Articles: adult.
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The present study explored the effects on therapeutic outcomes of training therapists in brief manualized therapy. As part of the Vanderbilt II project, each of 16 therapists (8 psychiatrists and 8 clinical psychologists) treated 2 moderately disturbed adult patients using his or her customary short-term treatment methods; they then received a year of training in a manualized form of brief dynamic therapy, Time-Limited Dynamic Psychotherapy (TLDP); finally, they administered TLDP to 2 additional patients. It was hypothesized that training would result in improved outcomes generally and that differentially greater improvement would be seen in patients commonly considered less suitable for brief dynamic therapy. ⋯ Los resultados a la terminación no apoyaron ninguna de las dos hipótesis. Las mediciones de dependencia interpersonal al año de seguimiento resultaron consistentes con la primera hipótesis, mientras que los resultados de seguimiento fueron inconsistentes con la segunda. Una revisión sistemática de los treinta y dos casos luego del entrenamiento sugiere que la mayoría de los terapeutas no había l.
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Two older adults presented to the emergency department with rib fractures following minor trauma. Both were discharged on oral analgesics and died within 2 days. Rib fractures more often lead to adverse outcomes in older adults. Emergency physicians should consider admitting any such patient who presents with two or more rib fractures.
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Surrogates and clinicians often make treatment decisions for decisionally incapacitated patients with limited knowledge of their preferences. This study examined patients' life-sustaining treatment preferences to facilitate advance care planning discussions and surrogate decision making. ⋯ In advance care planning discussions, clinicians might explore with patients their preferences about short- and long-term treatments with variability in their invasiveness (including CPR) in both their current health state and hypothetical situations representing different levels of functional impairment. When surrogates have no knowledge about the wishes of formerly competent patients, clinicians may help them with medical decisions by discussing what other people commonly want in similar circumstances.
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Despite recent advances in technology, the mortality rate for patients suffering from adult respiratory distress syndrome remains in the range of 40-50%. This high mortality rate may be in part related to complications from ventilator management, such as ventilator-induced lung injury. In these patients, adjunct therapies aiming at ameliorating ventilator-induced lung injury are being developed. This article discusses the rationale for use of pharmacologic adjunct therapies, including inhaled nitric oxide, surfactant replacement therapy, antioxidants, prostaglandins, and corticosteroids, in patients with acute lung injury, and reviews the effectiveness of these agents in human clinical trials to date.
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Pharmacoepidemiol Drug Saf · Jan 2000
A retrospective study to determine if hydroxyurea augmentation of antiretroviral drug regimens that contain ddI and/or d4T increases the risk of developing peripheral neuropathy in HIV-1 infected individuals.
To determine if hydroxyurea augmentation of antiretroviral drug regimens that contain ddI and/or d4T increases the risk of developing peripheral neuropathy in HIV-1 infected individuals. In addition, to determine predictors of peripheral neuropathy occurrence in HIV-1 infected individuals who are on a ddI- and/or d4T-containing antiretroviral drug regimen. ⋯ These findings suggest that hydroxyurea augmentation of a ddI- and/or d4T-containing antiretroviral drug regimen may increase the risk of peripheral neuropathy occurrence in HIV-1 infected patients. Copyright (c) 2000 John Wiley & Sons, Ltd.