RESUMO
The COVID-19 pandemic has highlighted the importance of environmental ventilation in reducing airborne pathogen transmission. Carbon dioxide monitoring is recommended in the community to ensure adequate ventilation. Dynamic measurements of ventilation quantifying human exhaled waste gas accumulation are not conducted routinely in hospitals. Instead, environmental ventilation is allocated using static hourly air change rates. These vary according to the degree of perceived hazard, with the highest change rates reserved for locations where aerosol-generating procedures are performed, where medical/anaesthetic gases are used and where a small number of high-risk infective or immunocompromised patients may be isolated to reduce cross-infection. We aimed to quantify the quality and distribution of ventilation in hospital by measuring carbon dioxide levels in a two-phased prospective observational study. First, under controlled conditions, we validated our method and the relationship between human occupancy, ventilation and carbon dioxide levels using non-dispersive infrared carbon dioxide monitors. We then assessed ventilation quality in patient-occupied (clinical) and staff break and office (non-clinical) areas across two hospitals in Scotland. We selected acute medical and respiratory wards in which patients with COVID-19 are cared for routinely, as well as ICUs and operating theatres where aerosol-generating procedures are performed routinely. Between November and December 2022, 127,680 carbon dioxide measurements were obtained across 32 areas over 8 weeks. Carbon dioxide levels breached the 800 ppm threshold for 14% of the time in non-clinical areas vs. 7% in clinical areas (p < 0.001). In non-clinical areas, carbon dioxide levels were > 800 ppm for 20% of the time in both ICUs and wards, vs. 1% in operating theatres (p < 0.001). In clinical areas, carbon dioxide was > 800 ppm for 16% of the time in wards, vs. 0% in ICUs and operating theatres (p < 0.001). We conclude that staff break, office and clinical areas on acute medical and respiratory wards frequently had inadequate ventilation, potentially increasing the risks of airborne pathogen transmission to staff and patients. Conversely, ventilation was consistently high in the ICU and operating theatre clinical environments. Carbon dioxide monitoring could be used to measure and guide improvements in hospital ventilation.
Assuntos
COVID-19 , Dióxido de Carbono , Humanos , Pandemias , Aerossóis e Gotículas Respiratórios , HospitaisRESUMO
BACKGROUND: BreastCheck is Ireland's breast screening service which offers biennial mammograms to women aged 50-69. Practicing regular breast self-examination (BSE) enhances women's awareness and increases their perception of their susceptibility to the risk of breast cancer, possibly increasing their likelihood of attending a screening programme which reduces breast cancer mortality. Research is needed to identify the promotors and barriers to both attending breast cancer screening and practicing BSE. PURPOSE: The aim of this study was to determine the promotors and barriers associated with attending breast cancer screening and practicing BSE in Irish women. MATERIALS AND METHODS: Data from the participants of TILDA wave 3 (2014-2015) was used, the participant population included females only (≥50 years old), a total of 3575 women. Bivariate analysis was used to identify variables that were significantly associated with having had a mammogram since the last interview (wave 2) or regularly checking their breasts for lumps (BSE). Regression analysis was then used to determine the effect the significant variables had on predicting the likelihood of participants attending breast screening or practicing BSE. RESULTS: Over half (55%) of all women over the age of 50 had a mammogram since wave 2 was completed (2012) and two thirds reported practicing regular BSE. The factors associated with having attended for breast cancer screening were: having private health insurance (OR = 1.86, 95%CI = 1.45-2.380), and practicing BSE (OR = 1.683, 95%CI = 1.344-2.107). The factors found to be associated with practicing regular BSE were: higher quality of life (OR = 1.035, 95%CI = 1.015-1.057), higher BMI (OR = 1.118, 95%CI = 1.020-1.226), being married (OR = 1.436, 95%CI = 1.190-1.732) and attending mammogram screening (OR = 1.691, 95%CI = 1.353-2.114). CONCLUSION: Regular participation in mammography screening reduces breast cancer mortality. Women eligible for BreastCheck were significantly more likely to attend screening. BSE is associated with increased attendance at screening. Health-care professionals should encourage BSE in order to increase screening uptake.
