Percutaneous cholecystostomy in critically ill patients with acute cholecystitis: Complications and late outcome

International Nuclear Information System (INIS)

Atar, E.; Bachar, G.N.; Berlin, S.; Neiman, C.; Bleich-Belenky, E.; Litvin, S.; Knihznik, M.; Belenky, A.; Ram, E.

2014-01-01

Aim: To evaluate the outcome of percutaneous cholecystostomy in critically ill patients with acute cholecystitis. Materials and methods: The study group included critically ill patients who underwent percutaneous cholecystostomy for acute cholecystitis at a tertiary medical centre in 2007–2011. Data on complications, morbidities, surgical outcome, and imaging findings were collected from the medical files and radiology information system. Results: There were 48 women (59.3%) and 33 men (40.7%), with a median age of 82 years (range 47–99 years). Seventy-one (88%) had calculous cholecystitis and 10 (12%), acalculous cholecystitis. The drain was successfully inserted in all cases with no immediate major procedural complications. Fifteen patients (18.5%) died in-hospital within 30 days, mainly (93%) due to septic shock (14/15), another 20 patients (24.7%) died during the study period of unrelated co-morbidities. Of the remaining 46 patients, 36 (78.2%) had surgical cholecystectomies. In patients with acalculous cholecystitis, the drain was removed after cessation of symptoms. Transcystic cholangiography identified five patients with additional stones in the common bile duct. They were managed by pushing the stones into the duodenum via the cystostomy access, sparing them the need for surgical exploration. Conclusions: Early percutaneous gallbladder drainage is safe and effective in critically ill patients in the acute phase of cholecystitis, with a high technical success rate. Surgical results in survivors are better than reported in patients treated surgically without drainage. Bile duct stones can be eliminated without creating an additional access

The economic impact of the insured patients with severe chronic and acute illnesses: a qualitative approach

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Budi Aji

2014-10-01

Full Text Available Background: Little research has focused on the economic hardship among the insured with severe illnesses and high treatment costs, in particular, the consequence of poorer insurance coverage for high-cost illnesses. Therefore, we presented the case for identifying the experiences of insured patients with severe chronic and acute illnesses. This study identified a qualitative understanding of the economic impact of severe chronic and acute illnesses and household strategies to deal with high treatment costs. Design: Interviews were conducted with 19 insured households of three different health insurance programs with a family member that had been hospitalized for severe chronic or acute illnesses in either Banyumas or Margono Sukarjo hospitals in Banyumas, Central Java, Indonesia. A thematic analysis was applied to guide the interpretation of the data. Results: Insured households with a family member that had been hospitalized for severe chronic and acute illnesses were greatly affected by the high treatment costs. Four major issues emerged from this qualitative study: insured patients are still burdened with high out-of-pocket payments, households adopt various strategies to cope with the high cost of treatments, households experience financial hardships, and positive and negative perceptions of the insured regarding their health insurance coverage for acute and chronic illnesses. Conclusions: Askes and Jamsostek patients faced financial burdens from high cost sharing for hospital amenities, non-covered drugs, and treatments and other indirect costs. Meanwhile, Jamkesmas beneficiaries faced no financial burden for related medical services but were rather burdened with indirect costs for the carers. Households relied on internal resources to cover hospital bills as the first strategy, which included the mobilization of savings, sale of assets, and borrowing of money. External support was tapped secondarily and included financial support from

Home treatment for acute psychiatric illness.

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Dean, C; Gadd, E M

1990-11-03

To determine the factors influencing the successful outcome of community treatment for severe acute psychiatric illnesses that are traditionally treated in hospital. All patients from a single electoral ward who were either admitted to hospital or treated at home over a two year period (1 October 1987 to 30 September 1989) were included in the study and their case notes audited. The second year of the study is reported. Electoral ward of Sparkbrook, Birmingham. 99 Patients aged 16-65 with severe acute psychiatric illness. 65 Patients were managed by home treatment alone; 34 required admission to hospital. The location of treatment was significantly (all p less than 0.05) influenced by social characteristics of the patients (marital state, age (in men), ethnicity, and living alone) and by characteristics of the referral (occurring out of hours; assessment taking place at hospital or police station). DSM-III-R diagnosis was more weakly associated with outcome. Violence during the episode was significantly related to admission, although deliberate self harm was not. Home treatment is feasible for most patients with acute psychiatric illness. A 24 hour on call assessment service increases the likelihood of success because admission is determined more strongly by social characteristics of the patient and the referral than by illness factors. Admission will still be required for some patients. A locally based mental health resource centre, a 24 hour on call service, an open referral system, and an active follow up policy increase the effectiveness of a home treatment service.

Psychodynamics in medically ill patients.

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Nash, Sara Siris; Kent, Laura K; Muskin, Philip R

2009-01-01

This article explores the role of psychodynamics as it applies to the understanding and treatment of medically ill patients in the consultation-liaison psychiatry setting. It provides historical background that spans the eras from Antiquity (Hippocrates and Galen) to nineteenth-century studies of hysteria (Charcot, Janet, and Freud) and into the twentieth century (Flanders Dunbar, Alexander, Engle, and the DSM). The article then discusses the effects of personality on medical illness, treatment, and patients' ability to cope by reviewing the works of Bibring, Kahana, and others. The important contribution of attachment theory is reviewed as it pertains the patient-physician relationship and the health behavior of physically ill patients. A discussion of conversion disorder is offered as an example of psychodynamics in action. This article highlights the important impact of countertransference, especially in terms of how it relates to patients who are extremely difficult and "hateful," and explores the dynamics surrounding the topic of physician-assisted suicide, as it pertains to the understanding of a patient's request to die. Some attention is also given to the challenges surrounding the unique experience of residents learning how to treat medically ill patients on the consultation-liaison service. Ultimately, this article concludes that the use and understanding of psychodynamics and psychodynamic theory allows consultation-liaison psychiatrists the opportunity to interpret the life narratives of medically ill patients in a meaningful way that contributes importantly to treatment.

[Acute care of critically ill children in general hospitals: organisation and training].

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van Sambeeck, S J L; Janssen, E J M; Hundscheid, T; Martens, S J L; Vos, G D

2013-01-01

To gain insight into how the acute care of critically ill children at general hospitals is organised, whether staff is sufficiently trained and whether the necessary materials and medications are present. Questionnaire combined with a site visit. Questionnaires were sent to all primarily involved specialists (emergency room specialists and paediatricians), and to the auxiliary anaesthetists and intensivists involved, at the nine general hospitals in Southeast Netherlands. Two researchers performed standardised interviews with the lead paediatricians on site and checked for materials and medication present in the emergency and paediatric departments. Of the 195 questionnaires sent, 97 (49.7%) were deemed suitable for analysis. The response from the primary specialists involved (77.6%) was more than twice that of the auxiliary specialists (31.9%). At 7 hospitals, verbal agreements on the organisation of acute care were maintained, 1 hospital had a written protocol, and 2 hospitals had a task force addressing this topic. One out of 5 respondents was unaware of the verbal agreements and 1 out of 3 mistakenly assumed that a protocol existed. Two out of 3 primary specialists involved were certified for Advanced Paediatric Life Support (APLS); 1 out of 13 of the auxiliary specialists had such a certificate. Scenario training was being conducted at 8 hospitals. A paediatric resuscitation cart was available at both the emergency and paediatric departments of 8 hospitals, 3 of which were fully stocked at both departments. Laryngeal mask airways and PEEP-valves (Positive End Expiratory Pressure) were lacking at 6 of the 9 hospitals. The medication stock was complete at all the hospitals. The organisation of and training for the acute care of critically ill children and presence of materials - the aspects we investigated - need attention at all general hospitals evaluated. It appeared that many specialists are not APLS certified and written protocols concerning organisation

Medical Student Attitudes about Mental Illness: Does Medical-School Education Reduce Stigma?

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Korszun, Ania; Dinos, Sokratis; Ahmed, Kamran; Bhui, Kamaldeep

2012-01-01

Background: Reducing stigma associated with mental illness is an important aim of medical education, yet evidence indicates that medical students' attitudes toward patients with mental health problems deteriorate as they progress through medical school. Objectives: Authors examined medical students' attitudes to mental illness, as compared with…

Opening the Door: The Experience of Chronic Critical Illness in a Long-Term Acute Care Hospital.

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Lamas, Daniela J; Owens, Robert L; Nace, R Nicholas; Massaro, Anthony F; Pertsch, Nathan J; Gass, Jonathon; Bernacki, Rachelle E; Block, Susan D

2017-04-01

Chronically critically ill patients have recurrent infections, organ dysfunction, and at least half die within 1 year. They are frequently cared for in long-term acute care hospitals, yet little is known about their experience in this setting. Our objective was to explore the understanding and expectations and goals of these patients and surrogates. We conducted semi-structured interviews with chronically critically ill long-term acute care hospital patients or surrogates. Conversations were recorded, transcribed, and analyzed. One long-term acute care hospital. Chronically critically ill patients, defined by tracheotomy for prolonged mechanical ventilation, or surrogates. Semi-structured conversation about quality of life, expectations, and planning for setbacks. A total of 50 subjects (30 patients and 20 surrogates) were enrolled. Thematic analyses demonstrated: 1) poor quality of life for patients; 2) surrogate stress and anxiety; 3) optimistic health expectations; 4) poor planning for medical setbacks; and 5) disruptive care transitions. Nearly 80% of patient and their surrogate decision makers identified going home as a goal; 38% were at home at 1 year. Our study describes the experience of chronically critically ill patients and surrogates in an long-term acute care hospital and the feasibility of patient-focused research in this setting. Our findings indicate overly optimistic expectations about return home and unmet palliative care needs, suggesting the need for integration of palliative care within the long-term acute care hospital. Further research is also needed to more fully understand the challenges of this growing population of ICU survivors.

Hand sanitizer and rates of acute illness in military aviation personnel.

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Van Camp, Roscoe O; Ortega, Hernando J

2007-02-01

Alcohol-based hand sanitizer (HS) kills most organisms that cause acute illness, an important cause of lost duty time among aviation personnel. This preliminary study observed the impact on the acute illness rate when HS was made readily accessible to pilots. Wall-mounted HS dispensers were placed in two fighter squadron operations buildings during November 2005 and various media were used to alert all base personnel to the importance of hand hygiene and cough hygiene. Data were obtained for two groups of personnel on the same base: 1) pilots who worked in the two HS-equipped buildings (Squadron) (n = 56); and 2) pilots and air traffic controllers who worked at other locations (Non-Squadron) (n = 61). The incidence of acute illness and the cumulative number of duty days lost was determined in each group for the winters of 2004-05 (no HS) and 2005-06 (HS available). For the Squadron group, the acute illness rates were 2.4% in 2004-5 (210 duty days lost) (no HS) compared with 0.9% in 2005-6 (78 duty days lost) when HS was provided. No year-to-year difference was apparent for the Non-Squadron group, where the illness rates were 2.4% in 2004-5 (229 duty days lost) and 2.3% in 2005-6 (221 duty days lost). Making HS readily available at locations frequented by pilots together with educating them regarding hand hygiene may reduce the occurrence of acute illness and number of duty days lost.

INTRA-ABDOMINAL HYPERTENSION AS A RISK FACTOR FOR ACUTE KIDNEY INJURY IN CRITICALLY ILL PATIENTS

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Sreelatha

2016-05-01

Full Text Available BACKGROUND AND AIMS Increased intra-abdominal pressure (IAP, also referred to as intra-abdominal hypertension (IAH, affects organ function in critically ill patients. The prevalence of IAH is between 32% - 65% in intensive care units. Normal IAP is ≈ 5–7 mmHg. According to WSACS definition, IAH = IAP ≥12 mmHg and is divided into 4 grades. They are Grade I (12-15 mmHg, Grade II (16-20 mmHg, Grade III (21-25 mmHg, Grade IV (>25 mmHg. Transvesical measurement of IAP currently is the most popular technique. Several systems with or without the need for electronic equipment are available that allow IAP measurement. The aim is to study the incidence of IAH in critically ill patients, to assess the risk factors for development of IAH, to study the role of IAH as a risk factor for Acute Kidney Injury (AKI, to assess the role of IAH as a risk factor for increased (Intensive Care Unit ICU mortality. SUBJECTS AND METHODS This is a prospective observational study. Study period was six months. The study included 52 patients admitted to Medical ICU in Government Medical College, Kozhikode, Kerala. RESULTS AND CONCLUSION There was a very high incidence of intra-abdominal hypertension in critically ill patients. IAH was significantly associated with risk factors like sepsis, mechanical ventilation, pancreatitis, capillary leak, ascites, cumulative fluid balance and cirrhosis. IAH is an independent risk factor for development of acute kidney injury. IAH is an independent predictor of mortality in critically ill patients.

Demographic determinants of acute gastrointestinal illness in Canada: a population study

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Horrocks Julie

2007-07-01

Full Text Available Abstract Background Gastrointestinal illness is an important global public health issue, even in developed countries, where the morbidity and economic impact are significant. Our objective was to evaluate the demographic determinants of acute gastrointestinal illness in Canadians. Methods We used data from two population-based studies conducted in select communities between 2001 and 2003. Together, the studies comprised 8,108 randomly selected respondents; proxies were used for all respondents under 12 years and for respondents under 19 years at the discretion of the parent or guardian. Using univariate and multivariate logistic regression, we evaluated the following demographic determinants: age, gender, cultural group, and urban/rural status of the respondent, highest education level of the respondent or proxy, number of people in the household, and total annual household income. Two-way interaction terms were included in the multivariate analyses. The final multivariate model included income, age, gender, and the interaction between income and gender. Results After adjusting for income, gender, and their interaction, children under 10 years had the highest risk of acute gastrointestinal illness, followed by young adults aged 20 to 24 years. For males, the risk of acute gastrointestinal illness was similar across all income levels, but for females the risk was much higher in the lowest income category. Specifically, in those with total annual household incomes of less than $20,000, the odds of acute gastrointestinal illness were 2.46 times higher in females than in males. Conclusion Understanding the demographic determinants of acute gastrointestinal illness is essential in order to identify vulnerable groups to which intervention and prevention efforts can be targeted.

Sarcopenia in cases of chronic and acute illness. A mini-review.

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Dovjak, Peter

2016-02-01

Loss of muscle mass and muscle weakness are often found in cases of acute or chronic illness in elderly patients. Sarcopenia is a risk factor for complications and higher mortality. Based on an exact diagnosis and knowledge of the risk factors for developing sarcopenia, it is now possible to improve the prognosis by providing effective treatment options. This review was carried out based on a PubMed search in the period from 1998 to 2015 using original articles and reviews and posting the terms "sarcopenia", "elderly" and "acute illness". Given the evidence from the current literature, in the case of acute illness it is feasible to identify patients at risk, diagnose sarcopenia and prescribe a multidimensional treatment program to prevent or treat sarcopenia even in the bustling environment of geriatric wards or institutions.

A patient-centered research agenda for the care of the acutely ill older patient.

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Wald, Heidi L; Leykum, Luci K; Mattison, Melissa L P; Vasilevskis, Eduard E; Meltzer, David O

2015-05-01

Hospitalists and others acute-care providers are limited by gaps in evidence addressing the needs of the acutely ill older adult population. The Society of Hospital Medicine sponsored the Acute Care of Older Patients Priority Setting Partnership to develop a research agenda focused on bridging this gap. Informed by the Patient-Centered Outcomes Research Institute framework for identification and prioritization of research areas, we adapted a methodology developed by the James Lind Alliance to engage diverse stakeholders in the research agenda setting process. The work of the Partnership proceeded through 4 steps: convening, consulting, collating, and prioritizing. First, the steering committee convened a partnership of 18 stakeholder organizations in May 2013. Next, stakeholder organizations surveyed members to identify important unanswered questions in the acute care of older persons, receiving 1299 responses from 580 individuals. Finally, an extensive and structured process of collation and prioritization resulted in a final list of 10 research questions in the following areas: advanced-care planning, care transitions, delirium, dementia, depression, medications, models of care, physical function, surgery, and training. With the changing demographics of the hospitalized population, a workforce with limited geriatrics training, and gaps in evidence to inform clinical decision making for acutely ill older patients, the identified research questions deserve the highest priority in directing future research efforts to improve care for the older hospitalized patient and enrich training. © 2015 Society of Hospital Medicine.

Attitudes toward people with mental illness among medical students

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Vijayalakshmi Poreddi

2015-01-01

Full Text Available Background: Globally, people with mental illness frequently encounter stigma, prejudice, and discrimination by public and health care professionals. Research related to medical students′ attitudes toward people with mental illness is limited from India. Aim: The aim was to assess and compare the attitudes toward people with mental illness among medical students′. Materials and Methods: A cross-sectional descriptive study design was carried out among medical students, who were exposed (n = 115 and not exposed (n = 61 to psychiatry training using self-reporting questionnaire. Results: Our findings showed improvement in students′ attitudes after exposure to psychiatry in benevolent (t = 2.510, P < 0.013 and stigmatization (t = 2.656, P < 0.009 domains. Further, gender, residence, and contact with mental illness were the factors that found to be influencing students′ attitudes toward mental illness. Conclusion: The findings of the present study suggest that psychiatric education proved to be effective in changing the attitudes of medical students toward mental illness to a certain extent. However, there is an urgent need to review the current curriculum to prepare undergraduate medical students to provide holistic care to the people with mental health problems.

Play as a mechanism of working through medical trauma for children with medical illnesses and their siblings.

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Nabors, Laura; Bartz, Jennifer; Kichler, Jessica; Sievers, Rebecca; Elkins, Rebecca; Pangallo, Jordan

2013-09-01

Children's reactions to medical trauma have been recorded through play. In this study, participants were 15 children with medical illnesses, 14 siblings of children with a medical illness, and 6 children in the community who did not have any ill family members. Children participated in play groups and their play with medical toys was videotaped and coded for themes that would provide a window on their perspectives. The play of children with medical illnesses and siblings was similar. Medical play was a mechanism for imaginal coping and working through stress related to medical experiences. In contrast, children in the comparison group did not engage in much medical play and when they did, they did not demonstrate a rich play experience with detailed medical stories. Future research should focus on ways to use play therapy techniques to help medically ill children and their siblings cope with their feelings and reactions to medical events related to chronic illness.

Can illness perceptions predict lower heart rate variability following acute myocardial infarction?

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Mary Princip

2016-11-01

Full Text Available Objective: Decreased heart rate variability (HRV has been reported to be a predictor of mortality after myocardial infarction (MI. Patients’ beliefs and perceptions concerning their illness may play a role in decreased HRV. This study investigated if illness perceptions predict HRV at three months following acute MI. Methods: 130 patients referred to a tertiary cardiology centre, were examined within 48 hours and three months following acute MI. At admission, patients’ cognitive representations of their MI were assessed using the German version of the self-rated Brief Illness Perception Questionnaire (Brief IPQ. At admission and after three months (follow-up, frequency and time domain measures of HRV were obtained from 5-min electrocardiogram (ECG recordings during stable supine resting. Results: Linear hierarchical regression showed that the Brief IPQ dimensions timeline (β coefficient = -0.29; p = .044, personal control (β = 0.47; p = .008 and illness understanding (β = 0.43; p = .014 were significant predictors of HRV, adjusted for age, gender, baseline HRV, diabetes, beta-blockers, left ventricular ejection fraction (LVEF, attendance of cardiac rehabilitation, and depressive symptoms. Conclusions: As patients’ negative perceptions of their illness are associated with lower HRV following acute MI, a brief illness perception questionnaire may help to identify patients who might benefit from a specific illness perceptions intervention.

Chikungunya as a cause of acute febrile illness in southern Sri Lanka.

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Megan E Reller

Full Text Available Chikungunya virus (CHIKV re-emerged in Sri Lanka in late 2006 after a 40-year hiatus. We sought to identify and characterize acute chikungunya infection (CHIK in patients presenting with acute undifferentiated febrile illness in unstudied rural and semi-urban southern Sri Lanka in 2007.We enrolled febrile patients ≥ 2 years of age, collected uniform epidemiologic and clinical data, and obtained serum samples for serology, virus isolation, and real-time reverse-transcriptase PCR (RT-PCR. Serology on paired acute and convalescent samples identified acute chikungunya infection in 3.5% (28/797 patients without acute dengue virus (DENV infection, 64.3% (18/28 of which were confirmed by viral isolation and/or real-time RT-PCR. No CHIKV/DENV co-infections were detected among 54 patients with confirmed acute DENV. Sequencing of the E1 coding region of six temporally distinct CHIKV isolates (April through October 2007 showed that all isolates posessed the E1-226A residue and were most closely related to Sri Lankan and Indian isolates from the same time period. Except for more frequent and persistent musculoskeletal symptoms, acute chikungunya infections mimicked DENV and other acute febrile illnesses. Only 12/797 (1.5% patients had serological evidence of past chikungunya infection.Our findings suggest CHIKV is a prominent cause of non-specific acute febrile illness in southern Sri Lanka.

Acute psychological trauma in the critically ill: Patient and family perspectives.

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Dziadzko, Volha; Dziadzko, Mikhail A; Johnson, Margaret M; Gajic, Ognjen; Karnatovskaia, Lioudmila V

2017-07-01

Post-intensive care syndrome (PICS), which encompasses profound psychological morbidity, affects many survivors of critical illness. We hypothesize that acute psychological stress during the intensive care unit (ICU) confinement likely contributes to PICS. In order to develop strategies that mitigate PICS associated psychological morbidity, it is paramount to first characterize acute ICU psychological stress and begin to understand its causative and protective factors. A structured interview study was administered to adult critical illness survivors who received ≥48h of mechanical ventilation in medical and surgical ICUs of a tertiary care center, and their families. Fifty patients and 44 family members were interviewed following ICU discharge. Patients reported a high level of psychological distress. The families' perception of patient's stress level correlated with the patient's self-estimated stress level both in daily life (rho=0.59; ptherapy/walking (14%) were perceived to be important mitigating factors. Clinicians' actions that were perceived to be very constructive included reassurance (54%), explanations (32%) and physical touch (8%). Fear, hallucinations, and the inability to communicate, are identified as central contributors to psychological stress during an ICU stay; the presence of family, and physician's attention are categorized as important mitigating factors. Patients and families identified several practical recommendations which may help assuage the psychological burden of the ICU stay. Copyright © 2017 Elsevier Inc. All rights reserved.

Nutritional status plays a crucial role in the mortality of critically ill patients with acute renal failure.

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Zhang, Haiyan; Zhang, Xiaodong; Dong, Lei

2018-02-01

We aimed to clarify associations between nutritional status and mortality in patients with acute renal failure. De-identified data were obtained from the Medical Information Mart for Intensive Care III database comprising more than 40,000 critical care patients treated at Beth Israel Deaconess Medical Centerbetween 2001 and 2012. Weight loss and body mass index criteria were used to define malnutrition. Data of 193 critically ill patients with acute renal failure were analyzed, including demographics, nutrition intervention, laboratory results, and disease severity. Main outcomes were in-hospital and 1-year mortality. The 1-year mortality was significantly higher in those with malnutrition than in those without malnutrition (50.0% vs 29.3%, p=0.010), but differences in in-hospital survival were not significant (p=0.255). Significant differences in mortality were found between those with malnutrition and without starting at the 52nd day after intensive care unit (ICU) discharge (p=0.036). No significant differences were found between men and women with malnutrition in in-hospital mortality (p=0.949) and 1-year mortality (p=0.051). Male patients requiring intervention with blood products/colloid supplements had greater risk of 1-year mortality, but without statistical significance. Nutritional status is a predictive factor for mortality among critically ill patients with acute renal failure, particularly 1-year mortality after ICU discharge. © American Federation for Medical Research (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The effect of protein intake and resistance training on muscle mass in acutely ill old medical patients - A randomized controlled trial

DEFF Research Database (Denmark)

Buhl, Sussi F; Andersen, Aino L; Andersen, Jens Rikardt

2016-01-01

admission and a daily protein supplement (18.8 g protein) and resistance training 3 times per week the 12 weeks following discharge. Muscle mass was assessed by Dual-energy X-ray Absorptiometry. Muscle strength was assessed by Hand Grip Strength and Chair Stand Test. Functional ability was assessed...... mass (unadjusted: β-coefficient = -1.28 P = 0.32, adjusted for gender: β-coefficient = -0.02 P = 0.99, adjusted for baseline lean mass: β-coefficient = -0.31 P = 0.80). The de Morton Mobility Index significantly increased in the Control Group (β-coefficient = -11.43 CI: 0.72-22.13, P = 0.04). No other...... differences were found. CONCLUSION: No significant effect on muscle mass was observed in this group of acutely ill old medical patients. High compliance was achieved with the dietary intervention, but resistance training was challenging. Clinical trials identifier NCT02077491....

Role of illness perceptions and medication beliefs on medication compliance of elderly hypertensive cohorts.

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Rajpura, Jigar R; Nayak, Rajesh

2014-02-01

Poor compliance with antihypertensive medications is one possible reason why its success in clinical trials has not been translated into everyday practice. In addition, medication noncompliance in elderly leads to increased hospitalizations, physician visits, and higher health care costs. The study assessed influence of illness perceptions and medications beliefs on medication compliance of elderly hypertensive cohorts. A cross-sectional survey research design, utilizing self-administered health surveys, was adapted to address key study objectives. Conceptualized associations among the study variables were explored to assess their individual as well as their collective impact on the medication compliance. A total of 78 (66%) study samples were found to be noncompliant with their medications. Analysis revealed that perceptions about illness and beliefs about medication jointly played a significant role in the prediction of medication compliance (F = 5.966, P compliance building in elderly populations having hypertension by incorporating the value and importance of patient perceptions of illness and medications in order to achieve desired patient outcomes.

Parent Preferences for Shared Decision-making in Acute Versus Chronic Illness.

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Tom, Dina M; Aquino, Christian; Arredondo, Anthony R; Foster, Byron A

2017-10-01

The goal of this study was to examine preferences for shared decision-making (SDM) in parents of acutely ill versus chronically ill children in the inpatient setting. Additionally, we explored the effect of parental perception of illness severity and uncertainty in illness on decision-making preference. In this cross-sectional study, we surveyed parents of children admitted to pediatric inpatient units at an academic, tertiary-care hospital. Surveys were administered in person and used validated tools to assess SDM preferences and uncertainty in illness. Descriptive statistics evaluated associations stratified by acute versus chronic illness, and multivariable analyses were performed. Of the 200 parents who participated, the majority were women (78%), Hispanic (81.5%), English speaking (73%), between 30 and 39 years old (37.5%), and had an education achievement of less than a college degree (77%). The mean age of hospitalized children was 8.1 years, and half reported a chronic illness. Most parents preferred an active (43%) or collaborative (40%) role in SDM. There was no association with SDM preference by demographics, number of previous hospitalizations, perception of illness severity, or uncertainty. However, parents of chronically ill children significantly preferred a passive role in SDM when they perceived a high level of uncertainty in illness. Most parents of hospitalized children prefer to take an active or collaborative role in SDM. However, parents of chronically ill children who perceive high levels of uncertainty surrounding their children's illness prefer a passive role, thus illustrating the complexity in decision-making among this parent population. Copyright © 2017 by the American Academy of Pediatrics.

Medical futility in the care of non-competent terminally ill patient: nursing perspectives and responsibilities.

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Scanlon, Andrew; Murphy, Maria

2014-05-01

Debate continues on the use of medical technology to prolong life independent of the quality of the outcomes. As a consequence, acute care nurses often find themselves in situations where they are asked to carry out physician's orders, in the context of a patient's deteriorating condition, which may be at odds with professional and personal ethical standards. This can cause nurses to become distressed when struggling with the ethical dilemmas involved with medical futility. This paper is a perspective on nursing considerations of our Code of Ethics and the concept of medical futility in acute nursing care. The utility of the Code is examined through a clinical vignette. A database search using the keywords medical futility and acute care limited to 2008 to 2012 and a secondary hand search of these references identified thirty journal publications. The Code of Ethics was examined via a clinical scenario pertinent to an acute environment. This paper examines the ethical principles that underpin nursing and illustrates how the code of ethics may serve as sign posts when faced with caring for a terminally ill patient that is inappropriately managed. Understanding how individual nurses may address ethical dilemmas when faced with medical futility can better enable the nurse to fulfil their role as patient advocate, health promoter and alleviator of suffering. Ongoing education and communication to decrease any ambiguity or anguish associated with a patient's impending death optimises apt outcomes. Copyright © 2012 Australian College of Critical Care Nurses Ltd. All rights reserved.

Factors influencing the pattern of malnutrition among acutely ill ...

African Journals Online (AJOL)

Factors influencing the pattern of malnutrition among acutely ill children presenting in ... height/length) measurements and z-scores calculated for the individual nutritional ... The factors associated with malnutrition included early introduction of ...

Gender roles, illness orientation and use of medical services.

Science.gov (United States)

Hibbard, J H; Pope, C R

1983-01-01

The study investigates illness orientation as a factor which may account for sex differences in the utilization of medical care. First, sex differences in the way symptoms are perceived, evaluated and acted upon (illness orientation) are analyzed. Then gender role factors which may account for sex differences in illness orientation are examined. Finally, the degree to which gender role factors and illness orientation account for sex differences in medical care utilization are assessed. The study population includes 1648 adults between the ages of 18 and 59. Medical record data covering 7 years of outpatient services are linked with survey data on the respondents. The findings show that while females are more likely to perceive symptoms than males, there is no apparent sex difference in a tendency to adopt the sick role when ill. In addition, results indicate that gender role factors such as level and type of role responsibility and concern with health are related to female though not male symptom reports. Illness orientation variables are related to rates of medical utilization for both sexes. However, it is primarily the perception of symptoms and an interest and concern with health which contributes to sex differences in utilization rates. When examining respondents who report either a very low or very high number of symptoms, sex differences in utilization rates fall below statistical significance.

Medical student attitudes about mental illness: does medical-school education reduce stigma?

Science.gov (United States)

Korszun, Ania; Dinos, Sokratis; Ahmed, Kamran; Bhui, Kamaldeep

2012-05-01

Reducing stigma associated with mental illness is an important aim of medical education, yet evidence indicates that medical students' attitudes toward patients with mental health problems deteriorate as they progress through medical school. Authors examined medical students' attitudes to mental illness, as compared with attitudes toward other medical illness, and the influence of the number of years spent in medical school, as well as of several key socio-demographic, ethnic, and cultural variables. A group of 760 U.K. medical students completed a nationwide on-line survey examining their attitudes toward patients with five conditions (pneumonia, depression, psychotic symptoms, intravenous drug use, long-standing unexplained abdominal complaints), using the Medical Condition Regard Scale (MCRS). Students were also asked whether they had completed the psychiatry rotation or had personal experience of mental disorders themselves or among their friends or family members. They were also asked about their ethnic group (using U.K. national census categories), religious affiliation, and how important religion was in their lives. Independent-samples t-tests and one-way ANOVA were used to compare differences between groups on the MCRS. Students showed the highest regard for patients with pneumonia and lowest regard for patients with long-standing, unexplained abdominal complaints. Although attitudes toward pneumonia were more positive in fifth-year students than in first-year students, attitudes toward unexplained chronic abdominal pain were worse in fifth-year students than in first-year students. Personal experience of mental health treatment, or that among family and friends, were associated with less stigmatizing attitudes. Men showed more stigmatization than women for nearly all conditions; Chinese and South Asian students showed more stigmatizing attitudes toward delusions and hallucinations than their white British counterparts. Medical students in this survey

Population distribution and burden of acute gastrointestinal illness in British Columbia, Canada

Directory of Open Access Journals (Sweden)

Fyfe Murray

2006-12-01

Full Text Available Abstract Background In developed countries, gastrointestinal illness (GI is typically mild and self-limiting, however, it has considerable economic impact due to high morbidity. Methods The magnitude and distribution of acute GI in British Columbia (BC, Canada was evaluated via a cross-sectional telephone survey of 4,612 randomly selected residents, conducted from June 2002 to June 2003. Respondents were asked if they had experienced vomiting or diarrhoea in the 28 days prior to the interview. Results A response rate of 44.3% was achieved. A monthly prevalence of 9.2% (95%CI 8.4 – 10.0, an incidence rate of 1.3 (95% CI 1.1–1.4 episodes of acute GI per person-year, and an average probability that an individual developed illness in the year of 71.6% (95% CI 68.0–74.8, weighted by population size were observed. The average duration of illness was 3.7 days, translating into 19.2 million days annually of acute GI in BC. Conclusion The results corroborate those from previous Canadian and international studies, highlighting the substantial burden of acute GI.

Acute kidney injury in critically ill child.

Science.gov (United States)

Al-Jboor, Wejdan; Almardini, Reham; Al Bderat, Jwaher; Frehat, Mahdi; Al Masri, Hazem; Alajloni, Mohammad Saleh

2016-01-01

Acute kidney injury (AKI) is a common and serious complication in patients in the Pediatric Intensive Care Unit (PICU). We conducted this study to estimate the incidence and the mortality rate of AKI in critically ill children as well as to describe some other related factors. A retrospective study was conducted at PICU of Queen Rania Abdulla Children Hospital, Amman, Jordan for the period extending from May 2011 to June 2013. The medical records of all patients admitted during this period, and their demographic data were reviewed. Patients with AKI were identified, and management and outcomes were reviewed and analyzed. AKI was evaluated according to modified RIFLE criteria. Of the 372 patients admitted to PICU, 64 (17.2%) patients developed AKI. Of these 64 patients who had AKI, 28 (43.7%) patients reached RIFLE max of risk, 21 (32.8%) patients reached injury, and 15 (23.4%) reached failure. Mean Pediatric Risk of Mortality II score at admission was significantly higher in patients with AKI than those without P <0.001. The age ranged between one month and 14 years with the median age as 5.4 year. Thirty-five (54.7%) were males. Sepsis was the most common cause of AKI. The mortality rate in critically ill children without AKI was 58.7%, whereas increased in children with AKI to 73.4%. The mortality rate in patients who received renal replacement therapy was 71.4% and was higher (81.5%) in patients who received mechanical ventilation (95%, [confidence interval (CI)] 79.3-83.4%) and was significantly higher in patients with multi-organ system dysfunction 90.3% (95%, [CI] 88.7-92.5%). The incidence of AKI in critically ill children is high and increased their mortality rate and higher mortality seen in the younger age group, especially those below one year. High mortality rate was associated with multi-organ system dysfunction and the need for mechanical ventilation.

Decision support tool for early differential diagnosis of acute lung injury and cardiogenic pulmonary edema in medical critically ill patients.

Science.gov (United States)

Schmickl, Christopher N; Shahjehan, Khurram; Li, Guangxi; Dhokarh, Rajanigandha; Kashyap, Rahul; Janish, Christopher; Alsara, Anas; Jaffe, Allan S; Hubmayr, Rolf D; Gajic, Ognjen

2012-01-01

At the onset of acute hypoxic respiratory failure, critically ill patients with acute lung injury (ALI) may be difficult to distinguish from those with cardiogenic pulmonary edema (CPE). No single clinical parameter provides satisfying prediction. We hypothesized that a combination of those will facilitate early differential diagnosis. In a population-based retrospective development cohort, validated electronic surveillance identified critically ill adult patients with acute pulmonary edema. Recursive partitioning and logistic regression were used to develop a decision support tool based on routine clinical information to differentiate ALI from CPE. Performance of the score was validated in an independent cohort of referral patients. Blinded post hoc expert review served as gold standard. Of 332 patients in a development cohort, expert reviewers (κ, 0.86) classified 156 as having ALI and 176 as having CPE. The validation cohort had 161 patients (ALI = 113, CPE = 48). The score was based on risk factors for ALI and CPE, age, alcohol abuse, chemotherapy, and peripheral oxygen saturation/Fio(2) ratio. It demonstrated good discrimination (area under curve [AUC] = 0.81; 95% CI, 0.77-0.86) and calibration (Hosmer-Lemeshow [HL] P = .16). Similar performance was obtained in the validation cohort (AUC = 0.80; 95% CI, 0.72-0.88; HL P = .13). A simple decision support tool accurately classifies acute pulmonary edema, reserving advanced testing for a subset of patients in whom satisfying prediction cannot be made. This novel tool may facilitate early inclusion of patients with ALI and CPE into research studies as well as improve and rationalize clinical management and resource use.

Cost effectiveness of enoxaparin as prophylaxis against venous thromboembolic complications in acutely ill medical inpatients: modelling study from the hospital perspective in Germany.

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Schädlich, Peter K; Kentsch, Michael; Weber, Manfred; Kämmerer, Wolfgang; Brecht, Josef Georg; Nadipelli, Vijay; Huppertz, Eduard

2006-01-01

To estimate, from the hospital perspective in Germany, the cost effectiveness of the low-molecular-weight heparin (LMWH) subcutaneous enoxaparin sodium 40 mg once daily (ENOX) relative to no pharmacological prophylaxis (NPP) and relative to subcutaneous unfractionated heparin (UFH) 5,000 IU three times daily (low-dose UFH [LDUFH]). Each is used in addition to elastic bandages/compression stockings and physiotherapy in the prevention of venous thromboembolic events (VTE) in immobilised acutely ill medical inpatients without impaired renal function or extremes of body weight. The incremental cost-effectiveness ratios (ICERs) of the 'additional cost for ENOX per clinical VTE avoided versus NPP' and 'additional cost for ENOX per episode of major bleeding avoided versus LDUFH' were chosen as target variables. The target variables were quantified using a modelling approach based on the decision-tree technique. Resource use during thromboprophylaxis, diagnosis and treatment of VTEs, episode of major bleeding and secondary pneumonia after pulmonary embolism (PE) was collected from a hospital survey. Costs were exclusively those to hospitals incurred by staff expenses, drugs, devices, disposables, laboratory tests and equipment for diagnostic procedures. These costs were determined by multiplying utilised resource items by the price or tariff of each item as of the first quarter of 2003. Safety and efficacy values of the comparators were taken from the MEDENOX (prophylaxis in MEDical patients with ENOXaparin) and the THE-PRINCE (THromboEmbolism-PRevention IN Cardiac or respiratory disease with Enoxaparin) trials and from a meta-analysis. The evaluation encompassed 8 (6-14) days of thromboprophylaxis plus time to treat VTE and episode of major bleeding in hospital. Point estimates of all model parameters were applied exclusively in the base-case analysis. There were incremental costs of euro 1,106 for ENOX per clinical VTE avoided versus NPP (1 euro approximately equals 1

Medical Care Expenditure in Suicides From Non-illness-related Causes

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Jungwoo Sohn

2014-11-01

Full Text Available Objectives: Several epidemiological studies on medical care utilization prior to suicide have considered the motivation of suicide, but focused on the influence of physical illnesses. Medical care expenditure in suicide completers with non-illness-related causes has not been investigated. Methods: Suicides motivated by non-illness-related factors were identified using the investigator’s note from the National Police Agency, which was then linked to the Health Insurance Review and Assessment data. We investigated the medical care expenditures of cases one year prior to committing suicide and conducted a case-control study using conditional logistic regression analysis after adjusting for age, gender, area of residence, and socioeconomic status. Results: Among the 4515 suicides motivated by non-illness-related causes, medical care expenditures increased in only the last 3 months prior to suicide in the adolescent group. In the younger group, the proportion of total medical expenditure for external injuries was higher than that in the older groups. Conditional logistic regression analysis showed significant associations with being a suicide completer and having a rural residence, low socioeconomic status, and high medical care expenditure. After stratification into the four age groups, a significant positive association with medical care expenditures and being a suicide completer was found in the adolescent and young adult groups, but no significant results were found in the elderly groups for both men and women. Conclusions: Younger adults who committed suicide motivated by non-illness-related causes had a higher proportion of external injuries and more medical care expenditures than their controls did. This reinforces the notion that suicide prevention strategies for young people with suicidal risk factors are needed.

Malnutrition in the acutely ill patient: is it more than just protein and ...

African Journals Online (AJOL)

Review Article: Malnutrition in the acutely ill patient: is it more than just protein and energy? 2011;24(3) ... illness/injury, significant mortality occurs after critically ill patients are discharged from ... a manner similar to that of administering an antibiotic or drug. .... delivery (median of 0.8 g/kg/day protein (after day 3) for the study.

Feasibility and Inter-Rater Reliability of Physical Performance Measures in Acutely Admitted Older Medical Patients

DEFF Research Database (Denmark)

Bodilsen, Ann Christine; Juul-Larsen, Helle Gybel; Petersen, Janne

2015-01-01

OBJECTIVE: Physical performance measures can be used to predict functional decline and increased dependency in older persons. However, few studies have assessed the feasibility or reliability of such measures in hospitalized older patients. Here we assessed the feasibility and inter-rater reliabi......OBJECTIVE: Physical performance measures can be used to predict functional decline and increased dependency in older persons. However, few studies have assessed the feasibility or reliability of such measures in hospitalized older patients. Here we assessed the feasibility and inter......-rater reliability of four simple measures of physical performance in acutely admitted older medical patients. DESIGN: During the first 24 hours of hospitalization, the following were assessed twice by different raters in 52 (≥ 65 years) patients admitted for acute medical illness: isometric hand grip strength, 4......, and 30-s chair stand were 8%, 7%, and 18%, and the SRD95% values were 22%, 17%, and 49%. CONCLUSION: In acutely admitted older medical patients, grip strength, gait speed, and the Cumulated Ambulation Score measurements were feasible and showed high inter-rater reliability when administered by different...

What Influences Mental Illness? Discrepancies Between Medical Education and Conception.

Science.gov (United States)

Einstein, Evan Hy; Klepacz, Lidia

2017-01-01

This preliminary study examined the differences between what was taught during a formal medical education and medical students' and psychiatry residents' conceptions of notions regarding the causes and determinants of mental illness. The authors surveyed 74 medical students and 11 residents via convenience sampling. The survey contained 18 statements which were rated twice based on truthfulness in terms of a participant's formal education and conception, respectively. Descriptive statistics and a Wilcoxon signed rank test determined differences between education and conception. Results showed that students were less likely to perceive a neurotransmitter imbalance to cause mental illness, as opposed to what was emphasized during a formal medical education. Students and residents also understood the importance of factors such as systemic racism and socioeconomic status in the development of mental illness, which were factors that did not receive heavy emphasis during medical education. Furthermore, students and residents believed that not only did mental illnesses have nonuniform pathologies, but that the Diagnostic and Statistical Manual of Mental Disorders also had the propensity to sometimes arbitrarily categorize individuals with potentially negative consequences. If these notions are therefore part of students' and residents' conceptions, as well as documented in the literature, then it seems appropriate for medical education to be further developed to emphasize these ideas.

How medical technologies shape the experience of illness.

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Hofmann, Bjørn; Svenaeus, Fredrik

2018-02-03

In this article we explore how diagnostic and therapeutic technologies shape the lived experiences of illness for patients. By analysing a wide range of examples, we identify six ways that technology can (trans)form the experience of illness (and health). First, technology may create awareness of disease by revealing asymptomatic signs or markers (imaging techniques, blood tests). Second, the technology can reveal risk factors for developing diseases (e.g., high blood pressure or genetic tests that reveal risks of falling ill in the future). Third, the technology can affect and change an already present illness experience (e.g., the way blood sugar measurement affects the perceived symptoms of diabetes). Fourth, therapeutic technologies may redefine our experiences of a certain condition as diseased rather than unfortunate (e.g. assisted reproductive technologies or symptom based diagnoses in psychiatry). Fifth, technology influences illness experiences through altering social-cultural norms and values regarding various diagnoses. Sixth, technology influences and changes our experiences of being healthy in contrast and relation to being diseased and ill. This typology of how technology forms illness and related conditions calls for reflection regarding the phenomenology of technology and health. How are medical technologies and their outcomes perceived and understood by patients? The phenomenological way of approaching illness as a lived, bodily being-in-the-world is an important approach for better understanding and evaluating the effects that medical technologies may have on our health, not only in defining, diagnosing, or treating diseases, but also in making us feel more vulnerable and less healthy in different regards.

Routine pre-admission screening for a medical illness in aggressive ...

African Journals Online (AJOL)

2009-10-03

Oct 3, 2009 ... can be a symptom of a psychiatric illness or a medical illness.2,3. Psychiatric .... reported a 27.2% prevalence of physical illness in psychiatric inpatients in Nigeria, Janse ..... Results in a state mental health system. Arch Gen ...

Attitudes of college students toward mental illness stigma and the misuse of psychiatric medications.

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Stone, Amanda M; Merlo, Lisa J

2011-02-01

Mental illness stigma remains a significant barrier to treatment. However, the recent increase in the medical and nonmedical use of prescription psychiatric medications among college students seems to contradict this phenomenon. This study explored students' attitudes and experiences related to psychiatric medications, as well as correlates of psychiatric medication misuse (ie, attitudes toward mental illness and beliefs about the efficacy of psychiatric medications). Data were collected anonymously via self-report questionnaires from April 2008 to February 2009. Measures included the Michigan Alcoholism Screening Test, the Drug Abuse Screening Test, Day's Mental Illness Stigma Scale, the Attitudes Toward Psychiatric Medication scale, and the Psychiatric Medication Attitudes Scale. Participants included 383 university students (59.2% female), recruited on the campus of a large state university or through online classes offered through the same university. High rates of psychiatric medication misuse were shown (13.8%) when compared to rates of medical use (6.8%), and students with prescriptions for psychiatric drugs were also more likely to be misusers (χ(2) = 20.60, P mental illness, including lower anxiety around the mentally ill (t = 3.26, P mental illness (t = -2.11, P mental illness, the appropriate use of psychiatric medications, and the potential consequences associated with abuse of these potent drugs. © Copyright 2011 Physicians Postgraduate Press, Inc.

Falls in hospital and new placement in a nursing home among older people hospitalized with acute illness.

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Basic, David; Hartwell, Tabitha J

2015-01-01

To examine the association between falls in hospital and new placement in a nursing home among older people hospitalized with acute illness. This prospective cohort study of 2,945 consecutive patients discharged alive from an acute geriatric medicine service used multivariate logistic regression to model the association between one or more falls and nursing home placement (primary analysis). Secondary analyses stratified falls by injury and occurrence of multiple falls. Demographic, medical, and frailty measures were considered in adjusted models. The mean age of all patients was 82.8±7.6 years and 94% were admitted through the emergency department. During a median length of stay (LOS) of 11 days, 257 (8.7%) patients had a fall. Of these, 66 (25.7%) sustained an injury and 53 (20.6%) had two or more falls. Compared with nonfallers, fallers were more likely to be placed in a nursing home (odds ratio [OR]: 2.03, 95% confidence interval [CI]: 1.37-3.00), after adjustment for age, sex, frailty, and selected medical variables (including dementia and delirium). Patients without injury (OR: 1.83, 95% CI: 1.17-2.85) and those with injury (OR: 2.35, 95% CI: 1.15-4.77) were also more likely to be placed. Patients who fell had a longer LOS (median 19 days vs 10 days; Pcare shows that falls in the hospital are significantly associated with new placement in a nursing home. Given the predominantly negative experiences and the financial costs associated with placement in a nursing home, fall prevention should be a high priority in older people hospitalized with acute illness.

The association of depression and anxiety with medical symptom burden in patients with chronic medical illness.

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Katon, Wayne; Lin, Elizabeth H B; Kroenke, Kurt

2007-01-01

Primary care patients with anxiety and depression often describe multiple physical symptoms, but no systematic review has studied the effect of anxiety and depressive comorbidity in patients with chronic medical illnesses. MEDLINE databases were searched from 1966 through 2006 using the combined search terms diabetes, coronary artery disease (CAD), congestive heart failure (CHF), asthma, COPD, osteoarthritis (OA), rheumatoid arthritis (RA), with depression, anxiety and symptoms. Cross-sectional and longitudinal studies with >100 patients were included as were all randomized controlled trials that measure the impact of improving anxiety and depressive symptoms on medical symptom outcomes. Thirty-one studies involving 16,922 patients met our inclusion criteria. Patients with chronic medical illness and comorbid depression or anxiety compared to those with chronic medical illness alone reported significantly higher numbers of medical symptoms when controlling for severity of medical disorder. Across the four categories of common medical disorders examined (diabetes, pulmonary disease, heart disease, arthritis), somatic symptoms were at least as strongly associated with depression and anxiety as were objective physiologic measures. Two treatment studies also showed that improvement in depression outcome was associated with decreased somatic symptoms without improvement in physiologic measures. Accurate diagnosis of comorbid depressive and anxiety disorders in patients with chronic medical illness is essential in understanding the cause and in optimizing the management of somatic symptom burden.

Factors affecting institutionalization in older Hong Kong Chinese patients after recovery from acute medical illnesses.

Science.gov (United States)

Luk, James Ka Hay; Chiu, Patrick Ka Chun; Chu, Leung Wing

2009-01-01

Older patients with medical illnesses are at risk of institutionalization. The purpose of this study is to investigate the factors leading to institutionalization in older patients after recovery from medical illnesses. We studied 535 older patients in two convalescence hospitals in Hong Kong. Of them, 116 patients (21.7%) needed to move to nursing homes upon discharge. Univariate analysis showed that age, single/divorced/widowed status, longer length of stay, pressure sores, urinary incontinence, urinary catheterization, falls, dementia, diabetes mellitus, Barthel index (100), Elderly Mobility Score (EMS), Chinese version of the mini-mental state examination (C-MMSE) and albumin levels were significant factors associated with institutionalization. Multivariate analysis showed that being single/divorced/widowed (odds ratio=OR=2.74, 95% confidence interval=CI=1.36-5.53, p=0.0048), having urinary incontinence on discharge (OR=5.13, CI=2.66-10.6, p<0.001) and admission due to falls (OR=2.4, CI=1.03-5.57, p=0.04) were independent risk factors for nursing home admission. Higher admission EMS (OR=0.91, CI=0.84-0.97, p=0.009), admission C-MMSE (OR=0.93, CI=0.87-0.98, p=0.019), and discharge albumin levels (OR=0.93, CI=0.88-0.99, p=0.02) were independent protecting factors against nursing home admission. Knowledge of these factors can allow us to predict accommodation outcome and develop intervention strategy to reduce institutionalization in the older patients.

What Influences Mental Illness? Discrepancies Between Medical Education and Conception

Directory of Open Access Journals (Sweden)

Evan Hy Einstein

2017-04-01

Full Text Available Objective: This preliminary study examined the differences between what was taught during a formal medical education and medical students’ and psychiatry residents’ conceptions of notions regarding the causes and determinants of mental illness. Methods: The authors surveyed 74 medical students and 11 residents via convenience sampling. The survey contained 18 statements which were rated twice based on truthfulness in terms of a participant’s formal education and conception, respectively. Descriptive statistics and a Wilcoxon signed rank test determined differences between education and conception. Results: Results showed that students were less likely to perceive a neurotransmitter imbalance to cause mental illness, as opposed to what was emphasized during a formal medical education. Students and residents also understood the importance of factors such as systemic racism and socioeconomic status in the development of mental illness, which were factors that did not receive heavy emphasis during medical education. Furthermore, students and residents believed that not only did mental illnesses have nonuniform pathologies, but that the Diagnostic and Statistical Manual of Mental Disorders also had the propensity to sometimes arbitrarily categorize individuals with potentially negative consequences. Conclusions: If these notions are therefore part of students’ and residents’ conceptions, as well as documented in the literature, then it seems appropriate for medical education to be further developed to emphasize these ideas.

How Mental Illness is Perceived by Iranian Medical Students: A Preliminary Study

Science.gov (United States)

Amini, Homayoun; Majdzadeh, Reza; Eftekhar-Ardebili, Hasan; Shabani, Amir; Davari-Ashtiani, Rozita

2013-01-01

The study aimed to assess medical students' attitudes toward mental illness following a 4-week psychiatry clerkship. All fifth-year medical students from three academic centers in Tehran were asked to participate in the study. They completed the questionnaire on the last day of their 4-week psychiatry clerkship. A self-administered questionnaire was used to examine participants' Attitudes Toward Mental Illness (ATMI). One hundred and sixty eight students completed the questionnaires (88.9% response rate). In general, the students had favorable attitudes toward mental illness at the end of their clerkship, with mean (± SD) ATMI total score of 78.6 (± 8.1) (neutral score, 66.0). The students showed the most favorable opinion (95.2%) about Category 5 (stereotypic attitude toward people with mental illness) whilst they revealed the least favorable opinion (64.3%) regarding Category 1 (social relations with people affected by mental illness). In addition, the students thought that movies were on the top of influential media on shaping the attitudes toward mental illness. Overall, most of Iranian medical students had generally favorable attitudes toward people with mental illness at the end of their clerkship. Therefore, it may be expected next generation of medical doctors show more favorable attitude toward mental illness. PMID:23878611

Outcome and prognostic factors of critically ill patients with acute renal failure requiring continuous renal replacement therapy

Directory of Open Access Journals (Sweden)

Aldawood Abdulaziz

2010-01-01

Full Text Available Continuous renal replacement therapy (CRRT has proved to be beneficial for the treatment of critically ill patients with acute renal failure (ARF. The aim of this study is to determine the outcome and identify the predictors of mortality of critically ill patients treated with CRRT for ARF in the intensive care unit (ICU. This prospective cohort study of critically ill patients with ARF requiring CRRT admitted to the ICU was carried out at a tertiary care hospital in Saudi Arabia from 2002 to 2008. A total of 644 of 7173 patients with ARF required CRRT were studied. About 9% of the ARF patients required CRRT and comprised mainly those with medical causes, carrying a mortality of 64%. Multivariate analysis found high serum creatinine as an independent factor for better outcome and requirement of mechanical ventilation (MV as an independent factor for worse outcome. In our cohort study, ARF requiring CRRT in the ICU was associated with a high mortality.

Mental Illness among Us: A New Curriculum to Reduce Mental Illness Stigma among Medical Students

Science.gov (United States)

Aggarwal, Anuj K.; Thompson, Maxwell; Falik, Rebecca; Shaw, Amy; O'Sullivan, Patricia; Lowenstein, Daniel H.

2013-01-01

Objectives: Medical students have been shown to have high levels of psychological distress, including self-stigmatization and unwillingness to seek care. The authors hypothesized that a student-led curriculum involving personal mental illness experience, given during the first-year neuroscience course, and titled "Mental Illness Among Us…

A Cross-sectional Surveillance Study of the Frequency and Etiology of Acute Respiratory Illness Among Pregnant Women.

Science.gov (United States)

Hause, Anne M; Avadhanula, Vasanthi; Maccato, Maurizio L; Pinell, Phillip M; Bond, Nanette; Santarcangelo, Patricia; Ferlic-Stark, Laura; Munoz, Flor M; Piedra, Pedro A

2018-05-05

Other than influenza, little is known about the consequences of viral acute respiratory illness (ARI) on pregnant women and fetuses. Our objectives were to determine the frequency of ARI due to respiratory viruses and the associated clinical outcomes during pregnancy. Pregnant women in their second or third trimester were enrolled if they reported having symptoms of ARI or were healthy within the preceding 2 weeks. Nasopharyngeal secretions were evaluated for respiratory viruses by molecular diagnostic assays. Clinical outcomes were evaluated at enrollment and via a follow-up telephone-based questionnaire 2 weeks later. There were 155 pregnant participants, with 81 ARI cases and 91 healthy controls. Acute lower respiratory tract illness (ALRTI) was identified in 29 cases (36%). Human rhinovirus (HRV), respiratory syncytial virus (RSV), and influenza virus accounted for 75% of virus-positive cases of ALRTI. Cases with ALRTI often reported a longer duration of illness, history of allergies, symptoms of wheezing, shortness of breath, or chest pain, and use of prescription medication. Two cases with ALRTI reported decreased fetal movement; a third case with ALRTI was hospitalized. In over one third of ARI cases, participants had symptoms consistent with ALRTI. Infection with HRV, RSV, or influenza virus was commonly detected in patients with ALRTI. Viral ALRTI during pregnancy appears to be common and is associated with significant morbidity.

Performance of a Mobile Phone App-Based Participatory Syndromic Surveillance System for Acute Febrile Illness and Acute Gastroenteritis in Rural Guatemala.

Science.gov (United States)

Olson, Daniel; Lamb, Molly; Lopez, Maria Renee; Colborn, Kathryn; Paniagua-Avila, Alejandra; Zacarias, Alma; Zambrano-Perilla, Ricardo; Rodríguez-Castro, Sergio Ricardo; Cordon-Rosales, Celia; Asturias, Edwin Jose

2017-11-09

With their increasing availability in resource-limited settings, mobile phones may provide an important tool for participatory syndromic surveillance, in which users provide symptom data directly into a centralized database. We studied the performance of a mobile phone app-based participatory syndromic surveillance system for collecting syndromic data (acute febrile illness and acute gastroenteritis) to detect dengue virus and norovirus on a cohort of children living in a low-resource and rural area of Guatemala. Randomized households were provided with a mobile phone and asked to submit weekly reports using a symptom diary app (Vigilant-e). Participants reporting acute febrile illness or acute gastroenteritis answered additional questions using a decision-tree algorithm and were subsequently visited at home by a study nurse who performed a second interview and collected samples for dengue virus if confirmed acute febrile illness and norovirus if acute gastroenteritis. We analyzed risk factors associated with decreased self-reporting of syndromic data using the Vigilant-e app and evaluated strategies to improve self-reporting. We also assessed agreement between self-report and nurse-collected data obtained during home visits. From April 2015 to June 2016, 469 children in 207 households provided 471 person-years of observation. Mean weekly symptom reporting rate was 78% (range 58%-89%). Households with a poor (mobile phones for text messaging at study enrollment (61%, 35/57 vs 76.7%, 115/150; RR 0.6, 95% CI 0.4-0.9), and were less likely to access care at the local public clinic (35%, 20/57 vs 67.3%, 101/150; RR 0.4, 95% CI 0.2-0.6). Parents of female enrolled participants were more likely to have low response rate (57.1%, 84/147 vs 43.8%, 141/322; RR 1.4, 95% CI 1.1-1.9). Several external factors (cellular tower collapse, contentious elections) were associated with periods of decreased reporting. Poor response rate (mobile phone app-based participatory syndromic

How do general practitioners use 'safety netting' in acutely ill children?

Science.gov (United States)

Bertheloot, Karen; Deraeve, Pieterjan; Vermandere, Mieke; Aertgeerts, Bert; Lemiengre, Marieke; De Sutter, An; Buntinx, Frank; Verbakel, Jan Y

2016-01-01

'Safety netting' advice allows general practitioners (GPs) to cope with diagnostic uncertainty in primary care. It informs patients on 'red flag' features and when and how to seek further help. There is, however, insufficient evidence to support useful choices regarding 'safety netting' procedures. To explore how GPs apply 'safety netting' in acutely ill children in Flanders. We designed a qualitative study consisting of semi-structured interviews with 37 GPs across Flanders. Two researchers performed qualitative analysis based on grounded theory components. Although unfamiliar with the term, GPs perform 'safety netting' in every acutely ill child, guided by their intuition without the use of specific guidelines. They communicate 'red flag' features, expected time course of illness and how and when to re-consult and try to tailor their advice to the context, patient and specific illness. Overall, GPs perceive 'safety netting' as an important element of the consultation, acknowledging personal and parental limitations, such as parents' interpretation of their advice. GPs do not feel a need for any form of support in the near future. GPs apply 'safety netting' intuitively and tailor the content. Further research should focus on the impact of 'safety netting' on morbidity and how the advice is conveyed to parents.

What worries parents when their preschool children are acutely ill, and why: a qualitative study.

OpenAIRE

Kai, J.

