Retratos de medicamentos homeopáticos com repertório de sintomas / Portraits of homeopathic medicines with a repertoire of symptoms

A obra Retratos de Medicamentos Homeopáticos é um inestimável trabalho da Dra. Margaret Tyler que descreve 125 imagens de remédios retratadas com citações de Hahnemann, T. F. Allen, Hering, Burnett, Farrington, Kent, Clarke e outros autores de grande relevância, bem como a sua própria experiência. Para todos os medicamentos, a autora apresenta informações valiosas, incluindo o histórico de uso e preparação, e o estudo comparado de cada remédio com um ou mais medicamentos que se assemelham. Ela relata histórias interessantes e bem-humoradas, e coloca também a lista de sintomas mais importantes e indicações características. A inclusão de casos, artigos e cartas de várias fontes enriquece a imagem dos remédios e alarga o âmbito deste trabalho como uma referência muito útil para aqueles que desejam conhecer melhor os medicamentos da Matéria Médica Homeopática. Ao final, encontra-se um Repertório de Sintomas cuidadosamente elaborado para facilitar a utilização clínica desta obra.

Retratos de medicamentos homeopáticos com repertório de sintomas / Portraits of homeopathic medicines with a repertoire of symptoms

A obra Retratos de Medicamentos Homeopáticos é um inestimável trabalho da Dra. Margaret Tyler que descreve 125 imagens de remédios retratadas com citações de Hahnemann, T. F. Allen, Hering, Burnett, Farrington, Kent, Clarke e outros autores de grande relevância, bem como a sua própria experiência. Para todos os medicamentos, a autora apresenta informações valiosas, incluindo o histórico de uso e preparação, e o estudo comparado de cada remédio com um ou mais medicamentos que se assemelham. Ela relata histórias interessantes e bem-humoradas, e coloca também a lista de sintomas mais importantes e indicações características. A inclusão de casos, artigos e cartas de várias fontes enriquece a imagem dos remédios e alarga o âmbito deste trabalho como uma referência muito útil para aqueles que desejam conhecer melhor os medicamentos da Matéria Médica Homeopática. Ao final, encontra-se um Repertório de Sintomas cuidadosamente elaborado para facilitar a utilização clínica desta obra.

Continuous oscillation: outcome in critically ill patients.

PURPOSE: To compare turning by an oscillating bed to standard 2-hour turning. Outcomes were survival, length of stay (LOS), duration of mechanical ventilation, and incidence of pneumonia. METHODS: One hundred and three intensive care patients were randomly assigned to standard turning or turning by an oscillating bed. Data, collected at baseline, daily for 7 days, and then three times weekly until study discharge, included demographics, initial Acute Physiology and Chronic Health Evaluation (APACHE II) score, ventilatory/gas exchange parameters, indicators of pneumonia, nursing measures, and chest roentgenograph. RESULTS: There were no significant differences for LOS, duration of ventilation, nor incidence of pneumonia. Higher survival for subjects on the oscillating bed reached borderline significance (P = .056) for subjects with APACHE II greater than or equal to 20. Longitudinal data were analyzed using the random effects model. No differences in ventilatory or gas exchange parameters were identified. Among subjects who developed pneumonia there was a significantly higher respiratory score (nursing acuity scale) for subjects on the oscillating bed. CONCLUSIONS: In selected critically ill patients oscillating therapy may improve survival and improve airway clearance. The frequency and degree of turning needed to prevent complications and improve outcome remains unclear. These newer beds should be used with discrimination so as to not increase hospital costs unnecessarily.

Validation of risk factors for the nursing diagnosis decreased intracranial adaptive capacity.

