Assuntos
Consentimento Livre e Esclarecido , Competência Mental , Transtornos Mentais/psicologia , Pessoas Mentalmente Doentes , Compreensão , Revelação , Doença , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Japão , Competência Mental/legislação & jurisprudência , Autonomia PessoalRESUMO
The Structured Interview for Competency and Incompetency Assessment Testing and Ranking Inventory (SICIATRI) is a structured interview guide to assess the competency for giving informed consent to treatment among psychiatric and medical patients. The competency levels of 48 psychiatric and medical inpatients were assessed by SICIATRI. A relatively high- inter-rater reliability of the SICIATRI items (over half of the items had kappa > or = .60) and concurrent validity (sensitivity = .83, specificity = .67 as measured against the global judgement of competency rating by the attending physician) were obtained. In addition to its brevity (it takes about 20 minutes to complete), these findings may warrant application of this instrument in a clinical setting.
Assuntos
Competência Mental , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Adulto , Idoso , Feminino , Hospitalização , Humanos , Consentimento Livre e Esclarecido , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Inventário de Personalidade/estatística & dados numéricos , Psicometria , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
This study was designed to examine the metabolic response of patients following transthoracic esophagectomy for carcinoma of the esophagus during the administration of total parenteral nutrition. Thirty-five patients underwent a right thoracotomy and transthoracic esophagectomy with nodal dissection in the neck, mediastinum, and abdomen. The resting energy expenditure (REE) was measured preoperatively, and on the 1st, 3rd, 5th, and 7th postoperative days (PODs) using indirect calorimetry. The REE was significantly higher following transthoracic esophagectomy on PODs 1, 3, 5, and 7 than preoperatively. The caloric contribution of fat was significantly less on 3rd, 5th, and 7th PODs than on the 1st POD. In contrast, carbohydrate oxidation increased significantly on the 3rd, 5th, and 7th PODs compared to that of the 1st POD. These results may help optimize the nutritional support regimen for post-esophagectomy patients.
Assuntos
Metabolismo Energético , Neoplasias Esofágicas/metabolismo , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Adulto , Idoso , Metabolismo dos Carboidratos , Ingestão de Energia , Humanos , Metabolismo dos Lipídeos , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Fenômenos Fisiológicos da Nutrição , Nutrição Parenteral Total , Proteínas/metabolismo , DescansoRESUMO
PURPOSE: Hepatic mitochondrial response to oral glucose load (redox tolerance test) was evaluated as an indicator of hepatic functional reserve of patients with obstructive jaundice. PATIENTS AND METHODS: The redox tolerance test was performed in 29 patients with obstructive jaundice before percutaneous transhepatic biliary drainage and 2 weeks after the procedure. RESULTS: The redox tolerance index (RTI) before drainage was not related to conventional parameters other than albumin, but was significantly associated with bilirubin half-life (P < 0.01). Of 19 patients with an RTI > or = 0.5 before drainage, all maintained similar values after drainage and experienced satisfactory clinical courses, even after major surgery. Of 10 patients with an RTI < 0.5 before drainage, 5 showed improvement and 5 deteriorated after drainage. Four of the latter 5 died within 60 days after drainage. The hospital mortality was significantly greater in patients with initial RTI < 0.5 than in patients with RTI > or = 0.5 (P < 0.01). CONCLUSION: The redox tolerance test is useful for evaluating hepatic functional reserve and prognosis in patients with obstructive jaundice.