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Nursing psychotherapeutic interventions: a review of clinical studies
Get PDFAIMS AND OBJECTIVES:
To summarise current knowledge about nursing psychotherapeutic interventions in adults.
BACKGROUND:
In Portugal, the provision of psychotherapeutic interventions is considered a competence of mental health nurses. However, literature is not totally clear about the differences between 'psychotherapy' and 'psychotherapeutic interventions' and about the specific characteristics that define a nursing psychotherapeutic intervention.
DESIGN:
Narrative review.
METHODS:
A literature review utilising MEDLINE, PsycINFO, CINAHL, the Web of Science, Psychology and Behavioral Sciences Collection, and MedicLatina computerised databases for the period from 2003-2013. A total of 151 eligible articles were identified. Relevant data were extracted, and findings were synthetised in a narrative synthesis.
RESULTS:
Nursing psychotherapeutic interventions are frequently based on 'Cognitive-Behavioural' rationale. The usual length of these interventions varies between 5-16 weeks, in a total of 5-12 sessions of 45-60 minutes. The mechanisms of change are heterogeneous, but the therapeutic relationship between the nurse and the client seems to be the most important positive predictive factor of nursing psychotherapeutic interventions. Some of the most used outcome assessment measures include the Beck Depression Inventory, the Hospital Anxiety and Depression Scale, and the CORE-OM. The effectiveness of nursing psychotherapeutic interventions has been widely demonstrated in many studies. However, the need of further studies to prove its cost effectiveness is evident.
CONCLUSIONS:
It is necessary to have a better understanding of nursing psychotherapeutic interventions, one that explains its conceptual limits, to improve mental health nursing knowledge and create suitable models of psychotherapeutic intervention in nursing.
RELEVANCE TO CLINICAL PRACTICE:
The findings of this review can create awareness for some weaknesses of nursing knowledge about the psychotherapeutic intervention and for the need to produce knowledge, to nurture the nursing discipline in the area of psychotherapeutic intervention with even more theoretical and practical support
Late-onset of eruptive syringomas: a diagnostic challenge
Get PDFSyringoma is a benign, adnexal tumor of the eccrine sweat gland ducts. Eruptive syringomas are a rare variant, occurring before or during puberty in most cases. A 57-year-old man was observed in our department, with a 10-year history of multiple brownish papules (1-4mm in diameter), localized on the neck, shoulders, trunk and axillae. The clinical diagnosis was cutaneous mastocytosis. Histopathological examination from a papule in the trunk was compatible with the diagnosis of syringoma. The patient was treated with isotretinoin, without any improvement. The clinical diagnosis of eruptive syringoma is difficult and histological examination is crucial for its diagnosis. Long-term morbidity is not associated with syringomas; they are treated for cosmetic reasons with unsatisfactory results
Transanal total mesorectal excision: a pure NOTES approach for selected patients
Get PDFThe concept of natural orifice transluminal endoscopic surgery (NOTES) has stimulated the development of various "incisionless" procedures. One of the most popular is the transanal approach for rectal lesions. The aims of this study were to report how we standardized NOTES technique for transanal mesorectal excision without abdominal assistance, discuss the difficulties and surgical outcomes of this technique and report its feasibility in a small group of selected patients.
METHODS:
Three consecutive female patients underwent transanal NOTES rectal resection without transabdominal laparoscopic assistance for rectal lesions. Functional results were assessed with the Fecal Incontinence Quality of Life scale and the Wexner score.
RESULTS:
The technical steps are described in details and complemented with a video. All procedures were completed without transabdominal laparoscopic help. The mesorectal plane was entirely dissected without any disruption, and distal and circumferential margins were tumor-free. No major complications were observed. Functional results show a significant impairment after surgery with improvement at 6 months to levels near those of the preoperative period.
CONCLUSIONS:
The performance and publication of NOTES procedures are subject to much discussion. Despite the small number of patients, this procedure appears feasible and can be accomplished maintaining fecal continence and respecting oncologic principles.info:eu-repo/semantics/publishedVersio
Biventricular Takotsubo vs Myocarditis – a diagnostic challenge
No full textBackground: Takotsubo cardiomyopathy (TCM) is an important differential diagnosis of acute coronary syndrome and myocarditis. It is characterized by normal or near-normal coronary arteries and regional wall motion abnormalities that extend beyond a single coronary vascular bed. Variants of the classical left ventricular (LV) apical ballooning are increasing in recognition as cardiac magnetic resonance (CMR) is more extensively used.
