RESUMO
Synopsis: Archerfishes (Toxotidae) are variously found in the fresh- and brackish-water environments of Asia Pacific and are well known for their ability to shoot water at terrestrial prey. These shots of water are intended to strike their prey and cause it to fall into the water for capture and consumption. While this behavior is well known, there are competing hypotheses (blowpipe vs. pressure tank hypothesis) of how archerfishes shoot and which oral structures are involved. Current understanding of archerfish shooting structures is largely based on two species, Toxotes chatareus and T. jaculatrix. We do not know if all archerfishes possess the same oral structures to shoot water, if anatomical variation is present within these oral structures, or how these features have evolved. Additionally, there is little information on the evolution of the Toxotidae as a whole, with all previous systematic works focusing on the interrelationships of the family. We first investigate the limits of archerfish species using new and previously published genetic data. Our analyses highlight that the current taxonomy of archerfishes does not conform to the relationships we recover. Toxotes mekongensis and T. siamensis are placed in the synonymy of T. chatareus, Toxotes carpentariensis is recognized as a species and removed from the synonymy of T. chatareus, and the genus Protoxotes is recognized for T. lorentzi based on the results of our analyses. We then take an integrative approach, using a combined analysis of discrete hard- and soft-tissue morphological characters with genetic data, to construct a phylogeny of the Toxotidae. Using the resulting phylogenetic hypothesis, we then characterize the evolutionary history and anatomical variation within the archerfishes. We discuss variation in the oral structures and the evolution of the mechanism with respect to the interrelationships of archerfishes, and find that the oral structures of archerfishes support the blowpipe hypothesis but soft-tissue oral structures may also play a role in shooting. Finally, by comparing the morphology of archerfishes to their sister group, we find that the Leptobramidae has relevant shooting features in the oral cavity, suggesting that some components of the archerfish shooting mechanism are examples of co-opted or exapted traits. Sinopsis Malay: Pelbagai jenis Ikan Sumpit (Toxotidae) dapat dijumpai di persekitaran air tawar dan payau di Asia Pasifik dan mereka terkenal dengan kebolehan mereka menembak air ke arah mangsa di darat. Tembakan air ini bertujuan untuk menyerang mangsa mereka dan menyebabkan mereka jatuh ke dalam air untuk ditangkap dan dimakan. Walaupun tingkah laku ini diketahui umum, terdapat hipotesis yang bersaing (hipotesis sumpitan vs. tangki tekanan) tentang cara ikan sumpit menembak dan struktur mulut yang terlibat. Pemahaman semasa tentang struktur menembak ikan sumpit adalah sebahagian besarnya berdasarkan dua spesies, Toxotes chatareus dan T. jaculatrix. Kami tidak pasti sama ada semua ikan sumpit mempunyai struktur mulut yang sama untuk menembak air, jika variasi anatomi terdapat dalam struktur mulut ini, atau bagaimana ciri-ciri ini telah berkembang. Tambahan pula, terdapat sedikit maklumat tentang evolusi Toxotidae secara keseluruhan, dengan semua penyelidikan sistematik sebelum ini memfokuskan pada hubungan saling keluarga. Kami pada mulanya mengkaji had spesies ikan sumpit ini menggunakan data genetik baharu dan yang diterbitkan sebelum ini. Analisis kami menunjukkan bahawa taksonomi semasa ikan sumpit tidak mematuhi hubungan yang kami perolehi. Toxotes mekongensis dan T. siamensis diletakkan bersama kesinoniman T. chatareus, Toxotes carpentariensis yang diiktiraf sebagai satu spesies dan dikeluarkan daripada kesinoniman T. chatareus, dan genus Protoxotes yang diiktiraf untuk T. lorentzi adalah berdasarkan hasil analisis kami. Kemudian kami mengambil pendekatan integratif, menggunakan analisis gabungan karakter morfologi tisu keras dan lembut diskret dengan data genetik, untuk membina filogeni Toxotidae. Menggunakan hipotesis filogenetik yang terhasil, kami kemudian mencirikan sejarah evolusi dan variasi anatomi dalam ikan sumpit. Kami membincangkan variasi dalam struktur mulut dan evolusi mekanisme berkenaan yang berkaitan dengan ikan sumpit, dan mendapati bahawa struktur mulut ikan sumpit menyokong hipotesis sumpitan tetapi struktur mulut tisu lembut juga mungkin memainkan peranan dalam cara menembak. Akhir sekali, dengan membandingkan morfologi ikan sumpit kepada kumpulan saudara mereka, kami mendapati bahawa Leptobramidae mempunyai ciri penangkapan yang relevan dalam rongga mulut mereka, menunjukkan bahawa beberapa komponen mekanisme penangkapan ikan sumpit merupakan contoh ciri-ciri yang diikut-sertakan atau diguna semula.
