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Sample records for ill adult patients

  1. Pancreatic exocrine insufficiency in critically ill adult patients.

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    Ma, Lijie; Liu, Yuhao; Lu, Zhifeng; Zhao, Li; Wang, Sheng

    2016-03-01

    Pancreatic exocrine insufficiency is usually present in patients with pancreatic diseases. Surprisingly, recent studies indicated that patients with critical illness often suffer from pancreatic injury due to non-specific reasons other than pancreatic diseases, and pancreatic exocrine insufficiency is also commonly observed in critically ill adult patients without preexisting pancreatic diseases. It is well known that malnutrition is the main clinical consequence of pancreatic exocrine insufficiency, thus, the high incidence of pancreatic exocrine insufficiency is most likely to be an important contributor of malnutrition which is a frequent problem associated with detrimental clinical outcomes in critically ill patients admitted into intensive care unit. In order to prevent pancreatic exocrine insufficiency due to primary pancreatic diseases, pancreatic enzyme replacement therapy is indispensable to treat indigestion, malabsorption and nutritional deficiency. Similarly, pancreatic enzyme supplementation has the potential to be an adjuvant therapy in critically ill patients with enteral nutrition therapy, which may be helpful to improve the nutritional status and the prognosis of critically ill patients by reducing the occurrence of malnutrition. Here, we reviewed the diagnostic methods of pancreatic exocrine function, the epidemiology and risk factors of pancreatic exocrine insufficiency, and potential treatment strategies for pancreatic exocrine insufficiency in critically ill adult patients.

  2. Milrinone for cardiac dysfunction in critically ill adult patients

    DEFF Research Database (Denmark)

    Koster, Geert; Bekema, Hanneke J; Wetterslev, Jørn;

    2016-01-01

    INTRODUCTION: Milrinone is an inotrope widely used for treatment of cardiac failure. Because previous meta-analyses had methodological flaws, we decided to conduct a systematic review of the effect of milrinone in critically ill adult patients with cardiac dysfunction. METHODS: This systematic...... review was performed according to The Cochrane Handbook for Systematic Reviews of Interventions. Searches were conducted until November 2015. Patients with cardiac dysfunction were included. The primary outcome was serious adverse events (SAE) including mortality at maximum follow-up. The risk of bias...... analyses displayed statistical and/or clinical heterogeneity of patients, interventions, comparators, outcomes, and/or settings and all featured missing data. DISCUSSION: The current evidence on the use of milrinone in critically ill adult patients with cardiac dysfunction suffers from considerable risks...

  3. Severe hypercapnia in critically ill adult cystic fibrosis patients.

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    Sheikh, Hassan S; Tiangco, Noel Dexter; Harrell, Christopher; Vender, Robert L

    2011-10-01

    Cystic fibrosis (CF) is a monogenetic autosomal recessive multi-organ disease affecting approximately 50,000 patients worldwide. Overall median survival is continually increasing but pulmonary disease remains the most common cause of death. Guidelines have been published in relation to the outpatient maintenance of lung health for CF patients and treatment of acute lung exacerbations but little information exists about the management of the critically ill CF patient. Invasive mechanical ventilation in CF patients with acute respiratory failure is associated with poor outcome and high mortality. Retrospective analysis of adult patients with CF who required endotracheal intubation and invasive mechanical ventilation in the Medical Intensive Care Unit (MICU). Between the years 2003 - 2009, 14 adult patients with CF required endotracheal intubation and invasive mechanical ventilation in the Medical Intensive Care Unit (MICU) of the Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA. Eleven patients died in the MICU because of progressive respiratory failure and inability to liberate from mechanical ventilation. Seven individuals consistently manifested arterial partial pressures of carbon dioxide (PaCO(2)) greater than 20.00 kPa despite high levels of conventional modes of mechanical ventilation. Intubated CF patients with respiratory failure have a high mortality rate. Based on our experience, multiple factors contribute to severe hypercapnia and the effectiveness of conventional modes of mechanical ventilation in many of these patients is limited. Cystic fibrosis; Mechanical ventilation; Critical care; Hypercapnia; Respiratory failure.

  4. Coping with illness and subjective theories of illness in adult patients with haematological malignancies: systematic review.

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    Koehler, Michael; Koenigsmann, Michael; Frommer, Joerg

    2009-03-01

    In parallel to development of individualised antineoplastic treatment, scientific interest in patients' subjective theories of illness (STOI) has emerged in the oncological community. STOI depend decisively on patients' information about their disease. Coping with illness is dependent from the individual situation and context, and it is generally modulated by patients' STOI. The purpose is fivefold: (1) to provide a thorough literature review about coping and about STOI in adult haematological patients, (2) to survey through which indicators the topics were operationalized in studies, (3) to clarify the kind of coherence between these two topics, (4) to explicate the interaction between STOI and other variables, and (5) to verify the clinical relevance of both topics. We searched 19 electronic databanks for English biomedical literature manuscripts (1995-2008) on this subject. Twenty-six studies met our criteria and varied in haematological entity, treatment concept, sample size and methodological design. We conclude that a subjective-individual regulation of patient's mental stability during a cytotoxic chemotherapy is important. Successful coping strategies develop not only based on objective, but also subjective evaluation mechanisms. We deduce consequences for doctor-patient communication and psychosocial care in haematology. The newly developed process model of subjective regulation in cancer patients, in general, views the oncological treatment process as a procedural mental evaluation.

  5. Analgesia for terminally ill adult patients. Preserve quality of life.

    Science.gov (United States)

    2011-11-01

    Adequate pain management is crucial in maintaining the best possible quality of life for terminally ill patients. This article examines pain management in the palliative care setting, based on a review of the literature using the standard Prescrire methodology. Accurate pain evaluation, preferably by the patient, is essential for guiding treatment decisions. Some causes of pain are amenable to specific treatments. The expected benefits and harms of the various treatment options and procedures must be weighed on a case by case basis. Quality of life should always be the first priority. The World Health Organization has developed a "three-step analgesic ladder", based on the use of increasingly potent analgesics: step I analgesics include paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs); codeine is the standard step II analgesic; and morphine is the standard step III analgesic. Fentanyl is an alternative to morphine. The daily morphine dose must be determined for each patient. Morphine titration starts with oral doses given every 4 hours, but additional doses can be taken every hour if necessary. Total consumption is then used to calculate the dose required the following day. A sustained-release product can be used to reduce the number of doses required when a consistently effective daily dose has been established. When patients are unable to take morphine orally, it can be given by subcutaneous injection, and by subcutaneous or intravenous infusion. Pumps allow the patient to self-administer morphine on demand. Fentanyl transdermal patches are another option for stable pain. Immediate-release oral forms and injections are useful for preventing or treating breakthrough pain. If morphine requirements increase during treatment, the most likely explanations are exacerbations of pain or an excessively long interval between doses. Pharmacological tolerance and psychological dependence are rare during palliative care. In case of renal failure, the morphine

  6. Nebulised dornase alfa versus placebo or hypertonic saline in adult critically ill patients

    DEFF Research Database (Denmark)

    Claudius, Casper; Perner, Anders; Møller, Morten Hylander

    2015-01-01

    BACKGROUND: Nebulised dornase alfa is used off-label in critically ill patients. We aimed to assess the benefits and harms of nebulised dornase alfa versus placebo, no prophylaxis, or hypertonic saline on patient-important outcome measures in adult critically ill patients. METHODS: We performed...... a systematic review with meta-analysis and trial sequential analysis (TSA) using the Cochrane Collaboration methodology. Eligible trials were randomised clinical trials comparing nebulised dornase alfa with placebo, no prophylaxis, or hypertonic saline. The predefined outcome measures were all-cause mortality...

  7. A program of nurse algorithm-guided care for adult patients with acute minor illnesses in primary care

    OpenAIRE

    Fabrellas, N?ria; S?nchez, Carmen; Juv?, Eul?lia; Aurin, Eva; Monserrat, Dolors; Casanovas, Esther; Urrea, Magali

    2013-01-01

    Background: Attention to patients with acute minor-illnesses requesting same-day consultation represents a major burden in primary care. The workload is assumed by general practitioners in many countries. A number of reports suggest that care to these patients may be provided, at in least in part, by nurses. However, there is scarce information with respect to the applicability of a program of nurse management for adult patients with acute minor-illnesses in large areas. The aim of this study...

