Pandemija koronavirusa SARS-CoV-2 je »novo realnost« prinesla tudi v vsakodnevno obravnavo bolnikov z duševno motnjo. Ob pomanjkanju specifičnih smernic in kliničnih izkušenj je predpisovanje ...psihofarmakoterapije bolnikom s covidom-19 povezano z različnimi izzivi. Zaradi možnih interakcij med psihofarmaki in zdravili, ki se uporabljajo za zdravljenje bolnikov s covidom-19, ter zaradi neugodnega vpliva psihiatričnih zdravil na simptome okužbe je občasno treba prilagoditi terapijo pri psihiatričnih bolnikih, obolelih s covidom-19. Po drugi strani pa je morebitne interakcije in vpliv psihofarmakov na potek okužbe potrebno upoštevati tudi ob zdravljenju psihopatoloških simptomov, ki jih lahko povzroči sama okužba s koronavirusom SARS-CoV-2, ali pa so posledica zdravil, ki se uporabljajo za zdravljenje okužbe. V prispevku so predstavljene dileme, s katerimi se srečujemo pri predpisovanju psihofarmakov bolnikom s covidom-19 in na podlagi literature, objavljene v zadnjih mesecih, povzete usmeritve glede izbire zdravil za akutna psihiatrična stanja pri teh bolnikih.
ABSTRACT
Aim
To evaluate the incidence, severity and characteristics of aggressive behaviour in patients hospitalized in acute psychiatric wards, as well as the association between patient ...characteristics and the incidence of recurrent aggressive behaviour.
Methods
A multicentre prospective study included all twelve acute wards in Slovenian psychiatric hospitals with a total capacity of 232 beds. Over five consecutive months, data on the number of treatment episodes involving aggressive behaviour and the number of aggressive incidents, their severity and characteristics were obtained using the Staff Observation Aggression Scale-Revised (SOAS-R). Patient- and event-based incident rates of verbal and physical aggression were calculated. The association between patient characteristics and recurrent aggressive behaviour was analysed. Patient characteristics data were extracted from hospital databases.
Results
3,190 treatment episodes were included during a 5-month period. Aggressive behaviour was observed in 13.4% of treatment episodes, and 922 aggressive incidents were recorded, which resulted in 3.98 incidents per 100 occupied bed days and 9.48 incidents per bed per year. 74.1% of incidents were severe, and more than half of incidents included physical aggression. 75.5% of incidents were directed against medical staff. 5.9% of treatment episodes were involved in multiple aggressive incidents. Compared to patients with single incidents, patients with recurrent aggression had a less frequent main diagnosis of substance use disorders and a longer duration of hospitalization.
Conclusion
Monitoring the frequency and characteristics of aggressive behaviour allows comparisons with other studies and, more importantly, it is necessary for planning and assessing the effectiveness of preventative aggression management strategies.
Background. Radical hysterectomy is performed on woman with cervical cancer or endometrial cancer that has spread to the cervix. Aims. To find whether our modified radical hysterectomy represents ...nerve sparing. Methods. In 28 patients, modified radical hysterectomy was applied (study group) and the width of the parametria and vaginal cuff were measured. Using a point-counting technique, nerve areal density was determined in cross sections of resected parametria at 0.5 cm (A), 1 cm (B), and 1.5 cm (C) from the cervix. The results were compared with 26 control patients who underwent classic radical hysterectomy. In the study group urodynamic measurements were performed after operation, and correlations with histologic data were calculated. The survival rates and adjuvant treatment were compared between the groups. Results. Adjuvant treatment was given to 53.57 % in the study and 65.38 % of patients in the control group (P > 0.3). The survival rate after 3 years was 92.85 % in the study and 84.61 % in the control group after more than 5 years. The width of the resected parametria was smaller in the study (mean: right 15.50 mm, left 15.71 mm) compared with the control group (mean: right 22.69 mm; P < 0.013; left 22.96 mm; P < 0.011). The nerve areal density in the lateral part of the right parametrium (C right 6.2 %) was lower in the study than in the control group (C right 9.7 %; P < 0.01). There were several correlations between parametrial width, nerve areal density and urodynamic parameters. Conclusions. Modified radical hysterectomy is less radical, and apparently also nerve sparing. It does not influence survival rates and does not impair the urinary tract function.
