Download or read book Sevrage en benzodiaz pines hypnotiques et sujet g written by Emilie Debaure and published by . This book was released on 2012 with total page 394 pages. Available in PDF, EPUB and Kindle. Book excerpt: Introduction : En France, l'insomnie et sa prise en charge par le recours aux benzodiazépines hypnotiques, constitue un problème de santé publique avec une sur- prescription plaçant la France second pays européen consommateur après la Suède. Cette consommation croît avec l'âge avec en 2007 une prévalence estimée à 32% chez les plus de 65 ans et une durée médiane de traitement de 7 mois. Une consommation chronique chez le sujet âgé fait pencher la balance bénéfices/risques en faveur des risques. L'HAS a donc participé en 2006 à l'élaboration de recommandations pour sevrer les plus de 65 ans. En 2010, une FMC s'est efforcée d'amener les médecins généralistes à appliquer ces recommandations grâce à un protocole de prise en charge validé par les anglo-saxons, et de permettre l'autoévaluation de leur pratique 3 mois plus tard. Objectif : Décrire l'auto-évaluation des pratiques en médecine générale après la formation. Méthode : Etude qualitative descriptive par un entretien de groupe ou « focus group » constitué de 9 médecins généralistes installés ayant suivi la formation et volontaires à appliquer le protocole proposé. Résultats : La formation a été nécessaire aux médecins généralistes pour acquérir des compétences avec en conséquence une diminution de leur prescription d'hypnotiques et une assurance dans la prise en charge de l'insomnie. Globalement, les médecins ont été plus systématiques et se sont posés plus souvent la question du sommeil. L'application du protocole avec ses consignes a suscité un intérêt général notamment à travers les outils apportés par la formation. Il a fourni un cadre aux médecins qui l'ont cependant considéré trop rigide et contraignant. En effet, de nombreux freins ont été identifiés: consultations chronophages, investissement en temps et en énergie, manque à gagner (paiement à l'acte), freins propres aux outils (complexité, ergonomie, nombre important) et au patient (âge, co- morbidités, investissement de l'hypnotique, coût, tricherie dans le remplissage des outils, manque de motivation). Ceci étant, le protocole reste exploitable car il a été réalisé dans sa globalité par les médecins et a abouti à des sevrages. Le principal facteur identifié favorisant ce sevrage est la motivation du patient et le facteur limitant est surtout représenté par l'investissement du patient pour son hypnotique (résistance). Les outils sont la principale source de motivation des médecins (ludiques), mais trop nombreux et parfois complexes (difficultés de compréhension). L'agenda du sommeil, outils de référence, apparaît simple et objectif. Discussion : La formation et la maitrise des outils mis à disposition apparaissent finalement plus important que le protocole en lui-même dans la prise en charge du sevrage. L'amélioration des pratiques nécessite donc une formation efficace. Il reste à savoir si les médecins formés obtiennent significativement plus de sevrages que s'ils ne l'étaient pas ?