  8. Enteral nutrition therapy for critically ill adult patients; critical review and algorithm creation.

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    Araújo-Junqueira, L; De-Souza, Daurea A

    2012-01-01

    Undernutrition directly affects critically ill patient's clinical outcome and mortality rates. Interdisciplinar algorithm creation aiming to optimize the enteral nutrition therapy for critically ill adult patients. Pubmed, SciELO, Scholar Google, Web of Science, Scopus, with research of these key words: protocols, enteral nutrition, nutritional support, critical care, undernutrition, fasting. Intensive Care Unit, Hospital de Clínicas, Federal University of Uberlándia, MG, Brazil. Were established in the algorithm a following sequential steps: After a clinical-surgical diagnosis, including the assessment of hemodynamic stability, were requested passage of a feeding tube in post-pyloric position and a drainage tube in gastric position. After hemodynamic stability it should be done the nutritional status diagnosis, calculated nutritional requirements, as well as chosen formulation of enteral feeding. Unless contraindicated, aiming to increase tolerance was started infusion with small volumes (15 ml/h) of a semi-elemental diet, normocaloric, hypolipidic (also hyperproteic, with addition of glutamine). To ensure infusion of the diet, as well as the progressive increase of infusion rates, the patient was monitored for moderate or severe intestinal intolerance. The schedule and infusion rates were respected and diet was not routinely suspended for procedures and diagnostic tests, unless indicated by the medical team. For nutrition therapy success it is essential routine monitoring and extensive interaction between the professionals involved. Nutritional conducts should be reevaluated and improved, seeking complete and specialized care to the critically ill patients. Adherence to new practices is challenging, though instruments such as protocols and algorithms help making information more accessible and comprehensible.

  9. Disturbances of sodium in critically ill adult neurologic patients: a clinical review.

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    Tisdall, Martin; Crocker, Matthew; Watkiss, Jonathan; Smith, Martin

    2006-01-01

    Disorders of sodium and water balance are common in critically ill adult neurologic patients. Normal aspects of sodium and water regulation are reviewed. The etiology of possible causes of sodium disturbance is discussed in both the general inpatient and the neurologic populations. Areas of importance are highlighted with regard to the differential diagnosis of sodium disturbance in neurologic patients, and management strategies are discussed. Specific discussions of the etiology, diagnosis, and management of cerebral salt wasting syndrome, the syndrome of inappropriate antidiuretic hormone secretion, and central diabetes insipidus are presented, as well as the problems of overtreatment. The importance of diagnosis at an early stage of these diseases is stressed, with a recommendation for conservative management of milder cases.

  10. Antimicrobial dosing concepts and recommendations for critically ill adult patients receiving continuous renal replacement therapy or intermittent hemodialysis.

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    Heintz, Brett H; Matzke, Gary R; Dager, William E

    2009-05-01

    Infectious diseases and impaired renal function often occur in critically ill patients, and delaying the start of appropriate empiric antimicrobial therapy or starting inappropriate therapy has been associated with poor outcomes. Our primary objective was to critically review and discuss the influence of chronic kidney disease (CKD) and acute kidney injury (AKI) on the clinical pharmacokinetic and pharmacodynamic properties of antimicrobial agents. The effect of continuous renal replacement therapies (CRRTs) and intermittent hemodialysis (IHD) on drug disposition in these two populations was also evaluated. Finally, proposed dosing strategies for selected antimicrobials in critically ill adult patients as well as those receiving CRRT or IHD have been compiled. We conducted a PubMed search (January 1980-March 2008) to identify all English-language literature published in which dosing recommendations were proposed for antimicrobials commonly used in critically ill patients, including those receiving CRRT or IHD. All pertinent reviews, selected studies, and associated references were evaluated to ensure their relevance. Forty antimicrobial, antifungal, and antiviral agents commonly used in critically ill patients were included for review. Dosage recommendations were synthesized from the 42 reviewed articles and peer-reviewed, evidence-based clinical drug databases to generate initial guidance for the determination of antimicrobial dosing strategies for critically ill adults. Because of the evolving process of critical illness, whether in patients with AKI or in those with CKD, prospective adaptation of these initial dosing recommendations to meet the needs of each individual patient will often rely on prospectively collected clinical and laboratory data.

  11. Violent victimization of adult patients with severe mental illness: a systematic review

    Directory of Open Access Journals (Sweden)

    Latalova K

    2014-10-01

    Full Text Available Klara Latalova,1,2 Dana Kamaradova,1,2 Jan Prasko1,2 1Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic; 2Department of Psychiatry, University Hospital Olomouc, Olomouc, Czech Republic Abstract: The aims of this paper are to review data on the prevalence and correlates of violent victimization of persons with severe mental illness, to critically evaluate the literature, and to explore possible approaches for future research. PubMed/MEDLINE and PsycINFO databases were searched using several terms related to severe mental illness in successive combinations with terms describing victimization. The searches identified 34 studies. Nine epidemiological studies indicate that patients with severe mental illness are more likely to be violently victimized than other community members. Young age, comorbid substance use, and homelessness are risk factors for victimization. Victimized patients are more likely to engage in violent behavior than other members of the community. Violent victimization of persons with severe mental illness has long-term adverse consequences for the course of their illness, and further impairs the quality of lives of patients and their families. Victimization of persons with severe mental illness is a serious medical and social problem. Prevention and management of victimization should become a part of routine clinical care for patients with severe mental illness. Keywords: victimization, violence, severe mental illness, schizophrenia, bipolar disorder

  12. A program of nurse algorithm-guided care for adult patients with acute minor illnesses in primary care.

    Science.gov (United States)

    Fabrellas, Núria; Sánchez, Carmen; Juvé, Eulàlia; Aurin, Eva; Monserrat, Dolors; Casanovas, Esther; Urrea, Magali

    2013-05-16

    Attention to patients with acute minor-illnesses requesting same-day consultation represents a major burden in primary care. The workload is assumed by general practitioners in many countries. A number of reports suggest that care to these patients may be provided, at in least in part, by nurses. However, there is scarce information with respect to the applicability of a program of nurse management for adult patients with acute minor-illnesses in large areas. The aim of this study is to assess the effectiveness of a program of nurse algorithm-guided care for adult patients with acute minor illnesses requesting same-day consultation in primary care in a largely populated area. A cross-sectional study of all adult patients seeking same day consultation for 16 common acute minor illnesses in a large geographical area with 284 primary care practices. Patients were included in a program of nurse case management using management algorithms. The main outcome measure was case resolution, defined as completion of the algorithm by the nurse without need of referral of the patient to the general practitioner. The secondary outcome measure was return to consultation, defined as requirement of new consultation for the same reason as the first one, in primary care within a 7-day period. During a two year period (April 2009-April 2011), a total of 1,209,669 consultations were performed in the program. Case resolution was achieved by nurses in 62.5% of consultations. The remaining cases were referred to a general practitioner. Resolution rates ranged from 94.2% in patients with burns to 42% in patients with upper respiratory symptoms. None of the 16 minor illnesses had a resolution rate below 40%. Return to consultation during a 7-day period was low, only 4.6%. A program of algorithms-guided care is effective for nurse case management of patients requesting same day consultation for minor illnesses in primary care.

  13. Beyond diagnosis: subjective theories of illness in adult patients with acute myeloid leukemia.

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    Koehler, Michael; Koehler, Katharina; Koenigsmann, Michael; Kreutzmann, Nicole; Fischer, Thomas; Frommer, Joerg

    2011-01-01

    Every acute myeloid leukemia (AML) patient asks: why me? But from the patients' perspective, there are no objective medical causes and no clear picture of AML. However, based on these missing medical answers, patients develop their own ideas about illness and treatment. These subjective theories of illness (STOI) are defined as the cognitive constructions ill people make regarding: (1) the nature of their disease; (2) its source; and (3) its treatment. STOI present a challenge for the physician-patient relationship. After the first interim staging, 12 patients with AML were interviewed. Case analyses were assigned to interindividual comparisons representing the predefined subject areas of STOI. Patients' vague subjective conceptions about the personalized etiology of AML resulted not only from health literacy deficits but also from their avoiding medical information to protect themselves from negative emotions. Through STOI, patients significantly co-determine the selection of (un-)conscious coping strategies with consequences for physician-patient communication.

