Methods: Patients suffering from chest pain or trauma were randomised to receive either a rapid dosing regimen (10 mg over 30 seconds, repeated once after three minutes if pain score remained above three) or a cautious regimen (5 mg over two minutes, repeated at three minute intervals if pain score remained above three to a maximum dose of 20 mg). Data were collected on analgesic effectiveness, changes in vital signs, and patient reported side effects.
Results: The pain score fell by a mean of 4.29 and 3.49 in the rapid and cautious regimen groups respectively (difference = 0.79, 95% CI 0.09 to 1.5, p = 0.028). However, over half the patients in both groups continued to suffer significant pain on arrival at hospital. There were no significant changes in vital signs after nalbuphine, but there was a greater incidence of patient reported drowsiness in rapid regimen patients (42% compared with 21%, 95% CI = 6.96 to 34.12%, p = 0.003).
Conclusion: A rapid dosing regimen of nalbuphine using 10 mg increments is more effective than and equally as safe as a cautious regimen using 5 mg increments. Further research is required to determine if a maximum dose exceeding 20 mg would result in fewer patients continuing to suffer significant pain before arrival at hospital.
There are conflicting reports on the effect of insulin on plasma Ca concentration in rats. Low doses appear to decrease and higher doses to increase plasma Ca. Since birds are known to be very sensitive to parathyroid hormone and have resistance to the hypoglycemic effects of insulin, the effect of commercial and highly purified insulin on plasma Ca concentration was studied in 10-day-old chicks 60 min after the administration of the hormone. Both commerical bovine and purified porcine insulin provoked a dose-related elevation of plasma Ca. Although hypophosphatemia was observed with the highest dose of insulin used (0.4U), hypercalcemia was observed with 0.05 U insulin, a dose that did not modify plasma phosphate concentration. The slopes of the dose-response curves of insulin and parathyroid hormone were indistinguishable and different from that of 1 alpha-hydroxyvitamin D3. Neither propranolol nor deprivation of vitamin D altered the hypercalcemic response to insulin. Unexpectedly, propranolol (40 microgram/chick) provoked elevation of plasma Ca. It is concluded that insulin raises plasma Ca concentration in the chick by a mechanism(s) not yet elucidated. 相似文献
Mindfulness-based meditation interventions have become increasingly popular in contemporary psychology. Other closely related meditation practices include loving-kindness meditation (LKM) and compassion meditation (CM), exercises oriented toward enhancing unconditional, positive emotional states of kindness and compassion. This article provides a review of the background, the techniques, and the empirical contemporary literature of LKM and CM. The literature suggests that LKM and CM are associated with an increase in positive affect and a decrease in negative affect. Preliminary findings from neuroendocrine studies indicate that CM may reduce stress-induced subjective distress and immune response. Neuroimaging studies suggest that LKM and CM may enhance activation of brain areas that are involved in emotional processing and empathy. Finally, preliminary intervention studies support application of these strategies in clinical populations. It is concluded that, when combined with empirically supported treatments, such as cognitive-behavioral therapy, LKM and CM may provide potentially useful strategies for targeting a variety of different psychological problems that involve interpersonal processes, such as depression, social anxiety, marital conflict, anger, and coping with the strains of long-term caregiving. 相似文献
The ongoing development of animal models of neurological and psychiatric disorders in combination with the development of advanced nuclear magnetic resonance (NMR) techniques and instrumentation has led to increased use of in vivo proton NMR spectroscopy ((1)H-MRS) for neurochemical analyses. (1)H-MRS is one of only a few analytical methods that can assay in vivo and longitudinal neurochemical changes associated with neurological and psychiatric diseases, with the added advantage of being a technique that can be utilized in both preclinical and clinical studies. In this review, recent progress in the use of (1)H-MRS to investigate animal models of neurological and psychiatric disorders is summarized with examples from the literature and our own work. 相似文献
Objectives To examine how practice constraints contribute to barriers in the health care of persons with dementia and their families,
particularly with respect to behavioral aspects of care.
Design Cross-sectional qualitative interview study of primary care physicians.
Setting Physicians’ offices.
Participants Forty primary care physicians in Northern California.
Measurements Open-ended interviews lasted 30–60 minutes and were structured by an interview guide covering clinician background and practice
setting, clinical care of a particular patient, and general approach to managing patients with AD or dementia. Interviews
were transcribed and themes reflecting constraints of practice were identified through a systematic coding process.
Results Recurring themes (i.e., those present in ≥25% of physician interviews) included insufficient time, difficulty in accessing
and communicating with specialists, low reimbursement, poor connections with community social service agencies, and lack of
interdisciplinary teams. Physician narratives suggest that these constraints may lead to delayed detection of behavior problems,
“reactive” as opposed to proactive management of dementia, and increased reliance on pharmacological rather than psychosocial
approaches.
Conclusion Physicians often feel challenged in caring for dementia patients, particularly those who are more behaviorally complex, because
of time and reimbursement constraints as well as other perceived barriers. Our results suggest that more effective educational
interventions (for families and physicians) and broader structural changes are needed to better meet the needs of the elderly
with dementia and their families now and in the future. Without these changes, dementia care is likely to continue to fall
short. 相似文献
Previous research has found a relationship between sleep paralysis (SP) and anxiety states and higher rates have been reported among certain ethnic groups. To advance the cross-cultural study of SP, we developed a brief assessment instrument (which can be self-administered), the Unusual Sleep Experiences Questionnaire (USEQ). In this article, we report on a pilot study with the USEQ in a sample of 208 college students. The instrument was easily understood by the participants, with one quarter reporting at least one lifetime episode of SP. As in previous studies, SP was associated with anxiety (in particular, panic attacks). 相似文献
We investigated the relative importance of "fear of arousal symptoms" (i.e., anxiety sensitivity) and "dissociation tendency" in generating ataque de nervios. Puerto Rican patients attending an outpatient psychiatric clinic were assessed for ataque de nervios frequency in the previous month, and they completed the Anxiety Sensitivity Index (ASI) and the Dissociation Experiences Scale (DES). ASI scores were especially high in the ataque-positive group (M=41.6, SD=12.8) as compared with the ataque-negative group (M=27.2, SD=11.7), t(2, 68)=4.6, P<.001. Among the whole sample (N=70), in a logistic regression analysis, the ASI significantly predicted (odds ratio=2.6) the presence of ataque de nervios, but the DES did not. In a linear regression analysis, ataque severity was significantly predicted by both the ASI (beta=.46) and the DES (beta=.29). The theoretical and clinical implications of the strong relationship of the ASI to ataque severity are discussed. 相似文献