RESUMEN
BACKGROUND: Inhaled ß-agonists are the cornerstone of acute treatment for asthma and chronic lung disease. Upon emergency department (ED) discharge, patients optimally receive prescriptions for metered-dose inhalers (MDIs) with instructions on their proper use. Yet prior studies suggest that ED personnel have limited knowledge of proper MDI techniques. It is unclear how effectively brief education will improve this knowledge to enable them to provide adequate patient instructions. OBJECTIVE: Our aim was to evaluate ED medical personnel's baseline knowledge of MDI use and the utility of brief education on their ability to use MDIs. METHODS: After providing written consent, a spirometry nurse evaluated emergency physicians and nurses on their ability to properly perform three (open-mouth/two-finger, spacer, and closed-mouth) MDI techniques. The same spirometry nurse then gave a short educational session demonstrating the proper MDI techniques. Two weeks later, the nurse re-evaluated the same personnel on their MDI techniques. RESULTS: All emergency medical personnel initially performed poorly in demonstrating proper MDI technique, averaging 29.8% steps done correctly. Two weeks after their educational session, they improved greatly, averaging 89.4% steps done correctly. CONCLUSIONS: This study demonstrated both that ED personnel had poor initial knowledge about MDI techniques and that a brief educational intervention improved most people's ability to use, and presumably to instruct patients/parents in proper use of, MDIs.
Asunto(s)
Asma , Inhaladores de Dosis Medida , Administración por Inhalación , Asma/tratamiento farmacológico , Servicio de Urgencia en Hospital , Humanos , Nebulizadores y VaporizadoresRESUMEN
A escola de psicanálise: o lugar para a verdade da experiência da transmissão. Toda a dificuldade deste tipo de experiência reside na irredutível singularidade do ato que se opõe necessariamente à verdade geral, universal. Dizemos que a transmissão não pode ser entendida na escola de psicanálise senão ao modo de uma verdade no um a um. Isto é, se a dimensão do real se opõe à toda veleidade de universalização. Aliás, a noção mesma de escola em psicanálise coloca uma questão delicada. Com efeito, considerar uma escola seria ter resolvido antecipadamente um a priori de elementos constitutivos de uma transmissão que asseguraria a realização desta transmissão de modo universal para todos. Ora, a dimensão de perda e de incerteza daquilo que se transmite no um a um não permite postular a noção de escola senão no só-depois daquilo que se pôde ou não fazer transmissão para um sujeito dado. Pretendemos neste texto tentar articular essas dimensões de modo a interrogar os termos de escola e de transmissão face a um verdade que não pode ser postulada como toda.
La escuela de psicoanálisis: el lugar para la verdad de la experiencia de transmisión. Toda la dificultad de este tipo de experiencia reside en la irreductible singularidad del acto que se opone necesariamente a la verdad general, universal. Decimos que la transmisión no puede ser entendida en la escuela de psicoanálisis sino como una verdad en el uno a uno. O sea, si la dimensión de lo real se opone a toda veleidad de universalización. Es más, la noción misma de escuela de psicoanálisis plantea una cuestión delicada. En efecto, considerar una escuela significaría haber resuelto anticipadamente un a priori de elementos constitutivos de una transmisión que aseguraría la realización de dicha transmisión de manera universal para todos. Pues bien, la dimensión de pérdida y de incertidumbre de aquello que se transmite en el uno a uno no permite postular la noción de escuela sino en el sólo-después de aquello que se pudo o no convertir en transmisión para un sujeto dado. En este texto intentaremos articular esas dimensiones para interrogar los términos escuela y transmisión en relación a una verdad que no puede ser postulada como toda.
The school of psychoanalysis: the place for the truth of the experience of transmission. All the difficulty of this kind of experience lies in the irreducible uniqueness of the act which necessarily opposes the general, universal truth. We say that the transmission cannot be understood in the school of psychoanalysis other than in the mode of a truth one by one. That is, if the dimension of the real opposes all fancy of universalization. In fact, the very notion of school in psychoanalysis poses a delicate question. Indeed, to consider a school would be to have resolved in advance an a priori of the constituent elements of a transmission which would ensure that this transmission was universally achieved for all. Now, the dimension of loss and uncertainty of what is transmitted in one by one does not allow us to postulate the notion of school other than only-after of what could or could not be transmitted to a given subject. We intend in this text to try to articulate these dimensions in order to question the terms of school and transmission facing a truth that cannot be postulated as a whole.
