Without talking to your doctor, never mix different types of medications, even those you can buy "over the counter," with antidepressants. Some antidepressants, while safe when taken alone, may cause problems when mixed with other drugs. These substances interfere with the nerve impulses when the impulses travel between nerve cells in the positive and negative emotion centers of the brain. If you have side effects: Antidepressants may cause mild, usually temporary, side effects in some people. These are not usually serious but should be reported to your doctor as soon as possible. The most common side effects and some suggestions for dealing with them include: ·Dry mouth - Take sips of water or chew sugarless gum. Bladder problems You may experience some mild problems emptying your bladder fully. Agitation (jittery feelings) If this does not go away after a short time, consult your doctor. If you look at your life and see only the bad parts, you are more likely to stay depressed. But if you can teach yourself to look for the good things in life, this often reduces depression. Seeing only the bad parts of your life and worrying about them can easily become a habit. But if you can practice thinking of good things you would like to happen in the future, you may feel less depressed. Amentalhealththerapistcanhelpyourecognize thoughts and actions that can lead to depression. He or she can help you to learn ways of thinking and acting that help you feel better. Changing thoughts that can make you feel bad Somethoughtsandexpectationsleadtobadfeelingsanddepression. It takes the same amount of energy to say to yourself, "I will do well at this" as to say "I will fail at this. Once you catch yourself doing this, practice "talking back" with positive "good" messages. Practicerecognizingallofthereasonsforasituationandfigure out what you can do about it. A Story A well known therapist and workshop leader tells workshop audiences a wonderful story about her grandmother who went to live on the shore overlooking a harbor. Look at the many colors of the fishing nets and how they glisten in the sun like rainbows. Look at the pelicans and how sleek they are as they dive into the water looking for fish. Look at the many colors of the fishing nets and how they glisten in the sun like rainbows. Sometimes we just need someone to point out the good things to us so we can remember to see them. Focus on activities that help you to feel better It often helps to change activities and usual routines. Focus on learning to cope with sadness, anger, and anxiety Focus on thoughts and activities that are not upsetting to you. When you wake up, what things would you notice different about your life that would let you know that this miracle has happened? For example, if the miracle happened, someone might say that they would make an appointment to get their hair cut. Make a list of things you might notice that were different about your life if a miracle happened and all your troubles and depression disappeared. If your list included dressing up and meeting a friend for lunch, try to schedule that. Key 4 Make physical activity a part of your life Take care of your plants or garden.
Behavioral health levels of care may include all of the following or a combination thereof: inpatient acute mental health, inpatient acute detoxification, inpatient acute substance abuse rehabilitation, substance abuse residential treatment, psychiatric residential treatment, partial hospital programs (sometimes called day treatment), and intensive outpatient programs. The facility must agree the per diem rate/per visit rate(s) apply to each approved and medically necessary day of substance use/psychiatric service and includes payment for all services rendered, including but not limited to: room and board (which includes all services rendered by facility employees), laboratory, radiology, equipment, pharmaceuticals, and other services incidental to the inpatient or outpatient service. Per diem payments for all inpatient admissions will account for all services during the stay, plus any observation charges within one day in advance of the admission. Under no circumstances will the Amerigroup total rental payments exceed the purchase price of the item. Amerigroup does not allow reimbursement for repair or replacement of purchased items while under the warranty period designated by the applicable manufacturer. The only exception to the Amerigroup rent-to-purchase policy is a custom wheelchair. There must be customization of the base frame of the wheelchair for the wheelchair to meet the definition of a custom-made wheelchair. The addition of customized options or accessories to a standard wheelchair does not result in that wheelchair being considered custom-made. Only custom-made wheelchairs will be considered for outright purchase by Amerigroup. For custom wheelchairs ordered by the physician, Amerigroup will conduct a medical necessity review. Mounting hardware is included with the accessory item and should not be billed separately or under a miscellaneous code. Typical therapies include but are not limited to antibiotic therapy, total parenteral nutrition, chemotherapy and pain management. Such supplies and clinical services are provided in an integrated manner under a plan established and periodically reviewed by the ordering physician or other health care provider. Amerigroup does not allow reimbursement for repair or replacement of rented or purchased items while under the warranty period designated by the applicable manufacturer. The addition of customized options or accessories to a standard wheelchair does not result in that 130 wheelchair being considered custom-made. For a custom wheelchair ordered by the physician, Amerigroup will conduct a medical necessity review. If it is a customized option/accessory, the statement must clearly describe what options or accessory was customized. If the description, manufacturer name, product name, product number and invoice cost are not provided with the claim, the claims will be denied for lack of adequate documentation. There is no separate or additional reimbursement for administration charges, measurements, fitting, delivery fees, taxes, etc. Hospice Reimbursement Hospice refers to covered services designed to give