RESUMO
Nitrate (NO3-N) export from row crop agricultural systems with subsurface tile drainage continues to be a major water quality concern. Woodchip bioreactors are an effective edge-of-field practice designed to remove NO3-N from tile drainage. The NO3-N removal rate of woodchip bioreactors can be impacted by several factors, including hydraulic residence time (HRT). This study examined the impact of three HRTs, 2â¯h, 8â¯h, and 16â¯h, on NO3-N removal in a set of nine pilot-scale woodchip bioreactors in Central Iowa. NO3-N concentration reduction from the inlet to the outlet was significantly different for all HRTs (pâ¯<â¯0.05). The 16â¯h HRT removed the most NO3-N by concentration (7.5â¯mgâ¯L-1) and had the highest removal efficiency at 53.8%. The 8â¯h HRT removed an average of 5.5â¯mgâ¯L-1 NO3-N with a removal efficiency of 32.1%. The 2â¯h HRT removed an average of 1.3â¯mgâ¯L-1 NO3-N with a removal efficiency of 9.0%. The 2â¯h HRT had the highest NO3-N mass removal rate (MRR) at 9.0â¯gâ¯m-3 day-1, followed by the 8â¯h HRT at 8.5â¯gâ¯m-3 day-1, and the 16â¯h HRT at 7.4â¯gâ¯m-3 day-1, all of which were statistically different (pâ¯<â¯0.05). Significant explanatory variables for removal efficiency were HRT (pâ¯<â¯0.001) and influent NO3-N concentration (pâ¯<â¯0.001), (R2â¯=â¯0.80), with HRT accounting for 93% contribution. When paired with results from a companion study, the ideal HRT for the bioreactors was 8â¯h to achieve maximum NO3-N removal while reducing the impact from greenhouse gas emissions.
Assuntos
Reatores Biológicos , Desnitrificação , Iowa , Nitratos , Nitrogênio , Óxidos de NitrogênioRESUMO
Rate of oxygen uptake by muscle mitochondria and respiratory chain protein concentrations differed between high- and low-residual feed intake (RFI) animals. The hypothesis of this research was that complex I (CI), II (CII), and III (CIII) mitochondria protein concentrations in lymphocyte (blood) mitochondria were related to the RFI phenotype of beef steers. Daily feed intake (ADFI) was individually recorded for 92 Hereford-crossbreed steers over 63 d using GrowSafe individual feed intake system. Predicted ADFI was calculated as the regression of ADFI on ADG and midtest BW. Difference between ADFI and predicted ADFI was RFI. Lymphocytes were isolated from low-RFI (-1.32 ± 0.11 kg/d; = 10) and high-RFI (1.34 ± 0.18 kg/d; = 8) steers. Immunocapture of CI, CII, and CIII proteins from the lymphocyte was done using MitoProfile CI, CII, and CIII immunocapture kits (MitoSciences Inc., Eugene, OR). Protein concentrations of CI, CII, and CIII and total protein were quantified using bicinchoninic acid colorimetric procedures. Low-RFI steers consumed 30% less ( = 0.0004) feed and had a 40% improvement ( < 0.0001) in feed efficiency compared with high-RFI steers with similar growth ( = 0.78) and weight measurements ( > 0.65). High- and low-RFI steers did not differ in CI ( = 0.22), CII ( = 0.69), and CIII ( = 0.59) protein concentrations. The protein concentration ratios for CI to CII ( = 0.03) were 20% higher and the ratios of CI to CIII ( = 0.01) were 30% higher, but the ratios of CII to CIII ( = 0.89) did not differ when comparing low-RFI steers with high-RFI steers. The similar magnitude difference in feed intake, feed efficiency measurements, and CI-to-CIII ratio between RFI phenotypes provides a plausible explanation for differences between the phenotypes. We also concluded that mitochondria isolated from lymphocytes could be used to study respiratory chain differences among differing RFI phenotypes. Further research is needed to determine if lymphocyte mitochondrial complex proteins can be used for identification of RFI phenotype.