Assuntos
Neoplasias da Mama , Autoexame de Mama , Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/epidemiologia , Detecção Precoce de Câncer , Estudos Longitudinais , Qualidade de Vida , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos e Questionários , Mamografia , Programas de Rastreamento , EnvelhecimentoRESUMO
Despite consensus guidelines on best practice in the care of older patients with cancer, geriatric assessment (GA) has yet to be optimally integrated into the field of oncology in most countries. There is a relative lack of consensus in the published literature as to the best approach to take, and there is a degree of uncertainty as to how integration of geriatric medicine principles might optimally predict patient outcomes. The aim of the current study was to obtain consensus on GA in oncology to inform the implementation of a geriatric oncology programme. A four-round Delphi process was employed. The Delphi method is a structured group facilitation process, using multiple iterations to gain consensus on a given topic. Consensus was reached on the optimal assessment method and interventions required for the commonly employed domains of GA. Other aspects of GA, such as screening methods and age cut-off for assessment, represented a higher degree of disagreement. The expert panel employed in this study clearly identified the criteria that should be included in a clinical geriatric oncology programme. In the absence of evidence-based guidelines, this may prove useful in the care of older cancer patients.
Assuntos
Avaliação Geriátrica/métodos , Neoplasias/terapia , Guias de Prática Clínica como Assunto , Adulto , Idoso , Consenso , Técnica Delphi , Feminino , Humanos , Irlanda , Masculino , Oncologia/métodosRESUMO
Radiation-induced toxicity is a common adverse side effect of radiation therapy. Previous studies have demonstrated a lack of evidence to support common skincare advice for radiotherapy patients. The aim of the current study was to investigate the management of radiation-induced skin toxicity across Europe and the USA. Where previous surveys have focused on national practice or treatment of specific sites, the current study aimed to gain a broader representation of skincare practice. An anonymous online survey investigating various aspects of radiotherapy skincare management was distributed to departments across Europe and the USA (n = 181/737 responded i.e. 25%). The UK was excluded as a similar survey was carried out in 2011. The results highlight the lack of consistency in both the prevention and management of radiation-induced skin toxicity. Recommended products are often not based on evidence-based practice. Examples include the continued use of aqueous cream and gentian violet, as well as the recommendations on washing restrictions during treatment. To our knowledge, this is the most extensive survey to date on the current management of radiation-induced skin toxicity. This study highlights significant disparities between clinical practice and research-based evidence published in recent systematic reviews and guidelines. Ongoing large prospective randomised trials are urgently needed.
Assuntos
Atenção à Saúde/normas , Profilaxia Pré-Exposição/normas , Radiodermite/terapia , Fármacos Dermatológicos/uso terapêutico , Gerenciamento Clínico , Europa (Continente) , Custos de Cuidados de Saúde , Pesquisas sobre Atenção à Saúde , Humanos , Estudos Prospectivos , Radiodermite/economia , Radiodermite/prevenção & controle , Estados UnidosRESUMO
BACKGROUND: People who use community-based drug treatment services spend a considerable amount of their time in treatment in direct contact with frontline staff. These staff are also fundamental to supporting the implementation of change to meet service user needs. Yet, very little is known about staff perspectives on the process and internal dynamics of drug treatment services, their views about what makes services work effectively, and how services can more effectively adopt to changes in practice. AIM AND METHOD: Conducted across Irish community opiate prescribing services and drawing on data from 12 in-depth qualitative interviews with frontline staff. This paper examines the narratives of staff about the factors which influence the dynamics and process of treatment services, particularly in relation to the implantation of change. FINDINGS: Change itself was described both in respect of how a service responded to immediate service user needs or supported planned change. Little distinction was made in respect of service attributes which facilitated a response in either context. Overwhelmingly, staff contextualised current service effectiveness, historical change, and desired change in how effectively their services met service user needs, which was also viewed as a significant motivation for change. Differences in operational standards across services in terms of practices, policy implementation, job roles, divisions between professional groups, and recruitment and retention of staff inhibited change adoption. Factors which were identified in terms of inhibiting or facilitating planned change were consistent with the wider literature on change implementation but provided unique insights in the context of substance misuse services. CONCLUSIONS: A range of interdependent factors which influence an 'eco-system' of service delivery were identified. Effective policy implementation in Ireland remains aspirational, but findings reported in this paper have important implications for future planning and design of services for people who use drugs, and provide a good basis for further investigation.
