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1.
J Crit Care ; 62: 124-130, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33352505

RESUMO

PURPOSE: Potential drug-drug interactions (pDDIs) may harm patients admitted to the Intensive Care Unit (ICU). Due to the patient's critical condition and continuous monitoring on the ICU, not all pDDIs are clinically relevant. Clinical decision support systems (CDSSs) warning for irrelevant pDDIs could result in alert fatigue and overlooking important signals. Therefore, our aim was to describe the frequency of clinically relevant pDDIs (crpDDIs) to enable tailoring of CDSSs to the ICU setting. MATERIALS & METHODS: In this multicenter retrospective observational study, we used medication administration data to identify pDDIs in ICU admissions from 13 ICUs. Clinical relevance was based on a Delphi study in which intensivists and hospital pharmacists assessed the clinical relevance of pDDIs for the ICU setting. RESULTS: The mean number of pDDIs per 1000 medication administrations was 70.1, dropping to 31.0 when considering only crpDDIs. Of 103,871 ICU patients, 38% was exposed to a crpDDI. The most frequently occurring crpDDIs involve QT-prolonging agents, digoxin, or NSAIDs. CONCLUSIONS: Considering clinical relevance of pDDIs in the ICU setting is important, as only half of the detected pDDIs were crpDDIs. Therefore, tailoring CDSSs to the ICU may reduce alert fatigue and improve medication safety in ICU patients.

2.
Tijdschr Psychiatr ; 61(8): 527-535, 2019.
Artigo em Holandês | MEDLINE | ID: mdl-31512736

RESUMO

BACKGROUND: In an era of patient centered care, the question rises whether practitioners of these patients are sufficiently aware of their treatment preferences.
AIM: To study the opinion and knowledge of older, long-term psychiatric patients about their medication and health priorities.
METHOD: Patients were interviewed with the Patient's Attitudes Towards Deprescribing questionnaire. Furthermore patients were asked to name their medication by heart, their health priorities and preferences in medication changes. These preferences were compared with those of their practitioners.
RESULTS: 47 patients (median age 67 years, median 11 drugs) were interviewed. The mean percentage of spontaneously recalled drugs was 37%. Though 64% believed all used drugs were necessary, 77% would like to deprescribe if the doctor said it was possible. Preferences in deprescribing of patients and doctors didn't correspond in about 80%.
CONCLUSION: Most of old psychiatric patients are willing to deprescribe, but await initiative of their doctor. They can recall little of their currently used drugs. Preferences in deprescribing of the patient and doctor do often not match. We recommend to include a patient interview about the need for education and treatment preferences in the annual medication reviews in order to deprescribe and deliver more patient centered care.


Assuntos
Antipsicóticos/uso terapêutico , Desprescrições , Transtornos Mentais/tratamento farmacológico , Preferência do Paciente , Assistência Centrada no Paciente , Idoso , Feminino , Humanos , Pacientes Internados , Masculino
3.
Ned Tijdschr Geneeskd ; 161: D1772, 2017.
Artigo em Holandês | MEDLINE | ID: mdl-28880144

RESUMO

The Netherlands' practice guideline 'Polypharmacy in older people' (2012) proposed selecting patients who would benefit from a periodical medication review. The guideline committee made it clear that firm evidence supporting selection was lacking, and recent studies evaluating the effects of medication review on relevant patient-related outcomes have failed to show a positive effect on almost any of these outcomes. Regulatory authorities have advised expanding the target population for medication review. We have to conclude, however, that rather than implementing medication reviews across a broad population of older people, many with a low risk of adverse events, it may be more cost-effective to limit this potentially useful but time-consuming intervention to a more select population who would benefit the most from it.


Assuntos
Revisão de Uso de Medicamentos , Polimedicação , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Humanos , Países Baixos
4.
Ned Tijdschr Geneeskd ; 161: D1770, 2017.
Artigo em Holandês | MEDLINE | ID: mdl-29303089

RESUMO

- Multidose drug dispensing (MDD) systems are individualised forms of distribution that give structure to medication use. - Starting to use a multidose drug dispensing system must be initiated in joint discussion with the patient, once alternatives such as dosing schemes or automatic repeat-prescription services have been considered. The patient's autonomy and self-management are central.- Studies have shown positive effects of individualised forms of distribution on intermediary outcome measures such as HbA1c, LDL cholesterol, blood pressure and adherence. - Changes in medication should preferably be implemented when the pharmacist orders a new multidose drug dispensing system. It is difficult for the pharmacist to determine whether an immediate change is necessary if the indication and other possible reasons for change are not known. - The prescriber should preferably enquire whether the patient has a multidose dispensing system and should state the moment or the reason for the change on the prescription.- Pharmacotherapy in patients using a multidose drug dispensing system should be reviewed annually.