Case report: We present a case of 69-year-old woman with a previous history of hypertension, diabetes and dyslipidaemia, transferred to our emergency department due to suspected acute coronary syndrome. She had a history of two episodes of an oppressive chest pain longer than 1 hour, orthopnoea and paroxysmal nocturnal dyspnoea 36 hours before. Two weeks before she had had a lower tract respiratory infection, that was not totally resolved. On admission, she only had dyspnoea. On examination, she had wheezing, arrhythmic pulse and hypertension. Breath sounds were absent in lower chest and rales were also noted. Electrocardiogram showed rapid atrial fibrillation, poor R wave progression in anteroseptal leads and inverted T waves in I, aVL and V2-V6 leads. Modest elevation in cardiac troponin (4.55 ng/mL) was observed. Chest x-ray showed bilateral pleural effusion. A transthoracic echocardiography (TTE) was immediately performed and revealed akinesis/dyskinesis of mid to apical segments (apical ballooning) of both ventricles, extended beyond a single epicardial coronary distribution, compatible with biventricular TCM. Cardiac catheterization showed absence of obstructive coronary disease. A CMR, performed two days later, showed moderate biventricular systolic dysfunction, hypokinesis in mid to apical segments of LV and hypokinesis in apical right ventricle. It also showed non-ischemic late gadolinium enhancement in antero-apical and lateral apical segments. After several days of medical management, the patient was discharged from the hospital in stable condition. TTE performed 6-month after evidenced complete biventricular function recovery and no segmental contractility changes. CMR supported the functional recovery and the resolution of contractility abnormalities, but noticed the intramyocardial late gadolinium enhancement in the segments previously reported.
Conclusion: There are fewer reports of this unusual presentation of TCM, described by ETT. This case represents a good example of the diagnostic challenge between myocarditis and takotsubo cardiomyopathy. Taking in account the exuberance of the case, the mild elevation of troponin, the full recovery of biventricular function and resolution of contractility abnormalities, it seems more probably to be a TCM, in a patient who, probably had a previous scar of myocarditis. Although, the hypothesis of acute myocarditis as the primary diagnosis cannot be excluded
Temporal trends of risk profile among patients admitted with acute coronary syndrome
Get PDFBackground: Clinical practice focuses on the primary prevention of cardiovascular (CVD) disease through the modification and pharmacological treatment of elevated risk factors, in order to minimize long-term CVD risk.
Aim: To determine if there are differences in risk profile of patients admitted with acute coronary syndrome over time.
Methods: We analysed 4871 patients admitted consecutively in our coronary care unit with a diagnosis of ACS and included in a prospective registry, from January 2002 to October 2013. Patients were divided in 3 groups of 4 consecutive years: group 1 – from 2002 to 2005 (n=1245, 25.6%); group 2 – from 2006 to 2009 (n=1562, 32%); group 3 - from 2010 to 2013 (n=2064, 42.4%). For each group we studied the prevalence of conventional risk factors (CRF) including diabetes, hypertension, smoking and dyslipidaemia over time and compared findings according to sex and type of acute coronary syndrome:
Results: Women were less prevalent in group 3 (26.2% vs 26.9% vs 22.6%, p=0.006). Temporal trends of age and diabetes didn’t show statistic signify. Group 2 and 3 evidenced higher body mass index (26.48±4.0 vs 27.13±5.8 vs 27.15±4.67 kg/m2; p<0.001), had higher prevalence of dyslipidaemia (43.1% vs 49.2% vs 56.3%; p<0.001), smoking (39.4% vs 65.0% vs 64.4%; p<0.001) and hypertension (55.7% vs 65.0% vs 64.4%; p<0.001). We found at least 1 CRF in 92,4% of patients. The first temporal period had higher prevalence of 1 or 2 CRF, on the contrary two thirds of patients in group 3 had 2 or 3 CRF.
Over time, hypertension was more prevalent in women (69.3% vs 77,4% vs 78.6%; p=0,007), on the other hand, smoking and dyslipidaemia occurred more often in men. It was observed an increasing tendency of smoking (44% vs 41.6% vs 54%; p100 mg/dl more often (66% vs 57% vs 68.8%; p=0.022), but higher control of systolic blood pressure below 140mmHg (54.2% vs 59.6% vs 65.7%, p<0.001.
Conclusion: We found that the risk profile of patients presenting with acute coronary syndrome worsened over the years. In recent time, patients had more CRF, being smoking and hypertension the leaders
Diabetes and hyperglycemia: relation with clinical outcome in the community acquired pneumonia
Get PDFBackground: Community acquired pneumonia (CAP) is a common condition and a major cause of morbidity.
Diabetes mellitus (DM) increases the risk and complications of infectious diseases. However, the
role of DM and glycemia at the time of presentation as prognostic factors in patients with CAP remains
to be clarified.