1996-01-01

OBJECTIVE: To identify and explore parents' concerns when young children become acutely ill. DESIGN: Qualitative study making use of semi-structured one to one and group interviews with parents of preschool children. SETTING: Disadvantaged inner city community. SUBJECTS: 95 parents of preschool children. RESULTS: Fever, cough, and the possibility of meningitis were parents' primary concerns when their children became acutely ill. Parents' concerns reflected lay beliefs, their interpretation o...

Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN): evolution of a content management system for point-of-care clinical decision support.

Science.gov (United States)

Barwise, Amelia; Garcia-Arguello, Lisbeth; Dong, Yue; Hulyalkar, Manasi; Vukoja, Marija; Schultz, Marcus J; Adhikari, Neill K J; Bonneton, Benjamin; Kilickaya, Oguz; Kashyap, Rahul; Gajic, Ognjen; Schmickl, Christopher N

2016-10-03

The Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN) is an international collaborative project with the overall objective of standardizing the approach to the evaluation and treatment of critically ill patients world-wide, in accordance with best-practice principles. One of CERTAIN's key features is clinical decision support providing point-of-care information about common acute illness syndromes, procedures, and medications in an index card format. This paper describes 1) the process of developing and validating the content for point-of-care decision support, and 2) the content management system that facilitates frequent peer-review and allows rapid updates of content across different platforms (CERTAIN software, mobile apps, pdf-booklet) and different languages. Content was created based on survey results of acute care providers and validated using an open peer-review process. Over a 3 year period, CERTAIN content expanded to include 67 syndrome cards, 30 procedure cards, and 117 medication cards. 127 (59 %) cards have been peer-reviewed so far. Initially MS Word® and Dropbox® were used to create, store, and share content for peer-review. Recently Google Docs® was used to make the peer-review process more efficient. However, neither of these approaches met our security requirements nor has the capacity to instantly update the different CERTAIN platforms. Although we were able to successfully develop and validate a large inventory of clinical decision support cards in a short period of time, commercially available software solutions for content management are suboptimal. Novel custom solutions are necessary for efficient global point of care content system management.

[Status of acute upper respiratory infection, influenza-like illness, and influenza vaccination coverage among community residents in Jinan].

Science.gov (United States)

Liu, Ying; Song, Shaoxia; Wang, Wei; Geng, Xingyi; Liu, Wen; Han, Debiao; Liu, Ti; Wu, Julong; Li, Zhong; Wang, Xianjun; Bi, Zhenqiang

2015-12-01

To analyze the status of acute upper respiratory infection and influenza-like illness (ILI) among community residents in Jinan in 2015, and to make a understand of the patient's medical treatment behavior and influenza vaccination coverage status in 2014. Balloting method and convenient sampling method were used to launch a household survey. The residents who had been in Jinan for more than 3 months were selected, to investigate the residents' attack ratio of acute upper respiratory and influenza-like from Jan. 8 to Feb. 7, 2015. Totally, 1 300 persons from 410 families were involved in this survey which recovered 1 241 valid questionnaires with the efficiency of 95.5%. Based on the national age-urban demographic statistics in 2010, the attack rates of acute respiratory infections, influenza-like illness were estimated by the direct standardization method, and the influenza vaccination rates were also calculated in this study. χ(2)-test method was used to compare the different status of incidence and vaccination among residents with different features. The attack rate of acute upper respiratory infection and influenza-like illness in Jinan from January 8, 2015 to February 7, 2015 were 30.2% (375 cases), and 6.1% (76 cases), respectively, with a standardized rate of 29.1% and 5.4%. 5.3% (66 cases) of the residents have vaccinated with the influenza vaccine inoculation, with an adjusted rate of 3.8%. The attack rate difference of acute upper respiratory tract infections was statistically significant between each age group (χ(2)=17.121, P= 0.002). The 0-4 age group had a highest attack rate (45.4%) of acute respiratory infection, while the 15-24 age group got the lowest (26.5%). 38.9% (146 cases) of patients went for a treatment in hospital. Among them, 37.7% (55 cases) of them selected the county level hospitals for treatment, 37.7% (55 cases) selected the community level hospitals, and 24.6% (36 cases) selected the individual clinic. Significant differences of

Acute medication overuse in headache

Directory of Open Access Journals (Sweden)

Abouch Valenty Krymchantovscki

2004-03-01

Full Text Available Primary headache patients frequently overuse analgesics. Acute medication overuse plays an important role in the transformation of episodic into chronic headaches. The sudden discontinuation of analgesic and migraine prevention introduction are the main issues in the management of chronic daily headache patients. Educational strategies for those who do not overuse acute medications and an agressive approach to those overusing are fundamental for the efficacy of the primary frequent headache treatment.

Acute Illness Among Surfers After Exposure to Seawater in Dry- and Wet-Weather Conditions.

Science.gov (United States)

Arnold, Benjamin F; Schiff, Kenneth C; Ercumen, Ayse; Benjamin-Chung, Jade; Steele, Joshua A; Griffith, John F; Steinberg, Steven J; Smith, Paul; McGee, Charles D; Wilson, Richard; Nelsen, Chad; Weisberg, Stephen B; Colford, John M

2017-10-01

Rainstorms increase levels of fecal indicator bacteria in urban coastal waters, but it is unknown whether exposure to seawater after rainstorms increases rates of acute illness. Our objective was to provide the first estimates of rates of acute illness after seawater exposure during both dry- and wet-weather periods and to determine the relationship between levels of indicator bacteria and illness among surfers, a population with a high potential for exposure after rain. We enrolled 654 surfers in San Diego, California, and followed them longitudinally during the 2013-2014 and 2014-2015 winters (33,377 days of observation, 10,081 surf sessions). We measured daily surf activities and illness symptoms (gastrointestinal illness, sinus infections, ear infections, infected wounds). Compared with no exposure, exposure to seawater during dry weather increased incidence rates of all outcomes (e.g., for earache or infection, adjusted incidence rate ratio (IRR) = 1.86, 95% confidence interval (CI): 1.27, 2.71; for infected wounds, IRR = 3.04, 95% CI: 1.54, 5.98); exposure during wet weather further increased rates (e.g., for earache or infection, IRR = 3.28, 95% CI: 1.95, 5.51; for infected wounds, IRR = 4.96, 95% CI: 2.18, 11.29). Fecal indicator bacteria measured in seawater (Enterococcus species, fecal coliforms, total coliforms) were strongly associated with incident illness only during wet weather. Urban coastal seawater exposure increases the incidence rates of many acute illnesses among surfers, with higher incidence rates after rainstorms. © The Author(s) 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.

Leave for illness/accident or in the event of illness of a close relative - New medical certificate templates

CERN Multimedia

HR department

2016-01-01

Medical certificate templates are now available in the Admin e-guide (follow the “Forms and templates” link):    Medical certificate for illness/accident Medical certificate for a medical examination or treatment Medical certificate in the event of illness of a close relative These templates are provided for the convenience of members of the personnel and their use is recommended but not compulsory. Other forms of medical certificates issued by a medical doctor may also be submitted, provided they contain the same items of information as those given in the templates. More information on the applicable rules and on the way leave is managed at CERN can be found in the Admin e-guide web pages. Human Resources department HR.leave@cern.ch

Attitudes towards mental illness among medical students in China: Impact of medical education on stigma.

Science.gov (United States)

Zhu, Yifan; Zhang, Hanwen; Yang, Ge; Hu, Xinran; Liu, Zhening; Guo, Na; He, Hongbo; Sun, Bin; Rosenheck, Robert

2018-06-01

Stigma towards people with mental illness impedes effective treatment. A recent study found that Chinese students were less socially accepting of people with mental illness than counterparts from other countries. The current study examined stigma among Chinese medical students at different levels of training. Medical students (N = 1372 from 12 Chinese schools) were surveyed with a questionnaire addressing attitudes and beliefs about people with mental illness. Analysis of variance was used to compare responses from students: (1) with no psychiatry training; (2) who had only taken a didactic course; and (3) who had completed both a course and a clinical rotation. Specific attitudes were identified through factor analysis. Interest in further training and other personal experience were also examined. Factor analysis revealed attitudes favoring: (1) social acceptance of people with mental illness, (2) not believing in supernatural causes of mental illness, (3) bio-psycho-social causation, (4) rehabilitation, and (5) social integration. The absence of consistent trends across training levels suggested that education did not increase nonstigmatized attitudes. Areas of most stigmatization were low social acceptance and little favor for social integration. Measures most strongly correlated with nonstigmatized attitudes were as follows: interest in clinical psychiatry, belief that psychiatry should be more valued, and having friends with mental illness. Although medical school education showed little effect on attitudes, students with more individual experiences such as planning to continue clinical psychiatric training, believing psychiatry should be more valued, and having friends with mental illness had less stigmatized attitudes than others. © 2017 John Wiley & Sons Australia, Ltd.

Adherence to medications by patients after acute coronary syndromes.

Science.gov (United States)

Sud, Anchal; Kline-Rogers, Eva M; Eagle, Kim A; Fang, Jianming; Armstrong, David F; Rangarajan, Krishna; Otten, Richard F; Stafkey-Mailey, Dana R; Taylor, Stephanie D; Erickson, Steven R

2005-11-01

Nonadherence to medication may lead to poor medical outcomes. To describe medication-taking behavior of patients with a history of acute coronary syndromes (ACS) for 4 classes of drugs and determine the relationship between self-reported adherence and patient characteristics. Consenting patients with the diagnosis of ACS were interviewed by telephone approximately 10 months after discharge. The survey elicited data characterizing the patient, current medication regimens, beliefs about drug therapy, reasons for discontinuing medications, and adherence. The survey included the Beliefs About Medicine Questionnaire providing 4 scales: Specific Necessity, Specific Concerns, General Harm, and General Overuse, and the Medication Adherence Scale (MAS). Multivariate regression was used to determine the independent variables with the strongest association to the MAS. A p value or =1 other person, and 42% indicating excellent or very good health. The percentage of patients continuing on medication at the time of the survey category ranged from 87.4% (aspirin) to 66.0% (angiotensin-converting enzyme inhibitors). Reasons for stopping medication included physician discontinuation or adverse effects. Of patients still on drug therapy, the mean MAS was 1.3 +/- 0.4, with 53.8% indicating nonadherence (score >1). The final regression model showed R(2) = 0.132 and included heart-related health status and Specific Necessity as significant predictor variables. After ACS, not all patients continue their drugs or take them exactly as prescribed. Determining beliefs about illness and medication may be helpful in developing interventions aimed at improving adherence.

Where did the acute medical trainees go? A review of the career pathways of acute care common stem acute medical trainees in London.

Science.gov (United States)

Gowland, Emily; Ball, Karen Le; Bryant, Catherine; Birns, Jonathan

2016-10-01

Acute care common stem acute medicine (ACCS AM) training was designed to develop competent multi-skilled acute physicians to manage patients with multimorbidity from 'door to discharge' in an era of increasing acute hospital admissions. Recent surveys by the Royal College of Physicians have suggested that acute medical specialties are proving less attractive to trainees. However, data on the career pathways taken by trainees completing core acute medical training has been lacking. Using London as a region with a 100% fill rate for its ACCS AM training programme, this study showed only 14% of trainees go on to higher specialty training in acute internal medicine and a further 10% to pursue higher medical specialty training with dual accreditation with internal medicine. 16% of trainees switched from ACCS AM to emergency medicine or anaesthetics during core ACCS training, and intensive care medicine proved to be the most popular career choice for ACCS AM trainees (21%). The ACCS AM training programme therefore does not appear to be providing what it was set out to do and this paper discusses the potential causes and effects. © Royal College of Physicians 2016. All rights reserved.

Medical Student Attitudes Towards People with Mental Illness in China: A Qualitative Study.

Science.gov (United States)

Luo, Audrey; He, Hongbo; Mohamed, Somaia; Rosenheck, Robert

2018-03-05

Stigma towards people with mental illness is a worldwide concern. A five-nation survey of medical student attitudes towards people with mental illness recently reported far lower levels of social acceptance among Chinese medical students compared to those from the US, Brazil, Ghana, and Nigeria. This qualitative study presented recent Chinese medical school graduates with probes based on questions used in the aforementioned cross-national study to elicit their views of factors underlying the negative attitudes towards social acceptance of people with mental illness. One-hour interviews were conducted with twenty psychiatry residents in June, 2016. Of 241 coded responses concerning negative attitudes, 51.5% were coded as reflecting fear of violent behavior, 22.8% as loss of face (i.e. shame from interpersonal associations), 17.0% lowered social status, 4.98% nonconforming social behavior, and 3.73% the heritability of mental illness. Low levels of social acceptance of individuals with mental illness among medical students in China are largely related to fears of violence of and loss of face. Understanding the attitudes of medical students may inform efforts to reduce stigma through educational initiatives targeted at both medical students and the general public.

Living well: an intervention to improve self-management of medical illness for individuals with serious mental illness.

Science.gov (United States)

Goldberg, Richard W; Dickerson, Faith; Lucksted, Alicia; Brown, Clayton H; Weber, Elyssa; Tenhula, Wendy N; Kreyenbuhl, Julie; Dixon, Lisa B

2013-01-01

Individuals with serious mental illness have elevated rates of comorbid chronic general medical conditions and may benefit from interventions designed to support illness self-management. This study examined the effectiveness of a modified version of the Chronic Disease Self-Management Program called Living Well for individuals with serious mental illness. A total of 63 mental health consumers with serious mental illness and at least one concurrent chronic general medical condition were randomly assigned to receive the 13-session peer-cofacilitated Living Well intervention or usual care. Participants were evaluated on attitudinal, behavioral, and functional outcomes at baseline, at the end of the intervention, and at a two-month follow-up. Living Well participants showed significant postintervention improvements across a range of attitudinal (self-efficacy and patient activation), behavioral (illness self-management techniques), and functional (physical and emotional well-being and general health functioning) outcomes. Although attenuation of effect was observed for most outcomes at two months postintervention, evidence was found of continued improvement in general self-management behaviors (use of action planning, brainstorming, and problem-solving). Continued advantage was found for the Living Well group in other areas, such as health-related locus of control and reports of healthy eating and physical activity. Receipt of Living Well was associated with a notable decrease in use of the emergency room for medical care, although the between-group difference was not statistically significant. Living Well shows promise in helping mental health consumers more effectively manage chronic general medical conditions and experience improved functioning and well-being.

Mental illness stigma among medical students and teachers.

Science.gov (United States)

Janoušková, Miroslava; Weissová, Aneta; Formánek, Tomáš; Pasz, Jiří; Bankovská Motlová, Lucie

2017-12-01

Medical school curriculum contributes to future doctors' attitude formation towards people with mental illness. The purpose of this study was to compare stigmatizing attitudes between medical students and faculty, analyse stigmatizing attitudes among students from different years of study and identify factors predicting stigma. A cross-sectional study with the use of scales measuring attitudes and social distance was designed. Online questionnaires were distributed to all students and teachers at a medical faculty in the Czech Republic. The response rate was 32.1% ( n = 308) among students and 26.7% ( n = 149) among teachers. Teachers had a greater prevalence of stigmatizing attitudes than students. Increased tolerant attitudes in students were detected after the fourth year, that is, following introduction to psychiatry. Preferred specialization in psychiatry and attending two psychiatry courses predicted more tolerant attitudes. Among both students and teachers, men possessed more stigmatizing attitudes towards people with mental illness. Age was an important predictor of stigmatizing attitudes among teachers. Educators should pay closer attention to the role of medical psychology and communication training implementation, which may be beneficial to improving skills and increasing medical students' self-esteem and feeling of competence throughout their psychiatry rotation.

Acute and long-term survival in chronically critically ill surgical patients: a retrospective observational study.

Science.gov (United States)

Hartl, Wolfgang H; Wolf, Hilde; Schneider, Christian P; Küchenhoff, Helmut; Jauch, Karl-Walter

2007-01-01

Various cohort studies have shown that acute (short-term) mortality rates in unselected critically ill patients may have improved during the past 15 years. Whether these benefits also affect acute and long-term prognosis in chronically critically ill patients is unclear, as are determinants relevant to prognosis. We conducted a retrospective analysis of data collected from March 1993 to February 2005. A cohort of 390 consecutive surgical patients requiring intensive care therapy for more than 28 days was analyzed. The intensive care unit (ICU) survival rate was 53.6%. Survival rates at one, three and five years were 61.8%, 44.7% and 37.0% among ICU survivors. After adjustment for relevant covariates, acute and long-term survival rates did not differ significantly between 1993 to 1999 and 1999 to 2005 intervals. Acute prognosis was determined by disease severity during ICU stay and by primary diagnosis. However, only the latter was independently associated with long-term prognosis. Advanced age was an independent prognostic determinant of poor short-term and long-term survival. Acute and long-term prognosis in chronically critically ill surgical patients has remained unchanged throughout the past 12 years. After successful surgical intervention and intensive care, long-term outcome is reasonably good and is mainly determined by age and underlying disease.

Acute medical assessment units: an efficient alternative to in-hospital acute medical care.

LENUS (Irish Health Repository)

Watts, M

2011-02-01

Acute Medical Assessment Units (AMAUs) are being proposed as an alternative to congested Emergency Departments (EDs for the assessment of patients with a range of acute medical problems. We retrospectively reviewed the discharge destination of patients referred to a newly established AMAU during a six-month period. During the same period we contrasted activity in the ED for a similar group of patients. 1,562 patients were assessed in the AMAU. 196 (12.5%) were admitted to an in-patient bed and 1,148 (73.5%) were entered into specific diagnosis-driven out-patient pathways. 1,465 patients attended the ED and 635 (43.3%) were admitted. Out-patient alternatives to expensive in-patient care need to be provided at the \\'coal face" of acute referral. The AMAU provides this, and as a consequence admission rates are relatively low. This is achieved by directly communicating with GPs, accessing senior clinical decision makers, and providing immediate access to diagnostically driven outpatient pathways.

Medication and physical activity and physical fitness in severe mental illness.

Science.gov (United States)

Perez-Cruzado, David; Cuesta-Vargas, Antonio; Vera-Garcia, Elisa; Mayoral-Cleries, Fermín

2018-05-23

Anti-psychotic medication has emerged as the primary medical treatment for people with severe mental illness, despite the great risks involved in the use of this medication. In addition, this population suffers from problems of obesity, sedentary lifestyle and poor physical fitness, which is aggravated by the use of this type of medication. The objective of this study is to explore the influence of the most commonly used antipsychotics in this population (Olanzapine and Risperidone) on physical activity and the physical fitness of people with severe mental illness. Sixty-two people between 26 and 61 years of age with severe mental illness were assessed. All participants were evaluated with a battery of 11 physical tests to assess their physical fitness and with the IPAQ-short version questionnaire to determine their level of physical activity. The doses of Risperidone and Olanzapine were also evaluated in all participants. Significant differences were found for physical activity, with higher levels reported in those patients with severe mental illness who did not take any of these medications. Regarding physical fitness, significant differences were only found for the consumption of Risperidone, with better physical fitness levels seen in patients who did not consume this medication; on the other hand, for the consumption of Olanzapine, differences were found in muscular strength, balance and aerobic condition with better values in non-Olanzapine consumers compared with Olanzapine consumers. Copyright © 2018 Elsevier B.V. All rights reserved.

СHILDREN OF MEGAPOLISES WHO FALL ILL FREQUENTLY: ACUTE RESPIRATORY INFECTION PREVENTION AND TREATMENT

Directory of Open Access Journals (Sweden)

R.M. Torshkhoeva

2006-01-01

Full Text Available The article is devoted to prevention and treatment of acute respiratory diseases children of megapolises who fall ill frequently. The authors prove the thesis that children falling ill frequently and residing in mega cities, and not only in Russia, have a similar immune status, according to which not only therapeutic but also preventive immunomodulatory treatment courses must be administered to them.Key words: frequently ill children, bacterial immunomodulation, cytokinic status.

Acute febrile illness in cirrhosis - thinking beyond spontaneous bacterial peritonitis!

Science.gov (United States)

Jain, Ajay K; Sircar, Shohini; Jain, Mayank; Adkar, Sagar; Waghmare, Chandrashekhar; Chahwala, Fatema

2012-10-01

The aim of this study was to look at the aetiological factors presenting as acute febrile illness in cirrhotic patients. The study group included all cirrhotic patients admitted as inpatients between January and December 2011 with a history of fever of less than seven days duration. Detailed history, clinical examination and investigations, as required, were noted. The data collected were analysed. A total of 42 patients formed the study group. The male-to-female ratio was 9.5:1. The mean age at presentation was 45.09 years (24-77 years). The aetiological factors for fever were: spontaneous bacterial peritonitis (20), lower respiratory tract infection (8), urinary tract infection (6), lower limb cellulitis (4), acute cholecystitis (2) and malaria (2). The mean MELD (model for end-stage liver disease) score at presentation was 20.4. Three patients with spontaneous bacterial peritonitis (SBP) and a mean MELD score of 31 died during the hospital admission. Febrile illness in cirrhosis is attributable to multiple causes. Outcome is dependent on the severity of underlying liver disease.

A controlled trial of mental illness related stigma training for medical students

Directory of Open Access Journals (Sweden)

Leese Morven

2011-07-01

Full Text Available Abstract Background The evidence base for mental illness related stigma interventions in health care professionals and trainees is underdeveloped. This study aimed to examine the impact of mental illness related stigma training on third year medical students' knowledge, attitudes and behaviour related to people with mental illness. Methods A non-randomised controlled trial was conducted with 110 third year medical students at a medical school in England to determine the effectiveness of a mental illness related stigma training package that targeted their knowledge, attitudes and behaviour. Results We detected a significant positive effect of factual content and personal testimonies training upon an improvement in knowledge, F(1, 61 = 16.3, p = 0.0002. No such difference was determined with attitudes or for behaviour. Conclusions Knowledge, attitudes and behaviour may need to be separately targeted in stigma reduction interventions, and separately assessed. The inter-relationships between these components in mental health promotion and medical education warrant further research. The study next needs to be replicated with larger, representative samples using appropriate evaluation instruments. More intensive training for medical students may also be required.

The long-term psychiatric and medical prognosis of perinatal mental illness.

Science.gov (United States)

Meltzer-Brody, Samantha; Stuebe, Alison

2014-01-01

The perinatal period provides an important window into a woman's long-term health. Perinatal mental illness is a common condition conferring potential serious long-term psychiatric and medical consequences for the mother and family. It is known that childbirth acts as a powerful trigger for depressive episodes in some women, and that women with histories of a mood disorder are particularly vulnerable. Some evidence links perinatal mental illness with obstetrical complications and reduced lactation initiation and duration. Therefore, perinatal mental illness may be a marker for long-term risk, and may contribute directly to subsequent cardiometabolic disease through both neuroendocrine mechanisms and the effects of mental illness on health behaviours. In clinical practice, these associations underscore the importance of screening and treating women with perinatal mental illness to ensure best possible long-term outcomes. Early screening and treatment may both mitigate the primary disease process and reduce the risk of comorbid medical conditions. Copyright © 2013 Elsevier Ltd. All rights reserved.

The absence of exanthema is related with death and illness severity in acute enterovirus infection

Directory of Open Access Journals (Sweden)

Hong-Tao Zhou

2014-11-01

Conclusions: A considerable proportion of children with an acute enterovirus infection in Guangdong Province, China during 2009–2012 presented no exanthema, and the absence of exanthema was found to be related to death and illness severity for these acute enterovirus infections. Clinicians in China should consider enterovirus as the possible pathogen when treating children with an acute pathogen infection without exanthema.

Acute liver failure and self-medication

OpenAIRE

OLIVEIRA, André Vitorio Câmara de; ROCHA, Frederico Theobaldo Ramos; ABREU, Sílvio Romero de Oliveira

2014-01-01

INTRODUCTION: Not responsible self-medication refers to drug use in high doses without rational indication and often associated with alcohol abuse. It can lead to liver damage and drug interactions, and may cause liver failure. AIM: To warn about how the practice of self-medication can be responsible for acute liver failure. METHOD: Were used the Medline via PubMed, Cochrane Library, SciELO and Lilacs, and additional information on institutional sites of interest crossing the headings acute l...

Disentangling the effect of illness perceptions on health status in people with type 2 diabetes after an acute coronary event.

Science.gov (United States)

Vos, Rimke Cathelijne; Kasteleyn, Marise Jeannine; Heijmans, Monique Johanna; de Leeuw, Elke; Schellevis, François Georges; Rijken, Mieke; Rutten, Guy Emile

2018-03-02

Chronically ill patients such as people with type 2 diabetes develop perceptions of their illness, which will influence their coping behaviour. Perceptions are formed once a health threat has been recognised. Many people with type 2 diabetes suffer from multimorbidity, for example the combination with cardiovascular disease. Perceptions of one illness may influence perceptions of the other condition. The aim of the current study was to evaluate the effect of an intervention in type 2 diabetes patients with a first acute coronary event on change in illness perceptions and whether this mediates the intervention effect on health status. The current study is a secondary data analysis of a RCT. Two hundred one participants were randomised (1:1 ratio) to the intervention (n = 101, three home visits) or control group (n = 100). Outcome variables were diabetes and acute coronary event perceptions, assessed with the two separate Brief Illness Perceptions Questionnaires (BIPQs); and health status (Euroqol Visual Analog Scale (EQ-VAS)). The intervention effect was analysed using ANCOVA. Linear regression analyses were used to assess whether illness perceptions mediated the intervention effect on health status. A positive intervention effect was found on the BIPQ diabetes items coherence and treatment control (F = 8.19, p = 0.005; F = 14.01, p effect was found on the other BIPQ diabetes items consequence, personal control, identity, illness concern and emotional representation. Regarding the acute coronary event, a positive intervention effect on treatment control was found (F = 7.81, p = 0.006). No intervention effect was found on the other items of the acute coronary event BIPQ. Better diabetes coherence was associated with improved health status, whereas perceiving more treatment control was not. The mediating effect of the diabetes perception 'coherence' on health status was not significant. Targeting illness perceptions of people with

Chronic conditions, fluid states: chronicity and the anthropology of illness

National Research Council Canada - National Science Library

Manderson, Lenore; Smith-Morris, Carolyn

2010-01-01

.... Breaking new ground in medical anthropology by challenging the chronic/acute divide in illness and disease, the editors, along with a group of rising scholars and some of the most influential minds...

Attitudes of Students at a US Medical School Toward Mental Illness and Its Causes.

Science.gov (United States)

Chiles, Catherine; Stefanovics, Elina; Rosenheck, Robert

2017-06-01

Stigma among health care providers toward people with mental illness is a worldwide problem. This study at a large US university examined medical student attitudes toward mental illness and its causes, and whether student attitudes change as they progress in their education. An electronic questionnaire focusing on attitudes toward people with mental illness, causes of mental illness, and treatment efficacy was used to survey medical students at all levels of training. Exploratory factor analysis was used to establish attitudinal factors, and analysis of variance was used to identify differences in student attitudes among these factors. Independent-samples t tests were used to assess attitudes toward efficacy of treatments for six common psychiatric and medical conditions. The study response rate was 42.6 % (n = 289). Exploratory factor analysis identified three factors reflecting social acceptance of mental illness, belief in supernatural causes, and belief in biopsychosocial causes. Stages of student education did not differ across these factors. Students who had completed the psychiatry clerkship were more likely to believe that anxiety disorders and diabetes could be treated effectively. Students reporting personal experiences with mental illness showed significantly more social acceptance, and people born outside the USA were more likely to endorse supernatural causes of mental illness. Sociocultural influences and personal experience with mental illness have a greater effect than medical education on attitudes toward people with mental illness. Psychiatric education appears to have a small but significant effect on student attitudes regarding treatment efficacy.

Acute liver failure and self-medication.

Science.gov (United States)

de Oliveira, André Vitorio Câmara; Rocha, Frederico Theobaldo Ramos; Abreu, Sílvio Romero de Oliveira

2014-01-01

Not responsible self-medication refers to drug use in high doses without rational indication and often associated with alcohol abuse. It can lead to liver damage and drug interactions, and may cause liver failure. To warn about how the practice of self-medication can be responsible for acute liver failure. Were used the Medline via PubMed, Cochrane Library, SciELO and Lilacs, and additional information on institutional sites of interest crossing the headings acute liver failure [tiab] AND acetaminophen [tiab]; self-medication [tiab] AND acetaminophen [tiab]; acute liver failure [tiab] AND dietary supplements [tiab]; self-medication [tiab] AND liver failure [tiab] and self-medication [tiab] AND green tea [tiab]. In Lilacs and SciELO used the descriptor self medication in Portuguese and Spanish. From total surveyed were selected 27 articles and five sites specifically related to the purpose of this review. Legislation and supervision disabled and information inaccessible to people, favors the emergence of cases of liver failure drug in many countries. In the list of released drugs that deserve more attention and care, are some herbal medicines used for the purpose of weight loss, and acetaminophen. It is recommended that institutes of health intensify supervision and better orient their populations on drug seemingly harmless, limiting the sale of products or requiring a prescription for release them.

Stigma towards mental illness among medical students in Australia and Ghana.

Science.gov (United States)

Lyons, Zaza; Laugharne, Jonathan; Laugharne, Richard; Appiah-Poku, John

2015-06-01

Stigma towards mental illness has been found to impact adversely on medical students' attitudes towards psychiatry. This study aimed to assess the impact of stigma among final year students at the University of Science and Technology in Kumasi, Ghana, and the University of Western Australia. A 28-item "Attitudes and stigma towards mental health" questionnaire was distributed to final year students at both universities. There was a significant difference in questionnaire scores, with Australian students showing more positive attitudes towards mental illness and lower levels of stigma compared with Ghanaian students. Stigmatization was expressed by Australian and Ghanaian students. A combination of medical school experiences and wider societal and cultural beliefs could be responsible for students' attitudes towards mental illness. Educators can develop locally relevant anti-stigma teaching resources throughout the psychiatry curriculum to improve students' attitudes towards psychiatry as a discipline and mental illness in general.

Acute renal failure in critically ill patients: a multinational, multicenter study

NARCIS (Netherlands)

Uchino, Shigehiko; Kellum, John A.; Bellomo, Rinaldo; Doig, Gordon S.; Morimatsu, Hiroshi; Morgera, Stanislao; Schetz, Miet; Tan, Ian; Bouman, Catherine; Macedo, Ettiene; Gibney, Noel; Tolwani, Ashita; Ronco, Claudio

2005-01-01

Although acute renal failure (ARF) is believed to be common in the setting of critical illness and is associated with a high risk of death, little is known about its epidemiology and outcome or how these vary in different regions of the world. To determine the period prevalence of ARF in intensive

The clinical presentation of acute bacterial meningitis varies with age, sex and duration of illness.

Science.gov (United States)

Johansson Kostenniemi, Urban; Norman, David; Borgström, Malin; Silfverdal, Sven Arne

2015-11-01

This Swedish study reviewed differences in clinical presentation and laboratory findings of acute bacterial meningitis in children aged one month to 17 years in Västerbotten County, Sweden. A register-based study was performed for the period 1986 to 2013 using the Västerbotten County Council's patient registration and laboratory records at the Department of Laboratory Medicine at Umeå University Hospital. The medical records were reviewed to extract data and confirm the diagnosis. We found 103 cases of acute bacterial meningitis, and Haemophilus influenzae was the most common pathogen, causing 40.8% of all cases, followed by Streptococcus pneumoniae at 30.1% and Neisseria meningitidis at 9.7%. Significant differences in clinical presentation and laboratory findings were found. Younger children were more unwell than older ones and had more diffuse symptoms on admission. In addition, important sex-related differences were found that might explain the higher case fatality rates for boys than girls. For example, boys tended to have a higher disturbance in the blood-brain barrier, which is known to be a negative prognostic factor. This study showed that clinical presentation for acute bacterial meningitis varied with age and sex and, to a lesser extent, on the duration of the illness. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Psychiatric diagnoses and psychoactive medication use among nonsurgical critically ill patients receiving mechanical ventilation

DEFF Research Database (Denmark)

Wunsch, Hannah; Christiansen, Christian Fynbo; Johansen, Martin B

2014-01-01

IMPORTANCE: The relationship between critical illness and psychiatric illness is unclear. OBJECTIVE: To assess psychiatric diagnoses and medication prescriptions before and after critical illness. DESIGN, SETTING, AND PARTICIPANTS: Population-based cohort study in Denmark of critically ill patien...

A comparison of adherence to hypoglycemic medications between Type 2 diabetes patients with and without serious mental illness

Science.gov (United States)

Kreyenbuhl, Julie; Leith, Jaclyn; Medoff, Deborah R.; Fang, LiJuan; Dickerson, Faith B.; Brown, Clayton H.; Goldberg, Richard W.; Potts, Wendy; Dixon, Lisa B.

2011-01-01

Inadequate self-management of chronic medical conditions like Type 2 diabetes may play a role in the poor health status of individuals with serious mental illnesses. We compared adherence to hypoglycemic medications and blood glucose control between 44 diabetes patients with a serious mental illness and 30 patients without a psychiatric illness. The two groups did not differ in their ability to manage a complex medication regimen as assessed by a performance-based measure of medication management capacity. However, significantly fewer patients with a mental illness self-reported nonadherence to their hypoglycemic regimens compared to those without a mental illness. Although individuals with mental illnesses also had better control of blood glucose, this metabolic parameter was not correlated with adherence to hypoglycemic medications in either patient group. The experience of managing a chronic mental illness may confer advantages to individuals with serious mental illnesses in the self-care of co-occurring medical conditions like Type 2 diabetes. PMID:21459458

Practice nurse and health visitor management of acute minor illness in a general practice.

Science.gov (United States)

Pritchard, A; Kendrick, D

2001-11-01

To evaluate practice nurse (PN) and health visitor (HV) management of patients with acute minor illnesses, monitor the effect on general practitioner (GP) workload, and describe the range of conditions seen by nurses. Patients requesting 'urgent' appointments (within 24 hours) were offered consultations with a PN or HV trained in the management of acute minor illness. Comparative data were collected before and after the establishment of the acute minor illness service. A general practice in Nottingham, England. Patient satisfaction, consultation rate, prescriptions, investigations, referrals and urgent re-consultations for the same condition within 2 weeks. About 2056 urgent consultations were recorded in the study period, of which 332 (16.1%) were seen by PNs and 46 (2.2%) by a HV. High levels of patient satisfaction were reported for all health professionals. Patients seeing the HV reported higher levels of satisfaction than those consulting GPs (P=0.033) and PNs (P=0.010). There was no difference by health professional for prescription rates (P=0.76), re-consultations (P=0.14), or referrals to secondary care (P=0.07). General practitioners were more likely to initiate further investigations than the PNs or HV (P manage patients with a range of conditions. General practitioner workload can be reduced while maintaining high patient satisfaction levels.

An assessment of attitudes towards people with mental illness among medical students and physicians in Ibadan, Nigeria.

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Ighodaro, Adesuwa; Stefanovics, Elina; Makanjuola, Victor; Rosenheck, Robert

2015-06-01

The authors surveyed attitudes towards mental illness among Nigerian medical personnel at three different levels of training and experience: medical students who had not completed their psychiatry rotation, medical students who had competed their psychiatry rotation, and graduate physicians. Six questions addressed beliefs about the effectiveness of treatments for four specific mental illnesses (schizophrenia, bipolar disorder, depression, and anxiety) and two medical illnesses (diabetes and hypertension) among the three groups. A self-report questionnaire including 56 dichotomous items was used to compare beliefs about and attitudes towards people with mental illness. Factor analysis was used to identify key attitudes and analysis of covariance (ANCOVA) was used to compare the groups adjusting for age and personal experience with people with mental illness. There were no significant trends in attitudes towards the effectiveness of medication. Exploratory factor analysis of the beliefs and attitudes items identified four factors: (1) comfort socializing with people with mental, illness; (2) non-superstitious beliefs about the causes of mental illness; (3) neighborly feelings towards people with mental illness; and (4) belief that stress and abuse are part of the etiology of mental illness. ANCOVA comparing attitudes among the three groups showed that on three (1, 2, and 4) of the four factors medical students who had completed a rotation in psychiatry had significantly higher scores than the medical students who had not completed a rotation in psychiatry. Graduate physicians showed a similar pattern scoring higher than the medical students who had not completed a rotation in psychiatry in two factors (1 and 4) but showed no differences from students who had completed their psychiatry rotation. While beliefs about medication effectiveness do not differ between medical trainees and graduate professionals, stigmatizing attitudes towards people with mental illness seem

Risk of viral acute gastrointestinal illness from non-disinfected drinking water distribution systems

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Acute gastrointestinal illness (AGI) resulting from pathogens directly entering the piping of drinking water distribution systems is insufficiently understood. Here, we estimate AGI incidence attributable to virus intrusions into non-disinfecting municipal distribution systems. Viruses were enumerat...

Defining guilt in depression: a comparison of subjects with major depression, chronic medical illness and healthy controls.

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Ghatavi, Kayhan; Nicolson, Rob; MacDonald, Cathy; Osher, Sue; Levitt, Anthony

2002-04-01

Although guilt is a widely accepted feature of depression, there is limited and inconsistent data defining the nature of this symptom. The purpose of the current study was to examine the specificity and nature of guilt in subjects with major depression as compared to patients with another chronic medical illness and healthy controls. Outpatients with current major depressive episode (MDE; n=34), past-MDE (n=22), chronic cardiac illness (n=20) and healthy controls (n=59) were administered the following measures: The Guilt Inventory (GI), State Shame and Guilt Scale (SSGS), 17-item Hamilton Rating Scale for Depression (Ham-D) and the Structured Clinical Interview for DSM-IV. Overall multivariate analysis of covariance comparing mean scores for the six guilt subscales [state-guilt, trait-guilt, moral standards (from the GI); state-guilt, -pride, and -shame (from the SSGS)] across the four groups was significant (F=9.1, df=6:121, pguilt (GI), current-MDE>past-MDE>cardiac=healthy controls; for trait-guilt (GI), current-MDE=past-MDE>cardiac=healthy controls; for state-shame, -guilt and -pride (SSGS), current-MDE>past-MDE, past-MDE=cardiac, past-MDE>healthy, cardiac=healthy controls. Among depressed patients, there was significant correlation between Ham-D score and all guilt sub-scales (pguilt, shame and low pride distinguish acutely depressed from all other groups, and are highly influenced by severity of depression. Trait-guilt does not differentiate acute from past depressed. Data suggests guilt may represent both an enduring and fluctuating feature of depressive illness over its longitudinal course.

Customization of a Severity of Illness Score Using Local Electronic Medical Record Data.

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Lee, Joon; Maslove, David M

2017-01-01

Severity of illness (SOI) scores are traditionally based on archival data collected from a wide range of clinical settings. Mortality prediction using SOI scores tends to underperform when applied to contemporary cases or those that differ from the case-mix of the original derivation cohorts. We investigated the use of local clinical data captured from hospital electronic medical records (EMRs) to improve the predictive performance of traditional severity of illness scoring. We conducted a retrospective analysis using data from the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II) database, which contains clinical data from the Beth Israel Deaconess Medical Center in Boston, Massachusetts. A total of 17 490 intensive care unit (ICU) admissions with complete data were included, from 4 different service types: medical ICU, surgical ICU, coronary care unit, and cardiac surgery recovery unit. We developed customized SOI scores trained on data from each service type, using the clinical variables employed in the Simplified Acute Physiology Score (SAPS). In-hospital, 30-day, and 2-year mortality predictions were compared with those obtained from using the original SAPS using the area under the receiver-operating characteristics curve (AUROC) as well as the area under the precision-recall curve (AUPRC). Test performance in different cohorts stratified by severity of organ injury was also evaluated. Most customized scores (30 of 39) significantly outperformed SAPS with respect to both AUROC and AUPRC. Enhancements over SAPS were greatest for patients undergoing cardiovascular surgery and for prediction of 2-year mortality. Custom models based on ICU-specific data provided better mortality prediction than traditional SAPS scoring using the same predictor variables. Our local data approach demonstrates the value of electronic data capture in the ICU, of secondary uses of EMR data, and of local customization of SOI scoring. © The Author(s) 2015.

Stigmatising attitudes towards persons with mental illness: a survey of medical students and interns from Southern Nigeria

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Joyce Ohiole Omoaregba

2012-01-01

Full Text Available Stigmatising attitudes towards persons with mental illness are commonly reported among health professionals. Familiarity with mental illness has been reported to improve these attitudes. Very few studies have compared future medical doctors’ attitudes toward types of mental illness, substance use disorders and physical illness. A cross-sectional survey of 5th and 6th year medical students as well as recently graduated medical doctors was conducted in April 2011. The 12-item level of contact report  and the Attitude towards Mental Illness Questionnaire were administered. Participants endorsed stigmatising attitudes towards mental illness; with attitudes more adverse for schizophrenia compared to depression. Stigmatising attitudes were similarly endorsed for substance use disorders. Paradoxically, attitudes towards HIV/AIDS were positive and similar to diabetes mellitus. Increasing familiarity with mental illness was weakly associated with better attitudes towards depression and schizophrenia. Stigmatising attitudes towards depression and schizophrenia are common among future doctors. Efforts to combat stigma are urgently needed and should be promoted among medical students and recent medical graduates.

Access to medicines for acute illness in middle income countries in Central America

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Isabel Cristina Martins Emmerick

2013-12-01

Full Text Available OBJECTIVE : To analyze the main predictors of access to medicines for persons who experienced acute health conditions. METHODS : This was a cross-sectional analytic study, based on data from household surveys. We examined the predictors of: (1 seeking care for acute illness in the formal health care system and (2 obtaining all medicines sought for the acute condition. RESULTS : The significant predictors of seeking health care for acute illnesses were urban geographic location, head of household with secondary school education or above, age under 15, severity of illness perceived by the respondent, and having health insurance. The most important predictor of obtaining full access to medicines was seeking care in the formal health care system. People who sought care in the formal system were three times more likely to receive all the medicines sought (OR 3.0, 95%CI 2.3;4.0. For those who sought care in the formal health system, the strongest predictors of full access to medicines were seeking care in the private sector, having secondary school education or above, and positive perceptions of quality of health care and medicines in public sector health facilities. For patients who did not seek care in the formal health system, full access to medicines was more likely in Honduras or Nicaragua than in Guatemala. Urban geographic location, higher economic status, and male gender were also significant predictors. CONCLUSIONS : A substantial part of the population in these three countries sought and obtained medicines outside of the formal health care system, which may compromise quality of care and pose a risk to patients. Determinants of full access to medicines inside and outside the formal health care system differ, and thus may require different strategies to improve access to medicines.

High altitude illness

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Hartman-Ksycińska, Anna; Kluz-Zawadzka, Jolanta; Lewandowski, Bogumił

High-altitude illness is a result of prolonged high-altitude exposure of unacclimatized individuals. The illness is seen in the form of acute mountain sickness (AMS) which if not treated leads to potentially life-threatening high altitude pulmonary oedema and high-altitude cerebral oedema. Medical problems are caused by hypobaric hypoxia stimulating hypoxia-inducible factor (HIF) release. As a result, the central nervous system, circulation and respiratory system function impairment occurs. The most important factor in AMS treatment is acclimatization, withdrawing further ascent and rest or beginning to descent; oxygen supplementation, and pharmacological intervention, and, if available, a portable hyperbaric chamber. Because of the popularity of high-mountain sports and tourism better education of the population at risk is essential.

Writing about an experience of illness in medical students

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Hwang K

2013-08-01

Full Text Available Kun Hwang,1 Huan Fan,1 Se Won Hwang2 1Department of Plastic Surgery, Inha University School of Medicine, Incheon, Korea; 2Peninsula Medical School, Exeter, UK Abstract: Pathography is defined as “historical biography from a medical, psychological, and psychiatric viewpoint.” We thought that writing about an experience of illness might help students understand patients’ experience and in turn grow in terms of self-understanding. Participants included 151 medical students. Students wrote about their own experience of illness and were asked to answer questions from the Likert scale. Most students wrote about themselves (79.2%; however, some students (20.8% wrote about the illness of others. Among the 149 pathographies, ecopathography was most frequent (30.9%, followed by testimonial pathography (25.5%; angry pathography (13.4% and alternative pathography (12.1% were relatively less frequent. Eighty-eight pathographies (59.1% showed 120 expressions of family relationship. Among the 120 cases, worrying about family members was most frequent (47.5%, followed by reliance on a family member (32.5%. All students wrote about the enlightenment experienced on returning to daily life. The sense of belonging together was most frequent (38.3%, followed by gratitude for living (20.8%, resolution to be a good doctor (18.1%, and a will to live and be healthy (12.1%. Answers on the Likert scale (total 5 for pathography beneficence were very high in understanding desirable doctor image (4.46, attaining morals and personality as a health care professional (4.49, and understanding basic communication skills (4.46. Writing about an experience of illness allows students to better understand patients’ experience and to grow in self-understanding. Keywords: writing, disease, patients, narration, pathography

Supernatural versus medical: Responses to mental illness from undergraduate university students in Trinidad.

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Ramkissoon, AnMarie Kamanie; Donald, Casswina; Hutchinson, Gerard

2017-06-01

Background/Introduction: Perceptions about the aetiology of mental illness are likely to influence help-seeking behaviour. Understanding help-seeking behaviour will improve service provision and access. Therefore, this is likely to improve treatment outcomes. We assessed the perceptions and help-seeking behaviours surrounding mental illness in a Trinidadian population of 158 tertiary-level students (136 female, 22 male; mean age 30) by analysing their responses to a questionnaire which asked for responses regarding a case vignette of a 25-year-old young woman exhibiting symptoms suggestive of schizophrenia. Of the respondents, 32.3% attributed the symptoms to supernatural causes. Specifically, 27.8% to someone doing her bad and 24.1% to evil spirits. In all, 77.2% of respondents indicated that mental illness was caused by medical problems and 63.3% to work stress. A minimum of 9.5% of the students therefore have dual perceptions regarding causation (77.2 + 32.3 = 109.5) Those who perceived causation to be supernatural said they would seek help from both medical ( p = .000) and supernatural ( p = .000) modalities. This also applied significantly to those who said the causation was medical, that is, seeking both religious intervention ( p = .000) and medical intervention (.000) as the first path in the health-seeking pathway. Dual help-seeking behaviour seems to be the functional result of an integration of religious and medical models of mental illness causation even in respondents who clearly identified only one of these as the likely cause of the illness behaviour.

Apixaban versus enoxaparin for thromboprophylaxis in medically ill patients

DEFF Research Database (Denmark)

Goldhaber, Samuel Z; Leizorovicz, Alain; Kakkar, Ajay K

2011-01-01

The efficacy and safety of prolonging prophylaxis for venous thromboembolism in medically ill patients beyond hospital discharge remain uncertain. We hypothesized that extended prophylaxis with apixaban would be safe and more effective than short-term prophylaxis with enoxaparin....

Constipation - prevalence and incidence among medical patients acutely admitted to hospital with a medical condition

DEFF Research Database (Denmark)

Noiesen, Eline; Trosborg, Ingelise; Bager, Louise

2014-01-01

To examine the prevalence and incidence of patient-reported symptoms of constipation in acutely hospitalised medical patients.......To examine the prevalence and incidence of patient-reported symptoms of constipation in acutely hospitalised medical patients....

Acute Kidney Injury as a Risk Factor for Delirium and Coma during Critical Illness.

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Siew, Edward D; Fissell, William H; Tripp, Christina M; Blume, Jeffrey D; Wilson, Matthew D; Clark, Amanda J; Vincz, Andrew J; Ely, E Wesley; Pandharipande, Pratik P; Girard, Timothy D

2017-06-15

Acute kidney injury may contribute to distant organ dysfunction. Few studies have examined kidney injury as a risk factor for delirium and coma. To examine whether acute kidney injury is associated with delirium and coma in critically ill adults. In a prospective cohort study of intensive care unit patients with respiratory failure and/or shock, we examined the association between acute kidney injury and daily mental status using multinomial transition models adjusting for demographics, nonrenal organ failure, sepsis, prior mental status, and sedative exposure. Acute kidney injury was characterized daily using the difference between baseline and peak serum creatinine and staged according to Kidney Disease Improving Global Outcomes criteria. Mental status (normal vs. delirium vs. coma) was assessed daily with the Confusion Assessment Method for the ICU and Richmond Agitation-Sedation Scale. Among 466 patients, stage 2 acute kidney injury was a risk factor for delirium (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.07-2.26) and coma (OR, 2.04; 95% CI, 1.25-3.34) as was stage 3 injury (OR for delirium, 2.56; 95% CI, 1.57-4.16) (OR for coma, 3.34; 95% CI, 1.85-6.03). Daily peak serum creatinine (adjusted for baseline) values were also associated with delirium (OR, 1.35; 95% CI, 1.18-1.55) and coma (OR, 1.44; 95% CI, 1.20-1.74). Renal replacement therapy modified the association between stage 3 acute kidney injury and daily peak serum creatinine and both delirium and coma. Acute kidney injury is a risk factor for delirium and coma during critical illness.

Healthcare disparities in critical illness.

Science.gov (United States)

Soto, Graciela J; Martin, Greg S; Gong, Michelle Ng

2013-12-01

To summarize the current literature on racial and gender disparities in critical care and the mechanisms underlying these disparities in the course of acute critical illness. MEDLINE search on the published literature addressing racial, ethnic, or gender disparities in acute critical illness, such as sepsis, acute lung injury, pneumonia, venous thromboembolism, and cardiac arrest. Clinical studies that evaluated general critically ill patient populations in the United States as well as specific critical care conditions were reviewed with a focus on studies evaluating factors and contributors to health disparities. Study findings are presented according to their association with the prevalence, clinical presentation, management, and outcomes in acute critical illness. This review presents potential contributors for racial and gender disparities related to genetic susceptibility, comorbidities, preventive health services, socioeconomic factors, cultural differences, and access to care. The data are organized along the course of acute critical illness. The literature to date shows that disparities in critical care are most likely multifactorial involving individual, community, and hospital-level factors at several points in the continuum of acute critical illness. The data presented identify potential targets as interventions to reduce disparities in critical care and future avenues for research.

Risk factors and outcome of transfusion-related acute lung injury in the critically ill: A nested case-control study

NARCIS (Netherlands)

Vlaar, Alexander P. J.; Binnekade, Jan M.; Prins, David; van Stein, Danielle; Hofstra, Jorrit J.; Schultz, Marcus J.; Juffermans, Nicole P.

2010-01-01

Objectives: To determine the incidence, risk factors, and outcome of transfusion-related acute lung injury in a cohort of critically ill patients. Design: In a retrospective cohort study, patients with transfusion-related acute lung injury were identified using the consensus criteria of acute lung

Risk factors and outcome of transfusion-related acute lung injury in the critically ill : A nested case-control study

NARCIS (Netherlands)

Vlaar, Alexander P. J.; Binnekade, Jan M.; Prins, David; van Stein, Danielle; Hofstra, Jorrit J.; Schultz, Marcus J.; Juffermans, Nicole P.

Objectives: To determine the incidence, risk factors, and outcome of transfusion-related acute lung injury in a cohort of critically ill patients. Design: In a retrospective cohort study, patients with transfusion-related acute lung injury were identified using the consensus criteria of acute lung

Effectiveness of non-adjuvanted pandemic influenza A vaccines for preventing pandemic influenza acute respiratory illness visits in 4 U.S. communities.

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Marie R Griffin

Full Text Available We estimated the effectiveness of four monovalent pandemic influenza A (H1N1 vaccines (three unadjuvanted inactivated, one live attenuated available in the U.S. during the pandemic. Patients with acute respiratory illness presenting to inpatient and outpatient facilities affiliated with four collaborating institutions were prospectively recruited, consented, and tested for influenza. Analyses were restricted to October 2009 through April 2010, when pandemic vaccine was available. Patients testing positive for pandemic influenza by real-time RT-PCR were cases; those testing negative were controls. Vaccine effectiveness was estimated in logistic regression models adjusted for study community, patient age, timing of illness, insurance status, enrollment site, and presence of high-risk medical conditions. Pandemic virus was detected in 1,011 (15% of 6,757 enrolled patients. Fifteen (1% of 1,011 influenza positive cases and 1,042 (18% of 5,746 test-negative controls had record-verified pandemic vaccination >14 days prior to illness onset. Adjusted effectiveness (95% confidence interval for pandemic vaccines combined was 56% (23%, 75%. Adjusted effectiveness for inactivated vaccines alone (79% of total was 62% (25%, 81% overall and 32% (-92%, 76%, 89% (15%, 99%, and -6% (-231%, 66% in those aged 0.5 to 9, 10 to 49, and 50+ years, respectively. Effectiveness for the live attenuated vaccine in those aged 2 to 49 years was only demonstrated if vaccination >7 rather than >14 days prior to illness onset was considered (61%∶ 12%, 82%. Inactivated non-adjuvanted pandemic vaccines offered significant protection against confirmed pandemic influenza-associated medical care visits in young adults.

Potentially inappropriate medication related to weakness in older acute medical patients

DEFF Research Database (Denmark)

Jensen, Line Due; Andersen, Ove; Hallin, Marianne

2014-01-01

: Patients aged ≥65 years admitted to the acute medical unit during the period October to December 2011 were included. Patients were interviewed at admission and at a follow-up visit 30 days after discharge. Data included information about medications, social status, functional status, cognitive status.......94), cognition (p = 0.10), pain (p = 0.46), or visual acuity (p = 0.55). CONCLUSIONS: Use of PIMs was very common among older people admitted to an acute medical unit. The use of PIMs is associated with low functional status, low handgrip strength, and reduced health-related quality of life.......: The prevalence of PIMs and the association with PIMs and functional status handgrip strength, HRQOL, comorbidities, social demographic data and vision. RESULTS: Seventy-one patients (55 % men) with a median age of 78.7 years participated. The median number of medications was eight per person. Eighty percent were...

Self-reported medical, medication and laboratory error in eight countries: risk factors for chronically ill adults.

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Scobie, Andrea

2011-04-01

To identify risk factors associated with self-reported medical, medication and laboratory error in eight countries. The Commonwealth Fund's 2008 International Health Policy Survey of chronically ill patients in eight countries. None. A multi-country telephone survey was conducted between 3 March and 30 May 2008 with patients in Australia, Canada, France, Germany, the Netherlands, New Zealand, the UK and the USA who self-reported being chronically ill. A bivariate analysis was performed to determine significant explanatory variables of medical, medication and laboratory error (P error: age 65 and under, education level of some college or less, presence of two or more chronic conditions, high prescription drug use (four+ drugs), four or more doctors seen within 2 years, a care coordination problem, poor doctor-patient communication and use of an emergency department. Risk factors with the greatest ability to predict experiencing an error encompassed issues with coordination of care and provider knowledge of a patient's medical history. The identification of these risk factors could help policymakers and organizations to proactively reduce the likelihood of error through greater examination of system- and organization-level practices.

Health-illness transition among persons using advanced medical technology at home.

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Fex, Angelika; Flensner, Gullvi; Ek, Anna-Christina; Söderhamn, Olle

2011-06-01

This study aimed to elucidate meanings of health-illness transition experiences among adult persons using advanced medical technology at home. As an increasing number of persons perform self-care while using different sorts of advanced medical technology at home, knowledge about health-illness transition experiences in this situation may be useful to caregivers in supporting these patients. A qualitative design was used. Five women and five men, all of whom performed self-care at home, either using long-term oxygen therapy from a ventilator or oxygen cylinder, or performing peritoneal or haemodialysis, were interviewed. Ethics committee approval was obtained. Informed consent was received from all participants, and ethical issues concerning their rights in research were raised. The interviews were analysed using a phenomenological hermeneutical methodology, including both an inductive and a deductive structural analysis. This method offers possibilities to obtain an increased understanding by uncovering a deeper meaning of lived experiences through interviews transcribed as texts. The health-illness transition for adult persons in this context was found to mean a learning process of accepting, managing, adjusting and improving daily life with technology, facilitated by realizing the gain from technology at home. Further, the meaning of the health-illness transition experience was interpreted as contentment with being part of the active and conscious process towards transcending into a new state of living, in which the individual and the technology were in tune. The healthy transition experience was characterized by human growth and becoming. This study elucidates one meaning of health-illness transition experiences in relation to the use of advanced medical technology on a more generic level, independent of the specific type of technology used. A positive attitude towards technology at home facilitates the transition. © 2010 The Authors. Scandinavian Journal of

Patient-centered medical homes in Louisiana had minimal impact on Medicaid population's use of acute care and costs.

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Cole, Evan S; Campbell, Claudia; Diana, Mark L; Webber, Larry; Culbertson, Richard

2015-01-01

The patient-centered medical home model of primary care has received considerable attention for its potential to improve outcomes and reduce health care costs. Yet little information exists about the model's ability to achieve these goals for Medicaid patients. We sought to evaluate the effect of patient-centered medical home certification of Louisiana primary care clinics on the quality and cost of care over time for a Medicaid population. We used a quasi-experimental pre-post design with a matched control group to assess the effect of medical home certification on outcomes. We found no impact on acute care use and modest support for reduced costs and primary care use among medical homes serving higher proportions of chronically ill patients. These findings provide preliminary results related to the ability of the patient-centered medical home model to improve outcomes for Medicaid beneficiaries. The findings support a case-mix-adjusted payment policy for medical homes going forward. Project HOPE—The People-to-People Health Foundation, Inc.

Hospital-Level Care at Home for Acutely Ill Adults: a Pilot Randomized Controlled Trial.

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Levine, David M; Ouchi, Kei; Blanchfield, Bonnie; Diamond, Keren; Licurse, Adam; Pu, Charles T; Schnipper, Jeffrey L

2018-05-01

Hospitals are standard of care for acute illness, but hospitals can be unsafe, uncomfortable, and expensive. Providing substitutive hospital-level care in a patient's home potentially reduces cost while maintaining or improving quality, safety, and patient experience, although evidence from randomized controlled trials in the US is lacking. Determine if home hospital care reduces cost while maintaining quality, safety, and patient experience. Randomized controlled trial. Adults admitted via the emergency department with any infection or exacerbation of heart failure, chronic obstructive pulmonary disease, or asthma. Home hospital care, including nurse and physician home visits, intravenous medications, continuous monitoring, video communication, and point-of-care testing. Primary outcome was direct cost of the acute care episode. Secondary outcomes included utilization, 30-day cost, physical activity, and patient experience. Nine patients were randomized to home, 11 to usual care. Median direct cost of the acute care episode for home patients was 52% (IQR, 28%; p = 0.05) lower than for control patients. During the care episode, home patients had fewer laboratory orders (median per admission: 6 vs. 19; p Home patients were more physically active (median minutes, 209 vs. 78; p home patients, one occurred in control patients. Median direct cost for the acute care plus 30-day post-discharge period for home patients was 67% (IQR, 77%; p home-care services (22% vs. 55%; p = 0.08) and fewer readmissions (11% vs. 36%; p = 0.32). Patient experience was similar in both groups. The use of substitutive home-hospitalization compared to in-hospital usual care reduced cost and utilization and improved physical activity. No significant differences in quality, safety, and patient experience were noted, with more definitive results awaiting a larger trial. Trial Registration NCT02864420.

Acute migraine medication adherence, migraine disability and patient satisfaction: A naturalistic daily diary study.

