of complexity: Level 1--Identification of abnormal breast by health professionals; Level 2--Medical assistance to women whose breast is considered abnormal, in order to diagnose and treat benign diseases and recognize suspect cases of cancer; Level 3--Management of the women with suspected or diagnosed breast cancer by a multidisciplinary team. Therefore, a proposal for wide action for breast cancer control in developing countries is presented.

Breast Neoplasms↗

PubMed1996

Beyond infant colic.

Some of the most interesting cases in pediatric practice evolve through time. What may begin as a clear, well defined problem with a predictable natural history and an accepted intervention strategy may develop into a more complex, multi-faceted set of problems. It is these children who potentially provide clinicians with new insights into behaviors. This case of a colicky infant illustrates the wide spectrum of behavioral and physiological symptoms that emerge from a specific underlying behavioral phenomenon. It also emphasizes the significant benefit derived from a longitudinal perspective of developmental events.

Colic↗

PubMedDate not supplied

[Marital problems in depressive patients: a review of the literature and own clinical investigations].

The study presents a review of the literature and our own findings on marital and social problems of patients with major depression, and their spouses. The impact of illness on family and social life is marked and includes restrictions in social and leisure activities, considerable strain on marital relationships, lack of support. The functional impairment in families of depressed patients is an important factor worsening the course of the illness. These data suggest that in the complex treatment of depression a focus on intervention and prevention in areas of family and marital life is desirable.

Depressive Disorder↗

PubMed1997

[The characteristics of the technical instrumental support for the osteosynthesis of femoral neck fractures using the Seppo fixator].

Operative treatment of fractures of the femur neck is the method of choice. The authors prefer the A. Seppo construction out of great number of fixtures but it is difficult to introduce and remove this fixture due to its complexity. To make the procedure of such interventions easier the authors propose a marking device, a screwdriver and a device allowing the fixture's curvature to be regulated. The modification of the technique and using a specially developed extractor is explained by difficulties in removing the fixture by common methods. The variant of the improved instrumental tooling proposed by the authors makes the operation more handy and practicable.

Equipment Design↗

PubMed1998

Nursing case management for psychogeriatric patients and their families: description of a clinical model.

A theoretical model of clinical case management for psychogeriatric patients and their families is described. Psychogeriatric patients often have complex health care needs, requiring specific nursing interventions. The increasing frailty of these patients over time, together with the risk for institutionalization, make professional nursing contribution to their care even more desirable. Nursing case management is described by means of a conceptual-operational continuum. On the conceptual site, the continuum includes a geriatric definition and core principles of case management. On the operational site, case management is described as a clinical system, a process, a technology, and a role. The process of case management is a deliberate, intellectual activity whereby the practice of nursing is approached in an orderly, systematic manner. It includes components of assessment, diagnosis, planning, implementation, and evaluation. The case management approach requires nurses to assume an active role in designing care maps and to work collaboratively with members of a multidisciplinary team.

Aged↗

PubMed1998

Role of histone deacetylases in acute leukemia.

Accumulating evidence points to a connection between cancer and transcriptional control by histone acetylation and deacetylation. This is particularly true with regard to the acute leukemias, many of which are caused by fusion proteins that have been created by chromosomal translocations. Genetic rearrangements that disrupt the retinoic acid receptor-alpha and acute myeloid leukemia-1 genes create fusion proteins that block terminal differentiation of hematopoietic cells by repressing transcription. These fusion proteins interact with nuclear hormone co-repressors, which recruit histone deacetylases to promoters to repress transcription. This finding suggests that proteins within the histone deacetylase complexes may be potential targets for pharmaceutical intervention in many leukemia patients.

Acute Disease↗