Assuntos
Embalagem de Medicamentos/métodos , Prescrições de Medicamentos , Quimioterapia Combinada/métodos , Idoso , Idoso de 80 Anos ou mais , Humanos , Adesão à Medicação
5.
Tijdschr Psychiatr ; 58(4): 262-71, 2016.
Artigo em Holandês | MEDLINE | ID: mdl-27075218

RESUMO

BACKGROUND: Medication review is a recurrent, structured and critical evaluation of pharmacotherapy by patient, physician and pharmacist. The Dutch Health Care Inspectorate considers medication review to be a way of improving the quality and safety of drug treatment. However, little is known about the costs, effectiveness and feasibility of medication review in the practice of mental health care. AIM: To obtain an impression of the costs and benefits of a first medication review in a clinical mental health care setting with chronic patients. METHOD: In 2013, the mental health organisation Yulius enrolled 70 hospitalised chronic patients for a first medication review. A detailed record was kept of the prescribed medication, medication changes, and the time invested. RESULTS: More than half of the proposed changes in medication were eventually implemented; 20% of these changes were made during a planned evaluation after three months. The number of drugs prescribed decreased after medication review; the reduction applied more often to somatic medication than to psychotropic medication. Costs relating to medication reviews seemed to be at least in balance with the benefits. CONCLUSION: In the group of patients with severe mental disorder, medication review seems to provide a good opportunity to assess the rationality of pharmacotherapy in a multidisciplinary approach. The time invested appears to be offset by the benefits of medication review.


Assuntos
Revisão de Uso de Medicamentos , Transtornos Mentais/tratamento farmacológico , Polimedicação , Psicotrópicos/economia , Psicotrópicos/uso terapêutico , Análise Custo-Benefício , Revisão de Uso de Medicamentos/estatística & dados numéricos , Humanos
6.
Drug Saf ; 39(1): 79-87, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26553305

RESUMO

INTRODUCTION: Medication-related problems can cause serious adverse drug events (ADEs) that may lead to hospitalization of the patient. There are multiple screening methods to detect and reduce potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). Whether this will result in less medication-related hospitalizations is unknown. The study objective was to assess the risk of preventable medication-related hospital admissions associated with potentially inappropriate prescribing, using the Beers 2012 and the Screening Tool of Older Person's Prescriptions and the Screening Tool to Alert doctors to Right Treatment (STOPP & START) 2008 criteria. DESIGN, SETTING AND PARTICIPANTS: A nested case-control study was conducted with a subset of Dutch participants from the Hospital Admissions Related to Medication (HARM) study. Cases were defined as patients aged ≥65 years with a potentially preventable medication-related hospital admission. For each case, one control was selected, matched for age and sex. The primary determinant was the presence of one or more PIMs according to the Beers 2012 and STOPP 2008 criteria. The secondary determinant was the presence of one or more PIMs and PPOs according to the STOPP & START 2008 criteria. The strength of the association between inappropriate prescribing and medication-related hospital admission was evaluated with multivariate logistic regression and expressed as odds ratios (ORs) with 95 % confidence intervals (CIs). RESULTS: The prevalence of Beers 2012 criteria PIMs in the total cohort was 44.4 %. The prevalence of STOPP & START 2008 criteria PIMs and PPOs were, respectively, 34.1 and 57.7 %. STOPP 2008 criteria PIMs were associated with preventable medication-related hospital admissions [OR adjusted for number of drugs and comorbidities (ORadj) 2.30, 95 % CI 1.30-4.07], whereas there was no association with Beers 2012 criteria PIMs (ORadj 1.49, 95 % CI 0.90-2.47). STOPP PIMs and START PPOs together were also associated with preventable medication-related hospital admissions (ORadj 3.47, 95 % CI 1.70-7.09). CONCLUSION: Our study shows that patients with potentially inappropriate prescribing detected with the STOPP & START 2008 criteria are at risk of preventable medication-related hospital admissions. The STOPP & START 2008 criteria can be used to identify older people at risk of medication-related problems.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Hospitalização/estatística & dados numéricos , Prescrição Inadequada/estatística & dados numéricos , Lista de Medicamentos Potencialmente Inapropriados , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Feminino , Humanos , Prescrição Inadequada/prevenção & controle , Modelos Logísticos , Masculino , Análise Multivariada , Países Baixos/epidemiologia , Prevalência
7.
Ned Tijdschr Geneeskd ; 155(36): A3802, 2011.
Artigo em Holandês | MEDLINE | ID: mdl-21914235

