ΠΦΥ -Εκπαίδευση > Αποσπάσματα από τον έντυπο & ηλεκτρονικό τύπο
Clinical Reviews.
Argirios Argiriou:
Summary points:
Stopping smoking before the age of 40 is crucial to improve health—beyond 40, people lose three months of life expectancy for every further year smoking.
The most important factor leading to failure of attempts to stop is nicotine dependence.
Nicotine dependence is most effectively treated with a combination of drugs and specialist behavioural support, such as provided by the NHS Stop Smoking Service.
Varenicline, bupropion, nortriptyline, and nicotine replacement are all effective.
Relapse during or after treatment is common, and treatment is usually needed several times.
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Prescribing smoking cessation drugs:
Bupropion (Zyban)
Start bupropion while smoking and quit smoking in the second week. Use 150 mg per day for six days, then 150 mg twice a day for eight weeks. Take the evening dose early to avoid wakefulness. Causes 1 in 1000 to have a seizure, which needs discussion with patient.
Nortriptyline (Nortrilen)
Start nortriptyline while smoking, increasing the dose from 25 mg to 75 mg. Quit while taking the maximum dose and continue for 8-12 weeks, tapering down at the end. Reassure patients that side effects abate in time and fewer than 1 in 10 patients stop because of side effects.
Varenicline (Champix)
Start varenicline while smoking. Comes in a starter pack escalating the dose from 0.5 mg daily to 1 mg twice a day by the second week. Quit in the second week. Continue for 12 weeks. Most people experience mild to moderate nausea, which can be reduced by taking varenicline after food and with water. Take the evening dose early to avoid wakefulness. Side effects abate with time and fewer than 1 in 10 patients stop the drug.
Nicotine replacement patches (Nicorette, Niquitin, Nicopas, Nicotinel)
Put the patch on smooth, hairless skin. Avoid using the same site for all patches. Put the 24 hour patches on the night of the last cigarette. If it slides off, tape it on with micropore. Skin reactions are common: check site rotation, use an emollient or hydrocortisone cream, consider changing the make of patch or switching to another form of nicotine replacement.
Δεν είναι ορατοί οι σύνδεσμοι (links).
Εγγραφή ή Είσοδος
Argirios Argiriou:
Summary points:
Schizophrenia usually starts in late adolescence or early adulthood.
Genetic risk and environmental factors interact to cause the disorder.
The most common symptoms are lack of insight, auditory hallucinations, and delusions.
Clinicians should suspect the disorder in a young adult presenting with unusual symptoms and altered behaviour.
Treatments can alleviate symptoms, reduce distress, and improve functioning.
Delayed treatment worsens the prognosis.
Suggested screening questions for patient presenting with possible psychosis:
Do you hear voices when no one is around? What do they say?
Do you ever think that people are talking or gossiping about you, maybe even thinking about trying to get you?
Do you ever think that somehow people can pick up on what you are thinking or can manipulate what you are thinking?
Δεν είναι ορατοί οι σύνδεσμοι (links).
Εγγραφή ή Είσοδος
Argirios Argiriou:
Summary points:
• Appropriate use of prophylaxis against deep vein thrombosis (DVT) in hospital inpatients is important for reducing the risk of fatal and non-fatal pulmonary embolism and post-thrombotic complications.
• For patients at low risk of DVT, ambulation is important, and mechanical methods of prophylaxis (such as graduated compression stockings and intermittent pneumatic compression devices) can provide added protection.
• Patients at higher risk of DVT should be considered for guideline based anticoagulation with low molecular weight heparin, unfractionated heparin, or vitamin K antagonists unless clearly contraindicated.
• Fondaparinux may provide additional prophylactic options.
• The place of aspirin in DVT prophylaxis remains controversial.
• To ensure adequate prophylaxis against DVT, doctors should be encouraged to follow appropriate guidelines.
Δεν είναι ορατοί οι σύνδεσμοι (links).
Εγγραφή ή Είσοδος
Argirios Argiriou:
Summary points:
Benign positional vertigo is one of the commonest causes of dizziness.
It is characterised by short attacks of rotational vertigo that are precipiated by head move-ments such as looking up, lying down, or turning over in bed.
The diagnosis is confirmed by Hallpike positional testing which shows a characteristic torsional nystagmus when the head is reclined and turned to the affected side.
Benign positional vertigo is probably caused by otoconial debris that is trapped in the posterior semicircular canal and starts to move when head position is changed quickly with respect to gravity. The concurrent flow of endolymph stimulates the hair cells of the affected canal, causing vertigo.
The condition can be treated successfully in most patients by a simple manoeuvre of the head that clears the canal from debris.
Repeated manoeuvres and self guided positional exercises will increase the success rate in those whose condition does not improve after one treatment session.
Δεν είναι ορατοί οι σύνδεσμοι (links).
Εγγραφή ή Είσοδος
and three videos with Dix-Hallpike and Epley Maneuvers, from youtube:
Δεν είναι ορατοί οι σύνδεσμοι (links).
Εγγραφή ή Είσοδος
Δεν είναι ορατοί οι σύνδεσμοι (links).
Εγγραφή ή Είσοδος (εδώ προτείνουν μετά τον χειρισμό του Epley να έχειι ο ασθενής τον αυχένα του ίσιο για 48 ώρες και για αυτό συνιστούν μάλιστα στην χρονική αυτή περίοδο να βάζουμε στον ασθενή αυχενικό κολλάρο).
(εδώ προτείνουν να εκτελέσει κανείς τον χειρισμό Epley τρεις συναπτές φορές)
feature=endscreen&NR=1 (με μοντέλο που δείχνει πώς μετακινούνται οι ωτόλιθοι κατά τον χειρισμό Epley).
Ear Model:
feature=channel
Bony Labyrinth Model - Semicircular Canals:
Δείτε και γραπτές οδηγίες στα Αγγλικά και στα Ελληνικά εδώ: Δεν είναι ορατοί οι σύνδεσμοι (links).
Εγγραφή ή Είσοδος και εδώ Δεν είναι ορατοί οι σύνδεσμοι (links).
Εγγραφή ή Είσοδος αντίστοιχα.
Και μία χρήσιμη συμβουλή φίλου μου ΩΡΛ στον τοίχο του στο facebook:
Ασθενής που αποστέλλεται από τον Παθολόγο του στον ΩΡΛ για έλεγχο ζάλης-ιλίγγου, πρέπει να έχει σταματήσει το όποιο φάρμακο για τον ίλιγγο παίρνει 3-4 ημέρες πριν, προκειμένου να αποφευχθούν τα όποια ψευδώς "αρνητικά" αποτελέσματα
Καλή σας ημέρα!!
Argirios Argiriou:
Summary points:
• Parkinson's disease should be suspected in someone with tremor, stiffness, slowness, balance problems, or gait disorders.
• All patients with suspected Parkinson's disease should be referred untreated to a specialist in differential diagnosis and be reviewed regularly by the specialist for accurate diagnosis and treatment.
• Much debate surrounds which drug class should be used as initial treatment for Parkinson's disease and which adjuvant therapy should be added when patients taking levodopa develop motor
complications.
• Patients should have access to a Parkinson's disease nurse specialist and allied health professionals throughout the course of the disease.
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