Psychotropic medication use for behavioral symptoms of dementia

Behavioral disturbances associated with dementia are common and burdensome. Although no psychotropic medications are currently approved by the US Food and Drug Administration (FDA) to treat such behavioral symptoms, a variety of drug classes are commonly used for these purposes. Atypical antipsychotic medications may be somewhat effective and are generally considered the pharmacologic treatments of choice; however “black box” warnings have recently been added to their labels by the FDA, warning of significantly increased risks of short-term mortality. Older conventional antipsychotic medications may also be somewhat effective but appear to pose risks that can be at least as great as those of the newer atypical drugs. Although antidepressants, benzodiazepines, mood stabilizers, acetylcholinesterase inhibitors, and N-methyl-D-aspartate (NMDA) receptor antagonists may be considered, particularly in patients with specific types of symptomatology, even less is known about their effectiveness and safety. Also, although various psychotropic medications used for behavioral disturbances in dementia patients may be somewhat effective, they have been increasingly associated with important safety risks.     

The role of intraoperative ultrasound in the diagnosis and treatment of hydatid liver disease

Liver hydatid disease still represents a frequent condition in Romania, especially among population of Dobrogea County, which may lead to life-threatening complications. To assess the role of intraoperative ultrasound (IOUS) in the diagnosis and treatment algorithms of liver hydatid disease. We could not find any similar studies in the literature in order to compare the results. The paper represents a retrospective study of IOUS performed for liver hydatid disease on a group of 43 patients admitted in the 2nd Clinic of Surgery - Clinical Emergency Hospital of Constanta. IOUS was intraabdominal (36 cases), transdiaphragmatic (7 cases) and was able to diagnose infected liver HC (7 cases), locate bilio-cystic fistulas (6 cases), hydatic cysts (18 cases) or relation with important anatomic elements (12). Ultrasound-guided frenotomy was performed in 5 cases and ultrasound-guided puncture in 9 cases. In 26 out of 43 patients (60.47%), IOUS influenced decision making during surgery. These data recommends IOUS in managing hydatid disease, allowing a complete diagnosis and optimal treatment, thus reducing postoperative morbidity.     

Colonic angiodysplasia in a chronic renal failure patient

An important cause of intestinal bleeding in patients with chronic renal failure is angiodysplasia. In retrospective reports up to 19-32% of patients had bleeding from angiodysplastic lesions. These are usually multiple, have a high tendency of rebleeding (25-47%) and are often located in the stomach and duodenum, but can affect the colon and the jejunum as well. Bleeding from angiodysplastic lesions is usually low grade and stops spontaneously in more than 90% of patients, but some times may be life threatening necessitate therapeutic interventions to achieve hemostasis. We report a case of an 18-year old female with renal failure on CAPD who presented a massive lower gastrointestinal bleeding and imposed emergency surgery.     

The Landmark Surgical Trials of the National Surgical Adjuvant Breast and Bowel Project

In this paper we provide a summary of several of the completed and ongoing surgical trials of the National Surgical Adjuvant Breast and Bowel Project, one of the cancer cooperative trials groups supported by the US National Cancer Institute.     

The Evaluation and Management of Persistent Nocturia

Nocturia, or waking at night to void, is a common symptom that leads to substantial morbidity. Men and women are both affected across a wide age range, such that the objective evaluation of nocturia remains a challenge, due largely to its multifactorial etiology. While for some patients, nocturia is caused by common structural conditions such as prostatic obstruction, for others it is due to a complex interplay between multiple underlying systemic diseases. For this reason, persistent nocturia merits particularly careful consideration. The purpose of this review is to describe the most recent salient research in the field of nocturia, with a particular emphasis on its evaluation and management.     

Four Ways To Teach PHC in a Changing World

Nurse educators are challenged to revise teaching/learning methods to support community-based primary health care (PHC) systems. The key elements are: integrating education with the realities of practice and people's needs; moving communities to strive towards solving their own health problems; and recognizing the socioeconomic health determinants. Described below are four educational methods based on PHC: inquiry-based learning, IMPACTS (a game to encourage multisectoral collaboration), distance education and community-based education.