Download or read book Sevrage des benzodiaz pines et apparent s vis e hypnotique chez le sujet g written by Stéphanie Marchand and published by . This book was released on 2014 with total page 60 pages. Available in PDF, EPUB and Kindle. Book excerpt: Introduction : En raison du niveau élevé de consommation chronique des BZD et Z à visée hypnotique et des risques potentiels surtout chez la personne âgée, la HAS a élaboré des recommandations en 2007 pour faciliter le sevrage de ces molécules. L’objectif de ce travail était de savoir si ces recommandations sont facilement applicables en pratique quotidienne par les médecins généralistes picards et de déterminer les éventuelles difficultés qu’ils peuvent rencontrer. Méthode : Un questionnaire a été envoyé à 600 médecins généralistes de Picardie dans le but de faire un état des lieux du suivi de ces recommandations. Résultats : 129 médecins ont répondu (21,5%). 94% trouvent que le sevrage des BZD et Z en ambulatoire est difficile alors même qu’ils sont convaincus de l’intérêt du sevrage à 85%. Seulement 22% des médecins interrogés pensent que les recommandations sont réellement applicables sur le terrain. Les principales difficultés rencontrées par les praticiens sont le refus des patients et leur méconnaissance des dangers des BZD, le profil du patient âgé, la dépendance au traitement, le manque d’alternatives médicamenteuses efficaces et dénuées d’effets indésirables, le problème de recours aux mesures d’accompagnement non médicamenteuses et l’organisation fastidieuse et chronophage du sevrage. Discussion : Devant ces difficultés, il semble important de pouvoir agir en amont, par plus de campagnes d’information du grand public, par l’amélioration des formations initiales et continues des médecins sur la prise en charge de l’insomnie du sujet âgé, par le renforcement de l’éducation des patients, par une meilleure évaluation de la balance bénéfice-risque d’une primoprescription de BZD et par la réalisation systématique d’un contrat de traitement initial. Il faudrait également que les généralistes puissent proposer plus souvent aux patients des consultations dédiées au sevrage et mieux les encadrer dans le processus de décroissance progressive des doses. Conclusion : Le sevrage des BZD en médecine générale est réalisable, mais ne semble pas être une tâche aisée en pratique quotidienne. Les recommandations de la HAS constituent un support incontestable, mais il faut pouvoir les adapter à l’activité professionnelle ambulatoire des généralistes ainsi qu’à chaque patient, ce qui n’est pas toujours évident. Cela implique notamment pour le médecin, une certaine motivation, du savoir-faire et un investissement en temps. Enfin, le patient aura plus de chances d’accepter la proposition de sevrage s’il a reçu une information globale dès le début de son traitement.
Download or read book DEPENDANCES ET SYNDROME DE SEVRAGE AUX BENZODIAZEPINES UTILISEES COMME ANXIOLYTIQUES ET HYPNOTIQUES written by ANNE-MARIE.. DORIN and published by . This book was released on 1987 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book V cu des propositions de sevrage en benzodiaz pines et apparent en soins primaires par le patient majeur consommateur chronique d hypnotiques et ou d anxiolytiques written by Lylia-Laure Lucenay and published by . This book was released on 2019 with total page 198 pages. Available in PDF, EPUB and Kindle. Book excerpt: INTRODUCTION : seuls 25 % des sujets acceptent un sevrage de leur traitement par BZDA à l'issu d'une proposition d'arrêt. Notre objectif est d'explorer le vécu de cette sollicitation. MÉTHODE : étude qualitative de 12 entretiens de patients majeurs suivis en soins primaires, dans les Hauts-de-Seine et le Val d'Oise, pour des troubles du sommeil ou anxieux, dont le traitement par BZDA est plus long que recommandé. Analyse thématique et de contenu, avec catégorisation puis théorisation sur le modèle de la théorie ancrée. RÉSULTATS : 4 thèmes et 23 sous-thèmes ont été exposés. La sensibilisation à l'exposition prolongée des BZDA est un discours péjoratif, attisée par de multiples solliciteurs. L'accueil d'une échéance est source de bousculement. Cette sollicitation influe sur la posture du patient dans le suivi et sur la relation médecin-patient. Les freins à cette démarche sont imputables au système de santé, à l'individu et à son attachement médicamenteux. Les changements attendus par les patients passent par une meilleure gestion de leur pathologie afin d'influer sur leur vécu actuel. Ils souhaitent davantage une réévaluation de leur parcours de soins qu'un sevrage de leur traitement. CONCLUSION : une autre vision du soin semble être attendue par les patients. Construite sur une pratique moins médicamenteuse. Elle ferait une part plus importante aux mesures d'accompagnement comme l'entretien motivationnelle, la psychoéducation et la promotion d'alternatives non médicamenteuses.