supportive care to members in the final phase of a terminal illness. Services include but are not limited to routine home care day, continuous home care day, inpatient respite care day and general inpatient care day. Routine home care day refers to covered services for a day on which a member who has elected to receive hospice care at his or her current residence and is not receiving continuous care. Routine home care day is payable at the Amerigroup rate using the appropriate coded service identifier(s). Covered services include but are not limited to any combination of the following services, without regard to volume or intensity occurring in one day: skilled nursing care, certified nurse assistance, homemaker, social worker, family counseling, respite care, therapies and bereavement services. Continuous home care day refers to covered services for a day on which a member who has elected hospice care is at home and receives hospice care consisting predominantly of nursing care on a continuous basis at home. A continuous home care day is only furnished during brief periods of crisis and only as necessary to maintain the terminally ill patient at home, with a minimum of eight hours of care being furnished on a particular day to qualify as a continuous home care day. Continuous home care day is payable at the Amerigroup rate; however, billing is required at an hourly rate using the appropriate revenue code. Billing for continuous home care day is required at an hourly rate using the appropriate coded service identifier(s), and reimbursement will not exceed the general inpatient care day reimbursement. Claims with less than eight hours of direct patient care in one day will be at the routine home care day reimbursement. Inpatient respite care day refers to covered services for a day on which a member who has elected hospice care receives services in an inpatient facility (skilled nursing facility, hospital or inpatient hospice house) on a short-term basis when necessary to relieve family members or others caring for the member, for respite. The inpatient respite care day is payable as a per diem rate using the appropriate revenue code.
For improving coverage, immunization needs to be brought closer to the communities. There is need to improve immunization practices at fixed sites along with better monitoring and supervision. Effective behavior change communication would increase the demand for vaccination. In Bihar, "Muskan ek Abhiyan" an innovative initiative started in 2007 is a good example, where a partnership of government organization, agencies, and highly motivated social workers has paid rich dividends. Rapid progress in the development of new vaccines means protection being available against a wider range of serious infectious diseases. The last couple of decades have seen the advent of many new vaccines in the private Indian market. However, most of these vaccines are at present accessible only to those who can afford to pay for them. Paradoxically, these vaccines are most often required by those that cannot afford them. Expanding coverage with these vaccines and introducing new vaccines which are cost effective in the Indian scenario are required. Vaccine production by indigenous manufacturers needs to be encouraged to bring down the costs, reduce dependence on imports, and ensure availability of vaccines specifically needed by India. Finally setting up a system for monitoring the incidence of vaccine preventable diseases and conducting appropriate epidemiological studies is necessary to make evidence-based decisions on incorporation of vaccines in the national schedule and study impact of vaccines on disease incidence, serotype replacement, epidemiologic shift, etc. It has also called for development and introduction of new and improved vaccines and technologies. The program now consists of vaccination for 12 diseasestuberculosis, diphtheria, pertussis (whooping cough), tetanus, poliomyelitis, measles, hepatitis B, diarrhea, Japanese encephalitis, rubella, pneumonia (Haemophilus Influenzae Type B) and Pneumococcal diseases (Pneumococcal pneumonia and meningitis). Vaccines against rotavirus, rubella, and polio (injectable) will help the country meet its millennium development goals four targets that include reducing child mortality by two-thirds by 2015, besides meeting meet global polio eradication targets. An adult vaccine against Japanese encephalitis will also be introduced in districts with high levels of the disease. Pneumococcal conjugate vaccine protects children against severe forms of pneumococcal disease, such as pneumonia and meningitis. Currently, the vaccine is being rolled out to approximately 21 lakh children in Himachal Pradesh and parts of Bihar and Uttar Pradesh in the first phase. This will be followed by introduction in Madhya Pradesh and Rajasthan next year, and eventually be expanded to the country in a phased manner. Out of all the causes of diarrhea, rotavirus is a leading cause of diarrhea in children less than 5 years of age. It is estimated that rotavirus cause 872,000 hospitalizations; 3,270,000 outpatient visits and estimated 78,000 deaths annually in India. However, there are number of barriers which adversely affect the immunization coverage rates in India. Some of the challenges to immunization include limited capacities of staff, and gaps in key areas such as predicting demand, logistics, and cold chain management, which result in high wastage rates. Differences in uptake are geographical, regional, rural-urban, poor-rich, and gender-related. Effectiveness of Muskaan Ek Abhiyan (the smile campaign) for strengthening routine immunization in Bihar, India. New Delhi: Ministry of Health and Family Welfare, Government of India; 2011 [online]. Universal Immunization Programme In India: the Determinants Of Childhood Immunization. The innate immune system triggers the development of adaptive immunity by presenting antigens to the B lymphocytes and T lymphocytes. Also humoral antibodies prevent colonization, being the first step in pathogenesis by encapsulated organisms like Hib (Haemophilus influenzae type b), pneumococcal, meningococcal, and organisms like diphtheria and pertussis. Cell-mediated immunity is the principal defense mechanism against intracellular microbes.