Assuntos
Alcaloides Opiáceos , Humanos , Motivação , Inovação OrganizacionalRESUMO
Children in care in Ireland have increased by 27% in the last decade. This population is recognized to be among the most vulnerable. This study aims to describe their placement histories, service use and mental health needs. Data was obtained on 174 children (56.5% of eligible sample) with a mean age of 10.83 (SD = 5.04). 114 (65.5%) were in care for three years or more. 29 (16.7%) did not have a SW and 49 (37.7%) had no GP 50 (28.7%) were attending CAMHS. Long term care, frequent placement changes and residential setting were significantly related with poorer outcomes and increased MH contact. Given the increase in numbers in care and the overall decrease in resource allocation to health and social care, individual care planning and prioritizing of resources are essential.
Assuntos
Cuidados no Lar de Adoção , Necessidades e Demandas de Serviços de Saúde , Serviços de Saúde Mental , Instituições Residenciais , Adolescente , Criança , Filho de Pais com Deficiência , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Irlanda , Masculino , Psicologia da Criança , Adulto JovemRESUMO
BACKGROUND: The coronavirus-2019 (COVID-19) pandemic is associated with increased potential for morally injurious events, during which individuals may experience, witness, or learn about situations that violate deeply held moral beliefs. However, it is unknown how pandemic risk and resilience factors are associated with COVID-related moral injury. METHODS: Individuals residing in the U.S. (N = 839; Mage = 37.09, SD = 11.06; 78% women; 63% White; 33% PTSD) participating in an online survey reported on COVID-19 related moral injury (modified Moral Injury Events Scale), perceived current and future threat of pandemic on life domains (social, financial, health), and COVID-19 risky and protective behaviors. Multivariate linear regressions examined associations of perceived threat and risky and protective behaviors on type of COVID-19 related moral injury (betrayal, transgression by others, self). RESULTS: Participants endorsed MI betrayal (57%, N = 482), transgression by other (59%, N = 497), and by self 17% (N = 145). Adjusting for sociodemographics, only future threat of COVID-19 to health was significantly associated with betrayal (B = 0.21, p = .001) and transgression by other (B = 0.16, p = .01), but not by self. In contrast, high frequency of risky behaviors was associated with transgressions by self (B = 0.23, p < .001). Sensitivity analyses showed PTSD did not moderate the observed effects. CONCLUSIONS: Betrayal and transgression by others was associated with greater perceived future threat of COVID-19 to health, but not financial or social domains. Stronger endorsement of transgression by self was associated with more frequently engaging in risky behaviors for contracting COVID-19. These findings may suggest the need for individual, community, and system level interventions to address COVID-19 related moral injury.
Assuntos
COVID-19 , Transtornos de Estresse Pós-Traumáticos , Adulto , Feminino , Humanos , Masculino , Pandemias , SARS-CoV-2 , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Childbirth has been linked to postpartum impairment. However, controversy exists regarding the onset and prevalence of post-traumatic stress disorder (PTSD) after childbirth, with seminal studies being limited by methodological issues. This longitudinal prospective study examined the prevalence of PTSD following childbirth in a large sample while controlling for pre-existing PTSD and affective symptomatology. METHOD: Pregnant women in their third trimester were recruited over a 12-month period and interviewed to identify PTSD and anxiety and depressive symptoms during the last trimester of pregnancy, 4-6 weeks postpartum, 12 weeks postpartum and 24 weeks postpartum. RESULTS: Of the 1067 women approached, 933 were recruited into the study. In total, 866 (93%) were retained to 4-6 weeks, 826 (89%) were retained to 12 weeks and 776 (83%) were retained to 24 weeks. Results indicated that, uncontrolled, 3.6% of women met PTSD criteria at 4-6 weeks postpartum, 6.3% at 12 weeks postpartum and 5.8% at 24 weeks postpartum. When controlling for PTSD and partial PTSD due to previous traumatic events as well as clinically significant anxiety and depression during pregnancy, PTSD rates were less at 1.2% at 4-6 weeks, 3.1% at 12 weeks and 3.1% at 24 weeks postpartum. CONCLUSIONS: This is the first study to demonstrate the occurrence of full criteria PTSD resulting from childbirth after controlling for pre-existing PTSD and partial PTSD and clinically significant depression and anxiety in pregnancy. The findings indicate that PTSD can result from a traumatic birth experience, though this is not the normative response.
