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http://projects.csail.mit.edu/courseware/?term=gre-essay-scoring gre essay scoring Ringer i. Introduction. Extremely low birth weight (elbw. Birth weight <1,000 g) infants are a unique group of patients in the newborn intensive care unit (nicu). Because these infants are so physiologically immature, they are extremely sensitive to small changes in respiratory management, blood pressure, fluid administration, nutrition, and virtually all other aspects of care. The optimal way to care for these infants ultimately will be established by ongoing research. However, the most effective care based on currently available evidence is best ensured through the implementation of standardized protocols for the care of the elbw infant within individual nicus. Our approach is outlined in table 13.1. Unifonnity of approach within an institution and a commitment to provide and evaluate care in a collaborative manner may be the most important aspects of such protocols. Ii. Prenatal considerations. If possible, extremely premature infants should be delivered in a facility with a high-risk obstetrical service and a level iii nicu. The safety of maternal transport must be weighed against the risks of infant transport (see chap. 17). Prenatal administration of glucocorticoids to the mother, even if there is no time for a full course, reduces the risk of respiratory distress syndrome (rds) and other sequelae of prematurity.

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thesis hepatoprotective activity »» contraindications ht should not be prescribed to women with a history of or active thromboembolic disease, breast cancer or estrogen-dependent neoplasm, pregnancy, liver disease, or undiagnosed vaginal bleeding. It also should not be used for the prevention or treatment of cardiovascular disease, cerebrovascular disease, or dementia. 3 »» methods of administration cyclic estrogen and progestogen  estrogen is administered daily, and progestogen is administered for 12 to 14 days of the month. The disadvantage of this method of administration is the return of monthly menses in approximately 90% of women 1 to 2 days following the last progestogen dose. Women may view this scheduled bleeding as an advantage to this method of administration as it limits spotting or soiling of undergarments. Continuous combined estrogen and progestogen estrogen and progestogen are administered daily and result in endometrial atrophy. Therefore, women do not experience a withdrawal bleed but may experience unanticipated breakthrough bleeding or spotting during the month. Although this may sound more appealing than a withdrawal bleed, women may view the unpredictable bleeding or spotting as a disadvantage to this type of administration. If bleeding persists beyond 6 to 12 months, women should seek medical attention to rule out endometrial hypertrophy or carcinoma. »» low-dose ht there is an increasing body of evidence proving the effectiveness of low-dose ht regimens in the management of menopausal symptoms. Several trials demonstrated that lower doses of conjugated equine estrogen (cee) ± medroxyprogesterone acetate (mpa) (cee 0. 45 mg or 0. 3 mg ± mpa 2. 5 mg or 1. 5 mg) decreased hot flashes comparable with standard ht, improved vulvovaginal atrophy, increased bone mineral density (bmd) at the spine and hip, and provided sufficient endometrial protection. 17–20 currently, no data are available on the effects of low-dose ht on the incidence of vte, breast cancer, or chd. Although many women have switched to low-dose ht, time will tell if lower doses translate into lower risks. »» bioidentical ht bioidentical hormones are exogenous hormones that are identical to those produced in a woman’s body (eg, estradiol, estrone, estriol, and progesterone). They are either commercially manufactured or chemically compounded in pharmacies into formulations such as topical creams, gels, and suppositories. The commercially manufactured prescription products are subject to regulation by the fda and have been tested for potency, purity, efficacy, and safety (see table 50–1). Conversely, pharmacistcompounded formulations are not subject to the same regulations and therefore, the efficacy and safety may be questionable. Often women view bioidentical hormones, particularly the pharmacist-compounded formulations, as “natural” and assume these formulations are safer than currently marketed prescription hormone products. Women may feel more comfortable using compounded products that are formulated based on individual hormone levels. However, due to a lack of regulation, these products may potentially cause more harm than benefit. In addition, pharmacist-compounded formulations can result in higher costs, because they are generally not covered by third-party payers. There is little evidence comparing the safety and efficacy of conventional ht to prescription bioidentical ht, and thus the same risks and benefits should be assumed. 5,21 »» benefits of ht vasomotor symptoms  ht remains the most effective treatment for vasomotor symptoms, and systemic ht should be considered only in women experiencing these symptoms. Benefits must outweigh risks, and decisions should be made only after careful consideration by the woman and her health care provider. If it is decided to use ht, it should be prescribed at the lowest dose that relieves or reduces menopausal symptoms and should be recommended only for short-term use (generally less than 5 years).

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