For assessment purposes, it is important to understand that individuals with disordered eating symptoms tend to self-evaluate their symptoms as compatible with their attitudes, behaviors, and beliefs (Keel & Haedt, 2008). Therefore, self-report outcomes may be biased and should be considered in conjunction with findings from a physical examination. Assessing parental feeding patterns is also important, as caregivers will likely be integral components of the treatment program and may themselves encounter difficulties initiating and maintaining a healthy relationship with food and weight. However, individuals with eating disorders are among the least likely to seek treatment (American Psychological Association HealthCenter, 1998). Pediatricians are crucial not only in identifying eating disorders, but also in managing the treatment process, including coordinated care with nutrition and mental health professionals (Rosen and the Committee on Adolescence, 2010; Scudder). Treatment providers should also discuss with both the individual and his/her family the role genetics may play in these disorders (Mazzeo & Bulik, 2008); this can minimize the guilt family members may experience and increase their willingness to be active participants in the treatment process. Treatment locations range from intensive patient settings, in which general medical consultation is readily available, to partial hospital and residential programs with varying levels of outpatient care. Individuals who weigh under 85 percent of their estimated healthy weights are likely to require a highly structured program and possibly 24-hour hospitalization. Hospitalization should occur before the onset of medical instability, as manifested by severely abnormal vital signs. Specifically, once the youth begins to display a rapid decline in food intake and dramatic loss of weight, treatment providers should seriously consider hospitalization. Furthermore, the presence of external stressors or comorbid psychiatric disorders may have a significant impact on this decision. Many individuals have a limited response to treatment and require long-term monitoring and intervention (U. Thus, ethical considerations may arise during the course of treatment, and involuntary hospitalization may be the necessary course. The prognosis in adolescents with eating disorders is much better than that in adults (Rosen and the Committee on Adolescence, 2010). Even with a higher probability of success, families should be aware that it might take as long as 10 years from the commencement of treatment to behavioral cure, including normal eating and normal weight (Rosen and the Committee on Adolescence). The majority of studies have been conducted with adolescents over age 15, although evaluation of adolescent males is limited (Keel & Haedt, 2008). The limitations of research of eating disorder interventions for males and young children should be acknowledged when considering the course of treatment. Increasing calories consumed may be difficult, but smaller, frequent meals, calorie dense foods, and substituting fruit juice for water may help negate psychological barriers, such as aversion to a feeling of fullness (Rosen and the Committee on Adolescence, 2010). For severely underweight individuals, individual treatment has been found to be most effective. Clinicians have reported that, as weight is restored, other eating disorder and psychiatric comorbid symptoms diminish; however, they often do not disappear completely. Psychoeducational nutrition groups have also been associated with positive outcomes (Herpertz-Dahlmann & Salbach-Andrae, 2008). Although helpful, it is important that nutrition counseling serve as only one component of a multidisciplinary treatment approach. Some studies have found that family therapy is associated with greater long-term benefits and better retention rates compared to individual psychotherapy (Bulik et al. This seems to be especially true when the family is treated as part of the treatment team. However, these findings are limited to generalizations because the individuals in these studies often did not receive both family and individual treatment, which commonly occurs in practice. Parents, along with the therapist, take responsibility to ensure the adolescent is eating sufficiently and controlling other pathologic weight control methods. Parents and the therapist help the adolescent gradually take over responsibility for his or her eating. Weight is restored in the second phase, and then the family moves onto the third phase. Family psychotherapy may not be appropriate for families in which one or both parents exhibit psychopathy or hostility to the affected child, and it may not be appropriate for the most medically compromised adolescents (Rosen and the Committee on Adolescence, 2010).