RESUMO

Elderly patients are at an increased risk of developing adverse drug events due to polypharmacy, co-morbidity and changes in physiology. Often, pharmacotherapy in frail elderly patients is initiated based on randomized trials from which this population has been excluded. In such cases, the question when to stop a medication may be as important as when to start it. It is important to consider whether the patient is using Potentially Inappropriate Medications (PIM) that should be stopped. Checklists can be helpful in detecting PIM. A recent study has shown that Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria can identify clinically relevant PIM much better than the Beers criteria often used. These outcomes indicate that patient safety can be improved if clinicians use checklists such as the STOPP.


Assuntos
Idoso Fragilizado , Prescrição Inadequada/efeitos adversos , Medicamentos sob Prescrição/efeitos adversos , Idoso de 80 Anos ou mais , Qualidade de Produtos para o Consumidor , Interações Medicamentosas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Humanos , Programas de Rastreamento , Registros Médicos , Erros de Medicação , Polimedicação , Medicamentos sob Prescrição/uso terapêutico
9.
Int Psychogeriatr ; 21(5): 931-40, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19538831

RESUMO

BACKGROUND: Although antipsychotic treatment of behavioral problems in dementia is common, studies investigating the course of these symptoms in nursing homes are scarce. Our primary objective is therefore to describe the course of behavioral problems during antipsychotic treatment in a large sample of elderly nursing home patients with dementia. METHODS: The course of behavioral problems during antipsychotic treatment was studied by comparing the characteristics of patients before, during and after antipsychotic treatment. The study was conducted using the VURAIDB, a database with over 40,000 assessments of over 10,000 nursing home residents in the Netherlands. We used the Challenging Behavior Profile (CBP) to measure an overall behavior score. RESULTS: In total, 556 patients starting with antipsychotics were studied. Of these, 101 (18.2%) improved and 260 (46.8%) deteriorated at three months on the behavior score, compared with their scores before therapy (z = -7.955; P<0.0001). Patients with severe challenging behavior showed improvement more often than patients with mild disturbances. The course of behavioral symptoms after withdrawal was evaluated in 520 patients. Of these patients, 352 (68%) remained stable or improved at 3 months compared with their scores before withdrawal (z = -0.697; p = 0.486), this figure was 58% at 6 months after withdrawal (z = -2.77; p = 0.006). CONCLUSIONS: During treatment of nursing home residents with dementia with antipsychotics the severity of most behavioral problems continues to increase in most patients, with only one out of six patients showing improvement. After withdrawal of antipsychotics, behavioral problems remained stable or improved in 58% of patients.


Assuntos
Doença de Alzheimer/tratamento farmacológico , Antipsicóticos/uso terapêutico , Instituição de Longa Permanência para Idosos , Transtornos Mentais/tratamento farmacológico , Casas de Saúde , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/psicologia , Antipsicóticos/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Países Baixos , Determinação da Personalidade , Resultado do Tratamento
11.
Tijdschr Gerontol Geriatr ; 40(2): 79-84, 2009 Apr.
Artigo em Holandês | MEDLINE | ID: mdl-19472574

RESUMO

Cholinesterase inhibitors are prescribed in the treatment of mild to moderate Alzheimer's dementia. Little is known about the cardiac safety of these drugs. We present two different cases in which cardiac events occurred during the use of a cholinesterase inhibitor. The pathophysiology, the effects of these drugs on the heart, information about the reports of side effects in pharmacovigilance databases and known literature are discussed. Although cardiac risks of cholinesterase inhibitors seem small, we advise to monitor cardiac effects of cholinesterase inhibitors carefully in patients with existing cardiac disease, especially in those using concomitant drugs known to interact with the cardiac risks of cholinesterase inhibitors.