Mitchell has proposed a series of factors that may aid in the identification of individual patients with intracranial hypertension at risk for decreased intracranial adaptive capacity. The etiology of decreased intracranial adaptive capacity is failure of normal intracranial compensatory mechanisms. The defining characteristic of this nursing diagnosis is repeated disproportionate increase in intracranial pressure (ICP) that can occur in response to a variety of noxious and nonnoxious stimuli. The purpose of this study was to determine predictive validity of two risk factors (wide amplitude of ICP tracing and increased level of ICP at rest) for the phenomenon of decreased intracranial adaptive capacity. Data were derived from secondary analysis of 30 recordings from a sample of eight children who had ICP monitoring as part of their medical treatment. Results indicated that wide amplitude of ICP tracing or wide amplitude plus increased level of ICP at rest (specificity and positive predictive value were each 100%) with suctioning and turning was more likely to be associated with a disproportionate increase in ICP than when an increased level of ICP at rest alone was the only risk factor (specificity = 25% and positive predictive value = 67% with suctioning and specificity and positive predictive value each = 40% with turning). It was also concluded that, despite high positive predictive values, the combination of risk factors was sufficient but not solely necessary for a disproportionate increase in ICP (false negative predictive value for wide amplitude was 65% with suctioning and false negative predictive value for increased level of ICP was 83% with suctioning and 43% with turning).(ABSTRACT TRUNCATED AT 250 WORDS)

The performance of four pleural drainage systems in an animal model of bronchopleural fistula.

In order to compare the performance of four pleural drainage units (PDU [Emerson Post-Operative Pump, Pleur-Evac, Sentinel Seal, Thora-Klex]), we created an animal model of bronchopleural fistula that simulated the type of air leak seen clinically (mean maximal flow = 5 L/min). The PDU were tested at 0 cm (water seal), -20 cm and -40 cmH2O suction. Compared to water seal, -20 cmH2O suction significantly increased the ability of all four PDU to evacuate air via the chest tube and abolished small differences in chest tube air leak seen among the PDU at water seal. An increase in suction to -40 cmH2O did not significantly alter flow via the chest tube. Previously demonstrated differences among the PDU in handling large air flows were not seen in this lower flow model of bronchopleural fistula. However, because of their higher resistance, use of the Sentinel Seal and of the Thora-Klex was technically impractical even at air leaks of 4 to 5 L/min.

Ineffective airway clearance related to airway infection.

Clearance of secretions is a common problem in patients who experience acute respiratory tract infections. Although the offending agent is a major factor, the degree of severity of ineffective airway clearance depends on many other factors: pulmonary host defenses, presence of underlying pulmonary disease, age, lifestyle habits, environments, airway clearance self-management skills, and time of specific treatment.

Influence of head-dependent positions on lung volume and oxygen saturation in chronic air-flow obstruction.

We investigated the influence of head-dependent positions upon functional residual capacity (FRC) and arterial oxygen saturation in 25 patients with clinically stable chronic air-flow obstruction and 25 normal subjects. Lung volume was measured by gas dilution in normal subjects and by plethysmography in patients with chronic obstructive pulmonary disease (COPD). Arterial oxygen saturation was determined by ear oximetry. In normal subjects, sitting FRC declined by 29.9% when a horizontal-supine posture was assumed, but underwent little further change as the supine subject was tilted head-downward to -25 degrees. Lateral decubitus positions caused declines from sitting FRC of 17.1% at 0 degrees, and 27.4% at -25 degrees. In contrast, patients with COPD experienced negligible changes in lung volume as position was varied. The mean falls from sitting FRC were 3.5% and 1.9% in the 0 degree supine and 0 degree lateral decubitus postures, respectively, and little further volume loss occurred in head-dependency. Eight patients actually increased FRC when recumbent. Positional lung volume changes measured by gas dilution exceeded those measured by plethysmography, suggesting that increased air trapping helped to maintain FRC as position was altered. Patients with COPD did not desaturate in any position tested. We conclude that patients with advanced COPD conserve lung volume and do not desaturate when tipped into head-dependent positions. Reduction of FRC is unlikely to contribute to the hypoxemia or dyspnea previously reported to occur in these patients during chest physiotherapy.

Hospitalization needs during an outpatient rehabilitation program for severe chronic airway obstruction.

The number of days of hospitalization for respiratory disease following entry into an outpatient pulmonary rehabilitation program was reviewed for 44 patients with chronic airway obstruction whose hospitalization records were available for the year prior to entry into the program. A significant reduction in the number of days of hospitalization occurred in patients for each of the four years following entry into the program, compared to the year prior to therapy.