Aims: To evaluate the relationship between DM/glycemia at the time of presentation and complications,
length of stay and mortality in patients with CAP, and the relationship between glycemic control and
complications in patients with diabetes.Methods: Observational, analytical and retrospective study of adults admitted to our hospital between
October/2011 and March/2012, with CAP. Electronic clinical data were analyzed and telephone calls were
done to assess mortality at 30 and 90 days. The chi-square test, Mann-Whitney and Kruskal-Wallis tests,
and logistic regression were used.
Results: Of the 440 included patients, 51.1% were women, 83.1% elderly and 29.3% had diagnosis of DM. Of
these, 48.8% had HbA1c measured (median 6.8%, IQR: 6.3-7.8%). The median glucose was 134 mg/dL (IQR:
111-176 mg/dL). Patients with DM were older (p = 0.002), had higher severity of pneumonia (p = 0.025),
more complications (p = 0.001) and longer hospital stay (p = 0.001). DM proved to be a predictor of complications
(p = 0.008). No association between DM and mortality was found, nor between HbA1c levels
and complications, length of stay and mortality. Higher glucose levels at admission were associated with
longer hospital stay (p = 0.016) and patients with hyperglycemia on admission had more complications
(no statistically significant). However, no association between glucose levels on admission and mortality
was found.
Conclusion: DM and hyperglycemia on admission are associated with adverse outcome in CAP. Both are
associated with longer hospital stay and DM predicts complications from CAP
Observational study in Takotsubo cardiomyopathy
Get PDFINTRODUCTION: Takotsubo cardiomyopathy (TC) is a still rarely diagnosed clinical syndrome,
which is characterized by transient cardiac dysfunction with reversible wall motion
abnormalities.
AIM: Determine the demographic characteristics, clinical presentation and prognosis of
patients with TC.
METHODS: Retrospective study of 39 patients admitted for TC in a cardiology center during a
period of 3 years.
RESULTS: In the population studied, the mean age was 67.15±12.01 years and women were
predominant.The most frequent comorbidities were hypertension (76.9%), dyslipidemia
(51.3%), psychiatric illness (23.1%) and diabetes mellitus (12.8%). The emotional stress was the
most common triggering event (n=10), however, in 17 patients we were not able to identify
any precipitating factor. Cardinal symptoms which led to admission, were acute chest pain
(n=28) and dyspnoea (n=15).
The most common ECG findings were ST segment elevation (n=21), inversion of the T wave
(n=21) and QTc prolongation (n=22).
All patients had typical wall motion abnormalities in the echocardiography and/or
ventriculography. The mean ejection fraction was 35.59±5.54%.
The most common in-hospital complication was acute heart failure (n=16, 41%), whereas 3
patients developed cardiogenic shock. The presence of moderate to severe LVS dysfunction
(p=0.048) and higher levels of C reactive protein (p=0.02) and pBNP (p=0.042) were associated
with the development of acute heart failure. Rhythm disturbances occurred in 3 patients and
there was only one non-cardiovascular death.
At follow-up at 6 months all patients showed recovery of LVS function; there was one
recurrence and 3 deaths from non-cardiovascular causes.
CONCLUSION: According to the literature, our review shows higher prevalence of TC in women
and a clinical and electrocardiographic presentation similar to the picture of an acute coronary
syndrome. In the acute phase, the TC is not necessarily a benign entity, because we observed a
high prevalence of acute heart failure
Impacto do tipo de fibrilhac¸ão auricular no contexto das síndromes coronárias agudas: características clínicas e prognóstico
Get PDFINTRODUCTION:
Atrial fibrillation (AF) is widely recognized as an adverse prognostic factor during acute myocardial infarction, although the impact of AF type - new-onset (nAF) or pre-existing (pAF) - is still controversial.
OBJECTIVES:
To identify the clinical differences and prognosis of nAF and pAF during acute coronary syndromes (ACS).
METHODS:
We performed a retrospective observational cohort study including 1373 consecutive patients (mean age 64 years, 77.3% male) admitted to a single center over a three-year period, with a six-month follow-up.
RESULTS:
AF rhythm was identified in 14.5% patients, of whom 71.4% presented nAF and 28.6% pAF. When AF types were compared, patients with nAF more frequently presented with ST-elevation ACS (p=0.003). Patients with pAF, in turn, were older (p=0.032), had greater left atrial diameter (p=0.001) and were less likely to have significant coronary lesions (p=0.034). Regarding therapeutic strategy, nAF patients were more often treated by rhythm control during hospital stay (p<0.001) and were less often anticoagulated at discharge (p=0.001). Compared with the population without AF, nAF was a predictor of death during hospital stay in univariate (p<0.001) and multivariate analysis (OR 2.67, p=0.047), but pAF was not. During follow-up, pAF was associated with higher mortality (p=0.014), while nAF patients presented only a trend towards worse prognosis.
CONCLUSIONS:
AF during the acute phase of ACS appears to have a negative prognostic impact only in patients with nAF and not in those with pAF