Assuntos
Bovinos/fisiologia , Complexo I de Transporte de Elétrons/metabolismo , Comportamento Alimentar/fisiologia , Linfócitos/metabolismo , Ração Animal/análise , Animais , Ingestão de Alimentos/fisiologia , Masculino , MitocôndriasRESUMO
Gestating Angus, nonlactating, spring-calving cows were used to determine variation in maintenance energy requirements (MR); to evaluate the relationship among MR and cow and calf performance, plasma concentrations of IGF-I, T4, glucose, insulin, and ruminal temperature; and to describe the LM proteome and evaluate protein abundance in cows with different MR. Cows (4 to 7 yr of age) with a BCS of 5.0 ± 0.2 and BW of 582 ± 37 kg in the second to third trimester of gestation were studied in 3 trials (trial 1, n = 23; trial 2, n = 32; trial 3, n = 38). Cows were individually fed a complete diet in amounts to meet predicted MR (Level 1 Model of NRC), and feed intake was adjusted weekly until constant BW was achieved for at least 21 d (maintenance). Cows were classified on the basis of MR as low (>0.5 SD less than mean, LMR), moderate (±0.5 SD of mean, MMR), or high (>0.5 SD more than mean, HMR) MR. Blood samples were taken at maintenance and at 2 mo postpartum in trial 2. Muscle biopsies were taken from LMR and HMR after cows consumed actual MR for 28 d (trial 2) or 21 d (trial 3). Proteins from LM were separated by 2-dimensional difference gel electrophoresis and were identified, and abundance was quantified and compared. The greatest differences in MR between cows were 29%, 24%, and 25% in trials 1, 2, and 3, respectively. Daily MR (NEm, kcal·BW(-0.75)·d(-1)) averaged 89.2 ± 6.3, 93.0 ± 4.9, and 90.4 ± 4.6 in trials 1, 2, and 3, respectively. Postpartum BW and BCS, calf birth and weaning weights, postpartum luteal activity, and ruminal temperature were not influenced by MR of the cows. Concentrations of IGF-I were greater (P = 0.001) in plasma of MMR compared with LMR cows consuming predicted MR diets, and MR was negatively correlated with concentrations of IGF-I in plasma (r = -0.38; P = 0.05) at 2 mo postpartum. A total of 103 proteins were isolated from LM; 52 gene products were identified. Abundance of specific proteins in the LM was not influenced (P > 0.11) by MR. Variation in MR of cows will make it possible to improve feed efficiency by selection. Identification of biomarkers for MR will allow selection of more efficient cows, which consume less feed and produce calves with similar weaning weights. Productive cows that require less feed for maintenance will improve efficiency of production and enhance sustainability of the environment.