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Seng, Elizabeth K; Robbins, Matthew S; Nicholson, Robert A

2017-09-01

Objective To examine the influence of acute migraine medication adherence on migraine disability and acute medication satisfaction. Methods Adults with migraine completed three months of daily electronic diaries assessing headache symptoms, acute medication taken, acute medication satisfaction, and daily migraine disability. Repeated measures mixed-effects models examined the effect of initial medication type [migraine-specific medication (MSM) vs. over-the-counter analgesic (OTC) vs. an opiate/barbiturate], the severity of pain at dosing, and their interaction with daily migraine disability and satisfaction with acute medication. Results Participants (N = 337; 92.5% female; 91.1% Caucasian, non-Hispanic; 84.0% with episodic migraine) recorded 29,722 diary days. Participants took acute medication on 96.5% of 8090 migraine days. MSM was most frequently taken first (58%), followed by OTC (29.9%) and an opiate/barbiturate (12.1%). Acute medication was most frequently taken when pain was mild (41.2%), followed by moderate (37.7%) and severe pain (11.4%). Initially dosing with MSM while pain was mild was associated with the lowest daily disability [medication × pain at dosing F (4, 6336.12) = 58.73, p migraine disability and highest acute medication satisfaction.

Concurrent acute illness and comorbid conditions poorly predict antibiotic use in upper respiratory tract infections: a cross-sectional analysis

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Perencevich Eli N

2007-05-01

Full Text Available Abstract Background Inappropriate antibiotic use promotes resistance. Antibiotics are generally not indicated for upper respiratory infections (URIs. Our objectives were to describe patterns of URI treatment and to identify patient and provider factors associated with antibiotic use for URIs. Methods This study was a cross-sectional analysis of medical and pharmacy claims data from the Pennsylvania Medicaid fee-for-service program database. We identified Pennsylvania Medicaid recipients with a URI office visit over a one-year period. Our outcome variable was antibiotic use within seven days after the URI visit. Study variables included URI type and presence of concurrent acute illnesses and chronic conditions. We considered the associations of each study variable with antibiotic use in a logistic regression model, stratifying by age group and adjusting for confounders. Results Among 69,936 recipients with URI, 35,786 (51.2% received an antibiotic. In all age groups, acute sinusitis, chronic sinusitis, otitis, URI type and season were associated with antibiotic use. Except for the oldest group, physician specialty and streptococcal pharyngitis were associated with antibiotic use. History of chronic conditions was not associated with antibiotic use in any age group. In all age groups, concurrent acute illnesses and history of chronic conditions had only had fair to poor ability to distinguish patients who received an antibiotic from patients who did not. Conclusion Antibiotic prevalence for URIs was high, indicating that potentially inappropriate antibiotic utilization is occurring. Our data suggest that demographic and clinical factors are associated with antibiotic use, but additional reasons remain unexplained. Insight regarding reasons for antibiotic prescribing is needed to develop interventions to address the growing problem of antibiotic resistance.

Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients

DEFF Research Database (Denmark)

Krag, Mette; Perner, Anders; Wetterslev, Jørn

2015-01-01

PURPOSE: To describe the prevalence of, risk factors for, and prognostic importance of gastrointestinal (GI) bleeding and use of acid suppressants in acutely ill adult intensive care patients. METHODS: We included adults without GI bleeding who were acutely admitted to the intensive care unit (IC...

Psychotropic Medication Adherence among Community-Based Individuals with Developmental Disabilities and Mental Illness

Science.gov (United States)

Tan, Xi; Marshall, Vincent D.; Balkrishnan, Rajesh; Patel, Isha; Chang, Jongwha; Erickson, Steven R.

2015-01-01

Psychotropic medications are a common treatment for mental illness in people with developmental disabilities. Medication adherence is a critical determinant of the effectiveness of psychotropic drugs, but psychotropic medication adherence research specific to this population remains limited. This retrospective study analyzed Marketscan®…

Risk of preterm birth by subtype among Medi-Cal participants with mental illness.

Science.gov (United States)

Baer, Rebecca J; Chambers, Christina D; Bandoli, Gretchen; Jelliffe-Pawlowski, Laura L

2016-10-01

Previous studies have demonstrated an association between mental illness and preterm birth (before 37 weeks). However, these investigations have not simultaneously considered gestation of preterm birth, the indication (eg, spontaneous or medically indicated), and specific mental illness classifications. The objective of the study was to examine the likelihood of preterm birth across gestational lengths and indications among Medi-Cal (California's Medicaid program) participants with a diagnostic code for mental illness. Mental illnesses were studied by specific illness classification. The study population was drawn from singleton live births in California from 2007 through 2011 in the birth cohort file maintained by the California Office of Statewide Health Planning and Development, which includes birth certificate and hospital discharge records. The sample was restricted to women with Medi-Cal coverage for prenatal care. Women with mental illness were identified using International Classification of Diseases, ninth revision, codes from their hospital discharge record. Women without a mental illness International Classification of Diseases, ninth revision, code were randomly selected at a 4:1 ratio. Adjusting for maternal characteristics and obstetric complications, relative risks and 95% confidence intervals were calculated for preterm birth comparing women with a mental illness diagnostic code with women without such a code. We identified 6198 women with a mental illness diagnostic code and selected 24,792 women with no such code. The risk of preterm birth in women with a mental illness were 1.2 times higher than women without a mental illness (adjusted relative risk, 1.2, 95% confidence interval, 1.1-1.3). Among the specific mental illnesses, schizophrenia, major depression, and personality disorders had the strongest associations with preterm birth (adjusted relative risks, 2.0, 2.0 and 3.3, respectively). Women receiving prenatal care through California's low

Impact of psychiatric education and training on attitude of medical students towards mentally ill: A comparative analysis

Directory of Open Access Journals (Sweden)

Tarun Yadav

2012-01-01

Full Text Available Background: A number of studies from the western world have explored the negative beliefs held by individuals towards people with mental illness. The knowledge of attitude and awareness of undergraduate medical students towards psychiatry, mental health and mental disorders is of utmost importance. Objective: The current study aims at assessment of attitudes of medical students towards mental illness and mentally ill. Materials and Methods: The study used a cross-sectional survey design. The instruments used included Beliefs toward Mental Illness (BMI scale, Attitudes to Mental Illness Questionnaire (AMIQ. ANOVA was carried out to compare the in between group differences for the four study groups. Additionally Bonferroni correction was used to conduct the post hoc analysis. Results: The interns were significantly more likely to agree with the statement that the mental disorders are recurrent; less likely to be of thought that the behavior of people with mental disorders is unpredictable; more likely to disagree with the fact that diagnosis of depression as described in the case vignette was going to damage the career of the individual; more likely to agree with the option of inviting a depressed person to a party; more likely to believe in fact that mentally ill individuals are more likely to be criminals as compared to medical students in different professional years. Conclusions: Adequate modifications to existing medical curriculum would help improve attitude of medical students towards mentally ill.

Effect of acute kidney injury on weaning from mechanical ventilation in critically ill patients.

Science.gov (United States)

Vieira, José M; Castro, Isac; Curvello-Neto, Américo; Demarzo, Sérgio; Caruso, Pedro; Pastore, Laerte; Imanishe, Marina H; Abdulkader, Regina C R M; Deheinzelin, Daniel

2007-01-01

Acute kidney injury (AKI) worsens outcome in various scenarios. We sought to investigate whether the occurrence of AKI has any effect on weaning from mechanical ventilation. Observational, retrospective study in a 23-bed medical/surgical intensive care unit (ICU) in a cancer hospital from January to December 2003. The inclusion criterion was invasive mechanical ventilation for > or =48 hrs. AKI was defined as at least one measurement of serum creatinine of > or =1.5 mg/dL during the ICU stay. Patients were then separated into AKI and non-AKI patients (control group). The criterion for weaning was the combination of positive end-expiratory pressure of or =85% increase in baseline serum creatinine (hazard rate, 2.30; 95% confidence interval, 1.30-4.08), oliguria (hazard rate, 2.51; 95% confidence interval, 1.24-5.08), and the number of antibiotics (hazard rate, 2.64; 95% confidence interval, 1.51-4.63) predicted longer duration of weaning. The length of ICU stay and ICU mortality rate were significantly greater in the AKI patients. After adjusting for Simplified Acute Physiology Score II, oliguria (odds ratio, 30.8; 95% confidence interval, 7.7-123.0) remained as a strong risk factor for mortality. This study shows that renal dysfunction has serious consequences in the duration of mechanical ventilation, weaning from mechanical ventilation, and mortality in critically ill cancer patients.

Identity work and illness careers of patients with medically unexplained symptoms

DEFF Research Database (Denmark)

Rossen, Camilla Blach; Buus, Niels; Stenager, Elsebeth

2018-01-01

often experience being met with mistrust and feel their identity threatened as a consequence of being illegitimately ill. There is a strong tendency in health care towards assessment thorough standardized so-called assessment packages. The study used a case study approach. Ethnographic fieldwork......This article reports a case study of the illness career and identity work of patients who have had medically unexplained symptoms for many years with a particular emphasis on their interactions with a specialized and standardized health care system. Patients with medically unexplained symptoms...... assessment with limited time can lead to a diagnostic limbo and that patients and health care professionals keep on searching for legitimate explanations for the patients' still unexplained symptoms. Consequently the patients were left in a constant identity negotiation....

A conceptual framework for the use of illness narratives in medical education.

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Kumagai, Arno K

2008-07-01

The use of narratives, including physicians' and patients' stories, literature, and film, is increasingly popular in medical education. There is, however, a need for an overarching conceptual framework to guide these efforts, which are often dismissed as "soft" and placed at the margins of medical school curricula. The purpose of this article is to describe the conceptual basis for an approach to patient-centered medical education and narrative medicine initiated at the University of Michigan Medical School in the fall of 2003. This approach, the Family Centered Experience, involves home visits and conversations between beginning medical students and patient volunteers and their families and is aimed at fostering humanism in medicine. The program incorporates developmental and learning theory, longitudinal interactions with individuals with chronic illness, reflective learning, and small-group discussions to explore the experience of illness and its care. The author describes a grounding of this approach in theories of empathy and moral development and clarifies the educational value that narratives bring to medical education. Specific pedagogical considerations, including use of activities to create "cognitive disequilibrium" and the concept of transformative learning, are also discussed and may be applied to narrative medicine, professionalism, multicultural education, medical ethics, and other subject areas in medical education that address individuals and their health care needs in society.

Correlates of self-harm behaviour in acutely ill patients with schizophrenia.

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Simms, Jane; McCormack, Vinny; Anderson, Richard; Mulholland, Ciaran

2007-03-01

This study compared acutely ill patients with schizophrenia with a history of self-harm (N=17) to those without a history of self-harm (N=16) on measures of depression, hopelessness, suicidal ideation, and demographic and psychiatric variables. A subgroup of these patients who experience auditory hallucinations, with and without a history of self-harm, were selected and compared on measures of depression, hopelessness, suicidal ideation and beliefs about voices. Employing a cross-sectional design, in-patients of two local psychiatric hospital, who met DSM-IV-TR criteria for schizophrenia and who were in an acute phase of the illness, were selected. Each patient was assessed using the Beck Depressions Inventory (BDI), Beck Hopelessness Scale (BHS) and the Beck Suicide Scale (BSS). Patients who experienced auditory verbal hallucinations completed the Beliefs About Voices Questionnaire Revised (BAVQ-R). Patients with a history of self-harm completed the Beck Suicide Intent Scale (BSI). Patients with a history of self-harm (N=17) had significantly greater symptoms of depression, greater suicidal thoughts, increased number of hospital admissions, greater duration of illness and were more likely to be married, compared to patients without a history of self-harm (N=16). Among the subgroup of patients who experience auditory hallucinations, those with a history of self-harm (N=9), believed their voice to be more malevolent, had a tendency to resist their voice and experienced significantly greater symptoms of depression and hopelessness compared to those without a history of self-harm (N=6). These findings highlight the importance for screening by clinicians during inpatient hospital stays and for monitoring to be ongoing following discharge. For the subgroup of patients who experience auditory hallucinations, future research should seek to explore the relationship between self-harm and beliefs about voices.

Incidence of influenza-like illness and severe acute respiratory infection during three influenza seasons in Bangladesh, 2008–2010

Science.gov (United States)

Alamgir, ASM; Rahman, Mustafizur; Homaira, Nusrat; Sohel, Badrul Munir; Sharker, MA Yushuf; Zaman, Rashid Uz; Dee, Jacob; Gurley, Emily S; Al Mamun, Abdullah; Mah-E-Muneer, Syeda; Fry, Alicia M; Widdowson, Marc-Alain; Bresee, Joseph; Lindstrom, Stephen; Azim, Tasnim; Brooks, Abdullah; Podder, Goutam; Hossain, M Jahangir; Rahman, Mahmudur; Luby, Stephen P

2012-01-01

Abstract Objective To determine how much influenza contributes to severe acute respiratory illness (SARI), a leading cause of death in children, among people of all ages in Bangladesh. Methods Physicians obtained nasal and throat swabs to test for influenza virus from patients who were hospitalized within 7 days of the onset of severe acute respiratory infection (SARI) or who consulted as outpatients for influenza-like illness (ILI). A community health care utilization survey was conducted to determine the proportion of hospital catchment area residents who sought care at study hospitals and calculate the incidence of influenza using this denominator. Findings The estimated incidence of SARI associated with influenza in children < 5 years old was 6.7 (95% confidence interval, CI: 0–18.3); 4.4 (95% CI: 0–13.4) and 6.5 per 1000 person–years (95% CI: 0–8.3/1000) during the 2008, 2009 and 2010 influenza seasons, respectively. The incidence of SARI in people aged ≥ 5 years was 1.1 (95% CI: 0.4–2.0) and 1.3 (95% CI: 0.5–2.2) per 10 000 person–years during 2009 and 2010, respectively. The incidence of medically attended, laboratory-confirmed seasonal influenza in outpatients with ILI was 10 (95% CI: 8–14), 6.6 (95% CI: 5–9) and 17 per 100 person–years (95% CI: 13–22) during the 2008, 2009 and 2010 influenza seasons, respectively. Conclusion Influenza-like illness is a frequent cause of consultation in the outpatient setting in Bangladesh. Children aged less than 5 years are hospitalized for influenza in greater proportions than children in other age groups. PMID:22271960

Studies on common illnesses and medical care utilization patterns of adolescents in Hong Kong.

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Lau, J T; Yu, A; Cheung, J C; Leung, S S

2000-12-01

To estimate the prevalences of common illnesses in Hong Kong adolescents, the sociodemographic and selected risk factors associated with these illnesses, and their health care utilization behavior and attitudes. A cross-sectional questionnaire survey of 3355 participating secondary school students (response rate = 98%). Self-reported 3-month prevalences were obtained for cough/cold/influenza (55.2%), digestive disorders (34.6%), accidental injuries (29.5%), headache/dizziness (23.6%), chronic anxiety/insomnia (20.1%), skin problems (9.5%), asthma (3.8%), liver disease (1.3%), and menstrual pain (13.8% of female students). Self-perceived poor health, smoking, and alcohol consumption were associated with many of these illnesses. Treatment choice depended on the illness suffered (e.g., most students with respiratory problems consulted medical practitioners, whereas most with chronic anxiety/insomnia did not). Many students lacked trust in their doctors, doctor-shopped, relied heavily on self-medication, did not comply with prescribed treatments, would not seek help about medical problems, felt they had insufficient access to health information, and wanted confidential health care. This study examined for the first time the common illnesses and health care utilization patterns of Hong Kong adolescents. Students with chronic anxiety/insomnia were much less likely to seek care, indicating a need for better education on mental health. Efforts to prevent smoking and alcohol consumption among adolescents need to be strengthened. The students' attitudes, poor compliance and help-seeking behaviors suggest suboptimal use of the health care system. Our findings are useful for international comparisons by medical practitioners, health care managers, and researchers.

An analysis of autopsy cases of non-Hodgkin lymphoma-with special reference to those masquerading as acute febrile illness.

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Saraf, Sonali Rajesh; Naphade, Nilesh S; Kalgutkar, Alka D

2016-01-01

As in any medical disorder, in non-Hodgkin lymphomas (NHLs) also, precise analysis of causes of death is needed to focus research efforts and improve morbidity and mortality. The aim of this study was to review the clinical presentation, mode of death and the immunophenotype of the autopsy cases of NHL. Autopsy cases wherein NHL was diagnosed, were selected for study. Autopsy cases which were diagnosed as NHL, either antemortem or after autopsy during a 7 years period at a tertiary care referral centre were studied and reviewed. Descriptive statistical analysis used. The autopsy findings seen in eight cases of NHL were reviewed. Except one, all cases were above 40 years age. Infective etiology (62%) followed by cardiorespiratory failure (38%) was the cause of death observed in these patients. In three cases, the antemortem diagnosis of NHL was missed as the patients were being treated for acute febrile illness and were referred late to the Tertiary Care Centre. One of these was a case of extra-nodal primary splenic lymphoma. As NHL present with nonspecific symptoms, these tumours may not be detected in early stages and hence may not be treated appropriately. These patients have weakened immunity and hence are prone to infection and sepsis which can be a major cause of mortality. This autopsy study experience has shown that NHL can masquerade as acute febrile illness which if not detected early and treated adequately can turn fatal.

Relationship of clinical course of illness variables to medical comorbidities in 900 adult outpatients with bipolar disorder'

NARCIS (Netherlands)

Post, Robert M.; Altshuler, Lori; Leverich, Gabriele S.; Frye, Mark A.; Suppes, Trish; McElroy, Susan L.; Keck, Paul E.; Nolen, Willem A.; Kupka, Ralph W.; Grunze, Heinz; Rowe, Mike

2015-01-01

BACKGROUND: Medical illnesses are highly comorbid with bipolar disorder, but their relationship to illness characteristics has not been previously delineated. METHODS: The incidence of 34 medical conditions and 6 poor prognosis factors (PPFs) was derived from answers to a questionnaire in over 900

Relationship of clinical course of illness variables to medical comorbidities in 900 adult outpatients with bipolar disorder'

NARCIS (Netherlands)

Post, R.M.; Altshuler, L.; Leverich, G.S.; Frye, M.A.; Suppes, T.; McElroy, S.L.; Keck, P.E.; Nolen, W.A.; Kupka, R.W.; Grunze, H.; Rowe, M.

2015-01-01

Background Medical illnesses are highly comorbid with bipolar disorder, but their relationship to illness characteristics has not been previously delineated. Methods The incidence of 34 medical conditions and 6 poor prognosis factors (PPFs) was derived from answers to a questionnaire in over 900

Depot-medication compliance for patients with psychotic disorders: the importance of illness insight and treatment motivation.

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Noordraven, Ernst L; Wierdsma, André I; Blanken, Peter; Bloemendaal, Anthony Ft; Mulder, Cornelis L

2016-01-01

Noncompliance is a major problem for patients with a psychotic disorder. Two important risk factors for noncompliance that have a severe negative impact on treatment outcomes are impaired illness insight and lack of motivation. Our cross-sectional study explored how they are related to each other and their compliance with depot medication. Interviews were conducted in 169 outpatients with a psychotic disorder taking depot medication. Four patient groups were defined based on low or high illness insight and on low or high motivation. The associations between depot-medication compliance, motivation, and insight were illustrated using generalized linear models. Generalized linear model showed a significant interaction effect between motivation and insight. Patients with poor insight and high motivation for treatment were more compliant (94%) (95% confidence interval [CI]: 1.821, 3.489) with their depot medication than patients with poor insight and low motivation (61%) (95% CI: 0.288, 0.615). Patients with both insight and high motivation for treatment were less compliant (73%) (95% CI: 0.719, 1.315) than those with poor insight and high motivation. Motivation for treatment was more strongly associated with depot-medication compliance than with illness insight. Being motivated to take medication, whether to get better or for other reasons, may be a more important factor than having illness insight in terms of improving depot-medication compliance. Possible implications for clinical practice are discussed.

The Relationship between Poverty and Healthcare Seeking among Patients Hospitalized with Acute Febrile Illnesses in Chittagong, Bangladesh.

Directory of Open Access Journals (Sweden)

M Trent Herdman

Full Text Available Delays in seeking appropriate healthcare can increase the case fatality of acute febrile illnesses, and circuitous routes of care-seeking can have a catastrophic financial impact upon patients in low-income settings. To investigate the relationship between poverty and pre-hospital delays for patients with acute febrile illnesses, we recruited a cross-sectional, convenience sample of 527 acutely ill adults and children aged over 6 months, with a documented fever ≥38.0 °C and symptoms of up to 14 days' duration, presenting to a tertiary referral hospital in Chittagong, Bangladesh, over the course of one year from September 2011 to September 2012. Participants were classified according to the socioeconomic status of their households, defined by the Oxford Poverty and Human Development Initiative's multidimensional poverty index (MPI. 51% of participants were classified as multidimensionally poor (MPI>0.33. Median time from onset of any symptoms to arrival at hospital was 22 hours longer for MPI poor adults compared to non-poor adults (123 vs. 101 hours rising to a difference of 26 hours with adjustment in a multivariate regression model (95% confidence interval 7 to 46 hours; P = 0.009. There was no difference in delays for children from poor and non-poor households (97 vs. 119 hours; P = 0.394. Case fatality was 5.9% vs. 0.8% in poor and non-poor individuals respectively (P = 0.001-5.1% vs. 0.0% for poor and non-poor adults (P = 0.010 and 6.4% vs. 1.8% for poor and non-poor children (P = 0.083. Deaths were attributed to central nervous system infection (11, malaria (3, urinary tract infection (2, gastrointestinal infection (1 and undifferentiated sepsis (1. Both poor and non-poor households relied predominantly upon the (often informal private sector for medical advice before reaching the referral hospital, but MPI poor participants were less likely to have consulted a qualified doctor. Poor participants were more likely to attribute delays in

Medical and Indirect Costs Associated with a Rocky Mountain Spotted Fever Epidemic in Arizona, 2002–2011

Science.gov (United States)

Drexler, Naomi A.; Traeger, Marc S.; McQuiston, Jennifer H.; Williams, Velda; Hamilton, Charlene; Regan, Joanna J.

2015-01-01

Rocky Mountain spotted fever (RMSF) is an emerging public health issue on some American Indian reservations in Arizona. RMSF causes an acute febrile illness that, if untreated, can cause severe illness, permanent sequelae requiring lifelong medical support, and death. We describe costs associated with medical care, loss of productivity, and death among cases of RMSF on two American Indian reservations (estimated population 20,000) between 2002 and 2011. Acute medical costs totaled more than $1.3 million. This study further estimated $181,100 in acute productivity lost due to illness, and $11.6 million in lifetime productivity lost from premature death. Aggregate costs of RMSF cases in Arizona 2002–2011 amounted to $13.2 million. We believe this to be a significant underestimate of the cost of the epidemic, but it underlines the severity of the disease and need for a more comprehensive study. PMID:26033020

Factors Associated With Follow-Up Attendance Among Rape Victims Seen in Acute Medical Care.

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Darnell, Doyanne; Peterson, Roselyn; Berliner, Lucy; Stewart, Terri; Russo, Joan; Whiteside, Lauren; Zatzick, Douglas

2015-01-01

Rape is associated with posttraumatic stress disorder (PTSD) and related comorbidities. Most victims do not obtain treatment for these conditions. Acute care medical settings are well positioned to link patients to services; however, difficulty engaging victims and low attendance at provided follow-up appointments is well documented. Identifying factors associated with follow-up can inform engagement and linkage strategies. Administrative, patient self-report, and provider observational data from Harborview Medical Center were combined for the analysis. Using logistic regression, we examined factors associated with follow-up health service utilization after seeking services for rape in the emergency department. Of the 521 diverse female (n = 476) and male (n = 45) rape victims, 28% attended the recommended medical/counseling follow-up appointment. In the final (adjusted) logistic regression model, having a developmental or other disability (OR = 0.40, 95% CI = 0.21-0.77), having a current mental illness (OR = 0.25, 95% CI = 0.13-0.49), and being assaulted in public (OR = 0.50, 95% CI = 0.28-0.87) were uniquely associated with reduced odds of attending the follow-up. Having a prior mental health condition (OR = 3.02, 95% CI = 1.86-4.91), a completed Sexual Assault Nurse Examiner's (SANE) examination (OR = 2.97, 95% CI = 1.84-4.81), and social support available to help cope with the assault (OR = 3.54, 95% CI = 1.76-7.11) were associated with an increased odds of attending the follow-up. Findings point to relevant characteristics ascertained at the acute care medical visit for rape that may be used to identify victims less likely to obtain posttraumatic medical and mental health services. Efforts to improve service linkage for these patients is warranted and may require alternative service delivery models that engage rape survivors and support posttraumatic recovery.

Incidence and factors associated with medication nonadherence in patients with mental illness: a cross-sectional study.

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Lucca, J M; Ramesh, M; Parthasarathi, G; Ram, D

2015-01-01

In spite of the progress made in the treatment of psychiatric disorders during the last few decades, nonadherence continues to be a frequent phenomenon, often associated with potentially severe clinical consequences and increased health-care costs. There are numerous factors associated with medication nonadherence in patients with mental illness. The aim of the study was to determine the incidence and factors associated with medication nonadherence among psychiatric outpatients. A cross-sectional study was carried out in the outpatient psychiatric department of an Indian tertiary care private hospital over a period of 1 year. Patients aged 18 years and above who presented with mental illness as diagnosed by the International Classification of Diseases (ICD)-10 and who were receiving at least one psychotropic medication for at least 1 month were included in the study. Medication adherence was assessed using the Medication Adherence Rating Scale (MARS). Of the 400 patients, 172 (43%) were nonadherent to their prescribed medications. There is a statistically significant association between the education (P = 0.001), number of drugs (P = 0.002), family income (P = 0.013), and nonadherence. Among the 172 patients, 33.5 % were nonadherent to their therapy due to patient-related factors followed by drug-related factors (32%) and disease-related factors (31%). The overall incidence of medication nonadherence in patients with mental illness was 43%. Numerous factors contributed to medication nonadherence. Strategies need to be developed and implemented to enhance medication adherence, and thereby achieve a better therapeutic outcome in patients with mental illness.

Incidence and factors associated with medication nonadherence in patients with mental illness: A cross-sectional study

Directory of Open Access Journals (Sweden)

J M Lucca

2015-01-01

Full Text Available Background: In spite of the progress made in the treatment of psychiatric disorders during the last few decades, nonadherence continues to be a frequent phenomenon, often associated with potentially severe clinical consequences and increased health-care costs. There are numerous factors associated with medication nonadherence in patients with mental illness. The aim of the study was to determine the incidence and factors associated with medication nonadherence among psychiatric outpatients. Materials and Methods: A cross-sectional study was carried out in the outpatient psychiatric department of an Indian tertiary care private hospital over a period of 1 year. Patients aged 18 years and above who presented with mental illness as diagnosed by the International Classification of Diseases (ICD-10 and who were receiving at least one psychotropic medication for at least 1 month were included in the study. Medication adherence was assessed using the Medication Adherence Rating Scale (MARS. Results: Of the 400 patients, 172 (43% were nonadherent to their prescribed medications. There is a statistically significant association between the education (P = 0.001, number of drugs (P = 0.002, family income (P = 0.013, and nonadherence. Among the 172 patients, 33.5 % were nonadherent to their therapy due to patient-related factors followed by drug-related factors (32% and disease-related factors (31%. Conclusion: The overall incidence of medication nonadherence in patients with mental illness was 43%. Numerous factors contributed to medication nonadherence. Strategies need to be developed and implemented to enhance medication adherence, and thereby achieve a better therapeutic outcome in patients with mental illness.

Mood and anxiety disorders as early manifestations of medical illness: a systematic review.

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Cosci, Fiammetta; Fava, Giovanni A; Sonino, Nicoletta

2015-01-01

Affective disturbances involving alterations of mood, anxiety and irritability may be early symptoms of medical illnesses. The aim of this paper was to provide a systematic review of the literature with qualitative data synthesis. MEDLINE, PsycINFO, EMBASE, Cochrane, and ISI Web of Science were systematically searched from inception to February 2014. Search terms were 'prodrome/early symptom', combined using the Boolean 'AND' operator with 'anxiety/depression/mania/hypomania/irritability/irritable mood/hostility', combined with the Boolean 'AND' operator with 'medical illness/medical disorder'. PRISMA guidelines were followed. A total of 21 studies met the inclusion criteria and were analyzed. Depression was found to be the most common affective prodrome of medical disorders and was consistently reported in Cushing's syndrome, hypothyroidism, hyperparathyroidism, pancreatic and lung cancer, myocardial infarction, Wilson's disease, and AIDS. Mania, anxiety and irritability were less frequent. Physicians may not pursue medical workup of cases that appear to be psychiatric in nature. They should be alerted that disturbances in mood, anxiety and irritability may antedate the appearance of a medical disorder.

Emergency medical readmission: long-term trends and impact on mortality.

LENUS (Irish Health Repository)

Glynn, Nigel

2011-04-01

There is increasing emphasis on prevention of emergency medical readmissions. The broad pattern of acute medical readmissions was studied over a seven-year period and the impact of any readmission on 30-day mortality was recorded. Significant predictors of outcome, including co-morbidity and illness severity score, were entered into a multivariate regression model, adjusting the univariate estimates of the readmission status on mortality. In total, 23,114 consecutive acute medical patients were admitted between 2002-8; the overall readmission rate was 27%. Readmission independently predicted an increased 30-day mortality; the odds ratio, was 1.12 (95% confidence interval (CI) 1.09 to 1.14). This fell to 1.05 (95% CI 1.02 to 1.08) when adjusted for outcome predictors including acute illness severity. The trend for readmissions was to progressively increase over time; the median times between consecutive admissions formed an exponential time series. Efforts to reduce or avoid readmissions may depend on an ability to modify the underlying chronic disease.

The central role of hypothalamic inflammation in the acute illness response and cachexia.

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Burfeind, Kevin G; Michaelis, Katherine A; Marks, Daniel L

2016-06-01

When challenged with a variety of inflammatory threats, multiple systems across the body undergo physiological responses to promote defense and survival. The constellation of fever, anorexia, and fatigue is known as the acute illness response, and represents an adaptive behavioral and physiological reaction to stimuli such as infection. On the other end of the spectrum, cachexia is a deadly and clinically challenging syndrome involving anorexia, fatigue, and muscle wasting. Both of these processes are governed by inflammatory mediators including cytokines, chemokines, and immune cells. Though the effects of cachexia can be partially explained by direct effects of disease processes on wasting tissues, a growing body of evidence shows the central nervous system (CNS) also plays an essential mechanistic role in cachexia. In the context of inflammatory stress, the hypothalamus integrates signals from peripheral systems, which it translates into neuroendocrine perturbations, altered neuronal signaling, and global metabolic derangements. Therefore, we will discuss how hypothalamic inflammation is an essential driver of both the acute illness response and cachexia, and why this organ is uniquely equipped to generate and maintain chronic inflammation. First, we will focus on the role of the hypothalamus in acute responses to dietary and infectious stimuli. Next, we will discuss the role of cytokines in driving homeostatic disequilibrium, resulting in muscle wasting, anorexia, and weight loss. Finally, we will address mechanisms and mediators of chronic hypothalamic inflammation, including endothelial cells, chemokines, and peripheral leukocytes. Copyright © 2015 Elsevier Ltd. All rights reserved.

Medical and Indirect Costs Associated with a Rocky Mountain Spotted Fever Epidemic in Arizona, 2002-2011.

Science.gov (United States)

Drexler, Naomi A; Traeger, Marc S; McQuiston, Jennifer H; Williams, Velda; Hamilton, Charlene; Regan, Joanna J

2015-09-01

Rocky Mountain spotted fever (RMSF) is an emerging public health issue on some American Indian reservations in Arizona. RMSF causes an acute febrile illness that, if untreated, can cause severe illness, permanent sequelae requiring lifelong medical support, and death. We describe costs associated with medical care, loss of productivity, and death among cases of RMSF on two American Indian reservations (estimated population 20,000) between 2002 and 2011. Acute medical costs totaled more than $1.3 million. This study further estimated $181,100 in acute productivity lost due to illness, and $11.6 million in lifetime productivity lost from premature death. Aggregate costs of RMSF cases in Arizona 2002-2011 amounted to $13.2 million. We believe this to be a significant underestimate of the cost of the epidemic, but it underlines the severity of the disease and need for a more comprehensive study. © The American Society of Tropical Medicine and Hygiene.

Hospital medicine (Part 2): what would improve acute hospital care?

LENUS (Irish Health Repository)

Kellett, John

2009-09-01

There are so many obvious delays and inefficiencies in our traditional system of acute hospital care; it is clear that if outcomes are to be improved prompt accurate assessment immediately followed by competent and efficient treatment is essential. Early warning scores (EWS) help detect acutely ill patients who are seriously ill and likely to deteriorate. However, it is not known if any EWS has universal applicability to all patient populations. The benefit of Rapid Response Systems (RRS) such as Medical Emergency Teams has yet to be proven, possibly because doctors and nurses are reluctant to call the RRS for help. Reconfiguration of care delivery in an Acute Medical Assessment Unit has been suggested as a "proactive" alternative to the "reactive" approach of RRS. This method ensures every patient is in an appropriate and safe environment from the moment of first contact with the hospital. Further research is needed into what interventions are most effective in preventing the deterioration and\\/or resuscitating seriously ill patients. Although physicians expert in hospital care decrease the cost and length of hospitalization without compromising outcomes hospital care will continue to be both expensive and potentially dangerous.

The impacts of using community health volunteers to coach medication safety behaviors among rural elders with chronic illnesses.

Science.gov (United States)

Wang, Chi-Jane; Fetzer, Susan J; Yang, Yi-Ching; Wang, Jing-Jy

2013-01-01

It is a challenge for rural health professionals to promote medication safety among older adults taking multiple medications. A volunteer coaching program to promote medication safety among rural elders with chronic illnesses was designed and evaluated. A community-based interventional study randomly assigned 62 rural elders with at least two chronic illnesses to routine care plus volunteer coaching or routine care alone. The volunteer coaching group received a medication safety program, including a coach and reminders by well-trained volunteers, as well as three home visits and five telephone calls over a two-month period. All the subjects received routine medication safety instructions for their chronic illnesses. The program was evaluated using pre- and post-tests of knowledge, attitude and behaviors with regard to medication safety. Results show the volunteer coaching group improved their knowledge of medication safety, but there was no change in attitude after the two-month study period. Moreover, the group demonstrated three improved medication safety behaviors compared to the routine care group. The volunteer coaching program and instructions with pictorial aids can provide a reference for community health professionals who wish to improve the medication safety of chronically ill elders. Copyright © 2013 Mosby, Inc. All rights reserved.

BURDEN AND QUALITY OF LIFE– A COMPARISON OF THOSE CARING FOR PSYCHIATRICALLY ILL AND MEDICALLY ILL

Directory of Open Access Journals (Sweden)

Shweta Rupendu

2018-02-01

Full Text Available BACKGROUND Despite epidemiological transitions, communicable diseases are widely prevalent world over, concomitantly non-communicable diseases are also on the rise. Mental and behavioural disorders account for 12% of the global burden of disease. Caregiving for both groups of patients, rests with an identified primary caregiver. Caregiving lays a great deal of burden on the caregiver, adversely affecting his quality of life. These factors influence the quality of caregiving, and thereby the long-term well-being of the patient. Differences between the two groups of caregivers has not been studied, more so in the Indian context. MATERIALS AND METHODS 60 caregivers of psychiatrically ill and 63 caregivers of the medically ill were studied. Burden of care was assessed using Elmstahl burden scale, and quality of life (QOL using WHOQOL BREF. RESULTS The socio demographic profile of both groups was similar. All subjects experienced a burden of care, with those caring for the psychiatrically ill experiencing a greater burden. QOL was poorer in the care givers of the psychiatrically ill, especially in those married, employed, and in a lower income group. The female care giver, mostly the spouse, experienced a greater burden of care and a poorer QOL. CONCLUSION Chronicity, stigma, poor insight and disabling dependence of the psychiatrically ill, are probably contributory. A higher caregiver burden and a lower QOL will influence quality of caregiving, and have an adverse effect on the course and prognosis of the illness. There is thus a need for routine assessment of the caregiver, and planned intervention for the same.

Arboviral Etiologies of Acute Febrile Illnesses in Western South America, 2000–2007

Science.gov (United States)

Forshey, Brett M.; Guevara, Carolina; Laguna-Torres, V. Alberto; Cespedes, Manuel; Vargas, Jorge; Gianella, Alberto; Vallejo, Efrain; Madrid, César; Aguayo, Nicolas; Gotuzzo, Eduardo; Suarez, Victor; Morales, Ana Maria; Beingolea, Luis; Reyes, Nora; Perez, Juan; Negrete, Monica; Rocha, Claudio; Morrison, Amy C.; Russell, Kevin L.; J. Blair, Patrick; Olson, James G.; Kochel, Tadeusz J.

2010-01-01

Background Arthropod-borne viruses (arboviruses) are among the most common agents of human febrile illness worldwide and the most important emerging pathogens, causing multiple notable epidemics of human disease over recent decades. Despite the public health relevance, little is know about the geographic distribution, relative impact, and risk factors for arbovirus infection in many regions of the world. Our objectives were to describe the arboviruses associated with acute undifferentiated febrile illness in participating clinics in four countries in South America and to provide detailed epidemiological analysis of arbovirus infection in Iquitos, Peru, where more extensive monitoring was conducted. Methodology/Findings A clinic-based syndromic surveillance system was implemented in 13 locations in Ecuador, Peru, Bolivia, and Paraguay. Serum samples and demographic information were collected from febrile participants reporting to local health clinics or hospitals. Acute-phase sera were tested for viral infection by immunofluorescence assay or RT-PCR, while acute- and convalescent-phase sera were tested for pathogen-specific IgM by ELISA. Between May 2000 and December 2007, 20,880 participants were included in the study, with evidence for recent arbovirus infection detected for 6,793 (32.5%). Dengue viruses (Flavivirus) were the most common arbovirus infections, totaling 26.0% of febrile episodes, with DENV-3 as the most common serotype. Alphavirus (Venezuelan equine encephalitis virus [VEEV] and Mayaro virus [MAYV]) and Orthobunyavirus (Oropouche virus [OROV], Group C viruses, and Guaroa virus) infections were both observed in approximately 3% of febrile episodes. In Iquitos, risk factors for VEEV and MAYV infection included being male and reporting to a rural (vs urban) clinic. In contrast, OROV infection was similar between sexes and type of clinic. Conclusions/Significance Our data provide a better understanding of the geographic range of arboviruses in South

Measurement of acute nonspecific low back pain perception in primary care physical therapy: reliability and validity of the brief illness perception questionnaire.

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Hallegraeff, Joannes M; van der Schans, Cees P; Krijnen, Wim P; de Greef, Mathieu H G

2013-02-01

The eight-item Brief Illness Perception Questionnaire is used as a screening instrument in physical therapy to assess mental defeat in patients with acute low back pain, besides patient perception might determine the course and risk for chronic low back pain. However, the psychometric properties of the Brief Illness Perception Questionnaire in common musculoskeletal disorders like acute low back pain have not been adequately studied. Patients' perceptions vary across different populations and affect coping styles. Thus, our aim was to determine the internal consistency, test-retest reliability and validity of the Dutch language version of the Brief Illness Perception Questionnaire in acute non-specific low back pain patients in primary care physical therapy. A non-experimental cross-sectional study with two measurements was performed. Eighty-four acute low back pain patients, in multidisciplinary health care center in Dutch primary care with a sample mean (SD) age of 42 (12) years, participated in the study. Internal consistency (Cronbach's α) and test-retest procedures (Intraclass Correlation Coefficients and limits of agreement) were evaluated at a one-week interval. The concurrent validity of the Brief Illness Perception Questionnaire was examined by using the Mental Health Component of the Short Form 36 Health Survey. The Cronbach's α for internal consistency was 0.73 (95% CI, 0.67 - 0.83); and the Intraclass Correlation Coefficient test-retest reliability was acceptable: 0.72 (95% CI, 0.53 - 0.82), however, the limits of agreement were large. The Intraclass Correlation Coefficient measuring concurrent validity 0.65 (95% CI, 0.46 - 0.80). The Dutch version of the Brief Illness Perception Questionnaire is an appropriate instrument for measuring patients' perceptions in acute low back pain patients, showing acceptable internal consistency and reliability. Concurrent validity is adequate, however, the instrument may be unsuitable for detecting changes in low

Explanatory models and distress in primary caregivers of patients with acute psychotic presentations: A study from South India.

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Joy, Deepa S; Manoranjitham, S D; Samuel, P; Jacob, K S

2017-11-01

Emotional distress among caregivers of people with mental illness is common, changes overtime and requires appropriate coping strategies to prevent long-term disability. Explanatory models, which underpin understanding of disease and illness, are crucial to coping. To study the association of explanatory models and distress among caregivers of people with acute psychotic illness. A total of 60 consecutive patients and their primary caregivers who presented to the Department of Psychiatry, Christian Medical College, Vellore, were recruited for the study. Positive and Negative Syndrome Scale (PANSS), Short Explanatory Model Interview (SEMI) and the General Health Questionnaire-12 (GHQ-12) were used to assess severity of psychosis, explanatory models of illness and emotional distress. Standard bivariate and multivariable statistics were employed. Majority of the caregivers simultaneously held multiple models of illness, which included medical and non-medical perspectives. The GHQ-12 score were significantly lower in people who held multiple explanatory models of illness when compared to the caregivers who believed single explanations. Explanatory models affect coping in caregivers of patients with acute psychotic presentations. There is a need to have a broad-based approach to recovery and care.

Key stakeholder perceptions about consent to participate in acute illness research: a rapid, systematic review to inform epi/pandemic research preparedness.

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Gobat, Nina H; Gal, Micaela; Francis, Nick A; Hood, Kerenza; Watkins, Angela; Turner, Jill; Moore, Ronald; Webb, Steve A R; Butler, Christopher C; Nichol, Alistair

2015-12-29

A rigorous research response is required to inform clinical and public health decision-making during an epi/pandemic. However, the ethical conduct of such research, which often involves critically ill patients, may be complicated by the diminished capacity to consent and an imperative to initiate trial therapies within short time frames. Alternative approaches to taking prospective informed consent may therefore be used. We aimed to rapidly review evidence on key stakeholder (patients, their proxy decision-makers, clinicians and regulators) views concerning the acceptability of various approaches for obtaining consent relevant to pandemic-related acute illness research. We conducted a rapid evidence review, using the Internet, database and hand-searching for English language empirical publications from 1996 to 2014 on stakeholder opinions of consent models (prospective informed, third-party, deferred, or waived) used in acute illness research. We excluded research on consent to treatment, screening, or other such procedures, non-emergency research and secondary studies. Papers were categorised, and data summarised using narrative synthesis. We screened 689 citations, reviewed 104 full-text articles and included 52. Just one paper related specifically to pandemic research. In other emergency research contexts potential research participants, clinicians and research staff found third-party, deferred, and waived consent to be acceptable as a means to feasibly conduct such research. Acceptability to potential participants was motivated by altruism, trust in the medical community, and perceived value in medical research and decreased as the perceived risks associated with participation increased. Discrepancies were observed in the acceptability of the concept and application or experience of alternative consent models. Patients accepted clinicians acting as proxy-decision makers, with preference for two decision makers as invasiveness of interventions increased

Medical problems of porters and trekkers in the Nepal Himalaya.

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Basnyat, B; Litch, J A

1997-05-01

The purpose of this study was to assess the incidence of medical illness among members of trekking groups in the Nepal Himalaya. The design was a cohort study using interview and clinical examination by a single physician. The setting was the Manaslu area in the central Nepal Himalaya along a 22-day trekking route with elevations ranging from 487 m to 5100 m. Subjects were 155 members of commercial trekking groups: 102 Nepali porters, 31 Nepali trek staff, and 22 Western trekkers. We found that medical problems occurred in 45% of party members. The porter cohort contained the highest diversity and severity of illness. The relatively larger porter cohort experienced 77% of the medical problems recorded compared with 17% among Western trekkers and 6% among trek staff. The incidence of medical problems was not significantly different in the porter staff (52%) and Western trekkers (55%) and was significantly lower for the trek staff (13%). High-altitude pharyngitis/bronchitis was the most common illness in the party (12%) followed by acute mountain sickness (8%) and gastroenteritis (6%). Other conditions included anxiety (3%), cellulitis (3%), scabies (3%), snow blindness (3%), acute alcohol intoxication (2%), conjunctivitis (2%), fever (2%), lacerations (2%), and hemorrhoids (1%). Illness with infectious etiologies comprised 33% of the medical problems. The incidence of altitude illness was not significantly less in the Nepali porter staff than in the Western trekkers. Evacuation was required in 5% of party members, all from the porter group. This study should alert expedition medical providers and trip leaders of the need to be observant for and prepared to treat the frequent and diverse medical problems among the porter staff in their party, in addition to the Western members. Medical problems are common in remote mountainous areas, indicating that trip physicians should be experienced in primary care.

[Delegation of medical activities in acute pain therapy].

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Erlenwein, J; Moroder, A; Biermann, E; Petzke, F; Ehlers, A P F; Bitter, H; Pogatzki-Zahn, E

2018-01-01

Acute pain management is an interprofessional and interdisciplinary task and requires a good and trustful cooperation between stakeholders. Despite provisions in Germany according to which medical treatment can only be rendered by a formally qualified physician ("Arztvorbehalt"), a physician does not have to carry out every medical activity in person. Under certain conditions, some medical activities can be delegated to medical auxiliary personnel but they need to be (1) instructed, (2) supervised and (3) checked by the physician himself; however, medical history, diagnostic assessment and evaluation, indications, therapy planning (e.g. selection, dosage), therapeutic decisions (e. g. modification or termination of therapy) and obtaining informed consent cannot be delegated. With respect to drug therapy, monitoring of the therapy remains the personal responsibility of the physician, while the actual application of medication can be delegated. From a legal perspective, the current practice needs to be stressed about what is within the mandatory requirements and what is not when medical activities are delegated to non-medical staff. The use of standards of care improves treatment quality but like any medical treatment it must be based on the physician's individual assessment and indications for each patient and requires personal contact between physician and patient. Delegation on the ward and in acute pain therapy requires the authorization of the delegator to give instructions in the respective setting. The transfer of non-delegable duties to non-medical personnel is regarded as medical malpractice.

Acute psychosis: A neuropsychiatric dilemma

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Daniel Saldanha

2013-01-01

Full Text Available The acute onset of psychotic symptoms in elderly can be the presenting clinical feature for various Central Nervous System as well as other systemic illnesses. The diagnosis and treatment of such presentation require a cautious medical work up and high level of suspicion even if the patient is not showing any cardinal symptoms for organic pathology.

Integrative Review of Mobile Phone Contacts and Medication Adherence in Severe Mental Illness.

Science.gov (United States)

Bright, Cordellia E

Poor medication adherence is a significant problem in individuals with severe mental illness (SMI). About 50% of people with SMI become nonadherent to treatment in the first month following discharge from the hospital. This study examined literature in the past decade (2006-2016) on the use of mobile phone contacts in individuals with SMI to improve medication adherence post hospital discharge. This integrative review used the search terms texting, text messaging, SMS, cell/mobile phone, medication adherence, medication compliance, and mental illness. Databases (CINAHL, PubMed, PsycINFO, and Scopus) and manual searching of reference lists were done. The main inclusion criteria were the use of mobile phone contacts on medication adherence in individuals with SMI. Adults 18 years and older, studies conducted from 2006 to 2016, and studies conducted in English were also criteria for inclusion. Only five studies met criteria for inclusion. Outcomes from the review showed that mobile phone contacts have been used to improve medication adherence in individuals with SMI and able to provide the four types of social support (instrumental, informational, emotional, and, appraisal). When phone contacts especially text messaging was used as an adjunct to other interventions, it yielded better medication adherence than when used alone. However, results on medication adherence rates were mixed in participants on both psychiatric and nonpsychiatric medications. Although mobile phone contacts are a promising tool to enhance medication adherence after hospital discharge, its effectiveness to increase medication adherence in this population remains inconclusive.

Challenges and rewards on the road to translational systems biology in acute illness: four case reports from interdisciplinary teams.

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An, Gary; Hunt, C Anthony; Clermont, Gilles; Neugebauer, Edmund; Vodovotz, Yoram

2007-06-01

Translational systems biology approaches can be distinguished from mainstream systems biology in that their goal is to drive novel therapies and streamline clinical trials in critical illness. One systems biology approach, dynamic mathematical modeling (DMM), is increasingly used in dealing with the complexity of the inflammatory response and organ dysfunction. The use of DMM often requires a broadening of research methods and a multidisciplinary team approach that includes bioscientists, mathematicians, engineers, and computer scientists. However, the development of these groups must overcome domain-specific barriers to communication and understanding. We present 4 case studies of successful translational, interdisciplinary systems biology efforts, which differ by organizational level from an individual to an entire research community. Case 1 is a single investigator involved in DMM of the acute inflammatory response at Cook County Hospital, in which extensive translational progress was made using agent-based models of inflammation and organ damage. Case 2 is a community-level effort from the University of Witten-Herdecke in Cologne, whose efforts have led to the formation of the Society for Complexity in Acute Illness. Case 3 is an institution-based group, the Biosystems Group at the University of California, San Francisco, whose work has included a focus on a common lexicon for DMM. Case 4 is an institution-based, transdisciplinary research group (the Center for Inflammation and Regenerative Modeling at the University of Pittsburgh), whose modeling work has led to internal education efforts, grant support, and commercialization. A transdisciplinary approach, which involves team interaction in an iterative fashion to address ambiguity and is supported by educational initiatives, is likely to be necessary for DMM in acute illness. Communitywide organizations such as the Society of Complexity in Acute Illness must strive to facilitate the implementation of DMM in

Fever, jaundice and acute renal failure.

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O'Toole, Sam M; Pathak, Neha; Toms, Graham C; Gelding, Susan V; Sivaprakasam, Venkat

2015-02-01

Leptospirosis is an uncommon infectious disease that has protean clinical manifestations ranging from an innocuous 'flu-like' illness to potentially life-threatening multi-organ failure. Here we describe a case of Weil's disease that presented on the acute medical take with fever, jaundice and acute renal failure. We highlight the importance of careful history taking at the time of admission and how understanding the epidemiology and pathophysiology of leptospirosis enables a definitive diagnosis to be reached. © 2015 Royal College of Physicians.

Reducing the stigma of mental illness in undergraduate medical education: a randomized controlled trial.

Science.gov (United States)

Papish, Andriyka; Kassam, Aliya; Modgill, Geeta; Vaz, Gina; Zanussi, Lauren; Patten, Scott

2013-10-24

The stigma of mental illness among medical students is a prevalent concern that has far reaching negative consequences. Attempts to combat this stigma through educational initiatives have had mixed results. This study examined the impact of a one-time contact-based educational intervention on the stigma of mental illness among medical students and compared this with a multimodal undergraduate psychiatry course at the University of Calgary, Canada that integrates contact-based educational strategies. Attitudes towards mental illness were compared with those towards type 2 diabetes mellitus (T2DM). A cluster-randomized trial design was used to evaluate the impact of contact-based educational interventions delivered at two points in time. The impact was assessed by collecting data at 4 time points using the Opening Minds Scale for Health Care Providers (OMS-HC) to assess changes in stigma. Baseline surveys were completed by 62% (n=111) of students before the start of the course and post-intervention ratings were available from 90 of these. Stigma scores for both groups were significantly reduced upon course completion (p mental illness and interest in a psychiatric career was increased at the end of the course. Stigma towards mental illness remained greater than for T2DM at all time points. Psychiatric education can decrease the stigma of mental illness and increase student confidence. However, one-time, contact-based educational interventions require further evaluation in this context. The key components are postulated to be contact, knowledge and attention to process, where attending to the student's internal experience of working with people with mental illness is an integral factor in modulating perceptions of mental illness and a psychiatric career.

International adaptation: psychosocial and parenting experiences of caregivers who travel to the United States to obtain acute medical care for their seriously ill child.

Science.gov (United States)

Margolis, Rachel; Ludi, Erica; Pao, Maryland; Wiener, Lori

2013-01-01

Despite the increasing trend of travel for medical purposes, little is known about the experience of parents and other caregivers who come to the United States specifically to obtain medical treatment for their seriously ill child. In this exploratory, descriptive qualitative study, we used a semi-structured narrative guide to conduct in-depth interviews with 22 Spanish- or English-speaking caregivers about the challenges encountered and adaptation required when entering a new medical and cultural environment. Caregivers identified the language barrier and transnational parenting as challenges while reporting hospital staff and their own families as major sources of support. Using the results of the study as a guide, clinical and program implications are provided and recommendations for social work practice discussed.

Attitudes of U.S. Psychiatry Residents and Fellows towards Mental Illness and its Causes: a Comparison Study with Medical Students.

Science.gov (United States)

Chiles, Catherine; Stefanovics, Elina; Rosenheck, Robert

2018-01-13

Stigma towards people with mental illness remains a burden for patients and healthcare providers. This study at a large US university examined the attitudes of psychiatry residents and fellows towards mental illness and its causes, and whether their attitudes differed from the medical student attitudes previously studied utilizing the same survey method. An electronic questionnaire examining attitudes toward people with mental illness, causes of mental Illness, and treatment efficacy was used to survey the attitudes of psychiatry residents and fellows. Exploratory factor analysis derived from the authors' medical student survey was used to examine attitudinal factors. The study response rate was 54.2% (n = 94). Factor analysis employed three factors previously identified reflecting social acceptance of mental illness, belief in supernatural causes, and belief in biopsychosocial causes. Residents and fellows reporting more personal experiences with mental illness, both as a group and when compared with medical students, were significantly more willing to socialize with the mentally ill. Respondents who had more professional (work) experience other than medical school or post-graduate training were less likely to believe in supernatural causes of mental illness. Female residents and fellows were more willing to socialize with the mentally ill, and were less likely to believe in supernatural causes for mental illness than their male counterparts. In our study, increased social acceptance of the mentally ill relates to having personal experiences, advanced training in psychiatry, and female gender. Both professional experiences outside of training and female gender reduced the belief in supernatural causes.

Acute respiratory illnesses in the first 18 months of life

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Ilse M. López Bravo

1997-01-01

Full Text Available To help assess the causes and frequency of acute respiratory illnesses (ARI during the first 18 months of life in Chile, a cohort of 437 children born in good health between May 1991 and April 1992 was followed at an urban health clinic in northern Santiago. Information was obtained from medical checkups performed at the clinic, from emergency health care services, from private physicians, and from interviews with each child's mother when the child was enrolled in the study and when it was 6, 12, and 18 months old. Followup was completed for 379 (87% of the children. ARI accounted for 67% of all 3762 episodes of illness recorded for these children in the 18-month study period, 1384 (55% of the ARI episodes affecting the upper respiratory tract and the remaining 1144 (45% affecting the lower. The overall rate of ARI observed was 33 episodes per 100 child-months of observation. The incidences of upper, lower, and total ARI episodes decreased significantly in the third six months of life. A statistically significant association was found between upper ARI ( > or = 2 episodes and maternal smoking ( > or = 5 cigarettes per day, but no significant associations were found with any of the other risk factors studied. However, lower ARI ( > or = 2 episodes was significantly associated with maternal schooling ( or = 4 episodes was significantly associated with these factors and also with the existence of one or more siblings, birth in a cold season, limited breast-feeding (<4 months, and low socioeconomic status. Significant associations were found between obstructive bronchitis episodes and most of the risk factors studied (gender, siblings, season of birth, duration of breast-feeding, maternal schooling, smoking, use of polluting fuels in the home, and a family history of atopic allergy; similarly, significant associations were found between the occurrence of pneumonia and many risk factors (including siblings, season of birth, duration of breast

Reversible acute adrenal insufficiency caused by fluconazole in a critically ill patient

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Krishnan, S G Santhana; Cobbs, R K

2006-01-01

A 38 year old man with history of obstructive sleep apnea and polycythaemia presented with hypercapnic respiratory failure that required intubation. He developed fever with infiltrates on chest radiography that required empiric antifungal therapy with fluconazole along with broad spectrum antibiotics. He developed acute adrenal insufficiency that recovered after fluconazole was stopped. It is believed that this complication of adrenal suppression attributable to fluconazole is underrecognised and it may be prudent to monitor all critically ill patients who are given fluconazole for this complication. PMID:16954446

Healthcare use for acute gastrointestinal illness in two Inuit communities: Rigolet and Iqaluit, Canada.

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Harper, Sherilee L; Edge, Victoria L; Ford, James; Thomas, M Kate; Pearl, David; Shirley, Jamal; McEwen, Scott A

2015-01-01

The incidence of self-reported acute gastrointestinal illness (AGI) in Rigolet, Nunatsiavut, and Iqaluit, Nunavut, is higher than reported elsewhere in Canada; as such, understanding AGI-related healthcare use is important for healthcare provision, public health practice and surveillance of AGI. This study described symptoms, severity and duration of self-reported AGI in the general population and examined the incidence and factors associated with healthcare utilization for AGI in these 2 Inuit communities. Cross-sectional survey data were analysed using multivariable exact logistic regression to examine factors associated with individuals' self-reported healthcare and over-the-counter (OTC) medication utilization related to AGI symptoms. In Rigolet, few AGI cases used healthcare services [4.8% (95% CI=1.5-14.4%)]; in Iqaluit, some cases used healthcare services [16.9% (95% CI=11.2-24.7%)]. Missing traditional activities due to AGI (OR=3.8; 95% CI=1.18-12.4) and taking OTC medication for AGI symptoms (OR=3.8; 95% CI=1.2-15.1) were associated with increased odds of using healthcare services in Iqaluit. In both communities, AGI severity and secondary symptoms (extreme tiredness, headache, muscle pains, chills) were significantly associated with increased odds of taking OTC medication. While rates of self-reported AGI were higher in Inuit communities compared to non-Inuit communities in Canada, there were lower rates of AGI-related healthcare use in Inuit communities compared to other regions in Canada. As such, the rates of healthcare use for a given disease can differ between Inuit and non-Inuit communities, and caution should be exercised in making comparisons between Inuit and non-Inuit health outcomes based solely on clinic records and healthcare use.

Evaluating Explicit and Implicit Stigma of Mental Illness in Mental Health Professionals and Medical Students

OpenAIRE

Kopera, Maciej; Suszek, Hubert; Bonar, Erin; Myszka, Maciej; Gmaj, Bart?omiej; Ilgen, Mark; Wojnar, Marcin

2014-01-01

The study investigated explicit and implicit attitudes towards people with mental illness among medical students (non-professionals) with no previous contact with mentally ill patients and psychiatrists and psychotherapists (professionals) who had at least 2?years of professional contact with mentally ill patients. Explicit attitudes where assessed by self-report. Implicit attitudes were measured with the Go/No-Go Association Task, a variant of the Implicit Association Test that does not requ...

Mandatory physical exercise for the prevention of mental illness in medical students

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Robert A. Bitonte

2014-09-01

Full Text Available Medical students experience higher rates of mental illness than the general population. With competition rising for success in medical school, and residency, increasing incidence of distress are leading this population to experience higher rates of thoughts of dropping out of school, and even suicide. Since many stigmas deter medical students from receiving mental health counseling, such as the perceived inability to handle the stresses of medical school, and the potential lack of competitiveness for residencies if reported, prevention of mental illness may be a better course to take in reducing prevalence in this population. Regular exercise has demonstrated a positive effect on not only promoting physical health, but also mental health. Exercise encourages a healthy mood, positive self esteem, and better cognition, while decreasing the chances of depression, anxiety, and burnout. Implementing exercise time into medical school curriculums, just like the basic sciences, albeit for less time in the day, could provide a feasible way to ensure that all students are taking time to partake in this important activity for their well being. Though medical schools are rigid with attempts to make changes in their curriculum, thirty minutes a day, three to five times a week of exercise of the students’ choice not only is more cost effective than counseling, but it also reduces the chances that they will experience burnout, which if left untreated could transcend into a compromised training experience.