Assuntos
Parto/psicologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Adulto , Ansiedade/etiologia , Ansiedade/psicologia , Depressão/etiologia , Depressão/psicologia , Feminino , Humanos , Período Pós-Parto/psicologia , Gravidez , Terceiro Trimestre da Gravidez/psicologia , Prevalência , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologiaRESUMO
There are many additional considerations when treating older adults with cancer, especially in the context of palliative care. Currently, radiation therapy is underutilised in some countries and disease sites, but there is also evidence of unnecessary treatment in other contexts. Making rational treatment decisions for older adults necessitates an underlying appraisal of the person's physiological reserve capacity. This is termed 'frailty', and there is considerable heterogeneity in its clinical presentation, from patients who are relatively robust and suitable for standard treatment, to those who are frail and perhaps require a different approach. Frailty assessment also presents an important opportunity for intervention, when followed by Comprehensive Geriatric Assessment (CGA) in those who require it. Generally, a two-step approach, with a short initial screening, followed by CGA, is advocated in geriatric oncology guidelines. This has the potential to optimise care of the older person, and may also reverse or slow the development of frailty. It therefore has an important impact on the patient's quality of life, which is especially valued in the context of palliative care. Frailty assessment also allows a more informed discussion of treatment outcomes and a shared decision-making approach. With regards to the radiotherapy regimen itself, there are many adaptations that can better facilitate the older person, from positioning and immobilisation, to treatment prescriptions. Treatment courses should be as short as possible and take into account the older person's unique circumstances. The additional burden of travel to treatment for the patient, caregiver or family/support network should also be considered. Reducing treatments to single fractions may be appropriate, or alternatively, hypofractionated regimens. In order to enhance care and meet the demands of a rapidly ageing population, future radiation oncology professionals require education on the basic principles of geriatric medicine, as many aspects remain poorly understood.
Assuntos
Fragilidade/radioterapia , Neoplasias/radioterapia , Cuidados Paliativos/métodos , Envelhecimento , HumanosRESUMO
BACKGROUND: Emotion dysregulation can elicit inflammatory activity. The current study examined whether specific maladaptive and adaptive emotion regulation strategies were associated with inflammatory markers in trauma-exposed veterans, above and beyond PTSD. METHODS: In a cohort study, 606 participants exposed to a Criterion A trauma and recruited from Veteran Health Administration facilities completed fasting blood draws, the Emotion Regulation Questionnaire, and the Clinician Administered PTSD Scale-IV. Inflammation was assessed with high sensitivity C-reactive protein (hsCRP), white blood cell count (WBC), and fibrinogen levels. An inflammation index was created by summing standardized log-transformed levels of the three biomarkers. Our primary linear regression models were adjusted for sex, age, race, education, income, creatinine, and PTSD. RESULTS: Suppression, but not cognitive reappraisal, was significantly associated with higher levels of the inflammatory index (ß = 0.14, p = 0.001). Parallel analyses for the individual inflammatory markers also showed suppression, but not reappraisal, was significantly associated with higher hsCRP (ß = 0.11, p = 0.01), WBC (ß = 0.11, p = 0.01), and fibrinogen (ß = 0.10, p = 0.02). CONCLUSIONS: Emotional suppression is related to elevated systemic inflammation independent of PTSD. Cognitive reappraisal is unrelated to inflammation. Findings suggest over-utilization of maladaptive, rather than under-utilization of adaptive, emotion regulation strategies may be associated with systemic inflammation in trauma-exposed veterans.