Assuntos
Inibidores da Colinesterase/efeitos adversos , Insuficiência Cardíaca/induzido quimicamente , Nootrópicos/efeitos adversos , Idoso , Doença de Alzheimer/tratamento farmacológico , Inibidores da Colinesterase/uso terapêutico , Evolução Fatal , Feminino , Humanos , Masculino , Nootrópicos/uso terapêutico
12.
J Psychopharmacol ; 23(8): 909-14, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18635700

RESUMO

It has been shown that elderly patients with dementia treated with atypical and conventional antipsychotics have a twofold increased risk of cerebrovascular adverse events (CVAEs). To investigate the temporal relationship between exposure to antipsychotics and the risk of CVAE, a case-control analysis nested within a cohort of 26,157 community-dwelling patients (mean age 76 +/- 9.7) with at least one antipsychotic prescription was conducted. Data were used from Dutch community pharmacies and hospital discharge records. Five hundred and eighteen cases of hospital admission for CVAE were identified. For each case, four randomly selected controls matched by sex and age were sampled from the cohort. To evaluate the temporal relationship between antipsychotic use and the occurrence of CVAE, two measures were used: the first being a current, recent or past user, and the second for the current users, the duration of use up to the index date. In addition, the cumulative exposure was assessed. Current and recent exposure to antipsychotics were associated with an increased risk of CVAE compared with non-users (odds ratio [OR] 1.7, CI 1.4-2.2). A strong temporal relationship was found; the OR for a history of use less than a week is 9.9 (5.7-17.2). The risk decreases in time and is comparable to non-users after 3 months of use (OR 1.0, CI 0.7-1.3). Cumulative exposure was not associated with an increase in risk. The risk of CVAE in elderly patients associated with antipsychotics is elevated especially during the first weeks of treatment. This risk decreases over time and is back on base level after 3 months of treatment. Chronic use is not associated with CVAE.


Assuntos
Antipsicóticos/efeitos adversos , Transtornos Cerebrovasculares/induzido quimicamente , Idoso , Feminino , Humanos , Masculino , Risco
13.
Ned Tijdschr Geneeskd ; 152(43): 2322-4, 2008 Oct 25.
Artigo em Holandês | MEDLINE | ID: mdl-19024061

RESUMO

A recent study in the JAMA described the effects of long-term daily treatment with whole-day bright light in elderly patients with dementia, with or without the addition of melatonin (2.5 mg daily), on cognition, mood, behavioural symptoms, activities of daily living and sleep. It was concluded that light has a modest benefit in improving some cognitive and non-cognitive symptoms of dementia. The effects of melatonin were negligible. Despite the small effects found of this study, the outcomes can be used in clinical practice since other small studies also show a trend towards positive effects of bright light in dementia patients. Since current pharmacotherapy for behavioural problems in dementia has very modest effects at the risk of serious adverse effects, non-pharmacological interventions must be encouraged. Increasing light intensity in the living rooms of patients with dementia is an easy and cheap intervention with possible positive effects on at least some patients.


Assuntos
Cognição/efeitos dos fármacos , Demência/terapia , Melatonina/uso terapêutico , Fototerapia/métodos , Afeto/efeitos dos fármacos , Idoso , Idoso de 80 Anos ou mais , Cognição/fisiologia , Demência/prevenção & controle , Depressão/prevenção & controle , Feminino , Humanos , Masculino , Melatonina/efeitos adversos , Transtornos do Sono-Vigília/prevenção & controle
14.
Ned Tijdschr Geneeskd ; 151(17): 977-80, 2007 Apr 28.
Artigo em Holandês | MEDLINE | ID: mdl-17520852

RESUMO

An 85-year-old woman presented at the emergency ward. She had had shortness of breath for several days and no bowel movements for 3 days. On the day ofhospitalisation she experienced sudden abdominal pain and collapsed as she went to the toilet. She was being treated for multiple conditions, including type-2 diabetes. She appeared to have lactic acidosis. At first, the symptoms were not attributed to metformin because she was receiving a low dose and serum-creatinine concentrations were within the normal range (98 micromol/l). Bowel ischaemia was suspected and surgery was performed but no defects were found. She was subsequently treated for metformin-related lactic acidosis but died shortly thereafter due in part to postoperative complications. Lactic acidosis is a rare side effect of metformin. In this patient, the retrospectively calculated glomerular filtration rate (GFR) was extremely low (23 ml/min). The serum-creatinine concentration was normal because the patient's body weight was low (40 kg). Impaired renal function is a risk factor for metformin-related lactic acidosis. Renal function can appear to be normal when measured by serum-creatinine concentration in older patients with reduced muscle mass, but calculation of GFR often reveals impairment. Metformin is contraindicated in patients with poor renal function. The increasing use of metformin in older patients for the treatment of diabetes mellitus warrants renewed attention to this severe side effect.