Reducing the stigma of mental illness in undergraduate medical education: a randomized controlled trial

Science.gov (United States)

2013-01-01

Background The stigma of mental illness among medical students is a prevalent concern that has far reaching negative consequences. Attempts to combat this stigma through educational initiatives have had mixed results. This study examined the impact of a one-time contact-based educational intervention on the stigma of mental illness among medical students and compared this with a multimodal undergraduate psychiatry course at the University of Calgary, Canada that integrates contact-based educational strategies. Attitudes towards mental illness were compared with those towards type 2 diabetes mellitus (T2DM). Method A cluster-randomized trial design was used to evaluate the impact of contact-based educational interventions delivered at two points in time. The impact was assessed by collecting data at 4 time points using the Opening Minds Scale for Health Care Providers (OMS-HC) to assess changes in stigma. Results Baseline surveys were completed by 62% (n=111) of students before the start of the course and post-intervention ratings were available from 90 of these. Stigma scores for both groups were significantly reduced upon course completion (p mental illness and interest in a psychiatric career was increased at the end of the course. Stigma towards mental illness remained greater than for T2DM at all time points. Conclusions Psychiatric education can decrease the stigma of mental illness and increase student confidence. However, one-time, contact-based educational interventions require further evaluation in this context. The key components are postulated to be contact, knowledge and attention to process, where attending to the student’s internal experience of working with people with mental illness is an integral factor in modulating perceptions of mental illness and a psychiatric career. PMID:24156397

The Association of Health Literacy with Illness and Medication Beliefs among Patients with Chronic Obstructive Pulmonary Disease.

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Minal S Kale

Full Text Available Low health literacy is associated with low adherence to self-management in many chronic diseases. Additionally, health beliefs are thought to be determinants of self-management behaviors. In this study we sought to determine the association, if any, of health literacy and health beliefs among elderly individuals with COPD.We enrolled a cohort of patients with COPD from two academic urban settings in New York, NY and Chicago, IL. Health literacy was measured using the Short Test of Functional Health Literacy in Adults. Using the framework of the Self-Regulation Model, illness and medication beliefs were measured with the Brief Illness Perception Questionnaire (B-IPQ and Beliefs about Medications Questionnaire (BMQ. Unadjusted analyses, with corresponding Cohen's d effect sizes, and multiple logistic regression were used to assess the relationships between HL and illness and medication beliefs.We enrolled 235 participants, 29% of whom had low health literacy. Patients with low health literacy were more likely to belong to a racial minority group (p<0.001, not be married (p = 0.006, and to have lower income (p<0.001 or education (p<0.001. In unadjusted analyses, patients with low health literacy were less likely to believe they will always have COPD (p = 0.003, Cohen's d = 0.42, and were more likely to be concerned about their illness ((p = 0.04, Cohen's d = 0.17. In analyses adjusted for sociodemographic factors and other health beliefs, patients with low health literacy were less likely to believe that they will always have COPD (odds ratio [OR]: 0.78, 95% confidence interval [CI]: 0.65-0.94. In addition, the association of low health literacy with expressed concern about medications remained significant (OR: 1.20, 95% CI: 1.05-1.37 though the association of low health literacy with belief in the necessity of medications was no longer significant (OR: 0.92, 95% CI: 0.82-1.04.In this cohort of urban individuals with COPD, low health literacy was

A Clinical Skills Instruction Program: The Acute Abdomen.

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Laube, Douglas W.; And Others

1982-01-01

An effective evaluation of the acutely ill female implies a thorough examination that integrates skills representing three learning domains. This process should include: a thorough medical history, a physical examination, good patient-physician rapport, and development of an efficacious management plan. A University of Iowa simulation approach is…

Hyperglycemia and acute kidney injury in critically ill children

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Gordillo R

2016-08-01

Full Text Available Roberto Gordillo,1 Tania Ahluwalia,2 Robert Woroniecki3 1Department of Pediatrics, Division of Nephrology, 2Department of Pediatrics, University of Illinois College of Medicine, Peoria, IL, USA; 3Division of Pediatric Nephrology and Hypertension, Stony Brook Children’s Hospital, Stony Brook, NY, USA Background: Hyperglycemia and acute kidney injury (AKI are common in critically ill children and have been associated with higher morbidity and mortality. The incidence of AKI in children is difficult to estimate because of the lack of a standard definition for AKI. The pediatric RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease criteria can be used to define AKI in children. Various biomarkers in urine and blood have been studied to detect AKI in critically ill children. However, it is not clear whether hyperglycemia is associated with AKI. Our objective was to evaluate the effect of hyperglycemia on kidney function and its effect on neutrophil gelatinase-associated lipocalin (NGAL in children. Methods: We studied retrospective and prospective cohorts of pediatric critically ill subjects admitted to the pediatric intensive care unit (PICU. We analyzed data from admission that included estimated glomerular filtration rate, plasma and urine NGAL, serum glucose and peak glycemia (highest glycemia during PICU admission, and length of hospital and PICU stay from two different institutions. Results: We found that the prevalence of hyperglycemia was 89% in the retrospective cohort and 86% in the prospective cohort, P=0.99. AKI was associated with peak glycemia, P=0.03. There was a statistically significant correlation between peak glycemia and hospital and PICU stays, P=<0.001 and P<0.001, respectively. Urine NGAL and plasma NGAL were not statistically different in subjects with and without hyperglycemia, P=0.99 and P=0.85, respectively. Subjects on vasopressors had lower estimated glomerular filtration rate and higher

Acute Muscular Sarcocystosis: an international investigation among ill travelers returning from Tioman Island, Malaysia, 2011 and 2012

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Two provider-based traveler-focused networks allowed for the detection of a large outbreak of acute muscular sarcocystosis (AMS). Clinicians evaluating travelers returning ill from Malaysia with fever and myalgia noted the biphasic aspect of the disease, the later onset of elevated CPK and eosinophi...

Cardiopulmonary resuscitation knowledge and opinions on end of life decision making of older adults admitted to an acute medical service.

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Sharma, Rupali; Jayathissa, Sisira; Weatherall, Mark

2016-01-08

To determine the knowledge in cardiopulmonary resuscitation (CPR) process, preference for CPR, and desire to participate in end-of-life decision making amongst older hospitalised patients. We prospectively interviewed 100 participants above 65 years of age awaiting discharge from acute medical ward and collected demographics, knowledge of CPR and opinion on CPR in various clinical scenarios. Amongst the participants, 58% had good understanding of all components of CPR and 91% overestimated its success. Fifty-eight percent wished to have CPR in current health status, but this declined if they were presented a hypothetical scenario of critical illness (46%), functional impairment (17%), terminal illness (13%) and dementia (13%). Tertiary education, male gender and not living alone were associated with accepting CPR. Ninety-three percent were comfortable discussing CPR and 84% felt comfortable documenting their wishes in the medical notes. Seventy percent wished such discussion to include themselves and their family. Older inpatients have a reasonable understanding of the components of CPR and wish to be involved in CPR decision-making. Clinical scenarios with poor prognosis may lead to patients declining CPR. Discussion and documentation of resuscitation wishes is useful in routine assessment process among elderly hospitalised patients.

Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN): evolution of a content management system for point-of-care clinical decision support

NARCIS (Netherlands)

Barwise, Amelia; Garcia-Arguello, Lisbeth; Dong, Yue; Hulyalkar, Manasi; Vukoja, Marija; Schultz, Marcus J.; Adhikari, Neill K. J.; Bonneton, Benjamin; Kilickaya, Oguz; Kashyap, Rahul; Gajic, Ognjen; Schmickl, Christopher N.

2016-01-01

The Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN) is an international collaborative project with the overall objective of standardizing the approach to the evaluation and treatment of critically ill patients world-wide, in accordance with best-practice principles. One of

Mental Illness and Mental Healthcare Receipt among Hospitalized Veterans with Serious Physical Illnesses.

Science.gov (United States)

Garrido, Melissa M; Prigerson, Holly G; Neupane, Suvam; Penrod, Joan D; Johnson, Christopher E; Boockvar, Kenneth S

2017-03-01

Psychosocial distress among patients with limited life expectancy influences treatment decisions, treatment adherence, and physical health. Veterans may be at elevated risk of psychosocial distress at the end of life, and understanding their mental healthcare needs may help identify hospitalized patients to whom psychiatric services should be targeted. To examine mental illness prevalence and mental health treatment rates among a national sample of hospitalized veterans with serious physical illnesses. Design, Subjects, and Measurements: This was a retrospective study of 11,286 veterans hospitalized in a Veterans Health Administration acute care facility in fiscal year 2011 with diagnoses of advanced cancer, congestive heart failure, chronic obstructive pulmonary disease, and/or advanced HIV/AIDS. Prevalent and incident mental illness diagnoses during and before hospitalization and rates of psychotherapy and psychotropic use among patients with incident depression and anxiety were measured. At least one-quarter of the patients in our sample had a mental illness or substance use disorder. The most common diagnoses at hospitalization were depression (11.4%), followed by alcohol abuse or dependence (5.5%), and post-traumatic stress disorder (4.9%). Of the 831 patients with incident past-year depression and 258 with incident past-year anxiety, nearly two-thirds received at least some psychotherapy or guideline-concordant medication within 90 days of diagnosis. Of 191 patients with incident depression and 47 with incident anxiety at time of hospitalization, fewer than half received mental healthcare before discharge. Many veterans hospitalized with serious physical illnesses have comorbid mental illnesses and may benefit from depression and anxiety treatment.

Cooperative epistemic work in medical practice

DEFF Research Database (Denmark)

Bansler, Jørgen P.; Havn, Erling Carl; Schmidt, Kjeld

2016-01-01

We examine an important part of the medical record that has not been studied extensively: physicians’ clinical notes. These notes constitute an explanatory medical narrative that documents the patient’s illness trajectory by combining each physician’s notes into a common text. Although several pr....... We conclude by discussing the implications of this research for the design of Electronic Medical Record (EMR) systems.......We examine an important part of the medical record that has not been studied extensively: physicians’ clinical notes. These notes constitute an explanatory medical narrative that documents the patient’s illness trajectory by combining each physician’s notes into a common text. Although several...... prior CSCW studies have addressed the role of the medical record in patient care, they have not dealt specifically with the role, structure, and content of these notes. In this article, we present a detailed analysis of a set of physicians’ clinical notes recording the acute hospitalization...

Addison's Disease Mimicking as Acute Pancreatitis: A Case Report.

Science.gov (United States)

Chaudhuri, Sayani; Rao, Karthik N; Patil, Navin; Ommurugan, Balaji; Varghese, George

2017-04-01

Over past two decades there has been significant improvement in medical field in elucidating the underlying pathophysiology and genetics of Addison's disease. Adrenal insufficiency (Addison's disease) is a rare disease with an incidence of 0.8/100,000 cases. The diagnosis may be delayed if the clinical presentation mimics a gastrointestinal disorder or psychiatric illness. We report a case of Addison's disease presenting as acute pain in abdomen mimicking clinical presentation of acute pancreatitis.

Dialysis-Requiring Acute Kidney Injury in Denmark 2000-2012

DEFF Research Database (Denmark)

Carlson, Nicholas; Hommel, Kristine; Olesen, Jonas Bjerring

2016-01-01

INTRODUCTION: Dialysis-requiring acute kidney injury is a severe illness associated with poor prognosis. However, information pertaining to incidence rates and prevalence of risk factors remains limited in spite of increasing focus. We evaluate time trends of incidence rates and changing patterns...... in prevalence of comorbidities, concurrent medication, and other risk factors in nationwide retrospective cohort study. MATERIALS AND METHODS: All patients with dialysis-requiring acute kidney injury were identified between January 1st 2000 and December 31st 2012. By cross-referencing data from national...... administrative registries, the association of changing patterns in dialysis treatment, comorbidity, concurrent medication and demographics with incidence of dialysis-requiring acute kidney injury was evaluated. RESULTS: A total of 18,561 adult patients with dialysis-requiring AKI were identified between 2000...

Plasticity of the systemic inflammatory response to acute infection during critical illness: development of the riboleukogram.

Directory of Open Access Journals (Sweden)

Jonathan E McDunn

2008-02-01

Full Text Available Diagnosis of acute infection in the critically ill remains a challenge. We hypothesized that circulating leukocyte transcriptional profiles can be used to monitor the host response to and recovery from infection complicating critical illness.A translational research approach was employed. Fifteen mice underwent intratracheal injections of live P. aeruginosa, P. aeruginosa endotoxin, live S. pneumoniae, or normal saline. At 24 hours after injury, GeneChip microarray analysis of circulating buffy coat RNA identified 219 genes that distinguished between the pulmonary insults and differences in 7-day mortality. Similarly, buffy coat microarray expression profiles were generated from 27 mechanically ventilated patients every two days for up to three weeks. Significant heterogeneity of VAP microarray profiles was observed secondary to patient ethnicity, age, and gender, yet 85 genes were identified with consistent changes in abundance during the seven days bracketing the diagnosis of VAP. Principal components analysis of these 85 genes appeared to differentiate between the responses of subjects who did versus those who did not develop VAP, as defined by a general trajectory (riboleukogram for the onset and resolution of VAP. As patients recovered from critical illness complicated by acute infection, the riboleukograms converged, consistent with an immune attractor.Here we present the culmination of a mouse pneumonia study, demonstrating for the first time that disease trajectories derived from microarray expression profiles can be used to quantitatively track the clinical course of acute disease and identify a state of immune recovery. These data suggest that the onset of an infection-specific transcriptional program may precede the clinical diagnosis of pneumonia in patients. Moreover, riboleukograms may help explain variance in the host response due to differences in ethnic background, gender, and pathogen. Prospective clinical trials are indicated

Effect of acute and chronic job demands on effective individual teamwork behaviour in medical emergencies.

Science.gov (United States)

Gevers, Josette; van Erven, Pierre; de Jonge, Jan; Maas, Maaike; de Jong, Jos

2010-07-01

This paper is a report of a study conducted to determine the combined effect of acute and chronic job demands on acute job strains experienced during medical emergencies, and its consequences for individual teamwork behaviour. Medical emergency personnel have to cope with high job demands, which may cause considerable work stress (i.e. job strains), particularly when both acute and chronic job demands are experienced to be high. This may interfere with effective individual teamwork behaviour. A cross-sectional survey study was conducted in 2008, involving 48 members (doctors and nurses) of medical emergency teams working in the emergency department of a Dutch general hospital. Data were analyzed by means of hierarchical regression analyses. High acute job demands impeded effective teamwork behaviour, but only when they resulted in acute job strain. Acute emotional demands were more likely to result in acute job strain when chronic emotional job demands were also experienced as high. Although acute cognitive and physical strains were also detrimental, effective teamwork behaviour was particularly impeded by acute emotional strain. Acute job strains impair effective individual teamwork behaviour during medical emergencies, and there is urgent need to prevent or reduce a build-up of job strain from high acute and chronic demands, particularly of the emotional kind.

Comparison of outpatient medically attended and community-level influenza-like illness-New York City, 2013-2015.

Science.gov (United States)

Russell, Kate E; Fowlkes, Ashley; Stockwell, Melissa S; Vargas, Celibell Y; Saiman, Lisa; Larson, Elaine L; LaRussa, Philip; Di Lonardo, Steve; Popowich, Michael; St George, Kirsten; Steffens, Andrea; Reed, Carrie

2018-05-01

Surveillance of influenza-like illness (ILI) in the United States is primarily conducted through medical settings despite a significant burden of non-medically attended ILI. To assess consistency between surveillance for respiratory viruses in outpatient and community settings using ILI surveillance from the Centers for Disease Control and Prevention Influenza Incidence Surveillance Project (IISP) and the Mobile Surveillance for Acute Respiratory Infections (ARI) and Influenza-Like Illness in the Community (MoSAIC) Study. The Influenza Incidence Surveillance Project conducts ILI surveillance in 3 primary care clinics in New York City, and MoSAIC conducts community-based ILI/ARI surveillance through text messaging among a cohort of New York City residents. Both systems obtain respiratory specimens from participants with ILI/ARI and test for multiple pathogens. We conducted a retrospective review of ILI cases in IISP and MoSAIC from January 2013 to May 2015 with descriptive analyses of clinical and laboratory data. Five-hundred twelve MoSAIC and 669 IISP participants met an ILI criteria (fever with cough or sore throat) and were included. Forty percent of MoSAIC participants sought care; the majority primary care. Pathogens were detected in 63% of MoSAIC and 70% of IISP cases. The relative distribution of influenza and other respiratory viruses detected was similar; however, there were statistically significant differences in the frequency that were not explained by care seeking. Outpatient and community-based surveillance in the one found similar timing and relative distribution of respiratory viruses, but community surveillance in a single neighborhood may not fully capture the variations in ILI etiology that occur more broadly. Published 2018. This article is a U.S. Government work and is in the public domain in the USA. Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd.

Healthcare use for acute gastrointestinal illness in two Inuit communities: Rigolet and Iqaluit, Canada†

Science.gov (United States)

Harper, Sherilee L.; Edge, Victoria L.; Ford, James; Thomas, M. Kate; Pearl, David; Shirley, Jamal; McEwen, Scott A.

2015-01-01

Background The incidence of self-reported acute gastrointestinal illness (AGI) in Rigolet, Nunatsiavut, and Iqaluit, Nunavut, is higher than reported elsewhere in Canada; as such, understanding AGI-related healthcare use is important for healthcare provision, public health practice and surveillance of AGI. Objectives This study described symptoms, severity and duration of self-reported AGI in the general population and examined the incidence and factors associated with healthcare utilization for AGI in these 2 Inuit communities. Design Cross-sectional survey data were analysed using multivariable exact logistic regression to examine factors associated with individuals’ self-reported healthcare and over-the-counter (OTC) medication utilization related to AGI symptoms. Results In Rigolet, few AGI cases used healthcare services [4.8% (95% CI=1.5–14.4%)]; in Iqaluit, some cases used healthcare services [16.9% (95% CI=11.2–24.7%)]. Missing traditional activities due to AGI (OR=3.8; 95% CI=1.18–12.4) and taking OTC medication for AGI symptoms (OR=3.8; 95% CI=1.2–15.1) were associated with increased odds of using healthcare services in Iqaluit. In both communities, AGI severity and secondary symptoms (extreme tiredness, headache, muscle pains, chills) were significantly associated with increased odds of taking OTC medication. Conclusions While rates of self-reported AGI were higher in Inuit communities compared to non-Inuit communities in Canada, there were lower rates of AGI-related healthcare use in Inuit communities compared to other regions in Canada. As such, the rates of healthcare use for a given disease can differ between Inuit and non-Inuit communities, and caution should be exercised in making comparisons between Inuit and non-Inuit health outcomes based solely on clinic records and healthcare use. PMID:26001982

Healthcare use for acute gastrointestinal illness in two Inuit communities: Rigolet and Iqaluit, Canada

Directory of Open Access Journals (Sweden)

Sherilee L. Harper

2015-05-01

Full Text Available Background: The incidence of self-reported acute gastrointestinal illness (AGI in Rigolet, Nunatsiavut, and Iqaluit, Nunavut, is higher than reported elsewhere in Canada; as such, understanding AGI-related healthcare use is important for healthcare provision, public health practice and surveillance of AGI. Objectives: This study described symptoms, severity and duration of self-reported AGI in the general population and examined the incidence and factors associated with healthcare utilization for AGI in these 2 Inuit communities. Design: Cross-sectional survey data were analysed using multivariable exact logistic regression to examine factors associated with individuals’ self-reported healthcare and over-the-counter (OTC medication utilization related to AGI symptoms. Results: In Rigolet, few AGI cases used healthcare services [4.8% (95% CI=1.5–14.4%]; in Iqaluit, some cases used healthcare services [16.9% (95% CI=11.2–24.7%]. Missing traditional activities due to AGI (OR=3.8; 95% CI=1.18–12.4 and taking OTC medication for AGI symptoms (OR=3.8; 95% CI=1.2–15.1 were associated with increased odds of using healthcare services in Iqaluit. In both communities, AGI severity and secondary symptoms (extreme tiredness, headache, muscle pains, chills were significantly associated with increased odds of taking OTC medication. Conclusions: While rates of self-reported AGI were higher in Inuit communities compared to non-Inuit communities in Canada, there were lower rates of AGI-related healthcare use in Inuit communities compared to other regions in Canada. As such, the rates of healthcare use for a given disease can differ between Inuit and non-Inuit communities, and caution should be exercised in making comparisons between Inuit and non-Inuit health outcomes based solely on clinic records and healthcare use.

Association between nutritional status and subjective health status in chronically ill children attending special schools.

Science.gov (United States)

Joosten, Koen; van der Velde, Kelly; Joosten, Pieter; Rutten, Hans; Hulst, Jessie; Dulfer, Karolijn

2016-04-01

In hospitalized children with a chronic disease, malnutrition was associated with a lower subjective health status. In outpatient children with a chronic disease attending special schools, this association has never been studied. The aim of this study was to assess the association between nutritional status and subjective health status in chronically ill children attending special schools. Overall, 642 children, median age 9.8 years (IQR 7.7-11.5), 60 % male, 72 % Caucasian, were included in this prospective study in nine special schools for chronically ill children in the Netherlands. Overall malnutrition was assessed as: acute malnutrition (nutritional risk-screening tool STRONGkids. Subjective health status was assessed with EQ-5D. Overall, 16 % of the children had overall malnutrition: 3 % acute and 13 % chronic malnutrition. Nurses reported 'some/severe problems' on the health status dimensions mobility (15 %), self-care (17 %), usual activities (19 %), pain/discomfort (22 %), and anxiety/depression (22 %) in chronically ill children. Their mean visual analogue scale score (VAS) was 73.0 (SD 11.1). Malnutrition, medication usage, and younger age explained 38 % of the variance of the VAS score. The presence of overall malnutrition in chronically ill children attending special schools was associated with lower subjective health status, especially in younger children and in those with chronic medication usage. Therefore, it is important to develop and use profile-screening tools to identify these children.

Unsuspected Dengue as a Cause of Acute Febrile Illness in Children and Adults in Western Nicaragua.

Directory of Open Access Journals (Sweden)

Megan E Reller

2016-10-01

Full Text Available Dengue is an emerging infectious disease of global significance. Suspected dengue, especially in children in Nicaragua's heavily-urbanized capital of Managua, has been well documented, but unsuspected dengue among children and adults with undifferentitated fever has not.To prospectively study dengue in semi-urban and rural western Nicaragua, we obtained epidemiologic and clinical data as well as acute and convalescent sera (2 to 4 weeks after onset of illness from a convenience sample (enrollment Monday to Saturday daytime to early evening of consecutively enrolled patients (n = 740 aged ≥ 1 years presenting with acute febrile illness. We tested paired sera for dengue IgG and IgM and serotyped dengue virus using reverse transcriptase-PCR. Among 740 febrile patients enrolled, 90% had paired sera. We found 470 (63.5% were seropositive for dengue at enrollment. The dengue seroprevalance increased with age and reached >90% in people over the age of 20 years. We identified acute dengue (serotypes 1 and 2 in 38 (5.1% patients. Only 8.1% (3/37 of confirmed cases were suspected clinically.Dengue is an important and largely unrecognized cause of fever in rural western Nicaragua. Since Zika virus is transmitted by the same vector and has been associated with severe congenital infections, the population we studied is at particular risk for being devastated by the Zika epidemic that has now reached Central America.

Medical dispatchers recognise substantial amount of acute stroke during emergency calls

DEFF Research Database (Denmark)

Viereck, Søren; Møller, Thea Palsgaard; Iversen, Helle Klingenberg

2016-01-01

without an inappropriate amount of false positive cases. CONCLUSIONS: We report an overall high recognition of stroke by medical dispatchers. A final diagnosis of TIA, compared to ICH, was positively associated with recognition of acute stroke. Emergency medical dispatchers serve as the essential first...... stroke are therefore critical in organising emergency stroke care. We aimed to describe the sensitivity and positive predictive value of medical dispatchers' ability to recognise acute stroke during emergency calls, and to identify factors associated with recognition. METHODS: This was an observational...... study of 2653 consecutive unselected patients with a final diagnosis of stroke or transient ischemic attack (TIA). All admitted through the Emergency Medical Services Copenhagen, during a 2-year study period (2012-2014). Final diagnoses were matched with dispatch codes from the Emergency Medical...

Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals.

LENUS (Irish Health Repository)

Gallagher, Paul

2011-11-01

Potentially inappropriate prescribing is common in older people presenting to hospital with acute illness in Ireland. The aim of this study was to determine if this phenomenon is unique to Ireland or whether it is a more widespread problem in hospitals across Europe.

Insufficiency of Medical Care for Patients with Acute Respiratory Failure

Directory of Open Access Journals (Sweden)

A. V. Dats

2017-01-01

Full Text Available The purpose of the research: to analyze insufficiency of medical care for patients with acute respiratory failure in the ICU.Materials and methods. It was a retrospective study of 160 patients' medical records (age from 15 to 84 years with acute respiratory failure (ARF hospitalized in the ICUs of 24 regional and municipal hospitals of the Irkutsk Oblast. Medical records were provided by the Territorial Fund of Compulsory Medical Insurance of citizens of Irkutsk region.The results. The basic defects in conducting mechanical ventilation were associated with improper lung function evaluation, microbiological tests of sputum and radiology. ARF was not diagnosed in 32 of 160 ICU patients (20%. In 23% of cases the causes of ARF were not diagnosed. The greatest part of the defects in the treatment of patients with acute respiratory failure was found during the treatment of hypoxemia: no recovery of the respiratory tract patency, no prescription of oxygen for hypoxemia, no mechanical ventilation for persistent hypoxemia on the background of maximum oxygen supply and late switching to mechanical ventilation at the stage of hypoxic cardiac arrest.Conclusions. The use of pulse oximetry alone in the absence of arterial blood gas analysis in 98% of patients with acute respiratory failure and failure to perform the lung X-ray and/or MSCT imaging in 21% of patients were accompanied by a high level of undiagnosed acute respiratory distress syndrome (78%, lung contusion (60%, pulmonary embolism (40%, cardiogenic pulmonary edema (33%, and nosocomial pneumonia (28%. Defects of treatment of patients with ARF in 46% of cases were caused by inadequate management of hypoxemia associated with the recovery of the respiratory tract patency, prescription of oxygen, and mechanical ventilation. 

Specialist home-based nursing services for children with acute and chronic illnesses.

Science.gov (United States)

Parab, Chitra S; Cooper, Carolyn; Woolfenden, Susan; Piper, Susan M

2013-06-15

Specialist paediatric home-based nursing services have been proposed as a cost-effective means of reducing distress resulting from hospital admissions, while enhancing primary care and reducing length of hospital stay. This review is an update of our original review, which was published in 2006. To evaluate specialist home-based nursing services for children with acute and chronic illnesses. We searched the following databases in February 2012: the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library 2012 Issue 2, Ovid MEDLINE, EMBASE, PsycINFO, CINAHL and Sociological Abstracts. We also searched ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform. No language restrictions were applied. Randomised controlled trials (RCTs) of children from birth to age 18 years with acute or chronic illnesses allocated to specialist home-based nursing services compared with conventional health care. Outcomes included utilisation of health care, physical and mental health, satisfaction, adverse health outcomes and costs. Two review authors extracted data from the studies independently and resolved any discrepancies by recourse to a third author. Meta-analysis was not appropriate because of the clinical diversity of the studies and the lack of common outcome measures. We screened 4226 titles to yield seven RCTs with a total of 840 participants. Participants, interventions and outcomes were diverse. No significant differences were reported in health outcomes; two studies reported a reduction in the hospital stay with no difference in the hospital readmission rates. Three studies reported a reduction in parental anxiety and improvement in child behaviours was reported in three studies. Overall increased parental satisfaction was reported in three studies. Also, better parental coping and family functioning was reported in one study. By contrast, one study each reported no impact on parental burden of care or on functional status of

A mixed methods exploration of family involvement in medical care for older adults with serious mental illness

NARCIS (Netherlands)

Aschbrenner, K.A.; Pepin, R.; Mueser, K.T.; Naslund, J.A.; Rolin, S.A.; Faber, M.J.; Bartels, S.J.

2014-01-01

OBJECTIVE: Many older persons with serious mental illness (SMI) suffer from high rates of comorbid medical conditions. Although families play a critical role in psychiatric illness management among adults with SMI, their contributions to improving health outcomes in this population has received

Differences in serum zinc levels in acutely ill and remitted adolescents and young adults with bulimia nervosa in comparison with healthy controls - a cross-sectional pilot study.

Science.gov (United States)

Zepf, Florian D; Rao, Pradeep; Runions, Kevin; Stewart, Richard M; Moore, Julia K; Wong, Janice Wy; Linden, Maike; Sungurtekin, Idil; Glass, Franziska; Gut, Linda; Peetz, Dirk; Hintereder, Gudrun; Schaab, Michael; Poustka, Fritz; Wöckel, Lars

2017-01-01

Research has implicated that changes in zinc (Zn) metabolism may be associated with the biological underpinnings of eating disorders, in particular anorexia nervosa. However, to date research on the role of Zn in patients with bulimia nervosa (BN) is scarce. We aimed to explore serum Zn concentrations in young patients with BN, with a focus on the stage of the disorder, comparing acutely ill and recovered patients with BN with healthy controls. Serum Zn concentrations were obtained from healthy controls and from acutely ill and remitted young patients with BN. Mean duration of remission was 4.0±3.5 years. Remitted patients showed elevated serum Zn concentrations when compared to controls (Cohen's d=2.022), but concentrations were still in the normal range. Acutely ill patients also had higher serum Zn levels when compared to controls (all values still being within the reference range, Cohen's d=0.882). There was no difference between acutely ill and remitted patients with BN in serum Zn concentrations. Of note, remitted patients had a significantly higher body weight when compared to the other two groups. Overall, there were no significant differences in dietary preferences with regard to Zn containing foods between the groups. The present study provides preliminary evidence that the underlying factors for changes in Zn serum concentrations in young patients with BN do not vary with regard to the stage of illness (acute versus remitted BN). Further prospective research is needed in order to disentangle the possible interplay between serum Zn status and bulimic eating behaviors.

Update: outbreak of acute febrile illness among athletes participating in Eco-Challenge-Sabah 2000--Borneo, Malaysia, 2000.

Science.gov (United States)

2001-01-19

During September 7-11, 2000, CDC was notified by the Idaho Department of Health, the Los Angeles County Department of Health Services, and the GeoSentinel Global Surveillance Network of at least 20 cases of acute febrile illness in three countries; all ill patients had participated in the Eco-Challenge-Sabah 2000 multisport expedition race in Borneo, Malaysia, during August 21-September 3, 2000. Participants included athletes from 29 U.S. states and 26 countries. This report updates the ongoing investigation of this outbreak through December 2, which suggests that Leptospira were the cause of illness and that water from the Segama River was the primary source of infection. Participants in adventure sports and exotic tourism should be aware of potential exposure to unusual and emerging infectious agents.

Mental ill health in the elderly: medical students’ social representations in the United Kingdom

Directory of Open Access Journals (Sweden)

Bruno Medeiros

2014-12-01

Full Text Available Objective This study aims to explore medical students’ social representations of mental ill health in older adults. Method It comprises an exploratory and qualitative investigation based on the theory of social representations. Two focus groups with pre-clinical medics (group 1, N=4; group 2, N=4 and 10 individual interviews with clinical medical students were conducted. Thematic analysis at a latent level explored meanings and differences between groups. Results Three overarching themes reflect participants’ representations of mental health problems in later life – mental ill health in old age, polarisation of care, and challenges to care. Primary health care appears as an important strategy to overcome barriers to mental health care in the community. Nevertheless, disqualifying representations, stigma and organization of services constitute the main challenges to quality mental health care in later life. Conclusion This paper highlights the need to address cultural and organizational barriers to promote quality care.

Adults hospitalised with acute respiratory illness rarely have detectable bacteria in the absence of COPD or pneumonia; viral infection predominates in a large prospective UK sample.

Science.gov (United States)

Clark, Tristan W; Medina, Marie-jo; Batham, Sally; Curran, Martin D; Parmar, Surendra; Nicholson, Karl G

2014-11-01

Many adult patients hospitalised with acute respiratory illness have viruses detected but the overall importance of viral infection compared to bacterial infection is unclear. Patients were recruited from two acute hospital sites in Leicester (UK) over 3 successive winters. Samples were taken for viral and bacterial testing. Of the 780 patients hospitalised with acute respiratory illness 345 (44%) had a respiratory virus detected. Picornaviruses were the most commonly isolated viruses (detected in 23% of all patients). Virus detection rates exceeded 50% in patients with exacerbation of asthma (58%), acute bronchitis and Influenza-like-illness (64%), and ranged from 30 to 50% in patients with an exacerbation of COPD (38%), community acquired pneumonia (36%) and congestive cardiac failure (31%). Bacterial detection was relatively frequent in patients with exacerbation of COPD and pneumonia (25% and 33% respectively) but was uncommon in all other groups. Antibiotic use was high across all clinical groups (76% overall) and only 21% of all antibiotic use occurred in patients with detectable bacteria. Respiratory viruses are the predominant detectable aetiological agents in most hospitalised adults with acute respiratory illness. Antibiotic usage in hospital remains excessive including in clinical conditions associated with low rates of bacterial detection. Efforts at reducing excess antibiotic use should focus on these groups as a priority. Registered International Standard Controlled Trial Number: 21521552. Copyright © 2014 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Attitudes of Brazilian Medical Students Towards Psychiatric Patients and Mental Illness: A Quantitative Study Before and After Completing the Psychiatric Clerkship.

Science.gov (United States)

da Rocha Neto, Helio Gomes; Rosenheck, Robert A; Stefanovics, Elina A; Cavalcanti, Maria Tavares

2017-06-01

The authors evaluated whether a psychiatric clerkship reduces stigmatized attitudes towards people with mental illness among medical students. A 56-item questionnaire was used to assess the attitudes of medical students towards patients with mental illness and their beliefs about its causes before and after their participation in their psychiatric clerkship at a major medical school in Rio de Janeiro. Exploratory factor analysis identified four factors, reflecting "social acceptance of people with mental illness," "normalizing roles for people with mental illness in society," "non-belief in supernatural causes for mental illness," and "belief in bio-psychosocial causes for mental illness." Analysis of variance was used to evaluate changes in these factors before and after the clerkship. One significant difference was identified with a higher score on the factor representing social acceptance after as compared to before the clerkship (p = 0.0074). No significant differences were observed on the other factors. Participation in a psychiatric clerkship was associated with greater social acceptance but not with improvement on other attitudinal factors. This may reflect ceiling effects in responses before the clerkship concerning supernatural and bio-psychosocial beliefs about causes of mental illness that left little room for change.

[Acute lithium poisoning: epidemiology, clinical characteristics, and treatment].

Science.gov (United States)

Burguera Vion, Víctor; Montes, José Manuel; Del Rey, José Manuel; Rivera-Gorrín, Maite; Rodao, José María; Tenorio, Maite; Saiz-Ruiz, Jerónimo; Liaño, Fernando

2017-02-01

Lithium continues to be the treatment of choice for bipolar disorder. Acute lithium poisoning is a potentially serious event. We present a retrospective observational significative study of episodes of acute lithium poisoning during a 52- month period. Poisoning was defined by a blood lithium concentration of 1.5 mEq/L or higher. We analyzed treatment and epidemiologic and clinical characteristics of 70 episodes were identified (incidence density among treated patients, 1.76 per 100 patient-years). The most frequent cause of lithium poisoning was a concurrent medical condition (46%). Most poisonings were mild (74.2%), but neurologic involvement was identified in 40.3%. Electrocardiographic abnormalities were found in 8 cases. Acute renal failure, found in 23 patients (37.1%), was mild in most cases, although 11 patients required hemodialysis. We concluded that acute lithium poisoning is an uncommon complication, but risk needs to be lowered. Patients should be warned to avoid dosage errors and to take special care during concurrent illnesses and while taking other medications.

Pharmacist-led medication review in an acute admissions unit

DEFF Research Database (Denmark)

Hansen, Trine Graabæk; Bonnerup, Dorthe Krogsgaard; Kjeldsen, Lene Juel

2015-01-01

of principles and methodologies, and the practical procedure is seldom described in detail, which makes reproducing study findings difficult. The objective of this paper is to provide a detailed description of a procedure developed and used for pharmacist-led medication review in acute admissions units......) collection of information about the patient's medical treatment, (3) patient interview, (4) critical examination of the patient's medications and (5) recommendations for the hospital physician.Conclusions We have provided a detailed description of a procedure for pharmacist-led medication review. We do so...

Is Hypoxia common despite oxygen treatment in the Acute Medical ...

African Journals Online (AJOL)

The delivery of oxygen in an acute Admissions Unit is always (often) riddled with difficulties. While most patients do get oxygen at some point of time it is often uncontrolled and inappropriate. This reflects inadequate and untrained staffing in the very busy Medical Units. We did a small study on 30 random acute admissions ...

Estimating the burden of acute gastrointestinal illness: a pilot study of the prevalence and underreporting in Saint Lucia, Eastern Caribbean.

Science.gov (United States)

Gabriel, Owen O; Jaime, Alina; Mckensie, Martin; Auguste, Ava; Pérez, Enrique; Indar, Lisa

2013-12-01

Saint Lucia was the first country to conduct a burden of illness study in the Caribbean to determine the community prevalence and underreporting of acute gastroenteritis (AGE). A retrospective cross-sectional population survey on AGE-related illness was administered to a random sample of residents of Saint Lucia in 20 April-16 May 2008 and 6-13 December 2009 to capture the high- and low-AGE season respectively. Of the selected 1,150 individuals, 1,006 were administered the survey through face-to-face interviews (response rate 87.4%). The overall monthly prevalence of AGE was 3.9%. The yearly incidence rate was 0.52 episodes/person-year. The age-adjusted monthly prevalence was 4.6%. The highest monthly prevalence of AGE was among children aged < 5 years (7.5%) and the lowest in persons aged 45-64 years (2.6%). The average number of days an individual suffered from diarrhoea was 3.8 days [range 1-21 day(s)]. Of the reported AGE cases, only seven (18%) sought medical care; however, 83% stayed at home due to the illness [(range 1-16 day(s), mean 2.5]; and 26% required other individuals to take care of them. The estimated underreporting of syndromic AGE and laboratory-confirmed foodborne disease pathogens was 81% and 99% respectively during the study period. The economic cost for treating syndromic AGE was estimated at US$ 3,892.837 per annum. This was a pilot study on the burden of illness (BOI) in the Caribbean. The results of the study should be interpreted within the limitations and challenges of this study. Lessons learnt were used for improving the implementation procedures of other BOI studies in the Caribbean.

Medicalizing versus psychologizing mental illness: what are the implications for help seeking and stigma? A general population study.

Science.gov (United States)

Pattyn, E; Verhaeghe, M; Sercu, C; Bracke, P

2013-10-01

This study contrasts the medicalized conceptualization of mental illness with psychologizing mental illness and examines what the consequences are of adhering to one model versus the other for help seeking and stigma. The survey "Stigma in a Global Context-Belgian Mental Health Study" (2009) conducted face-to-face interviews among a representative sample of the general Belgian population using the vignette technique to depict schizophrenia (N = 381). Causal attributions, labeling processes, and the disease view are addressed. Help seeking refers to open-ended help-seeking suggestions (general practitioner, psychiatrist, psychologist, family, friends, and self-care options). Stigma refers to social exclusion after treatment. The data are analyzed by means of logistic and linear regression models in SPSS Statistics 19. People who adhere to the biopsychosocial (versus psychosocial) model are more likely to recommend general medical care and people who apply the disease view are more likely to recommend specialized medical care. Regarding informal help, those who prefer the biopsychosocial model are less likely to recommend consulting friends than those who adhere to the psychosocial model. Respondents who apply a medical compared to a non-medical label are less inclined to recommend self-care. As concerns treatment stigma, respondents who apply a medical instead of a non-medical label are more likely to socially exclude someone who has been in psychiatric treatment. Medicalizing mental illness involves a package deal: biopsychosocial causal attributions and applying the disease view facilitate medical treatment recommendations, while labeling seems to trigger stigmatizing attitudes.

Indirect, out-of-pocket and medical costs from influenza-related illness in young children.

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Ortega-Sanchez, Ismael R; Molinari, Noelle-Angelique M; Fairbrother, Gerry; Szilagyi, Peter G; Edwards, Kathryn M; Griffin, Marie R; Cassedy, Amy; Poehling, Katherine A; Bridges, Carolyn; Staat, Mary Allen

2012-06-13

Studies have documented direct medical costs of influenza-related illness in young children, however little is known about the out-of-pocket and indirect costs (e.g., missed work time) incurred by caregivers of children with medically attended influenza. To determine the indirect, out-of-pocket (OOP), and direct medical costs of laboratory-confirmed medically attended influenza illness among young children. Using a population-based surveillance network, we evaluated a representative group of children aged accounting databases, and follow-up interviews with caregivers. Outcome measures included work time missed, OOP expenses (e.g., over-the-counter medicines, travel expenses), and direct medical costs. Costs were estimated (in 2009 US Dollars) and comparisons were made among children with and without high risk conditions for influenza-related complications. Data were obtained from 67 inpatients, 121 ED patients and 92 outpatients with laboratory-confirmed influenza. Caregivers of hospitalized children missed an average of 73 work hours (estimated cost $1456); caregivers of children seen in the ED and outpatient clinics missed 19 ($383) and 11 work hours ($222), respectively. Average OOP expenses were $178, $125 and $52 for inpatients, ED-patients and outpatients, respectively. OOP and indirect costs were similar between those with and without high risk conditions (p>0.10). Medical costs totaled $3990 for inpatients and $730 for ED-patients. Out-of-pocket and indirect costs of laboratory-confirmed and medically attended influenza in young children are substantial and support the benefits of vaccination. Published by Elsevier Ltd.

HIGH-ALTITUDE ILLNESS

Directory of Open Access Journals (Sweden)

Dwitya Elvira

2015-05-01

Full Text Available AbstrakHigh-altitude illness (HAI merupakan sekumpulan gejala paru dan otak yang terjadi pada orang yang baru pertama kali mendaki ke ketinggian. HAI terdiri dari acute mountain sickness (AMS, high-altitude cerebral edema (HACE dan high-altitude pulmonary edema (HAPE. Tujuan tinjauan pustaka ini adalah agar dokter dan wisatawan memahami risiko, tanda, gejala, dan pengobatan high-altitude illness. Perhatian banyak diberikan terhadap penyakit ini seiring dengan meningkatnya popularitas olahraga ekstrim (mendaki gunung tinggi, ski dan snowboarding dan adanya kemudahan serta ketersediaan perjalanan sehingga jutaan orang dapat terpapar bahaya HAI. Di Pherice, Nepal (ketinggian 4343 m, 43% pendaki mengalami gejala AMS. Pada studi yang dilakukan pada tempat wisata di resort ski Colorado, Honigman menggambarkan kejadian AMS 22% pada ketinggian 1850 m sampai 2750 m, sementara Dean menunjukkan 42% memiliki gejala pada ketinggian 3000 m. Aklimatisasi merupakan salah satu tindakan pencegahan yang dapat dilakukan sebelum pendakian, selain beberapa pengobatan seperti asetazolamid, dexamethasone, phosopodiestrase inhibitor, dan ginko biloba.Kata kunci: high-altitude illness, acute mountain sickness, edema cerebral, pulmonary edema AbstractHigh-altitude illness (HAI is symptoms of lung and brain that occurs in people who first climb to altitude. HAI includes acute mountain sickness (AMS, high-altitude cerebral edema (HACE and high altitude pulmonary edema (HAPE. The objective of this review was to understand the risks, signs, symptoms, and treatment of high-altitude illness. The attention was given to this disease due to the rising popularity of extreme sports (high mountain climbing, skiing and snowboarding and the ease and availability of the current travelling, almost each year, millions of people could be exposed to the danger of HAI. In Pherice, Nepal (altitude 4343 m, 43% of climbers have symptoms of AMS. Furthermore, in a study conducted at sites in

The association of the original OSHA chemical hazard communication standard with reductions in acute work injuries/illnesses in private industry and the industrial releases of chemical carcinogens.

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Oleinick, Arthur

2014-02-01

OSHA predicted the original chemical Hazard Communication Standard (HCS) would cumulatively reduce the lost workday acute injury/illness rate for exposure events by 20% over 20 years and reduce exposure to chemical carcinogens. JoinPoint trend software identified changes in the rate of change of BLS rates for days away from work for acute injuries/illnesses during 1992-2009 for manufacturing and nonmanufacturing industries for both chemical, noxious or allergenic injury exposure events and All other exposure events. The annual percent change in the rates was used to adjust observed numbers of cases to estimate their association with the standard. A case-control study of EPA's Toxic Release Inventory 1988-2009 data compared carcinogen and non-carcinogens' releases. The study estimates that the HCS was associated with a reduction in the number of acute injuries/illnesses due to chemical injury exposure events over the background rate in the range 107,569-459,395 (Hudson method/modified BIC model) depending on whether the HCS is treated as a marginal or sole factor in the decrease. Carcinogen releases have declined at a substantially faster rate than control non-carcinogens. The previous HCS standard was associated with significant reductions in chemical event acute injuries/illnesses and chemical carcinogen exposures. © 2013 Wiley Periodicals, Inc.

Addison’s Disease Mimicking as Acute Pancreatitis: A Case Report

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Chaudhuri, Sayani; Rao, Karthik N; Ommurugan, Balaji; Varghese, George

2017-01-01

Over past two decades there has been significant improvement in medical field in elucidating the underlying pathophysiology and genetics of Addison’s disease. Adrenal insufficiency (Addison’s disease) is a rare disease with an incidence of 0.8/100,000 cases. The diagnosis may be delayed if the clinical presentation mimics a gastrointestinal disorder or psychiatric illness. We report a case of Addison’s disease presenting as acute pain in abdomen mimicking clinical presentation of acute pancreatitis. PMID:28571196

Sodium Bicarbonate Versus Sodium Chloride for Preventing Contrast-Associated Acute Kidney Injury in Critically Ill Patients: A Randomized Controlled Trial.

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Valette, Xavier; Desmeulles, Isabelle; Savary, Benoit; Masson, Romain; Seguin, Amélie; Sauneuf, Bertrand; Brunet, Jennifer; Verrier, Pierre; Pottier, Véronique; Orabona, Marie; Samba, Désiré; Viquesnel, Gérald; Lermuzeaux, Mathilde; Hazera, Pascal; Dutheil, Jean-Jacques; Hanouz, Jean-Luc; Parienti, Jean-Jacques; du Cheyron, Damien

2017-04-01

To test whether hydration with bicarbonate rather than isotonic sodium chloride reduces the risk of contrast-associated acute kidney injury in critically ill patients. Prospective, double-blind, multicenter, randomized controlled study. Three French ICUs. Critically ill patients with stable renal function (n = 307) who received intravascular contrast media. Hydration with 0.9% sodium chloride or 1.4% sodium bicarbonate administered with the same infusion protocol: 3 mL/kg during 1 hour before and 1 mL/kg/hr during 6 hours after contrast medium exposure. The primary endpoint was the development of contrast-associated acute kidney injury, as defined by the Acute Kidney Injury Network criteria, 72 hours after contrast exposure. Patients randomized to the bicarbonate group (n = 151) showed a higher urinary pH at the end of the infusion than patients randomized to the saline group (n = 156) (6.7 ± 2.1 vs 6.2 ± 1.8, respectively; p 0.99) were also similar between the saline and bicarbonate groups, respectively. Except for urinary pH, none of the outcomes differed between the two groups. Among ICU patients with stable renal function, the benefit of using sodium bicarbonate rather than isotonic sodium chloride for preventing contrast-associated acute kidney injury is marginal, if any.

Contextual factors associated with health care service utilization for children with acute childhood illnesses in Nigeria.

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Sulaimon T Adedokun

Full Text Available To examine the independent contribution of individual, community and state-level factors to health care service utilization for children with acute childhood illnesses in Nigeria.The study was based on secondary analyses of cross-sectional population-based data from the 2013 Nigeria Demographic and Health Survey (DHS. Multilevel logistic regression models were applied to the data on 6,427 under-five children who used or did not use health care service when they were sick (level 1, nested within 896 communities (level 2 from 37 states (level 3.About one-quarter of the mothers were between 15 and 24 years old and almost half of them did not have formal education (47%. While only 30% of the children utilized health service when they were sick, close to 67% lived in the rural area. In the fully adjusted model, mothers with higher education attainment (Adjusted odds ratio [aOR] = 1.63; 95% credible interval [CrI] = 1.31-2.03, from rich households (aOR = 1.76; 95% CrI = 1.35-2.25, with access to media (radio, television or magazine (aOR = 1.18; 95% CrI = 1.08-1.29, and engaging in employment (aOR = 1.18; 95% CrI = 1.02-1.37 were significantly more likely to have used healthcare services for acute childhood illnesses. On the other hand, women who experienced difficulty getting to health facilities (aOR = 0.87; 95% CrI = 0.75-0.99 were less likely to have used health service for their children.Our findings highlight that utilization of healthcare service for acute childhood illnesses was influenced by not only maternal factors but also community-level factors, suggesting that public health strategies should recognise this complex web of individual composition and contextual composition factors to guide provision of healthcare services. Such interventions could include: increase in female school enrolment, provision of interest-free loans for small and medium scale enterprises, introduction of mobile clinics and establishment of more primary health care

Optimal use of acute headache medication: a qualitative examination of behaviors and barriers to their performance.

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Seng, Elizabeth K; Holroyd, Kenneth A

2013-10-01

This study aims to qualitatively examine the behaviors required to optimally use acute headache medication and the barriers to successful performance of these behaviors. The efficacy of drug treatment is partly determined by medication adherence. The adherence literature has focused almost exclusively on the behaviors required to optimally use medications that are taken on a fixed schedule, as opposed to medications taken on an as needed basis to treat acute episodes of symptoms, such as headaches. Twenty-one people with headache and 15 health care providers participated in qualitative phenomenological interviews that were transcribed and coded by a multidisciplinary research team using phenomenological analysis. Interviews revealed 8 behaviors required to optimally use acute headache medication, including cross-episode behaviors that people with headache regularly perform to ensure optimal acute headache medication use, and episode-specific behaviors used to treat an individual headache episode. Interviews further revealed 9 barriers that hinder successful performance of these behaviors. Behaviors required to optimally use acute headache medication were numerous, often embedded in a larger chain of behaviors, and were susceptible to disruption by numerous barriers. © 2013 American Headache Society.

Viral etiologies of influenza-like illness and severe acute respiratory infections in Thailand.

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Chittaganpitch, Malinee; Waicharoen, Sunthareeya; Yingyong, Thitipong; Praphasiri, Prabda; Sangkitporn, Somchai; Olsen, Sonja J; Lindblade, Kim A

2018-07-01

Information on the burden, characteristics and seasonality of non-influenza respiratory viruses is limited in tropical countries. Describe the epidemiology of selected non-influenza respiratory viruses in Thailand between June 2010 and May 2014 using a sentinel surveillance platform established for influenza. Patients with influenza-like illness (ILI; history of fever or documented temperature ≥38°C, cough, not requiring hospitalization) or severe acute respiratory infection (SARI; history of fever or documented temperature ≥38°C, cough, onset respiratory syncytial virus (RSV), metapneumovirus (MPV), parainfluenza viruses (PIV) 1-3, and adenoviruses by polymerase chain reaction (PCR) or real-time reverse transcriptase-PCR. We screened 15 369 persons with acute respiratory infections and enrolled 8106 cases of ILI (5069 cases respiratory viruses tested, while for SARI cases respiratory viruses, particularly seasonality, although adjustments to case definitions may be required. © 2018 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

Discontinuing the Use of PRN Intramuscular Medication for Agitation in an Acute Psychiatric Hospital.

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Hayes, Ariel; Russ, Mark J

2016-03-01

This study examined the impact of eliminating intramuscular PRN medication for agitation on patient and staff safety in an acute psychiatric inpatient setting. The current retrospective chart review investigated the use of PRN medications (oral and intramuscular) to treat acute agitation, including aggression, and related outcomes before and after a mandated change in PRN practice that required real time physician input before administration of intramuscular medications. The use of both oral and intramuscular PRN medications dramatically decreased following implementation of the mandated change in practice. In particular, the use of intramuscular PRNs for agitation decreased by about half. Despite this decrease, the assault rate in the hospital was unchanged, and the utilization of restraint and seclusion continued to decrease. It is possible to reduce the utilization of PRN medications for agitation without broadly compromising safety on acute care psychiatric inpatient units.

A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury

DEFF Research Database (Denmark)

Karvellas, Constantine J; Farhat, Maha R; Sajjad, Imran

2011-01-01

Introduction: Our aim was to investigate the impact of early versus late initiation of renal replacement therapy (RRT) on clinical outcomes in critically ill patients with acute kidney injury (AKI). Methods: Systematic review and meta-analysis were used in this study. PUBMED, EMBASE, SCOPUS, Web ...

A demonstration of mobile phone deployment to support the treatment of acutely ill children under five in Bushenyi district, Uganda.

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Kabakyenga, Jerome; Barigye, Celestine; Brenner, Jennifer; Maling, Samuel; Buchner, Denise; Nettle-Aquirre, Alberto; Singhal, Nalini; Kyomuhangi, Teddy; Tumusiime, David; Finch, Janet; MacLeod, Stuart

2016-03-01

Benefits of mobile phone deployment for children mobile phone use. Impact was assessed by quantitative measures and qualitative evaluation through household surveys, focus group discussions, and key informant interviews. CHWs in targeted sites improved child healthcare through mobile phone use coupled with iCCM. Of acutely ill children, 92.6% were correctly managed. Significant improvements in clinical outcomes compared to those obtained by CHWs with enhanced iCCM training alone were unproven in this limited demonstration. Nonetheless, qualitative evaluation showed gains in treatment planning, supply management, and logistical efficiency. Provider confidence and communications were enhanced as was ease and accuracy of record keeping. Mobile phones appear synergistic with iCCM to bolster basic supportive care for acutely ill children provided by CHWs. The full impact of expanded mobile phone deployment warrants further evaluation prior to scaling up in low-resource settings.

[The Intentions Affecting the Medical Decision-Making Behavior of Surrogate Decision Makers of Critically Ill Patients and Related Factors].

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Su, Szu-Huei; Wu, Li-Min

2018-04-01

The severity of diseases and high mortality rates that typify the intensive care unit often make it difficult for surrogate decision makers to make decisions for critically ill patients regarding whether to continue medical treatments or to accept palliative care. To explore the behavioral intentions that underlie the medical decisions of surrogate decision makers of critically ill patients and the related factors. A cross-sectional, correlation study design was used. A total of 193 surrogate decision makers from six ICUs in a medical center in southern Taiwan were enrolled as participants. Three structured questionnaires were used, including a demographic datasheet, the Family Relationship Scale, and the Behavioral Intention of Medical Decisions Scale. Significantly positive correlations were found between the behavioral intentions underlying medical decisions and the following variables: the relationship of the participant to the patient (Eta = .343, p = .020), the age of the patient (r = .295, p medical decisions of the surrogate decision makers, explaining 13.9% of the total variance. In assessing the behavioral intentions underlying the medical decisions of surrogate decision makers, health providers should consider the relationship between critical patients and their surrogate decision makers, patient age, the length of ICU stay, and whether the patient has a pre-signed advance healthcare directive in order to maximize the effectiveness of medical care provided to critically ill patients.

Enterovirus genotypes among patients with severe acute respiratory illness, influenza-like illness, and asymptomatic individuals in South Africa, 2012-2014.

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Hellferscee, Orienka; Tempia, Stefano; Walaza, Sibongile; Variava, Ebrahim; Dawood, Halima; Wolter, Nicole; Madhi, Shabir A; du Plessis, Mignon; Cohen, Cheryl; Treurnicht, Florette K

2017-10-01

Enteroviruses can cause outbreaks of severe acute respiratory illness (SARI) and EV-A, -B, -C, and -D species have different pathogenic profiles and circulation patterns. We aimed to characterize and determine the prevalence of enterovirus genotypes among South African patients with respiratory illness and controls during June 2012 to July 2014. Syndromic SARI and influenza-like illness (ILI) surveillance was performed at two sentinel sites. At each site nasopharyngeal/oropharyngeal specimens were collected from SARI and ILI patients as well as controls. Specimens were tested for enterovirus by real-time PCR. Positive specimens were further genotyped by sequencing a region of the VP1 gene. The prevalence of enterovirus was 5.8% (87/1494), 3.4% (103/3079), and 3.4% (46/1367) among SARI, ILI, and controls, respectively (SARI/controls, P = 0.002 and ILI/control, P = 0.973). Among the 101/236 (42.8%) enterovirus-positive specimens that could be genotyped, we observed a high diversity of circulating enterovirus genotypes (a total of 33 genotypes) from all four human enterovirus species with high prevalence of Enterovirus-B (60.4%; 61/101) and Enterovirus-A (21.8%; 22/101) compared to Enterovirus-C (10.9%; 11/101) and Enterovirus-D (6.9%; 7/101) (P = 0.477). Of the enterovirus genotypes identified, Echovirus 30 (9.9%, 10/101), Coxsackie virus B5 (7.9%, 8/101) and Enterovirus-D68 (6.9%, 7/101) were most prevalent. There was no difference in disease severity (SARI or ILI compared to controls) between the different enterovirus species (P = 0.167). We observed a high number of enterovirus genotypes in patients with respiratory illness and in controls from South Africa with no disease association of EV species with disease severity. © 2017 Wiley Periodicals, Inc.

About status of oncological illness rate in Kazakhstan

International Nuclear Information System (INIS)

Omarova, K.O.

2000-01-01

One of the principal problem of Republic of Kazakhstan's pediatricians is onco-hematological diseases. In 1999 hematological illness rate in the Republic makes up 2964.8 per 100,000 of children's population. Side by side with widespread iron-deficit anemia the aplastic anemia and the acute leukemia are often meeting. Annual index of acute leukemia illness number in Kazakhstan makes up 2.6 per 100,000 of children's population. Core of examined children group with acute leukemia presents children living nearby nuclear sites and arrived from Chernobyl and who in consequence (after 3-5 years) fallen ill. It is concluded, that cause of leukemia is sum of unfavourable epidemiologic factors

A hard pill to swallow: medication, empathy, and the value of collaborative recovery.

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Bizub, Anne L

2013-06-01

Recovery from mental illness is a complex journey that is greatly facilitated when client and professional helper collaborate in the decision making process. It is further aided when the latter has an empathetic awareness of the client's experience, especially with regard to the impact of pharmacological treatment. The following article describes one psychologist's experience of being prescribed medication during a period of acute illness. Analysis of this experience is via a narrative, phenomenological approach. Results suggest that even when taken as directed, a medication can augment one's subjective feeling of illness. It further shows how challenging it can be for the ailing individual to assert his or her needs for something other than hospitalization. Although only one case is analyzed, it points to the impact that medication may have on the life of a person with mental illness, reinforcing the importance of collaboration and empathetic understanding of the other's experience.