  14. Violent victimization of adult patients with severe mental illness: a systematic review

    Science.gov (United States)

    Latalova, Klara; Kamaradova, Dana; Prasko, Jan

    2014-01-01

    The aims of this paper are to review data on the prevalence and correlates of violent victimization of persons with severe mental illness, to critically evaluate the literature, and to explore possible approaches for future research. PubMed/MEDLINE and PsycINFO databases were searched using several terms related to severe mental illness in successive combinations with terms describing victimization. The searches identified 34 studies. Nine epidemiological studies indicate that patients with severe mental illness are more likely to be violently victimized than other community members. Young age, comorbid substance use, and homelessness are risk factors for victimization. Victimized patients are more likely to engage in violent behavior than other members of the community. Violent victimization of persons with severe mental illness has long-term adverse consequences for the course of their illness, and further impairs the quality of lives of patients and their families. Victimization of persons with severe mental illness is a serious medical and social problem. Prevention and management of victimization should become a part of routine clinical care for patients with severe mental illness. PMID:25336958

  15. 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 (ICU...... bleeding occurred in 2.6 % (95 % confidence interval 1.6-3.6 %) of patients. The following variables at ICU admission were independently associated with clinically important GI bleeding: three or more co-existing diseases (odds ratio 8.9, 2.7-28.8), co-existing liver disease (7.6, 3.3-17.6), use of renal...

  16. Which health care facilities do adult malawian antiretroviral therapy patients utilize during intercurrent illness? a cross sectional study

    Directory of Open Access Journals (Sweden)

    Masangalawe Caroline

    2011-12-01

    Full Text Available Abstract Background Antiretroviral therapy (ART clinic populations have expanded enormously in the successful Malawi ART scale-up programme. Overcrowding, long waiting times and living far away from the clinic may affect the extent to which patients use their ART clinic for intercurrent illnesses. Methods We interviewed patients of a large urban ART clinic in Blantyre, Malawi, during routine visits about the choice of health care facility during recent illness episodes. Results Out of 346 enrolled adults, mean age 39.8 (range 18-70 years, 54.3% female, 202 (58% reported one or more illness in the past 6 months, during which 85 (42.1%; 95%-confidence interval: 36.9-47.3% did not utilize their own clinic. Long distance to the clinic was the main subjective reason, while low education attainment, rural residence, perceived mild illness and dissatisfaction with the ART service were associated with not using their own clinic in multivariate analyses. Of all participants, 83.6% were satisfied with the service provided; only 6.1% were aware of the full service package of the ART clinic. Conclusions ART patients often seek health care outside their own clinic, which may have detrimental effects, and has consequences for ART counseling content and reporting of ART information in health passports.

  17. Physical rehabilitation interventions for adult patients with critical illness across the continuum of recovery: an overview of systematic reviews protocol.

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    Connolly, Bronwen; O'Neill, Brenda; Salisbury, Lisa; McDowell, Kathryn; Blackwood, Bronagh

    2015-09-29

    Patients admitted to the intensive care unit with critical illness often experience significant physical impairments, which typically persist for many years following resolution of the original illness. Physical rehabilitation interventions that enhance restoration of physical function have been evaluated across the continuum of recovery following critical illness including within the intensive care unit, following discharge to the ward and beyond hospital discharge. Multiple systematic reviews have been published appraising the expanding evidence investigating these physical rehabilitation interventions, although there appears to be variability in review methodology and quality. We aim to conduct an overview of existing systematic reviews of physical rehabilitation interventions for adult intensive care patients across the continuum of recovery. This protocol has been developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) guidelines. We will search the Cochrane Systematic Review Database, Database of Abstracts of Reviews of Effectiveness, Cochrane Central Register of Controlled Trials, MEDLINE, Excerpta Medica Database and Cumulative Index to Nursing and Allied Health Literature databases. We will include systematic reviews of randomised controlled trials of adult patients, admitted to the intensive care unit and who have received physical rehabilitation interventions at any time point during their recovery. Data extraction will include systematic review aims and rationale, study types, populations, interventions, comparators, outcomes and quality appraisal method. Primary outcomes of interest will focus on findings reflecting recovery of physical function. Quality of reporting and methodological quality will be appraised using the PRISMA checklist and the Assessment of Multiple Systematic Reviews tool. We anticipate the findings from this novel overview of systematic reviews will contribute to the

  18. Hospital Triage System for Adult Patients Using an Influenza-Like Illness Scoring System during the 2009 Pandemic—Mexico

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    Rodriguez-Noriega, Eduardo; Gonzalez-Diaz, Esteban; Morfin-Otero, Rayo; Gomez-Abundis, Gerardo F.; Briseño-Ramirez, Jaime; Perez-Gomez, Hector Raul; Lopez-Gatell, Hugo; Alpuche-Aranda, Celia M.; Ramírez, Ernesto; López, Irma; Iguala, Miguel; Chapela, Ietza Bojórquez; Zavala, Ethel Palacios; Hernández, Mauricio; Stuart, Tammy L.; Villarino, Margarita Elsa; Widdowson, Marc-Alain; Waterman, Steve; Uyeki, Timothy; Azziz-Baumgartner, Eduardo

    2010-01-01

    Background Pandemic influenza A (H1N1) virus emerged during 2009. To help clinicians triage adults with acute respiratory illness, a scoring system for influenza-like illness (ILI) was implemented at Hospital Civil de Guadalajara, Mexico. Methods A medical history, laboratory and radiology results were collected on emergency room (ER) patients with acute respiratory illness to calculate an ILI-score. Patients were evaluated for admission by their ILI-score and clinicians' assessment of risk for developing complications. Nasal and throat swabs were collected from intermediate and high-risk patients for influenza testing by RT-PCR. The disposition and ILI-score of those oseltamivir-treated versus untreated, clinical characteristics of 2009 pandemic influenza A (H1N1) patients versus test-negative patients were compared by Pearson's Χ2, Fisher's Exact, and Wilcoxon rank-sum tests. Results Of 1840 ER patients, 230 were initially hospitalized (mean ILI-score = 15), and the rest were discharged, including 286 ambulatory patients given oseltamivir (median ILI-score = 11), and 1324 untreated (median ILI-score = 5). Fourteen (1%) untreated patients returned, and 3 were hospitalized on oseltamivir (median ILI-score  = 19). Of 371 patients tested by RT-PCR, 104 (28%) had pandemic influenza and 42 (11%) had seasonal influenza A detected. Twenty (91%) of 22 imaged hospitalized pandemic influenza patients had bilateral infiltrates compared to 23 (38%) of 61 imaged hospital test-negative patients (p<0.001). One patient with confirmed pandemic influenza presented 6 days after symptom onset, required mechanical ventilation, and died. Conclusions The triaging system that used an ILI-score complimented clinicians' judgment of who needed oseltamivir and inpatient care and helped hospital staff manage a surge in demand for services. PMID:20498718

  19. Hospital triage system for adult patients using an influenza-like illness scoring system during the 2009 pandemic--Mexico.