Assuntos
Acidose Láctica/induzido quimicamente , Hipoglicemiantes/efeitos adversos , Metformina/efeitos adversos , Idoso de 80 Anos ou mais , Contraindicações , Creatinina/sangue , Diabetes Mellitus Tipo 2/tratamento farmacológico , Evolução Fatal , Feminino , Taxa de Filtração Glomerular , Humanos , Hipoglicemiantes/metabolismo , Intestinos/irrigação sanguínea , Isquemia/cirurgia , Nefropatias/induzido quimicamente , Nefropatias/fisiopatologia , Metformina/metabolismo
15.
Ned Tijdschr Geneeskd ; 149(38): 2099-103, 2005 Sep 17.
Artigo em Holandês | MEDLINE | ID: mdl-16201599

RESUMO

Elderly patients are highly susceptible for developing adverse drug reactions (ADR) that can lead to hospitalisation or death. Most of these ADR can be prevented if doctors adjust their prescriptions. Beers et al. have developed a list of drugs that should not be prescribed to elderly patients since they are known for their association with serious ADR. In The Netherlands, 20% of elderly patients receive drugs that are in the so-called Beers list. Although the Beers list has not been adjusted to the Dutch situation, avoidance of these drugs may reduce drug-related hospital admittance. Development of an improved list of drugs that should not be prescribed to elderly patients is needed that is applicable to The Netherlands.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos , Envelhecimento , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Geriatria , Idoso , Envelhecimento/efeitos dos fármacos , Envelhecimento/metabolismo , Envelhecimento/fisiologia , Uso de Medicamentos , Feminino , Humanos , Masculino , Países Baixos
16.
Ned Tijdschr Geneeskd ; 149(4): 165-7, 2005 Jan 22.
Artigo em Holandês | MEDLINE | ID: mdl-15702733

RESUMO

Post-hoc analysis by the pharmaceutical company Eli Lilly of 5 randomised clinical trials concerning the efficacy ofolanzapine in patients with dementia, has shown that patients taking olanzapine have a risk of experiencing a cerebrovascular accident which is 3 times higher than patients taking placebo. This increased risk has also been found in patients with dementia who take risperidone. Details concerning this relationship cannot be obtained from the sparse information supplied by the producers of risperidone and olanzapine. The pathophysiological mechanisms by which atypical antipsychotics may lead to cerebrovascular accidents are not well understood. Atypical antipsychotics are often prescribed for conditions in which evidence of the efficacy of this group of medications is lacking. This association between antipsychotics and cerebrovascular accidents emphasises the need for a stricter and evidence-based prescription policy for antipsychotics. In cases of adverse drug reaction, more openness on the part of pharmaceutical companies is desirable.


Assuntos
Antipsicóticos/efeitos adversos , Benzodiazepinas/efeitos adversos , Risperidona/efeitos adversos , Acidente Vascular Cerebral/induzido quimicamente , Acidente Vascular Cerebral/epidemiologia , Antipsicóticos/uso terapêutico , Benzodiazepinas/uso terapêutico , Demência/tratamento farmacológico , Humanos , Olanzapina , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Risperidona/uso terapêutico
17.
Ned Tijdschr Geneeskd ; 147(25): 1201-4, 2003 Jun 21.
Artigo em Holandês | MEDLINE | ID: mdl-12848053

RESUMO

Two patients were presented at our hospital with hypothermia following dose adjustment of antipsychotic medication. The first patient, a mentally retarded 45-year-old man developed a temperature of 31.7 degrees C several days after starting of levomepromazine. The second patient, an 41-year-old schizophrenic man, whose risperidone dose had been increased following a psychotic crisis, developed deep hypothermia (temperature 29.7 degrees C) and severe respiratory insufficiency requiring pressure support ventilation. Both patients were admitted to the ICU and recovered completely. Antipsychotics influence hypothalamic thermoregulation and may induce hypothermia by stimulating dopamine (mainly D2) receptors and blocking 5-HT2 receptors. Furthermore, antipsychotics may reduce the shivering capability and can cause peripheral vasodilatation and reduced shunting by blocking skin alpha 1 receptors. Hypothermia can be a lethal condition. When a patient's clinical condition deteriorates following the start of antipsychotic medication, the presence of hypothermia should be excluded.