Izhodišče: Katetrska ablacija je danes uveljavljena metoda zdravljenja preddvorne fibrilacije (AF). O zgodnjih in srednjeročnih izidih smo že poročali. Tokrat želimo predstaviti še dolgoročne ...klinične izide.
Metode: Spremljali smo vse bolnike, pri katerih smo v obdobju 2003‒2009 prvič opravili katetrsko ablacijo paroksizmalne ali vztrajajoče AF zaradi neučinkovitosti antiaritmičnega zdravljenja. Upoštevali smo tudi ablacijske posege zaradi tipične atrijske undulacije (AU) po letu 1999. Glavni cilj ablacijskega posega je bil popolna električna osamitev pljučnih ven (PV). Uporabili smo metodo segmentne radiofrekvenčne ablacije s fluoroskopskim nadzorom in beleženjem elektrogramov na krožnem katetru »laso«. Pri bolnikih s tipično AU smo opravili linijsko ablacijo kavotrikuspidalne ožine. Bolnike smo spremljali vsaj 5 let po doseženi popolni osamitvi PV oz. do telefonskega razgovora v aprilu 2020 oz. do morebitne smrti. Razvrstili smo jih v tri skupine: a) uspešne, tj. v stabilnem sinusnem ritmu z nemotečimi palpitacijami do 5 min, brez rednega antiaritmičnega zdravljenja, b) delno uspešne, ko so bili pretežno v sinusnem ritmu, z epizodami dokumentirane AF/AU do enkrat letno in tudi občasno uporabo antiaritmičnih zdravil v ustreznih odmerkih in c) neuspešne, tj. s pogostimi epizodami AF/AU, neučinkovitim antiaritmičnim zdravljenjem v ustreznih odmerkih ali z dolgotrajno vztrajajočo AF/AU. Ablacijski poseg smo ponovili zaradi recidiva AF/AU, vendar ne prej kot po 3 mesecih. Ob sumu na ponovitev aritmije smo naročili serijske posnetke EKG in Holterjevega monitoriranja. Podatke smo vrednotili s Kaplan-Meierjevo analizo, testom-t in Fisherjevim testom. Vrednost p < 0,05 je bila značilna.
Rezultati: V raziskavo smo uvrstili 128 bolnikov (95 moških, 33 žensk; mediana starost pri prvem posegu zaradi AF je bila 54,5 let, rang 19–75), pri katerih smo opravili povprečno 1,7 ablacijskega posega zaradi AF oziroma 2 posega, če smo upoštevali še ablacije AU. Spremljanje je zaključilo 117 bolnikov (85 moških in 32 ženskah) po povprečno 11,7 letih (mediana 140 mesecev, rang 21–230 mesecev). Umrlo je 10 bolnikov (6 moških, 4 ženske), nihče pa zaradi ablacijskega posega. Od soobolevnosti sta bili v ospredju maligna bolezen in ščitnična disfunkcija. Verjetnost za ohranitev stabilnega sinusnega ritma je bila po 10 letih približno 50-odstotna. Po 15-odstotnem padcu verjetnosti za sinusni ritem v prvem letu je bil padec nato linearen, in sicer 4 % letno. Ablacijsko zdravljenje je bilo uspešno pri 54 bolnikih (46 %), delno uspešno pri 25 (21 %) in neuspešno pri 38 bolnikih (33 %, manj uspešno pri ženskah, p < 0,05). V zadnjih 10 letih spremljanja smo opravili manjši del ablacijskih posegov ‒ 46 (16 %). Antiaritmična zdravila je prejemalo 38 bolnikov (32 %), pretežno amiodaron in propafenon. Med ablacijskim posegom smo povzročili tamponado pri 5 bolnikih (4 %). Nihče od njih ni potreboval kirurškega posega. Drugih večjih zapletov ni bilo.
