Prolonged estrogen therapy in postmenopausal women

The therapeutic use of estrogens for more than 25 years made it possible to examine evidence of their safety and effectiveness in a study of 292 postmenopausal women who had undergone prolonged estrogen therapy. Diethylstilbestrol and conjugated equine estrogens have been used most frequently since 1945. The study showed that only 5% of patients necessitated discontinuation from severe side effects; the latter of the 2 compounds was tolerated without side effects among almost all patients. Hot flashes were completely relieved in 93 of 94 patients. Prolonged estrogen therapy was the treatment for postmenopausal osteoporosis in 119 patients, 103 of whom had suffered collapse of vertabrae. Either complete or significant relief from pain occurred in 90%. A group of 27 women showed evidence that estrogen is a prophylactic against postmenopausal osterporosis. Justification for the fear that mammary and cervical carcinoma may result from this therapy is absent. When combined with periodic pelvic and vaginal cytological examinations, prolonged cyclic oral estrogen therapy is safe and effective treatment for postmenopausal women with disabling symptoms or osteoporosis.     

Psychological Correlates of Outcome after Coronary Artery Bypass Graft

Background

Psychological effects of Coronary Artery Bypass graft (CABG) have been of interest all over the world but there is a paucity of Indian work.

Methods

30 patients undergoing CABG at a service hospital were included. All patients filled a specially designed proforma. Mini Mental Status Examination, Hospital anxiety and depression scale, Coronary scale, Seattle angina questionnaire and Euro-QOL 5D were performed before and seven days after CABG.

Results

43.3% had significant anxiety and 30% had significant depression before CABG. Following CABG, 36.67% of the patients had significant anxiety while 40% had significant depression. On the Seattle angina questionnaire, physical limitation reduced from 71.6 ± 7.9 to 53.1 ± 14.6. There was significant improvement in treatment satisfaction from 37.8 ± 6.1 to 59.4 ± 4.2 following CABG. On th euro quality of life scale (EQ5D) health status improved from 38.17 ± 9.51 before CABG to 68.5 ± 5.28 after CABG.

Conclusion

There is a significant incidence of anxiety and depression in patients undergoing CABG, both before and after surgery.Key Words: CABG, anxiety, depression     

Effects of impulse frequency, PTP, and temperature on responses elicited in large populations of motoneurons by impulses in single Ia-fibers

Excitatory postsynaptic potentials (EPSPs) were evoked in large populations of motoneurons by impulses in single Ia- and group II fibers and recorded from L7 and S1 ventral roots by means of a sucrose-gap technique and spike-triggered averaging, as previously described (33, 34). Factors known to influence conduction at branch points in peripheral nerves or transmission in the Ia projection to motoneurons were studied to determine their effects on these postsynaptic population potentials (PSPPs). When impulse frequency was plotted against the amplitude of these PSPPs, a sequence of low-frequency depression, higher frequency facilitation, and still higher frequency depression was regularly observed. Similar plots of PSPP amplitude versus impulse frequency in a small sample of group II spindle fibers did not reveal any low-frequency depression. Higher frequency facilitation and depression followed the same pattern as that produced by Ia-fibers. Early potentiation of the PSPPs was produced by applying 20 stimulating pulses at 500/s to branches of the medial gastrocnemius nerves containing single Ia-fibers. Single, posttetanic PSPPs were recorded at fixed intervals following each tetanus and averaged. A brief, initial depression followed by a rapidly declining potentiation of PSPPs was regularly observed. When the core temperature was reduced from 41 to 35 degrees C, there was an approximately linear increase in the amplitude of PSPPs. At each temperature a combination of cooling and posttetanic potentiation (PTP) elicited larger PSPPs than cooling alone. The effects of impulse frequency, PTP, and temperature on PSPPs may all be interpreted in terms of their known effects on action potentials or on conduction at branch points in peripheral nerves. Similar effects on transmission or transmission failure in the terminal arborizations of Ia-fibers would account for the influence of these factors on PSPPs. Alternatively, these same three factors might cause similar effects on PSPPs through influences they might exert on the transmitter release mechanism.     

Using clinical simulation to teach patient safety in an acute/critical care nursing course

High-fidelity simulation using lifelike mannequins has been used to teach medical and aviation students, but little is known about using this method to educate nurses. The process and methods authors used to develop, implement, and evaluate high-fidelity simulation experiences in an acute/critical care elective for senior nursing students are described. Authors share their insight, experiences, and lessons learned, along with practical information and a framework, in developing simulations and debriefing.