For a complete list of covered A and B recommendation screenings and age and frequency limitations go to the U. See page 111 for our coverage of these vaccines when provided by pharmacies in the vaccine network. Basic Option Continued from previous page: Note: We waive your deductible and coinsurance amount for services billed by Participating/ Non-participating providers related to Influenza (flu) vaccines. Preventive Care, Adult - continued on next page 2021 Blue Cross and Blue Shield Service Benefit Plan 43 Standard and Basic Option Section 5(a) Standard and Basic Option Benefit Description Preventive Care, Adult (cont. Regular coverage criteria and benefit levels apply to subsequent claims for those types of tests if performed in the same year. If you receive both preventive and diagnostic services from your Provider on the same day, you are responsible for paying you cost-share for the diagnostic services. Note: Preventive care benefits are not available for surgical removal of breasts, ovaries, or prostate. Note: See page 112 for our payment levels for medications to promote better health as recommended under the Affordable Care Act. Note: Unless otherwise noted, the benefits listed above and on pages 42-43 do not apply to children up to age 22. You Pay Standard Option See page 42 Basic Option See page 42 Not covered: · Genetic testing related to family history of cancer or other disease, except as described on page 44 Note: See page 41 for our coverage of medically necessary diagnostic genetic testing. All charges All charges Preventive Care, Child Benefits are provided for preventive care services for children up to age 22. This includes: · Well-child visits, examinations, and other preventive services as adopted by December 31, 2019, and described in the Bright Future Guidelines as provided by the American Academy of Pediatrics. For a complete list of the American Academy of Pediatrics Bright Future Guidelines go to brightfutures. Standard Option Preferred: Nothing (no deductible) Participating: 35% of the Plan allowance (deductible applies) Non-participating: 35% of the Plan allowance (deductible applies), plus any difference between our allowance and the billed amount Note: When billed by a facility, such as the outpatient department of a hospital, we provide benefits as shown here, according to the contracting status of the facility. Basic Option Preferred: Nothing Participating/Non-participating: You pay all charges (except as noted below) Note: For services billed by Participating and Nonparticipating laboratories or radiologists, you pay any difference between our allowance and the billed amount. Note: When nutritional counseling is via the contracted telehealth provider network, we provide benefits as shown here for Preferred providers. Refer to Section 5(h), Wellness and Other Special Features, for information on how to access a telehealth provider. Note: Any procedure, injection, diagnostic service, laboratory, or X-ray service done in conjunction with a routine examination and not included in the preventive listing of services will be subject to the applicable member copayments, coinsurance, and deductible. You Pay Standard Option Continued from previous page: Note: We waive the deductible and coinsurance amount for services billed by Participating/ Non-participating providers related to Influenza (flu) vaccines. Basic Option Continued from previous page: Note: We provide benefits for services billed by Participating/ Non-participating providers related to Influenza (flu) vaccines. If you use a Nonparticipating provider, you pay any difference between our allowance and the billed amount. Maternity Care Maternity (obstetrical) care including related conditions resulting in childbirth or miscarriage, such as: · Prenatal care (including ultrasound, laboratory, and diagnostic tests) Note: See Section 5(h) for details about our Pregnancy Care Incentive Program. Basic Option Preferred: Nothing Note: For Preferred facility care related to maternity, including care at Preferred birthing facilities, your responsibility for covered inpatient services is limited to $175 per admission. For outpatient facility services related to maternity, see the notes on pages 82-85. Maternity Care - continued on next page 2021 Blue Cross and Blue Shield Service Benefit Plan 46 Standard and Basic Option Section 5(a) Standard and Basic Option Benefit Description Maternity Care (cont. See Section 5(e) for our coverage of mental health visits to Non-preferred providers and benefits for additional mental health services. Note: Benefits for home nursing visits (skilled) related to covered maternity care are subject to the visit limitations described on page 59. Note: Maternity care benefits are not provided for prescription drugs required during pregnancy, except as recommended under the Affordable Care Act. Note: Here are some things to keep in mind: · You do not need to precertify your delivery; see page 26 for other circumstances, such as extended stays for you or your newborn. You Pay Standard Option Continued from previous page: Participating: 35% of the Plan allowance (deductible applies) Non-participating: 35% of the Plan allowance (deductible applies), plus any difference between our allowance and the billed amount Note: You may request prior approval and receive specific benefit information in advance for the delivery itself and any other maternity-related surgical procedures to be provided by a Non-participating physician when the charge for that care will be $5,000 or more.