Differences in serum zinc levels in acutely ill and remitted adolescents and young adults with bulimia nervosa in comparison with healthy controls – a cross-sectional pilot study

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Zepf, Florian D; Rao, Pradeep; Runions, Kevin; Stewart, Richard M; Moore, Julia K; Wong, Janice WY; Linden, Maike; Sungurtekin, Idil; Glass, Franziska; Gut, Linda; Peetz, Dirk; Hintereder, Gudrun; Schaab, Michael; Poustka, Fritz; Wöckel, Lars

2017-01-01

Background Research has implicated that changes in zinc (Zn) metabolism may be associated with the biological underpinnings of eating disorders, in particular anorexia nervosa. However, to date research on the role of Zn in patients with bulimia nervosa (BN) is scarce. Objective We aimed to explore serum Zn concentrations in young patients with BN, with a focus on the stage of the disorder, comparing acutely ill and recovered patients with BN with healthy controls. Methods Serum Zn concentrations were obtained from healthy controls and from acutely ill and remitted young patients with BN. Mean duration of remission was 4.0±3.5 years. Results Remitted patients showed elevated serum Zn concentrations when compared to controls (Cohen’s d=2.022), but concentrations were still in the normal range. Acutely ill patients also had higher serum Zn levels when compared to controls (all values still being within the reference range, Cohen’s d=0.882). There was no difference between acutely ill and remitted patients with BN in serum Zn concentrations. Of note, remitted patients had a significantly higher body weight when compared to the other two groups. Overall, there were no significant differences in dietary preferences with regard to Zn containing foods between the groups. Conclusion The present study provides preliminary evidence that the underlying factors for changes in Zn serum concentrations in young patients with BN do not vary with regard to the stage of illness (acute versus remitted BN). Further prospective research is needed in order to disentangle the possible interplay between serum Zn status and bulimic eating behaviors. PMID:29089768

Characteristics of acute febrile illness and determinants of illness recovery among adults presenting to Singapore primary care clinics

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Zaw Myo Tun

2016-10-01

Full Text Available Abstract Background Undifferentiated acute febrile illness (AFI is a common presentation among adults in primary care settings in Singapore but large gaps exist in the understanding of the characteristics of these patients. We studied clinical and epidemiological characteristics of AFI patients and factors associated with delayed recovery from AFI. Methods We performed a secondary data analysis using data from the Early DENgue infection and outcome (EDEN study on 2046 adult patients presenting at 5 Singapore polyclinics between December 2007 and February 2013 with a history of fever (≥38 °C for less than 72 h. We used an accelerated failure time model to investigate factors associated with delayed recovery from AFI. Results The mean age of patients was 36.6 years, 65 % were male, 51 % were of Chinese ethnicity, and 75 % lived in public housing. Median illness duration was 5 days (interquartile range, 3–7. In multivariable analysis, the unemployed and white collar workers had longer illness duration compared with blue collar workers (time ratio (TR, 1.10; 95 % confidence interval (CI, 1.03–1.17 and TR, 1.08; 95 % CI, 1.02–1.15, respectively. Patients with more symptoms at initial consultation had slower recovery (TR, 1.03 per additional symptom; 95 % CI, 1.02–1.03. Other clinical factors were also associated with longer duration of illness, including use of analgesics (TR, 1.21; 95 % CI, 1.15–1.28; use of cough medicines (TR, 1.14; 95 % CI, 1.08–1.20; use of antibiotics (TR, 1.14; 95 % CI, 1.07–1.21; and hospitalization (TR, 1.59; 95 % CI, 1.39–1.82. Compared to patients with normal WBC count at first consultation, those with low WBC count had slower recovery (TR, 1.14; 95 % CI, 1.07–1.21, while the reverse was observed among patients with high WBC count (TR, 0.94; 95 % CI, 0.88–1.00. Conclusions Differences in illness duration among different types of employment may reflect differences in their underlying

Oral health impacts of medications used to treat mental illness.

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Cockburn, N; Pradhan, A; Taing, M W; Kisely, S; Ford, P J

2017-12-01

Many psychotropic medications affect oral health. This review identified oral side effects for antidepressant, antipsychotic, anticonvulsant, antianxiety and sedative drugs that are recommended in Australia for the management of common mental illnesses and provides recommendations to manage these side-effects. The Australian Therapeutic Guidelines and the Australian Medicines Handbook were searched for medications used to treat common mental health conditions. For each medication, the generic name, class, and drug company reported side-effects were extracted from the online Monthly Index of Medical Specialties (eMIMs) and UpToDate databases. Meyler's Side Effect of Drugs Encyclopaedia was used to identify additional oral adverse reactions to these medications. Fifty-seven drugs were identified: 23 antidepressants, 22 antipsychotics or mood stabilisers, and 12 anxiolytic or sedative medications. Xerostomia (91%) the most commonly reported side effect among all classes of medications of the 28 identified symptoms. Other commonly reported adverse effects included dysguesia (65%) for antidepressants, and tardive dyskinesia (94%) or increased salivation (78%) for antipsychotic medications. While xerostomia has often been reported as a common adverse effect of psychotropic drugs, this review has identified additional side effects including dysguesia from antidepressants and tardive dyskinesia and increased salivation from antipsychotics. Clinicians should consider oral consequences of psychotropic medication in addition to other side-effects when prescribing. For antidepressants, this would mean choosing duloxetine, agomelatine and any of the serotonin re-uptake inhibitors except sertraline. In the case of antipsychotics and mood stabilisers, atypical agents have less oral side effects than older alternatives. Copyright © 2017 Elsevier B.V. All rights reserved.

Hypokalemia in acute medical patients

DEFF Research Database (Denmark)

Jensen, Helene Christine Kildegaard; Brabrand, Mikkel; Vinholt, Pernille Just

2015-01-01

. METHODS: We conducted a prospective cohort study involving all first time admissions (n=11988) to the Acute Medical Department at Odense University Hospital linking potassium level at admission with registry data on patient characteristics, laboratory data, redeemed prescriptions and time of death......: Hypokalemia occurred in 16.8% of first time admissions (n=2011). It was associated with an adjusted hazard ratio [HR] of 1.34 (95% confidence interval [CI], 0.98-1.85) for 7-day mortality and 1.56 (CI, 1.18-3.06) for 8-30 day mortality. Among patients with more severe hypokalemia (plasma [K(+)

Healthcare-seeking behaviors for acute respiratory illness in two communities of Java, Indonesia: a cross-sectional survey.

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Praptiningsih, Catharina Y; Lafond, Kathryn E; Wahyuningrum, Yunita; Storms, Aaron D; Mangiri, Amalya; Iuliano, Angela D; Samaan, Gina; Titaley, Christiana R; Yelda, Fitra; Kreslake, Jennifer; Storey, Douglas; Uyeki, Timothy M

2016-06-01

Understanding healthcare-seeking patterns for respiratory illness can help improve estimations of disease burden and inform public health interventions to control acute respiratory disease in Indonesia. The objectives of this study were to describe healthcare-seeking behaviors for respiratory illnesses in one rural and one urban community in Western Java, and to explore the factors that affect care seeking. From February 8, 2012 to March 1, 2012, a survey was conducted in 2520 households in the East Jakarta and Bogor districts to identify reported recent respiratory illnesses, as well as all hospitalizations from the previous 12-month period. We found that 4% (10% of those less than 5years) of people had respiratory disease resulting in a visit to a healthcare provider in the past 2weeks; these episodes were most commonly treated at government (33%) or private (44%) clinics. Forty-five people (0.4% of those surveyed) had respiratory hospitalizations in the past year, and just over half of these (24/45, 53%) occurred at a public hospital. Public health programs targeting respiratory disease in this region should account for care at private hospitals and clinics, as well as illnesses that are treated at home, in order to capture the true burden of illness in these communities. Published by Elsevier Ltd.

The hemodynamic tolerability and feasibility of sustained low efficiency dialysis in the management of critically ill patients with acute kidney injury

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Nisenbaum Rosane

2010-11-01

Full Text Available Abstract Background Minimization of hemodynamic instability during renal replacement therapy (RRT in patients with acute kidney injury (AKI is often challenging. We examined the relative hemodynamic tolerability of sustained low efficiency dialysis (SLED and continuous renal replacement therapy (CRRT in critically ill patients with AKI. We also compared the feasibility of SLED administration with that of CRRT and intermittent hemodialysis (IHD. Methods This cohort study encompassed four critical care units within a single university-affiliated medical centre. 77 consecutive critically ill patients with AKI who were treated with CRRT (n = 30, SLED (n = 13 or IHD (n = 34 and completed at least two RRT sessions were included in the study. Overall, 223 RRT sessions were analyzed. Hemodynamic instability during a given session was defined as the composite of a > 20% reduction in mean arterial pressure or any escalation in pressor requirements. Treatment feasibility was evaluated based on the fraction of the prescribed therapy time that was delivered. An interrupted session was designated if Results Hemodynamic instability occurred during 22 (56.4% SLED and 43 (50.0% CRRT sessions (p = 0.51. In a multivariable analysis that accounted for clustering of multiple sessions within the same patient, the odds ratio for hemodynamic instability with SLED was 1.20 (95% CI 0.58-2.47, as compared to CRRT. Session interruption occurred in 16 (16.3, 30 (34.9 and 11 (28.2 of IHD, CRRT and SLED therapies, respectively. Conclusions In critically ill patients with AKI, the administration of SLED is feasible and provides comparable hemodynamic control to CRRT.

Surveys of medical seeking preference, mental health literacy, and attitudes toward mental illness in Taiwan, 1990-2000.

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Wu, Chia-Yi; Liu, Shen-Ing; Chang, Shu-Sen; Sun, Fang-Ju

2014-01-01

Mental health promotion campaigns require a good understanding of public attitudes and mental health literacy. Few studies have investigated changes in these two aspects over time. We aimed to examine such changes and their associations with help-seeking preference in Taiwan. Data were extracted from the Taiwan Social Change Survey (1990, 1995, and 2000) based on national representative samples. Each wave of the surveys included four questions about attitudes toward severe mental illness, a case vignette describing depressive and anxiety symptoms to evaluate respondents' mental health literacy, and their preference of medical and/or informal help-seeking if they develop such symptoms. Mental and physical health statuses measured using the Chinese Health Questionnaire and self-reported chronic physical illnesses were included as covariates. There were 2531, 2075, and 1892 respondents in the three waves of the surveys, respectively. During the 1990 s, approximately one in four to five Taiwanese held some misconceptions toward mental illness. The attitudes toward mental illness were generally not associated with medical or informal help-seeking preference after statistical adjustment. However, respondents viewing symptoms in the vignette as physical or mental in origin were more willing to seek help than those who saw these symptoms as not being an illness. Attribution of depressive and anxiety symptoms appeared to be more likely to influence help-seeking behaviors than attitudes toward mental illness. Enhancing public mental health literacy toward depression may help facilitate help-seeking in response to potential mental illness. Copyright © 2013. Published by Elsevier B.V.

[Effects of critical ultrasonic management of Peking Union Medical College Hospital on the etiological diagnosis of patients with acute respiratory failure].

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Zhao, Hua; Wang, Xiaoting; Liu, Dawei; Zhang, Hongmin; He, Huaiwu; Long, Yun

2015-12-15

To evaluate the diagnostic value and potential therapeutic impact of Peking Union Medical College Hospital critical ultrasonic management (PCUM) in the early management of critically ill patients with acute respiratory failure (ARF). Patients admitted into the ICU of Peking Union Medical College Hospital for ARF were consecutively recruited over a 18-month period. Patients were randomly divided into conventional group and PCUM group (critical care ultrasonic examination was added in addition to conventional examinations). The two groups were compared with respect to time to preliminary diagnosis, time to final diagnosis, diagnostic accuracy, time to treatment response, time to other examination. A total of 187 patients were included in this study. The two groups showed no significant differences in general clinical information or final diagnosis (P > 0.05). The PCUM group had a shorter time to preliminary diagnosis, time to final diagnosis, time to treatment response, time to X-ray/CT examination, and a higher diagnostic accuracy than the conventional group (P < 0.001). PCUM had high sensitivity and specificity for the diagnosis of acute respiratory distress syndrome (ARDS) (sensitivity 92.0%, specificity 98.5%), acute pulmonary edema (sensitivity 94.7%, specificity 96.1%), pulmonary consolidation (sensitivity 85.7%, specificity 98.6%), COPD/asthma (sensitivity 84.2%, specificity 98.7%). The PCUM is seem to be an attractive complementary diagnostic tool and able to contribute to an early therapeutic decision for the patients with ARF.

Quality of life, treatment adherence, and locus of control: multiple family groups for chronic medical illnesses.

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López-Larrosa, Silvia

2013-12-01

The Multiple Family Groups (MFGs) approach for patients with a chronic medical illness and their families is a structured psychoeducational program that unfolds in six weekly 90-minute sessions. In the MFGs, patients and family members explore new ways to balance illness and nonillness priorities in family life (Steinglass, 1998; Steinglass, 2000 Cuadernos de Terapia Familiar, 44-45, 11; Steinglass, Ostroff, & Steinglass, 2011 Family Process, 50, 393). © FPI, Inc.

Acute versus primary care: the health care decision making process for individuals with severe mental illness.

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Decoux, Michelle

2005-11-01

This study's purpose was to determine factors influencing treatment choices of individuals with severe mental illness (SMI). The sample was drawn from admissions to residential crisis programs in San Francisco. Inclusion criteria were an Axis I and Axis III disorder. This qualitative study utilized grounded theory method. Interviews and field notes were coded for recurring themes. Descriptive data were also collected. Participants revealed that the most important influences on treatment decisions were immediate need for care, the belief that their subacute complaints will not be taken seriously by providers, positive reinforcement for emergency service use, and enabling factors such as insurance coverage. Other remarkable findings included: numerous reports of substance induced medical crises, lack of support from family, and unawareness of client's medical conditions in psychiatric facilities. Health care seeking behaviors are learned and learning that will promote the use of outpatient services in SMI must include positive experiences in the delivery of care in the primary care setting. Participants were knowledgeable regarding their illnesses and able to articulate symptoms of illness well. Failure to communicate symptoms appeared to reflect the participant's perception of a lack of response to their reports.

How are the Experiences and Needs of Families of Individuals with Mental Illness Reflected in Medical Education Guidelines?

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Riebschleger, Joanne; Scheid, Jeanette; Luz, Clare; Mickus, Maureen; Liszewski, Christine; Eaton, Monaca

2008-01-01

Objective: This descriptive study explored the extent that medical education curriculum guidelines contained content about the experiences and needs of family members of people with serious mental illness. Methods: Key family-focused-literature themes about the experiences and needs of families of individuals with mental illness were drawn from a…

[Nutritional support response in critically ill patients; differences between medical and surgical patients].

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Zamora Elson, M; Serón Arbeloa, C; Labarta Monzón, L; Garrido Ramírez de Arellano, I; Lander Azcona, A; Marquina Lacueva, M I; López Claver, J C; Escós Orta, J

2012-01-01

To assess the nutritional response of a group of critically ill patients, as well as the differences in the response to nutritional support between medical and surgical patients. One-year long retrospective study including critically ill patients on artificial nutrition for 7 days. Throughout the first week, three nutritional biochemical controls were done that included albumin, prealbumin, transferrin, cholesterol, and electrolytes. Other data gathered were: nutritional risk index, age, gender, weight, height, APACHE, delay of onset of nutritional support, access route, predicted and real caloric intake, medical or surgical patient, hospital stay, duration of the central venous catheter, urinary tube, and/or mechanical ventilation, incidence and density of incidence of nosocomial infections. Sixty-three patients were studied, 30 (47%) medical and 33 (53%) surgical/trauma patients, with a usage of EN higher among medical patients (16/30, 53% vs. 5/33, 15%), PN higher among surgical patients (25/33, 76%), and mixed nutrition similar in both groups (5 medical and 3 surgical patients) (p = 0.001). There were no differences between medical and surgical patients regarding: both predicted and real caloric and nitrogenous intake, APACHE, delay of onset of nutrition, phosphorus, magnesium or glucose levels, mortality and incidence of nosocomial infections. There were no differences either in hospital stay or use of mechanical ventilation, although these tended to be lower in surgical patients. The baseline biochemical parameters did not show differences between both groups, although they were worse among surgical patients. These patients presented during the study period steady albumin levels with improvement in the remaining parameters, whereas medical patients showed a decrease in albumin and transferrin levels, steady prealbumin levels, and slightly improvement in cholesterol levels. We have observed higher usage of PN among surgical patients, which showed worse

Medical management of patients overexposed to irradiation in acute and subacute accidents

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Genyao, Ye; Guilin, Wang; Shimin, Huang; Xiyuan, Cheng; Bingzhi, Mao; Yingqi, Li [North Taiping Road Hospital, Beijing, BJ (China)

1991-11-01

The authors summarize the experiences in the medical management of 7 radiation accidents resulting in 5 cases of acute radiation sickness, 3 cases of subacute radiation sickness and 8 cases of overexposed persons with estimated physical doses below 1 Gy in the past 5 years. The therapeutic measures including the application of antiradiation drugs such as estriol and herbal medicine '208', measures to improve the microcirculation and transfusion of fetal liver cells, etc., were emphasized in the treatment of acute radiation sickness. For subacute radiation sickness, large doses of stanozolum (18 mg/d) in combination with 654-2 (60 mg/d) were administered as the principal therapeutic agents. The advances in the medical management of acute accidentally overexposed cases in China are briefly reviewed and discussed.

Enterovirus genotypes among patients with severe acute respiratory illness, influenza-like illness, and asymptomatic individuals in South Africa, 2012–2014

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Hellferscee, Orienka; Tempia, Stefano; Walaza, Sibongile; Variava, Ebrahim; Dawood, Halima; Wolter, Nicole; Madhi, Shabir A.; du Plessis, Mignon; Cohen, Cheryl; Treurnicht, Florette K.

2017-01-01

Enteroviruses can cause outbreaks of severe acute respiratory illness (SARI) and EV-A, -B, -C, and -D species have different pathogenic profiles and circulation patterns. We aimed to characterize and determine the prevalence of enterovirus genotypes among South African patients with respiratory illness and controls during June 2012 to July 2014. Syndromic SARI and influenza-like illness (ILI) surveillance was performed at two sentinel sites. At each site nasopharyngeal/oropharyngeal specimens were collected from SARI and ILI patients as well as controls. Specimens were tested for enterovirus by real-time PCR. Positive specimenswere further genotyped by sequencing a region of theVP1 gene. The prevalence of enterovirus was 5.8% (87/1494), 3.4% (103/3079), and 3.4% (46/1367) among SARI, ILI, and controls, respectively (SARI/controls, P=0.002 and ILI/control, P = 0.973). Among the 101/236 (42.8%) enterovirus-positive specimens that could be genotyped, we observed a high diversity of circulating enterovirus genotypes (a total of 33 genotypes) from all four human enterovirus species with high prevalence of Enterovirus-B (60.4%; 61/101) and Enterovirus-A (21.8%; 22/101) compared to Enterovirus-C (10.9%; 11/101) and Enterovirus-D (6.9%; 7/101) (P = 0.477). Of the enterovirus genotypes identified, Echovirus 30 (9.9%, 10/101), Coxsackie virus B5 (7.9%, 8/101) and Enterovirus-D68 (6.9%, 7/101) were most prevalent. There was no difference in disease severity (SARI or ILI compared to controls) between the different enterovirus species (P = 0.167).We observed a high number of enterovirus genotypes in patients with respiratory illness and in controls from South Africa with no disease association of EV species with disease severity. PMID:28574589

More concerns and stronger beliefs about the necessity of medication in patients with acromegaly are associated with negative illness perceptions and impairment in quality of life.

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Andela, Cornelie D; Biermasz, Nienke R; Kaptein, Adrian A; Pereira, Alberto M; Tiemensma, Jitske

2015-10-01

Patients with acromegaly can be treated with surgery, radiotherapy and/or medical treatment. In general, patients' beliefs about medication are associated with illness perceptions, a contributory factor of Quality of Life (QoL). At present, there are no quantitative studies on medication beliefs in patients with acromegaly. Here, we aimed to examine possible associations between medication beliefs, illness perceptions, and QoL. Furthermore we aimed to explore whether illness perceptions of patients with remission of acromegaly receiving medical treatment differ from patients without medical treatment. Cross-sectional evaluation of 73 patients with remission of acromegaly (n = 28 patients with medication, n = 45 without medication). The Beliefs about Medicines Questionnaire (BMQ), Illness Perception Questionnaire-Revised (IPQ-R), EuroQoL-5D, and AcroQoL were used for the assessment. Stronger beliefs about the necessity of medical treatment and stronger concerns about the adverse effects were associated with attributing more symptoms to acromegaly, perceiving more negative consequences, and having a stronger belief in a cyclical timeline (BMQ, all P Negative medication beliefs were related to more negative illness perceptions and worse disease-specific QoL. Patients receiving medical treatment for acromegaly tend to perceive a more chronic timeline of their disease, compared to patients with remission without medical treatment. These psychological factors need to be taken into account when treating patients and developing a psychosocial education program aiming to improve QoL. Copyright © 2015 Elsevier Ltd. All rights reserved.

Rhabdomyolysis in Critically Ill Surgical Patients.

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Kuzmanovska, Biljana; Cvetkovska, Emilija; Kuzmanovski, Igor; Jankulovski, Nikola; Shosholcheva, Mirjana; Kartalov, Andrijan; Spirovska, Tatjana

2016-07-27

Rhabdomyolysis is a syndrome of injury of skeletal muscles associated with myoglobinuria, muscle weakness, electrolyte imbalance and often, acute kidney injury as severe complication. of this study is to detect the incidence of rhabdomyolysis in critically ill patients in the surgical intensive care unit (ICU), and to raise awareness of this medical condition and its treatment among the clinicians. A retrospective review of all surgical and trauma patients admitted to surgical ICU of the University Surgical Clinic "Mother Teresa" in Skopje, Macedonia, from January 1 st till December 31 st 2015 was performed. Patients medical records were screened for available serum creatine kinase (CK) with levels > 200 U/l, presence of myoglobin in the serum in levels > 80 ng/ml, or if they had a clinical diagnosis of rhabdomyolysis by an attending doctor. Descriptive statistical methods were used to analyze the collected data. Out of totally 1084 patients hospitalized in the ICU, 93 were diagnosed with rhabdomyolysis during the course of one year. 82(88%) patients were trauma patients, while 11(12%) were surgical non trauma patients. 7(7.5%) patients diagnosed with rhabdomyolysis developed acute kidney injury (AKI) that required dialysis. Average values of serum myoglobin levels were 230 ng/ml, with highest values of > 5000 ng/ml. Patients who developed AKI had serum myoglobin levels above 2000 ng/ml. Average values of serum CK levels were 400 U/l, with highest value of 21600 U/l. Patients who developed AKI had serum CK levels above 3000 U/l. Regular monitoring and early detection of elevated serum CK and myoglobin levels in critically ill surgical and trauma patients is recommended in order to recognize and treat rhabdomyolysis in timely manner and thus prevent development of AKI.

Acute care in Tanzania: Epidemiology of acute care in a small community medical centre

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Rachel M. Little

2013-12-01

Discussion: Respiratory infections, malaria, and skin or soft tissue infections are leading reasons for seeking medical care at a small community medical centre in Arusha, Tanzania, highlighting the burden of infectious diseases in this type of facility. Males may be more likely to present with trauma, burns, and laceration injuries than females. Many patients required one or no procedures to determine their diagnosis, most treatments administered were inexpensive, and most patients were discharged home, suggesting that providing acute care in this setting could be accomplished with limited resources.

Medication use in pregnancy: a cross-sectional, multinational web-based study.

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Lupattelli, A; Spigset, O; Twigg, M J; Zagorodnikova, K; Mårdby, A C; Moretti, M E; Drozd, M; Panchaud, A; Hämeen-Anttila, K; Rieutord, A; Gjergja Juraski, R; Odalovic, M; Kennedy, D; Rudolf, G; Juch, H; Passier, A; Björnsdóttir, I; Nordeng, H

2014-02-17

Intercountry comparability between studies on medication use in pregnancy is difficult due to dissimilarities in study design and methodology. This study aimed to examine patterns and factors associated with medications use in pregnancy from a multinational perspective, with emphasis on type of medication utilised and indication for use. Cross-sectional, web-based study performed within the period from 1 October 2011 to 29 February 2012. Uniform collection of drug utilisation data was performed via an anonymous online questionnaire. Multinational study in Europe (Western, Northern and Eastern), North and South America and Australia. Pregnant women and new mothers with children less than 1 year of age. Prevalence of and factors associated with medication use for acute/short-term illnesses, chronic/long-term disorders and over-the-counter (OTC) medication use. The study population included 9459 women, of which 81.2% reported use of at least one medication (prescribed or OTC) during pregnancy. Overall, OTC medication use occurred in 66.9% of the pregnancies, whereas 68.4% and 17% of women reported use of at least one medication for treatment of acute/short-term illnesses and chronic/long-term disorders, respectively. The extent of self-reported medicated illnesses and types of medication used by indication varied across regions, especially in relation to urinary tract infections, depression or OTC nasal sprays. Women with higher age or lower educational level, housewives or women with an unplanned pregnancy were those most often reporting use of medication for chronic/long-term disorders. Immigrant women in Western (adjusted OR (aOR): 0.55, 95% CI 0.34 to 0.87) and Northern Europe (aOR: 0.50, 95% CI 0.31 to 0.83) were less likely to report use of medication for chronic/long-term disorders during pregnancy than non-immigrants. In this study, the majority of women in Europe, North America, South America and Australia used at least one medication during pregnancy. There

Cholecystectomy vs. percutaneous cholecystostomy for the management of critically ill patients with acute cholecystitis: a protocol for a systematic review.

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Ambe, Peter C; Kaptanis, Sarantos; Papadakis, Marios; Weber, Sebastian A; Zirngibl, Hubert

2015-05-30

Acute cholecystitis is a common diagnosis. However, the heterogeneity of presentation makes it difficult to standardize management. Although surgery is the mainstay of treatment, critically ill patients have been managed via percutaneous cholecystostomy. However, the role of percutaneous cholecystostomy in the management of such patients has not been clearly established. This systematic review will compare the outcomes of critically ill patients with acute cholecystitis managed with percutaneous cholecystostomy to those of similar patients managed with cholecystectomy. Systematic searches will be conducted across relevant health databases including the Cochrane Library, Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE, Embase, and Scopus using the following keywords: (acute cholecystitis OR severe cholecystitis OR cholecystitis) AND (cholecystectomy OR laparoscopic cholecystectomy OR open cholecystectomy) AND (Cholecystostomy OR percutaneous cholecystectomy OR gallbladder drain OR gallbladder tube OR transhepatic gallbladder drain OR transhepatic gallbladder tube OR cholecystostomy tube). The reference lists of eligible articles will be hand searched. Articles from 2000-2014 will be identified using the key terms "acute cholecystitis, cholecystectomy, and percutaneous cholecystostomy". Studies including both interventions will be included. Relevant data will be extracted from eligible studies using a specially designed data extraction sheet. The Newcastle-Ottawa scale will be used to assess the quality of non-randomized studies. Central tendencies will be reported in terms of means and standard deviations where necessary, and risk ratios will be calculated where possible. All calculations will be performed with a 95 % confidence interval. Furthermore, the Fisher's exact test will be used for the calculation of significance, which will be set at p < 0.05. Pooled estimates will be presented after consideration of both clinical and

Frequency of co-existence of dengue and malaria in patients presenting with acute febrile illness

International Nuclear Information System (INIS)

Hisam, A.; Rahman, M.; Kadir, E.; Ezam, N.; Khan, M.B.

2014-01-01

To find out the frequency of co-existence of malaria and dengue fever in patients presenting with acute febrile illness. Methods: The descriptive cross-sectional study was conducted at the Military Hospital Rawalpindi from June to November 2012. A total of 500 patients with complaint of acute febrile illness were selected after applying the inclusion and exclusion criteria. Preliminary data was collected on a pretested proforma. Blood samples of patients were tested for dengue serology and malaria parasite. Results were entered in respective proforma. Co-existence was considered present when a patient had both dengue serology and malaria parasite slide positive. SPSS 20 was used for data analysis. Result: Of the total, 349 (69.8%) were males and 151 (30.2%) females. Dengue serology was positive in 16 (3.2%); 81(16.2%) had malaria parasite slide positive; 403 (80.4%) had none of the two findings. Co-existence of both dengue and malaria was nil among the whole sample. In males, 67 (13.4%) had malaria, while 11 (2.2%) had dengue. In females, 14 (2.8%) had malaria, while 5 (1%) suffered from dengue fever. Conclusion: Co-existence of dengue and malaria was zero per cent in 500 patients visiting Military Hospital Rawalpindi. More studies shall be conducted to find out whether the reason of having zero per cent co-existence is that dengue or/and malaria epidemic did not occur in 2012 or whether there are some other factors involved. (author)

Prognostic criteria in acute pancreatitis: importance of assessment of pancreatic necrosis by contrast-enhanced CT

International Nuclear Information System (INIS)

Echevarria, F.; Martinez, B.; Lopez, F.; Vuelta, R.V.

1997-01-01

To compare the value of the clinical criteria of Ranson, the classical tomographic criteria of Balthzar and the severity of illness index according to CT in predicting the development of complications of acute pancreatitis. A retrospective study was performed in 100 patients with clinical and analytical evidence of acute pancreatitis. All patients were assessed according to Ranson score at admission and 48 hours later, and contrast-enhanced abdominal CT was carried out. The tomographic images were analyzed on the basis of the classical criteria of Balthazar and the new CT severity of illness index, which includes the assessment of pancreatic necrosis, identified as the areas of the pancreas that are not enhanced by the administration of the contrast material. These three criteria were then correlated with onset of medical and surgical implications. Our findings show that, of the three criteria analyzed, the CT severity of illness index presents the greatest specificity, sensitivity and positive and negative predictive values in the prediction of complications of acute pancreatitis. We conclude that the inclusion of pancreatic necrosis in the tomographic study improves the early assessment of the prognosis of acute pancreatitis. (Author) 20 refs

Constipation--prevalence and incidence among medical patients acutely admitted to hospital with a medical condition.

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Noiesen, Eline; Trosborg, Ingelise; Bager, Louise; Herning, Margrethe; Lyngby, Christel; Konradsen, Hanne

2014-08-01

To examine the prevalence and incidence of patient-reported symptoms of constipation in acutely hospitalised medical patients. Constipation is a common medical problem with severe consequences, and most people suffer from constipation at some point in their lives. In the general population, constipation is one of the most common complaints and is a significant personal and public health burden. Alteration in patients' patterns of elimination while in hospital has long been identified as either a potential or an actual problem that requires attention. Knowledge of the prevalence and incidence of constipation during hospitalisation is only sporadic. The study was descriptive and a prospective cohort design was chosen. The Constipation Assessment Scale was translated into Danish and was used for the assessment of patient-reported bowel function. Five nurses made the assessments at admission to the acute medical ward and three days after admission. Three hundred and seventy-three patients participated in this study. Thirty-nine percent of the patients showed symptoms of constipation at admission. Of the patients who did not have the symptoms at admission, 43% developed the symptoms during the first three days of their stay in hospital. Significantly more of the older patients developed symptoms of moderate constipation. The incidence rate was 143 new cases per 1000 patient days. In this study, symptoms of constipation were common among patients acutely admitted to hospital due to different medical conditions. Symptoms of constipation were also developed during the first three days of the stay in hospital. The study highlights the need to develop both clinical guidelines towards treating constipation, and preventive measures to ensure that patients do not become constipated while staying in hospital. © 2013 John Wiley & Sons Ltd.

Inclusion of persons with mental illness in patient-centred medical homes: cross-sectional findings from Ontario, Canada.

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Steele, Leah S; Durbin, Anna; Sibley, Lyn M; Glazier, Richard

2013-01-01

In Ontario, Canada, the patient-centred medical home is a model of primary care delivery that includes 3 model types of interest for this study: enhanced fee-for-service, blended capitation, and team-based blended capitation. All 3 models involve rostering of patients and have similar practice requirements but differ in method of physician reimbursement, with the blended capitation models incorporating adjustments for age and sex, but not case mix, of rostered patients. We evaluated the extent to which persons with mental illness were included in physicians' total practices (as rostered and non-rostered patients) and were included on physicians' rosters across types of medical homes in Ontario. Using population-based administrative data, we considered 3 groups of patients: those with psychotic or bipolar diagnoses, those with other mental health diagnoses, and those with no mental health diagnoses. We modelled the prevalence of mental health diagnoses and the proportion of patients with such diagnoses who were rostered across the 3 medical home model types, controlling for demographic characteristics and case mix. Compared with enhanced fee-for-service practices, and relative to patients without mental illness, the proportions of patients with psychosis or bipolar disorders were not different in blended capitation and team-based blended capitation practices (rate ratio [RR] 0.91, 95% confidence interval [CI] 0.82-1.01; RR 1.06, 95% CI 0.96-1.17, respectively). However, there were fewer patients with other mental illnesses (RR 0.94, 95% CI 0.90-0.99; RR 0.89, 95% CI 0.85-0.94, respectively). Compared with expected proportions, practices based on both capitation models were significantly less likely than enhanced fee-for-service practices to roster patients with psychosis or bipolar disorders (for blended capitation, RR 0.92, 95% CI 0.90-0.93; for team-based capitation, RR 0.92, 95% CI 0.88-0.93) and also patients with other mental illnesses (for blended capitation

Issues concerning the on-going care of patients with comorbidities in acute care and post-discharge in Australia: a literature review.

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Williams, Allison; Botti, Mari

2002-10-01

Advances in medical science and improved lifestyles have reduced mortality rates in Australia and most western countries. This has resulted in an ageing population with a concomitant growth in the number of people who are living with chronic illnesses. Indeed a significant number of younger people experience more than one chronic illness. Large numbers of these may require repeated admissions to hospital for acute or episodic care that is superimposed upon the needs of their chronic conditions. To explore the issues that circumscribe the complexities of caring for people with concurrent chronic illnesses, or comorbidities, in the acute care setting and postdischarge. A literature review to examine the issues that impact upon the provision of comprehensive care to patients with comorbidities in the acute care setting and postdischarge. Few studies have investigated this subject. From an Australian perspective, it is evident that the structure of the current health care environment has made it difficult to meet the needs of patients with comorbidities in the acute care setting and postdischarge. This is of major concern for nurses attempting to provide comprehensive care to an increasingly prevalent group of chronically ill people. Further research is necessary to explore how episodic care is integrated into the on-going management of patients with comorbidities and how nurse clinicians can better use an episode of acute illness as an opportunity to review their overall management.

Refusal of medical treatment in the pediatric emergency service: analysis of reasons and aspects.

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Gündüz, Ramiz Coşkun; Halil, Halit; Gürsoy, Cüneyt; Çifci, Atilla; Özgün, Seher; Kodaman, Tuğba; Sönmez, Mehtap

2014-01-01

Refusal of treatment for acutely ill children is still an important problem in the emergency service. When families refuse medical treatment for their acutely ill children, healthcare professionals may attempt to provide information and negotiate with the family concerning treatment refusal and its possible adverse outcomes, and request consent for refusal of medical treatment. There is insufficient data about refusal of treatment in our country. The purpose of this study was to analyze the causes of treatment refusal in the pediatric emergency service. We collected data recorded on informed consent forms. During a 2-year-study period, 215 patients refused treatment recommended by acute health care professionals. The majorty of patients were in the 0-2 year age group. Hospitalization was the type of treatment most commonly refused; restrictions regarding family members staying with their children during hospitalization and admission to another hospital were the major reasons for refusal of treatment. Clarifying the reasons for treatment refusal may help us to overcome deficiencies, improve conditions, resolve problems and build confidence between healthcare providers and service users, increasing users' satisfaction in the future.

[Establishment of comprehensive prediction model of acute gastrointestinal injury classification of critically ill patients].

Science.gov (United States)

Wang, Yan; Wang, Jianrong; Liu, Weiwei; Zhang, Guangliang

2018-03-25

To develop the comprehensive prediction model of acute gastrointestinal injury (AGI) grades of critically ill patients. From April 2015 to November 2015, the binary channel gastrointestinal sounds (GIS) monitor system which has been developed and verified by the research group was used to gather and analyze the GIS of 60 consecutive critically ill patients who were admitted in Critical Care Medicine of Chinese PLA General Hospital. Also, the AGI grades (Grande I(-IIII(, the higher the level, the heavier the gastrointestinal dysfunction) were evaluated. Meanwhile, the clinical data and physiological and biochemical indexes of included patients were collected and recorded daily, including illness severity score (APACHE II( score, consisting of the acute physiology score, age grade and chronic health evaluation), sequential organ failure assessment (SOFA score, including respiration, coagulation, liver, cardioascular, central nervous system and kidney) and Glasgow coma scale (GCS); body mass index, blood lactate and glucose, and treatment details (including mechanical ventilation, sedatives, vasoactive drugs, enteral nutrition, etc.) Then principal component analysis was performed on the significantly correlated GIS (five indexes of gastrointestinal sounds were found to be negatively correlated with AGI grades, which included the number, percentage of time, mean power, maximum power and maximum time of GIS wave from the channel located at the stomach) and clinical factors after standardization. The top 5 post-normalized main components were selected for back-propagation (BP) neural network training, to establish comprehensive AGI grades models of critically ill patients based on the neural network model. The 60 patients aged 19 to 98 (mean 54.6) years and included 42 males (70.0%). There were 22 cases of multiple fractures, 15 cases of severe infection, 7 cases of cervical vertebral fracture, 7 cases of aortic repair, 5 cases of post-toxicosis and 4 cases of cerebral

[Management of chemical burns and inhalation poisonings in acute medical care procedures of the State Fire Service].

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Chomoncik, Mariusz; Nitecki, Jacek; Ogonowska, Dorota; Cisoń-Apanasewicz, Urszula; Potok, Halina

2013-01-01

Emergency Medical Services (EMS) were founded by the government to perform tasks aimed at providing people with help in life-threatening conditions. The system comprises two constituent parts. The first one is public administrative bodies which are to organise, plan, coordinate and supervise the completion of the tasks. The other constituent is EMS units which keep people, resources and units in readiness. Supportive services, which include: the State Fire Service (SFS) and the National Firefighting and Rescue System (NFRS), are of great importance for EMS because they are eligible for providing acute medical care (professional first aid). Acute medical care covers actions performed by rescue workers to help people in life-threatening conditions. Rescue workers provide acute medical care in situations when EMS are not present on the spot and the injured party can be accessed only with the use of professional equipment by trained workers of NFRS. Whenever necessary, workers of supportive services can assist paramedics' actions. Cooperation of all units of EMS and NFRS is very important for rescue operations in the integrated rescue system. Time is a key aspect in delivering first aid to a person in life-threatening conditions. Fast and efficient first aid given by the accident's witness, as well as acute medical care performed by a rescue worker can prevent death and minimise negative effects of an injury or intoxication. It is essential that people delivering first aid and acute medical care should act according to acknowledged and standardised procedures because only in this way can the process of decision making be sped up and consequently, the number of possible complications following accidents decreased. The present paper presents an analysis of legal regulations concerning the management of chemical burn and inhalant intoxication in acute medical care procedures of the State Fire Service. It was observed that the procedures for rescue workers entitled to

Sarcopenia and malnutrition in acutely ill hospitalized elderly: Prevalence and outcomes.

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Cerri, Anna Paola; Bellelli, Giuseppe; Mazzone, Andrea; Pittella, Francesca; Landi, Francesco; Zambon, Antonella; Annoni, Giorgio

2015-08-01

Data about the prevalence of sarcopenia among hospitalized patients is lacking and it is unclear whether the diagnostic criteria commonly used in community-dwellers is applicable in acutely ill subjects. The aims of this report are: (i) to assess the prevalence of sarcopenia among hospitalized patients; (ii) to assess whether the European Working Group on Sarcopenia in Older People (EWGSOP) criteria are applicable in an acute care setting; and (iii) to assess the mortality rate at 3 months. 103 patients admitted to the Acute Geriatric Clinic were enrolled. Inclusion criteria were: age ≥65 years and malnutrition or risk of malnutrition, according to the Mini Nutritional Assessment Short Form. Sarcopenia was diagnosed using the EWGSOP criteria by means of bioimpedance analysis, handgrip strength and gait speed, within 72 h of admission. Information on deaths was obtained by telephone interview at 3 months following discharge. Sarcopenia was diagnosed in 22 patients (21.4%). Twenty-three patients (22.3%) were not able to perform the gait speed and/or the handgrip strength because bedridden or requiring intensive treatments. In this group, a definite diagnosis of sarcopenia was not possible, lacking at least one EWGSOP criteria. Eleven (10.7%) patients died within the 3 months post-discharge period. Kaplan-Meier survival curves showed that sarcopenic patients died significantly more frequently than others (log-rank p ≤ 0.001). In a population of hospitalized elderly malnourished or at risk of malnutrition, sarcopenia is highly prevalent and associated with an increased risk to die in the short-term. Furthermore, the EWGSOP criteria cannot be satisfactorily applied in a relevant proportion of patients. Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Association between illness severity and timing of initial enteral feeding in critically ill patients: a retrospective observational study

Directory of Open Access Journals (Sweden)

Huang Hsiu-Hua

2012-05-01

Full Text Available Abstract Background Early enteral nutrition is recommended in cases of critical illness. It is unclear whether this recommendation is of most benefit to extremely ill patients. We aim to determine the association between illness severity and commencement of enteral feeding. Methods One hundred and eight critically ill patients were grouped as “less severe” and “more severe” for this cross-sectional, retrospective observational study. The cut off value was based on Acute Physiology and Chronic Health Evaluation II score 20. Patients who received enteral feeding within 48 h of medical intensive care unit (ICU admission were considered early feeding cases otherwise they were assessed as late feeding cases. Feeding complications (gastric retention/vomiting/diarrhea/gastrointestinal bleeding, length of ICU stay, length of hospital stay, ventilator-associated pneumonia, hospital mortality, nutritional intake, serum albumin, serum prealbumin, nitrogen balance (NB, and 24-h urinary urea nitrogen data were collected over 21 days. Results There were no differences in measured outcomes between early and late feedings for less severely ill patients. Among more severely ill patients, however, the early feeding group showed improved serum albumin (p = 0.036 and prealbumin (p = 0.014 but worsened NB (p = 0.01, more feeding complications (p = 0.005, and prolonged ICU stays (p = 0.005 compared to their late feeding counterparts. Conclusions There is a significant association between severity of illness and timing of enteral feeding initiation. In more severe illness, early feeding was associated with improved nutritional outcomes, while late feeding was associated with reduced feeding complications and length of ICU stay. However, the feeding complications of more severely ill early feeders can be handled without significantly affecting nutritional intake and there is no eventual difference in length of hospital stay or mortality

Peer-Led Self-Management of General Medical Conditions for Patients With Serious Mental Illnesses: A Randomized Trial.

Science.gov (United States)

Druss, Benjamin G; Singh, Manasvini; von Esenwein, Silke A; Glick, Gretl E; Tapscott, Stephanie; Tucker, Sherry Jenkins; Lally, Cathy A; Sterling, Evelina W

2018-02-01

Individuals with serious mental illnesses have high rates of general medical comorbidity and challenges in managing these conditions. A growing workforce of certified peer specialists is available to help these individuals more effectively manage their health and health care. However, few studies have examined the effectiveness of peer-led programs for self-management of general medical conditions for this population. This randomized study enrolled 400 participants with a serious mental illness and one or more chronic general medical conditions across three community mental health clinics. Participants were randomly assigned to the Health and Recovery Peer (HARP) program, a self-management program for general medical conditions led by certified peer specialists (N=198), or to usual care (N=202). Assessments were conducted at baseline and three and six months. At six months, participants in the intervention group demonstrated a significant differential improvement in the primary study outcome, health-related quality of life. Specifically, compared with the usual care group, intervention participants had greater improvement in the Short-Form Health Survey physical component summary (an increase of 2.7 versus 1.4 points, p=.046) and mental component summary (4.6 versus 2.5 points, p=.039). Significantly greater six-month improvements in mental health recovery were seen for the intervention group (p=.02), but no other between-group differences in secondary outcome measures were significant. The HARP program was associated with improved physical health- and mental health-related quality of life among individuals with serious mental illness and comorbid general medical conditions, suggesting the potential benefits of more widespread dissemination of peer-led disease self-management in this population.

Ventilation with lower tidal volumes for critically ill patients without the acute respiratory distress syndrome: a systematic translational review and meta-analysis

NARCIS (Netherlands)

Serpa Neto, Ary; Nagtzaam, Liselotte; Schultz, Marcus J.

2014-01-01

There is convincing evidence for benefit from lung-protective mechanical ventilation with lower tidal volumes in patients with the acute respiratory distress syndrome (ARDS). It is uncertain whether this strategy benefits critically ill patients without ARDS as well. This manuscript systematically

Validating a decision tree for serious infection: diagnostic accuracy in acutely ill children in ambulatory care.

Science.gov (United States)

Verbakel, Jan Y; Lemiengre, Marieke B; De Burghgraeve, Tine; De Sutter, An; Aertgeerts, Bert; Bullens, Dominique M A; Shinkins, Bethany; Van den Bruel, Ann; Buntinx, Frank

2015-08-07

Acute infection is the most common presentation of children in primary care with only few having a serious infection (eg, sepsis, meningitis, pneumonia). To avoid complications or death, early recognition and adequate referral are essential. Clinical prediction rules have the potential to improve diagnostic decision-making for rare but serious conditions. In this study, we aimed to validate a recently developed decision tree in a new but similar population. Diagnostic accuracy study validating a clinical prediction rule. Acutely ill children presenting to ambulatory care in Flanders, Belgium, consisting of general practice and paediatric assessment in outpatient clinics or the emergency department. Physicians were asked to score the decision tree in every child. The outcome of interest was hospital admission for at least 24 h with a serious infection within 5 days after initial presentation. We report the diagnostic accuracy of the decision tree in sensitivity, specificity, likelihood ratios and predictive values. In total, 8962 acute illness episodes were included, of which 283 lead to admission to hospital with a serious infection. Sensitivity of the decision tree was 100% (95% CI 71.5% to 100%) at a specificity of 83.6% (95% CI 82.3% to 84.9%) in the general practitioner setting with 17% of children testing positive. In the paediatric outpatient and emergency department setting, sensitivities were below 92%, with specificities below 44.8%. In an independent validation cohort, this clinical prediction rule has shown to be extremely sensitive to identify children at risk of hospital admission for a serious infection in general practice, making it suitable for ruling out. NCT02024282. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Parasitic Diseases and Psychiatric Illness

OpenAIRE

Weiss, Mitchell Gralnick

1994-01-01

Distinguishing parasitic diseases from other infections and tropical medical disorders based on microbiological classification is a matter of convenience. Organic brain syndromes are associated with both protozoan and helminthic infections; side-effects of drugs commonly used to treat parasitoses may impair mood and cause anxiety, agitation or psychosis. Emotional states may in turn affect the experience of medical illness. Psychiatrically significant features of medical illness are determine...

Educating medical students about the personal meaning of terminal illness using the film, "Wit".

Science.gov (United States)

Ozcakir, Alis; Bilgel, Nazan

2014-08-01

Addressing the emotional needs of dying patients is rarely found to have a place in formal medical curriculum and is also a difficult area to teach through classical medical lectures. "Cinemeducation" is a wonderful way to educate health care providers about the magnitude of emotions that arise during those difficult situations. The aims of this study were to test the relevance and usefulness of the movie 'Wit' in teaching medical students about the personal meaning of terminal illness and to assess the impact of this teaching method on students' attitudes toward palliative care. This was an education study using qualitative and quantitative data analysis of 518 first-year medical students in a single medical faculty in Turkey. Students watched the entire film, filled out an evaluation questionnaire, and answered questions about the film. Students also expressed their own feelings and thoughts about palliative care. Overall, 88% rated the film as excellent, very good, or good. According to 54% of the students, the emotions of terminally ill patients were fully portrayed in the film and in a very realistic way. Approximately 61.4% of the students found this film emotional. Most students (80.5%) stated that this film made them think about the emotional and spiritual suffering that dying patients go through and found this learning approach about palliative care more useful than didactic lectures and journal article readings but not more useful than bedside rounds. It was thought that caring for dying patients would be very or fairly personally satisfying for 65.3% of the students. The film 'Wit' gave the students an opportunity to explore their beliefs, values and attitudes in terms of the bio-psycho-social-spiritual aspects of health care and encouraged them to think more about the humanitarian issues of the medical profession.

A method of teaching critical care skills to undergraduate student midwives using the Maternal-Acute Illness Management (M-AIM) training day.

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McCarthy, Rose; Nuttall, Janet; Smith, Joyce; Hollins Martin, Caroline J

2014-11-01

The most recent Confidential Enquiry into Maternal Deaths (CMACE, 2011) identified human errors, specifically those of midwives and obstetricians/doctors as a fundamental component in contributing to maternal death in the U.K. This paper discusses these findings and outlines a project to provide training in Maternal-Acute Illness Management (M-AIM) to final year student midwives. Contents of the program are designed to educate and simulate AIM skills and increase confidence and clinical ability in early recognition, management and referral of the acutely ill woman. An outline of the Maternal-AIM program delivered at the University of Salford (Greater Manchester, UK) is presented to illustrate how this particular institution has responded to a perceived need voiced by local midwifery leaders. It is proposed that developing this area of expertise in the education system will better prepare student midwives for contemporary midwifery practice. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Dementia and serious coexisting medical conditions: a double whammy.

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Maslow, Katie

2004-09-01

Research-based information about the prevalence of other serious medical conditions in people with dementia has become available only recently, and the true prevalence is not known, primarily because many people with dementia do not have a diagnosis. The existing information is sufficient, however, to show that these other conditions are common in people with dementia. It is also clear that coexisting medical conditions increase the use and cost of health care services for people with dementia, and conversely, dementia increases the use and cost of health care services for people with other serious medical conditions. Nurses and other healthcare professionals should expect to see these relationships in their elderly patients. They should know how to recognize possible dementia and assess, or obtain an assessment of, the patient's cognitive status. They should expect the worsening of cognitive and related symptoms in acutely ill people with dementia and try to eliminate factors that cause this worsening, to the extent possible, while assuring the family that the symptoms are likely to improve once the acute phase of illness or treatment is over. Families, nurses, and other health care professionals are challenged by the complex issues involved in caring for a person with both dementia and other serious medical conditions. Greater attention to these issues by informed and thoughtful clinicians will improve outcomes for the people and their family and professional caregivers.

Influenza and other respiratory virus infections in outpatients with medically attended acute respiratory infection during the 2011-12 influenza season.

Science.gov (United States)

Zimmerman, Richard K; Rinaldo, Charles R; Nowalk, Mary Patricia; Gk, Balasubramani; Thompson, Mark G; Moehling, Krissy K; Bullotta, Arlene; Wisniewski, Stephen

2014-07-01

Respiratory tract infections are a major cause of outpatient visits, yet only a portion is tested to determine the etiologic organism. Multiplex reverse transcriptase polymerase chain reaction (MRT-PCR) assays for detection of multiple viruses are being used increasingly in clinical settings. During January-April 2012, outpatients with acute respiratory illness (≤ 7 days) were tested for influenza using singleplex RT-PCR (SRT-PCR). A subset was assayed for 18 viruses using MRT-PCR to compare detection of influenza and examine the distribution of viruses and characteristics of patients using multinomial logistic regression. Among 662 participants (6 months-82 years), detection of influenza was similar between the MRT-PCR and SRT-PCR (κ = 0.83). No virus was identified in 267 (40.3%) samples. Commonly detected viruses were human rhinovirus (HRV, 15.4%), coronavirus (CoV, 10.4%), respiratory syncytial virus (RSV, 8.4%), human metapneumovirus (hMPV, 8.3%), and influenza (6%). Co-detections were infrequent (6.9%) and most commonly occurred among those infections (P = 0.008), nasal congestion was more frequent in CoV, HRV, hMPV, influenza and RSV infections (P = 0.001), and body mass index was higher among those with influenza (P = 0.036). Using MRT-PCR, a viral etiology was found in three-fifths of patients with medically attended outpatient visits for acute respiratory illness during the influenza season; co-detected viruses were infrequent. Symptoms varied by viral etiology. © 2014 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

A mixed methods exploration of family involvement in medical care for older adults with serious mental illness.

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Aschbrenner, Kelly A; Pepin, Renee; Mueser, Kim T; Naslund, John A; Rolin, Stephanie A; Faber, Marjan J; Bartels, Stephen J

2014-01-01

Many older persons with serious mental illness (SMI) suffer from high rates of comorbid medical conditions. Although families play a critical role in psychiatric illness management among adults with SMI, their contributions to improving health outcomes in this population has received little attention. This study explored family involvement in medical care for older adults with SMI. This mixed methods study involved analysis of quantitative data collected from older adults with SMI and cardiovascular risk (n = 28) participating in a pilot study of an intervention designed to improve patient-centered primary care augmented by qualitative interviews with their relatives (n = 13) to explore family involvement in medical care. Approximately 89% of older adults with SMI reported family involvement in at least one aspect of their medical care (e.g., medication reminders, medical decision making). However, many family members reported that they were rarely involved in their relative's medical visits, and most did not perceive a need to be involved during routine care. Family members identified obesity as their relative's primary health concern and many wanted guidance from providers on effective strategies for supporting weight loss. Although many family members did not perceive a need to be involved in their relative's routine medical visits, they expressed interest in talking with providers about how to help their relative change unhealthy behaviors. Educating patients, families, and providers about the potential benefits of family involvement in medical care, including routine medical visits for persons with SMI and cardiovascular health risk may promote patient- and family-centered collaboration in this high-risk population.

Canadian Cardiovascular Society Consensus Conference recommendations on heart failure update 2007: Prevention, management during intercurrent illness or acute decompensation, and use of biomarkers.

Science.gov (United States)

Arnold, J Malcom O; Howlett, Jonathan G; Dorian, Paul; Ducharme, Anique; Giannetti, Nadia; Haddad, Haissam; Heckman, George A; Ignaszewski, Andrew; Isaac, Debra; Jong, Philip; Liu, Peter; Mann, Elizabeth; McKelvie, Robert S; Moe, Gordon W; Parker, John D; Svendsen, Anna M; Tsuyuki, Ross T; O'Halloran, Kelly; Ross, Heather J; Rao, Vivek; Sequeira, Errol J; White, Michel

2007-01-01

Heart failure is common, yet it is difficult to treat. It presents in many different guises and circumstances in which therapy needs to be individualized. The Canadian Cardiovascular Society published a comprehensive set of recommendations in January 2006 on the diagnosis and management of heart failure, and the present update builds on those core recommendations. Based on feedback obtained through a national program of heart failure workshops during 2006, several topics were identified as priorities because of the challenges they pose to health care professionals. New evidence-based recommendations were developed using the structured approach for the review and assessment of evidence adopted and previously described by the Society. Specific recommendations and practical tips were written for the prevention of heart failure, the management of heart failure during intercurrent illness, the treatment of acute heart failure, and the current and future roles of biomarkers in heart failure care. Specific clinical questions that are addressed include: which patients should be identified as being at high risk of developing heart failure and which interventions should be used? What complications can occur in heart failure patients during an intercurrent illness, how should these patients be monitored and which medications may require a dose adjustment or discontinuation? What are the best therapeutic, both drug and nondrug, strategies for patients with acute heart failure? How can new biomarkers help in the treatment of heart failure, and when and how should BNP be measured in heart failure patients? The goals of the present update are to translate best evidence into practice, to apply clinical wisdom where evidence for specific strategies is weaker, and to aid physicians and other health care providers to optimally treat heart failure patients to result in a measurable impact on patient health and clinical outcomes in Canada.

Early nutritional support and physiotherapy improved long-term self-sufficiency in acutely ill older patients.

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Hegerová, Petra; Dědková, Zuzana; Sobotka, Luboš

2015-01-01

An acute disease is regularly associated with inflammation, decreased food intake, and low physical activity; the consequence is loss of muscle mass. However, the restoration of muscle tissue is problematic, especially in older patients. Loss of muscle mass leads to further decrease of physical activity which leads, together with recurring disease, to the progressive muscle mass loss accompanied by loss of self-sufficiency. Early nutrition support and physical activity could reverse this situation. Therefore, the aim of this study was to determine whether an active approach based on early nutritional therapy and exercise would influence the development of sarcopenia and impaired self-sufficiency during acute illness. Two hundred patients >78 y were admitted to a hospital internal medicine department and participated in a prospective, randomized controlled study. The patients were randomized to a control group receiving standard treatment (n = 100) or to an intervention group (n = 100). The intervention consisted of nutritional supplements (600 kcal, 20 g/d protein) added to a standard diet and a simultaneous intensive rehabilitation program. The tolerance of supplements and their influence on spontaneous food intake, self-sufficiency, muscle strength, and body composition were evaluated during the study period. The patients were then regularly monitored for 1 y post-discharge. The provision of nutritional supplements together with early rehabilitation led to increased total energy and protein intake while the intake of standard hospital food was not reduced. The loss of lean body mass and a decrease in self-sufficiency were apparent at discharge from the hospital and 3 mo thereafter in the control group. Nutritional supplementation and the rehabilitation program in the study group prevented these alterations. A positive effect of nutritional intervention and exercise during the hospital stay was apparent at 6 mo post-discharge. The early nutritional intervention

Associations between comorbid anxiety, diabetes control, and overall medical burden in patients with serious mental illness and diabetes.

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Bajor, Laura A; Gunzler, Douglas; Einstadter, Douglas; Thomas, Charles; McCormick, Richard; Perzynski, Adam T; Kanuch, Stephanie W; Cassidy, Kristin A; Dawson, Neal V; Sajatovic, Martha

2015-01-01

While previous work has demonstrated elevation of both comorbid anxiety disorders and diabetes mellitus type II in individuals with serious mental illness, little is known regarding the impact of comorbid anxiety on diabetes mellitus type II outcomes in serious mental illness populations. We analyzed baseline data from patients with serious mental illness and diabetes mellitus type II to examine relationships between comorbid anxiety, glucose control as measured by hemoglobin A1c score, and overall illness burden. Using baseline data from an ongoing prospective treatment study involving 157 individuals with serious mental illness and diabetes mellitus type II, we compared individuals with and without a comorbid anxiety disorder and compared hemoglobin A1c levels between these groups to assess the relationship between anxiety and management of diabetes mellitus type II. We conducted a similar analysis using cumulative number of anxiety diagnoses as a proxy for anxiety load. Finally, we searched for associations between anxiety and overall medical illness burden as measured by Charlson score. Anxiety disorders were seen in 33.1% (N=52) of individuals with serious mental illness and diabetes mellitus type II and were associated with increased severity of depressive symptoms and decreased function. Hemoglobin A1c levels were not significantly different in those with or without anxiety, and having multiple anxiety disorders was not associated with differences in diabetes mellitus type II control. However, depressive symptoms were significantly associated with higher hemoglobin A1c levels. Neither comorbid anxiety nor anxiety load was significantly associated with overall medical burden. One in three people with serious mental illness and diabetes mellitus type II had anxiety. Depressive symptoms were significantly associated with Hb1Ac levels while anxiety symptoms had no relation to hemoglobin A1c; this is consistent with previously published work. More studies are

Regoaling: a conceptual model of how parents of children with serious illness change medical care goals

Science.gov (United States)

2014-01-01

Background Parents of seriously ill children participate in making difficult medical decisions for their child. In some cases, parents face situations where their initial goals, such as curing the condition, may have become exceedingly unlikely. While some parents continue to pursue these goals, others relinquish their initial goals and generate new goals such as maintaining the child’s quality of life. We call this process of transitioning from one set of goals to another regoaling. Discussion Regoaling involves factors that either promote or inhibit the regoaling process, including disengagement from goals, reengagement in new goals, positive and negative affect, and hopeful thinking. We examine these factors in the context of parental decision making for a seriously ill child, presenting a dynamic conceptual model of regoaling. This model highlights four research questions that will be empirically tested in an ongoing longitudinal study of medical decision making among parents of children with serious illness. Additionally, we consider potential clinical implications of regoaling for the practice of pediatric palliative care. Summary The psychosocial model of regoaling by parents of children with a serious illness predicts that parents who experience both positive and negative affect and hopeful patterns of thought will be more likely to relinquish one set of goals and pursue a new set of goals. A greater understanding of how parents undergo this transition may enable clinicians to better support them through this difficult process. PMID:24625345

Predictors of Traditional Medical Practices in Illness Behavior in Northwestern Ethiopia: An Integrated Model of Behavioral Prediction Based Logistic Regression Analysis

Directory of Open Access Journals (Sweden)

Abenezer Yared

2017-01-01

Full Text Available This study aimed at investigating traditional medical beliefs and practices in illness behavior as well as predictors of the practices in Gondar city, northwestern Ethiopia, by using the integrated model of behavioral prediction. A cross-sectional quantitative survey was conducted to collect data through interviewer administered structured questionnaires from 496 individuals selected by probability proportional to size sampling technique. Unadjusted bivariate and adjusted multivariate logistic regression analyses were performed, and the results indicated that sociocultural predictors of normative response and attitude as well as psychosocial individual difference variables of traditional understanding of illness causation and perceived efficacy had statistically significant associations with traditional medical practices. Due to the influence of these factors, majority of the study population (85% thus relied on both herbal and spiritual varieties of traditional medicine to respond to their perceived illnesses, supporting the conclusion that characterized the illness behavior of the people as mainly involving traditional medical practices. The results implied two-way medicine needs to be developed with ongoing research, and health educations must take the traditional customs into consideration, for integrating interventions in the health care system in ways that the general public accepts yielding a better health outcome.

