Pro re nata medication for psychoses: the knowledge and beliefs of doctors and nurses

Objective: To examine the knowledge and beliefs of doctors and nurses in inpatient psychiatric units about pro re nata (PRN) (as needed) medications for psychotic disorders. Methods: Medical (n = 44) and nursing (n = 80) staff in two metropolitan public hospital units completed a structured questionnaire about their use of PRN psychotropic medications on one occasion during the four months from March-June 1999. Results: Nurses selected more indications for PRN antipsychotics than doctors (3.49 vs 2.72, p < 0.05), whereas doctors selected more indications for PRN benzodiazepines (3.77 vs 3.19, p < 0.05). The groups did not differ in the number of selected indications for using anticholinergics. For agitation, the majority of nurses viewed both benzodiazepines (56%) and antipsychotics (86%) as effective, with 60% preferring an antipsychotic. For the acute control of psychotic symptoms, 99% of nurses believed antipsychotics were effective and 58% benzodiazepines, with 87% preferring an antipsychotic. A large majority of doctors viewed both PRN benzodiazepines, 94% ,and antipsychotics, 81%, as effective for agitation, and 55% preferred to use a benzodiazepine. For psychotic symptoms, 80% believed PRN antipsychotics were effective, but only 32% viewed benzodiazepines as effective, and 64% preferred to use an antipsychotic. Nursing staff identified more non-pharmacological techniques for managing both agitation and psychotic symptoms and reported using these more often than doctors. Junior staff, both nursing and medical, had less knowledge of non-pharmacological alternatives to PRN medication than senior staff. Conclusions: Disparities existed between doctors and nurses views on the indications for PRN medication in the acute management of psychoses, thus it is important for doctors to specify indications when writing PRN prescriptions. Despite evidence for the safety and effectiveness of benzodiazepines, there was widespread reluctance to use them as PRN medication in acute psychoses. Beliefs of some staff about PRN medications were at odds with the known properties of these medicines. Educational interventions for both nurses and doctors are required to achieve best practice in PRN medication.

Pro re nata medication for psychoses: an audit of practice in two metropolitan hospitals

Objective: To examine the use of pro re nata (PRN) (as needed) medication in hospitalized patients with psychotic disorders. Methods: Retrospective chart reviews were conducted at two large public psychiatry units situated in inner city general hospitals. Pro re nata medication prescription, administration and outcomes were examined during inpatient episodes of care for 184 consecutive admissions of patients diagnosed with a psychotic disorder. Patient demographics, diagnoses, and regularly prescribed medication were also recorded. All admissions were drawn from a three-month period from December 1998-February 1999. Results: The most prevalent diagnoses were schizophrenia related disorders (n = 111) and mania (n = 34). Substance use disorders (n = 49) were the most common comorbid dis-orders. Pro re nata medication was administered during the acute phase of 82% of admissions. Drugs prescribed Pro re nata were mostly typical antipsychotics, benzodiazepines and/or anti-cholinergics. Coprescription of typical antipsychotics PRN with regularly scheduled atypical antipsychotics was common (64%). Pro re nata medications accounted for 31% of the total antipsychotic dose and 28% of the total anxiolytic dose administered during acute treatment. Higher daily doses of PRN medication were given to manic patients, males, younger patients and those with substance use disorders. Pro re nata prescriptions usually specified a maximum daily dose (87%) but rarely gave indications for use (6%). Adminis-tration records frequently lacked a specified reason for use (48%) or a notation of outcome (64%). Unit staff noted medication-related morbidity in 37% of patients receiving PRN medication, compared to 3% of patients receiving only regularly scheduled medication. Extrapyramidal symptoms (EPS) were most frequently associated with administration of PRN haloperidol (Relative Risk vs other PRN medications = 5.61, 95% CI = 2.36-13.73). Conclusions: Pro re nata medications comprised a significant part of the treatment which psychotic patients received. The common practice of coprescribing PRN typical antipsychotics with scheduled atypical antipsychotics is potentially problematical since administration of PRN medication is associated with significant medication related morbidity. Preferential use of benzodiazepines as PRN agents may minimize this morbidity and foster subsequent compliance with regularly prescribed antipsychotics.

Documentação oficial e o mito da educadora nata na educação infantil

O artigo descreve a trajetória, bem como apresenta as conclusões de pesquisa que resultou em dissertação de mestrado em educação, defendida em 1997, cujo objeto de estudo é o profissional que atua na educação infantil em nosso país. As análises levaram à conclusão de que, ao longo da história, tem-se reforçado a imagem do profissional dessa área como sendo a da mulher "naturalmente" educadora, passiva, paciente, amorosa, que sabe agir com bom senso, é guiada pelo coração, em detrimento da formação profissional. A não-valorização salarial, a inferioridade perante os demais docentes, a vinculação do seu trabalho com o doméstico e a deficiência articulam-se à difusão da figura mitificada, que não consegue desvincular-se das significações que interligam a mãe e a criança.