Which one of the following would be the most effective form of emergency contraception to recommend for R. Which one of the following would be the most appropriate form of contraception to discuss with and recommend for R. She wants to know the chances that her method has failed or whether she is having a serious adverse effect. When asked about adherence, she says she usually takes her birth control on time but that she stopped 3 days ago because she was worried that the hormones were leading to her nausea. The package insert states that 572 women among the total 11,593 women in the clinical trial discontinued from the trial because of problem Y. Which one of the following represents the best way to communicate this information to R. She completes the medical history questionnaire but does not want to have her blood pressure measured. Which one of the following contraceptive methods would be most appropriate to offer A. Other than preventing pregnancy indefinitely, she would like her method to help with her heavy menstrual bleeding. Accreditation Guide for Hospitals Dear Colleague, Thank you for looking to the Joint Commission when it comes to your accreditation needs. Joint Commission recognition is a visible demonstration to your patients, their families, your staff and the community of your commitment to the highest level of safety and quality. This guide provides information about several important areas including eligibility, how to request accreditation and prepare for the process, the on-site survey process, and accreditation decisions. We hope that you will find this guide helpful in understanding the accreditation process. If you have questions, or would like to speak with someone directly, please contact me. Any questions that you have about the overall accreditation process and your preparation efforts can be directed to (630) 792-5817. This is a no-cost service accessed over the phone or through the Joint Commission website. Survey Activity Guide Once you request an Application for Accreditation, you will gain access through a secure log-in to the Joint Commission extranet site, "Joint Commission Connect". This guide provides important information about the Joint Commission, eligibility for accreditation, on-site surveys, survey preparation and accreditation decisions. Our Mission To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. The Joint Commission was founded in 1951 under the auspices of the American Hospital Association, the American Medical Association, the American College of Physicians, and the American College of Surgeons, with the later addition of the American Dental Association, to act as an independent accrediting body for hospitals nationwide. Today, Joint Commission accreditation of a hospital is a widely recognized standard for evaluating and demonstrating high quality services. Payers, regulatory agencies, and managed care contractors may require Joint Commission accreditation for reimbursement, certification and licensure, or as a key element of their participation agreements. Joint Commission accreditation also benefits your organization by: Strengthening community confidence Achieving accreditation is a visible demonstration to the community that your hospital is committed to providing high quality services, as reviewed by an external group of specialists. Validating quality care to your patients and their families Joint Commission standards are focused on one goal: raising the safety and quality of care to the highest possible level. Achieving accreditation is a strong validation that you have taken the extra steps to ensure the highest level of safety and quality currently available. Helping you organize and strengthen your improvement efforts Joint Commission standards include state-of-the-art performance improvement concepts that provide a framework for continuous improvement using standards as a means to achieve and maintain excellent operational systems. Improving liability insurance coverage By enhancing risk management efforts, accreditation may improve access to or reduce the cost of liability insurance coverage. A list of liability insurers that recognize Joint Commission accreditation can be found on our website at.
