The cognitive impact of anticholinergics:a clinical review

Context: The cognitive side effects of medications with anticholinergic activity have been documented among older adults in a variety of clinical settings. However, there has been no systematic confirmation that acute or chronic prescribing of such medications lead to transient or permanent adverse cognitive outcomes. Objective: Evaluate the existing evidence regarding the effects of anticholinergic medications on cognition in older adults. Data sources: We searched the MEDLINE, OVID, and CINAHL databases from January, 1966 to January, 2008 for eligible studies. Study selection: Studies were included if the anticholinergic activity was systematically measured and correlated with standard measurements of cognitive performance. Studies were excluded if they reported case studies, case series, editorials, and review articles. Data extraction: We extracted the method used to determine anticholinergic activity of medications and its association with cognitive outcomes. Results: Twenty-seven studies met our inclusion criteria. Serum anticholinergic assay was the main method used to determine anticholinergic activity. All but two studies found an association between the anticholinergic activity of medications and either delirium, cognitive impairment or dementia. Conclusions: Medications with anticholinergic activity negatively affect the cognitive performance of older adults. Recognizing the anticholinergic activity of certain medications may represent a potential tool to improve cognition.

Follow-ups and interpreter-mediated discourse

The edited volume documents the proceedings of the ESF workshop "Follow-ups across discourse domains: a cross-cultural exploration of their forms and functions". It examines the forms and functions of the dialogue act of a follow-up, viz. accepting or challenging a prior communicative act, in political discourse across spoken and written dialogic genres. Specifically, it considers (1) the discourse domains of political interviews, editorials, op-eds and discussion forums, (2) their sequential organization as regards the status of initial (or 1st order) follow-up, a follow-up of a prior follow-up (2nd order follow-up), or nth-order follow-up, and (3) their discursive realization as regards degrees of indirectness and responsiveness which are conceptualized as a continuum along the lines of degrees of explicitness and degrees of responsiveness. The chapters come from the fields of linguistics, discourse analysis, socio-pragmatics, communication, political science and psychology, examining the heterogeneous field of political discourse and its manifestation in diverse discourse genres with respect to evasiveness, indirectness and redundancy in mediated political discourse, professional discourse, discourse identity and doing politics, to name but the most prominent questions.

Metformin in patients with type 2 diabetes and kidney disease:a systematic review

IMPORTANCE: Metformin is widely viewed as the best initial pharmacological option to lower glucose concentrations in patients with type 2 diabetes mellitus. However, the drug is contraindicated in many individuals with impaired kidney function because of concerns of lactic acidosis. OBJECTIVE: To assess the risk of lactic acidosis associated with metformin use in individuals with impaired kidney function. EVIDENCE ACQUISITION: In July 2014, we searched the MEDLINE and Cochrane databases for English-language articles pertaining tometformin, kidney disease, and lactic acidosis in humans between 1950 and June 2014.We excluded reviews, letters, editorials, case reports, small case series, and manuscripts that did not directly pertain to the topic area or that met other exclusion criteria. Of an original 818 articles, 65 were included in this review, including pharmacokinetic/metabolic studies, large case series, retrospective studies, meta-analyses, and a clinical trial. RESULTS: Although metformin is renally cleared, drug levels generally remain within the therapeutic range and lactate concentrations are not substantially increased when used in patients with mild to moderate chronic kidney disease (estimated glomerular filtration rates, 30-60 mL/min per 1.73m2). The overall incidence of lactic acidosis in metformin users varies across studies from approximately 3 per 100 000 person-years to 10 per 100 000 person-years and is generally indistinguishable from the background rate in the overall population with diabetes. Data suggesting an increased risk of lactic acidosis in metformin-treated patients with chronic kidney disease are limited, and no randomized controlled trials have been conducted to test the safety ofmetformin in patients with significantly impaired kidney function. Population-based studies demonstrate that metformin may be prescribed counter to prevailing guidelines suggesting a renal risk in up to 1 in 4 patients with type 2 diabetes mellitus-use which, in most reports, has not been associated with increased rates of lactic acidosis. Observational studies suggest a potential benefit from metformin on macrovascular outcomes, even in patients with prevalent renal contraindications for its use. CONCLUSIONS AND RELEVANCE: Available evidence supports cautious expansion of metformin use in patients with mild to moderate chronic kidney disease, as defined by estimated glomerular filtration rate, with appropriate dosage reductions and careful follow-up of kidney function.