Zaključek: Ablacijsko zdravljenje AF je dolgoročno dovolj uspešno, varno in po podatkih drugih avtorjev tudi cenovno učinkovito. Zato ga lahko priporočimo večini bolnikov z AF. Za celostno obravnavo bolnikov z AF pa so pomembni tudi: ureditev odpravljivih dejavnikov tveganja, antiaritmično zdravljenje in kakovostno antikoagulacijsko zdravljenje.
Uroginekologija se ukvarja z diagnosticiranjem in zdravljenjem motenj v funkciji medeničnega dna. Gre za pogost pojav, s katerim se srečuje vsaj polovica vseh žensk. Simptomi, ki kažejo na ...disfunkcijo medeničnega dna, so številni. Najpogosteje pa se srečujemo s tistimi, ki jih povzročata urinska inkontinenca in zdrs medeničnih organov (ZMO).
Začetna obravnava bolnice z motnjami v funkciji medeničnega dna zajema uroginekološko anamnezo z analizo dnevnika uriniranja, analizo urina ter klinični pregled. Cilj usmerjene uroginekološke anamneze je opredelitev bolničinih glavnih simptomov, njihovega trajanja, značilnosti in vpliva na bolničino kakovost življenja. Nadalje bolnico povprašamo o jakosti teh simptomov, sprožilnih dejavnikih in njihovem začetku. Pomembno je opredeliti količino in vrsto tekočine, ki jo bolnica zaužije čez dan. Prav tako pridobimo celotno ginekološko anamnezo, podatke o spremljajočih boleznih, operacijah in možnih alergijah. Skupaj z anamnezo lahko analiziramo tudi dnevnik uriniranja, ki nam poda pomembne podatke glede frekvence, inkontinenčih epizod, uporabe vložkov, vnosa tekočin in stopnje urgence ter inkontinence v določenem obdobju.
Anamnezi sledi klinični pregled, ki je sestavljen iz splošnega statusa, pregleda trebuha in vaginalnega pregleda z oceno stopnje ZMO ter moči mišic medeničnega dna (MMD). Priporočamo, da se za oceno ZMO uporablja Pelvic Organ Prolapse Quantification System (sistem POP-Q) in da se moč MMD ocenjuje z digitalno palpacijo, pri čemer se za opredelitev moči krčenja uporablja bodisi šeststopenjsko oxfordsko lestvico bodisi štiristopenjsko lestvico moči MMD. Zaradi visoke prevalence okužb sečil pri ženskah s simptomi v spodnjih sečilih sta nepogrešljiv del obravnave teh bolnic tudi analiza urina in urinokultura.
Uvod: Forenzična psihiatrija obravnava ranljivo skupino pacientov. Paciente zaznamuje »več stigmatizirana identiteta«, ki vključuje stigmatiziranje duševne motnje, po drugi strani pa tudi ...stigmatiziranje kriminalnega dejanja, ki ga je oseba storila. Namen raziskave je bil raziskati poznavanje in odnos zaposlenih v zdravstveni negi do pacienta v forenzični psihiatriji.Metode: Izvedli smo opisno neeksperimentalno kvantitativno raziskavo. Vprašalnik je bil razdeljen priložnostnemu vzorcu 320 zaposlenih v zdravstveni negi na področju psihiatrije in izven psihiatrične stroke, realizacija je bila 74,4 % (n = 238).Rezultati: Anketiranci so obravnavo na področju forenzične psihiatrije poznali povprečno (x = 3,04, s = 1,17). Zaposleni izven psihiatrije (n = 55, = 5,72, s = 2,57) so izražali bolj odklonilen odnos (U = 838,50, p < 0,001) kot zaposleni v psihiatriji (n = 66, x = 7,53, s = 2,17), prepoznavali več negativnih značilnosti pacienta (U = 115,000, p = 0,043) in izražali več stigme (U = 1218,000, p = 0,002).Diskusija in zaključek: Zaposlene na področju psihiatrije je manj strah, gojijo manj stigme in bolj poznajo področje forenzične psihiatrije. Ker so poznavanje, strah in prisotna stigma povezani s kakovostjo zdravstvene obravnave, je treba zaposlene usposobiti za delo z ranljivimi skupinami prebivalstva, kot so pacienti v forenzični psihiatriji. Tako lahko nudijo bolj kakovostno zdravstveno obravnavo.
