Asunto(s)
Trasplante de Médula Ósea/efectos adversos , Neoplasias Hematológicas/complicaciones , Síndrome Metabólico/etiología , Adulto , Enfermedades Cardiovasculares/etiología , Femenino , Neoplasias Hematológicas/terapia , Humanos , Estudios Longitudinales , Síndrome Metabólico/complicaciones , Síndrome Metabólico/diagnóstico , SobrevivientesRESUMEN
OBJECTIVE: To determine the impact of OBRA 87 on antipsychotic prescribing in a 485-bed nursing home. DESIGN: Twelve-month retrospective cohort review of medical charts, medication administration records, and computerized pharmacy records. MEASUREMENTS: The percent of residents by diagnostic group and antipsychotic use. MAIN RESULTS: An attempt was made to stop or lower the dose of antipsychotic in 75% of the 107 residents studied. Antipsychotics were stopped in 45% of residents with a dementia-only diagnosis and 25% of residents with a psychiatric diagnosis (P < 0.05). Residents with documented symptoms appropriate for the use of antipsychotic, per OBRA 87, were significantly less likely to have their antipsychotic stopped. Twenty percent of residents whose antipsychotic was either stopped or its dose lowered had the agent restarted or its dose increased. CONCLUSION: OBRA 87 had a significant impact on antipsychotic use in this facility.
Asunto(s)
Antipsicóticos/uso terapéutico , Demencia/tratamiento farmacológico , Regulación Gubernamental , Instituciones de Cuidados Intermedios/normas , Trastornos Mentales/tratamiento farmacológico , Enfermos Mentales , Anciano , Anciano de 80 o más Años , Chicago , Estudios de Cohortes , Demencia/epidemiología , Demencia/fisiopatología , Grupos Diagnósticos Relacionados , Utilización de Medicamentos/tendencias , Gobierno Federal , Femenino , Guías como Asunto , Humanos , Instituciones de Cuidados Intermedios/legislación & jurisprudencia , Masculino , Trastornos Mentales/epidemiología , Trastornos Mentales/fisiopatología , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Selección de Paciente , Estudios Retrospectivos , Estados UnidosRESUMEN
Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder in which renal tubules become enormously enlarged due to fluid accumulation. Na(+) -K(+) -ATPase was compared in normal and cystic regions of whole kidneys and in confluent primary cultures of microdissected renal tubule and cyst-lining epithelia. Immunostaining with antibodies directed against the Na(+) -K(+) -ATPase catalytic alpha-subunit was confined to apical, luminal plasma membranes of ADPKD epithelia, which was a complete reversal of the normal renal tubule polarized location in basolateral membranes. Mislocated Na(+) -K(+) -ATPase was shown to be functionally active, because identical intense apical staining was observed by use of a cytochemical assay. In addition, biochemical assays showed a significant increase in these ouabain-inhibitable Na(+) -K(+) -ATPase specific activity levels in ADPKD kidneys compared with age-matched normal kidneys. Specific binding of [3H] ouabain was not only increased but also confined to the apical membrane vesicles prepared from cystic regions of ADPKD kidneys compared with normal age-matched controls, in which binding was confined to basolateral membrane vesicles. Although steady-state levels of Na(+) -K(+) -ATPase alpha- and beta-subunit in mRNAs were increased somewhat in ADPKD kidneys, this alone was not sufficient to account for the observed activation. Confluent ADPKD epithelia grown on dual-chamber, permeable membrane supports also showed reversed polarity of 22NaCl vectorial transport, because this was from basal to apical media compartments. Because this transport could also be blocked by ouabain, this suggested apical Na(+) -K(+) -ATPase was responsible and implicated altered polarity of Na(+) -K(+) -ATPase and resultant Na+ secretion as a mechanism for cyst formation in ADPKD. Because no reversal of polarity of other basolateral or apical membrane proteins was detected, an intracellular sorting defect specific for Na(+) -K(+) -ATPase is proposed.