    Directory of Open Access Journals (Sweden)

    Eduardo Rodriguez-Noriega

    Full Text Available BACKGROUND: Pandemic influenza A (H1N1 virus emerged during 2009. To help clinicians triage adults with acute respiratory illness, a scoring system for influenza-like illness (ILI was implemented at Hospital Civil de Guadalajara, Mexico. METHODS: A medical history, laboratory and radiology results were collected on emergency room (ER patients with acute respiratory illness to calculate an ILI-score. Patients were evaluated for admission by their ILI-score and clinicians' assessment of risk for developing complications. Nasal and throat swabs were collected from intermediate and high-risk patients for influenza testing by RT-PCR. The disposition and ILI-score of those oseltamivir-treated versus untreated, clinical characteristics of 2009 pandemic influenza A (H1N1 patients versus test-negative patients were compared by Pearson's Chi(2, Fisher's Exact, and Wilcoxon rank-sum tests. RESULTS: Of 1840 ER patients, 230 were initially hospitalized (mean ILI-score = 15, and the rest were discharged, including 286 ambulatory patients given oseltamivir (median ILI-score = 11, and 1324 untreated (median ILI-score = 5. Fourteen (1% untreated patients returned, and 3 were hospitalized on oseltamivir (median ILI-score = 19. Of 371 patients tested by RT-PCR, 104 (28% had pandemic influenza and 42 (11% had seasonal influenza A detected. Twenty (91% of 22 imaged hospitalized pandemic influenza patients had bilateral infiltrates compared to 23 (38% of 61 imaged hospital test-negative patients (p<0.001. One patient with confirmed pandemic influenza presented 6 days after symptom onset, required mechanical ventilation, and died. CONCLUSIONS: The triaging system that used an ILI-score complimented clinicians' judgment of who needed oseltamivir and inpatient care and helped hospital staff manage a surge in demand for services.

  20. Antiepileptic dosing for critically ill adult patients receiving renal replacement therapy.

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    Smetana, Keaton S; Cook, Aaron M; Bastin, Melissa L Thompson; Oyler, Douglas R

    2016-12-01

    The aim of this review was to evaluate current literature for dosing recommendations for the use of antiepileptic medications in patients receiving renal replacement therapy (RRT). With the assistance of an experienced medical librarian specialized in pharmacy and toxicology, we searched MEDLINE, EMBASE, CINAHL, Web of Science, WorldCat, and Scopus through May 2016. Four hundred three articles were screened for inclusion, of which 130 were identified as potentially relevant. Micromedex® DRUGDEX as well as package inserts were used to obtain known pharmacokinetic properties and dosage adjustment recommendations in RRT if known. Data regarding antiepileptic drug use in RRT are limited and mostly consist of case reports limiting our proposed dosing recommendations. Known pharmacokinetic parameters should guide dosing, and recommendations are provided where possible. Additional studies are necessary before specific dosing recommendations can be made for most antiepileptic drugs in critically ill patients receiving RRT, specifically with newer agents. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Illness perception in Chinese adults with epilepsy.

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    Ji, Haixia; Zhang, Lei; Li, Lunlan; Gong, Guiping; Cao, Zhaolun; Zhang, Jianfeng; Zhou, Nong; Wang, Yu; Tu, Houmian; Wang, Kai

    2016-12-01

    Epilepsy is among the most common neurological disorders worldwide. Understanding the patient's subjective experience plays an important role in the treatment and rehabilitation of the patient. However, few studies are concerned about the illness perception of Chinese adults with epilepsy. 117 Chinese adults with epilepsy and 87 Chinese adults with chronic liver disease completed the Chinese version of the Revised Illness Perception Questionnaire (CIPQ-R). The Chinese epilepsy patients also completed the Social Support Rating Scale (SSRS) and Simplified Coping Style Questionnaire (SCSQ). A comparison about CIPQ-R score between the epilepsy group and chronic liver group was conducted using the independent sample t test. Partial correlation coefficients were calculated among the eight subscales of the CIPQ-R and its associated factors. Results for the CIPQ-R indicated that both the epilepsy patients and the chronic liver disease patients had a moderate belief in their personal control and treatment control over their disorder. Consistent with our hypothesis, patients with epilepsy and those with chronic liver disease perceived their respective disease similarly in terms of timeline and illness coherence. However, epilepsy patients had a higher negative emotional representations level than that we expected when compared to those of the patients suffering from chronic liver disease. Partial correlation analysis in Chinese epilepsy patients showed that the timeline acute/chronic dimension and emotional representations dimension were closely related to the other dimensions of illness perception. Moreover, the illness perception of the patients was significantly associated with social support, coping style, duration of epilepsy, seizure frequency, and the number of antiepileptic drugs. Chinese patients with epilepsy had limited understanding of the illness, and poor belief in personal control and treatment control. They had a negative emotional response to their illness

  2. New Guidelines for Assessment of Malnutrition in Adults: Obese Critically Ill Patients.

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    Mauldin, Kasuen; O'Leary-Kelley, Colleen

    2015-08-01

    Recently released recommendations for detection and documentation of malnutrition in adults in clinical practice define 3 types of malnutrition: starvation related, acute disease or injury related, and chronic disease related. The first 2 are more easily recognized, but the third may be more often unnoticed, particularly in obese patients. Critical care patients tend to be at high risk for malnutrition and thus require a thorough nutritional assessment. Compared with patients of earlier times, intensive care unit patients today tend to be older, have more complex medical and comorbid conditions, and often are obese. Missed or delayed detection of malnutrition in these patients may contribute to increases in hospital morbidity and longer hospital stays. Critical care nurses are in a prime position to screen patients at risk for malnutrition and to work with members of the interprofessional team in implementing nutritional intervention plans.

  3. Long-term outcome of critically ill adult patients with acute epiglottitis.

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    Tomasz Chroboczek

    Full Text Available Acute epiglottitis is a potentially life threatening disease, with a growing incidence in the adult population. Its long-term outcome after Intensive Care Unit (ICU hospitalization has rarely been studied.Thirty-four adult patients admitted for acute epiglottitis were included in this retrospective multicentric study. The mean age was 44 ± 12 years (sex ratio: 5.8. Sixteen patients (47% had a history of smoking while 8 (24% had no previous medical history. The average time of disease progression before ICU was 2.6 ± 3.6 days. The main reasons for hospitalization were continuous monitoring (17 cases, 50% and acute respiratory distress (10 cases, 29%. Microbiological documentation could be made in 9 cases (26%, with Streptococcus spp. present in 7 cases (21%. Organ failure at ICU admission occurred in 8 cases (24%. Thirteen patients (38% required respiratory assistance during ICU stay; 9 (26% required surgery. Two patients (6% died following hypoxemic cardiac arrest. Five patients (15% had sequelae at 1 year. Patients requiring respiratory assistance had a longer duration of symptoms and more frequent anti inflammatory use before ICU admission and sequelae at 1 year (p < 0.05 versus non-ventilated patients. After logistic regression analysis, only exposure to anti-inflammatory drugs before admission was independently associated with airway intervention (OR, 4.96; 95% CI, 1.06-23.16.The profile of the cases consisted of young smoking men with little comorbidity. Streptococcus spp. infection represented the main etiology. Outcome was favorable if early respiratory tract protection could be performed in good conditions. Morbidity and sequelae were greater in patients requiring airway intervention.

  4. A course on the transition to adult care of patients with childhood-onset chronic illnesses.

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    Hagood, James S; Lenker, Claire V; Thrasher, Staci

    2005-04-01

    Children with special health care needs born today have a 90% chance of surviving into adulthood, making their transition to adult systems of care an issue that will affect almost all physicians. However, many adult generalists and specialists are not familiar with the management of chronic diseases that begin in childhood. While the public health system has made transition to appropriate adult care a priority, and many specialty organizations have endorsed this concept, there are no published studies addressing how the concept of transition can be taught to medical students or residents. The authors describe a one-week course for medical students, begun in 2001 at their institution, that addresses the transition for youth with special health care needs, emphasizing patient and family-centered care, cultural competence, and decision making in end-of-life issues. Cystic fibrosis, a common genetic disease with increasing life expectancy, is used as the model for the course. Involvement of interdisciplinary faculty, interviews with youth with special health care needs and family caregivers, readings from academic and nonacademic literature, and group discussions are presented as teaching methods. Key insights based on experience with the course are the need to include the voices of patients and families, the use of faculty from various professions and specialties to model interdisciplinary care, and the insight that problems specific to transition offer into contemporary health care financing. Future studies should measure the impact of such courses on students' knowledge of transition issues, and determine essential information required for physicians in practice.