Assuntos
Cognição/fisiologia , Regulação Emocional/fisiologia , Veteranos/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Proteína C-Reativa/análise , Estudos de Coortes , Emoções/fisiologia , Feminino , Fibrinogênio/análise , Humanos , Inflamação/metabolismo , Inflamação/fisiopatologia , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Transtornos de Estresse Pós-Traumáticos/psicologia , Ferimentos e Lesões/psicologiaRESUMO
The combination of less positive and more negative expectations for the future (i.e., lower optimism and higher pessimism) increases risk for disease and early mortality. We tested the possibility that expectancies might influence health outcomes by altering the rate of biological aging, specifically of the immune system (immunosenescence). However, no studies to date have examined associations between optimism or pessimism and indicators of immunosenescence such as leukocyte telomere length (TL) and interleukin-6 (IL-6) levels. We investigated whether dispositional tendencies towards optimism and pessimism were associated with TL and IL-6 in a sample of 36 healthy post-menopausal women. Multiple regression analyses where optimism and pessimism were entered simultaneously, and chronological age and caregiver status were controlled, indicated that pessimism was independently associated with shorter TL (beta=-.68, p=.001) and higher IL-6 concentrations (beta=.50, p=.02). In contrast, optimism was not independently associated with either measure of immunosenescence. These findings suggest that dispositional pessimism may increase IL-6 and accelerate rate of telomere shortening. Mechanistic causal relationships between these parameters need to be investigated.
Assuntos
Interleucina-6/sangue , Personalidade/genética , Estresse Psicológico/genética , Estresse Psicológico/imunologia , Telômero/genética , Afeto , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/sangue , Envelhecimento/genética , Envelhecimento/imunologia , Atitude , Cuidadores , Ensaio de Imunoadsorção Enzimática , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Leucócitos/imunologia , Leucócitos/metabolismo , Pessoa de Meia-Idade , Seleção de Pacientes , Inventário de Personalidade , Análise de Regressão , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Estresse Psicológico/sangue , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Anecdotal reports and books have been published linking an over growth of Candida Albicans with chronic fatigue syndrome (CFS), suggesting dietary change as a treatment option. Little scientific data has been published to validate this controversial theory. This study aims to determine the efficacy of dietary intervention on level of fatigue and quality of life (QoL) in individuals with CFS. METHODS: A 24-week randomized intervention study was conducted with 52 individuals diagnosed with CFS. Patients were randomized to either a low sugar low yeast (LSLY) or healthy eating (HE) dietary interventions. Primary outcome measures were fatigue as measured by the Chalder Fatigue Score and QoL measured by Medical Outcomes Survey Short Form-36. RESULTS: A high drop out rate occurred with 13 participants not completing the final evaluation (7HE/6LSLY). Intention to treat analysis showed no statistically significant differences on primary outcome measurements. CONCLUSION: In this randomized control trial, a LSLY diet appeared to be no more efficacious on levels of fatigue or QoL compared to HE. Given the difficulty with dietary compliance experienced by participants, especially in the LSLY group, it would appear HE guidance is a more pragmatic approach than advocating a complicated dietary regime.
Assuntos
Candidíase/complicações , Candidíase/dietoterapia , Carboidratos da Dieta/administração & dosagem , Síndrome de Fadiga Crônica/dietoterapia , Síndrome de Fadiga Crônica/etiologia , Adulto , Ansiedade/epidemiologia , Candida albicans/crescimento & desenvolvimento , Depressão/epidemiologia , Síndrome de Fadiga Crônica/epidemiologia , Feminino , Humanos , Masculino , Qualidade de Vida , Resultado do TratamentoRESUMO
One of the most widely used antitumor drugs is cis-diamminedichloroplatinum(II) (cisplatin), and mechanisms of cisplatin resistance have been investigated in numerous model systems. Many studies have used mouse leukemia L1210/0 as a reference wild-type cell line, and cisplatin-resistant subclones have been derived from it. Increased DNA excision repair capacity is thought to play a key role in the acquired cisplatin resistance, and this has influenced development of drugs for clinical trials. We report here that the L1210/0 line is in fact severely deficient in nucleotide excision repair of damaged DNA in vivo and in vitro. L1210/0 cell extracts could be complemented by extracts from repair-defective human xeroderma pigmentosum (XP) or rodent excision repair cross-complementing (ERCC) mutant cells, except for XPG/ERCC5 mutants. Purified XPG protein could restore repair proficiency to L1210/0 extracts. Expression of mouse XPG mRNA was similar in all L1210 lines studied, suggesting a point mutation or small alteration of XPG in L1210/0 cells. The DNA repair capacity of a cisplatin-resistant subline, L1210/DDP10, is similar to that of type culture collection L1210 cells and to those of other normal mammalian cell lines. Nucleotide excision repair of DNA is thus clearly important in the intrinsic cellular defense against cisplatin. However, in contrast to what is generally believed, enhancement of DNA repair above the normal level in these rodent cells does not appear to be a mechanism of acquired resistance to the drug.