Otimização da produção de nata (celulose bacteriana) por fermentação em superfície

A nata de coco, alimento glicídico obtido por fermentação em superfície promovida por Acetobacter xylinum, é bastante difundida em alguns países asiáticos, principalmente nas Filipinas. Como meio de cultivo são utilizadas a água ou o leite de coco, produtos de baixo valor econômico e resíduos de processamento da fruta; há indicativos na literatura, entretanto, de que outros resíduos agro-industriais como soro de leite ou mesmo suco de frutas podem ser utilizados. A fim de avaliar a produção de nata para posteriores estudos visando o uso de meios alternativos, foi utilizado um meio de composição definida com o qual foi possível definir as condições de pH, de inóculo e de incubação, assim como observar a influência de açúcares e de ácidos no processo. Foram delineados experimentos usando-se ácido acético e glucose como variáveis de entrada visando a otimização do processo. As condições de fermentação incluíram correção do pH para 4, adição de 10% (v/v) de inóculo ao meio e incubação a 28°C por 10 dias. As condições encontradas como ótimas em relação às concentrações iniciais dos nutrientes considerados foram 0,65 moles/l de ácido acético e 67,4 g/l de glucose, com o que se produz 7,107 g de nata por 250 ml de meio .

Summa S. Thomae hodiernis academiarum moribus accommodata, sive, cursus theologiae : juxta mentem & in quantum licuit, juxta ordinem & litteram D. Thomae in sua Summa, insertis pro re nata digressionibus inhistoriam ecclesiasticam, ad usum scholarum thomisticarum

UANL

Documentação oficial e o mito da educadora nata na educação infantil

O artigo descreve a trajetória, bem como apresenta as conclusões de pesquisa que resultou em dissertação de mestrado em educação, defendida em 1997, cujo objeto de estudo é o profissional que atua na educação infantil em nosso país. As análises levaram à conclusão de que, ao longo da história, tem-se reforçado a imagem do profissional dessa área como sendo a da mulher naturalmente educadora, passiva, paciente, amorosa, que sabe agir com bom senso, é guiada pelo coração, em detrimento da formação profissional. A não-valorização salarial, a inferioridade perante os demais docentes, a vinculação do seu trabalho com o doméstico e a deficiência articulam-se à difusão da figura mitificada, que não consegue desvincular-se das significações que interligam a mãe e a criança.

Scheduled versus Pro Re Nata Dosing in the VIEW Trials

PURPOSE To analyze visual acuity (VA) outcomes before and after preplanned treatment regimen change in the VIEW studies at week 52 (W52). DESIGN Multiple post hoc analyses for retrospectively defined subgroups in 2 multicenter, multinational, double-masked trials. PARTICIPANTS Two thousand four hundred fifty-seven neovascular age-related macular degeneration (AMD) patients. METHODS Patients were randomized to treatment with 0.5 mg ranibizumab given monthly, a 0.5-mg or 2-mg intravitreal aflibercept injection given monthly, or 2 mg intravitreal aflibercept given every other month, after 3 initial monthly doses, up to W52. From W52 through W96, patients received their original dosing assignment using a capped pro re nata (PRN) regimen, with defined retreatment criteria based on VA and morphologic signs of disease activity and mandatory dosing at least every 12 weeks. MAIN OUTCOME MEASURES Best-corrected VA (BCVA) and optical coherence tomography assessments were mandatory at all visits from baseline to W96. Outcomes were changes in BCVA and central retinal thickness. Outcomes were evaluated in all patients who completed 2 years of the VIEW studies using the last observation carried forward method for missing data at interim visits. RESULTS After W52, approximately 20% of patients lost 5 Early Treatment Diabetic Retinopathy Study (ETDRS) letters or more across all treatment arms with PRN treatment. Patients who met the retreatment criterion of loss of 5 ETDRS letters or more in the first quarter of the PRN dosing phase did not recover; mean final VA loss across the 4 study arms was -4.4 to -5.8 letters. Outcomes of these patients up to W52 were indistinguishable from those of the overall population. There were no differences between groups in serious ocular adverse events or Anti-Platelet Trialists' Collaboration arterial thromboembolic events through W96. CONCLUSIONS These analyses suggest that there are subgroups of patients for whom VA outcomes in the second year of the VIEW studies were less stable than in the first year and for whom W52 seems to be an important inflection point. Although alternate reasons specific to the nature of the underlying AMD cannot be fully excluded, the switch in treatment regimen at W52 is a plausible explanation.

Nathan Nata ben Jekuthiel Salman ... [Illustration] : Beurkundung ...

Nathan Nata ben Jekuthiel Salman

Lettere di illustri letterati scritte alla celebre poetessa Paolina Grismondi, nata contessa Secco-Suardo, fra le arcadi Lesbia Cidonia.

Letters in French or Italian.

Iacobi Capelli ... Fragmenta ex variis authorib[us] pressim conci[n]nata, humanaru[m] literarum candidatis dicere ausim ediscenda.

Mode of access: Internet.

Notizie biografiche di Isabella Albrizzi nata Teotochi.

[Preliminary leaf wanting.]