  5. Clinical practice guidelines for evidence-based management of sedoanalgesia in critically ill adult patients.

    Science.gov (United States)

    Celis-Rodríguez, E; Birchenall, C; de la Cal, M Á; Castorena Arellano, G; Hernández, A; Ceraso, D; Díaz Cortés, J C; Dueñas Castell, C; Jimenez, E J; Meza, J C; Muñoz Martínez, T; Sosa García, J O; Pacheco Tovar, C; Pálizas, F; Pardo Oviedo, J M; Pinilla, D I; Raffán-Sanabria, F; Raimondi, N; Righy Shinotsuka, C; Suárez, M; Ugarte, S; Rubiano, S

    2013-11-01

    contains recommendations and suggestions based on the best evidence available for the management of sedation, analgesia and delirium of the critically ill patient, including a bundle of strategies that serves this purpose. We highlight the assessment of pain and agitation/sedation through validated scales, the use of opioids initially to apropiate analgesic control, associated with multimodal strategies in order to reduce opioide consumption; to promote the lowest level of sedation necessary avoiding over-sedation. Also, in case of the need of sedatives, choose the most appropiate for the patient needs, avoiding the use of benzodiazepines and identify risk factors for delirium, in order to prevent its occurrence, diagnose delirium and treat it with the most suitable pharmacological agent, whether it is haloperidol, atypical antipsychotics or dexmedetomidine, once again, avoiding the use of benzodiazepines and decreasing the use of opioids. Copyright © 2013 Elsevier España, S.L. y SEMICYUC. All rights reserved.

  6. Investigation of a potential zoonotic transmission of orthoreovirus associated with acute influenza-like illness in an adult patient.

    Science.gov (United States)

    Chua, Kaw Bing; Voon, Kenny; Yu, Meng; Keniscope, Canady; Abdul Rasid, Kasri; Wang, Lin-Fa

    2011-01-01

    Bats are increasingly being recognized as important reservoir hosts for a large number of viruses, some of them can be highly virulent when they infect human and livestock animals. Among the new bat zoonotic viruses discovered in recent years, several reoviruses (respiratory enteric orphan viruses) were found to be able to cause acute respiratory infections in humans, which included Melaka and Kampar viruses discovered in Malaysia, all of them belong to the genus Orthoreovirus, family Reoviridae. In this report, we describe the isolation of a highly related virus from an adult patient who suffered acute respiratory illness in Malaysia. Although there was no direct evidence of bat origin, epidemiological study indicated the potential exposure of the patient to bats before the onset of disease. The current study further demonstrates that spillover events of different strains of related orthoreoviruses from bats to humans are occurring on a regular basis, which calls for more intensive and systematic surveillances to fully assess the true public health impact of these newly discovered bat-borne zoonotic reoviruses.

  7. Personality and illness adaptation in adults with type 1 diabetes: the intervening role of illness coping and perceptions.

    Science.gov (United States)

    Rassart, Jessica; Luyckx, Koen; Klimstra, Theo A; Moons, Philip; Groven, Chris; Weets, Ilse

    2014-03-01

    Inspired by the common sense model, the present cross-sectional study examined illness perceptions and coping as intervening mechanisms in the relationship between Big Five personality traits and illness adaptation in adults with Type 1 diabetes. A total of 368 individuals with Type 1 diabetes (18-35 years old) completed questionnaires on personality, diabetes-related problems, illness perceptions, and illness coping. First, Neuroticism, Agreeableness, and Conscientiousness predicted patients' illness adaptation, above and beyond the effects of sex, age, and illness duration. Second, illness coping was found to be an important mediating mechanism in the relationship between the Big Five and illness adaptation. Finally, perceived consequences and perceived personal control partially mediated the relationship between the Big Five and illness coping. These findings underscore the importance of examining patients' personality to shed light on their daily functioning and, hence, call for tailored intervention programs which take into account the personality of the individual patient.

  8. Dependency in Critically Ill Patients

    Directory of Open Access Journals (Sweden)

    Rumei Yang

    2016-03-01

    Full Text Available By necessity, critically ill patients admitted to intensive care units (ICUs have a high level of dependency, which is linked to a variety of negative feelings, such as powerlessness. However, the term dependency is not well defined in the critically ill patients. The concept of “dependency” in critically ill patients was analyzed using a meta-synthesis approach. An inductive process described by Deborah Finfgeld-Connett was used to analyze the data. Overarching themes emerged that reflected critically ill patients’ experience and meaning of being in dependency were (a antecedents: dependency in critically ill patients was a powerless and vulnerable state, triggered by a life-threatening crisis; (b attributes: the characteristic of losing “self” was featured by dehumanization and disembodiment, which can be alleviated by a “self”-restoring process; and (c outcomes: living with dependency and coping with dependency. The conceptual model explicated here may provide a framework for understanding dependency in critically ill patients.

  9. Dependency in Critically Ill Patients

    Directory of Open Access Journals (Sweden)

    Rumei Yang

    2016-03-01

    Full Text Available By necessity, critically ill patients admitted to intensive care units (ICUs have a high level of dependency, which is linked to a variety of negative feelings, such as powerlessness. However, the term dependency is not well defined in the critically ill patients. The concept of “dependency” in critically ill patients was analyzed using a meta-synthesis approach. An inductive process described by Deborah Finfgeld-Connett was used to analyze the data. Overarching themes emerged that reflected critically ill patients’ experience and meaning of being in dependency were (a antecedents: dependency in critically ill patients was a powerless and vulnerable state, triggered by a life-threatening crisis; (b attributes: the characteristic of losing “self” was featured by dehumanization and disembodiment, which can be alleviated by a “self”-restoring process; and (c outcomes: living with dependency and coping with dependency. The conceptual model explicated here may provide a framework for understanding dependency in critically ill patients.

  10. Psychodynamics in medically ill patients.

    Science.gov (United States)

    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.

  11. Arterial blood gas analysers: accuracy in determining haemoglobin, glucose and electrolyte concentrations in critically ill adult patients.

    Science.gov (United States)

    Quinn, L M; Hamnett, N; Wilkin, R; Sheikh, A

    2013-01-01

    Arterial blood gas (ABG) machines are vital tools in the assessment of critically ill patients. Current ABG point-of-care (POC) analysers provide information on concentrations of haemoglobin, glucose and electrolytes in addition to acid-base balance. Awaiting results from venous analysers may present a significant delay in diagnosis and management, thus reliance on arterial blood gas determination of these parameters is increasing. However, published data on the concordance between the two modalities are limited. This study aims to assess the concordance of ABG machines in analysing haemoglobin, glucose and electrolyte concentrations compared to standard venous analysers as the gold standard. Results from 100 patients undergoing ABG analysis and simultaneous venous sampling without therapeutic intervention between sampling were compared. Differences in haemoglobin, glucose, sodium and potassium concentrations were determined and analysed using statistical software (Statview). There was a significant difference (P 5 mmol/L), ABG readings varied significantly (P Arterial blood gas analysers are invaluable for rapid assessment of critically ill patients; however, estimations of haemoglobin, glucose and potassium concentrations (> 5 mmol/L) obtained from such machines should be interpreted with caution and confirmed using standard venous samples.

  12. Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients.