Medical Therapy for Cushing's Syndrome in the Twenty-first Century.

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Tritos, Nicholas A; Biller, Beverly M K

2018-06-01

Medical therapy has a useful adjunctive role in many patients with Cushing's syndrome. Patients with pituitary corticotroph adenomas who have received radiation therapy to the sella require medical therapy until the effects of radiation therapy occur. In addition, patients with Cushing's syndrome who cannot undergo surgery promptly, including those who are acutely ill and cannot safely undergo tumor resection, may benefit from medical therapy as a bridge to surgery. Other possible candidates for medical therapy are those with unresectable tumors or those whose tumor location remains unknown despite adequate diagnostic evaluation. Copyright © 2018 Elsevier Inc. All rights reserved.

Structure, process, and annual ICU mortality across 69 centers: United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study.

Science.gov (United States)

Checkley, William; Martin, Greg S; Brown, Samuel M; Chang, Steven Y; Dabbagh, Ousama; Fremont, Richard D; Girard, Timothy D; Rice, Todd W; Howell, Michael D; Johnson, Steven B; O'Brien, James; Park, Pauline K; Pastores, Stephen M; Patil, Namrata T; Pietropaoli, Anthony P; Putman, Maryann; Rotello, Leo; Siner, Jonathan; Sajid, Sahul; Murphy, David J; Sevransky, Jonathan E

2014-02-01

Hospital-level variations in structure and process may affect clinical outcomes in ICUs. We sought to characterize the organizational structure, processes of care, use of protocols, and standardized outcomes in a large sample of U.S. ICUs. We surveyed 69 ICUs about organization, size, volume, staffing, processes of care, use of protocols, and annual ICU mortality. ICUs participating in the United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study. Sixty-nine intensivists completed the survey. We characterized structure and process variables across ICUs, investigated relationships between these variables and annual ICU mortality, and adjusted for illness severity using Acute Physiology and Chronic Health Evaluation II. Ninety-four ICU directors were invited to participate in the study and 69 ICUs (73%) were enrolled, of which 25 (36%) were medical, 24 (35%) were surgical, and 20 (29%) were of mixed type, and 64 (93%) were located in teaching hospitals with a median number of five trainees per ICU. Average annual ICU mortality was 10.8%, average Acute Physiology and Chronic Health Evaluation II score was 19.3, 58% were closed units, and 41% had a 24-hour in-house intensivist. In multivariable linear regression adjusted for Acute Physiology and Chronic Health Evaluation II and multiple ICU structure and process factors, annual ICU mortality was lower in surgical ICUs than in medical ICUs (5.6% lower [95% CI, 2.4-8.8%]) or mixed ICUs (4.5% lower [95% CI, 0.4-8.7%]). We also found a lower annual ICU mortality among ICUs that had a daily plan of care review (5.8% lower [95% CI, 1.6-10.0%]) and a lower bed-to-nurse ratio (1.8% lower when the ratio decreased from 2:1 to 1.5:1 [95% CI, 0.25-3.4%]). In contrast, 24-hour intensivist coverage (p = 0.89) and closed ICU status (p = 0.16) were not associated with a lower annual ICU mortality. In a sample of 69 ICUs, a daily plan of care review and a lower bed-to-nurse ratio were both associated with a

Acute renal failure in the medical ICU still predictive of high mortality ...

African Journals Online (AJOL)

Background. We aimed to determine the outcome and certain predictors of outcome for acute renal failure (ARF) in the medical intensive care unit (ICU) at Tygerberg Hospital. Method. We conducted a retrospective, single-centre cohort study over 12 months comprising all patients admitted to the medical ICU with all causes ...

Somali Refugees' Perceptions of Mental Illness.

Science.gov (United States)

Bettmann, Joanna E; Penney, Deb; Clarkson Freeman, Pamela; Lecy, Natalie

2015-01-01

Nearly 13% of the U.S. population is comprised of foreign-born individuals, with Somalis constituting one of the largest resettled groups. Research suggests that, among Somali refugees, rates of mental illness are high. Yet research shows Somalis underutilize mental health services. Understanding their perceptions of mental illness and its cures may help practitioners to design more effective treatments for this population. Thus, this pilot study investigated Somali refugees' perceptions of mental illness and its treatments. Using purposive sampling, this qualitative study interviewed 20 Somali refugees using a semi-structured interview guide. Qualitative analysis yielded participants' perceptions of mental illness through their descriptions of physical symptoms accompanying mental illness, the stigma of mental illness, causes of mental illness, medical and non-medical treatments for mental illness, spirit possession causing mental illness, and the Qur'an as treatment for mental illness. Such information may help practitioners in the United States approach Somali clients in the most culturally coherent manner.

The diagnostic value of troponin in critically ill.

Science.gov (United States)

Voga, Gorazd

2010-01-01

Troponin T and I are sensitive and specific markers of myocardial necrosis. They are used for the routine diagnosis of acute coronary syndrome. In critically ill patients they are basic diagnostic tool for diagnosis of myocardial necrosis due to myocardial ischemia. Moreover, the increase of troponin I and T is related with adverse outcome in many subgroups of critically ill patients. The new, high sensitivity tests which have been developed recently allow earlier and more accurate diagnosis of acute coronary syndrome. The use of the new tests has not been studied in critically ill patients, but they will probably replace the old tests and will be used on the routine basis.

Measurement of acute nonspecific low back pain perception in primary care physical therapy : reliability and validity of the brief illness perception questionnaire

NARCIS (Netherlands)

Hallegraeff, Joannes M.; van der Schans, Cees P.; Krijnen, Wim P.; de Greef, Mathieu H. G.

2013-01-01

Background: The eight-item Brief Illness Perception Questionnaire is used as a screening instrument in physical therapy to assess mental defeat in patients with acute low back pain, besides patient perception might determine the course and risk for chronic low back pain. However, the psychometric

Intermediate-term and long-term mortality among acute medical patients hospitalized with community-acquired sepsis

DEFF Research Database (Denmark)

Henriksen, Daniel P; Pottegård, Anton; Laursen, Christian B

2017-01-01

OBJECTIVE: Admission with severe sepsis is associated with an increased short-term mortality, but it is unestablished whether sepsis severity has an impact on intermediate-term and long-term mortality following admission to an acute medical admission unit. PATIENTS AND METHODS: This was a populat......OBJECTIVE: Admission with severe sepsis is associated with an increased short-term mortality, but it is unestablished whether sepsis severity has an impact on intermediate-term and long-term mortality following admission to an acute medical admission unit. PATIENTS AND METHODS......: This was a population-based study of all adults admitted to an acute medical admission unit, Odense University Hospital, Denmark, from September 2010 to August 2011, identified by symptoms and clinical findings. We categorized the mortality periods into intermediate-term (31-180 days) and long-term (181-365, 366...

Religiously Integrated Cognitive Behavioral Therapy: A New Method of Treatment for Major Depression in Patients With Chronic Medical Illness

Science.gov (United States)

Pearce, Michelle J.; Koenig, Harold G.; Robins, Clive J.; Nelson, Bruce; Shaw, Sally F.; Cohen, Harvey J.; King, Michael B.

2015-01-01

Intervention studies have found that psychotherapeutic interventions that explicitly integrate clients’ spiritual and religious beliefs in therapy are as effective, if not more so, in reducing depression than those that do not for religious clients. However, few empirical studies have examined the effectiveness of religiously (vs. spiritually) integrated psychotherapy, and no manualized mental health intervention had been developed for the medically ill with religious beliefs. To address this gap, we developed and implemented a novel religiously integrated adaptation of cognitive–behavioral therapy (CBT) for the treatment of depression in individuals with chronic medical illness. This article describes the development and implementation of the intervention. First, we provide a brief overview of CBT. Next, we describe how religious beliefs and behaviors can be integrated into a CBT framework. Finally, we describe Religiously Integrated Cognitive Behavioral Therapy (RCBT), a manualized therapeutic approach designed to assist depressed individuals to develop depression-reducing thoughts and behaviors informed by their own religious beliefs, practices, and resources. This treatment approach has been developed for 5 major world religions (Christianity, Judaism, Islam, Buddhism, and Hinduism), increasing its potential to aid the depressed medically ill from a variety of religious backgrounds. PMID:25365155

Self-perception of aging and acute medical events in chronically institutionalized middle-aged and older persons with schizophrenia.

Science.gov (United States)

Cheng, Sheung-Tak; Yip, Leona C Y; Jim, Olivia T T; Hui, Anna N N

2012-09-01

To examine the relationship between self-perceptions of aging and acute medical events in chronically institutionalized middle-aged and older persons with schizophrenia. Participants were 83 persons with schizophrenia (30% women; mean age = 58.48, SD = 8.14) residing in a long-stay care home, who were without organic mental disorders, mental retardation, serious audiovisual impairment, and serious cognitive and physical impairment. They received assessments in body mass index, functional health, and global mental status, and responded to measures of self-perception of aging at baseline. Acute events that required medical attention were recorded for the next 3 months. 8% of the participants had acute medical events. Bivariate analysis suggested that number of comorbid medical conditions, mobility, Mini-Mental State Examination, and negative self-perception of aging were predictive of acute medical events. However, multivariate analysis (logistic regression) showed that only mobility (OR = 0.78, p = 0.04) and negative self-perception of aging (OR = 3.38, p = 0.02) had independent effects on acute medical events, with the latter being the stronger predictor. Positive aging self-perception, body mass index, and smoking were unrelated to medical events. Physical vulnerabilities may not be sufficient to explain the development of acute medical events in late-life schizophrenia. How individuals perceive their aging process, which is expected to regulate health behavior and help-seeking, may be an even more important factor. Further research should investigate whether such self-perceptions, which are probably rooted in stereotypes about aging socialized early in life, are modifiable in this population. Copyright © 2011 John Wiley & Sons, Ltd.

Long-term sequelae of severe acute kidney injury in the critically ill patient without comorbidity: a retrospective cohort study.

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Gijs Fortrie

Full Text Available Acute kidney injury (AKI necessitating renal replacement therapy (RRT is associated with high mortality and increased risk for end stage renal disease. However, it is unknown if this applies to patients with a preliminary unremarkable medical history. The purpose of this study was to describe overall and renal survival in critically ill patients with AKI necessitating RRT stratified by the presence of comorbidity.A retrospective cohort study was performed, between 1994 and 2010, including all adult critically ill patients with AKI necessitating RRT, stratified by the presence of comorbidity. Logistic regression, survival curve and cox proportional hazards analyses were used to evaluate overall and renal survival. Standardized mortality rate (SMR analysis was performed to compare long-term survival to the predicted survival in the Dutch population.Of the 1067 patients included only 96(9.0% had no comorbidity. Hospital mortality was 56.6% versus 43.8% in patients with and without comorbidity, respectively. In those who survived hospitalization 10-year survival was 45.0% and 86.0%, respectively. Adjusted for age, sex and year of treatment, absence of comorbidity was not associated with hospital mortality (OR=0.74, 95%-CI=0.47-1.15, while absence of comorbidity was associated with better long-term survival (adjusted HR=0.28, 95%-CI = 0.14-0.58. Compared to the Dutch population, patients without comorbidity had a similar mortality risk (SMR=1.6, 95%-CI=0.7-3.2, while this was increased in patients with comorbidity (SMR=4.8, 95%-CI=4.1-5.5. Regarding chronic dialysis dependency, 10-year renal survival rates were 76.0% and 92.9% in patients with and without comorbidity, respectively. Absence of comorbidity was associated with better renal survival (adjusted HR=0.24, 95%-CI=0.07-0.76.While hospital mortality remains excessively high, the absence of comorbidity in critically ill patients with RRT-requiring AKI is associated with a relative good long

Assessment of Mobility in Older People Hospitalized for Medical Illness Using de Morton Mobility Index and Cumulated Ambulation Score-Validity and Minimal Clinical Important Difference

DEFF Research Database (Denmark)

Trøstrup, Jeanette; Andersen, Helle; Kam, Charlotte Agger Meiner

2017-01-01

BACKGROUND AND PURPOSE: Older adults acutely hospitalized for medical illness typically have comorbidity and disability, and inhospital physical inactivity greatly increases the likelihood of developing new disability. Thus, assessment of the patients' mobility status is crucial for planning....... Assessments of mobility using the DEMMI (score range 0-100), the CAS (score range 0-6), and the Barthel Index (BI, score range 0-100) were performed by physical or occupational therapists at hospital admission and discharge. In addition, at discharge patients and therapists were independently asked to assess...... and geriatric wards. In contrast, the CAS appears to be appropriate to identify whether a patient is independently mobile or needs assistance, while the measure is less suitable for measuring improvements in mobility.This is an open-access article distributed under the terms of the Creative Commons Attribution...

Illness perceptions of Libyans with T2DM and their influence on medication adherence: a study in a diabetes center in Tripoli.

Science.gov (United States)

Ashur, Sana Taher; Shah, Shamsul Azhar; Bosseri, Soad; Morisky, Donald E; Shamsuddin, Khadijah

2015-01-01

The surrounding environment influences the constitution of illness perceptions. Therefore, local research is needed to examine how Libyan diabetes patients perceive diabetes and how their perceptions influence their medication adherence. A cross-sectional study was conducted at the National Centre for Diabetes and Endocrinology in Tripoli, Libya, between October and December 2013. A total of 523 patients with type 2 diabetes participated in this study. A self-administered questionnaire was used for data collection; this included the Revised Illness Perception Questionnaire and the eight-item Morisky Medication Adherence Scale. The respondents showed moderately high personal control and treatment control perceptions and a moderate consequences perception. They reported a high perception of diabetes timeline as chronic and a moderate perception of the diabetes course as unstable. The most commonly perceived cause of diabetes was Allah's will. The prevalence of low medication adherence was 36.1%. The identified significant predictors of low medication adherence were the low treatment control perception (p=0.044), high diabetes identity perception (p=0.008), being male (p=0.026), and employed (p=0.008). Diabetes illness perceptions of type 2 diabetic Libyans play a role in guiding the medication adherence and could be considered in the development of medication adherence promotion plans.

Illness perceptions of Libyans with T2DM and their influence on medication adherence: a study in a diabetes center in Tripoli

Directory of Open Access Journals (Sweden)

Sana Taher Ashur

2015-12-01

Full Text Available Background: The surrounding environment influences the constitution of illness perceptions. Therefore, local research is needed to examine how Libyan diabetes patients perceive diabetes and how their perceptions influence their medication adherence. Methods: A cross-sectional study was conducted at the National Centre for Diabetes and Endocrinology in Tripoli, Libya, between October and December 2013. A total of 523 patients with type 2 diabetes participated in this study. A self-administered questionnaire was used for data collection; this included the Revised Illness Perception Questionnaire and the eight-item Morisky Medication Adherence Scale. Results: The respondents showed moderately high personal control and treatment control perceptions and a moderate consequences perception. They reported a high perception of diabetes timeline as chronic and a moderate perception of the diabetes course as unstable. The most commonly perceived cause of diabetes was Allah's will. The prevalence of low medication adherence was 36.1%. The identified significant predictors of low medication adherence were the low treatment control perception (p=0.044, high diabetes identity perception (p=0.008, being male (p=0.026, and employed (p=0.008. Conclusion: Diabetes illness perceptions of type 2 diabetic Libyans play a role in guiding the medication adherence and could be considered in the development of medication adherence promotion plans.

Plain abdominal radiographs in acute medical emergencies: an abused investigation?

Science.gov (United States)

Feyler, S; Williamson, V; King, D

2002-02-01

Plain abdominal radiographs are commonly requested for acute medical emergencies on patients with non-specific abdominal symptoms and signs. In this study 131 plain abdominal radiographs performed on the day of admission were prospectively analysed. In only 16 cases (12%) the reasons for requests conformed to the recommended guidelines by the Royal College of Radiologists. The reason for the request was stated in the case notes in only three cases. In 62 cases (47%), there was no comment made on the film by the requesting clinician. There was a discrepancy in the interpretation of the radiograph between the clinician and the radiologist in 31 cases (24%). The clinical management was influenced by plain abdominal radiographs in only nine cases (7%). The majority of plain abdominal radiographs requested on acute medical emergencies is inappropriate. There is a need to ensure guidelines are followed to prevent unnecessary exposure of patients to radiation as well as preventing expenditure on irrelevant investigations.

Administration of fenoldopam in critically ill small animal patients with acute kidney injury: 28 dogs and 34 cats (2008-2012).

Science.gov (United States)

Nielsen, Lindsey K; Bracker, Kiko; Price, Lori Lyn

2015-01-01

To describe the clinical features and outcomes of critically ill dogs and cats with acute kidney injury (AKI) receiving fenoldopam infusions compared to patients with AKI that did not receive fenoldopam. Retrospective clinical study from May 1, 2008 until June 1, 2012. Private emergency and specialty referral hospital. Client-owned dogs (28) and cats (34) with AKI that received fenoldopam compared with similar patients with AKI (30 dogs and 30 cats) that did not. None. The medical records of 62 critically ill dogs and cats with AKI that received fenoldopam were reviewed. Presenting clinical signs, physical examination findings, and primary and secondary disease processes were identified in all patients. The mean number of days on fenoldopam was 1.5 days (range 0.3-4.0 days) for dogs and 1.9 days (range 1.0-4.0 days) for cats. Eleven of 28 (39%) dogs survived to discharge and 13 of 34 (38%) of the cats survived to discharge. Of the animals in the group receiving fenoldopam that died, the majority (84%) were euthanized. Potential adverse reactions were evaluated, with hypotension being the most commonly encountered adverse effect (7% of fenoldopam group [FG] dogs and 23% of FG cats). When compared with patients with AKI that did not receive fenoldopam, no significant differences were found between the groups with regards to survival, length of hospital stay, adverse effects, or changes in creatinine, BUN, or sodium concentrations except that patients receiving fenoldopam were significantly more likely to have received other renally active medications. In this study of patients with AKI, fenoldopam administration at 0.8 μg/kg/min in dogs and 0.5 μg/kg/min in cats appeared relatively safe but was not associated with improvement in survival to discharge, length of hospital stay, or improvement in renal biochemical parameters when compared to patients with AKI not receiving fenoldopam. © Veterinary Emergency and Critical Care Society 2015.

Evaluation of an influenza-like illness case definition in the diagnosis of influenza among patients with acute febrile illness in Cambodia.

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Kasper, Matthew R; Wierzba, Thomas F; Sovann, Ly; Blair, Patrick J; Putnam, Shannon D

2010-11-07

Influenza-like illness (ILI) is often defined as fever (>38.0°C) with cough or sore throat. In this study, we tested the sensitivity, specificity, and positive and negative predictive values of this case definition in a Cambodia patient population. Passive clinic-based surveillance was established at nine healthcare centers to identify the causes of acute undifferentiated fever in patients aged two years and older seeking treatment. Fever was defined as tympanic membrane temperature >38°C lasting more than 24 hours and less than 10 days. Influenza virus infections were identified by polymerase chain reaction. From July 2008 to December 2008, 2,639 patients were enrolled. From 884 (33%) patients positive for influenza, 652 presented with ILI and 232 acute fever patients presented without ILI. Analysis by age group identified no significant differences between influenza positive patients from the two groups. Positive predictive values (PPVs) varied during the course of the influenza season and among age groups. The ILI case definition can be used to identify a significant percentage of patients with influenza infection during the influenza season in Cambodia, assisting healthcare providers in its diagnosis and treatment. However, testing samples based on the criteria of fever alone increased our case detection by 34%.

[Prospective assessment of medication errors in critically ill patients in a university hospital].

Science.gov (United States)

Salazar L, Nicole; Jirón A, Marcela; Escobar O, Leslie; Tobar, Eduardo; Romero, Carlos

2011-11-01

Critically ill patients are especially vulnerable to medication errors (ME) due to their severe clinical situation and the complexities of their management. To determine the frequency and characteristics of ME and identify shortcomings in the processes of medication management in an Intensive Care Unit. During a 3 months period, an observational prospective and randomized study was carried out in the ICU of a university hospital. Every step of patient's medication management (prescription, transcription, dispensation, preparation and administration) was evaluated by an external trained professional. Steps with higher frequency of ME and their therapeutic groups involved were identified. Medications errors were classified according to the National Coordinating Council for Medication Error Reporting and Prevention. In 52 of 124 patients evaluated, 66 ME were found in 194 drugs prescribed. In 34% of prescribed drugs, there was at least 1 ME during its use. Half of ME occurred during medication administration, mainly due to problems in infusion rates and schedule times. Antibacterial drugs had the highest rate of ME. We found a 34% rate of ME per drug prescribed, which is in concordance with international reports. The identification of those steps more prone to ME in the ICU, will allow the implementation of an intervention program to improve the quality and security of medication management.

Consultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis.

Science.gov (United States)

Bell, Derek; Lambourne, Adrian; Percival, Frances; Laverty, Anthony A; Ward, David K

2013-01-01

Recent recommendations for physicians in the UK outline key aspects of care that should improve patient outcomes and experience in acute hospital care. Included in these recommendations are Consultant patterns of work to improve timeliness of clinical review and improve continuity of care. This study used a contemporaneous validated survey compared with clinical outcomes derived from Hospital Episode Statistics, between April 2009 and March 2010 from 91 acute hospital sites in England to evaluate systems of consultant cover for acute medical admissions. Clinical outcomes studied included adjusted case fatality rates (aCFR), including the ratio of weekend to weekday mortality, length of stay and readmission rates. Hospitals that had an admitting Consultant presence within the Acute Medicine Unit (AMU, or equivalent) for a minimum of 4 hours per day (65% of study group) had a lower aCFR compared with hospitals that had Consultant presence for less than 4 hours per day (p40 acute medical admissions per day had a lower aCFR compared to hospitals with fewer than 40 admissions per day (pstudy is the first large study to explore the potential relationships between systems of providing acute medical care and clinical outcomes. The results show an association between well-designed systems of Consultant working practices, which promote increased patient contact, and improved patient outcomes in the acute hospital setting.

Illness representations in patients with hand injury.

LENUS (Irish Health Repository)

Chan, Jeffrey C Y

2009-07-01

Differences in illness perception about hand injury may partly explain the variation in health behaviours such as adherence to post-operative therapy, coping strategy, emotional response and eventual clinical outcome. This study examined the illness perception of patients with hand injuries in the acute trauma setting.

Cholera Illness and Symptoms

Science.gov (United States)

... Share Compartir Cholera is an acute, diarrheal illness caused by infection of the intestine with the bacterium Vibrio cholerae and is spread by ingestion of contaminated food or water. The infection is often mild or without symptoms, ...

Attach importance to intervention therapy of acute abdomen

International Nuclear Information System (INIS)

Li Xuan

2006-01-01

Acute abdomen means a set of clinical emergency with acute abdominalgia as the primary characteristic symptom of onset, including others as the acute onset, quick symptom changes, severe illness, and oftenly need surgical treatment; therefore, acute abdomen ought to be designated within surgery domain. As interventional therapy is extensively applied in clinical medicine, now a days many victims of acute abdomen, especially those with ambiguous clinical diagnosis requiring an initial invasive examination (angiography, PTC, etc), should be referred to interventional therapy before taking an item of invasive measures. This new concept management has achieved good clinical curative effect and become one of the remarkable achievements in acute abdomen therapeutics. Such predominance finds proper expression in the following two aspects: (1) The evolution of contemporary medical iconography has made it possible to duly and accurately diagnose acute abdomen, and thus created a diagnostic predominance for us-interventionalists; (2) Intervention therapy is featured with its unique minimal invasion and massive effectiveness, and thus provides high leading edge than conventional surgical operation. The authors believe that intervention management ought to become the first-choice for treating the above mentioned acute abdomen. (authors)

ASSESSMENT OF EFFICACY IN APPLICATION OF TOPICAL IMMUNOLOGIC RESPONSE MODIFIER FOR PREVENTION OF INFLUENZA AND ACUTE RESPIRATORY INFECTIONS IN CHILDREN

Directory of Open Access Journals (Sweden)

I.N. Lytkina

2009-01-01

Full Text Available The purpose of this work was to assess the efficacy of bacterial lysate for prevention of acute respiratory infections. The article provides results of monitoring children in the orphanage who were administered the medication of this group as a prophylactic drug against acute respiratory infections. Children also from orphanages who were not administered the medication were selected as a control group. It was found that out of 80 children who underwent preventive treatment, only 26 children fell ill, while out of 80 children in the control group so did 78 orphans. The results achieved allowed the topical immunologic response modifier to be recommended as a general preventive medication for wide use in children in the period of seasonal respiratory infection incidence rate pickup.Key words: influenza, acute respiratory infections, preventive treatment, children.

Haemodialysis is an effective treatment in acute metabolic decompensation of maple syrup urine disease

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P.S. Atwal

2015-09-01

Full Text Available Acute metabolic decompensation in maple syrup urine disease can occur during intercurrent illness and is a medical emergency. A handful of reports in the medical literature describe the use of peritoneal dialysis and haemodialysis as therapeutic inventions. We report the only patient from our centre to have haemodialysis performed in this setting. Combined with dietary BCAA restriction and calorific support, haemodialysis allows rapid reduction in plasma leucine concentrations considerably faster than conservative methods.

Important Aspects of Pharmacist-led Medication Reviews in an Acute Medical Ward

DEFF Research Database (Denmark)

Bülow, Cille; Faerch, Kirstine Ullitz; Armandi, Helle

2018-01-01

In some hospitals, clinical pharmacists review the medication to find drug-related problems (DRPs) in acutely admitted patients. We aimed to identify the nature of identified DRPs and investigate factors of potential importance for the clinical implementation of pharmacist suggestions. In 100.......05). The most frequently implemented suggestions were based on DRPs concerning 'indication for drug treatment not noticed', 'inappropriate drug form' and 'drug dose too low', with implementation rates of 83%, 67% and 63%, respectively. In our sample, the pharmacist's MR suggestions were only implemented...

Medication cost problems among chronically ill adults in the US: did the financial crisis make a bad situation even worse?

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Piette JD

2011-04-01

Full Text Available John D Piette1, Ann Marie Rosland1, Maria J Silveira1, Rodney Hayward1, Colleen A McHorney21Ann Arbor VA Healthcare System, Ann Arbor, MI, USA; 2US Outcomes Research, Merck and Co, Inc, North Wales, PA, USAAbstract: A national internet survey was conducted between March and April 2009 among 27,302 US participants in the Harris Interactive Chronic Illness Panel. Respondents reported behaviors related to cost-related medication non-adherence (CRN and the impacts of medication costs on other aspects of their daily lives. Among respondents aged 40–64 and looking for work, 66% reported CRN in 2008, and 41% did not fill a prescription due to cost pressures. More than half of respondents aged 40–64 and nearly two-thirds of those in this group who were looking for work or disabled reported other impacts of medication costs, such as cutting back on basic needs or increasing credit card debt. More than one-third of respondents aged 65+ who were working or looking for work reported CRN. Regardless of age or employment status, roughly half of respondents reporting medication cost hardship said that these problems had become more frequent in 2008 than before the economic recession. These data show that many chronically ill patients, particularly those looking for work or disabled, reported greater medication cost problems since the economic crisis began. Given links between CRN and worse health, the financial downturn may have had significant health consequences for adults with chronic illness.Keywords: medication adherence, cost-of-care, access to care, chronic disease

Presenile dementia in a 41-year old male Nigerian medical doctor ...

African Journals Online (AJOL)

Presenile dementia reflects an underlying pathology that affects the cerebral cortex, its sub-cortical connections or both occurring in persons below 65 years of age. In this study, a case report of a 41-yr old medical doctor whose mental illness spanned 8 yrs is presented. Initially he came with paranoid psychosis of the acute ...

An analysis of autopsy cases of non-Hodgkin lymphoma-with special reference to those masquerading as acute febrile illness

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Sonali Rajesh Saraf

2016-01-01

Conclusion: As NHL present with nonspecific symptoms, these tumours may not be detected in early stages and hence may not be treated appropriately. These patients have weakened immunity and hence are prone to infection and sepsis which can be a major cause of mortality. This autopsy study experience has shown that NHL can masquerade as acute febrile illness which if not detected early and treated adequately can turn fatal.

Nurses' medication administration practices at two Singaporean acute care hospitals.

Science.gov (United States)

Choo, Janet; Johnston, Linda; Manias, Elizabeth

2013-03-01

This study examined registered nurses' overall compliance with accepted medication administration procedures, and explored the distractions they faced during medication administration at two acute care hospitals in Singapore. A total of 140 registered nurses, 70 from each hospital, participated in the study. At both hospitals, nurses were distracted by personnel, such as physicians, radiographers, patients not under their care, and telephone calls, during medication rounds. Deviations from accepted medication procedures were observed. At one hospital, the use of a vest during medication administration alone was not effective in avoiding distractions during medication administration. Environmental factors and distractions can impact on the safe administration of medications, because they not only impair nurses' level of concentration, but also add to their work pressure. Attention should be placed on eliminating distractions through the use of appropriate strategies. Strategies that could be considered include the conduct of education sessions with health professionals and patients about the importance of not interrupting nurses while they are administering medications, and changes in work design. © 2013 Wiley Publishing Asia Pty Ltd.

Bedside intravascular ultrasound-guided inferior vena cava filter placement in medical-surgical intensive care critically-ill patients

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Mohammad A. Abusedera

2015-09-01

Conclusions: Bedside IVUS-guided filter placement in medical-surgical critically ill patient in intensive care unit is a feasible, safe and reliable technique for IVC interruption. IVUS may be the most appropriate tool to guide filter insertion in obese patient.

Burden of Acute Gastrointestinal Illness in Gálvez, Argentina, 2007

Science.gov (United States)

Perez, Enrique; Majowicz, Shannon E.; Reid-Smith, Richard; Albil, Silvia; Monteverde, Marcos; McEwen, Scott A.

2010-01-01

This study evaluated the magnitude and distribution of acute gastrointestinal illness (GI) in Gálvez, Argentina, and assessed the outcome of a seven-day versus 30-day recall period in survey methodology. A cross-sectional population survey, with either a seven-day or a 30-day retrospective recall period, was conducted through door-to-door visits to randomly-selected residents during the ‘high’ and the ‘low’ seasons of GI in the community. Comparisons were made between the annual incidence rates obtained using the seven-day and the 30-day recall period. Using the 30-day recall period, the mean annual incidence rates was 0.43 (low season of GI) and 0.49 (high season of GI) episodes per person-year. Using the seven-day recall period, the mean annual incidence rate was 0.76 (low season of GI) and 2.66 (high season of GI) episodes per person-year. This study highlights the significant burden of GI in a South American community and confirms the importance of seasonality when investigating GI in the population. The findings suggest that a longer recall period may underestimate the burden of GI in retrospective population surveys of GI. PMID:20411678

Early psychological reactions in parents of children with a life threatening illness within a pediatric hospital setting.

Science.gov (United States)

Muscara, F; McCarthy, M C; Woolf, C; Hearps, S J C; Burke, K; Anderson, V A

2015-07-01

Parents of children with life threatening illness or injuries are at elevated risk of distress reactions, involving symptoms of acute stress disorder, depression and anxiety. Currently, the impact of child illness factors is unclear, and to date research systematically examining the prevalence of these psychological reactions across different illness groups with an acute life threat is sparse. This is important to explore given that studies show that parent functioning impacts on the psychological adjustment and recovery of the ill child. WHAT DOES THIS STUDY ADD?: At four weeks following a child's diagnosis of a serious illness, 49-54% of parents met DSM-IV criteria for acute stress disorder, across a number of illness groups, whereas 15-27% of parents were in the moderate/severe range for depression and anxiety, and 25-31% for stress. Results from this study demonstrate that rates and severity of these psychological reactions in parents of seriously ill children do not vary according to illness type. A life threatening childhood illness/injury can lead to significant distress reactions in parents, with independent studies finding such reactions in several different illness groups. To date, there is limited research systematically comparing the prevalence of adverse parental psychological reactions across different childhood illness groups with an acute life threat. This study aimed to investigate the frequency and severity of symptoms of acute traumatic stress, depression, anxiety and general stress in parents, following admission of their child to hospital for a life threatening illness. The study also aimed to explore the relationship between these symptoms, and to determine whether they differ according to illness/injury. Cross-sectional data from a prospective, longitudinal study are reported. Participants were 194 parents of 145 children (49 couples), admitted to cardiology (n=53), oncology (n=40) and pediatric intensive care units (n=52), for serious

Incidencia y mortalidad por anemia en pacientes gravemente enfermos Incidence and mortality due to anemia in acutely ill patients

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Maicelys Ramírez Zaldívar

2012-09-01

Full Text Available Introducción: la anemia es una de las enfermedades más conocidas y evaluadas en la práctica médica diaria. Objetivo: determinar la morbilidad y mortalidad de pacientes graves con anemia. Métodos: se realizó un estudio prospectivo de 118 pacientes ingresados en la Unidad de Terapia Intensiva del Hospital General Universitario "Vladimir Ilich Lenin" de Holguín, desde agosto hasta diciembre de 2010. Las variables discretas fueron comparadas mediante el test de £i al cuadrado y el de Fisher, y las continuas, por medio de las pruebas de T-Student y Mann-Whitney (la hemoglobina media, para á=0,05. Resultados: la anemia afectó 79,6 % de los integrantes de la serie y aumentó evolutivamente, con el consecuente empeoramiento de estos, de los cuales fallecieron 34,0 %, quienes tenían mayor edad (p=0,0004, necesitaron más transfusiones sanguíneas (p=0,005 y presentaron el trastorno de la hemoglobina más tardíamente (5,1 días. De los pacientes con anemia grave (hemoglobina:0,05. Conclusiones: la anemia en los pacientes graves se relacionó con una mayor mortalidad, estadía, necesidad de transfusiones de glóbulos rojos y causas médicas (neurológicas, en tanto, la edad avanzada y la gravedad de la anemia de aparición tardía se asociaron fundamentalmente a la mortalidad.Introduction: anemia is one of the well-known and evaluated diseases in the daily medical practice. Objective: to determine the morbidity and mortality of acutely ill patients with anemia. Methods: a prospective study of 118 patients admitted in the Intensive Therapy Unit of "Vladimir Ilich Lenin" General University Hospital in Holguín was carried out from August to December, 2010. Discrete variables were compared by means of the X² and Fisher tests, and the continuous variables, by means of the T-Student and Mann-Whitney tests (the mean hemoglobin, for á =0.05. Results: anemia affected 79.6% of the members of the series and it increased progressively, with the

Skin breakdown in acute care pediatrics.

Science.gov (United States)

Suddaby, Elizabeth C; Barnett, Scott D; Facteau, Lorna

2006-04-01

The purpose of this study was to develop a simple, single-page measurement tool that evaluates risk of skin breakdown in the peadiatric population and apply it to the acutely hospitalized child. Data were collected over a 15-month period from 347 patients on four in-patient units (PICU, medical-surgical, oncology, and adolescents) on skin breakdown using the AHCPR staging guidelines and compared to the total score on the Starkid SkinScale in order to determine its ability to predict skin breakdown. The inter-rater reliability of the Starkid Skin Scale was r2 = 0.85 with an internal reliablity of 0.71. The sensitivity of the total score was low (17.5%) but highly specific (98.5%). The prevalence of skin breakdown in the acutely hospitalized child was 23%, the majority (77.5%) occurring as erythema of the skin. Buttocks, perineum, and occiput were the most common locations of breakdown. Occiput breakdown was more common in critically ill (PICU) patients while diaper dermatitis was more common in the general medical-surgical population.

Consultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis.

Directory of Open Access Journals (Sweden)

Derek Bell

Full Text Available Recent recommendations for physicians in the UK outline key aspects of care that should improve patient outcomes and experience in acute hospital care. Included in these recommendations are Consultant patterns of work to improve timeliness of clinical review and improve continuity of care. This study used a contemporaneous validated survey compared with clinical outcomes derived from Hospital Episode Statistics, between April 2009 and March 2010 from 91 acute hospital sites in England to evaluate systems of consultant cover for acute medical admissions. Clinical outcomes studied included adjusted case fatality rates (aCFR, including the ratio of weekend to weekday mortality, length of stay and readmission rates. Hospitals that had an admitting Consultant presence within the Acute Medicine Unit (AMU, or equivalent for a minimum of 4 hours per day (65% of study group had a lower aCFR compared with hospitals that had Consultant presence for less than 4 hours per day (p40 acute medical admissions per day had a lower aCFR compared to hospitals with fewer than 40 admissions per day (p<0.03 and had a lower 7 day re-admission rate (p<0.02. This study is the first large study to explore the potential relationships between systems of providing acute medical care and clinical outcomes. The results show an association between well-designed systems of Consultant working practices, which promote increased patient contact, and improved patient outcomes in the acute hospital setting.

Acute Renal Failure Induced by Chinese Herbal Medication in Nigeria

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Effiong Ekong Akpan

2015-01-01

Full Text Available Traditional herbal medicine is a global phenomenon especially in the resource poor economy where only the very rich can access orthodox care. These herbal products are associated with complications such as acute renal failure and liver damage with a high incidence of mortalities and morbidities. Acute renal failure from the use of herbal remedies is said to account for about 30–35% of all cases of acute renal failure in Africa. Most of the herbal medications are not usually identified, but some common preparation often used in Nigeria includes “holy water” green water leaves, bark of Mangifera indica (mango, shoot of Anacardium occidentale (cashew, Carica papaya (paw-paw leaves, lime water, Solanum erianthum (Potato tree, and Azadirachta indica (Neem trees. We report a rare case of a young man who developed acute renal failure two days after ingestion of Chinese herb for “body cleansing” and general wellbeing. He had 4 sessions of haemodialysis and recovered kidney function fully after 18 days of admission.

Conversations About Goals and Values Are Feasible and Acceptable in Long-Term Acute Care Hospitals: A Pilot Study.

Science.gov (United States)

Lamas, Daniela J; Owens, Robert L; Nace, R Nicholas; Massaro, Anthony F; Pertsch, Nathan J; Moore, Susan T; Bernacki, Rachelle E; Block, Susan D

2017-07-01

The chronically critically ill have survived acute critical illness but require prolonged mechanical ventilation. These patients are frequently transferred from acute care to long-term acute care hospitals (LTACHs) for prolonged recovery, yet many suffer setbacks requiring readmission to acute care. The patient's relatively improved condition while at the LTACH might be an opportunity for communication regarding care goals; however, there have been no prior studies of the feasibility of such conversations in the LTACH. To determine the feasibility, acceptability, and potential usefulness of conversations about serious illness with chronic critical illness patients or their surrogate decision makers after LTACH admission. We adapted an existing conversation guide for use in chronically critically ill (defined by tracheotomy for prolonged ventilation) LTACH patients or their surrogates to explore views about quality of life, understanding of medical conditions, expectations, and planning for setbacks. These conversations were conducted by one interviewer and summarized for the patients' clinicians. We surveyed patients, surrogates, and clinicians to assess acceptability. A total of 70 subjects were approached and 50 (71%) were enrolled, including 30 patients and 20 surrogates. The median duration of the conversation was 14 minutes 45 seconds [IQR 12:46, 19]. The presence of ongoing mechanical ventilation did not lead to longer conversations; in fact, conversations with patients were shorter than those with surrogates. The majority of subjects (81%) described the conversation as worthwhile. The majority of clinicians (73%) reported that the conversation offered a new and significant understanding of the patient's preferences if a setback were to occur. Conversations about serious illness care goals can be accomplished in a relatively short period of time, are acceptable to chronically critically ill patients and their surrogate decision makers in the LTACH, and are

Detection of human bocavirus from children and adults with acute respiratory tract illness in Guangzhou, southern China

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Liu Wen-Kuan

2011-12-01

Full Text Available Abstract Background Human bocavirus (HBoV is a newly discovered parvovirus associated with acute respiratory tract illness (ARTI and gastrointestinal illness. Our study is the first to analyze the characteristics of HBoV-positive samples from ARTI patients with a wide age distribution from Guangzhou, southern China. Methods Throat swabs (n=2811 were collected and analyzed from children and adults with ARTI over a 13-month period. The HBoV complete genome from a 60 year-old female patient isolate was also determined. Results HBoV DNA was detected in 65/2811 (2.3% samples, of which 61/1797 were from children (Mycoplasma pneumoniae had the highest frequency of 16.9% (11/65. Upper and lower respiratory tract illness were common symptoms, with 19/65 (29.2% patients diagnosed with pneumonia by chest radiography. All four adult patients had systemic influenza-like symptoms. Phylogenetic analysis of the complete genome revealed a close relationship with other HBoVs, and a more distant relationship with HBoV2 and HBoV3. Conclusions HBoV was detected from children and adults with ARTI from Guangzhou, southern China. Elderly people were also susceptive to HBoV. A single lineage of HBoV was detected among a wide age distribution of patients with ARTI.

Acute Respiratory Failure in Acute Poisoning by Neutrotropic Substances

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A. N. Lodyagin

2008-01-01

Full Text Available Objective: to evaluate the efficiency of methods for diagnosing and treating critically ill patients with acute respiratory failure (ARF in acute poisoning by neurotropic substances. Subjects and methods. Two hundred and thirty-three patients with acute severe intoxication with neurotropic poisons were examined. All the patients were admitted for toxic-hypoxic coma and ARF; in this connection all the patients underwent artificial ventilation (AV. The patients were divided into 3 groups: 1 those in whom the traditional treatments (AV, detoxifying therapy, and infusional and cardiotropic support could restore the basic parameters of vital functions, as judged from the recovered oxygenation index; these patients had no metabolic shifts; 2 those who had signs of pulmonary hyperhydration, low cardiac output and moderate metabolic disorders, as suggested by elevated lactate levels; 3 seriously ill patients in whom the interval between the time of poisoning to care delivery was more than 20 hours; the patients of this group had the most significant metabolic disorders. Results. Correction of ARF in critically ill patients with acute poisoning should include, in addition to the rational parameters of AV and detoxifying therapy, agents for targeted therapy for sequels of hypoxia and energy deficiency states. For maximally rapid and effective oxygen transport recovery, the addition of perfluorane to the complex therapy cardinally improves the results of treatment and reduces mortality rates. Conclusion. The complexity of the pathogenesis of ARF and its sequels is a ground for diagnosing and correcting not only ventilation disturbances, but also pulmonary microcirculatory disorders and metabolic disturbances. Key words: acute intoxication with neu-rotropic poisons, acute respiratory failure, pulmonary hyperhydration, hypoxia, metabolic disturbances.

Catatonia in the medically ill: Etiology, diagnosis, and treatment. The Academy of Consultation-Liaison Psychiatry Evidence-Based Medicine Subcommittee Monograph.

Science.gov (United States)

Denysenko, Lex; Sica, Nicole; Penders, Thomas M; Philbrick, Kemuel L; Walker, Audrey; Shaffer, Scott; Zimbrean, Paula; Freudenreich, Oliver; Rex, Nicole; Carroll, Brendan T; Francis, Andrew

2018-05-01

Catatonia in medically ill patients is rare but often unrecognized. This monograph summarizes current knowledge on the diagnosis, epidemiology, etiology, and management of catatonia occurring in the medical setting. PubMed searches were used to identify relevant articles from 1962 to present. More than 3,000 articles were obtained and reviewed for relevance, including references of articles identified by the initial search. Several areas were identified as important, including: (1) catatonia and delirium; (2) malignant catatonia; (3) pediatric catatonia; (4) catatonia associated with another medical condition (CAMC); (5) drug exposure and withdrawal syndromes associated with catatonia; and (6) treatment of catatonia in the medical setting. Catatonia in the medically ill appears to have numerous etiologies, although etiology does not seem to modify the general treatment approach of prompt administration of lorazepam. Delirium and catatonia are commonly comorbid in the medical setting and should not be viewed as mutually exclusive. Electroconvulsive therapy should be offered to patients who do not respond to benzodiazepines or have malignant features. Removing offending agents and treating the underlying medical condition is paramount when treating CAMC. Memantine or amantadine may be helpful adjunctive agents. There is not enough evidence to support the use of antipsychotics or stimulants in treating CAMC.

Depressive illness delayed Hamlet's revenge.

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Shaw, A B; Pickering, Neil

2002-12-01

If Hamlet had not delayed his revenge there would have been no play. Many explanations of the delay have been offered in the last four centuries. None is convincing. The interpretation which best fits the evidence best is that Hamlet was suffering from an acute depressive illness, with some obsessional features. He could not make a firm resolve to act. In Shakespeare's time there was no concept of acute depressive illness, although melancholy was well known. Melancholy, however, would have been seen as a character defect. In the tragic model the hero brings himself and others to ruin because of a character defect. Thus, at the time, the play conformed to the tragic model. With today's knowledge, it does not. This analysis adds to, but does not replace, other insights into the play.

Remote Collaboration, Decision Support, and On-Demand Medical Image Analysis for Acute Stroke Care

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Sales Barros, Renan; Borst, Jordi; Kleynenberg, Steven; Badr, Celine; Ganji, Rama-Rao; de Bliek, Hubrecht; Zeng-Eyindanga, Landry-Stephane; van den Brink, Henk; Majoie, Charles; Marquering, Henk; Olabarriaga, Silvia Delgado

2015-01-01

Acute stroke is the leading cause of disabilities and the fourth cause of death worldwide. The treatment of stroke patients often requires fast collaboration between medical experts and fast analysis and sharing of large amounts of medical data, especially image data. In this situation, cloud

Impact of Severe Acute Respiratory Syndrome (SARS Outbreaks on the Use of Emergency Department Medical Resources

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Chien-Cheng Huang

2005-06-01

Conclusion: The SARS outbreak did not eliminate the need of critically ill patients for advanced medical support. However, besides an overall decrease in patient numbers, the SARS epidemic markedly altered demographic information, clinical characteristics, and the use of medical services by adult patients in the ED of a SARS-dedicated hospital.

Creating opportunities for interdisciplinary collaboration and patient-centred care: how nurses, doctors, pharmacists and patients use communication strategies when managing medications in an acute hospital setting.

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Liu, Wei; Gerdtz, Marie; Manias, Elizabeth

2016-10-01

This paper examines the communication strategies that nurses, doctors, pharmacists and patients use when managing medications. Patient-centred medication management is best accomplished through interdisciplinary practice. Effective communication about managing medications between clinicians and patients has a direct influence on patient outcomes. There is a lack of research that adopts a multidisciplinary approach and involves critical in-depth analysis of medication interactions among nurses, doctors, pharmacists and patients. A critical ethnographic approach with video reflexivity was adopted to capture communication strategies during medication activities in two general medical wards of an acute care hospital in Melbourne, Australia. A mixed ethnographic approach combining participant observations, field interviews, video recordings and video reflexive focus groups and interviews was employed. Seventy-six nurses, 31 doctors, 1 pharmacist and 27 patients gave written consent to participate in the study. Data analysis was informed by Fairclough's critical discourse analytic framework. Clinicians' use of communication strategies was demonstrated in their interpersonal, authoritative and instructive talk with patients. Doctors adopted the language discourse of normalisation to standardise patients' illness experiences. Nurses and pharmacists employed the language discourses of preparedness and scrutiny to ensure that patient safety was maintained. Patients took up the discourse of politeness to raise medication concerns and question treatment decisions made by doctors, in their attempts to challenge decision-making about their health care treatment. In addition, the video method revealed clinicians' extensive use of body language in communication processes for medication management. The use of communication strategies by nurses, doctors, pharmacists and patients created opportunities for improved interdisciplinary collaboration and patient-centred medication

Associations of moderate and severe overweight with self-reported illness and medical care in Dutch adults

NARCIS (Netherlands)

Seidell, J C; de Groot, L.C.; van Sonsbeek, J L; Deurenberg, P.; Hautvast, J.G.A.J.

Data on height, weight, illness, medical care consumption, and demographic variables for 19,126 Dutch adults aged 20 years or older were obtained from three annual Health Interview Surveys. Data on severely overweight (Body Mass Index 30.0-40.0 kg/m2) and moderately overweight (BMI 25.0-29.9 kg/m2)

Depressive symptoms in Parkinson’s disease and in non-neurological medical illnesses

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Assogna F

2013-03-01

Full Text Available Francesca Assogna,1 Sabrina Fagioli,1 Luca Cravello,1 Giuseppe Meco,2 Mariangela Pierantozzi,3 Alessandro Stefani,3 Francesca Imperiale,2 Carlo Caltagirone,1,3 Francesco E Pontieri,4 Gianfranco Spalletta11I.R.C.C.S. Santa Lucia Foundation, Rome, Italy; 2Department of Neurology and Psychiatry (Parkinson’s Centre and Research Centre of Social Diseases (CIMS, University “Sapienza”, Rome, Italy; 3Department of Neuroscience, University “Tor Vergata”, Rome, Italy; 4Department of Neuroscience, Mental Health and Sensory Systems, University “Sapienza”, Movement Disorder Unit, Sant’Andrea Hospital, Rome, ItalyBackground: Patients with neurological and non-neurological medical illnesses very often complain of depressive symptoms that are associated with cognitive and functional impairments. We compared the profile of depressive symptoms in Parkinson’s disease (PD patients with that of control subjects (CS suffering from non-neurological medical illnesses.Methods: One-hundred PD patients and 100 CS were submitted to a structured clinical interview for identification of major depressive disorder (MDD and minor depressive disorder (MIND, according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR, criteria. The Hamilton Depression Rating Scale (HDRS and the Beck Depression Inventory (BDI were also administered to measure depression severity.Results: When considering the whole groups, there were no differences in depressive symptom frequency between PD and CS apart from worthlessness/guilt, and changes in appetite reduced rates in PD. Further, total scores and psychic and somatic subscores of HDRS and BDI did not differ between PD and CS. After we separated PD and CS in those with MDD, MIND, and no depression (NODEP, comparing total scores and psychic/somatic subscores of HDRS and BDI, we found increased total depression severity in NODEP PD and reduced severity of the psychic symptoms of

Hospital-acquired acute kidney injury in medical, surgical, and intensive care unit: A comparative study

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T B Singh

2013-01-01

Full Text Available Acute kidney injury (AKI is a common complication in hospitalized patients. There are few comparative studies on hospital-acquired AKI (HAAKI in medical, surgical, and ICU patients. This study was conducted to compare the epidemiological characteristics, clinical profiles, and outcomes of HAAKI among these three units. All adult patients (>18 years of either gender who developed AKI based on RIFLE criteria (using serum creatinine, 48 h after hospitalization were included in the study. Patients of acute on chronic renal failure and AKI in pregnancy were excluded. Incidence of HAAKI in medical, surgical, and ICU wards were 0.54%, 0.72%, and 2.2% respectively ( P < 0.0001. There was no difference in age distribution among the groups, but onset of HAAKI was earliest in the medical ward ( P = 0.001. RIFLE-R was the most common AKI in medical (39.2% and ICU (50% wards but in the surgical ward, it was RIFLE-F that was most common (52.6%. Acute tubular necrosis was more common in ICU ( P = 0.043. Most common etiology of HAAKI in medical unit was drug induced (39.2%, whereas in surgical and ICU, it was sepsis (34% and 35.2% respectively. Mortality in ICU, surgical and medical units were 73.5%, 43.42%, and 37.2%, respectively ( P = 0.003. Length of hospital stay in surgical, ICU and medical units were different ( P = 0.007. This study highlights that the characters of HAAKI are different in some aspects among different hospital settings.

Risk factors for incident delirium in an acute general medical setting: a retrospective case-control study.

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Tomlinson, Emily Jane; Phillips, Nicole M; Mohebbi, Mohammadreza; Hutchinson, Alison M

2017-03-01

To determine predisposing and precipitating risk factors for incident delirium in medical patients during an acute hospital admission. Incident delirium is the most common complication of hospital admission for older patients. Up to 30% of hospitalised medical patients experience incident delirium. Determining risk factors for delirium is important for identifying patients who are most susceptible to incident delirium. Retrospective case-control study with two controls per case. An audit tool was used to review medical records of patients admitted to acute medical units for data regarding potential risk factors for delirium. Data were collected between August 2013 and March 2014 at three hospital sites of a healthcare organisation in Melbourne, Australia. Cases were 161 patients admitted to an acute medical ward and diagnosed with incident delirium between 1 January 2012 and 31 December 2013. Controls were 321 patients sampled from the acute medical population admitted within the same time range, stratified for admission location and who did not develop incident delirium during hospitalisation. Identified using logistic regression modelling, predisposing risk factors for incident delirium were dementia, cognitive impairment, functional impairment, previous delirium and fracture on admission. Precipitating risk factors for incident delirium were use of an indwelling catheter, adding more than three medications during admission and having an abnormal sodium level during admission. Multiple risk factors for incident delirium exist; patients with a history of delirium, dementia and cognitive impairment are at greatest risk of developing delirium during hospitalisation. Nurses and other healthcare professionals should be aware of patients who have one or more risk factors for incident delirium. Knowledge of risk factors for delirium has the potential to increase the recognition and understanding of patients who are vulnerable to delirium. Early recognition and

Reducing Medical Students' Stigmatization of People with Chronic Mental Illness: A Field Intervention at the "Living Museum" State Hospital Art Studio

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Cutler, Janis L.; Harding, Kelli J.; Hutner, Lucy A.; Cortland, Clarissa; Graham, Mark J.

2012-01-01

Objective: The authors designed an intervention to reduce beginning medical students' stigmatization of people with chronic mental illness (CMI). Methods: Pre-clinical medical students visited a state psychiatric facility's "Living Museum," a combination patient art studio/display space, as the intervention. During the visit, students interacted…

Factors influencing the level of self-stigmatisation in people with mental illness.

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Kalisova, Lucie; Michalec, Jiri; Hadjipapanicolaou, Demetra; Raboch, Jiri

2018-06-01

The aim of this study was to assess sociodemographic factors and factors connected with treatment of mental illness and to decide whether they can influence the level of self-stigma. Sociodemographic characteristics (age, gender, family status, level of employment, level of education) and characteristics related to illness and treatment (diagnosis, length of treatment, adherence to treatment) were gathered in a group of patients in stable mental condition, without acute symptoms of mental illness. Self-stigma was measured using the Self-stigma of Mental Illness Scale - short form (SSMIS-SF). The sample included 197 patients: 99 patients in group 1 (G1) with psychosis and 98 in group 2 (G2) with anxious and affective disorders. The average age was 44.15 ± 12.91 years, the length of illness was 11.67 ± 9.21 years and 48% of patients were men. The total average SSMIS-SF score was 61.54 ± 23.34. We found no statistically significant difference in the total level of self-stigmatisation between these groups ( t(197) = 0.77; p = .441). The level of self-stigmatisation (total score of SSMIS-SF) in patients in G1 (psychosis) increased with the length of illness r(99) = .253; p = .011. Employment status seems to correlate with the level of self-stigmatisation ( F(3, 184) = 5.27; p = .002). Patients unemployed and on disability pension had higher levels of self-stigmatisation than patients working full-time. Patients who took medication regularly (full medical adherence) had lower scores of SSMIS-SF total scores in comparison with patients with lower compliance ( t(195) = 3.476; p = .001; Cohen's d = .25). According to our results, with regard to the factors that were followed, self-stigmatisation correlates with the presence of employment (social inclusion), duration of illness in patients with psychosis and treatment adherence. We did not find a statistically significant influence of age, gender, marital status or clinical diagnosis on the level of self-stigma.

Impact of Vehicular Networks on Emergency Medical Services in Urban Areas

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Chun-Liang Lee

2014-10-01

Full Text Available The speed with which emergency personnel can provide emergency treatment is crucial to reducing death and disability among acute and critically ill patients. Unfortunately, the rapid development of cities and increased numbers of vehicles are preventing emergency vehicles from easily reaching locations where they are needed. A significant number of researchers are experimenting with vehicular networks to address this issue, but in most studies the focus has been on communication technologies and protocols, with few efforts to assess how network applications actually support emergency medical care. Our motivation was to search the literature for suggested methods for assisting emergency vehicles, and to use simulations to evaluate them. Our results and evidence-based studies were cross-referenced to assess each method in terms of cumulative survival ratio (CSR gains for acute and critically ill patients. Simulation results indicate that traffic light preemption resulted in significant CSR increases of between 32.4% and 90.2%. Route guidance was found to increase CSRs from 14.1% to 57.8%, while path clearing increased CSRs by 15.5% or less. It is our hope that this data will support the efforts of emergency medical technicians, traffic managers, and policy makers.

Impact of vehicular networks on emergency medical services in urban areas.

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Lee, Chun-Liang; Huang, Chung-Yuan; Hsiao, Tzu-Chien; Wu, Chun-Yen; Chen, Yaw-Chung; Wang, I-Cheng

2014-10-31

The speed with which emergency personnel can provide emergency treatment is crucial to reducing death and disability among acute and critically ill patients. Unfortunately, the rapid development of cities and increased numbers of vehicles are preventing emergency vehicles from easily reaching locations where they are needed. A significant number of researchers are experimenting with vehicular networks to address this issue, but in most studies the focus has been on communication technologies and protocols, with few efforts to assess how network applications actually support emergency medical care. Our motivation was to search the literature for suggested methods for assisting emergency vehicles, and to use simulations to evaluate them. Our results and evidence-based studies were cross-referenced to assess each method in terms of cumulative survival ratio (CSR) gains for acute and critically ill patients. Simulation results indicate that traffic light preemption resulted in significant CSR increases of between 32.4% and 90.2%. Route guidance was found to increase CSRs from 14.1% to 57.8%, while path clearing increased CSRs by 15.5% or less. It is our hope that this data will support the efforts of emergency medical technicians, traffic managers, and policy makers.

Inappropriate prescribing in the elderly: a comparison of the Beers criteria and the improved prescribing in the elderly tool (IPET) in acutely ill elderly hospitalized patients.