Assuntos
Cisplatino/toxicidade , Dano ao DNA , Reparo do DNA , Proteínas de Ligação a DNA/genética , Animais , Sequência de Bases , DNA/efeitos dos fármacos , DNA/efeitos da radiação , Primers do DNA/química , Resistência a Medicamentos , Endonucleases , Expressão Gênica , Leucemia L1210 , Camundongos , Dados de Sequência Molecular , Mutação , Proteínas Nucleares , RNA Mensageiro/genética , Fatores de Transcrição , Raios UltravioletaRESUMO
Self harm in the absence of expressed suicidal intent is an under explored area in psychiatric nursing research. This paper reports on findings of a study undertaken in two acute psychiatric inpatient units in Ireland. The purpose of the study was to gain an understanding of the practices of psychiatric nurses in relation to people who self harm, but who are not considered suicidal. Semi structured interviews were held with eight psychiatric nurses. Content analysis revealed several themes. For the purpose of this paper the prevention and intervention strategies psychiatric nurses engage in when working with non-suicidal self harming individuals are presented. Recommendations for further research are offered.
Assuntos
Atitude do Pessoal de Saúde , Tomada de Decisões , Serviços Preventivos de Saúde/normas , Enfermagem Psiquiátrica/métodos , Segurança , Comportamento Autodestrutivo/terapia , Tentativa de Suicídio , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Comportamento Autodestrutivo/enfermagem , Comportamento Autodestrutivo/prevenção & controleRESUMO
It has been suggested that patient-centred care be adopted as the primary method of mental health service delivery. This approach has been widely described in the literature and various frameworks for its delivery have been developed; however, many lack evaluation at present. The primary aim of this study was to gain an understanding of psychiatric nursing practice with people who self-harm using a qualitative descriptive approach. One of its objectives was to explore psychiatric nurses' approach and philosophical underpinnings to care. A sample of eight psychiatric nurses from two acute psychiatric admission units in Ireland was gained through convenience sampling. Data were collected through in-depth semi-structured interviews and analysed using a combination of content and theme analysis. Barker's Tidal Model was being utilized as the basis of nursing practice in both units. This paper presents one of the themes that emerged from the findings on the concept of patient-centred care, and how this translated in the use of the Tidal Model.
Assuntos
Atitude do Pessoal de Saúde , Unidades Hospitalares/organização & administração , Recursos Humanos de Enfermagem Hospitalar , Admissão do Paciente , Assistência Centrada no Paciente/organização & administração , Enfermagem Psiquiátrica/organização & administração , Doença Aguda , Competência Clínica , Comportamento Cooperativo , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Irlanda , Masculino , Modelos de Enfermagem , Papel do Profissional de Enfermagem/psicologia , Relações Enfermeiro-Paciente , Pesquisa em Avaliação de Enfermagem , Pesquisa Metodológica em Enfermagem , Recursos Humanos de Enfermagem Hospitalar/organização & administração , Recursos Humanos de Enfermagem Hospitalar/psicologia , Participação do Paciente , Filosofia em Enfermagem , Pesquisa Qualitativa , Comportamento Autodestrutivo/diagnóstico , Comportamento Autodestrutivo/psicologia , Comportamento Autodestrutivo/terapia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The incidence of common bile duct calculi in patients selected for laparoscopic cholecystectomy is 4 to 6 percent. Management is controversial. We report our experience with fine bore cannulation of the cystic duct in patients found on operative cholangiography to have common bile duct stones. STUDY DESIGN: We performed a prospective study of 310 patients who underwent laparoscopic cholecystectomy to evaluate the role of fine bore intubation of the cystic duct at the time of operation. Operative cholangiogrphy was attempted on all patients. In 9 patients, the fine bore tube was left in situ for at least 6 weeks. RESULTS: Intubation was found to be safe and well-tolerated. It permitted biliary decompression and allowed repeat cholangiography. Thirty percent of patients had spontaneous clearance of the common duct stones, which was shown on repeat studies. CONCLUSIONS: Fine bore cannulation of the cystic duct is a safe procedure that allows repeat cholangiography, thus eliminating false-positive results. It reduces the need for intervention by demonstrating the spontaneous disappearance of retained calculi in up to a third of cases.