    Science.gov (United States)

    Hernández-Tejedor, A; Peñuelas, O; Sirgo Rodríguez, G; Llompart-Pou, J A; Palencia Herrejón, E; Estella, A; Fuset Cabanes, M P; Alcalá-Llorente, M A; Ramírez Galleymore, P; Obón Azuara, B; Lorente Balanza, J A; Vaquerizo Alonso, C; Ballesteros Sanz, M A; García García, M; Caballero López, J; Socias Mir, A; Serrano Lázaro, A; Pérez Villares, J M; Herrera-Gutiérrez, M E

    The standardization of the Intensive Care Medicine may improve the management of the adult critically ill patient. However, these strategies have not been widely applied in the Intensive Care Units (ICUs). The aim is to elaborate the recommendations for the standardization of the treatment of critical patients. A panel of experts from the thirteen working groups (WG) of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) was selected and nominated by virtue of clinical expertise and/or scientific experience to carry out the recommendations. Available scientific literature in the management of adult critically ill patients from 2002 to 2016 was extracted. The clinical evidence was discussed and summarised by the experts in the course of a consensus finding of every WG and finally approved by the WGs after an extensive internal review process that was carried out between December 2015 and December 2016. A total of 65 recommendations were developed, of which 5 corresponded to each of the 13 WGs. These recommendations are based on the opinion of experts and scientific knowledge, and are intended as a guide for the intensivists in the management of critical patients. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  13. Stress ulcer prophylaxis versus placebo or no prophylaxis in adult hospitalised acutely ill patients-protocol for a systematic review with meta-analysis and trial sequential analysis

    DEFF Research Database (Denmark)

    Jensen, Søren Marker; Perner, Anders; Wetterslev, Jørn

    2017-01-01

    or no prophylaxis as control interventions. The participants will be adult hospitalised acutely ill patients with high risk of gastrointestinal bleeding. We will systematically search the Cochrane Library, MEDLINE, EMBASE, Science Citation Index, BIOSIS and Epistemonikos for relevant literature. We will follow...... the recommendations by the Cochrane Collaboration and the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. The risk of systematic errors (bias) and random errors will be assessed, and the overall quality of evidence will be evaluated using the Grading of Recommendations Assessment...

  14. Permissive underfeeding versus target enteral feeding in adult critically ill patients (PermiT Trial: a study protocol of a multicenter randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Arabi Yaseen M

    2012-10-01

    Full Text Available Abstract Background Nutritional support is an essential part of the management of critically ill patients. However, optimal caloric intake has not been systematically evaluated. We aim to compare two strategies of enteral feeding: permissive underfeeding versus target feeding. Method/Design This is an international multi-center randomized controlled trial in critically ill medical- surgical adult patients. Using a centralized allocation, 862 patients will be randomized to permissive underfeeding or target feeding. Patients in the permissive group receive 50% (acceptable range is 40% to 60% of the calculated caloric requirement, while those in the targeted group receive 100% (acceptable range 70% to 100% of the calculated caloric requirement. The primary outcome is 90-day all-cause mortality. Secondary outcomes include ICU and hospital mortality, 28-day, and 180-day mortality as well as health care-associated infections, organ failure, and length of stay in the ICU and hospital. The trial has 80% power to detect an 8% absolute reduction in 90-day mortality assuming a baseline risk of death of 25% at an alpha level of 0.05. Discussion Patient recruitment started in November 2009 and is currently active in five centers. The Data Monitoring Committee advised continuation of the trial after the first interim analysis. The study is expected to finish by November 2013. Trial registration Current Controlled Trials ISRCTN68144998

  15. Delirium in critically ill patients

    NARCIS (Netherlands)

    Slooter, A J C; Van De Leur, R R; Zaal, I J

    2017-01-01

    Delirium is common in critically ill patients and associated with increased length of stay in the intensive care unit (ICU) and long-term cognitive impairment. The pathophysiology of delirium has been explained by neuroinflammation, an aberrant stress response, neurotransmitter imbalances, and

  16. Critically ill obstetric patients

    Directory of Open Access Journals (Sweden)

    Kirti Rajesh Bendre

    2015-04-01

    Methods: This is a retrospective study carried out in a medical college with tertiary hospital facility in Mumbai. The ICU admissions for a period of 5 years from October 2005 to October 2010 were reviewed. Results: Over 5 years, 48 out of 10800 obstetric patients were admitted in ICU (0.4%. Most common reasons for admissions were obstetric hemorrhage and preeclampsia. The most common intervention done was transfusion of blood and blood products. Conclusions: We need better information about high risk obstetrics in order to improve maternal care. The study identifies the risk factors for maternal mortality and severe maternal morbidity, most significant being obstetric hemorrhage. Lack of antenatal care and delay in referral to intensive care unit adversely affect the maternal outcome. [Int J Reprod Contracept Obstet Gynecol 2015; 4(2.000: 370-372

  17. Impact of oral melatonin on critically ill adult patients with ICU sleep deprivation: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Huang, Huawei; Jiang, Li; Shen, Ling; Zhang, Guobin; Zhu, Bo; Cheng, Jiajia; Xi, Xiuming

    2014-08-18

    Sleep deprivation is common in critically ill patients in intensive care units (ICU). It can result in delirium, difficulty weaning, repeated nosocomial infections, prolonged ICU length of stay and increased ICU mortality. Melatonin, a physiological sleep regulator, is well known to benefit sleep quality in certain people, but evidence for the effectiveness in ICU sleep disturbance is limited. This study has a prospective, randomized, double-blind, controlled, parallel-group design. Eligible patients are randomly assigned to one of the two treatment study groups, labelled the 'melatonin group' or the 'placebo group'. A dose of 3 mg of oral melatonin or placebo is administered at 9:00 pm on four consecutive days. Earplugs and eye masks are made available to every participant. We plan to enrol 198 patients. The primary outcome is the objective sleep quality measured by the 24-hour polysomnography. The secondary outcomes are the subjective sleep quality assessed by the Richards Campbell Sleep Questionnaire, the anxiety level evaluated by the Visual Analogue Scale-Anxiety, the number of delirium-free days in 8 and 28 days, the number of ventilation-free days in 28 days, the number of antibiotic-free days, ICU length of stay, the overall ICU mortality in 28 days and the incidence and severity of the side effects of melatonin in ICU patients. Additionally, the body stress levels, oxidative stress levels and inflammation levels are obtained via measuring the plasma melatonin, cortisone, norepinephrine, malonaldehyde(MDA), superoxide dismutase(SOD), interleukin-6 (IL-6) and interleukin-8 (IL-8)concentrations. The proposed study will be the first randomized controlled study to use the polysomnography, which is the gold standard of assessing sleep quality, to evaluate the effect of melatonin on the sleep quality and circadian rhythms of ICU patients. The results may recommend a new treatment for ICU patients with sleep deprivation that is safe, effective and easily

  18. Teaching strategies for atypical presentation of illness in older adults.

    Science.gov (United States)

    Gray-Miceli, Deanna; Aselage, Melissa; Mezey, Mathy

    2010-07-01

    Atypical presentation of illness is a phenomenon where "seeing is believing." Expert geriatric nurses and clinicians know all too well the early signs and symptoms of this phenomenon, which frequently masquerades bacterial infections, pain, acute myocardial infarction, heart failure, or other serious medical ailments in older adults. Students, however, as novices to clinical practice, require interactive learning approaches to reflect on the patient's illness presentations, help with developing the necessary skills to analyze and synthesize clinically relevant data, and witness resolution of an atypical presentation when found and treated. Use of a case study as an educational tool can facilitate critical thinking about a clinical problem, such as atypical presentation of illness, for students within a problem-based learning format. Furthermore, we highlight strategies for teaching students atypical presentation of illness with consideration of student learning preferences, which include visual, auditory, reading, and kinesthetic modes of learning.

  19. Delirium in critically ill patients.

    Science.gov (United States)

    Slooter, A J C; Van De Leur, R R; Zaal, I J

    2017-01-01

    Delirium is common in critically ill patients and associated with increased length of stay in the intensive care unit (ICU) and long-term cognitive impairment. The pathophysiology of delirium has been explained by neuroinflammation, an aberrant stress response, neurotransmitter imbalances, and neuronal network alterations. Delirium develops mostly in vulnerable patients (e.g., elderly and cognitively impaired) in the throes of a critical illness. Delirium is by definition due to an underlying condition and can be identified at ICU admission using prediction models. Treatment of delirium can be improved with frequent monitoring, as early detection and subsequent treatment of the underlying condition can improve outcome. Cautious use or avoidance of benzodiazepines may reduce the likelihood of developing delirium. Nonpharmacologic strategies with early mobilization, reducing causes for sleep deprivation, and reorientation measures may be effective in the prevention of delirium. Antipsychotics are effective in treating hallucinations and agitation, but do not reduce the duration of delirium. Combined pain, agitation, and delirium protocols seem to improve the outcome of critically ill patients and may reduce delirium incidence. © 2017 Elsevier B.V. All rights reserved.