LENUS (Irish Health Repository)

Barry, P J

2012-02-03

-dwelling subjects. The total number of inappropriate prescriptions identified using the Beers\\' criteria (ID) was 148 affecting 121 patients. The Beers\\' criteria (CD) identified 69 inappropriate prescriptions in 60 patients and the IPET identified 112 inappropriate prescriptions in 78 patients. The Beers criteria (ID and CD combined) identified at least one inappropriate prescription in 34% of subjects and the IPET identified one in at least 22% of subjects. CONCLUSIONS: This study identifies high rates of use of inappropriate medications in community-dwelling elderly presenting with acute illness to hospital. These are comparable with inappropriate prescribing rates identified in previous studies. The revised Beers\\' criteria (2003) identified more inappropriate prescriptions than the IPET in this population of elders.

Acute Febrile Illness and Complications Due to Murine Typhus, Texas, USA1,2.

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Afzal, Zeeshan; Kallumadanda, Sunand; Wang, Feng; Hemmige, Vagish; Musher, Daniel

2017-08-01

Murine typhus occurs relatively commonly in southern Texas, as well as in California. We reviewed records of 90 adults and children in whom murine typhus was diagnosed during a 3-year period in 2 hospitals in southern Texas, USA. Most patients lacked notable comorbidities; all were immunocompetent. Initial signs and symptoms included fever (99%), malaise (82%), headache (77%), fatigue (70%), myalgias (68%), and rash (39%). Complications, often severe, in 28% of patients included bronchiolitis, pneumonia, meningitis, septic shock, cholecystitis, pancreatitis, myositis, and rhabdomyolysis; the last 3 are previously unreported in murine typhus. Low serum albumin and elevated procalcitonin, consistent with bacterial sepsis, were observed in >70% of cases. Rash was more common in children; thrombocytopenia, hyponatremia, elevated hepatic transaminases, and complications were more frequent in adults. Murine typhus should be considered as a diagnostic possibility in cases of acute febrile illness in southern and even in more northern US states.

Ketamine sedation for patients with acute agitation and psychiatric illness requiring aeromedical retrieval.

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Le Cong, Minh; Gynther, Bruce; Hunter, Ernest; Schuller, Peter

2012-04-01

Aeromedical retrieval services face the difficult problem of appropriate levels of sedation for transport of acutely agitated patients to definitive care. This paper describes a technique using ketamine, which is titratable and avoids problems associated with airway management. A 3-year review of a new technique of ketamine sedation by aeromedical retrieval teams from the Cairns base of the Queensland section of the Royal Flying Doctor Service of Australia. Clinical records were systematically reviewed for ketamine administration and signs of adverse events during transport and in the subsequent 72 h. 18 patients were sedated during retrieval with intravenous ketamine. Effective sedation was achieved in all cases, with no significant adverse events noted during retrieval or 72 h afterwards. Ketamine sedation is effective and safe in agitated patients with a psychiatric illness in the aeromedical setting and does not lead to worsening agitation in the subsequent 72-h period.

Gastroschisis in Europe - A Case-malformed-Control Study of Medication and Maternal Illness during Pregnancy as Risk Factors

DEFF Research Database (Denmark)

Given, Joanne E; Loane, Maria; Garne, Ester

2017-01-01

BACKGROUND: Gastroschisis, a congenital anomaly of the abdomen, is associated with young maternal age and has increased in prevalence in many countries. Maternal illness and medication exposure are among environmental risk factors implicated in its aetiology. METHODS: A population-based case-malf...

Resting energy expenditure in critically ill patients: Evaluation methods and clinical applications

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Ana Cláudia Soncini Sanches

Full Text Available Summary Patients on intensive care present systemic, metabolic, and hormonal alterations that may adversely affect their nutritional condition and lead to fast and important depletion of lean mass and malnutrition. Several factors and medical conditions can influence the energy expenditure (EE of critically ill patients, such as age, gender, surgery, serious infections, medications, ventilation modality, and organ dysfunction. Clinical conditions that can present with EE change include acute kidney injury, a complex disorder commonly seen in critically ill patients with manifestations that can range from minimum elevations in serum creatinine to renal failure requiring dialysis. The nutritional needs of this population are therefore complex, and determining the resting energy expenditure is essential to adjust the nutritional supply and to plan a proper diet, ensuring that energy requirements are met and avoiding complications associated with overfeeding and underfeeding. Several evaluation methods of EE in this population have been described, but all of them have limitations. Such methods include direct calorimetry, doubly labeled water, indirect calorimetry (IC, various predictive equations, and, more recently, the rule of thumb (kcal/kg of body weight. Currently, IC is considered the gold standard.

A narrative review of studies of refusal of psychotropic medication in acute inpatient psychiatric care.

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Owiti, J A; Bowers, L

2011-09-01

This paper offers a narrative review of the 22 studies of medication refusal in acute psychiatry. Because of varied definitions of medication refusal, diverse methodologies and few rigorous studies, it has not been possible to draw firm conclusions on the average rate of refusal of psychotropic medications in acute psychiatry. However, it is clear that medication refusal is common and leads to poor outcomes characterized by higher rates of seclusion, restraint, threats of, and actual, assaults and longer hospitalizations. There are no statistically significant differences between refusers and acceptors in gender, marital status and preadmission living arrangements. Although no firm conclusions on the influence of ethnicity, status at admission and diagnosis on refusal, the refusers are more likely to have higher number of previous hospitalizations and history of prior refusal. The review indicates that staff factors such as the use of temporary staff, lack of confidence in ward staff and ineffective ward structure are associated with higher rates of medication refusal. Comprehensive knowledge of why, and how, patients refuse medication is lacking. Research on medication refusal is still fragmented, of variable methodological quality and lacks an integrating model. © 2011 Blackwell Publishing.

Is 'gut feeling' by medical staff better than validated scores in estimation of mortality in a medical intensive care unit? - The prospective FEELING-ON-ICU study.

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Radtke, Anne; Pfister, Roman; Kuhr, Kathrin; Kochanek, Matthias; Michels, Guido

2017-10-01

The aim of the FEELING-ON-ICU study was to compare mortality estimations of critically ill patients based on 'gut feeling' of medical staff and by Acute Physiology And Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II and Sequential Organ Failure Assessment (SOFA). Medical staff estimated patients' mortality risks via questionnaires. APACHE II, SAPS II and SOFA were calculated retrospectively from records. Estimations were compared with actual in-hospital mortality using receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC). 66 critically ill patients (60.6% male, mean age 63±15years (range 30-86)) were evaluated each by a nurse (n=66, male 32.4%) and a physician (n=66, male 67.6%). 15 (22.7%) patients died on the intensive care unit. AUC was largest for estimations by physicians (AUC 0.814 (95% CI 0.705-0.923)), followed by SOFA (AUC 0.749 (95% CI 0.629-0.868)), SAPS II (AUC 0.723 (95% CI 0.597-0.849)), APACHE II (AUC 0.721 (95% CI 0.595-0.847)) and nursing staff (AUC 0.669 (95% CI 0.529-0.810)) (p<0.05 for all results). The concept of physicians' 'gut feeling' was comparable to classical objective scores in mortality estimations of critically ill patients. Concerning practicability physicians' evaluations were advantageous to complex score calculation. Copyright © 2017 Elsevier Inc. All rights reserved.

Predicting Risk of Suicide Attempt Using History of Physical Illnesses From Electronic Medical Records

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Luo, Wei; Tran, Truyen; Berk, Michael; Venkatesh, Svetha

2016-01-01

Background Although physical illnesses, routinely documented in electronic medical records (EMR), have been found to be a contributing factor to suicides, no automated systems use this information to predict suicide risk. Objective The aim of this study is to quantify the impact of physical illnesses on suicide risk, and develop a predictive model that captures this relationship using EMR data. Methods We used history of physical illnesses (except chapter V: Mental and behavioral disorders) from EMR data over different time-periods to build a lookup table that contains the probability of suicide risk for each chapter of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes. The lookup table was then used to predict the probability of suicide risk for any new assessment. Based on the different lengths of history of physical illnesses, we developed six different models to predict suicide risk. We tested the performance of developed models to predict 90-day risk using historical data over differing time-periods ranging from 3 to 48 months. A total of 16,858 assessments from 7399 mental health patients with at least one risk assessment was used for the validation of the developed model. The performance was measured using area under the receiver operating characteristic curve (AUC). Results The best predictive results were derived (AUC=0.71) using combined data across all time-periods, which significantly outperformed the clinical baseline derived from routine risk assessment (AUC=0.56). The proposed approach thus shows potential to be incorporated in the broader risk assessment processes used by clinicians. Conclusions This study provides a novel approach to exploit the history of physical illnesses extracted from EMR (ICD-10 codes without chapter V-mental and behavioral disorders) to predict suicide risk, and this model outperforms existing clinical assessments of suicide risk. PMID:27400764

A person-centred approach in medicine to reduce the psychosocial and existential burden of chronic and life-threatening medical illness.

Science.gov (United States)

Grassi, Luigi; Mezzich, Juan E; Nanni, Maria Giulia; Riba, Michelle B; Sabato, Silvana; Caruso, Rosangela

2017-10-01

The psychiatric, psychosocial, and existential/spiritual pain determined by chronic medical disorders, especially if in advanced stages, have been repeatedly underlined. The right to approach patients as persons, rather than symptoms of organs to be repaired, has also been reported, from Paul Tournier to Karl Jaspers, in opposition and contrast with the technically-enhanced evidence-based domain of sciences that have reduced the patients to 'objects' and weakened the physician's identity deprived of its ethical value of meeting, listening, and treating subjects. The paper will discuss the main psychosocial and existential burden related to chronic and advanced medical illnesses, and the diagnostic and therapeutic implications for a dignity preserving care within a person-centred approach in medicine, examined in terms of care of the person (of the person's whole health), for the person (for the fulfilment of the person's health aspirations), by the person (with physicians extending themselves as total human beings), and with the person (working respectfully with the medically ill person).

Incidence and risk factors of acute kidney injury among the critically ill neonates

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Ayman A El-Badawy

2015-01-01

Full Text Available Acute kidney injury (AKI is a complex disorder with clinical manifestations ranging from mild dysfunction to complete kidney failure. The published literature on the incidence and outcome of AKI in the critically ill neonatal population is scarce. The aim of this study was to evaluate the types, the associated risk factors and short-term outcome of AKI in the critically ill neonates. A cohort study was conducted including 100 critically ill neonates successively admitted to the Neonatal Intensive Care Unit. The inclusion criteria were a gestational age ≥28 weeks and body weight ≥1 kg. Exclusion criteria included those with multiple congenital anomalies or on drugs altering glomerular filtration rate or AKI developing postoperatively. Neonates were evaluated for the development of AKI [creatinine >1.5 mg/dL and/or blood urea nitrogen (BUN >20 mg/dL] and were assigned as group A (who developed AKI and group B (who did not develop AKI. Forty-one patients developed AKI (group A among whom nine (22% showed oliguric AKI. The most common risk factors among group A patients were sepsis (75.6% and nephrotoxic drug administration (75.6%, followed by shock (39%. There were no statistically significant differences between both groups except for male sex predominance and necrotizing enterocolitis (NEC, which were significantly higher among group A (P <0.05. Use of continuous positive airway pressure (CPAP ventilation was significantly higher in neonates without AKI (13.6% vs 0.0%, P = 0.02. The mortality rate among group A reached 51.2%. Various risk factors including gender, gestational age, birth weight, shock, NEC, sepsis, nephrotoxic drugs, oliguria and mechanical ventilation were studied as regards outcome of group A, and all factors except gender and oliguria proved to be significantly higher in deceased neonates. Male sex and NEC were important risk factors for developing AKI that was predominantly non-oliguric. CPAP ventilation may have a

[Definition of medical competence. The point of view of chronically-ill patients in the Andalusian public healthcare system (Spain)].

Science.gov (United States)

Prieto Rodríguez, M Ángeles; Danet Danet, Alina; Escudero Carretero, María J; Ruiz Azarola, Ainhoa; Pérez Corral, Olivia; García Toyos, Noelia

2012-01-01

To identify the attributes used by chronically-ill patients to describe physicians' competence in the public healthcare system in Andalucia. A total of 147 chronically-ill patients and their relatives were included in this qualitative study. Focal groups and in-depth interviews were performed in health centers and outpatient centers in Granada, Malaga, Seville, Cadiz and Cordoba between 2007 and 2008. Content analysis was carried out using Nudist Vivo. The participants defined medical competence as combining elements of technical ability and knowledge (awareness of and interest in the disease, continuity of follow-up and requesting specific tests) with interpersonal skills related to communication, information (informing, listening, trust, prompting questions) and attention (courtesy, cordiality, respect, interest and approachability). Primary care was expected to provide a close relationship, personalized treatment, information, drug prescription, and referral to specialized care. Specialized care was expected to provide an accurate diagnosis and appropriate treatment, information and follow-up. Highly valued aspects of emergency care were symptom relief, accurate diagnosis, referral to specialists and courtesy. Chronically-ill patients based their evaluation of medical competence on technical and interpersonal skills. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

Blood corticosterone concentration reaches critical illness levels early during acute malnutrition in the weanling mouse.

Science.gov (United States)

Monk, Jennifer M; Makinen, Kimberley; Shrum, Bradly; Woodward, Bill

2006-03-01

Acute (i.e., wasting) pediatric malnutrition consistently elevates blood glucocorticoid levels, but neither the magnitude of the rise in concentration nor its kinetics is clear. Male and female C57BL/6J mice, initially 19 days old, and CBA/J mice, initially 23 days old, consumed a complete purified diet either ad libitum (age-matched control) or in restricted daily quantities (mimicking marasmus), or they consumed a purified isocaloric low-protein diet ad libitum (mimicking incipient kwashiorkor). Serum levels of corticosterone were assessed by double antibody radioimmunoassay after 3, 6, and 14 days (C57BL/6J strain) or after 6 and 14 days in the genetically distant CBA/J strain. Age-matched control groups of both strains exhibited mean corticosterone levels of 5-30 ng/ml, whereas the acutely malnourished groups exhibited mean levels of this hormone that were elevated by more than an order of magnitude as early as 3 days after initiation of weight loss. This outcome was confirmed in a second experiment in which the serum corticosterone level of C57BL/6J weanlings was examined by competitive binding enzyme immunoassay 3 and 14 days after initiation of the dietary protocols. Therefore, deficits of protein and/or energy in weanling murine systems relevant to acute pediatric malnutrition elicit early elevations in blood glucocorticoid levels to a magnitude reminiscent of critical illness and multiple trauma. The key to this novel finding was an exsanguination method that permitted accurate assessment of the blood corticosterone level of the healthy, quiescent mouse. Overall, the results of this investigation provide a new perspective on the glucocorticoids as part of the early hormonal response to acute weanling malnutrition coincident with the shift toward catabolic metabolism and the initiation of depression in cellular immune competence.

End-of-life mental health assessments for older aged, medically ill persons with expressed desire to die.

Science.gov (United States)

Weinberger, Linda E; Sreenivasan, Shoba; Garrick, Thomas

2014-01-01

In recent years, assisted suicide has been legalized in four states for those who are terminally ill and wish to end their lives with the assistance of lethal doses of medications prescribed by a physician. The ethics-related and legal questions raised by end-of-life suicide and decisional capacity to refuse treatment assessments are complex. In treating patients with end-stage medical conditions or disorders that severely affect the future quality of their lives, clinicians tend to engage in suicide prevention at all costs. Overriding the patient's expressed desire to die conflicts with another value, however, that of the individual's right to autonomy. We provide a framework for understanding these difficult decisions, by providing a review of the epidemiology of suicide in later life; reviewing findings from a unique dataset of suicides among the elderly obtained from the Los Angeles County Coroner's Office, as well as data from states with legalized assisted suicide; presenting a discussion of the two frameworks of suicidal ideation as a pathological versus an existential reaction; and giving a case example that highlights the dilemmas faced by clinicians addressing decisional capacity to refuse treatment in an elderly, medically ill patient who has expressed the wish to die. © 2014 American Academy of Psychiatry and the Law.

Challenges of establishing the correct diagnosis of outbreaks of acute febrile illnesses in Africa: the case of a likely Brucella outbreak among nomadic pastoralists, northeast Kenya, March-July 2005.

Science.gov (United States)

Ari, Mary D; Guracha, Argata; Fadeel, Moustafa Abdel; Njuguna, Charles; Njenga, M Kariuki; Kalani, Rosalia; Abdi, Hassan; Warfu, Osman; Omballa, Victor; Tetteh, Christopher; Breiman, Robert F; Pimentel, Guillermo; Feikin, Daniel R

2011-11-01

An outbreak of acute febrile illness was reported among Somali pastoralists in remote, arid Northeast Kenya, where drinking raw milk is common. Blood specimens from 12 patients, collected mostly in the late convalescent phase, were tested for viral, bacterial, and parasitic pathogens. All were negative for viral and typhoid serology. Nine patients had Brucella antibodies present by at least one of the tests, four of whom had evidence suggestive of acute infection by the reference serologic microscopic agglutination test. Three patients were positive for leptospiral antibody by immunoglobulin M enzyme-linked immunosorbent assay, and two were positive for malaria. Although sensitive and specific point-of-care testing methods will improve diagnosis of acute febrile illness in developing countries, challenges of interpretation still remain when the outbreaks are remote, specimens collected too late, and positive results for multiple diseases are obtained. Better diagnostics and tools that can decipher overlapping signs and symptoms in such settings are needed.

Guidelines for adults on self-medication for the treatment of acute diarrhoea

NARCIS (Netherlands)

Wingate, D.; Phillips, S. F.; Lewis, S. J.; Malagelada, J. R.; Speelman, P.; Steffen, R.; Tytgat, G. N.

2001-01-01

Acute uncomplicated diarrhoea is commonly treated by self-medication. Guidelines for treatment exist, but are inconsistent, sometimes contradictory, and often owe more to dogma than evidence. An ad hoc multidisciplinary group has reviewed the literature to determine best practice. In general it is

Helping Patients With Physical Illness Cope With Hospitalization ...

African Journals Online (AJOL)

Helping Patients With Physical Illness Cope With Hospitalization: Implication For The Nurses And Medical Social Workers In Meeting The Physical And ... their illness, allaying the fear and anxiety of the patients about outcomes of medical treatments (surgical operation and death), providing support for patients' ...

On being Credibly Ill

DEFF Research Database (Denmark)

Mik-Meyer, Nanna

2011-01-01

unexplained symptoms. The study is conducted in Denmark using qualitative interviews with welfare officers and clients. The paper's focus is on how issues of gender and class intersect in the negotiation of illness among welfare officers and clients. The particular client group in question consists...... of individuals that are defined by their lack of a bio-medical diagnosis. Their ‘lack’ of identity accentuates how gender and class become central in the categorisation practices, constructing the ill person as either bio-medically sick or as a person who may be suffering but only from diffuse psychological...

Use of medications by people with chronic fatigue syndrome and healthy persons: a population-based study of fatiguing illness in Georgia.

Science.gov (United States)

Boneva, Roumiana S; Lin, Jin-Mann S; Maloney, Elizabeth M; Jones, James F; Reeves, William C

2009-07-20

Chronic fatigue syndrome (CFS) is a debilitating condition of unknown etiology and no definitive pharmacotherapy. Patients are usually prescribed symptomatic treatment or self-medicate. We evaluated prescription and non-prescription drug use among persons with CFS in Georgia and compared it to that in non-fatigued Well controls and also to chronically Unwell individuals not fully meeting criteria for CFS. A population-based, case-control study. To identify persons with possible CFS-like illness and controls, we conducted a random-digit dialing telephone screening of 19,807 Georgia residents, followed by a detailed telephone interview of 5,630 to identify subjects with CFS-like illness, other chronically Unwell, and Well subjects. All those with CFS-like illness (n = 469), a random sample of chronically Unwell subjects (n = 505), and Well individuals (n = 641) who were age-, sex-, race-, and geographically matched to those with CFS-like illness were invited for a clinical evaluation and 783 participated (48% overall response rate). Clinical evaluation identified 113 persons with CFS, 264 Unwell subjects with insufficient symptoms for CFS (named ISF), and 124 Well controls; the remaining 280 subjects had exclusionary medical or psychiatric conditions, and 2 subjects could not be classified. Subjects were asked to bring all medications taken in the past 2 weeks to the clinic where a research nurse viewed and recorded the name and the dose of each medication. More than 90% of persons with CFS used at least one drug or supplement within the preceding two weeks. Among users, people with CFS used an average of 5.8 drugs or supplements, compared to 4.1 by ISF and 3.7 by Well controls. Persons with CFS were significantly more likely to use antidepressants, sedatives, muscle relaxants, and anti-acids than either Well controls or the ISF group. In addition, persons with CFS were significantly more likely to use pain-relievers, anti-histamines and cold/sinus medications than

Acute effects of energy drinks in medical students.

Science.gov (United States)

García, Andrés; Romero, César; Arroyave, Cristhian; Giraldo, Fabián; Sánchez, Leidy; Sánchez, Julio

2017-09-01

To determine the acute effects of a variety of recognized energy drinks on medical students, based on the hypothesis that these beverages may affect negatively cardiovascular parameters, stress levels and working memory. Eighty young healthy medical students were included in the study. 62.5 % of the participants were male, and the age mean was 21.45 years. Each person was evaluated via measurement of systolic and diastolic blood pressure, electrocardiogram (ECG), heart rate, oxygen saturation, breath rate, temperature, STAI score (to assess anxiety state), salivary cortisol and N-back task score (to determine cognitive enhancement). These evaluations were performed before and following the intake of either carbonated water or one of three energy drinks containing caffeine in similar concentrations and an undetermined energy blend; A contained less sugar and no taurine. Thirty-minute SBP increased significantly in the A and C groups. The B group exhibited a diminution of the percentage of the 1-h SBP increase, an increase of 1-h DBP and QTc shortening. HR showed an increase in the percent change in the A and C groups. Cortisol salivary levels increased in the B group. The STAI test score decreased in the C group. The percent change in N-back scores increased in the A group. The data reinforce the need for further research on the acute and chronic effects of energy drinks to determine the actual risks and benefits. Consumers need to be more informed about the safety of these energy drinks, especially the young student population.

An Interactive Mobile Phone-Website Platform to Facilitate Real-Time Management of Medication in Chronically ill Patients.

Science.gov (United States)

Anglada-Martínez, Helena; Martin-Conde, Maite; Rovira-Illamola, Marina; Sotoca-Momblona, Jose Miguel; Sequeira, Ethel; Aragunde, Valentin; Codina-Jané, Carles

2017-08-01

Poor adherence to medication is a prevalent issue that affects 50-60% of chronically ill patients. We present Medplan, a platform for patients/caregivers and healthcare professionals (HCPs) that aims to enhance adherence, increase patient medication knowledge, and facilitate communication between patients and HCPs. The Medplan platform was designed and developed by a multidisciplinary team composed of primary care and hospital physicians, pharmacists, patients, and developers. We questioned 62 patients in order to know their opinion about the different functions the app would incorporate and other possible features that should be taken into consideration. Medplan comprises a website for HCPs and an application (app) that is installed on the patient's phone. The app is available in Spanish, Catalan, and English. The patient's medication plan was introduced by the HCP and interfaced with the app. Each medicine is represented by an icon showing the indication of the treatment, the trade name, active ingredients, dose, and route of administration. Information about special requirements (e.g., need to take medication on an empty stomach), side effects, or lifestyle recommendations can also be provided. Additional functions include a medication reminder alarm system, by which patients can confirm whether or not they have taken the drug. Patients can self-track their adherence, and all data collected are sent automatically to the website for analysis by the HCP. Weekly motivation messages are sent to encourage adherence. A tool enabling interactive communication between patients and HCPs (primary care or hospital care) is also included. The app contains a feature enabling the HCP to verify the suitability of over-the-counter drugs. Medplan has the potential to significantly improve management of medication in chronically ill patients. A pilot study is being conducted to test whether Medplan is useful and effective.

Cost and economic burden of illness over 15 years in Nepal: A comparative analysis.

Science.gov (United States)

Swe, Khin Thet; Rahman, Md Mizanur; Rahman, Md Shafiur; Saito, Eiko; Abe, Sarah K; Gilmour, Stuart; Shibuya, Kenji

2018-01-01

With an increasing burden of non-communicable disease in Nepal and limited progress towards universal health coverage, country- and disease-specific estimates of financial hardship related to healthcare costs need to be evaluated to protect the population effectively from healthcare-related financial burden. To estimate the cost and economic burden of illness and to assess the inequality in the financial burden due to catastrophic health expenditure from 1995 to 2010 in Nepal. This study used nationally representative Nepal Living Standards Surveys conducted in 1995 and 2010. A Bayesian two-stage hurdle model was used to estimate average cost of illness and Bayesian logistic regression models were used to estimate the disease-specific incidence of catastrophic health payment and impoverishment. The concentration curve and index were estimated by disease category to examine inequality in healthcare-related financial hardship. Inflation-adjusted mean out-of-pocket (OOP) payments for chronic illness and injury increased by 4.6% and 7.3%, respectively, while the cost of recent acute illness declined by 1.5% between 1995 and 2010. Injury showed the highest incidence of catastrophic expenditure (30.7% in 1995 and 22.4% in 2010) followed by chronic illness (12.0% in 1995 and 9.6% in 2010) and recent acute illness (21.1% in 1995 and 7.8% in 2010). Asthma, diabetes, heart conditions, malaria, jaundice and parasitic illnesses showed increased catastrophic health expenditure over time. Impoverishment due to injury declined most (by 12% change in average annual rate) followed by recent acute illness (9.7%) and chronic illness (9.6%) in 15 years. Inequality analysis indicated that poorer populations with recent acute illness suffered more catastrophic health expenditure in both sample years, while wealthier households with injury and chronic illnesses suffered more catastrophic health expenditure in 2010. To minimize the economic burden of illness, several approaches need to be

Overweight or obese BMI is associated with earlier, but not later survival after common acute illnesses.

Science.gov (United States)

Prescott, Hallie C; Chang, Virginia W

2018-02-06

Obesity has been associated with improved short-term mortality following common acute illness, but its relationship with longer-term mortality is unknown. Observational study of U.S. Health and Retirement Study (HRS) participants with federal health insurance (fee-for-service Medicare) coverage, hospitalized with congestive heart failure (N = 4287), pneumonia (N = 4182), or acute myocardial infarction (N = 2001), 1996-2012. Using cox proportional hazards models, we examined the association between overweight or obese BMI (BMI ≥ 25.0 kg/m 2 ) and mortality to 5 years after hospital admission, adjusted for potential confounders measured at the same time as BMI, including age, race, sex, education, partnership status, income, wealth, and smoking status. Body mass index (BMI) was calculated from self-reported height and weight collected at the HRS survey prior to hospitalization (a median 1.1 year prior to hospitalization). The referent group was patients with a normal BMI (18.5 to BMI was associated with lower mortality at 1 year after hospitalization for congestive heart failure, pneumonia, and acute myocardial infarction-with adjusted hazard ratios of 0.68 (95% CI 0.59-0.79), 0.74 (95% CI: 0.64-0.84), and 0.65 (95%CI: 0.53-0.80), respectively. Among participants who lived to one year, however, subsequent survival was similar between patients with normal versus overweight/obese BMI. In older Americans, overweight or obese BMI was associated with improved survival following hospitalization for congestive heart failure, pneumonia, and acute myocardial infarction. This association, however, is limited to the shorter-term. Conditional on surviving to one year, we did not observe a survival advantage associated with excess weight.

Acute disseminated encephalomyelitis in dengue viral infection.

Science.gov (United States)

Wan Sulaiman, Wan Aliaa; Inche Mat, Liyana Najwa; Hashim, Hasnur Zaman; Hoo, Fan Kee; Ching, Siew Mooi; Vasudevan, Ramachandran; Mohamed, Mohd Hazmi; Basri, Hamidon

2017-09-01

Dengue is the most common arboviral disease affecting many countries worldwide. An RNA virus from the flaviviridae family, dengue has four antigenically distinct serotypes (DEN-1-DEN-4). Neurological involvement in dengue can be classified into dengue encephalopathy immune-mediated syndromes, encephalitis, neuromuscular or dengue muscle dysfunction and neuro-ophthalmic involvement. Acute disseminated encephalomyelitis (ADEM) is an immune mediated acute demyelinating disorder of the central nervous system following recent infection or vaccination. This monophasic illness is characterised by multifocal white matter involvement. Many dengue studies and case reports have linked ADEM with dengue virus infection but the association is still not clear. Therefore, this article is to review and discuss concerning ADEM in dengue as an immune-medicated neurological complication; and the management strategy required based on recent literature. Copyright © 2017 Elsevier Ltd. All rights reserved.

Study on the attitude of “Tomorrow's Doctors” towards mental illness ...

African Journals Online (AJOL)

Different studies show different attitudes towards mental illness among medical students. This study was initiated to explore the attitude towards mental illness among medical students in a medical college of Manipur. A cross-sectional selfadministered questionnaire-based study was conducted among medical students in ...

Incidence of Decompression Illness and Other Diving Related Medical Problems Amongst Royal Navy Divers 1995-1999

Science.gov (United States)

1999-01-01

conditions hypobares ou hyperbares ] To order the complete compilation report, use: ADA395680 The component part is provided here to allow users access to...following report: TITLE: Operational Medical Issues in Hypo-and Hyperbaric Conditions [les Questions medicales a caractere oprationel liees aux...Navy diving accidents, and with the assistance of the British Hyperbaric Association (BHA) all civilian cases of decompression illness treated by member

Medication details documented on hospital discharge: cross-sectional observational study of factors associated with medication non-reconciliation.

LENUS (Irish Health Repository)

Grimes, Tamasine C

2012-02-01

AIMS: Movement into or out of hospital is a vulnerable period for medication safety. Reconciling the medication a patient is using before admission with the medication prescribed on discharge, and documenting any changes (medication reconciliation) is recommended to improve safety. The aims of the study were to investigate the factors contributing to medication reconciliation on discharge, and identify the prevalence of non-reconciliation. METHODS: The study was a cross-sectional, observational survey using consecutive discharges from purposively selected services in two acute public hospitals in Ireland. Medication reconciliation, potential for harm and unplanned re-admission were investigated. RESULTS: Medication non-reconciliation was identified in 50% of 1245 inpatient episodes, involving 16% of 9569 medications. The majority of non-reconciled episodes had potential to result in moderate (63%) or severe (2%) harm. Handwritten rather than computerized discharges (adjusted odds ratio (adjusted OR) 1.60, 95% CI 1.11, 2.99), increasing number of medications (adjusted OR 1.26, 95% CI 1.21, 1.31) or chronic illness (adjusted OR 2.08, 95% CI 1.33, 3.24) were associated with non-reconciliation. Omission of endocrine, central nervous system and nutrition and blood drugs was more likely on discharge, whilst omission on admission and throughout inpatient care, without documentation, was more likely for obstetric, gynaecology and urinary tract (OGU) or respiratory drugs. Documentation in the discharge communication that medication was intentionally stopped during inpatient care was less likely for cardiovascular, musculoskeletal and OGU drugs. Errors involving the dose were most likely for respiratory drugs. CONCLUSIONS: The findings inform strategies to facilitate medication reconciliation on discharge from acute hospital care.

Medical students' attitudes to mental illnesses and to psychiatry before and after the psychiatric clerkship: Training in a specialty and a general hospital.

Science.gov (United States)

Economou, Marina; Kontoangelos, Kontantinos; Peppou, Lily Evangelia; Arvaniti, Aikaterini; Samakouri, Maria; Douzenis, Athanasios; Papadimitriou, George N

2017-12-01

Medical students' attitudes to mental illnesses and psychiatry may be reshaped during the psychiatric training, with important implications in their future practice of the profession. Therefore, the present study set out to explore the impact of the psychiatric clerkship in students' attitudes, while taking into consideration the site of their practical training. To this end, a total of 678 final-year medical students were recruited. Students completed a self-reported questionnaire entailing the Attitudes to Psychiatry scale, the Attitudes to Mental Illness scale and the Greek Social Distance scale before and after their placement. Findings indicate that the psychiatric clerkship had a positive effect in reducing stigma towards both psychiatry and mental illnesses, with the effect being more pronounced in the general hospital with respect to the former, while in the specialty hospital was more marked regarding the latter. A further exploration of the determinants of change revealed that the improvement discerned in the general hospital was only among those without professional experience of mental illnesses. Therefore, the psychiatric clerkship may exert a substantial influence on shaping favourable attitudes towards mental illnesses and psychiatry; however, other elements should also be taken into consideration, if the clerkship is to tackle stigma in healthcare. Copyright © 2017 Elsevier B.V. All rights reserved.

A mobility program for an inpatient acute care medical unit.

Science.gov (United States)

Wood, Winnie; Tschannen, Dana; Trotsky, Alyssa; Grunawalt, Julie; Adams, Danyell; Chang, Robert; Kendziora, Sandra; Diccion-MacDonald, Stephanie

2014-10-01

For many patients, hospitalization brings prolonged periods of bed rest, which are associated with such adverse health outcomes as increased length of stay, increased risk of falls, functional decline, and extended-care facility placement. Most studies of progressive or early mobility protocols designed to minimize these adverse effects have been geared toward specific patient populations and conducted by multidisciplinary teams in either ICUs or surgical units. Very few mobility programs have been developed for and implemented on acute care medical units. This evidence-based quality improvement project describes how a mobility program, devised for and put to use on a general medical unit in a large Midwestern academic health care system, improved patient outcomes.

Stress in adolescents with a chronically ill parent: inspiration from Rolland's Family Systems-Illness model

NARCIS (Netherlands)

Sieh, D.S.; Dikkers, A.L.C.; Visser-Meily, J.M.A.; Meijer, A.M.

2012-01-01

This article was inspired by Rolland’s Family Systems-Illness (FSI) model, aiming to predict adolescent stress as a function of parental illness type. Ninety-nine parents with a chronic medical condition, 82 partners, and 158 adolescent children (51 % girls; mean age = 15.1 years) participated in

Impact of a Newly Constructed Motor Vehicle Road on Altitude Illness in the Nepal Himalayas.

Science.gov (United States)

Reisman, Jonathan; Deonarain, Dinesh; Basnyat, Buddha

2017-12-01

This study investigated the impact that motor vehicle travel along a newly constructed road has on altitude illness (including acute mountain sickness, high-altitude cerebral edema, and high-altitude pulmonary edema). The new road from Besisahar (760 m) to Manang (3540 m) in Nepal was completed in December 2014. We enrolled all patients diagnosed with altitude illness at the Himalayan Rescue Association Manang clinic in fall 2016. Phi coefficients were calculated to test for an association between Nepali ethnicity and rapid ascent by motor vehicle. A retrospective review looked at all patients with altitude illness from fall (September-November) 2010 to spring (February-May) 2016. In fall 2016, more than half (54%) of patients with altitude illness traveled to Manang by motor vehicle, and one-third (33%) reached Manang from low altitude (Besisahar) in less than 48 hours. Nepali nationality had a significant association with motor vehicle travel (phi +0.69, P road (P constructed road from Besisahar to Manang appears to be related to a significant increase in the number of patients with all forms of altitude illness, especially among Nepalis. The authors believe that educational interventions emphasizing prevention are urgently needed. Copyright © 2017 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

Morgellons: contested illness, diagnostic compromise and medicalisation.

Science.gov (United States)

Fair, Brian

2010-05-01

The case of Morgellons illustrates how the emergence of a new medically contested illness intersected with and impacted on the diagnostic processes of an existing uncontested psychiatric condition, Delusional Parasitosis (DP). More specifically, the sociopolitical processes at play in the contested illness, Morgellons, dubiously reflect patient empowerment, as well the resilience and power of medical jurisdiction. This research offers insights into the contested illness and medicalisation literatures, and aims to bridge these two approaches towards the relationship between patient empowerment and medical authority, which I do through the notion of doctor-patient compromise. The data for this research come from a comprehensive qualitative analysis of Morgellons discourse through four key sources: the pro-Morgellons website Morgellons.org; the anti-Morgellons website Morgellonswatch.com; the popular media's portrayal of Morgellons; and the DP and Morgellons articles published in peer-reviewed medical journals, as made available on PubMed.

Exertional Heat Illness and Human Gene Expression

National Research Council Canada - National Science Library

Sonna, L.A; Sawka, M. N; Lilly, C. M

2007-01-01

Microarray analysis of gene expression at the level of RNA has generated new insights into the relationship between cellular responses to acute heat shock in vitro, exercise, and exertional heat illness...

Strategies for the optimal timing to start renal replacement therapy in critically ill patients with acute kidney injury.

Science.gov (United States)

Bagshaw, Sean M; Wald, Ron

2017-05-01

Renal replacement therapy (RRT) is increasingly utilized to support critically ill patients with severe acute kidney injury (AKI). The question of whether and when to start RRT for a critically ill patient with AKI has long troubled clinicians. When severe complications of AKI develop, the need to commence RRT is unambiguous. In the absence of such complications but in the presence of severe AKI, the optimal time and thresholds for starting RRT are uncertain. The majority of existing data have largely been derived from observational studies. These have been limited due to confounding by indication, considerable heterogeneity in case mix and illness severity, and variably applied definitions for both AKI and for how "timing" was anchored relative to starting RRT. It is unclear whether a preemptive or earlier strategy of RRT initiation aimed largely at avoiding complications related to AKI or a more conservative strategy where RRT is started in response to developing complications leads to better patient-centered outcomes and health services use. This question has been the focus of 2 recently completed randomized trials. In this review, we provide an appraisal of available evidence, discuss existing knowledge gaps, and provide perspective on future research that will better inform the optimal timing of RRT initiation in AKI. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

A comparison of the incidence and understanding of altitude illness between porters and trekkers in the Solu Khumbu Region of Nepal.

Science.gov (United States)

Newcomb, Lauren; Sherpa, Chhewang; Nickol, Annabel; Windsor, Jeremy

2011-09-01

Altitude illness can occur in anyone who ascends to high altitude. Better understanding of altitude illness is associated with a lower incidence of acute mountain sickness (AMS). The purpose of this study is to compare, for the first time, the incidence and understanding of altitude illness between foreign trekkers and indigenous porters in Nepal. Interviews and questionnaires were completed at the International Porter Protection Group Rescue Post at Machermo (4470 m). Participants completed the Lake Louise acute mountain sickness self-assessment questionnaire. They were also asked about their actions in response to high altitude illness scenarios as well as their perception of the vulnerability of porters vs trekkers to altitude illness. Ascent profile, age, gender, ethnic origin, and altitude of home residence were also obtained. Trekkers (n=131) had a significantly higher incidence of AMS (21% vs 8%) than porters (n=92; P porters (whose home villages were below 3050 m, n=61) had a numerically higher, though not significantly different, incidence of AMS (10% vs 3%) compared to highland porters (n=31). The majority of trekkers and porters recognized the symptoms of altitude illness and the most appropriate action to be taken. Despite the lower incidence of AMS in porters, around half felt that they were at greater risk than trekkers. Porters had a lower incidence of AMS, which may be attributable to repeated ascents through the trekking season, or differences in reporting symptoms. Both trekkers and porters demonstrated appropriate knowledge of actions to be taken in response to altitude illness. Copyright © 2011 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

What diagnoses may make patients more seriously ill than they first appear? Mortality according to the Simple Clinical Score Risk Class at the time of admission compared to the observed mortality of different ICD9 codes identified on death or discharge.

LENUS (Irish Health Repository)

Kellett, John

2009-01-01

The Simple Clinical Score (SCS) determined at the time of admission places acutely ill general medical patients into one of five risk classes associated with an increasing risk of death within 30 days. The cohort of acute medical patient that the SCS was derived from had, on average, four combinations of 74 groupings of ICD9 codes. This paper reports the ICD9 codes associated with the different SCS risk classes and identifies those ICD9 codes with a greater observed mortality than that of other patients in the same SCS risk class.

Medical costs in patients with heart failure after acute heart failure events: one-year follow-up study.

Science.gov (United States)

Kim, Eugene; Kwon, Hye-Young; Baek, Sang Hong; Lee, Haeyoung; Yoo, Byung-Su; Kang, Seok-Min; Ahn, Youngkeun; Yang, Bong-Min

2018-03-01

This study investigated annual medical costs using real-world data focusing on acute heart failure. The data were retrospectively collected from six tertiary hospitals in South Korea. Overall, 330 patients who were hospitalized for acute heart failure between January 2011 and July 2012 were selected. Data were collected on their follow-up medical visits for 1 year, including medical costs incurred toward treatment. Those who died within the observational period or who had no records of follow-up visits were excluded. Annual per patient medical costs were estimated according to the type of medical services, and factors contributing to the costs using Gamma Generalized Linear Models (GLM) with log link were analyzed. On average, total annual medical costs for each patient were USD 6,199 (±9,675), with hospitalization accounting for 95% of the total expenses. Hospitalization cost USD 5,904 (±9,666) per patient. Those who are re-admitted have 88.5% higher medical expenditure than those who have not been re-admitted in 1 year, and patients using intensive care units have 19.6% higher expenditure than those who do not. When the number of hospital days increased by 1 day, medical expenses increased by 6.7%. Outpatient drug costs were not included. There is a possibility that medical expenses for AHF may have been under-estimated. It was found that hospitalization resulted in substantial costs for treatment of heart failure in South Korea, especially in patients with an acute heart failure event. Prevention strategies and appropriate management programs that would reduce both frequency of hospitalization and length of stay for patients with the underlying risk of heart failure are needed.

Delirium in the Critically Ill Child: Assessment and Sequelae.

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Paterson, Rebecca S; Kenardy, Justin A; De Young, Alexandra C; Dow, Belinda L; Long, Debbie A

2017-01-01

Delirium is a common and serious neuropsychiatric complication in critically ill patients of all ages. In the context of critical illness, delirium may emerge as a result of a cascade of underlying pathophysiologic mechanisms and signals organ failure of the brain. Awareness of the clinical importance of delirium in adults is growing as emerging research demonstrates that delirium represents a serious medical problem with significant sequelae. However, our understanding of delirium in children lags significantly behind the adult literature. In particular, our knowledge of how to assess delirium is complicated by challenges in recognizing symptoms of delirium in pediatric patients especially in critical and intensive care settings, and our understanding of its impact on acute and long-term functioning remains in its infancy. This paper focuses on (a) the challenges associated with assessing delirium in critically ill children, (b) the current literature on the outcomes of delirium including morbidity following discharge from PICU, and care-giver well-being, and (c) the importance of assessment in determining impact of delirium on outcome. Current evidence suggests that delirium is a diagnostic challenge for clinicians and may play a detrimental role in a child's recovery after discharge from the pediatric intensive care unit (PICU). Recommendations are proposed for how our knowledge and assessment of delirium in children could be improved.

Socio-economic disadvantage, quality of medical care and admission for acute severe asthma.

Science.gov (United States)

Kolbe, J; Vamos, M; Fergusson, W

1997-06-01

In asthma, socio-economic and health care factors may operate by a number of mechanisms to influence asthma morbidity and mortality. To determine the quality of medical care including the patient perception of the doctor-patient relationship, and the level of socio-economic disadvantage in patients admitted to hospital with acute severe asthma. One hundred and thirty-eight patients (15-50 years) admitted to hospital (general ward or intensive care unit) with acute asthma were prospectively assessed using a number of previously validated instruments. The initial subjects had severe asthma on admission (pH = 7.3 +/- 0.2, PaCO2 = 7.1 +/- 5.0 kPa, n = 90) but short hospital stay (3.7 +/- 2.6 days). Although having high morbidity (40% had hospital admission in the last year and 60% had moderate/severe interference with sleep and/or ability to exercise), they had indicators of good ongoing medical care (96% had a regular GP, 80% were prescribed inhaled steroids, 84% had a peak flow meter, GP measured peak flow routinely in 80%, 52% had a written crisis plan and 44% had a supply of steroids at home). However, they were severely economically disadvantaged (53% had experienced financial difficulties in the last year, and for 35% of households the only income was a social security benefit). In the last year 39% had delayed or put off GP visit because of cost. Management of the index attack was compromised by concern about medical costs in 16% and time off work in 20%. Patients admitted to hospital with acute asthma have evidence of good quality on-going medical care, but are economically disadvantaged. If issues such as financial barriers to health care are not acknowledged and addressed, the health care services for asthmatics will not be effectively utilised and the current reductions in morbidity and mortality may not be maintained.

Clinical and autopsy parameters of acute medical deaths in an emergency facility in South-west Nigeria

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JNA Ajuluchukwu

2013-01-01

Full Text Available Background: Acute medical deaths are usually consequences of acute critical diseases, or acute exacerbations of chronic diseases. Thus, autopsy - confirmed characteristics would provide support for future management strategies. Objectives: To examine clinical and autopsy parameters including causes of death (COD and mechanisms of death (MOD among acute medical deaths. Methods: A 5-year (2005-2009 retrospective analysis was undertaken of Emergency Department (ED related medical deaths occurring 4 days in 42.8%. Coma -36%, and dyspnoea -10% prompted early presentation; but late presentation (>4days characterised cough (4%, fever (10%, and body swelling (19%. Of the total, 23% presented after 10 pm, 16% were "dead on arrival" (DOA, and 40% died within six hours of arrival. Three commonest CODs were circulatory-cardiovascular disease [CVD](36%, infections/septicaemia (18%, and malignancies (8.4%. CVD subset was older (52 years, with significant male preponderance (62.5% vs 37.5%; p<0.05; but comparable mean age in both sexes. Common MODs were cerebral dysfunction (29% - including sub-types of intra-cerebral haemorrhage (51.8% and tonsillar herniation (33.3%, heart failure (19%, and septicaemia (15%. Conclusion: The highlights were late presentation, early demise from communicable and noncommunicable diseases; and common "exit" mechanisms of septicaemia, heart failure and cerebral dysfunction. These data will guide management and preventive strategies.

Heat-related illness in the African wilderness

African Journals Online (AJOL)

Wilderness heat-related illnesses span a continuum of medical problems caused by ... of modern science, clothing technology, and an understanding of physiology ..... guidelines for wilderness emergency care, heat-related illnesses, and EAH ...

Attitude toward mental illness amongst urban nonpsychiatric health professionals

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V Pande

2011-01-01

Full Text Available Background: This study was designed to examine the attitude of nonpsychiatric health professionals about mental illness in urban multispeciality tertiary care setting. Aim: To assess attitude toward mental illness among urban nonpsychiatric health professionals. Materials and Methods: A cross-sectional study design was used. A pretested, semistructured questionnaire was administered to 222 medical and paramedical staff at two tertiary care hospitals at Chandigarh. Results: There is an increased awareness of mental illness especially in military subjects. Literacy was associated with a positive attitude toward mental illness. Health care givers commonly fail to ask about the emotional well being of their patients. Many saw referral to psychiatrist as a form of punishment. There is uniform desire for more knowledge about psychiatric disorders in medical and paramedical staff. Conclusions: This study demonstrates the need for educational programs aimed at demystifying mental illness. A better understanding of mental disorders among the nonpsychiatric medical professional would help to allay fear and mistrust about mentally ill persons in the community as well as lessen stigmatization toward such persons.

Sports injuries and illnesses during the London Summer Olympic Games 2012.

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Engebretsen, Lars; Soligard, Torbjørn; Steffen, Kathrin; Alonso, Juan Manuel; Aubry, Mark; Budgett, Richard; Dvorak, Jiri; Jegathesan, Manikavasagam; Meeuwisse, Willem H; Mountjoy, Margo; Palmer-Green, Debbie; Vanhegan, Ivor; Renström, Per A

2013-05-01

The Olympic Movement Medical Code encourages all stakeholders to ensure that sport is practised without danger to the health of the athletes. Systematic surveillance of injuries and illnesses is the foundation for developing preventive measures in sport. To analyse the injuries and illnesses that occurred during the Games of the XXX Olympiad, held in London in 2012. We recorded the daily occurrence (or non-occurrence) of injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues by the London Organising Committee of the Olympic and Paralympic Games' (LOCOG) medical staff. In total, 10 568 athletes (4676 women and 5892 men) from 204 NOCs participated in the study. NOC and LOCOG medical staff reported 1361 injuries and 758 illnesses, equalling incidences of 128.8 injuries and 71.7 illnesses per 1000 athletes. Altogether, 11% and 7% of the athletes incurred at least one injury or illness, respectively. The risk of an athlete being injured was the highest in taekwondo, football, BMX, handball, mountain bike, athletics, weightlifting, hockey and badminton, and the lowest in archery, canoe slalom and sprint, track cycling, rowing, shooting and equestrian. 35% of the injuries were expected to prevent the athlete from participating during competition or training. Women suffered 60% more illnesses than men (86.0 vs 53.3 illnesses per 1000 athletes). The rate of illness was the highest in athletics, beach volleyball, football, sailing, synchronised swimming and taekwondo. A total of 310 illnesses (41%) affected the respiratory system and the most common cause of illness was infection (n=347, 46%). At least 11% of the athletes incurred an injury during the games and 7% of the athletes' an illness. The incidence of injuries and illnesses varied substantially among sports. Future initiatives should include the development of preventive measures tailored for each specific sport and the

Rational use of oxygen in medical disease and anesthesia

DEFF Research Database (Denmark)

Meyhoff, Christian S; Staehr, Anne K; Rasmussen, Lars S

2012-01-01

Supplemental oxygen is often administered during anesthesia and in critical illness to treat hypoxia, but high oxygen concentrations are also given for a number of other reasons such as prevention of surgical site infection (SSI). The decision to use supplemental oxygen is, however, controversial......, because of large heterogeneity in the reported results and emerging reports of side-effects. The aim of this article is to review the recent findings regarding benefits and harms of oxygen therapy in anesthesia and acute medical conditions....

Estimated Glomerular Filtration Rate Correlates Poorly with Four-Hour Creatinine Clearance in Critically Ill Patients with Acute Kidney Injury

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Christopher J. Kirwan

2013-01-01

Full Text Available Introduction. RIFLE and AKIN provide a standardised classification of acute kidney injury (AKI, but their categorical rather than continuous nature restricts their use to a research tool. A more accurate real-time description of renal function in AKI is needed, and some published data suggest that equations based on serum creatinine that estimate glomerular filtration rate (eGFR can provide this. In addition, incorporating serum cystatin C concentration into estimates of GFR may improve their accuracy, but no eGFR equations are validated in critically ill patients with AKI. Aim. This study tests whether creatinine or cystatin-C-based eGFR equations, used in patients with CKD, offer an accurate representation of 4-hour creatinine clearance (4CrCl in critically ill patients with AKI. Methods. Fifty-one critically ill patients with AKI were recruited. Thirty-seven met inclusion criteria, and the performance of eGFR equations was compared to 4CrCl. Results. eGFR equations were better than creatinine alone at predicting 4CrCl. Adding cystatin C to estimates did not improve the bias or add accuracy. The MDRD 7 eGFR had the best combination of correlation, bias, percentage error and accuracy. None were near acceptable standards quoted in patients with chronic kidney disease (CKD. Conclusions. eGFR equations are not sufficiently accurate for use in critically ill patients with AKI. Incorporating serum cystatin C does not improve estimates. eGFR should not be used to describe renal function in patients with AKI. Standards of accuracy for validating eGFR need to be set.

Evolving paradigm of illnesses presented to medical Intensive Care Unit in body builders: Cases from tertiary care center.

Science.gov (United States)

Garg, Sunil Kumar

2015-04-01

Bodybuilding is the use of progressive resistance exercise to control and develop one's musculature. With the rise in number of persons adopting this activity, there is evolving paradigm of illnesses presented to intensive care in this population subset. Strict adherence to details of bodybuilding and avoidance of unsupervised medications are essential to prevent untoward effects.

Clinical Presentations of Acute Leukemia

International Nuclear Information System (INIS)

Shahab, F.; Raziq, F.

2014-01-01

Objective: To document the clinical presentation and epidemiology of various types of acute leukemia with their respective referral source at a tertiary level centre in Peshawar. Study Design: An observational study. Place and Duration of Study: Department of Pathology, Hayatabad Medical Complex (HMC), Peshawar, from January 2011 to May 2012. Methodology: A total of 618 bone marrow biopsy reports were reviewed. All biopsy reports labeled as acute leukemia were reviewed for age, gender, address, referring unit, diagnosis on bone marrow examination, presenting complaints, duration of illness and findings of clinical examination. Results: Ninety-two patients were diagnosed as suffering from acute leukemias (15%). ALL was most prevalent (46%), followed by AML (38%) and undifferentiated acute leukemia (16%). Males were affected more compared to females (60% vs. 40%). ALL and AML were predominant in pediatric (64%) and adults (77%) patients respectively. Patients from Afghanistan accounted for 33% of all cases followed by Peshawar (14%). Fever (77%), pallor (33%) and bleeding disorders (23%) were the main presenting complaints. Enlargement of liver, spleen and lymph nodes together was associated with ALL compared with AML (p = 0.004). Conclusion: ALL-L1 and AML-M4 were the most common sub-types. Fever, pallor and bleeding disorders were the main presenting complaints. Enlargement of liver, spleen and lymph nodes was more frequently associated with ALL compared to AML. (author)

Comparing Mental Illness Stigma among Nurses in Psychiatric and Non-Psychiatric Wards in Tabriz University of Medical Sciences

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Ebrahimi Hossein

2017-03-01

Full Text Available Stigma can complicate people’s mental health problems by affecting different sides of personal life, increasing negative attitudes, causing discriminatory behavior towards them, and reducing the chances of recovery and returning to normal life. This research aims to compare the stigma of mental illness among nurses working in psychiatric and non-psychiatric wards in Tabriz University of Medical Sciences. A total of 240 nurses participated in this descriptive and analytic study. The data were collected using a demographic questionnaire and the Community Attitudes towards the Mentally Ill (CAMI Scale, which is a 40-item self-report questionnaire. All data were analyzed using SPSS 13. The majority of nurses have a medium level of stigma toward people with mental illness, and there is no significant relation between the type of wards and mean stigma scores. After eliminating factors such as mental illness in nurses and their families, it seems that only working with people with mental illness in psychiatric wards is not enough to create a positive attitude toward them. Additionally, the less physical activity and taking advantage of legal benefits of work hardship for psychiatric nurses, low income, and stigma toward psychiatric nursing, probably may make a difference in inclining to work in psychiatry ward between the two groups in spite of relatively equal stigma scores.

Febrile illness diagnostics and the malaria-industrial complex: a socio-environmental perspective

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Justin Stoler

2016-11-01

Full Text Available Abstract Background Global prioritization of single-disease eradication programs over improvements to basic diagnostic capacity in the Global South have left the world unprepared for epidemics of chikungunya, Ebola, Zika, and whatever lies on the horizon. The medical establishment is slowly realizing that in many parts of sub-Saharan Africa (SSA, particularly urban areas, up to a third of patients suffering from acute fever do not receive a correct diagnosis of their infection. Main body Malaria is the most common diagnosis for febrile patients in low-resource health care settings, and malaria misdiagnosis has soared due to the institutionalization of malaria as the primary febrile illness of SSA by international development organizations and national malaria control programs. This has inadvertently created a “malaria-industrial complex” and historically obstructed our complete understanding of the continent’s complex communicable disease epidemiology, which is currently dominated by a mélange of undiagnosed febrile illnesses. We synthesize interdisciplinary literature from Ghana to highlight the complexity of communicable disease care in SSA from biomedical, social, and environmental perspectives, and suggest a way forward. Conclusion A socio-environmental approach to acute febrile illness etiology, diagnostics, and management would lead to substantial health gains in Africa, including more efficient malaria control. Such an approach would also improve global preparedness for future epidemics of emerging pathogens such as chikungunya, Ebola, and Zika, all of which originated in SSA with limited baseline understanding of their epidemiology despite clinical recognition of these viruses for many decades. Impending ACT resistance, new vaccine delays, and climate change all beckon our attention to proper diagnosis of fevers in order to maximize limited health care resources.

Emotional dysfunction in schizophrenia spectrum psychosis: the role of illness perceptions.

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Watson, P W B; Garety, P A; Weinman, J; Dunn, G; Bebbington, P E; Fowler, D; Freeman, D; Kuipers, E

2006-06-01

Assessing illness perceptions has been useful in a range of medical disorders. This study of people with a recent relapse of their psychosis examines the relationship between illness perception, their emotional responses and their attitudes to medication. One hundred patients diagnosed with a non-affective psychotic disorder were assessed within 3 months of relapse. Measures included insight, self-reported illness perceptions, medication adherence, depression, self-esteem and anxiety. Illness perceptions about psychosis explained 46, 36 and 34% of the variance in depression, anxiety and self-esteem respectively. However, self-reported medication adherence was more strongly associated with a measure of insight. Negative illness perceptions in psychosis are clearly related to depression, anxiety and self-esteem. These in turn have been linked to symptom maintenance and recurrence. Clinical interventions that foster appraisals of recovery rather than of chronicity and severity may therefore improve emotional well-being in people with psychosis. It might be better to address adherence to medication through direct attempts at helping them understand their need for treatment.

Impact of chronic kidney disease on long-term ischemic and bleeding outcomes in medically managed patients with acute coronary syndromes

DEFF Research Database (Denmark)

Melloni, Chiara; Cornel, Jan H; Hafley, Gail

2016-01-01

AIMS: We aimed to study the relationship of chronic kidney disease stages with long-term ischemic and bleeding outcomes in medically managed acute coronary syndrome patients and the influence of more potent antiplatelet therapies on platelet reactivity by chronic kidney disease stage. METHODS...... AND RESULTS: We estimated creatinine clearance for 8953 medically managed acute coronary syndrome patients enrolled in the Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes trial. Patients were classified by chronic kidney disease stage: normal renal...... function/mild (creatinine clearance >60 mL/min); moderate (creatinine clearance 30-60 mL/min); severe (creatinine clearance event rates through 30 months were evaluated for ischemic (cardiovascular death, myocardial infarction or stroke; primary end point) and bleeding (Global Use...

Unusual acute encephalitis involving the thalamus: imaging features

Energy Technology Data Exchange (ETDEWEB)

Kim, Sam Soo [Kangwon National University Hospital, Chuncheon (Korea, Republic of); Chang, Kee Hyun; Kim, Kyung Won; Han Moon Hee [Seoul National University College of Medicine, Seoul (Korea, Republic of); Park, Sung Ho; Nam, Hyun Woo [Seoul City Boramae Hospital, Seoul (Korea, Republic of); Choi, Kyu Ho [Kangnam St. Mary' s Hospital, Seoul (Korea, Republic of); Cho, Woo Ho [Sanggyo Paik Hospital, Seoul (Korea, Republic of)

2001-06-01

To describe the brain CT and MR imaging findings of unusual acute encephalitis involving the thalamus. We retrospectively reviewed the medical records and CT and/or MR imaging findings of six patients with acute encephalitis involving the thalamus. CT (n=6) and MR imaging (n=6) were performed during the acute and/or convalescent stage of the illness. Brain CT showed brain swelling (n=2), low attenuation of both thalami (n=1) or normal findings (n=3). Initial MR imaging indicated that in all patients the thalamus was involved either bilaterally (n=5) or unilaterally (n=1). Lesions were also present in the midbrain (n=5), medial temporal lobe (n=4), pons (n=3), both hippocampi (n=3) the insular cortex (n=2), medulla (n=2), lateral temporal lobe cortex (n=1), both cingulate gyri (n=1), both basal ganglia (n=1), and the left hemispheric cortex (n=1). These CT or MR imaging findings of acute encephalitis of unknown etiology were similar to a combination of those of Japanese encephalitis and herpes simplex encephalitis. In order to document the specific causative agents which lead to the appearance of these imaging features, further investigation is required.