Assuntos
Animais Recém-Nascidos/crescimento & desenvolvimento , Bovinos/fisiologia , Ingestão de Energia/fisiologia , Metabolismo Energético/fisiologia , Hormônios/sangue , Músculo Esquelético/fisiologia , Proteômica , Animais , Animais Recém-Nascidos/fisiologia , Biomarcadores/sangue , Glicemia/metabolismo , Temperatura Corporal/fisiologia , Peso Corporal/fisiologia , Bovinos/crescimento & desenvolvimento , Feminino , Insulina/sangue , Fator de Crescimento Insulin-Like I/metabolismo , Rúmen/fisiologia , Tiroxina/sangueRESUMO
This study was conducted to determine the relative contribution of feeding behavior, DMI, apparent DM digestibility (DMD), and passage rate on variation in BW gain. One hundred forty-three crossbred steers were used in this study to determine the factors that contribute to variation in BW gain. Steers were 304 ± 1 d of age and had an initial BW of 338 ± 3 kg. Steers had ad libitum access to feed, and fresh feed was offered twice daily at 0800 and 1500 h. Individual feed intake and BW gains were determined for 106 d. Titanium dioxide was used as an external marker to estimate apparent DMD and passage rate. A multiple-regression analysis was used to determine the relative contribution of initial BW, feed intake, feeding behaviors, digestibility, and passage rate to variance in BW gain, and a path analysis was conducted to determine direct and indirect relationships of the variables. In the regression analysis, initial BW and DMI accounted for 33% of the variation in BW gain. Substituting meal events and meal size for DMI did not increase the amount of variance in BW gain (27%) accounted for by the regression model. There was a slight increase in the variance in BW gain (35%) when apparent DMD was added to initial BW and DMI. When meal events and meal size were substituted for DMI, there was a decrease (30%) in variance accounted for in BW gain. The regression coefficient for the passage rate did not differ from zero (P = 0.63) when the passage rate was substituted for apparent DMD in the regression model that also included initial BW and DMI, nor did it differ from zero (P = 0.39) in the model that substitutes meal events and meal size for DMI. Three models were used in the path analysis. For all 3 models there was a positive correlation (P < 0.001) between DMI and BW gain but not between apparent DMD and BW gain. In all 3 models there was a significant correlation between meal size, meal events, and initial BW on DMI (P < 0.001). Results of both the regression and path analyses suggest that both apparent DMD and passage rate accounted for small proportions of the variance, suggesting that they are minor contributors toward variance in BW gain among cattle fed the same concentrate diet.
Assuntos
Bovinos/fisiologia , Ingestão de Alimentos/fisiologia , Comportamento Alimentar/fisiologia , Aumento de Peso/fisiologia , Ração Animal , Fenômenos Fisiológicos da Nutrição Animal/fisiologia , Animais , Bovinos/crescimento & desenvolvimento , Bovinos/metabolismo , Dieta/veterinária , Digestão/fisiologia , Ingestão de Líquidos/fisiologia , MasculinoRESUMO
BACKGROUND: When designing therapeutic short-interfering RNAs (siRNAs), off-target effects (OTEs) are usually predicted by computational quantification of messenger RNAs (mRNAs) that contain matches to the siRNA seed sequence in their 3' UTRs. It is assumed that the higher the number of predicted transcriptional OTEs, the greater the size of the actual OTE signature and the more detrimental the phenotypic consequences in target-negative cells. METHODS: We tested this general assumption by investigating the OTEs of potential therapeutic siRNAs targeting the human papillomavirus (HPV) type-16 E7 oncogene. We studied HPV-negative squamous epithelial cells, from normal cervix (NCx) and skin (HaCaT), which would be vulnerable to 'bystander' OTEs following transfection in vivo. RESULTS: We observed no correlation between the number of computationally predicted OTEs and the actual number of seed-dependent OTEs (P=0.76). On average only 20.5% of actual transcriptional OTEs were seed-dependent (i.e., predicted). The unpredicted OTEs included stimulation of innate immune pathways, as well as indirect (downstream) effects of other OTEs, which affected important cancer-associated pathways. Although most significant OTEs observed were seen in both NCx and HaCaT cells, only 0-5.9% of differentially expressed genes overlapped between the two cell types. CONCLUSION: These data do not support the assumption that actual OTEs correlate well with predicted OTEs.
Assuntos
Papillomavirus Humano 16/genética , Proteínas E7 de Papillomavirus/genética , Neoplasias do Colo do Útero/virologia , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/virologia , Linhagem Celular Tumoral , Colo do Útero/citologia , Células Epiteliais/virologia , Feminino , Humanos , Interferência de RNA , RNA Interferente Pequeno , Pele/citologia , Neoplasias do Colo do Útero/genéticaRESUMO
In this paper we present the first study of the VUV photoabsorption spectrum of condensed phase SO(2) recorded over the VUV region 120 to 320 nm (10.33 to 3.64 eV). Distinct spectral features were observed that can be used to distinguish between the formation of amorphous and crystalline ice structures. These signatures may then be used to probe the formation of different ice structures as a function of both deposition rate and substrate temperature.
