Partnership, sexuality, and sexual disorders in morbidly obese women: consequences of weight loss after gastric banding.

BACKGROUND: A study was performed to determine what consequences surgery for morbid obesity has on sexual attitudes and partnership in obese female patients. METHOD: Semi-structured interviews concerning sociodemographic data, sexuality and relationship were conducted on 82 female patients preoperatively and at least 1 year postoperatively. RESULTS: Physical appearance played the main role in the decision to undergo weight reduction surgery in only 17% of the study patients. Postoperatively, half of the patients were satisfied with their physical appearance 1 year after surgery, the other half not. Preoperatively, 44% of the patients stated that sexuality with their partners was satisfying and the frequency of sexual intercourse was regular. Postoperatively, 63% of the patients stated that they enjoyed sex more, compared with 12% of the patients who enjoyed sex less than before surgery. Postoperatively, 20% of the patients reported that partnership had changed positively, 10% negatively. CONCLUSIONS: The results indicate that many of the sexual problems in obese individuals are the result of an underlying lack of self-esteem, unsatisfactory relationships, or collective stigmatization of obese individuals. Binge eating, often found in morbidly obese patients, seems to be less the result of or compensation for sexual problems but is more likely to stem from other psychosocial or psychological problems.

Discharge planning for the head-injured patient.

While the ultimate goal of discharge planning is discharge from the hospital, many steps come between admission and discharge of the head-injured patient. This article outlines those steps.

The pathophysiology of shock brain.

Shock brain is becoming more recognized as a distinct clinical problem. However, in order to effectively prevent and treat it, the clinician must have a firm grasp of the metabolic requirements and oxygen supply and demand of the normal brain. In addition, it is useful to understand how various types of shock compare and contrast in their ability to injure the brain. In this way, health professionals will be able to base assessment findings and therapies on sound physiologic principles, and thus hopefully improve patient outcomes.

Wound healing and immunocompromise.

A better understanding of the physiology of wound healing has been the impetus for the development of a large number of wound care products. However, infection remains the primary deterrent to successful wound closure; often those factors (both internal and external) that make the patient more susceptible to infection also negatively affect the quality of any wound that does heal. Factors that contribute to immunocompromise significantly impact on wound inflammatory response and maturation. The nurse has an exciting and vital role now and in the future not only in supporting the patient's own immune defenses, but in promoting those factors that will hasten wound repair.

[A pilot study of fathers on parental leave in Tirol.]. / Une étude pilote sur le congé parental de pères au Tirol.

The current study examines fathers in parental leave in Tirol. The authors have come to realise that systematic reflections concerning fathers on leave of their work are rare. The authors attempt to answer the following question: does parental leave have implications on child/father attachment? The pilot study examines a small sample of 15 father/child couples. The description and analysis of father/child interactions was elaborated with the Child Adult Relationship Index (CARE-Index) designed by Crittenden (1988, 2000).

Time-saving tips for preparing your manuscript: strategies for acceptance on the first attempt!

This experienced nurse author and reviewer describes ways to avoid the 10 time-wasters in developing a manuscript. Many of these strategies can help lead to acceptance of the manuscript on the first submission, thus saving revision time.

The pathophysiology of multi-system organ failure in the trauma patient.

Multiple trauma mortality in the critical care setting most often occurs as a result of multi-system organ failure (MSOF). Mortality rates increase exponentially as successive organ systems fail. Although the role of shock in determining patient outcome has been extensively investigated, inflammatory factors and sepsis are becoming increasingly implicated in the development of MSOF. The physiologic effect of these factors on individual organ systems is explained. Signs, symptoms, and key criteria for determining organ system failure also are presented to assist the nurse in recognition and prevention.

A novel equipment bridge for helicopter transport of critically ill patients.

A three-piece equipment bridge designed to simplify transfer of critically ill patients by helicopter or land ambulance is described. A lightweight, support frame is first secured onto a standard stretcher while still allowing access to the patient. An equipment module can then be attached to the frame. Emergency access to the patient is quickly achieved by detaching the equipment module, while ventilation and monitoring continue uninterrupted. The unit is fully self-contained and has a low centre of gravity to assist stability.

Therapeutic outcome of adjustable gastric banding in morbid obese patients.

We examined 77 obese patients treated with bariatric surgery in order to analyse treatment success, and compare those with a good or a poor outcome. The subjects, who were recruited one year after undergoing adjustable gastric banding, were asked questions concerning their sociodemographic status, postoperative course, past and present weight status, eating behaviours and difficulties in changing eating habits. Furthermore, we also used two body image questionnaires, and considered the patients' evaluations of positive and negative changes, as well as their wishes for the future. There were no preoperative differences between the 71% of patients in the good outcome group and the 29% in the poor outcome group. With regard to the postoperative course, the poor outcome group had more problems in adapting to new eating behaviours, experienced significantly more post-surgical complications, and had a persistently negative body evaluation. Both groups were satisfied with their achieved weight loss achieved, and their improved self-esteem and mobility. Adjustable gastric banding seems to be successful in inducing weight loss and allowing a better quality of life. However, factors such as postoperative complications, the ability and willingness to adopt new eating attitudes, and an improved body image seem to be crucial for therapeutic outcome.

Risk profile of SSrIs in elderly depressive patients with co-morbid physical illness.

BACKGROUND: So far, most studies on treatment strategies in elderly depressive patients have included only patients in good physical health, thereby excluding and neglecting somatic co-morbidity, which is very prevalent and relevant in geriatric psychiatry. METHOD: 40 elderly depressive inpatients at the Department of Internal Medicine in Hochzirl who had started on SSRI monotherapy were allocated to this prospective post-marketing surveillance study. A stable medication for their physical illness for at least six months was a prerequisite. A Mini Mental State Exam (MMSE) score of >24 was required for study entry. The four-week study consisted of one baseline and four follow-up examinations, including psychiatric and medical history, as well as ratings for psychopathology and treatment-related adverse events. The antidepressants administered were paroxetine (20 mg/d), citalopram (20 mg/d), fluoxetine (20 mg/d) and sertraline (50 mg/d). Depression was rated using the 21-item Hamilton Depression Scale (HAMD); side effects were evaluated by the UKU Side Effect Rating Scale, and we used the Hillside Akathisia Scale (HAS) to record the incidence of SSRI-induced akathisia. RESULTS AND CONCLUSION: Our results suggest that SSRls are effective and reasonably safe in elderly depressive patients with co-morbid physical illness. Adverse effects are more common, but generally tolerable, than in younger and physically healthy patients. The risk profile of SSRls in this population can be considered favorable.