Assuntos
Colangiografia , Colecistectomia Laparoscópica , Ducto Cístico , Cálculos Biliares/diagnóstico por imagem , Intubação , Humanos , Período Intraoperatório , Estudos ProspectivosRESUMO
The precise etiology of autism remains unclear. Obstetric adversity has been described as one factor that may increase the risk for the disorder. We examined the contemporaneous birth records of 49 children satisfying DSM-III-R criteria for autistic disorder, at four Dublin maternity hospitals, using the previous same-sex live birth in that hospital as a control. Data were evaluated blind to subject status using two obstetric complication (OC) rating scales. No significant differences in obstetric adversity were found between index and control groups. Autistic individuals did not differ from controls in terms of previously described risk factors for this disorder (maternal age, maternal parity, birth order, and low birth weight) in autism. These data do not support the view that OCs increase the risk for later autism.
Assuntos
Transtorno Autístico/etiologia , Complicações do Trabalho de Parto/diagnóstico , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Irlanda , Masculino , Gravidez , Fatores de RiscoRESUMO
BACKGROUND: In Ireland, general surgeons provide paediatric surgical services to patients remote from specialist paediatric units. AIM: To review general paediatric surgical services in the Mid-Western Health Board (MWHB) region with a view to informing future policy decisions in Ireland. METHODS: From 1995 to 2000, the paediatric surgical workload at the Mid-Western Regional Hospital was reviewed. Operations performed, level of operating surgeon, morbidity and mortality were recorded. RESULTS: There were 3,166 general paediatric surgical patients cared for by three general surgeons and one urologist, all with paediatric surgical training. There was an increase in day cases (55% to 70%) and operations at which the consultant was the main operator (40% to 67%). There was no mortality and the morbidity rate was less than 1%. CONCLUSIONS: General paediatric surgery and urology is well provided for in the MWHB by appropriately trained surgeons. Lack of opportunity for surgeons in training to obtain general paediatric surgical experience will put this service at risk as the current cohort of surgeons retire. Expansion in specialist paediatric surgical services, changes in general surgical training to include general paediatric surgery or proleptic appointments may be required.
Assuntos
Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Criança , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Previsões , Hospitais Pediátricos , Humanos , Irlanda , Carga de TrabalhoRESUMO
BACKGROUND: Individuals with schizophrenia have functionally significant deficits in automatic and controlled social cognition, but no currently available pharmacologic treatments reduce these deficits. The neuropeptide oxytocin has multiple prosocial effects when administered intranasally in humans and there is growing interest in its therapeutic potential in schizophrenia. METHODS: We administered 40 IU of oxytocin and saline placebo intranasally to 29 male subjects with schizophrenia and 31 age-matched, healthy controls in a randomized, double-blind, placebo-controlled, cross-over study. Social cognition was assessed with The Awareness of Social Inference Test (TASIT) and the Reading the Mind in the Eyes Test (RMET). We examined the effects of oxytocin administration on automatic social cognition (the ability to rapidly interpret and understand emotional cues from the voice, face, and body); controlled social cognition (the ability to comprehend indirectly expressed emotions, thoughts, and intentions through complex deliberations over longer time periods); and a control task (the ability to comprehend truthful dialog and perform general task procedures) in individuals with and without schizophrenia using mixed factorial analysis of variance models. RESULTS: Patients with schizophrenia showed significant impairments in automatic and controlled social cognition compared to healthy controls, and administration of oxytocin significantly improved their controlled, but not automatic, social cognition, F(1, 58)=8.75; p=0.004. Conversely, oxytocin administration had limited effects on social cognition in healthy participants. Patients and controls performed equally well and there were no effects of oxytocin administration on the control task. DISCUSSION: Intact social cognitive abilities are associated with better functional outcomes in individuals with schizophrenia. Our data highlight the potentially complex effects of oxytocin on some but not all aspects of social cognition, and support the exploration of intranasal oxytocin as a potential adjunct treatment to improve controlled social cognition in schizophrenia.