Asunto(s)
Psicoanálisis/educación , Teoría Psicoanalítica , ConocimientoRESUMEN
INTRODUCTION AND AIM: Hepatocellular carcinoma (HCC) is the most common type of liver cancer in adults and has seen a rapid increase in incidence in the United States. Racial and ethnic differences in HCC incidence have been observed, with Latinos showing the greatest increase over the past four decades, highlighting a concerning health disparity. The goal of the present study was to compare the clinical features at the time of diagnosis of HCC in Latino and Caucasian patients. MATERIAL AND METHODS: We retrospectively screened a total of 556 charts of Latino and Caucasian patients with HCC. RESULTS: The mean age of HCC diagnosis was not significantly different between Latinos and Caucasians, but Latinos presented with higher body mass index (BMI). Rates of hypertension, diabetes, and hyperlipidemia were similar in the two groups. The most common etiology of liver disease was alcohol drinking in Latinos, and chronic hepatitis C in Caucasian patients. Non-Alcoholic Steatohepatitis (NASH) was the associated diagnosis in 8.6% of Latinos and 4.7% of Caucasians. Interestingly, alpha-fetoprotein (AFP) levels at time of diagnosis were higher in Latino patients compared to Caucasians, but this difference was evident only in male patients. Multifocal HCC was slightly more frequent in Latinos, but the two groups had similar cancerous vascular invasion. Latino patients also presented with higher rates of both ascites and hepatic encephalopathy. CONCLUSION: Latino and Caucasian patients with HCC present with a different profile of etiologies, but cancer features appear to be more severe in Latinos.
Asunto(s)
Carcinoma Hepatocelular/etnología , Hispánicos o Latinos , Cirrosis Hepática/complicaciones , Neoplasias Hepáticas/etnología , Estadificación de Neoplasias , Medición de Riesgo/métodos , Población Blanca , California/epidemiología , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/etiología , Femenino , Humanos , Incidencia , Cirrosis Hepática/diagnóstico , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/etiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia/tendenciasRESUMEN
BACKGROUND: Bioprosthetic heart valves (BHVs), fabricated from glutaraldehyde-pretreated bovine pericardium or porcine aortic valves, are widely used for the surgical or interventional treatment of heart valve disease. Reoperation becomes increasingly necessary over time because of BHV dysfunction. METHODS AND RESULTS: Forty-seven explanted BHV aortic valve replacements were retrieved at reoperation for clinically severe BHV dysfunction over the period 2010-2016. Clinical explant analyses of BHV leaflets for calcium (atomic absorption spectroscopy) and oxidized amino acids, per mass spectroscopy, were primary end points. Comorbidities for earlier BHV explant included diabetes mellitus and coronary artery bypass grafting. Mean calcium levels in BHV leaflets were significantly increased compared with unimplanted BHV (P<0.001); however, time to reoperation did not differ comparing calcified and noncalcified BHV. BHV dityrosine, an oxidized amino acid cross-link, was significantly increased in the explants (227.55±33.27 µmol/mol [dityrosine/tyrosine]) but was undetectable in unimplanted leaflets (P<0.001). BHV regional analyses revealed that dityrosine, ranging from 57.5 to 227.8 µmol/mol (dityrosine/tyrosine), was detectable only in the midleaflet samples, indicating the site-specific nature of dityrosine formation. 3-Chlorotyrosine, an oxidized amino acid formed by myeloperoxidase-catalyzed chlorinating oxidants, correlated with BHV calcium content in leaflet explant analyses from coronary artery bypass graft patients (r=0.62, P=0.01) but was not significantly correlated with calcification in non-coronary artery bypass graft explanted BHV. CONCLUSIONS: Both increased BHV leaflet calcium levels and elevated oxidized amino acids were associated with bioprosthesis dysfunction necessitating reoperation; however, BHV calcium levels were not a determinant of implant duration, indicating a potentially important role for oxidized amino acid formation in BHV dysfunction.