Análise de conceito do diagnóstico de enfermagem autocontrole ineficaz da saúde em pacientes submetidos à hemodiálise

The concept analysis process carefully examines the description and uses of a word or term, enabling the standardization of language, in addition to providing representation to the profession, and facilitate the work of taxonomies. The aim of the study was to analyze the concept of nursing diagnosis ineffective self-health in patients undergoing hemodialysis. Study concept analysis, based on Walker and Avant model and operationalized through integrative literature review. The databases searched were: SCOPUS, CINAHL, PUBMED, LILACS and COCHRANE, with descriptors: Selfmanagement, Adherence and Hemodialysis. The inclusion criteria were: articles published in the last five years, complete articles are available free in selected databases; articles available in Portuguese, English or Spanish; and articles that address the self-concept of health, the antecedents and the consequent. And Exclusion: editorials, letters to the editor, theses and dissertations. The survey of the articles occurred in the months from January to March 2014. The initial sample of 16785 articles, with 11748 in PUBMED, 4767 in Scopus, 174 in CINAHL, the Cochrane 70 and 26 in LILACS. After applying the criteria, 76 articles were selected, 19 in CINAHL, 18 in PUBMED, 30 in Scopus, and 9 in LILACS. In analyzing the data, given that the concept was sought in the literature was self-health, was held interpretation to ineffective self-health diagnosis through the transposition in the denial of the attributes, antecedents and consequences identified. It is noteworthy that the terms identified in the literature as defining characteristics and related factors of the diagnosis under study were added to the survey, not even the transposition into opposite term is possible. The results show that the concept developed for the inefficient self-health diagnosis was: the patient's inability to control habits and achieve the negotiated with professionals therapeutic targets, resulting in health complications. 33 antecedents relating to social, psychological and therapeutic aspects and 16 consequential, involving physiological, social, psychological and therapeutic aspects were identified. Thus, it is concluded that the ineffective self-health concept is broad and involves individual patient factors and the therapeutic relationship between patient and professionals. It is believed that the study contributed to the improvement of diagnosis in renal clientele, besides being an important base for the growth of the scientific body of nursing, subsidizing the development of own technology area

Divulgação científica para empoderamento institucional: o discurso da revista Darcy e a midiatização da academia

Science has remained in hegemonic position among the various forms of knowledge that enable us perceive our surroundings. After a growing movement of introversion of the scientific field, which enabled the empowerment of the academy, it is growing today the discussion about the need to spread knowledge of this area to society. Our study aims to observe the discourse of institutional science communication, taking into account the historical conditions that made possible the emergence of science as legitimate observation of nature and of man and also the credibility granted to the media. Therefore, we have as our study object the editorials of the Darcy magazine, for scientific and cultural journalism of the University of Brasilia. We focused on observing the discourse of knowledge sharing by the media, using the concepts of field, from Bourdieu’s work, and Agamben’s "profanation" together with notions from the organizational communication area. Also, the concepts of dispositive, discourse and knowledge-power used are based on the studies from the French school which associate them to the need of thinking power as a relation between what is and what is not said, having Michel Foucault as an important exponent of this area. The research, which uses as a method the Discourse Analysis, shows us a process of mutual validation of the scientific and journalistic discourses, which contribute to the strengthening of the institution itself as well as the scientific field, in texts which have as a backdrop the institutional image and reputation.

Comparing sentence-level features for authorship analysis in Portuguese

In this paper we compare the robustness of several types of stylistic markers to help discriminate authorship at sentence level. We train a SVM-based classifier using each set of features separately and perform sentence-level authorship analysis over corpus of editorials published in a Portuguese quality newspaper. Results show that features based on POS information, punctuation and word / sentence length contribute to a more robust sentence-level authorship analysis. © Springer-Verlag Berlin Heidelberg 2010.

Queen's College Journal (1879-1880)

The Journal has been Queen's main student newspaper since it was founded in 1873. It appears twice a week on campus with a mix of news, sports, and entertainment stories, editorials, letters to the editor, and photographs. The paper is students' most important source of news and general information and has been a training ground for scores of Canadian journalists.

Queen's College Journal (1880-1881)

The Journal has been Queen's main student newspaper since it was founded in 1873. It appears twice a week on campus with a mix of news, sports, and entertainment stories, editorials, letters to the editor, and photographs. The paper is students' most important source of news and general information and has been a training ground for scores of Canadian journalists.

Queen's College Journal (1881-1882)

The Journal has been Queen's main student newspaper since it was founded in 1873. It appears twice a week on campus with a mix of news, sports, and entertainment stories, editorials, letters to the editor, and photographs. The paper is students' most important source of news and general information and has been a training ground for scores of Canadian journalists.

Queen's College Journal (1882-1883)

The Journal has been Queen's main student newspaper since it was founded in 1873. It appears twice a week on campus with a mix of news, sports, and entertainment stories, editorials, letters to the editor, and photographs. The paper is students' most important source of news and general information and has been a training ground for scores of Canadian journalists.

Queen's College Journal (1883-1884)

The Journal has been Queen's main student newspaper since it was founded in 1873. It appears twice a week on campus with a mix of news, sports, and entertainment stories, editorials, letters to the editor, and photographs. The paper is students' most important source of news and general information and has been a training ground for scores of Canadian journalists.

Queen's College Journal (1884-1885)

The Journal has been Queen's main student newspaper since it was founded in 1873. It appears twice a week on campus with a mix of news, sports, and entertainment stories, editorials, letters to the editor, and photographs. The paper is students' most important source of news and general information and has been a training ground for scores of Canadian journalists.

Queen's College Journal (1885-1886)

The Journal has been Queen's main student newspaper since it was founded in 1873. It appears twice a week on campus with a mix of news, sports, and entertainment stories, editorials, letters to the editor, and photographs. The paper is students' most important source of news and general information and has been a training ground for scores of Canadian journalists.