Assuntos
Antipsicóticos/efeitos adversos , Regulação da Temperatura Corporal/efeitos dos fármacos , Hipotermia Induzida , Adulto , Temperatura Corporal/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Receptores de Serotonina/metabolismo
18.
Ned Tijdschr Geneeskd ; 146(47): 2221-4, 2002 Nov 23.
Artigo em Holandês | MEDLINE | ID: mdl-12481516

RESUMO

Three patients, 2 men aged 55 and 54 years and a woman aged 86 years, were admitted to hospital for treatment of symptoms resulting from terminal disease (pain, agitation, nausea etc.). In all three patients, continuous subcutaneous infusion (CSI) of medication was successfully used to control the symptoms. Compared with intravenous infusion, the technique of CSI is easy to learn and is associated with fewer complications. Its reliability and ease-of-use make it a technique that can be used not only in a hospital setting, but also in general practice and nursing homes. Medication used in palliative care (e.g. morphine, haloperidol, metoclopramide, levomepromazine, midazolam) can often be administered safely by CSI. In palliative care, where goals should be accomplished with minimal burden to the patient, CSI must be considered the technique of choice in patients who are unable to swallow their medication.


Assuntos
Cuidados Paliativos/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Infusões Parenterais/métodos , Masculino , Pessoa de Meia-Idade , Náusea/tratamento farmacológico , Dor/tratamento farmacológico , Vômito/tratamento farmacológico
19.
Angiology ; 52(6): 409-16, 2001 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-11437031

RESUMO

The objective of this study was to investigate the extent to which internal risk factors for the development of decubitus ulcers are related to the blood flow response following the relief of a pressure load. There were 122 nursing home patients (43 men, 69 women, mean age: 81 +/- 8 years; range: 60-97). The following potential, internal risk factors for the development of decubitus ulcers were assessed: chronic disorders (diabetes mellitus, cardiovascular disease [congestive heart failure, history of myocardial infarct or angina pectoris] and cerebrovascular accident), fever, blood pressure, nutritional status, serum hemoglobin concentration, and serum urea and serum creatinine concentrations. Skin temperature response (latency time and total response time) was measured following relief of a 100 kPa test pressure. The presence of cardiovascular disease, cerebrovascular accident, poor nutritional condition, high serum urea and male gender showed a significant relationship with an impaired blood flow response. The delayed latency found showed a similarity to the so-called "no-reflow phenomenon." The association of cardiovascular disease and a cerebrovascular accident with a delay in the blood flow response may result from endothelial damage. A poor nutritional condition may be associated with a deficit of scavengers of oxygen-derived free radicals. The presence of free radicals may damage endothelium during reperfusion, thus influencing the blood flow response. The association of high serum urea with delayed vasodilatation may theoretically be explained by the association of serum urea and impaired kidney functioning, since the kidney is an important organ in the production of vasoactive substances. Serum urea can also be considered a measure for nutritional condition. Gender may function as a substitute for other, unmeasured factors that are related to blood flow response.


Assuntos
Lesão por Pressão/etiologia , Lesão por Pressão/fisiopatologia , Pele/irrigação sanguínea , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pressão , Lesão por Pressão/terapia , Probabilidade , Prognóstico , Fluxo Sanguíneo Regional/fisiologia , Medição de Risco , Fatores de Risco , Amostragem , Distribuição por Sexo
20.
Neth J Med ; 59(1): 39-40, 2001 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-11438199

RESUMO

Sternal puncture for harvesting bone marrow is a procedure with potentially lethal complications. Both the occurrence of pneumothorax and sternal fracture are reported. We present two patients with a cardiac tamponade following elective sternal puncture. (See Editorial p. 4).


Assuntos
Biópsia por Agulha/efeitos adversos , Tamponamento Cardíaco/etiologia , Esterno , Adulto , Feminino , Humanos , Pessoa de Meia-Idade
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