Assuntos
Elétrons , Dióxido de Enxofre/química , Absorção , Cristalização , Fotoquímica , Espectrofotometria Ultravioleta/métodos , Temperatura , VibraçãoRESUMO
UNLABELLED: This study evaluated the use of methylphenidate for depression in advanced cancer DESIGN: Phase II open-label prospective study. ELIGIBILITY CRITERIA: No previous use of methylphenidate or current use of other antidepressants. EVALUATION: Depression and response to treatment were determined by asking the patient: "are you depressed?" Patients were assessed at baseline and at days 3, 5, and 7. TREATMENT: Starting dose was 5 mg at 8:00 a.m. and 12:00 noon. The dose was titrated for lack of response on any of the assessment days. RESPONSE CRITERIA: A negative response to the question: "are you depressed?" RESULTS: Some 41 patients were enrolled and 30 (15 men, 15 women) completed the study. Median age was 68 years (range: 30-90). Methylphenidate was stopped for six patients because of side effects and five were not evaluable; 21 responded to 10 mg/day on day 3; the other nine responded to 20 mg/day on day 5, 29 maintained their positive response through day 7. Anorexia, fatigue, concentration, and sedation also improved in some. All who completed the study had tolerable side effects, none of which caused treatment to stop. CONCLUSIONS: Methylphenidate is effective for depression in advanced cancer A starting dose of 10 mg in divided doses is effective in most patients. Dose escalation may be needed. Improvement occurs within three days. Close monitoring of side effects is recommended.
Assuntos
Estimulantes do Sistema Nervoso Central/uso terapêutico , Depressão/tratamento farmacológico , Depressão/etiologia , Metilfenidato/uso terapêutico , Neoplasias/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Anorexia/induzido quimicamente , Atenção/efeitos dos fármacos , Estimulantes do Sistema Nervoso Central/farmacologia , Depressão/diagnóstico , Esquema de Medicação , Monitoramento de Medicamentos , Fadiga/induzido quimicamente , Feminino , Humanos , Masculino , Metilfenidato/farmacologia , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Fases do Sono/efeitos dos fármacos , Resultado do TratamentoRESUMO
This article discusses the use of a medication kit at home for terminal symptoms. This innovation has been in place for more than two years at the Hospice of the Cleveland Clinic. There is no previously published information on this innovation in the literature.
Assuntos
Tratamento Farmacológico/métodos , Emergências , Serviços Hospitalares de Assistência Domiciliar/organização & administração , Assistência Terminal/métodos , Analgésicos Opioides/uso terapêutico , Ansiolíticos/uso terapêutico , Antieméticos/uso terapêutico , Atropina/uso terapêutico , Clorpromazina/uso terapêutico , Diazepam/uso terapêutico , Humanos , Morfina/uso terapêutico , Antagonistas Muscarínicos/uso terapêutico , Ohio , Cuidados PaliativosRESUMO
The enzymes in the cytochrome p450 monooxygenase system (CYP) are the major enzymes responsible for metabolizing medications. The CYP2D6 isomer is responsible for metabolizing certain opioids, neuroleptics, antidepressants and cardiac medications. Owing to CYP2D6's low capacity and high affinity it is easily saturated by substrate and/or inhibited, resulting in pharmacokinetic interactions. Polymorphisms of the structural gene are common, leading to wide inter-individual and ethnic differences in drug metabolism. Clinically important drug interactions, which may be anticipated in the palliative medicine population, are reviewed.