Asunto(s)
Insuficiencia de la Válvula Aórtica/etiología , Estenosis de la Válvula Aórtica/etiología , Válvula Aórtica/patología , Bioprótesis , Calcinosis/etiología , Calcio/metabolismo , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Prótesis Valvulares Cardíacas , Válvulas Cardíacas/cirugía , Estrés Oxidativo , Falla de Prótesis , Adulto , Anciano , Anciano de 80 o más Años , Válvula Aórtica/metabolismo , Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/metabolismo , Insuficiencia de la Válvula Aórtica/patología , Insuficiencia de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/metabolismo , Estenosis de la Válvula Aórtica/patología , Estenosis de la Válvula Aórtica/cirugía , Calcinosis/metabolismo , Calcinosis/patología , Calcinosis/cirugía , Comorbilidad , Depsipéptidos/metabolismo , Remoción de Dispositivos , Progresión de la Enfermedad , Femenino , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Válvulas Cardíacas/metabolismo , Válvulas Cardíacas/patología , Humanos , Masculino , Espectrometría de Masas , Persona de Mediana Edad , Diseño de Prótesis , Sistema de Registros , Factores de Riesgo , Espectrofotometría Atómica , Factores de Tiempo , Resultado del Tratamiento , Tirosina/análogos & derivados , Tirosina/metabolismo , Adulto JovenRESUMEN
O presente texto trata da construção do sujeito do inconsciente na instituição familiar. O autor dialoga com o texto de Lacan, Os complexos familiares, em seus respectivos desdobramentos na constituição da imagem especular, bem como na implicação do outro (irmão) no aparecimento do ciúme e sua repercussão no laço social
RESUMEN
O presente artigo trabalha o estatuto do corpo, em psicanálise, mais especificamente a sua constituição na infância e o seu desdobramento na adolescência. O autor sustenta a hipótese de que há a necessidade da constituição da fantasia para o surgimento do sujeito. Atribui, também, ao rompimento da fantasia o fator desencadeante de mal-estar
RESUMEN
Desde o nascimento, o objeto está ligado à angústia. Ainda que haja dessimetria em relação à relação com o objeto, é, no entanto, a angústia que liga antes de mais nada a mãe e a criança. Do ponto de vista da criança, presa em seu narcisismo, o exterior é impensável. Do ponto de vista da mãe, a criança só é pensável na medida em que ocupa o lugar de algo além de si mesmo. Em conseqüência, a criança encontra-se logo de início perdida como objeto da perda de sua mãe. A angústia cria o objeto, e poderíamos quase dizer que não há outro objeto além daquele que toma consistência pelo fato de tornar a angústia menos forte. É preciso, portanto, perceber um certo tipo de ilusão para que a criança apreenda o mundo e um certo tipo de desilusão para que a criança tome consistência real para sua mãe(AU)
The object is linked to anxiety as soon as birth. Though there is a dissymmetry towards the relationship to the object, meanwhile anxiety links mother and child. From the childs point of view, taken into his narcissism, outside cannot be thought. From the mothers point of view, the child can only be thought as somebody taking the place of something else than himself. Consequently, the child is therefore lost as an object of the loss of his mother. Anxiety creates the object, and we could nearly say that there is no other object than the one taking consistence while lowering anxiety. There is a necessity to envisage a certain type of illusion so that the child be able to perceive the world and a certain type of disillusionment so that the child takes a real consistence for his mother(AU)
Asunto(s)
Humanos , Estrés Psicológico/psicología , Apego a Objetos , Ilusiones/psicología , Castración/psicologíaRESUMEN
Desde o nascimento, o objeto está ligado à angústia. Ainda que haja dessimetria em relação à relação com o objeto, é, no entanto, a angústia que liga antes de mais nada a mãe e a criança. Do ponto de vista da criança, presa em seu narcisismo, o exterior é impensável. Do ponto de vista da mãe, a criança só é pensável na medida em que ocupa o lugar de algo além de si mesmo. Em conseqüência, a criança encontra-se logo de início perdida como objeto da perda de sua mãe. A angústia cria o objeto, e poderíamos quase dizer que não há outro objeto além daquele que toma consistência pelo fato de tornar a angústia menos forte. É preciso, portanto, perceber um certo tipo de ilusão para que a criança apreenda o mundo e um certo tipo de desilusão para que a criança tome consistência real para sua mãe.
The object is linked to anxiety as soon as birth. Though there is a dissymmetry towards the relationship to the object, meanwhile anxiety links mother and child. From the childs point of view, taken into his narcissism, outside cannot be thought. From the mothers point of view, the child can only be thought as somebody taking the place of something else than himself. Consequently, the child is therefore lost as an object of the loss of his mother. Anxiety creates the object, and we could nearly say that there is no other object than the one taking consistence while lowering anxiety. There is a necessity to envisage a certain type of illusion so that the child be able to perceive the world and a certain type of disillusionment so that the child takes a real consistence for his mother.