Download or read book Substance Abuse and Physical Disability written by Allen W. Heinemann and published by Routledge. This book was released on 1993 with total page 320 pages. Available in PDF, EPUB and Kindle. Book excerpt: Until now, there was virtually no literature available on this dual problem of physical disability and substance abuse. Substance Abuse and Physical Disability brings together these topics to provide readers with the vital information necessary to understand the significant challenges, risks, and threats that substance abuse and chemical dependency pose for the physically disabled. This seminal book provides the materials needed by professionals to understand the context of substance abuse in the lives of persons with disabilities, identify chemical dependency problems, and implement effective treatment strategies. Covering an important but often overlooked area, this book enables rehabilitation professionals to treat their substance abusing clients more effectively. This resourceful book is divided into three sections, discussing the context, issues, and problems of substance abuse; causes, types, and prevalence of substance abuse; and assessment, treatment, and prevention issues. This thorough coverage includes chapters addressing medical complications and prescription medication issues in rehabilitation; pain management; consequences of alcohol and drug problems following physical disability; and a review of assessment and treatment issues to help rehabilitation workers select chemical dependency treatment programs. Chapters also describe the establishment of a chemical dependence program at a facility for the physically disabled, and strategies to engage families in chemical dependency treatment. Full of helpful, practical information, Substance Abuse and Physical Disability is an invaluable guide for all rehabilitation professionals as well as physicians, nurses, psychologists, vocational rehabilitation counselors, and allied health therapists. Substance abuse counselors and chemical dependency professionals will find much useful information on helping persons who have mobility, sensory, and communication limitations.
Download or read book Circadian Rhythm Sleep Wake Disorders written by R. Robert Auger and published by Springer Nature. This book was released on 2020-05-26 with total page 251 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book resolves to bridge the communication gap between research and clinical practice for circadian rhythm sleep-wake disorders. Beginning with a scientific background on biological timekeeping, opening chapters describe the crucial nature of maintaining delicate temporal organization of physiological and molecular events within the body. Following this are discussions on circadian physiology and methods of circadian assessments. Subsequent chapters then relay comprehensive information regarding the International Classification of Sleep Disorders-defined circadian rhythm sleep-wake disorders (CRSWDs), specifically discussing etiology and epidemiology, but focusing on evidence-based treatment data. Concluding discussions provide guidance for the application of light therapy and discuss future roles for optimized lighting environments. Nuanced and market-demanded, Circadian Rhythm Sleep-Wake Disorders: An Evidence-Based Guide for Clinicians and Investigators is an invaluable resource for Sleep Medicine clinicians, circadian researchers, and other interested parties.
Download or read book Clinical Guide to the Diagnosis and Treatment of Mental Disorders written by Michael B. First and published by John Wiley & Sons. This book was released on 2010-02-08 with total page 566 pages. Available in PDF, EPUB and Kindle. Book excerpt: Two key challenges face mental health practitioners: making the correct psychiatric diagnosis and choosing the most appropriate treatment option. This book aims to help with both. Clinical Guide to the Diagnosis and Treatment of Mental Disorders - Second Edition combines clinically-relevant information about each of theDSM-IV-TR diagnoses with clear, detailed information on treatment options, giving full clinical management advice. Once again, the editors, both leading psychiatrists, have condensed the chapters on Disorders from Tasman et al’s acclaimed two volume textbook of Psychiatry (now in its Third Edition), retaining only the content they deem particularly relevant to the clinician for ease of use. Each disorder is discussed under the headings of Diagnosis (including Assessment Issues, Comorbidity, Course, and Differential Diagnosis, giving diagnostic decision trees where relevant) and Treatment (listing all therapeutic options, giving practical advice for patient management, summarising treatment specifics with tables and treatment flowcharts). The original edition established itself as the first point of reference for any clinician or mental health practitioner needing expert advice on therapeutic options for any psychiatric disorder. This edition features an additional chapter on the psychiatric interview and assessment of mental status to increase its utility. It echoes the progress in psychiatry regarding the establishment of an evidenced-based model of taxonomy, diagnosis, etiology, and treatment. Indeed, from a psychologist's perspective, the equal consideration provided to empirically supported psychosocial treatments versus somatic treatment is a significant development in the field of psychiatry. Jonathan Weinand in PsycCritiques, the American Psychological Association Review of Books