Assuntos
Citocromo P-450 CYP2D6/metabolismo , Sistema Enzimático do Citocromo P-450/metabolismo , Inibidores Enzimáticos/farmacologia , Oxigenases de Função Mista/metabolismo , Cuidados Paliativos , Fármacos Cardiovasculares/farmacologia , Fármacos do Sistema Nervoso Central/farmacologia , Citocromo P-450 CYP2D6/genética , Citocromo P-450 CYP3A , Sistema Enzimático do Citocromo P-450/genética , Interações Medicamentosas , Indução Enzimática/efeitos dos fármacos , Humanos , Oxigenases de Função Mista/genética , Medicamentos sem Prescrição/farmacologia , Cuidados Paliativos/normas , Grupos Raciais/genéticaAssuntos
Analgesia/métodos , Analgésicos/uso terapêutico , Assistência de Longa Duração/métodos , Dor/tratamento farmacológico , Cuidados Paliativos/métodos , Analgesia/normas , Humanos , Assistência de Longa Duração/normas , Náusea/etiologia , Náusea/prevenção & controle , Dor/diagnóstico , Dor/etiologia , Medição da Dor , Cuidados Paliativos/normas , Qualidade da Assistência à Saúde , Vômito/etiologia , Vômito/prevenção & controle , Xerostomia/etiologia , Xerostomia/prevenção & controleRESUMO
We conducted a prospective assessment of 50 consecutive admissions to an acute palliative medicine unit, using the bedside confusion scale (BSCS). Information including age, gender, diagnosis, and the presence or absence of brain metastasis was collected. Possible predisposing factors for delirium were recorded. Forty-one of 50 consecutive admissions were screened. There were 18 men and 23 women with a median age of 65 years (average: 60-75). The most common diagnoses among all were lung and breast cancer. Thirteen patients were delirious (BSCS score of > or = 2), 10 borderline (BSCS score = 1), and 21 normal (BSCS score = 0). Brain metastases and drugs appeared to be the most common predisposing factors of delirium. Forty percent of those that were delirious received haloperidol as symptomatic treatment. The BSCS is simple, portable, valid, quick, and easy to use by any medical team member. Delirium is common in hospitalized patients with advanced cancer.
Assuntos
Confusão/classificação , Confusão/diagnóstico , Delírio/classificação , Delírio/diagnóstico , Neoplasias/complicações , Exame Neurológico/métodos , Quartos de Pacientes , Índice de Gravidade de Doença , Idoso , Estudos de Casos e Controles , Causalidade , Confusão/etiologia , Delírio/etiologia , Feminino , Avaliação Geriátrica , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Projetos Piloto , Prevalência , Estudos Prospectivos , Fatores de TempoRESUMO
Thalidomide is an immunomodulator, anti-angiogenic agent, anti-cytokine, and anti-integrin. Alone or in combination with other drugs, thalidomide has also demonstrated anti-cachexin and anti-neoplastic properties. Anorexia and cachexia are common symptoms of advanced cancer. Since certain cytokines also promote tumor growth, we may have a class of agents with palliative and anti-tumor benefits in combination with anti-neoplastics and anti-cytokines, such as thalidomide.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Anorexia/tratamento farmacológico , Anorexia/etiologia , Caquexia/tratamento farmacológico , Caquexia/etiologia , Imunossupressores/uso terapêutico , Oncologia/métodos , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Assistência Terminal/métodos , Talidomida/uso terapêutico , Inibidores da Angiogênese/imunologia , Inibidores da Angiogênese/farmacologia , Antineoplásicos/uso terapêutico , Citocinas/antagonistas & inibidores , Interações Medicamentosas , Quimioterapia Combinada , Humanos , Imunossupressores/imunologia , Imunossupressores/farmacologia , Integrinas/antagonistas & inibidores , Neoplasias/imunologia , Talidomida/imunologia , Talidomida/farmacologiaAssuntos
Assistência de Longa Duração/métodos , Manejo da Dor , Dor/classificação , Cuidados Paliativos/métodos , Distribuição por Idade , Idoso , Doença Crônica , Delírio/diagnóstico , Delírio/etiologia , Depressão/diagnóstico , Depressão/etiologia , Diagnóstico Diferencial , Dispneia/diagnóstico , Dispneia/etiologia , Humanos , Neoplasias/complicações , Dor/diagnóstico , Dor/epidemiologia , Dor/etiologia , Medição da Dor , Qualidade da Assistência à Saúde , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/etiologiaRESUMO
Islam holds life as sacred and belonging to God and that all creatures will die one day. Suicide is forbidden. Muslims believe death is only a transition between two different lives. The terminally ill Muslim desires to perform five ritual requirements. Do not resuscitate (DNR) orders are acceptable. A deceased Muslim must always be buried after being ritually washed and wrapped. There are different Muslim schools of thought, but they are united regarding their views on death and dying.
