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Premature Termination of Treatment among Adults Attending Treatment for Eating Disorders: A Critical Review

Open Journal of Medical Psychology 2020年第3期9卷 123-140页

作者： Flávia Machado Seidinger-Leibovitz Adams Rodrigues Malta Larissa Rodrigues Rodrigo Almeida Bastos pedro augusto thiene leme Daniela Ferreira Araújo Silva Egberto Ribeiro Turato Carla Maria Vieira Department of Medical Psychology and Psychiatry School of Medical Sciences State University of Campinas Campinas Brazil Department of Obstetrics and Gynecology School of Medical Sciences State University of Campinas Campinas Brazil Department of Health Sciences and Pediatric Dentistry Piracicaba Dental School State University of Campinas Piracicaba Brazil Federal University of Sã o Paulo Department of Preventive Medicine S&#227 o Paulo Brazil Science and Technology Center in Sovereignty and Food Security/Institute of Bioscience S&#227 o Paulo State University (UNESP) Botucatu S&#227 o Paulo Brazil

The article presents a critical review regarding the premature termination of eating disorder’s treatment among inpatients and outpatients, with the aim of identifying—emotional, psychodynamic and family-related aspects involved. The search strategy used the following MeSH terms combined by Boolean operators: “eating disorders” AND “treatment” OR “patient dropouts” OR “drop-out/dropouts” OR “attrition” OR “premature termination” AND “empirical study” OR “qualitative research”, for on Medline/PUBMED, PsycINFO and EMBASE databases. This article follows the PRISMA Guidelines. A total of 26 studies composed this review, of which 24 were original research articles, 1 was a review and 1 a theoretical article. Only two articles applied qualitative methods analyzing categories of content obtained by in-depth interviews, three combine quantitative and qualitative methods and other three present qualitative analyses while discussing quantitative studies. Further qualitative studies should be carried out to clarify meanings of dropout, premature termination of treatment, and attrition. Different expectations held by patients and by therapeutic teams, and the interpersonal difficulties of these types of patients, stand out as difficulties in constructing “therapeutic alliances”, with impacts on dropout, premature termination and attrition rates.

关键词： Eating Disorders Adults Patient Dropouts Attrition Premature Termination of Treatment Inpatients Outpatients

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Immunomodulatory effects of anesthetics in obese patients

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World Journal of Critical Care Medicine 2017年第3期6卷 140-152页

作者： Luciana Boavista Barros Heil pedro leme Silva Paolo Pelosi Patricia Rieken Macedo Rocco Laboratory of Pulmonary Investigation Carlos Chagas Filho Institute of Biophysics Federal University of Rio de Janeiro Centro de Ciências da Saúde Department of Surgical Sciences and Integrated Diagnostics IRCCS AOU San Martino-IST University of Genoa

Anesthesia and surgery have an impact on inflammatory responses, which influences perioperative homeostasis. Inhalational and intravenous anesthesia can alter immune-system homeostasis through multiple processes that include activation of immune cells(such as monocytes, neutrophils, and specific tissue macrophages) with release of pro-or anti-inflammatory interleukins, upregulation of cell adhesion molecules, and overproduction of oxidative radicals. The response depends on the timing of anesthesia, anesthetic agents used, and mechanisms involved in the development of inflammation or immunosuppression. Obese patients are at increased risk for chronic diseases and may have the metabolic syndrome, which features insulin resistance and chronic low-grade inflammation. Evidence has shown that obesity has adverse impacts on surgical outcome, and that immune cells play an important role in this process. Understanding the effects of anesthetics on immune-system cells in obese patients is important to support proper selection of anesthetic agents, which may affect postoperative outcomes. This review article aims to integrate current knowledge regarding the effects of commonly used anesthetic agents on the lungs and immune response with the underlying immunology of obesity. Additionally, it identifies knowledge gaps for future research to guide optimal selection of anesthetic agents for obese patients from an immunomodulatory standpoint.

关键词： Anesthesia Immune system Perioperative care Obesity Inflammation

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