  20. The challenges of transferring chronic illness patients to adult care: reflections from pediatric and adult rheumatology at a US academic center

    Directory of Open Access Journals (Sweden)

    Hersh Aimee O

    2009-06-01

    Full Text Available Abstract Background Little is known about the transfer of care process from pediatric to adult rheumatology for patients with chronic rheumatic disease. The purpose of this study is to examine changes in disease status, treatment and health care utilization among adolescents transferring to adult care at the University of California San Francisco (UCSF. Methods We identified 31 eligible subjects who transferred from pediatric to adult rheumatology care at UCSF between 1995–2005. Subject demographics, disease characteristics, disease activity and health care utilization were compared between the year prior to and the year following transfer of care. Results The mean age at the last pediatric rheumatology visit was 19.5 years (17.4–22.0. Subject diagnoses included systemic lupus erythematosus (52%, mixed connective tissue disease (16%, juvenile idiopathic arthritis (16%, antiphospholipid antibody syndrome (13% and vasculitis (3%. Nearly 30% of subjects were hospitalized for disease treatment or management of flares in the year prior to transfer, and 58% had active disease at the time of transfer. In the post-transfer period, almost 30% of subjects had an increase in disease activity. One patient died in the post-transfer period. The median transfer time between the last pediatric and first adult rheumatology visit was 7.1 months (range 0.7–33.6 months. Missed appointments were common in the both the pre and post transfer period. Conclusion A significant percentage of patients who transfer from pediatric to adult rheumatology care at our center are likely to have active disease at the time of transfer, and disease flares are common during the transfer period. These findings highlight the importance of a seamless transfer of care between rheumatology providers.

  1. Illness perceptions in adult congenital heart disease: A multi-center international study.

    Science.gov (United States)

    Rassart, Jessica; Apers, Silke; Kovacs, Adrienne H; Moons, Philip; Thomet, Corina; Budts, Werner; Enomoto, Junko; Sluman, Maayke A; Wang, Jou-Kou; Jackson, Jamie L; Khairy, Paul; Cook, Stephen C; Subramanyan, Raghavan; Alday, Luis; Eriksen, Katrine; Dellborg, Mikael; Berghammer, Malin; Johansson, Bengt; Rempel, Gwen R; Menahem, Samuel; Caruana, Maryanne; Veldtman, Gruschen; Soufi, Alexandra; Fernandes, Susan M; White, Kamila S; Callus, Edward; Kutty, Shelby; Luyckx, Koen

    2017-10-01

    Illness perceptions are cognitive frameworks that patients construct to make sense of their illness. Although the importance of these perceptions has been demonstrated in other chronic illness populations, few studies have focused on the illness perceptions of adults with congenital heart disease (CHD). This study examined (1) inter-country variation in illness perceptions, (2) associations between patient characteristics and illness perceptions, and (3) associations between illness perceptions and patient-reported outcomes. Our sample, taken from APPROACH-IS, consisted of 3258 adults with CHD from 15 different countries. Patients completed questionnaires on illness perceptions and patient-reported outcomes (i.e., quality of life, perceived health status, and symptoms of depression and anxiety). Patient characteristics included sex, age, marital status, educational level, employment status, CHD complexity, functional class, and ethnicity. Linear mixed models were applied. The inter-country variation in illness perceptions was generally small, yet patients from different countries differed in the extent to which they perceived their illness as chronic and worried about their illness. Patient characteristics that were linked to illness perceptions were sex, age, employment status, CHD complexity, functional class, and ethnicity. Higher scores on consequences, identity, and emotional representation, as well as lower scores on illness coherence and personal and treatment control, were associated with poorer patient-reported outcomes. This study emphasizes that, in order to gain a deeper understanding of patients' functioning, health-care providers should focus not only on objective indicators of illness severity such as the complexity of the heart defect, but also on subjective illness experiences. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Selenium supplementation for critically ill adults

    DEFF Research Database (Denmark)

    Allingstrup, Mikkel; Afshari, Arash

    2015-01-01

    BACKGROUND: Selenium is a trace mineral essential to health and has an important role in immunity, defence against tissue damage and thyroid function. Improving selenium status could help protect against overwhelming tissue damage and infection in critically ill adults. This Cochrane review......, to May 20, 2014), EMBASE (Ovid SP, to May 20, 2014), CAB, BIOSIS and CINAHL. We handsearched the reference lists of the newest reviews and cross-checked with our search in MEDLINE. We contacted the main authors of included studies to request any missed, unreported or ongoing studies. The latest search...... in order to retrieve relevant and missing data. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and we resolved any disagreements by discussion. Our primary outcome measure was all-cause mortality. We performed several subgroup and sensitivity analyses to assess the effects...

  3. EPICO 2.0 project. Development of educational therapeutic recommendations using the DELPHI technique on invasive candidiasis in critically ill adult patients in special situations.

    Science.gov (United States)

    Zaragoza, Rafael; Ferrer, Ricard; Maseda, Emilio; Llinares, Pedro; Rodriguez, Alejandro

    2014-01-01

    Although there has been an improved management of invasive candidiasis in the last decade, still controversial issues remain, especially in different therapeutic critical care scenarios. We sought to identify the core clinical knowledge and to achieve high agreement recommendations required to care for critically ill adult patients with invasive candidiasis for antifungal treatment in special situations and different scenarios. Second prospective Spanish survey reaching consensus by the DELPHI technique, conducted anonymously by electronic e-mail in the first phase to 23 national multidisciplinary experts in invasive fungal infections from five national scientific societies including intensivists, anesthesiologists, microbiologists, pharmacologists and infectious disease specialists, answering 30 questions prepared by a coordination group after a strict review of literature in the last five years. The educational objectives spanned four categories, including peritoneal candidiasis, immunocompromised patients, special situations, and organ failures. The agreement among panelists in each item should be higher than 75% to be selected. In a second phase, after extracting recommendations from the selected items, a meeting was held with more than 60 specialists in a second round invited to validate the preselected recommendations. In the first phase, 15 recommendations were preselected (peritoneal candidiasis (3), immunocompromised patients (6), special situations (3), and organ failures (3)). After the second round the following 13 were validated: Peritoneal candidiasis (3): Source control and early adequate antifungal treatment is mandatory; empirical antifungal treatment is recommended in secondary nosocomial peritonitis with Candida spp. colonization risk factors and in tertiary peritonitis. Immunocompromised patients (5): consider hepatotoxicity and interactions before starting antifungal treatment with azoles in transplanted patients; treat candidemia in

  4. Glycemic control in critically ill patients

    OpenAIRE

    2012-01-01

    Hyperglycemia is common in critically ill patients and can be caused by various mechanisms, including nutrition, medications, and insufficient insulin. In the past, hyperglycemia was thought to be an adaptive response to stress, but hyperglycemia is no longer considered a benign condition in patients with critical illnesses. Indeed, hyperglycemia can increase morbidity and mortality in critically ill patients. Correction of hyperglycemia may improve clinical outcomes. To date, a definite answ...

  5. A Real-World, Multicenter Assessment of Drugs Requiring Weight-Based Calculations in Overweight, Adult Critically Ill Patients

    Directory of Open Access Journals (Sweden)

    Sandra L. Kane-Gill

    2013-01-01

    Full Text Available Prescribing appropriate doses of drugs requiring weight-based dosing is challenging in overweight patients due to a lack of data. With 68% of the US population considered overweight and these patients being at an increased risk for hospitalization, clinicians need guidance on dosing weight-based drugs. The purpose of this study was to identify “real-world” dose ranges of high-risk medications administered via continuous infusion requiring weight-based dosing and determine the reasons for dosing changes (ineffectiveness or adverse drug reactions. A prospective, multicenter, observational study was conducted in four intensive care units at three institutions. A total of 857 medication orders representing 11 different high-risk medications in 173 patients were reviewed. It was noted that dosing did not increase in proportion to weight classification. Overall, 14 adverse drug reactions occurred in nine patients with more in overweight patients (9 of 14. A total of 75% of orders were discontinued due to ineffectiveness in groups with higher body mass indexes. Ineffectiveness leads to dosing adjustments resulting in the opportunity for medication errors. Also, the frequent dosing changes further demonstrate our lack of knowledge of appropriate dosing for this population. Given the medications’ increased propensity to cause harm, institutions should aggressively monitor these medications in overweight patients.