When we talk about personality disorders, people usually have a very emotional reaction, with pain and unpleasant emotions being the most common. Those who have a relationship with a person who has a ...personality disorder, usually do not know what they are facing, but they do experience feelings of unease, despair, sadness, anger and depression, while doubting their own experience and perception of the world. Family and friends often feel like they are “caught in a relationship web”, which keeps getting more and more tangled, instead of untangling. Personality disorders cause everyone a lot of suffering, anger and disappointment, manifesting in every dimension of the human experience, but the behavior of a person with a personality disorder and the responses from the environment are actually a lot more predictable than you might imagine. In order to present this demanding and little-known topic to the widest range of readers, the handbook uses stories of everyday people to illustrate how their experiences of personality disorders intertwine with stress, mood disorders and problems with addiction. It also presents the process of identifying individual personality disorders and various options of self-help and recovery. The handbook is intended for anyone who is interested in the field of personality disorders, is personally facing mental health problems, or has a relative who is dealing with these issues.
The purpose was to determine the incidence of voice disorders in a group of professional actors and singers, to compare the two groups, and to investigate the potential causes of their voice ...problems.
65 actors and 63 singers from professional theatres and choirs were included. The data concerning voice problems, their possible causes, and factors adversely affecting voice quality were obtained through a questionnaire. The results were compared between the groups of professional singers and actors, and between the subgroups of singers and actors both with and without frequent voice problems.
The incidence of frequent voice problems over the entire career in singers and actors was lower than reported in the literature. Professional actors displayed more inappropriate life and vocal habits than the singers. Significant risk factors for voice disorders in singers turned out to be loud speech (p=0.029) and the presence of allergies or asthma (p=0.048). No such significant risk factors were found in actors.
The study confirmed the importance of preventive examination of the vocal tract function before enrolling in studies for an elite voice user. Professional singers and especially actors demonstrated insufficient knowledge of proper voice care. The results suggest that elite voice users require additional information on voice hygiene and occasional professional help from college to the end of career. Speech and language therapists can play a crucial role in such voice care in order to effectively prevent voice problems in elite voice users.
Abstract Introduction Among physiotherapists, work-related musculoskeletal disorders (WMSDs) are the most common health problem. This study aimed to provide evidence for planning evidence-based ...health promotion programmes for ensuring and maintaining adequate physical fitness (PF) to decrease WMSDs among physiotherapists which would have started already during the study. Methods A cross-sectional study involved the participation of a total of 100 physiotherapy students and 62 physiotherapists. Observed variables were prevalence of WMSDs in the last 12 months, lasting >3 days during physiotherapeutic activities and five PF components: body composition, cardiorespiratory and muscle endurance, muscle strength, and flexibility. A chi-square test and binary logistic regression were used as the main analytical methods. Results Prevalence of WMSDs in physiotherapists was 63.9% (the most common locations: lower back, shoulders, neck), while in physiotherapy students it was 46.5% (the most common locations: lower back, neck, upper back) (p=0.031). Among the PF components, the results showed statistically significantly worse flexibility among students compared to physiotherapists (about two thirds of students had poor or very poor results of flexibility testing) (p=0.002) in comparison to physiotherapists. A statistically significant positive association between WMSDs and PF was observed only between knee pain and poor cardiorespiratory endurance (OR=4.03 with 95% CI 1.12-14.58; p=0.033). Conclusion The study showed poor flexibility among students indicating that it is necessary to direct them to perform activities that will increase the extensibility of muscles. The awareness of this problem should be increased. A specific role should be played by staff involved in clinical practice.
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