Generalized anxiety disorder: acute and chronic treatment.

Science.gov (United States)

Rynn, Moira A; Brawman-Mintzer, Olga

2004-10-01

Clinical and epidemiological data suggest that generalized anxiety disorder (GAD) is a chronic illness causing patients to suffer for many years leading to significant distress in daily life functioning. The literature suggests the several conclusions. GAD is a disorder in need of appropriate treatment and often has a chronic course with comorbid conditions, such as major depression and other anxiety disorders. Benzodiazepines, while effective anxiolytic agents acutely, when prescribed for >4 weeks cause rebound anxiety and following prolonged therapy may lead to withdrawal symptoms. Antidepressants cause significant anxiety relief compared with placebo and for psychosocial treatment cognitive-behavioral therapy is an efficacious psychosocial treatment. Many GAD patients are in need of long-term medication management. Furthermore, there is limited data for patients diagnosed with GAD the treatment outcome with the combination of medication and psychotherapy both acutely and long-term; how to best sequence these treatments; for those patients who do not meet remission criteria what is the ideal approach for augmentation; and for patients with treatment-refractory GAD the empirical evidence is lacking on medication switching and augmentation strategies. Research is needed in the area of developing treatment strategies for patients suffering from treatment-refractory GAD. There is still an urgent need to explore treatment combinations and duration strategies in the management of patients suffering with GAD.

Predicting recovery from acute kidney injury in critically ill patients

DEFF Research Database (Denmark)

Itenov, Theis S; Berthelsen, Rasmus Ehrenfried; Jensen, Jens-Ulrik

2018-01-01

these patients. DESIGN: Observational study with development and validation of a risk prediction model. SETTING: Nine academic ICUs in Denmark. PARTICIPANTS: Development cohort of critically ill patients with AKI at ICU admission from the Procalcitonin and Survival Study cohort (n = 568), validation cohort.......1%. CONCLUSION: We constructed and validated a simple model that can predict the chance of recovery from AKI in critically ill patients....

The effect of hospitalization with medical illnesses on the suicide risk in the oldest old: a population-based register study

DEFF Research Database (Denmark)

Erlangsen, Annette; Vach, Werner; Jeune, Bernhard

2005-01-01

-level register data. SETTING: Population-based record linkage. PARTICIPANTS: All persons aged 52 and older living in Denmark during 1996 to 1998 (N=1,684,205). MEASUREMENTS: The studied event is completed suicide. The following time-varying variables are included in the analysis: current age, hospitalization...... been hospitalized during the previous 2 years: 113 per 100,000 versus 80 per 100,000 in the general population of men aged 80 and older. Also, the oldest-old women with a history of hospitalization had a higher suicide rate than their peer group. Nevertheless, the oldest old experienced a lower...... with no hospitalization, although they experience a lower increase in risk after hospitalization than the middle-aged. The increased prevalence of medical illnesses explains a part of the greater suicide risk with age, especially for the oldest old women. Considering that hospitalization with medical illness often...

Potentially inappropriate prescribing and the risk of adverse drug reactions in critically ill older adults

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Galli TB

2016-12-01

Full Text Available Background: Potentially inappropriate medication (PIM use in the elderly is associated with increased risk of adverse drug reactions (ADRs, but there is limited information regarding PIM use in the intensive care unit (ICU setting. Objective: The aim of the study is to describe the prevalence and factors associated with the use of PIM and the occurrence of PIM-related adverse reactions in the critically ill elderly. Methods: This study enrolled all critically ill older adults (60 years or more admitted to medical or cardiovascular ICUs between January and December 2013, in a large tertiary teaching hospital. For all patients, clinical pharmacists listed the medications given during the ICU stay and data on drugs were analyzed using 2012 Beers Criteria, to identify the prevalence of PIM. For each identified PIM the medical records were analyzed to evaluate factors associated with its use. The frequency of ADRs and, the causal relationship between PIM and the ADRs identified were also evaluated through review of medical records. Results: According to 2012 Beers Criteria, 98.2% of elderly patients used at least one PIM (n=599, of which 24.8% were newly started in the ICUs. In 29.6% of PIMs, there was a clinical circumstance that justified their prescription. The number of PIMs was associated with ICU length of stay and total number of medications. There was at least one ADR identified in 17.8% of patients; more than 40% were attributed to PIM, but there was no statistical association. Conclusions: There is a high prevalence of PIM used in acutely ill older people, but they do not seem to be the major cause of adverse drug reactions in this population. Although many PIMs had a clinical circumstance that led to their prescription during the course of ICU hospitalization, many were still present upon hospital discharge. Therefore, prescription of PIMs should be minimized to improve the safety of elderly patients.

Temporary Decompression in Critically Ill Patients: Retrospective Comparison of Ileostomy and Colostomy.

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Lin, Zhi-Liang; Yu, Wen-Kui; Shi, Jia-Liang; Chen, Qi-Yi; Tan, Shan-Jun; Li, Ning

2014-05-01

In critically ill patients, gastrointestinal function plays an important role in multiple organ dysfunction syndrome. Patients suffering from acute lower gastrointestinal dysfunction need to be performed a temporary fecal diversion after the failure of conservative treatment. This study aims to determine which type of fecal diversion is associated with better clinical outcomes in critically ill patients. Data of critically ill patients requiring surgical decompression following acute lower gastrointestinal dysfunction between January 2008 and June 2013 were retrospectively analyzed. Comparison was made between ileostomy group and colostomy group regarding the stoma-related complications and the recovery after stoma creation. 63 patients consisted of temporary ileostomy group (n = 35) and temporary colostomy group (n = 28) were included in this study. First bowel movement and length of enteral nutrition intolerance after fecal diversion were both significantly shorter in the ileostomy group than in the colostomy group (1.70 ± 0.95 vs. 3.04 ± 1.40; p colostomy group. Both procedures provide an effective defunctioning of the distant gastrointestinal tract with a low complication incidence. We prefer a temporary ileostomy to temporary colostomy for acute lower gastrointestinal dysfunction in critically ill patients.

Injury and illness sustained by human competitors in the 2010 iditarod sled dog race.

Science.gov (United States)

Gallea, James W; Higgins, George L; Germann, Carl A; Strout, Tania D

2014-07-01

Alaska's 1049-mile Iditarod Trail Sled Dog Race is the world's longest sled dog race and the flagship event in the sport of sled dog racing. Race conditions are typically harsh. Physicians are not officially enlisted to care for human competitors. Instead, medical needs are met through an informal system of volunteers, local health care providers, and a fleet of bush planes. The goals of this study were to identify the types of human injury and illness experienced and the methods by which these conditions are treated. Competitors in the 2010 Iditarod were surveyed at the halfway point and at the finish of the race. Survey elements included specific types and frequencies of injuries and illnesses, and the sources and types of treatments. Seventy-one teams entered the race, 62 participated in the halfway point survey, and 55 completed the finish line survey. Ninety-nine injuries were reported by 42 (68%) of the survey respondents. Frostbite was the most common injury, occurring in 20 (31%) of the respondents. Musculoskeletal pain was also commonly reported. Two mushers sustained closed head injuries, with 1 requiring evacuation. Twenty-three mushers (37%) reported an acute nontraumatic condition, most frequently an upper respiratory infection (9 respondents). In most instances, medical conditions were self-managed. Race veterinarians and support staff, as well as local village clinicians, administered the majority of care, typically wound care or oral antibiotic administration. Most injuries and illnesses sustained by mushers in the Iditarod are minor and self-treatable. Life-threatening conditions are rare, and the need for an organized medical care system seems low. Copyright © 2014 Elsevier Inc. All rights reserved.

Review of Epidemiological Studies of Drinking-Water Turbidity in Relation to Acute Gastrointestinal Illness.

Science.gov (United States)

De Roos, Anneclaire J; Gurian, Patrick L; Robinson, Lucy F; Rai, Arjita; Zakeri, Issa; Kondo, Michelle C

2017-08-17

Turbidity has been used as an indicator of microbiological contamination of drinking water in time-series studies attempting to discern the presence of waterborne gastrointestinal illness; however, the utility of turbidity as a proxy exposure measure has been questioned. We conducted a review of epidemiological studies of the association between turbidity of drinking-water supplies and incidence of acute gastrointestinal illness (AGI), including a synthesis of the overall weight of evidence. Our goal was to evaluate the potential for causal inference from the studies. We identified 14 studies on the topic (distinct by region, time period and/or population). We evaluated each study with regard to modeling approaches, potential biases, and the strength of evidence. We also considered consistencies and differences in the collective results. Positive associations between drinking-water turbidity and AGI incidence were found in different cities and time periods, and with both unfiltered and filtered supplies. There was some evidence for a stronger association at higher turbidity levels. The studies appeared to adequately adjust for confounding. There was fair consistency in the notable lags between turbidity measurement and AGI identification, which fell between 6 and 10 d in many studies. The observed associations suggest a detectable incidence of waterborne AGI from drinking water in the systems and time periods studied. However, some discrepant results indicate that the association may be context specific. Combining turbidity with seasonal and climatic factors, additional water quality measures, and treatment data may enhance predictive modeling in future studies. https://doi.org/10.1289/EHP1090.

Skeletal muscle deiodinase type 2 regulation during illness in mice

NARCIS (Netherlands)

Kwakkel, J.; van Beeren, H. C.; Ackermans, M. T.; Platvoet-ter Schiphorst, M. C.; Fliers, E.; Wiersinga, W. M.; Boelen, A.

2009-01-01

We have previously shown that skeletal muscle deiodinase type 2 (D2) mRNA (listed as Dio2 in MGI Database) is up-regulated in an animal model of acute illness. However, human Studies on the expression Of muscle D2 during illness report conflicting data. Therefore, we evaluated the expression of

The use of medical care and the prevalence of serious illness in an adult Prader-Willi syndrome cohort.

Science.gov (United States)

Sinnema, Margje; Maaskant, Marian A; van Schrojenstein Lantman-de Valk, Henny M J; Boer, Harm; Curfs, Leopold M G; Schrander-Stumpel, Constance T R M

2013-08-01

Adults with Prader-Willi syndrome (PWS) have an increased occurrence of several medical conditions. We report on the consequences of high morbidity rates such as prevalence rate of hospital admissions, medication use and surgery in a Dutch cohort of adults with PWS. Special attention is paid to causes and symptoms of serious illness. Participants were contacted via the Dutch Prader-Willi Parent Association and through physicians specializing in persons with ID. The persons with PWS and their main caregivers were visited at home. Information was collected through semi-structured interviews on 102 adults with PWS. The need for medical care in the neonatal period is associated with hypotonia and feeding problems. Hospital admissions for respiratory tract infections are frequent. During childhood most hospital admissions were due to PWS syndrome specific surgery. During adolescence hospital admissions occurred for scoliosis surgery and endocrine evaluations. At adult age, hospitalization was associated with inguinal hernia surgery, diabetes mellitus, psychosis, erysipelas, water and drug intoxications. In the older group, respiratory infections were again the main reason for hospital admissions. Frequently used medications at adult age included psychotropics, laxatives, anti-diabetics and dermatologic preparations. Abnormal drinking patterns, problems with anesthesia, decreased ability to vomit, abnormal pain awareness and unpredictable fever responses were frequent and often lead to delayed diagnoses of serious conditions. People with PWS are frequent users of medical-care. Reasons for hospitalization and medication use are age specific. Knowledge on the different presentation of symptoms in people with PWS is needed. In case of unexplained illness, disturbances of consciousness and behavioral changes in people with PWS, an infection should be ruled out in the first place. Information from this study may help in preventing conditions and recognizing conditions in an

Brief review: Adoption of electronic medical records to enhance acute pain management.

Science.gov (United States)

Goldstein, David H; Phelan, Rachel; Wilson, Rosemary; Ross-White, Amanda; VanDenKerkhof, Elizabeth G; Penning, John P; Jaeger, Melanie

2014-02-01

The purpose of this paper is to examine physician barriers to adopting electronic medical records (EMRs) as well as anesthesiologists' experiences with the EMRs used by the acute pain management service at two tertiary care centres in Canada. We first review the recent literature to determine if physician barriers to adoption are changing given the exponential growth of information technology and the evolving healthcare environment. We next report on institutional experience from two academic health sciences centres regarding the challenges they encountered over the past ten years in developing and implementing an electronic medical record system for acute pain management. The key identified barriers to adoption of EMRs are financial, technological, and time constraints. These barriers are identical to those reported in a systematic review performed prior to 2009 and remain significant factors challenging implementation. These challenges were encountered during our institution's process of adopting EMRs specific to acute pain management. In addition, our findings emphasize the importance of physician participation in the development and implementation stages of EMRs in order to incorporate their feedback and ensure the EMR system is in keeping with their workflow. Use of EMRs will inevitably become the standard of care; however, many barriers persist to impede their implementation and adoption. These challenges to implementation can be facilitated by a corporate strategy for change that acknowledges the barriers and provides the resources for implementation. Adoption will facilitate benefits in communication, patient management, research, and improved patient safety.

Relating calls to US poison centers for potential exposures to medications to Centers for Disease Control and Prevention reporting of influenza-like illness.

Science.gov (United States)

Beauchamp, Gillian A; McKeown, Nathanael J; Rodriguez, Sergio; Spyker, Daniel A

2016-03-01

The Centers for Disease Control (CDC) monitors influenza like illness (ILI) and the National Poison Data System (NPDS) warehouses call data uploaded by US poison centers regarding reported exposures to medication. We examined the relationship between calls to poison centers regarding reported exposures to medications commonly used to treat ILI and weekly reports of ILI. The CDC reports ILI, by age group, for each of 10 Health and Human Services (HHS) regions. We examined NPDS summary data from calls reported to poison centers regarding reported exposures to acetaminophen, cough/cold medications, and promethazine, for the same weeks, age groups, and HHS regions for influenza seasons 2000-2013. ILI and NPDS exposures were examined using graphical plots, descriptive statistics, stepwise regression analysis, and Geographic Information Systems (GIS). About 5,101,841 influenza-like illness cases were reported to the CDC, and 2,122,940 calls regarding reported exposures to medications commonly used to treat ILI, were reported by poison centers to the NPDS over the 13 flu seasons. Analysis of stepwise models of the linear untransformed data involving 24 NPDS data groups and for 60 ILI measures, over the 13 influenza seasons, demonstrated that reported exposures to medications used to treat ILI correlated with reported cases of ILI with a median R(2 )=( )0.489 (min R(2 )=( )0.248, max R(2 )=( )0.717), with mean ± SD of R(2 )=( )0.494 ± 0.121. Median number of parameters used (degrees of freedom - 1) was 7. NPDS data regarding poison center calls for selected ILI medication exposures were highly correlated with CDC ILI data. Since NPDS data are available in real time, it provides complimentary ILI monitoring. This approach may provide public health value in predicting other illnesses which are not currently as thoroughly monitored.

"For Their Own Good": A Response to Popular Arguments Against Permitting Medical Assistance in Dying (MAID) where Mental Illness Is the Sole Underlying Condition.

Science.gov (United States)

Dembo, Justine; Schuklenk, Udo; Reggler, Jonathan

2018-01-01

Canada is approaching its federal government's review of whether patients should be eligible for medical assistance in dying (MAID) where mental illness is the sole underlying medical condition, and when "natural death" is not "reasonably foreseeable". For those opposed, arguments involve the following themes: capacity, value of life, vulnerability, stigma, irremediability, and the role of physicians. It has also been suggested that those who are able-bodied should have to kill themselves, even though suicide may be painful, lonely, and violent. Opponents of MAID for severe, refractory suffering due to mental illness imply that it is acceptable to remove agency from such patients on paternalistic grounds. After years of efforts to destigmatise mental illness, these kinds of arguments effectively declare all patients with mental illness, regardless of capacity, unable to make considered choices for themselves. The current paper argues that decisions about capacity must be made on an individual-patient basis. Given the rightful importance granted to respect for patient autonomy in liberal democracies, the wholesale removal of agency advocated by opponents of a permissive MAID regime is difficult to reconcile with Canadian constitutional values.

Aspects of protein metabolism in children in acute and chronic illness

NARCIS (Netherlands)

Geukers, V.G.M.

2014-01-01

In critically ill children, a negative protein balance is associated with an increased incidence of infections, fewer ventilator-free days, and increased length of stay in the pediatric intensive care unit. Additionally, a malnourished state due to chronic illness increases the risk of respiratory

Interactive algorithms for teaching and learning acute medicine in the network of medical faculties MEFANET.

Science.gov (United States)

Schwarz, Daniel; Štourač, Petr; Komenda, Martin; Harazim, Hana; Kosinová, Martina; Gregor, Jakub; Hůlek, Richard; Smékalová, Olga; Křikava, Ivo; Štoudek, Roman; Dušek, Ladislav

2013-07-08

Medical Faculties Network (MEFANET) has established itself as the authority for setting standards for medical educators in the Czech Republic and Slovakia, 2 independent countries with similar languages that once comprised a federation and that still retain the same curricular structure for medical education. One of the basic goals of the network is to advance medical teaching and learning with the use of modern information and communication technologies. We present the education portal AKUTNE.CZ as an important part of the MEFANET's content. Our focus is primarily on simulation-based tools for teaching and learning acute medicine issues. Three fundamental elements of the MEFANET e-publishing system are described: (1) medical disciplines linker, (2) authentication/authorization framework, and (3) multidimensional quality assessment. A new set of tools for technology-enhanced learning have been introduced recently: Sandbox (works in progress), WikiLectures (collaborative content authoring), Moodle-MEFANET (central learning management system), and Serious Games (virtual casuistics and interactive algorithms). The latest development in MEFANET is designed for indexing metadata about simulation-based learning objects, also known as electronic virtual patients or virtual clinical cases. The simulations assume the form of interactive algorithms for teaching and learning acute medicine. An anonymous questionnaire of 10 items was used to explore students' attitudes and interests in using the interactive algorithms as part of their medical or health care studies. Data collection was conducted over 10 days in February 2013. In total, 25 interactive algorithms in the Czech and English languages have been developed and published on the AKUTNE.CZ education portal to allow the users to test and improve their knowledge and skills in the field of acute medicine. In the feedback survey, 62 participants completed the online questionnaire (13.5%) from the total 460 addressed

The hidden costs: Identification of indirect costs associated with acute gastrointestinal illness in an Inuit community

Science.gov (United States)

Vriezen, Rachael; Edge, Victoria L.; Ford, James; Wood, Michele; Harper, Sherilee

2018-01-01

Background Acute gastrointestinal illness (AGI) incidence and per-capita healthcare expenditures are higher in some Inuit communities as compared to elsewhere in Canada. Consequently, there is a demand for strategies that will reduce the individual-level costs of AGI; this will require a comprehensive understanding of the economic costs of AGI. However, given Inuit communities’ unique cultural, economic, and geographic contexts, there is a knowledge gap regarding the context-specific indirect costs of AGI borne by Inuit community members. This study aimed to identify the major indirect costs of AGI, and explore factors associated with these indirect costs, in the Inuit community of Rigolet, Canada, in order to develop a case-based context-specific study framework that can be used to evaluate these costs. Methods A mixed methods study design and community-based methods were used. Qualitative in-depth, group, and case interviews were analyzed using thematic analysis to identify and describe indirect costs of AGI specific to Rigolet. Data from two quantitative cross-sectional retrospective surveys were analyzed using univariable regression models to examine potential associations between predictor variables and the indirect costs. Results/Significance The most notable indirect costs of AGI that should be incorporated into cost-of-illness evaluations were the tangible costs related to missing paid employment and subsistence activities, as well as the intangible costs associated with missing community and cultural events. Seasonal cost variations should also be considered. This study was intended to inform cost-of-illness studies conducted in Rigolet and other similar research settings. These results contribute to a better understanding of the economic impacts of AGI on Rigolet residents, which could be used to help identify priority areas and resource allocation for public health policies and programs. PMID:29768456

Clinical profile and outcome of acute encephalitis syndrome (AES patients treated in College of Medical Sciences-Teaching Hospital

Directory of Open Access Journals (Sweden)

Lekhjung J Thapa

2014-01-01

Full Text Available Objective: Acute encephalitis syndrome is a cause of significant morbidity and mortality in Nepal. Although Japanese encephalitis virus (JEV was thought to be a major cause for acute encephalitis syndrome, more non-Japanese encephalitis virus cases are reported. The outcome of patients with acute encephalitis syndrome is variable. Our study was designed to study the clinical profile and outcome of patients with acute encephalitis syndrome managed in tertiary care center in central Nepal. Methods: The record of patients admitted with diagnosis of acute encephalitis syndrome,from January 2010 to December 2010 in College of Medical Sciences-Teaching Hospital (CMS-TH was reviewed. They were classified clinically as meningitis, encephalitis and meningoencephalitis. The clinical details and reports of the patients were recorded and analyzed. Results: Total of 85 cases of meningitis and encephalitis were identified. Mean age was 19.18 years. Fifty-six (65.9% patients were males and 29 (34.1% were females. Sixty (70.58% patients had meningitis, 8 (9.41% had encephalitis, and 17 (20.0% had meningoencephalitis. JE serology was positive in 4 patients (4.7%. Seventy-two (84.7% patients made full recovery and were discharged from hospital. Thirteen (15.3% patients left against medical advice (LAMA. Conclusion: Acute encephalitis syndrome is still a major public health problem in Nepal. Few of these patients have Japanese Encephalitis. There is a trend towards improved outcome because of availability of improved health services. However, financial constraint remains a challenge in management of acute encephalitis syndrome. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-2, 31-37 DOI: http://dx.doi.org/10.3126/jcmsn.v9i2.9685

Sports injuries and illnesses in the Sochi 2014 Olympic Winter Games.

Science.gov (United States)

Soligard, Torbjørn; Steffen, Kathrin; Palmer-Green, Debbie; Aubry, Mark; Grant, Marie-Elaine; Meeuwisse, Willem; Mountjoy, Margo; Budgett, Richard; Engebretsen, Lars

2015-04-01

Systematic surveillance of injuries and illnesses is the foundation for developing preventive measures in sport. To analyse the injuries and illnesses that occurred during the XXII Olympic Winter Games, held in Sochi in 2014. We recorded the daily occurrence (or non-occurrence) of injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues by the Sochi 2014 medical staff. NOC and Sochi 2014 medical staff reported 391 injuries and 249 illnesses among 2780 athletes from 88 NOCs, equalling incidences of 14 injuries and 8.9 illnesses per 100 athletes over an 18-day period of time. Altogether, 12% and 8% of the athletes incurred at least one injury or illness, respectively. The percentage of athletes injured was highest in aerial skiing, snowboard slopestyle, snowboard cross, slopestyle skiing, halfpipe skiing, moguls skiing, alpine skiing, and snowboard halfpipe. Thirty-nine per cent of the injuries were expected to prevent the athlete from participating in competition or training. Women suffered 50% more illnesses than men. The rate of illness was highest in skeleton, short track, curling, cross-country skiing, figure skating, bobsleigh and aerial skiing. A total of 159 illnesses (64%) affected the respiratory system, and the most common cause of illness was infection (n=145, 58%). Overall, 12% of the athletes incurred at least one injury during the games, and 8% an illness, which is similar to prior Olympic Games. The incidence of injuries and illnesses varied substantially between sports. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Expatriates ill after travel: results from the Geosentinel Surveillance Network.

Science.gov (United States)

Lim, Poh-Lian; Han, Pauline; Chen, Lin H; MacDonald, Susan; Pandey, Prativa; Hale, DeVon; Schlagenhauf, Patricia; Loutan, Louis; Wilder-Smith, Annelies; Davis, Xiaohong M; Freedman, David O

2012-12-31

Expatriates are a distinct population at unique risk for health problems related to their travel exposure. We analyzed GeoSentinel data comparing ill returned expatriates with other travelers for demographics, travel characteristics, and proportionate morbidity (PM) for travel-related illness. Our study included 2,883 expatriates and 11,910 non-expatriates who visited GeoSentinel clinics ill after travel. Expatriates were more likely to be male, do volunteer work, be long-stay travelers (>6 months), and have sought pre-travel advice. Compared to non-expatriates, expatriates returning from Africa had higher proportionate morbidity (PM) for malaria, filariasis, schistosomiasis, and hepatitis E; expatriates from the Asia-Pacific region had higher PM for strongyloidiasis, depression, and anxiety; expatriates returning from Latin America had higher PM for mononucleosis and ingestion-related infections (giardiasis, brucellosis). Expatriates returning from all three regions had higher PM for latent TB, amebiasis, and gastrointestinal infections (other than acute diarrhea) compared to non-expatriates. When the data were stratified by travel reason, business expatriates had higher PM for febrile systemic illness (malaria and dengue) and vaccine-preventable infections (hepatitis A), and volunteer expatriates had higher PM for parasitic infections. Expatriates overall had higher adjusted odds ratios for latent TB and lower odds ratios for acute diarrhea and dermatologic illness. Ill returned expatriates differ from other travelers in travel characteristics and proportionate morbidity for specific diseases, based on the region of exposure and travel reason. They are more likely to present with more serious illness.

Acute respiratory symptoms and general illness during the first year of life: a population-based birth cohort study

DEFF Research Database (Denmark)

von Linstow, Marie-Louise; Holst, Klaus Kähler; Larsen, Karina

2008-01-01

. Determinants for respiratory symptoms were increasing age, winter season, household size, size of residence, day-care attendance, and having siblings aged 1-3 years attending a day nursery. In conclusion, the present study provides detailed data on the occurrence of disease symptoms during the first year......Respiratory symptoms are common in infancy. Most illnesses occurring among children are dealt with by parents and do not require medical attention. Nevertheless, few studies have prospectively and on a community-basis assessed the amount of respiratory symptoms and general illness in normal infants...... out by multiple logistic regression analysis. On average, children had general symptoms for 3.5 months during their first year of life, nasal discharge being most frequent followed by cough. Frequency of all symptoms increased steeply after 6 months of age. Each child had on average 6.3 episodes...

The Medical Home Concept and Congenital Adrenal Hyperplasia: a Comfortable Habitat!

Directory of Open Access Journals (Sweden)

Witchel SelmaFeldman

2010-05-01

Full Text Available Patient-centered interdisciplinary health care for children with chronic medical disorders represents an evolution from the traditional "stop and go" treatment for acute illnesses. This model for health care delivery has been called the "medical home," a concept that was originally developed in pediatrics for the care of children with special needs. Patient and family-centered, comprehensive, interdisciplinary, culturally effective, and readily accessible health care delivery is desirable for the care of children with congenital adrenal hyperplasia. As children with congenital adrenal hyperplasia (CAH become adolescents and young adults, transfer of this health care delivery model to adult endocrinologists is appropriate.

The Medical Home Concept and Congenital Adrenal Hyperplasia: A Comfortable Habitat!

Directory of Open Access Journals (Sweden)

Selma Feldman Witchel

2010-01-01

Full Text Available Patient-centered interdisciplinary health care for children with chronic medical disorders represents an evolution from the traditional “stop and go” treatment for acute illnesses. This model for health care delivery has been called the “medical home,” a concept that was originally developed in pediatrics for the care of children with special needs. Patient and family-centered, comprehensive, interdisciplinary, culturally effective, and readily accessible health care delivery is desirable for the care of children with congenital adrenal hyperplasia. As children with congenital adrenal hyperplasia (CAH become adolescents and young adults, transfer of this health care delivery model to adult endocrinologists is appropriate.

Respiratory syncytial virus in adults with severe acute respiratory illness in a high HIV prevalence setting.

Science.gov (United States)

Moyes, Jocelyn; Walaza, Sibongile; Pretorius, Marthi; Groome, Michelle; von Gottberg, Anne; Wolter, Nicole; Haffejee, Sumayya; Variava, Ebrahim; Cohen, Adam L; Tempia, Stefano; Kahn, Kathleen; Dawood, Halima; Venter, Marietjie; Cohen, Cheryl; Madhi, Shabir A

2017-10-01

There are limited data on the epidemiology of respiratory syncytial virus (RSV) illness in HIV-infected adults or the elderly in Africa. We studied the epidemiology of RSV-associated severe acute respiratory illness (SARI) hospitalizations in adults in South Africa from 2009 through 2013. Individuals admitted to sentinel surveillance hospitals were investigated by respiratory tract swabs for RSV, using a multiplex real-time polymerase chain reaction assay. The incidence of RSV-associated SARI was calculated for the one site with population denominators. Of 7796 participants investigated, 329 (4%) tested positive for RSV. On multivariable analysis, HIV-infected individuals with RSV-associated SARI had greater odds of being in the age groups 18-44 and 45-64 years (odd ratios (OR) 26.3; 95% confidence interval (CI) 6.2-112.1 and OR 11.4; 95% CI 2.6-50.0) compared with those ≥65 years and being female (OR 2.7; 95% CI 1.4-5.4). The relative risk of hospitalization with RSV-associated SARI was 12-18 times higher in HIV infected individual compared to that of HIV-uninfected. The incidence of RSV-associated SARI was higher in HIV-infected individuals and those aged 65 years and older. Further studies are warranted to describe the disease association of RSV detected in adults with SARI. Copyright © 2017 The British Infection Association. All rights reserved.

Walking a fine line: managing the tensions associated with medication non-adherence in an acute inpatient psychiatric setting.

Science.gov (United States)

Wijnveld, Anne-Marie; Crowe, Marie

2010-05-01

The aim of this study was to use a phenomenological methodology to examine mental health nurses' experiences of administering medications to patients who were non-adherent in an acute inpatient service. There is a large body of literature focused on exploring the issue of non-adherence to prescribed medication, but there is very little examining this from mental health nurses' perspectives. Many of the medications prescribed for patients diagnosed with a psychiatric disorder have serious side effects and limited efficacy. Mental health nurses in acute inpatient environments are regularly confronted with the difficulties inherent in the conflicting roles associated with the need to maintain therapeutic relationships and the expectation that they ensure patients take their medications. This is a qualitative study exploring mental health nurses' descriptions of managing medication adherence in an acute inpatient unit. The interpretive phenomenological methodology of Van Manen (Researching Lived Experience: Human Science for an Action Sensitive Pedagogy, 1990) was used in this study to capture the experiences of a group of nurses. This research process involves a dynamic interplay between the following six research activities: (1) turning to the nature of the lived experience; (2) investigating the experience as we live it; (3) reflecting on essential themes; (4) a description of the phenomenon through the art of writing and rewriting; (5) maintaining a strong and oriented pedagogical relation to the phenomenon; and (6) balancing the research context by considering parts and whole. Four themes emerged from the existential analysis that described the mental health nurses' experiences: doing the job for doctors (relationality); stopping and listening (temporality); stepping in (corporeality); and walking a fine line (spatiality). It is proposed that models of therapeutic interventions offering alternative or conjunctive treatment to medications could be incorporated into

Approaches to self-management in chronic illness.

Science.gov (United States)

Novak, Marta; Costantini, Lucia; Schneider, Sabrina; Beanlands, Heather

2013-01-01

Management of a chronic medical condition is a complex process and requires coordinated action between healthcare providers and patients. This process is further complicated by the fact that an increasing number of patients suffer from multiple chronic conditions. Self-management involves active participation of the patients in the everyday care of the symptoms of their illness(es) and medical treatments, as well as maintaining general health and prevention of progression of medical conditions. Managing the psychosocial consequences of illness is also an important component of self-management. Data have demonstrated that enhancing self-management improves quality of life, coping, symptom management, disability, and reduces healthcare expenditures and service utilization. To foster self-management, potential barriers to implementation as well as facilitators and supports for this approach must be acknowledged. In this article, we review various aspects of self-management in chronic illness, focusing on chronic kidney disease. Better understanding of these concepts will facilitate patient-provider collaboration, improve patient care with increased patient and staff satisfaction, and may ultimately result in better clinical outcomes and enhanced quality of life for both the patients and their families. © 2013 Wiley Periodicals, Inc.

Characteristics of critically ill patients in ICUs in mainland China.

Science.gov (United States)

Du, Bin; An, Youzhong; Kang, Yan; Yu, Xiangyou; Zhao, Mingyan; Ma, Xiaochun; Ai, Yuhang; Xu, Yuan; Wang, Yushan; Qian, Chuanyun; Wu, Dawei; Sun, Renhua; Li, Shusheng; Hu, Zhenjie; Cao, Xiangyuan; Zhou, Fachun; Jiang, Li; Lin, Jiandong; Chen, Erzhen; Qin, Tiehe; He, Zhenyang; Zhou, Lihua

2013-01-01

We sought to describe the demographics, case mix, interventions, and clinical outcome of critically ill patients admitted to ICUs in Mainland China. A 2-month (July 1, 2009, to August 31, 2009) prospective, observational cohort study. Twenty-two ICUs in Mainland China. Adult patients admitted to participating ICUs during the study period with an ICU length of stay >24 hrs. None. Patient characteristics, including demographics, underlying diseases, severity of illness, admission status, complications, intervention and treatment during ICU stay, and clinical outcome were recorded in case report form. The primary outcome measure was all-cause hospital mortality. Independent predictors for hospital mortality were determined with multivariate logistic regression analysis. One thousand two hundred ninety-seven patients met the inclusion criteria for the study, 821 (63.3%) were male, and mean age was 58.5 ± 19.2 yrs. Mean Acute Physiology and Chronic Health Evaluation II score was 18.0 ± 8.1, and mean Sequential Organ Failure Assessment score was 6.5 ± 3.8. One third of the patients were postoperative ICU admissions. Seven hundred sixty-five patients (59.0%) developed infections, followed by severe sepsis or septic shock (484, 37.3%), acute kidney injury (398, 30.7%), and acute lung injury/acute respiratory distress syndrome (351, 27.1%). Mechanical ventilation was used in almost three fourths of the patients, whereas any type of renal replacement therapy was used in 173 patients (13.3%). Hospital mortality was 20.3%. Multivariate logistic regression analysis found that Acute Physiology and Chronic Health Evaluation II score, solid tumor, severe sepsis/septic shock, acute lung injury/acute respiratory distress syndrome, and acute kidney injury were independent risk factors for hospital mortality. Critically ill patients in ICUs in Mainland China exhibited a case mix similar to those of Western countries, although there are significant differences in intensive care unit

Long term mortality in critically ill burn survivors.

Science.gov (United States)

Nitzschke, Stephanie; Offodile, Anaeze C; Cauley, Ryan P; Frankel, Jason E; Beam, Andrew; Elias, Kevin M; Gibbons, Fiona K; Salim, Ali; Christopher, Kenneth B

2017-09-01

Little is known about long term survival risk factors in critically ill burn patients who survive hospitalization. We hypothesized that patients with major burns who survive hospitalization would have favorable long term outcomes. We performed a two center observational cohort study in 365 critically ill adult burn patients who survived to hospital discharge. The exposure of interest was major burn defined a priori as >20% total body surface area burned [TBSA]. The modified Baux score was determined by age + %TBSA+ 17(inhalational injury). The primary outcome was all-cause 5year mortality based on the US Social Security Administration Death Master File. Adjusted associations were estimated through fitting of multivariable logistic regression models. Our final model included adjustment for inhalational injury, presence of 3rd degree burn, gender and the acute organ failure score, a validated ICU risk-prediction score derived from age, ethnicity, surgery vs. medical patient type, comorbidity, sepsis and acute organ failure covariates. Time-to-event analysis was performed using Cox proportional hazard regression. Of the cohort patients studied, 76% were male, 29% were non white, 14% were over 65, 32% had TBSA >20%, and 45% had inhalational injury. The mean age was 45, 92% had 2nd degree burns, 60% had 3rd degree burns, 21% received vasopressors, and 26% had sepsis. The mean TBSA was 20.1%. The mean modified Baux score was 72.8. Post hospital discharge 5year mortality rate was 9.0%. The 30day hospital readmission rate was 4%. Patients with major burns were significantly younger (41 vs. 47 years) had a significantly higher modified Baux score (89 vs. 62), and had significantly higher comorbidity, acute organ failure, inhalational injury and sepsis (all Pburns. In the multivariable logistic regression model, major burn was associated with a 3 fold decreased odds of 5year post-discharge mortality compared to patients with TBSAburn, gender and the acute organ failure score

Acute Lymphoblastic Leukemia Presented as Multiple Breast Masses

International Nuclear Information System (INIS)

Bayrak, Ilkay Koray; Yalin, Turkay; Ozmen, Zafer; Aksoz, Tolga; Doughanji, Roula

2009-01-01

Breast metastases in cases leukemia are very rare and occur primarily in patients with acute myeloid leukemia. We report the involvement of breast metastases in a 30-year-old woman with acute T cell lymphoblastic leukemia. The patient's mammograms revealed an extremely dense pattern with ill-defined, denser mass-like lesions in both breasts. A bilateral breast ultrasonographic evaluation revealed lobular-shaped and partly ill-defined hypoechoic masses with a multi-septated nodular (mottled) appearance

Direct, indirect and intangible costs of acute hand and wrist injuries: A systematic review.

Science.gov (United States)

Robinson, Luke Steven; Sarkies, Mitchell; Brown, Ted; O'Brien, Lisa

2016-12-01

Injuries sustained to the hand and wrist are common, accounting for 20% of all emergency presentations. The economic burden of these injuries, comprised of direct (medical expenses incurred), indirect (value of lost productivity) and intangible costs, can be extensive and rise sharply with the increase of severity. This paper systematically reviews cost-of-illness studies and health economic evaluations of acute hand and wrist injuries with a particular focus on direct, indirect and intangible costs. It aims to provide economic cost estimates of burden and discuss the cost components used in international literature. A search of cost-of-illness studies and health economic evaluations of acute hand and wrist injuries in various databases was conducted. Data extracted for each included study were: design, population, intervention, and estimates and measurement methodologies of direct, indirect and intangible costs. Reported costs were converted into US-dollars using historical exchange rates and then adjusted into 2015 US-dollars using an inflation calculator RESULTS: The search yielded 764 studies, of which 21 met the inclusion criteria. Twelve studies were cost-of-illness studies, and seven were health economic evaluations. The methodology used to derive direct, indirect and intangible costs differed markedly across all studies. Indirect costs represented a large portion of total cost in both cost-of-illness studies [64.5% (IQR 50.75-88.25)] and health economic evaluations [68% (IQR 49.25-73.5)]. The median total cost per case of all injury types was US$6951 (IQR $3357-$22,274) for cost-of-illness studies and US$8297 (IQR $3858-$33,939) for health economic evaluations. Few studies reported intangible cost data associated with acute hand and wrist injuries. Several studies have attempted to estimate the direct, indirect and intangible costs associated with acute hand and wrist injuries in various countries using heterogeneous methodologies. Estimates of the economic

Severe acute respiratory syndrome in a doctor working at the Prince of Wales Hospital.

Science.gov (United States)

Wong, R S M

2003-06-01

Severe acute respiratory syndrome is a new disease that is highly contagious and is spreading in the local community and worldwide. This report is of a hospital medical officer with severe acute respiratory syndrome. He presented with sudden onset of fever, chills, myalgia, headache, and dizziness in early March 2003. He developed progressive respiratory symptoms and bilateral pulmonary infiltrates during the second week of his illness. Blood tests showed lymphopenia, mild thrombocytopenia, and prolonged activated partial thromboplastin time with normal d-dimer level. His chest condition gradually responded to ribavirin and corticosteroids, and serial chest X-ray showed resolving pulmonary infiltrates. The importance of early diagnosis lies in the potential for early treatment, leading to better response.

Outbreak of Mysterious Illness Among Hospital Staff

DEFF Research Database (Denmark)

Jacobsen, Peter; Ebbehøj, Niels Erik

2016-01-01

BACKGROUND: Hospitals are rarely reported as settings for mass psychogenic illness (MPI). The present report scrutinizes an outbreak of probable MPI among hospital staff, with medical intervention reinforcing the course of the illness. CASE REPORT: Four of seven staff members in an emergency...

Challenges in Clinical Management of Radiation-Induced Illnesses in Exploration Spaceflight

Science.gov (United States)

Blue, Rebecca; Chancellor, Jeffery; Suresh, Rahul; Carnell, Lisa; Reyes, David; Nowadly, Craig; Antonsen, Erik

2018-01-01

Historical solar particle events (SPEs) provide context for some understanding of acute radiation exposure risk to astronauts traveling outside of low Earth orbit. Modeling of potential doses delivered to exploration crewmembers anticipates limited radiation-induced health impacts, including prodromal symptoms of nausea, emesis, and fatigue, but suggests that more severe clinical manifestations are unlikely. Recent large animal-model research in space-analogs closely mimicking SPEs has identified coagulopathic events independent of the hematopoietic sequelae of higher radiation doses, similar in manifestation to disseminated intravascular coagulation (DIC). We explored the challenges of clinical management of radiation-related clinical manifestations, using currently accepted modeling techniques and anticipated physiological sequelae, to identify medical capabilities needed to successfully manage SPE-induced radiation illnesses during exploration spaceflight.

[Medical Rehabilitation as an Attractive Field of Work for Medical Doctors? - A Qualitative Survey].

Science.gov (United States)

Lederle, Mareike; Kotzjan, Priscilla Simone; Niehues, Christiane; Brüggemann, Silke; Bitzer, Eva-Maria

2017-10-01

In the German Health system there is an increasing competition in the recruitment of specialised staff, especially for rehabilitation centres, which are deemed less attractive. Therefore, this study examines the attractiveness of the field of medical rehabilitation from the point of view of medical professionals. We conducted 16 semi-structured interviews with doctors from 7 rehabilitation centres with different medical specialisations. The interviews were digitized and transcribed. A structured content analysis was carried out using the software MAXQDA 11. 745 codes were identified and assigned to the categories "attractiveness", "unfavourable aspects" and "special features" of rehabilitation. Regarding medical rehabilitation, the interviewees appreciated especially the predictable, flexible working environment with little time pressure. Other than working with rehabilitative patients working as part of an interdisciplinary team was of high importance for the interviewees. Among the special features of rehabilitation in comparison with acute care were the higher relevance of the bio-psycho-social model of health and illness as well as the higher proportion of communication and organisation. Medical rehabilitation in Germany is an attractive field of work for medical doctors. This fact should be considered more with regards to rehabilitation's public image. © Georg Thieme Verlag KG Stuttgart · New York.

REMINDER: In a medical emergency call 74444

CERN Multimedia

2005-01-01

What happened? A CERN colleague, complaining of pains that might indicate serious heart problem, went to the ?infirmary' on the Prévessin site for medical aid. He was unaware that the ?infirmary' was in fact no such thing, but the office of the French contractors' medical practitioner, and, on top of that, it was closed. He therefore took his own car and went to the CERN Fire Station on the Meyrin Site (Building 65). The firemen and the CERN medical team took care of him and requested helicopter transport to the Geneva cantonal hospital, where he responded well to medical treatment. What do we learn from this event? You must call the CERN internal number 74444 in the event of serious and acute illness, and do not have to present yourself in person or get somebody to go with you. This number is not reserved exclusively for accident, pollution, fire etc. The Firemen can prodice professional assistance at all times as required: first aid on the spot, amulance transport and medical assistance as necessary. ...

Emergency management of acute abdomen in children.

Science.gov (United States)

Balachandran, Binesh; Singhi, Sunit; Lal, Sadhna

2013-03-01

Acute abdomen can be defined as a medical emergency in which there is sudden and severe pain in abdomen with accompanying signs and symptoms that focus on an abdominal involvement. It accounts for about 8 % of all children attending the emergency department. The goal of emergency management is to identify and treat any life-threatening medical or surgical disease condition and relief from pain. In mild cases often the cause is gastritis or gastroenteritis, colic, constipation, pharyngo-tonsilitis, viral syndromes or acute febrile illnesses. The common surgical causes are malrotation and Volvulus (in early infancy), intussusception, acute appendicitis, and typhoid and ischemic enteritis with perforation. Lower lobe pneumonia, diabetic ketoacidosis and acute porphyria should be considered in patients with moderate-severe pain with little localizing findings in abdomen. The approach to management in ED should include, in order of priority, a rapid cardiopulmonary assessment to ensure hemodynamic stability, focused history and examination, surgical consult and radiologic examination to exclude life threatening surgical conditions, pain relief and specific diagnosis. In a sick patient the initial steps include rapid IV access and normal saline 20 ml/kg (in the presence of shock/hypovolemia), adequate analgesia, nothing per oral/IV fluids, Ryle's tube aspiration and surgical consultation. An ultrasound abdomen is the first investigation in almost all cases with moderate and severe pain with localizing abdominal findings. In patients with significant abdominal trauma or features of pancreatitis, a Contrast enhanced computerized tomography (CECT) abdomen will be a better initial modality. Continuous monitoring and repeated physical examinations should be done in all cases. Specific management varies according to the specific etiology.

as a cause of acute-onset febrile illness in cats

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Edward B Breitschwerdt

2015-08-01

Full Text Available Case series summary At different time points spanning 6 months, three adopted feral flea-infested cats, residing in the household of a veterinary technician, became acutely anorexic, lethargic and febrile. Enrichment blood culture/PCR using Bartonella alpha Proteobacteria growth medium (BAPGM confirmed initial infection with the same Bartonella henselae genotype in all three cases. With the exception of anemia and neutropenia, complete blood counts, serum biochemical profiles and urinalysis results were within reference intervals. Also, tests for feline leukemia virus, feline immunodeficiency virus, Toxoplasma gondii and feline coronavirus antibodies were negative. Serial daily temperature monitoring in one case confirmed a cyclic, relapsing febrile temperature pattern during 1 month, with resolution during and after treatment with azithromycin. Bartonella henselae Western immunoblot (WB results did not consistently correlate with BAPGM enrichment blood culture/PCR results or B henselae indirect fluorescent antibody (IFA titers, and WB titration results were not informative for establishing antibiotic treatment failure. During the respective follow-up periods, no illnesses or additional febrile episodes were reported, despite repeat documentation of B henselae bacteremia in two cats available for follow-up (one with the same genotype and the other with a different B henselae genotype; one cat was, unfortunately, killed by dogs before follow-up testing. Relevance and novel information We conclude that microbiological diagnosis and treatment of B henselae infection in cats can be challenging, that antibody titration results and resolution of clinical abnormalities may not correlate with a therapeutic cure, and that fever and potentially neutropenia should be differential diagnostic considerations for young cats with suspected bartonellosis.

Understanding of Altitude Illness and Use of Pharmacotherapy Among Trekkers and Porters in the Annapurna Region of Nepal.

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Havryliuk, Tatiana; Acharya, Bhuwan; Caruso, Emily; Cushing, Tracy

2015-09-01

We surveyed Nepali porters and guides as well as English- and non-English-speaking trekkers on their knowledge of altitude illness and its treatment during trekking expeditions to the Annapurna region of Nepal. From March 15 to April 15, 2014, Nepali porters and visiting trekkers were surveyed regarding their ability to recognize and treat altitude illness in Manang, Nepal (3540 m). Their personal use of medications and home remedies and presence of acute mountain sickness (AMS) symptoms were also assessed. 504 subjects were surveyed, including 108 Nepalis. Overall incidence of AMS symptoms was 16%, 5% among Nepalis, and 21% among trekkers. Subjects recognized that headache (88%) was one of the symptoms of AMS, however many reported not knowing the symptoms of high altitude pulmonary edema (40%) or high altitude cerebral edema (42%). 58% of subjects reported carrying and 16% reported taking acetazolamide, while only 2 (0.4%) respondents took dexamethasone. The majority of subjects reported that they would be able to recognize (67%) and treat (62%) altitude illness. Trekkers reported a higher incidence of AMS symptoms than Nepalis. Although most respondents recognized symptoms of AMS, both Nepalis and trekkers lacked knowledge regarding more serious presentations of altitude illness, thus both groups were overconfident in their ability to recognize and treat altitude illness.

Conceptual and operational definitions of the components of the nursing diagnosis Acute Pain (00132

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Marisa Dibbern Lopes Correia

2017-12-01

Full Text Available ABSTRACT Objective: to develop the operational and conceptual definitions of the defining characteristics and related factors of the nursing diagnosis Acute Pain (00132 for nonverbal critically ill patients. Method: integrative literature review in the databases/libraries: Medical Literature Analysis and Retrieval System Online (MEDLINE via Pubmed, Cochrane Library, The Cumulative Index to Nursing and Allied Health Literature (CINAHL and Latin American & Caribbean Health Sciences Literature (LILACS. Results: 799 results were found in the literature, of which 80 studies were selected for full text reading and 16 were used in the elaboration of definitions for the 17 defining characteristics and three related factors of the nursing diagnosis. The gray literature, ie, thesis, dissertations, books, guidelines and dictionary was also explored to ensure the robustness needed to clarify the topics not covered by the studies. Conclusion: the definitions aim to facilitate the identification of the nursing diagnosis for nonverbal critically ill patients and to support future teaching and research on the nursing diagnosis of Acute Pain (00132.

The role of influenza, RSV and other common respiratory viruses in severe acute respiratory infections and influenza-like illness in a population with a high HIV sero-prevalence, South Africa 2012-2015.

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Pretorius, Marthi A; Tempia, Stefano; Walaza, Sibongile; Cohen, Adam L; Moyes, Jocelyn; Variava, Ebrahim; Dawood, Halima; Seleka, Mpho; Hellferscee, Orienka; Treurnicht, Florette; Cohen, Cheryl; Venter, Marietjie

2016-02-01

Viruses detected in patients with acute respiratory infections may be the cause of illness or asymptomatic shedding. To estimate the attributable fraction (AF) and the detection rate attributable to illness for each of the different respiratory viruses We compared the prevalence of 10 common respiratory viruses (influenza A and B viruses, parainfluenza virus 1-3; respiratory syncytial virus (RSV); adenovirus, rhinovirus, human metapneumovirus (hMPV) and enterovirus) in both HIV positive and negative patients hospitalized with severe acute respiratory illness (SARI), outpatients with influenza-like illness (ILI), and control subjects who did not report any febrile, respiratory or gastrointestinal illness during 2012-2015 in South Africa. We enrolled 1959 SARI, 3784 ILI and 1793 controls with a HIV sero-prevalence of 26%, 30% and 43%, respectively. Influenza virus (AF: 86.3%; 95%CI: 77.7-91.6%), hMPV (AF: 85.6%; 95%CI: 72.0-92.6%), and RSV (AF: 83.7%; 95%CI: 77.5-88.2%) infections were associated with severe disease., while rhinovirus (AF: 46.9%; 95%CI: 37.6-56.5%) and adenovirus (AF: 36.4%; 95%CI: 20.6-49.0%) were only moderately associated. Influenza, RSV and hMPV can be considered pathogens if detected in ILI and SARI while rhinovirus and adenovirus were commonly identified in controls suggesting that they may cause only a proportion of clinical disease observed in positive patients. Nonetheless, they may be important contributors to disease. Copyright © 2015 Elsevier B.V. All rights reserved.

Continuing or Temporarily Stopping Prestroke Antihypertensive Medication in Acute Stroke:An Individual Patient Data Meta-Analysis

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Woodhouse, Lisa J.; Manning, Lisa; Potter, John F.; Berge, Eivind; Sprigg, Nikola; Wardlaw, Joanna; Lees, Kennedy R.; Bath, Philip M.; Robinson, Thompson G.; , Blood Pressure in Acute Stroke Collaboration (BASC)

2017-01-01

Over 50% of patients are already taking blood pressure-lowering therapy on hospital admission for acute stroke. An individual patient data meta-analysis from randomized controlled trials was undertaken to determine the effect of continuation versus temporarily stopping pre-existing antihypertensive medication in acute stroke. Key databases were searched for trials against the following inclusion criteria: randomized design; stroke onset ≤48 hours; investigating the effect of continuation vers...

Risk Factors for Development of Acute Kidney Injury in Critically Ill Patients: A Systematic Review and Meta-Analysis of Observational Studies

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Rodrigo Cartin-Ceba

2012-01-01

Full Text Available Background. Acute kidney injury (AKI is a frequent complication of critically ill patients. The impact of different risk factors associated with this entity in the ICU setting is unknown. Objectives. The purpose of this research was to assess the risk factors associated with the development of AKI in critically ill patients by meta-analyses of observational studies. Data Extraction. Two reviewers independently and in duplicate used a standardized form to collect data from published reports. Authors were contacted for missing data. The Newcastle-Ottawa scale assessed study quality. Data Synthesis. Data from 31 diverse studies that enrolled 504,535 critically ill individuals from a wide variety of ICUs were included. Separate random-effects meta-analyses demonstrated a significantly increased risk of AKI with older age, diabetes, hypertension, higher baseline creatinine, heart failure, sepsis/systemic inflammatory response syndrome, use of nephrotoxic drugs, higher severity of disease scores, use of vasopressors/inotropes, high risk surgery, emergency surgery, use of intra-aortic balloon pump, and longer time in cardiopulmonary bypass pump. Conclusion. The best available evidence suggests an association of AKI with 13 different risk factors in subjects admitted to the ICU. Predictive models for identification of high risk individuals for developing AKI in all types of ICU are required.

Nutritional status, exclusive breastfeeding and management of acute respiratory illness and diarrhea in the first 6 months of life in infants from two regions of Indonesia.

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Oktaria, V; Lee, K J; Bines, J E; Watts, E; Satria, C D; Atthobari, J; Nirwati, H; Kirkwood, C D; Soenarto, Y; Danchin, M H

2017-12-21

Infant morbidity and mortality rates remain high in Indonesia, with acute respiratory illnesses (ARI) and diarrhea the leading two health problems in children under 5 years. We aimed to describe the nutritional status, feeding practice and case management of ARI and diarrhea of infants from two regions of Indonesia during the first 6 months of life. This study was an observational study conducted in parallel to an immunogenicity and efficacy trial of an oral rotavirus vaccine (RV3-BB) in the Klaten and Yogyakarta regions, Indonesia. Mothers were interviewed at 3 time points: within the first 6 days of their infant's life, and at 8-10 and 22-24 weeks of age. Questions asked included pregnancy history, infant nutritional status, feeding status and health of infants within up to 2 weeks prior to the assessment. Between February 2013 and January 2014, 233 mother-infant pairs were recruited. 60% (136/223) of infants were exclusively breastfed (EBF) until 6 months of age with the strongest support for EBF reported by mothers themselves 70% (101/223) and 25% (36/223) from their partners. At 6 months, 6% (14/223) of infants were underweight and severely underweight; 4% (8/ 223) wasted and severely wasted; and 12% (28/223) were stunted and severely stunted. Non-recommended medication use was high, with 54% (21/39) of infants with reported cough within 2 weeks of an assessment receiving cough medication, 70% (27 /39) an antihistamine, 26% (10/39) a mucolytic and 15% (6 /39) an oral bronchodilator. At age 22-24 week, infants with reported diarrhea within 2 weeks of an assessment had low use of oral rehydration solutions (ORS) (3/21;14%) and zinc therapy (2/ 21;10%). In this unique observational study, breastfeeding rates of 60% at 6 months were below the Indonesian national target of >75%. Adherence to WHO guidelines for management of ARI and diarrhea was poor, with high use of non-recommended cough medications and oral bronchodilators in the first 6 months of life

Acute Lymphoblastic Leukemia Presented as Multiple Breast Masses

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Bayrak, Ilkay Koray; Yalin, Turkay; Ozmen, Zafer; Aksoz, Tolga; Doughanji, Roula [Ondokuz Mayis University, Samsun (Turkmenistan)

2009-10-15

Breast metastases in cases leukemia are very rare and occur primarily in patients with acute myeloid leukemia. We report the involvement of breast metastases in a 30-year-old woman with acute T cell lymphoblastic leukemia. The patient's mammograms revealed an extremely dense pattern with ill-defined, denser mass-like lesions in both breasts. A bilateral breast ultrasonographic evaluation revealed lobular-shaped and partly ill-defined hypoechoic masses with a multi-septated nodular (mottled) appearance.

The social construction of illness: key insights and policy implications.

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Conrad, Peter; Barker, Kristin K

2010-01-01

The social construction of illness is a major research perspective in medical sociology. This article traces the roots of this perspective and presents three overarching constructionist findings. First, some illnesses are particularly embedded with cultural meaning--which is not directly derived from the nature of the condition--that shapes how society responds to those afflicted and influences the experience of that illness. Second, all illnesses are socially constructed at the experiential level, based on how individuals come to understand and live with their illness. Third, medical knowledge about illness and disease is not necessarily given by nature but is constructed and developed by claims-makers and interested parties. We address central policy implications of each of these findings and discuss fruitful directions for policy-relevant research in a social constructionist tradition. Social constructionism provides an important counterpoint to medicine's largely deterministic approaches to disease and illness, and it can help us broaden policy deliberations and decisions.

Body temperature measurement in mice during acute illness: implantable temperature transponder versus surface infrared thermometry.

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Mei, Jie; Riedel, Nico; Grittner, Ulrike; Endres, Matthias; Banneke, Stefanie; Emmrich, Julius Valentin

2018-02-23

Body temperature is a valuable parameter in determining the wellbeing of laboratory animals. However, using body temperature to refine humane endpoints during acute illness generally lacks comprehensiveness and exposes to inter-observer bias. Here we compared two methods to assess body temperature in mice, namely implanted radio frequency identification (RFID) temperature transponders (method 1) to non-contact infrared thermometry (method 2) in 435 mice for up to 7 days during normothermia and lipopolysaccharide (LPS) endotoxin-induced hypothermia. There was excellent agreement between core and surface temperature as determined by method 1 and 2, respectively, whereas the intra- and inter-subject variation was higher for method 2. Nevertheless, using machine learning algorithms to determine temperature-based endpoints both methods had excellent accuracy in predicting death as an outcome event. Therefore, less expensive and cumbersome non-contact infrared thermometry can serve as a reliable alternative for implantable transponder-based systems for hypothermic responses, although requiring standardization between experimenters.

Expatriates ill after travel: Results from the Geosentinel Surveillance Network

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Lim Poh-Lian

2012-12-01

Full Text Available Abstract Background Expatriates are a distinct population at unique risk for health problems related to their travel exposure. Methods We analyzed GeoSentinel data comparing ill returned expatriates with other travelers for demographics, travel characteristics, and proportionate morbidity (PM for travel-related illness. Results Our study included 2,883 expatriates and 11,910 non-expatriates who visited GeoSentinel clinics ill after travel. Expatriates were more likely to be male, do volunteer work, be long-stay travelers (>6 months, and have sought pre-travel advice. Compared to non-expatriates, expatriates returning from Africa had higher proportionate morbidity (PM for malaria, filariasis, schistosomiasis, and hepatitis E; expatriates from the Asia-Pacific region had higher PM for strongyloidiasis, depression, and anxiety; expatriates returning from Latin America had higher PM for mononucleosis and ingestion-related infections (giardiasis, brucellosis. Expatriates returning from all three regions had higher PM for latent TB, amebiasis, and gastrointestinal infections (other than acute diarrhea compared to non-expatriates. When the data were stratified by travel reason, business expatriates had higher PM for febrile systemic illness (malaria and dengue and vaccine-preventable infections (hepatitis A, and volunteer expatriates had higher PM for parasitic infections. Expatriates overall had higher adjusted odds ratios for latent TB and lower odds ratios for acute diarrhea and dermatologic illness. Conclusions Ill returned expatriates differ from other travelers in travel characteristics and proportionate morbidity for specific diseases, based on the region of exposure and travel reason. They are more likely to present with more serious illness.

Using scores to identify patients at risk of short term mortality at arrival to the acute medical unit