RESUMO
OBJECTIVE: To investigate whether implementation of a stepwise multidisciplinary intervention ('STA OP!' ['STAND UP!']) is effective in reducing behavioural problems and depressive symptoms in nursing home residents with advanced dementia. DESIGN: Cluster randomised controlled trial. METHOD: We implemented the STA OP! protocol on the intervention units by training the entire multidisciplinary team. This team was trained in all 6 steps of the protocol during five 3-hour sessions. Professionals working on the control unit received training on general technical nursing skills, dementia management and pain, but then without the stepwise component. All elderly care physicians were given additional training in pain management in patients with dementia, based on the guidelines on pain in vulnerable older people. Measurements were taken at baseline, and after 3 and 6 months. We used longitudinal 'multilevel' techniques to correct for clustering of data (e.g. at unit level) for statistical analysis (Dutch Trial Register: NTR1967). RESULTS: A total of 288 residents with dementia were included, from 12 nursing homes (21 units): 148 in the intervention group in 11 units and 140 in the control group in 10 units. On the units where the STA OP! protocol was used there was a significant decline in agitation, neuropsychiatric symptoms and depression compared with the control units at 6 months. Furthermore, use of anti-depressive medication was significantly lower on the intervention units (odds ratio: 0.32; 95% CI: 0.10-0.98). CONCLUSION: This cluster RCT revealed that the stepwise multidisciplinary intervention STA OP! is effective in reducing behavioural problems and use of psycho-pharmaceuticals in nursing home residents with dementia.
Assuntos
Demência/psicologia , Demência/terapia , Comportamento Problema/psicologia , Idoso , Análise por Conglomerados , Depressão/diagnóstico , Depressão/etiologia , Depressão/terapia , Humanos , Casas de Saúde , Manejo da Dor , Agitação Psicomotora/etiologia , Agitação Psicomotora/terapia , PsicoterapiaRESUMO
We describe a patient who underwent replacement of the descending aorta with reimplantation of the coronary arteries for acute type II aortic dissection and developed iatrogenic left main stem stenosis 1 year after operation. The patient was successfully treated by stent implantation in the left main stem.
Assuntos
Angioplastia Coronária com Balão/métodos , Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Estenose Coronária/terapia , Idoso , Implante de Prótese Vascular/métodos , Estenose Coronária/etiologia , Vasos Coronários/cirurgia , Humanos , Masculino , Stents , Resultado do TratamentoAssuntos
Cafeína/efeitos adversos , Demência/etiologia , Demência/psicologia , Diabetes Mellitus/psicologia , Geriatria/educação , Idoso , Protocolos Clínicos , Estudos de Coortes , Currículo/normas , Demência/induzido quimicamente , Diabetes Mellitus/terapia , Educação , Avaliação Geriátrica , Geriatria/normas , Humanos , Países Baixos , Casas de Saúde , Estudos ProspectivosRESUMO
Reports by others that stress surrounding AID alters the menstrual cycle has prompted some physicians to provide pharmacologic control to predict the day of ovulation. We studied the BBT charts of 47 women who had predictable menstrual cycles in the 2 months preceding AID in order to compare them with day of ovulation and length of luteal phase of the 1st month of AID. Although there was a significant difference in the day of ovulation between AID and non-AID months, the difference was less than 1 day. We did not find the large shift in ovulation day during the 1st month of AID reported by others.