Download or read book Goodman and Gilman s Manual of Pharmacology and Therapeutics written by Louis Sanford Goodman and published by McGraw Hill Professional. This book was released on 2008 with total page 1232 pages. Available in PDF, EPUB and Kindle. Book excerpt: Put the authority of Goodman & Gilman's in the palm of your hand! 5 STAR DOODY'S REVIEW! "...the most authoritative and trusted source of pharmacological information, has now spawned a portable pocket drug guide....This manual extracts the essential core drug information from the eleventh edition of the parent book, referring the reader to the online version of the parent book for historical aspects, many chemical and clinical details, and additional figures and references. This makes G & G a very useful book. This will be of use to individuals in training or practice in the fields of pharmacy, medicine, nursing, or allied health disciplines where knowledge of drug actions are important....Each chapter provides the core essential information provided in the parent book in a very readable format. Readers can use this easy to handle and read manual for essential information along with the online version of the parent book as a reference for more in-depth specific information on drugs."--Doody's Review Service The Goodman & Gilman Manual of Pharmacology and Therapeutics offers the renowned content of Goodman & Gilman's Pharmacological Basis of Therapeutics, Eleventh Edition, condensed into an ultra-handy, streamlined reference. More than just a pocket drug guide, this indispensable resource offers: A carry-along source of essential fundamental information, with all the authority of Goodman & Gilman's Pharmacological Basis of Therapeutics, Eleventh Edition The benefits of the world's leading pharmacology text in a convenient, portable format Comprehensive, yet streamlined and clinically relevant coverage of the pharmacological basis of therapeutics High-yield overview of pharmacokinetics, pharmacodynamics, and the foundations of pharmacology Expert insights into the properties, mechanisms, and uses of all the major drug classes Considerations of vital patient-specific issues
Download or read book Gabbard s Treatments of Psychiatric Disorders written by Glen O. Gabbard and published by American Psychiatric Pub. This book was released on 2014-05-05 with total page 1250 pages. Available in PDF, EPUB and Kindle. Book excerpt: The definitive treatment textbook in psychiatry, this fifth edition of Gabbard's Treatments of Psychiatric Disorders has been thoroughly restructured to reflect the new DSM-5® categories, preserving its value as a state-of-the-art resource and increasing its utility in the field. The editors have produced a volume that is both comprehensive and concise, meeting the needs of clinicians who prefer a single, user-friendly volume. In the service of brevity, the book focuses on treatment over diagnostic considerations, and addresses both empirically-validated treatments and accumulated clinical wisdom where research is lacking. Noteworthy features include the following: Content is organized according to DSM-5® categories to make for rapid retrieval of relevant treatment information for the busy clinician. Outcome studies and expert opinion are presented in an accessible way to help the clinician know what treatment to use for which disorder, and how to tailor the treatment to the patient. Content is restricted to the major psychiatric conditions seen in clinical practice while leaving out less common conditions and those that have limited outcome research related to the disorder, resulting in a more streamlined and affordable text. Chapters are meticulously referenced and include dozens of tables, figures, and other illustrative features that enhance comprehension and recall. An authoritative resource for psychiatrists, psychologists, and psychiatric nurses, and an outstanding reference for students in the mental health professions, Gabbard's Treatments of Psychiatric Disorders, Fifth Edition, will prove indispensable to clinicians seeking to provide excellent care while transitioning to a DSM-5® world.
Download or read book Orthogeriatrics written by Paolo Falaschi and published by Springer Nature. This book was released on 2021 with total page 355 pages. Available in PDF, EPUB and Kindle. Book excerpt: This new open access edition supported by the Fragility Fracture Network aims at giving the widest possible dissemination on fragility fracture (especially hip fracture) management and notably in countries where this expertise is sorely needed. It has been extensively revised and updated by the experts of this network to provide a unique and reliable content in one single volume. Throughout the book, attention is given to the difficult question of how to provide best practice in countries where the discipline of geriatric medicine is not well established and resources for secondary prevention are scarce. The revised and updated chapters on the epidemiology of hip fractures, osteoporosis, sarcopenia, surgery, anaesthesia, medical management of frailty, peri-operative complications, rehabilitation and nursing are supplemented by six new chapters. These include an overview of the multidisciplinary approach to fragility fractures and new contributions on pre-hospital care, treatment in the emergency room, falls prevention, nutrition and systems for audit. The reader will have an exhaustive overview and will gain essential, practical knowledge on how best to manage fractures in elderly patients and how to develop clinical systems that do so reliably.