Assuntos
Atitude Frente a Morte/etnologia , Atitude Frente a Saúde/etnologia , Diversidade Cultural , Islamismo/psicologia , Assistência Terminal/psicologia , Ética Médica , Rituais Fúnebres , Pesar , Humanos , Defesa do Paciente/legislação & jurisprudência , Ordens quanto à Conduta (Ética Médica) , Assistência Terminal/métodos , Estados UnidosRESUMO
For any palliative medicine inpatient unit to be economically viable, certain management metrics need to be followed. Palliative medicine can provide both a compassionate and economical service within the current acute inpatient hospital environment. In this article, we will review the administrative and financial factors we have identified that influence the business of acute palliative medicine.
Assuntos
Administração Financeira de Hospitais/organização & administração , Cuidados Paliativos na Terminalidade da Vida/organização & administração , Unidades Hospitalares/organização & administração , Cuidados Paliativos/organização & administração , Comércio , Grupos Diagnósticos Relacionados/economia , Custos Diretos de Serviços/estatística & dados numéricos , Custos Hospitalares/estatística & dados numéricos , Hospitais de Ensino , Humanos , Tempo de Internação/economia , Ohio , Planejamento de Assistência ao Paciente/organização & administração , Alta do Paciente , Admissão e Escalonamento de Pessoal/economiaRESUMO
"What's new in therapeutics?" will examine and evaluate drugs that may have a place in hospice, palliative, and long-term care. Mirtazepine will be examined and evaluated. Mirtazepine is a potential alternative anti-depressant with multiple additional benefits. It is an atypical anti-depressant, which has both noradrenergic and specific serotonergic receptor antagonism (NaSSa), and a unique pharmacological profile. Mirtazepine appears to be a "designer drug" for palliative medicine with a number of benefits, but cost may be a drawback.
Assuntos
Amitriptilina/uso terapêutico , Antidepressivos Tricíclicos/uso terapêutico , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Mianserina/uso terapêutico , Assistência Terminal/métodos , Antidepressivos Tricíclicos/classificação , Antidepressivos Tricíclicos/economia , Antidepressivos Tricíclicos/farmacologia , Custos de Medicamentos , Medicamentos Essenciais/uso terapêutico , Antagonistas dos Receptores Histamínicos H1/classificação , Antagonistas dos Receptores Histamínicos H1/economia , Antagonistas dos Receptores Histamínicos H1/farmacologia , Humanos , Mianserina/análogos & derivados , Mianserina/classificação , Mianserina/economia , Mianserina/farmacologia , Mirtazapina , Seleção de PacientesRESUMO
Methadone is recommended as being free of some of the neuropsychological side effects noticed with morphine, which are attributed to active metabolites. A patient that received methadone for cancer-associated pain developed myoclonus as a side effect. This has rarely been reported before in the literature. The pathophysiology and management of myoclonus are discussed.
Assuntos
Analgésicos Opioides/efeitos adversos , Neoplasias do Colo/complicações , Metadona/efeitos adversos , Mioclonia/induzido quimicamente , Dor/tratamento farmacológico , Dor/etiologia , Assistência Terminal/métodos , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade , Mioclonia/classificação , Mioclonia/fisiopatologia , Mioclonia/terapiaRESUMO
Psychostimulants such as methylphenidate are used for fatigue in cancer patients. We report a prospective, open-label, pilot study of the successful use of methylphenidate to treat fatigue in nine of 11 consecutive patients with advanced cancer. Seven had received radiation or chemotherapy, a median of three weeks (range from one to 30 weeks) prior to methylphenidate. A rapid onset of benefit was noted, even in the presence of mild anemia. Sedation and pain also improved in some. Only one patient had side effects severe enough to stop the medication.