Diseases
The prevalence of premenstrual dysphoric disorder in a randomly selected group of urban and rural women. Using the daily record of severity of problems as a screening instrument for premenstrual syndrome. Effective open-label treatment of premenstrual dysphoric disorder with venlafaxine. An overview of four studies of a continuous oral contraceptive (levonorgestrel 90 mcg/ethinyl estradiol 20 mcg) on premenstrual dysphoric disorder and premenstrual syndrome. Continuous oral levonorgestrel/ethinyl estradiol for treating premenstrual dysphoric disorder. Calcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual symptoms. Dietary vitamin D intake, 25-hydroxyvitamin D3 levels and premenstrual syndrome in a college-aged population. Plasma 25-hydroxyvitamin D and risk of premenstrual syndrome in a prospective cohort study. Effects and treatment methods of acupuncture and herbal medicine for premenstrual syndrome/premenstrual dysphoric disorder: systematic review. Cognitive-behavioral therapy for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review. Prevalence, incidence and stability of premenstrual dysphoric disorder in the community. Premenstrual syndrome prevalence and fluctuation over time: results from a French population-based survey. Cyclical mood changes as in the premenstrual tension syndrome during sequential estrogen-progestagen postmenopausal replacement therapy. Prescription medications are an important tool for the management of chronic diseases. Enrollees and controls were matched on medication class, pharmacy urbanicity, followup time, age, and sex. Medication adherence has been shown to improve health outcomes and decreases total healthcare costs. Despite these differences in approach, each pharmacist-driven model works and produces consistently positive results. However, medications are most effective if taken at appropriate doses in correct quantity and at appropriate time intervals. These issues are important not only for the clinical outcomes of individual patients but also as a major public health concern. Taken together, non-adherence and nonpersistence results in excess costs to the health care system that total in the hundreds of billions of dollars each year. This model helps patients manage their prescriptions through a monthly appointment to refill medications and scheduled interactions with the pharmacist. In particular, refill coordination at a single pharmacy is recognized as an effective tactic to improve adherence. The model helps patients manage their prescriptions through scheduled visits and discussions with their pharmacist. Additionally, as health care moves to a value-based system, a non-research objective of this study was to understand how community pharmacies could come together to form a virtual network of pharmacies to improve adherence. Prescription fill records and patient data were collected during the study period for all patients at these pharmacies. Patients could be included in more than one medication class group if they met the inclusion criteria independently for each. Patients were required to have a minimum of sixty days of data after their first fill to allow for adequate follow-up. Patients with invalid demographic data or those at pharmacies with no enrollees were excluded. Patients meeting this criterion were approached by a pharmacy staff member and given information about the program and the opportunity to opt-in. Patients opting-in to the program signed a form acknowledging their acceptance of the terms of the intervention. Measures the outcomes of interest for this study were medication adherence and medication non-persistence. Control patients were included in the analysis from the first qualifying medication fill within the study period.
Only 30% of the studies described the use of prospective self report forms or diaries. The rest assessed adverse effects retrospectively at follow-up appointments, were vague about their methods or failed to systematically report adverse effects. It is important that studies report numerical results for all outcomes and not just for significant or selected findings. As there were insufficient studies to conduct a sensitivity analysis to explore the effect of adequate allocation concealment and double-blinding, the extent to which bias affected estimates of effect is unclear. This review went on to suggest that combined oral contraceptives are a more suitable option for women requiring contraception. As noted above, the use of oral contraceptives for dysmenorrhoea is the topic of another Cochrane review (Wong 2009). Potential biases in the review process the cross-over design requires that each study participant receives two or more treatments in a random order, each participant thus acting as her own control. Cross-over trials are suitable for evaluating interventions with a temporary effect in the treatment of stable, chronic conditions (Higgins 2011). In order for cross-over trials to be given adequate weight in meta-analysis, study authors need to report an explicit statement that they used paired statistical analysis, plus a summary effect measure and an estimate of variability for each outcome. As very few cross-over trials in the review provided this information, most were analysed as if they used a parallel design. As a result their findings may have been underweighted in analysis, resulting in wider confidence intervals than would otherwise be the case. This was probably partly due to confounding by study age, since many of the studies included in the analysis were older parallel-group studies, which overall tended to report higher effect estimates than the more recent studies. In order to facilitate this process, trial publications need to provide a detailed account of statistical methods used and present full results with summary effect measures and measures of variance. Many thanks to Valeria Ivanova and Owen Sinclair, who advised on the early stages, to all the people who kindly translated trials and to Will 27 Nonsteroidal anti-inflammatory drugs for dysmenorrhoea (Review) Copyright © 2015 the Cochrane Collaboration. Thanks also to Marian Showell (Trials Search Co-ordinator) for designing and running multiple searches for the 2009 and 2015 updates. Comparison of ketoprofen and naproxen in the treatment of dysmenorrhoea, with special regard to the time of onset of pain relief. Pain relief in dysmenorrhea can be achieved more rapidly with ketoprofen than with naproxen [Snabbare smartlindring vid dysmenorre med ketoprofen an med naproxen]. A double-blind cross-over study comparing flurbiprofen with naproxen-sodium for the treatment of primary dysmenorrhea. Double-blind clinical trial with potassium diclofenac versus placebo in primary dysmenorrhoea [Estudo clinico comparativo, duplocego com diclofenaco potassico versus placebo na dismenorreia primaria]. An attempt at real prophylaxis of primary dysmenorrhea: comparison between meclofenamate sodium and naproxen sodium. Bitner 2004 {published data only (unpublished sought but not used)} Bitner M, Katternhorn J, Gao J, Kellstein D. Efficacy and tolerability of lumiracoxib in the treatment of primary dysmenorrhoea. Lumiracoxib, a novel cyclooxygenase-2 selective inhibitor, is an effective and well-tolerated treatment for nausea. Chantler 2008 {published data only (unpublished sought but not used)} Chantler I, Mitchell D, Fuller A. The effect of three cyclo-oxygenase inhibitors on intensity of primary dysmenorrhoeic pain. Diclofenac potassium attenuates dysmenorrhea and restores exercise performance in women with primary dysmenorrhea. Costa 1987a Costa S, Mioli M, Ravaioli R, Bufalino L, Gardini F. Prostaglandin synthetase inhibitor piroxicam betacyclodextrin in the treatment of primary dysmenorrhea. Costa 1987b Costa S, Mioli M, Ravaioli R, Bufalino L, Gardini F.