Download or read book Sleep Medicine written by Teofilo Lee-Chiong and published by Oxford University Press. This book was released on 2008-04-24 with total page 714 pages. Available in PDF, EPUB and Kindle. Book excerpt: "Sleep Medicine: Essentials and Review can be used both as a text for managing sleep disorders and as a review for preparing for the Sleep Medicine Certification Examination and the Board of Registered Polysomnographic Technologists Examination. Dr. Teofilo Lee-Chiong also includes over 600 board-type multiple choice questions with answers and explanations." "This book will be valuable to sleep specialists, pulmonologists, neurologists, psychiatrists, internists, family practice physicians, otolaryngologists, respiratory therapists, nurses, sleep technologists, and other health providers interested in learning more about sleep neurophysiology and sleep disorders." --Book Jacket.
Download or read book Refractory Status Epilepticus written by Xuefeng Wang and published by Springer. This book was released on 2017-09-05 with total page 340 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book aims to offer the accumulated fertile experience of treating drug-resistant epileptic patients collected over the past few decades, focusing on aspects of neurology, neurosurgery, emergency care, critical care medicine and basic medical research. Refractory status epilepticus is one of the most common severe and acute diseases in neurology and neurocritical care; it is also the main cause of death in epileptic patients. In the context of prevention and treatment processes, it is not only necessary to terminate epileptic seizures, but to also address the disruption of the patient’s internal environment and provide critical life support. Effective treatment calls for multi-disciplinary support from neurology, neurosurgery, emergency care, critical care medicine, and other fields. Further, since the clinical features of epileptic seizure are not specific, it is necessary to differentiate it from other diseases that produce convulsions, disorders of consciousness, syncope, mental and behavioral disorders, myoclonus, etc., to avoid misdiagnosis. In this book, it comprehensively and systematically describes the basic knowledge as well as prevention and treatment tips, providing an invaluable reference resource for medical students and professionals in neurology, neurosurgery, emergency care and critical care medicine.
Download or read book Manometric Diagnosis of Gastrointestinal Motility Disorders written by Juan-Ramón Malagelada and published by Thieme Medical Publishers. This book was released on 1986 with total page 168 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Prediction of Percutaneous Penetration written by R. C. Scott and published by . This book was released on 1991 with total page 666 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Seizures written by Norman Delanty and published by Springer Science & Business Media. This book was released on 2002 with total page 392 pages. Available in PDF, EPUB and Kindle. Book excerpt: Seizures are frightening events. They frighten the patients who experience them; they frighten those who witness them; they also frighten many physicians who have to deal with them. Most individuals with seizures present to family physicians or to emergency room physicians. However, despite the fact that seizures are among the most common neurological conditions, most general practitioners, family practice specialists, and intemists do not see large numbers of patients with seizures. Given the apoplectic appearance of generalized tonic clonic convulsions, it is not difficult to understand why they arouse such emotional responses in those that experience them, those that witness them, and those whose care is sought for them. Seizures are symptoms of something wrong with the brain. Many different kinds of perturbations in brain anatomy, chemistry, or physiology can produce seizures. For many individuals, seizures occur in the context of an acute illness and will not recur once that illness is treated. These individuals do not have epilepsy. They have transient disturbances in brain function attributable to systemic medical conditions. It is important to recognize these issues, because, first, the seizure may be the initial, or even only, manifestation of the underlying medical problem and this needs to be recognized.
Download or read book European Journal of Toxicology written by and published by . This book was released on 1972 with total page 508 pages. Available in PDF, EPUB and Kindle. Book excerpt:
