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luni, 11 octombrie 2021

 One of the recommendations to reduce medication errors and harm is to use the “five rights”: the right patient, the right drug, the right dose, the right route, and the right time. When a medication error does occur during the administration of a medication, we are quick to blame the nurse and accuse her/him of not completing the five rights. The five rights should be accepted as a goal of the medication process not the “be all and end all” of medication safety. 

Judy Smetzer, Vice President of the Institute for Safe Medication Practices (ISMP), writes, “They are merely broadly stated goals, or desired outcomes, of safe medication practices that offer no procedural guidance on how to achieve these goals. Thus, simply holding healthcare practitioners accountable for giving the right drug to the right patient in the right dose by the right route at the right time fails miserably to ensure medication safety. Adding a sixth, seventh, or eighth right (e.g., right reason, right drug formulation, right line attachment) is not the answer, either.” [The five rights: A destination without a map. ISMP Medication Safety Alert. January 25, 2007;12(2).]
The five rights focus on individual performance and not on human factors and system defects that may make completing the tasks difficult or impossible.
There are a number of factors that may interfere with a nurse’s ability to complete these functions.
Ms. Smetzer continues, “Thus, the healthcare practitioners’ duty is not so much to achieve the five rights, but to follow the procedural rules designed by the organization to produce these outcomes. And if the procedural rules cannot be followed because of system issues, healthcare practitioners also have a duty to report the problem so it can be remedied.”

joi, 7 octombrie 2021

 Medication treatment of anxiety is generally safe and effective and is often used in conjunction with therapy. Medication may be a short-term or long-term treatment option, depending on severity of symptoms, other medical conditions, and other individual circumstances. However, it often takes time and patience to find the drug that works best for you.

Medications are commonly prescribed by physicians (family practice, pediatricians, OB-GYNs, psychiatrists), as well as nurse practitioners in many states.

More than 1in 6 Americans take a psychiatric drug (such as an antidepressant or a sedative). according to a 2013 Medical Expenditure Panel Survey (MEPS), which gathered information on the cost and use of health care in the United States. Antidepressants were the most common type of psychiatric drug in the survey, with 12 percent of adults reporting that they filled prescriptions for these drugs, the study said.

Between 2011 and 2014, approximately one in nine Americans of all ages reported taking at least one antidepressant medication in the past month, according to national survey data released by the Centers for Disease Control and Prevention (CDC). Three decades ago, less than one in 50 people did. 

Variety of Medications

Four major classes of medications are used in the treatment of anxiety disorders:

Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs relieve symptoms by blocking the reabsorption, or reuptake, of serotonin by certain nerve cells in the brain. This leaves more serotonin available, which improves mood. SSRIs (citalopram, escitalopram, fluoxetine, paroxetine, and sertraline) generally produced fewer side effects when compared with tricyclic antidepressants.  However, common side effects include insomnia or sleepiness, sexual dysfunction, and weight gain. They are considered an effective treatment for all anxiety disorders, although the treatment of obsessive-compulsive disorder, or OCD, typically requires higher doses.

Read this blog post about SSRIs and Benzodiazepines 

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
The serotonin-norepinephrine reuptake inhibitor, or SNRI, class (venlafaxine and duloxetine) is notable for a dual mechanism of action: increasing the levels of the neurotransmitters serotonin and norepinephrine by inhibiting their reabsorption into cells in the brain. As with other medications, side effects may occur, including stomach upset, insomnia, headache, sexual dysfunction, weight gain and minor increase in blood pressure. These medications are considered as effective as SSRIs, so they are also considered a first-line treatment for the treatment of anxiety disorders, but not for obsessive compulsive disorder ,where SSRI’s are the preferred first line treatment.

This class of drugs is frequently used for short-term management of anxiety and as an add on treatment, in treatment resistant anxiety disorders.They are not recommended as a treatment for Post Traumatic Stress Disorder. Benzodiazepines (alprazolam, clonazepam, diazepam, and lorazepam) are highly effective in promoting relaxation and reducing muscular tension and other physical symptoms of anxiety. Long-term use may require increased doses to achieve the same effect, which may lead to problems related to tolerance and dependence.

Read this blog post about SSRIs and Benzodiazepines

Tricyclic Antidepressants
Concerns about long-term use of the benzodiazepines led many doctors to favor tricyclic antidepressants (amitriptyline, imipramine, and nortriptyline). Although effective in the treatment of some anxiety disorders(but not Social Anxiety Disorder), they can cause significant side effects, including orthostatic hypotension (drop in blood pressure on standing), constipation, urinary retention, dry mouth, and blurry vision.

Contact your physician if you experience side effects, even if you are not sure a symptom is caused by a medication. Do not stop taking a medication without consulting with the prescribing physician; abrupt discontinuation may cause other health risks.

Medications will work only if they are taken according the explicit instructions of your physician, but they may not resolve all symptoms of an anxiety disorder.

Learn more about how antidepressants work.

