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Prior desensitization can significantly allay anxiety about medical procedures A dry run can be done to reinforce the oral description Cooperation during acute problem periods can be enhanced by the use of appropriate reinforcers such as a favorite nurse or helpful family member People who are positive reinforcers are even more helpful during the intermediate phases when the patient becomes resistant to the seemingly endless procedures (eg, debridement of burned areas) Specific situations (eg, psychological dependency on the respirator) can be corrected by weaning with appropriate reinforcers (eg, watching a favorite movie on a videorecorder when disconnected from the ventilator) Behavioral approaches should be used in a positive and optimistic way for maximal reinforcement Relaxation techniques and attentional distraction can be used to block side effects of a necessary treatment (eg, nausea in cancer chemotherapy)

A change in environment requires adaptation Because of the illness, admission and hospitalization may be more easily handled than discharge Reintegration into society can be difficult In some cases, the family is a negative influence A predischarge evaluation must be made to determine whether the family will be able to cope with the physical or mental changes in the patient Working with the family while the patient is in the acute stage may presage a successful transition later on Development of a new social life can be facilitated by various self-help organizations (eg, the stoma club) Sharing problems with others in similar circumstances eases the return to a social life, which may be quite different from that prior to the illness

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Prepare the patient and family for what is to come This includes the types of units where the patient will be quartered, the procedures that will be performed, and any disfigurements that will result from surgery Repetition improves understanding The nursing staff can be helpful, since patients

Condition types are used to define pricing elements such as prices, discounts, surcharges, or taxes Should you wish to make any alteration to the condition type or assign a new access sequence to an existing condition type, copy the condition type that represents the nearest outcome you are after and change its key to begin with the letter Z Then proceed to change the condition type to suit your needs Following are a number of useful SAP standard condition types one may use to copy from:

The prognosis is good in all patients who have reversible medical and surgical conditions It is guarded when there is

Whooley MA Depression and cardiovascular disease: healing the broken hearted JAMA 2006 Jun 28;295(24):2874 81 [PMID: 16804154]

serious functional loss that impairs vocational, educational, or societal possibilities especially in the case of progressive and ultimately life-threatening illness

Ciechanowski P et al Influence of patient attachment style on self-care and outcomes in diabetes Psychosom Med 2004 Sep Oct;66(5):720 8 [PMID: 15385697] Hogarth DK et al Management of sedation in mechanically ventilated patients Curr Opin Crit Care 2004 Feb;10(1):40 6 [PMID: 15166848]

Specific information regarding psychiatric disorders in geriatric patients appears in CMDT Online at http://www accessmedicinecom (See also 4)

Hormones exert their effects by interacting with receptors on the cell surface (catecholamines and peptide hormones) or in the cytoplasm and nucleus (thyroid and steroid hormones) An endocrine disorder results from deficient or excessive hormone levels Hormone deficiencies are typically caused by reduced hormonal secretion, either from damaged endocrine glands or from congenitally absent or dysfunctional endocrine glands Some endocrine deficiencies are caused by target tissue resistance or by congenital secretion of an inactive hormone (rare) Syndromes due to excessive hormone secretion are usually caused by tumors (benign or malignant) or hyperplasia of endocrine glands, by ectopic secretion of hormones by other tumors, or (rarely) by congenital constituent activation of target organ receptors

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