It was shown that ketamine (50 mg/kg/day) potentiated the teratogenic effects of cocaine (20 mg/kg/day), but was not teratogenic on its own. Considering the higher metabolic rate of mice, the authors stated that the doses applied were comparable to those used by addicted humans and should be toxic to first time users. As also shown in the study by Chan et al (2005) the combination of cocaine and ketamine is a deleterious one. Transient interference (lasting >= 4 hr) in the activity of these transmitters during the synaptogenesis period (the last trimester of pregnancy and the first several years after birth in humans) causes millions of developing neurones to commit suicide (die by apoptosis). Whereas negative findings were obtained in poorly conducted (compared to current standards) bacterial tests, a positive result was reported from an Sister Chromatid Exchange test in vitro. Moreover unpublished data (submitted to the German Federal Institute for Drugs and Medical Devices as part of an application for a marketing authorization) from genotoxicity testing with the S(+) enantiomere of ketamine in a standard battery of validated in vitro and in vivo tests did not reveal any evidence for a genotoxic potential. Provided that the genotoxicity findings with the S(+) enantiomere of ketamine can be extrapolated to the racemate it can be concluded that ketamine is highly unlikely to possess any relevant genotoxic properties (Adhvaryu et al. Carcinogenic potential: No data on the carcinogenic potential of ketamine are available. Rofael et al (2003) did a series of investigations in rats in order to elucidate the possible mechanism of action. From the experiments it can be concluded that cocaine has immunotoxic properties possible by neuro-endocrinal mechanisms. Neurotoxicity: One issue that has been investigated in animals, but has received little attention in the clinical literature and that may be of importance for especially the recreational user of ketamine, is the neurotoxicity as observed in rats (Olney et al. When administered subcutaneously, ketamine (40 mg/kg) caused vacuolisation in posterior cingulate and retrosplenial cerebrocortical neurones in the rat. It may be anticipated that substances with opposite pharmacological actions to those classes of drugs mentioned here may enhance the neurotoxicity of ketamine. Two recent publications give additional insights into the possible mechanisms of the neurotoxicity of ketamine. A more pronounced neurotoxic effect in adult rats is also mentioned as a result of the investigations of Beals et al (2004). There may be several reasons why these findings in rats have not led to the abandonment of the clinical use of ketamine. First, ketamine is generally accepted as a safe anaesthetic without long-term adverse effects (Shorn and Whitwam, 1980; Reich and Silvay, 1989). Secondly, benzodiazepines are usually co-administered with ketamine to reduce the occurrence of emergence phenomena (for a description, see below Human, Clinical experience). Benzodiazepines have been shown in rats to protect against the ketamine-induced neurotoxicity. Contrarily, there may be reasons why the findings on the neurotoxicity of ketamine in the rat may be of concern to recreational users of ketamine. First, drug users will not take ketamine in combination with protective agents like benzodiazepines. Moreover, compounds increasing the neurotoxic potency of ketamine might be co-administered. Secondly, recreational use implies repeated exposure, whereas clinical use is mostly incidental. Longterm adverse effects in long-term users of ketamine have been reported, however are scarce. These included persisting impairment of attention and recall and a subtle visual anomaly (Jansen, 1990). Effects after frequent use mentioned were "jolts" or "shocks" when moving their eyes, sharply impaired visual tracking, impaired recognition of metaphor, impaired language skills and memory problems. These adverse effects (that fade with time) are related by the author to malfunction of or damage to the cingulate and retrosplenial cortices. To date, there is insufficient evidence to ascertain such a relationship in humans. Human Clinical experience Ketamine is considered an anaesthetic with a good safety profile (Reich and Silvay, 1989). Its major drawback, limiting its clinical use is the occurrence of emergence reactions. Emergence phenomena in patients awakening from a ketamine narcosis have been described following early clinical experience, and included hallucinations, vivid dreams, floating sensations and delirium. These symptoms were found to be reduced by concurrent use of benzodiazepines, putting the patient in a low stimulus environment and by providing information on the possible emergence reactions preoperatively.
Delinquent-motivated firesetting conceptualizes the use of fire as one way of acting out against authority. These children rarely show empathy but tend to avoid harming others (Dittman, 2004a). Given that firesetting is one of 15 symptoms for conduct disorder, it makes sense to explore the relationship between delinquency and firesetting. Pathological-motivated firesetting is the rarest of the motivations seen by practitioners in this field and describes a severely disturbed juvenile. It includes those who are actively psychotic, acutely paranoid or delusional, or who have lived in chronically disturbed and bizarre environments. While motivational typologies can be useful in assessment and treatment interventions, many youth present with seemingly complex and multiple motivations for firesetting behavior. Variables linked to juvenile firesetting include peer pressure, curiosity, mental health and substance abuse problems, and lack of adult supervision (Burn Institute, 2004; MacKay et al. Research has also found a relationship between involvement in firesetting and parents/caregivers who smoke, due to the availability of matches and cigarette lighters and because the purposive use of fire is familiar to the juvenile (Porth & Hughes, 2000). Comorbidity Clinical studies that have examined juvenile firesetters found that many have conduct and aggression problems. Approximately 15 percent of firesetting youth are females (MatchBook Journal, 2016). A study investigating the prevalence of self-reported firesetting determined that female firesetters are more likely to have serious antisocial behaviors, participate in risk-taking activities, and have a substance abuse problem (Becker et al. Another study, which researched a potential link between juvenile firesetting and delinquency, found that firesetters are more likely than non-firesetters to be delinquent, while adolescents who continue in the practice of firesetting tend to be chronically criminal (Becker et al. Assessment Overall, individual and family-related factors that may predispose the firesetting youth should be identified in order to effectively treat this behavior. Assessing personality structure and individual characteristics, family and social circumstances, and immediate environmental conditions allow for more effective treatment (Williams & Clements, 2007). Factors to be considered include history or frequency of incidents, method, motive, ignition, target, and behavior (Sharp et al. It is important to gather data not only to plan treatment, but also to discover the motivation behind the firesetting behavior (Sharp, Blaakman, & Cole). Assessment of a juvenile firesetters should include a comprehensive structured interview with the young person and their parents, with a view to getting information on family function, supervision, and discipline practices (Dolan et al. A number of firesetting assessment models, specific instruments, and protocols have been developed and are currently utilized by practitioners and researchers in the field. Treatments Currently, there are no evidence-based treatment approaches for the juvenile firesetting population (Kolko, Herschell, & Scharf, 2006). However, the Office of Juvenile Justice and Delinquency Prevention identified seven components common to juvenile firesetting programs as successful (1997): 1. A program management component to make key decisions, coordinate interagency efforts and foster interagency support; 2. A screening and evaluation component to identify and evaluate children who have been involved in firesetting; 3. An intervention services component to provide primary prevention, early intervention, and/or treatment for juveniles, especially those who have already set fires or shown an unusual interest in fire; 4. A referral component to link the program with agencies that might help identify juvenile firesetters or provide services to them and their families; 5. A publicity and outreach component to raise public awareness of the program and encourage early identification of juvenile firesetters; 6. A juvenile justice system component to forge relationships with juvenile justice agencies that often handle juvenile firesetters. Additional treatment components that have been suggested in the literature are fire service collaboration and fire safety education, behavioral interventions, family therapy, and hospitalizations, residential placement, and/or medication (Stadolnik, 2000). Unfortunately, there is no single identified treatment that is considered effective for treating this behavior. However, many treatments have proven beneficial in the management of this behavior. These treatments are appropriately applied to firesetters with consideration for their age (Slavkin, 2000) and are outlined in Table 2. However, structured treatments designed to intervene with children who set fires were still found to have greater effect in the long-term than brief visits with a firefighter (Kolko). Social skills training may also help juveniles who have trouble expressing their emotions.
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