Ketamine (Eskatimine)

ADAA Public Statement - March 6, 2019:  On March 5, 2019 the FDA approved a new nasal spray medication- Spravato (esketamine) for treatment-resistant depression, available only at a certified doctor’s office or clinic. Ketamine represents a major step forward in the treatment of depression and suicide prevention. ADAA recognizes that clinicians want to offer their patients evidence-based options which have passed through the numerous stages of FDA testing, and this marks the first FDA approval of a ketamine product for a psychiatric indication. This is also the first antidepressant with a novel mechanism of action that we have had in decades.     

The development of the intranasal esketamine formulation with an intermittent dosing strategy offers a new approach to the treatment of refractory depression that could also impact greatly the care of patients with suicidal activity.   

While this newly approved treatment offers hope as a fast acting and durable antidepressant option for patients who have not responded adequately to conventional SSRI or SNRI medications, it is important to be cautious. Many patients may seek out esketamine have not received trials with other evidence-based treatments including pharmacotherapy and psychotherapy or rTMS or ECT. 

It is also important to note that the long-term efficacy of ketamine is not established and there is also concern about the potential abuse liability factor which will be highlighted by the FDA on the drug’s label. 

Patients considering the use of Spravato should ask their doctor what the long-term follow up strategy should be and whether there are any potential negative consequences over time with continued use. 

Additional Research Studies About Ketamine and Psychedlics: Posted April 2021

AMJ Psychiatry 2020 Issue: Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and ImplementationRoger S. McIntyre, M.D., Joshua D. Rosenblat, M.D., M.Sc., (ADAA President Elect and CMO) Charles B. Nemeroff, M.D., Ph.D., Gerard Sanacora, M.D., Ph.D., (ADAA member) James W. Murrough, M.D., Ph.D., Michael Berk, Ph.D., M.B.B.Ch., Elisa Brietzke, M.D., Ph.D., Seetal Dodd, Ph.D.,Philip Gorwood, M.D., Ph.D., Roger Ho, M.D., M.B.B.S., Dan V. Iosifescu, M.D., Carlos Lopez Jaramillo, M.D., Ph.D., Siegfried Kasper, M.D., Kevin Kratiuk, B.Pharm., Jung Goo Lee, M.D., Ph.D., Yena Lee, H.B.Sc., Leanna M.W. Lui, Rodrigo B. Mansur, M.D., Ph.D., George I. Papakostas, M.D., Mehala Subramaniapillai, M.Sc., (ADAA member) Michael Thase, M.D., Eduard Vieta, M.D., Ph.D., Allan H. Young, M.Phil., M.B.Ch.B., Carlos A. Zarate, Jr., M.D., Stephen Stahl, M.D., Ph.D.

In this article,an international group of mood disorder experts provides a synthesis of the literature with respect to the efficacy, safety, and tolerability of ketamine and esketamine in adults with treatment-resistant depression. The authors also provide guidance for the implementation of these agents in clinical practice,with particular attention to practice parameters at point of care. Areas of consensus and future research vistas are discussed.

AMJ Psychiatry 2020 Issue: Psychedelics and Psychedelic-Assisted PsychotherapyCollin M. Reiff, M.D., Elon E. Richman, M.D., (ADAA President Elect and CMO) Charles B. Nemeroff, M.D., Ph.D., Linda L. Carpenter, M.D., Alik S. Widge, M.D., Ph.D., Carolyn I. Rodriguez, M.D., Ph.D., (ADAA member) Ned H. Kalin, M.D., William M. McDonald, M.D., and the Work Group on Biomarkers and Novel Treatments, a Division of the American Psychiatric Association Council of Research

  • Objective: The authors provide an evidenced-based summary of the literature on the clinical application of psychedelic drugs in psychiatric disorders.
  • Results: The most significant database exists for MDMA and psilocybin, which have been designated by the U.S. Food and Drug Administration (FDA) as “breakthrough therapies” for posttraumatic stress disorder (PTSD) and treatment-resistant depression, respectively. The research on LSD and ayahuascais observational, but available evidence suggests that these agents may have therapeutic effects in specific psychiatric disorders.
  • Conclusions: Randomized clinical trials support the efficacy of MDMA in the treatment of PTSD and psilocybin in the treatment of depression and cancer-related anxiety. The research to support the use of LSD and ayahuasca in the treatment of psychiatric disorders is preliminary, although promising. Overall, the database is insufficient for FDA approval of any psychedelic compound for routine clinical use in psychiatric disorders at this time, but continued research on the efficacy of psychedelics for the treatment of psychiatric disorders is warranted.

marți, 26 ianuarie 2021

 Uscator de par BaByliss Expert Protect D362E, 2300 W, 2 viteze, 3 Trepte de temperatura, cool shot, difuzor, Negru

Uscator de par BaByliss Expert Protect D362E, 2300 W, 6 nivele de temperatura, Difuzor, Negru

Uscatorul de par Expert 2300 de la BaByliss Paris este cel mai puternic din gama Expert. Pentru un par sanatos, stralucitor si care sa nu se degradeze in timp alege un beauty gadget profesionist.  Cu o viteza de 85km/h, parul tau va fi uscat in doar cateva minute si te vei bucura de mai mult timp pentru tine. Alege uscatorul de par  Dryer Expert Protect 2300 pentru performanta profesionala un timp indelungat.

Dotat cu un motor profesional, acesta asigura o viteza mare de uscare si rezultate de coafare perfecte. Performanta exceptionala a uscatorului este sporita de functia Turbo, care accelereaza puterea de uscare a acestuia, reducand in acelasi timp consumul de energie cu 25%. Te bucuri astfel de rezultate ca la salon, in propria casa. Si eficient si economic, ce iti poti dori mai mult de la un uscator de par?

Viteza si caldura pot fi ajustate usor pentru a crea stilul perfect. Foloseste functia de aer rece la finalul uscarii parului pentru o mai buna fixare a coafurii.

Uscatorul de par Dryer Expert Protect 2300 are un filtru in partea din spate care poate fi scos pentru curatare. In plus, acesta fereste prinderea parului in uscator. Recomandarea noastra este ca periodic sa scoateti si sa curatati regulat filtrul, pentru a preveni acumularile.

Uscatorul Dryer Expert Protect D362E vine in pachet cu 2 accesorii. Duza de 10 mm concentreaza fluxul de aer cald pentru o uscare si o stilizare rapida, iar difuzorul te ajuta sa obtii volum si sa iti definesti buclele naturale.
Consum redus

Dotat cu un motor profesional si avand o viteza de uscare de 85km/h, parul tau va fi uscat si aranjat in cel mai scurt timp. Ai la dispozitie si functia Turbo care accelereaza puterea de uscare atunci cand iti doresti rezultate rapide, iar consmul de energie este redus de la 2300W la 1700W.
Filtru detsabil

Uscatorul de par Dryer Expert Protect are in componenta un filtru detasabil pentru o curatare usoara si care totodata previne prinderea parului in timpul utilizarii.


Perie rotativa BaByliss 2735E, 1000W, Ionizare, 4 Accesorii, 2 Setari temperatura/viteza, Cool-Shot, geanta depozitare, Negru

Perie rotativa BaByliss 2735E, 1000W, Ionizare, 4 Accesorii, 2 Setari temperatura/viteza, Cool-Shot, geanta depozitare, Negru

Peria rotativa BeLiss brushing 1000W este un must-have pentru orice fata! Iti usuci si aranjezi parul asa cum iti doresti in acelasi timp, cu minim de efort chiar la tine acasa. Datorita tehnologiei de ultima generatie nu mai este nevoie sa apelezi la un salon de specialitate, deoarece poti obtine aceleasi rezultate cu usurinta, acasa!Design modern pentru utilizare usoara.

Datorita designului modern, compact si a manerului subtire si ergonomic, peria rotativa BeLiss Brushing 1000W 2735E este foarte usor de utilizat. Astfel, obtii un look de revista cu minim de efort!

4 accesorii pentru coafuri creative.

Peria rotativa BabyLiss vine cu patru accesorii foarte utile:

• difuzor pentru uscarea parului;
• perie rotativa de 50mm pentru volum;
• capat pentru indrpetare;
• perie pentru finisare.

In plus, primesti o geanta de depozitare inclusa in pachet! Astfel, fiecare accesoriu este protejat.

Tehnologie avansata pentru rezultate de durata.

Dubla directie de rotatie te ajuta sa obtii un look natural, care sa ti se potriveasca: intoarce-ti varfurile spre  interior sau spre exterior, in functie de stilul pe care doresti sa il adopti.

Functia ionica elimina efectul static, astfel aspectul de par electrizat dispare iar parul tau devine matasos si lucios!

Incearca si tu inovatia BaByliss!
Functie Ionica

Cu ajutorul functiei ionice iti vei putea aranja parul simplu si usor, aceasta eliminand electricitatea statica prin eliberarea de ioni negativi si conferind stralucire parului. Invelisul ceramic ajuta la distribuirea uniforma a temperaturii pentru o coafare ca la salon!
Dubla directie de rotatie

Peria rotativa Beliss Brushing 2735E dispune de dubla directie de rotatie, astfel ca o poti utiliza cu usurinta spre interior sau exterior. Peria se roteste in mod automat, conferind volum parului in timp ce este uscat. Peria rotativa este perfecta pentru orice tip de par, avand doua viteze si doua trepte de temperatura care se pot ajusta in functie de tipul tau de par.
4 Accesorii incluse

Peria Rotativa Beliss Brushing are 4 tipuri de accesorii cu care iti poti usca, indrepta si coafa parul. Cele 4 accesorii sunt: difuzor pentru uscare, perie rotativa de 50 mm pentru volum, capat pentru indreptare si perie pentru finisare.
Cablu rotativ 360°

Cablul rotativ faciliteaza o utilizare usoara, indiferent de pozitia in care tii peria rotativa. Astfel, cablul nu iti sta in cale, iar tu te coafezi cu usurinta si confort maxim!
Functie Aer Rece

Peria rotativa Beliss Brushing 2735E dispune de functie de aer rece pentru fixarea finala a coafurii

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