  6. Outcomes in adult critically Ill cancer patients with and without neutropenia: a systematic review and meta-analysis of the Groupe de Recherche en Réanimation Respiratoire du patient d'Onco-Hématologie (GRRR-OH)

    Science.gov (United States)

    Bourmaud, Aurélie; Azoulay, Elie; Mokart, Djamel; Darmon, Michael

    2017-01-01

    PURPOSE Whether neutropenia has an impact on the mortality of critically ill cancer patients remains controversial, yet it is widely used as an admission criterion and prognostic factor. METHODS Systematic review and meta-analysis. Studies on adult cancer patients and intensive care units were searched on PubMed and Cochrane databases (2005-2015). Summary estimates of mortality risk differences were calculated using the random-effects model. RESULTS Among the 1,528 citations identified, 38 studies reporting on 6,054 patients (2,097 neutropenic patients) were included. Median mortality across the studies was 54% [45–64], with unadjusted mortality in neutropenic and non-neutropenic critically ill patients of 60% [53–74] and 47% [41–68], respectively. Overall, neutropenia was associated with a 10% increased mortality risk (6%-14%; I2 = 50%). The admission period was not associated with how neutropenia affected mortality. Mortality significantly dropped throughout the study decade [−11% (−13.5 to −8.4)]. This mortality drop was observed in non-neutropenic patients [−12.1% (−15.2 to −9.0)] but not in neutropenic patients [−3.8% (−8.1 to +5.6)]. Sensitivity analyses disclosed no differences in underlying malignancy, mechanical ventilation use, or Granulocyte-colony stimulating factor use. Seven studies allowed the adjustment of severity results (1,350 patients). Although pooled risk difference estimates were similar to non-adjusted results, there was no significant impact of neutropenia on mortality (risk difference of mortality, 9%; 95% CI, −15 to +33) CONCLUSION Although the unadjusted mortality of neutropenic patients was 11% higher, this effect disappeared when adjusted for severity. Therefore, when cancer patients become critically ill, neutropenia cannot be considered as a decision-making criterion. PMID:27661125

  7. Transition From Intravenous to Subcutaneous Insulin in Critically Ill Adults.

    Science.gov (United States)

    Doolin, Meagan K; Walroth, Todd A; Harris, Serena A; Whitten, Jessica A; Fritschle-Hilliard, Andrew C

    2016-07-01

    Glycemic control decreases morbidity and mortality in critically ill patients. However, limited guidance exists regarding the transition from intravenous (IV) to subcutaneous insulin therapy. A validated protocol for transition is necessary since glycemic variability, hyperglycemia, and hypoglycemia adversely impact patient outcomes. The objective was to determine the safest and most effective method to transition critically ill adults from IV to subcutaneous insulin. This single-center, retrospective, observational study included adults admitted to the burn, medical, or surgical/trauma intensive care units from January 1, 2011, to September 30, 2014. A computer-based program provided a reflection of the patient's total daily IV insulin requirements. This information was then utilized to stratify patients into groups according to their initial dose of subcutaneous insulin as a percentage of the prior 24-hour IV requirements (group stratification: 0-49%, 50-59%, 60-69%, 70-79%, ≥80%). The primary endpoint was the percentage of blood glucose (BG) concentrations within target range (70-150 mg/dL) 48 hours following transition. One hundred patients with 1394 BG concentrations were included. The 50-59% group achieved the highest rate of BG concentrations in goal range (68%) (P 50-59% of their 24-hour IV insulin requirements. A dosing protocol will be implemented to transition to 50-70% subcutaneous insulin. Follow-up data will be reviewed to assess the protocol's safety and efficacy. © 2016 Diabetes Technology Society.

  8. The impact of actual and perceived disease severity on pre-operative psychological well-being and illness behaviour in adult congenital heart disease patients.

    Science.gov (United States)

    Callus, Edward; Utens, Elisabeth M W J; Quadri, Emilia; Ricci, Cristian; Carminati, Mario; Giamberti, Alessandro; Chessa, Massimo

    2014-04-01

    The purpose of this study was to investigate whether the objective medical parameters related to congenital heart disease and patients' ratings of cardiac disease severity were related to psychological well-being and illness behaviour during the pre-operative period. A total of 143 patients (63 male patients; 16-73 years old) with congenital heart disease evaluated the severity of their cardiac condition using a numerical rating scale ranging from 0, indicating the least severe condition, to 100, indicating the most severe condition. Psychological well-being was assessed using the Psychological General Well-Being Index (total score ≤ 60 indicating severe distress) and illness behaviour using the Illness Behavior Questionnaire. Pre-operative psychological well-being was not related to the objective medical parameters reflecting cardiac disease severity. In contrast, total psychological well-being scores correlated significantly with patients' subjective ratings of disease severity (p Illness Behavior Questionnaire, the scores on denial were higher and those on hypochondria were lower compared with other hospitalised patients. This study shows that the perception of cardiac disease severity, and not the medical parameters in congenital heart disease, is related to the patients' pre-operative psychological state. Thus, more importance needs to be given to assessing the patients' pre-operative perception and psychological state independently of cardiac severity. Targeted interventions with regard to the cardiac condition are recommended.

  9. Cost of illness and illness perceptions in patients with fibromyalgia

    NARCIS (Netherlands)

    Vervoort, V.M.C.; Vriezekolk, J.E.; Olde Hartman, T.C.; Cats, H.A.; van Helmond, T.; Van der Laan, W.H.; Geenen, R.; Van den Ende, C.H.M.

    2016-01-01

    OBJECTIVES: The disease impact and economic burden of fibromyalgia (FM) are high for patients and society at large. Knowing potential determinants of economic costs may help in reducing this burden. Cognitive appraisals (perceptions) of the illness could affect costs. The present study estimated

  10. A systematic review of prognostic/end-of-life communication with adults in the advanced stages of a life-limiting illness: patient/caregiver preferences for the content, style, and timing of information.

    Science.gov (United States)

    Parker, Sharon M; Clayton, Josephine M; Hancock, Karen; Walder, Sharon; Butow, Phyllis N; Carrick, Sue; Currow, David; Ghersi, Davina; Glare, Paul; Hagerty, Rebecca; Tattersall, Martin H N

    2007-07-01

    Evidence-based recommendations concerning how to discuss dying, life expectancy, and likely future symptoms with patients with a limited life expectancy and their families are lacking. The aim of this systematic review was to review studies regarding prognostic/end-of-life communication with adult patients in the advanced stages of a life-limiting illness and their caregivers. Relevant studies meeting the inclusion criteria were identified by searching computerized databases up to November 2004. One hundred twenty-three studies met the criteria for the full review, and 46 articles reported on patient/caregiver preferences for content, style, and timing of information. The majority of the research was descriptive. Although there were individual differences, patients/caregivers in general had high levels of information need at all stages of the disease process regarding the illness itself, likely future symptoms and their management, and life expectancy and information about clinical treatment options. Patient and caregiver information needs showed a tendency to diverge as the illness progressed, with caregivers needing more and patients wanting less information. Patients and caregivers preferred a trusted health professional who showed empathy and honesty, encouraged questions, and clarified each individual's information needs and level of understanding. In general, most patients/caregivers wanted at least some discussion of these topics at the time of diagnosis of an advanced, progressive, life-limiting illness, or shortly after. However, they wanted to negotiate the content and extent of this information.

  11. Cryptosporidium muris: Infectivity and Illness in Healthy Adult Volunteers

    Science.gov (United States)

    Chappell, Cynthia L.; Okhuysen, Pablo C.; Langer-Curry, Rebecca C.; Lupo, Philip J.; Widmer, Giovanni; Tzipori, Saul

    2015-01-01

    Although Cryptosporidium parvum and C. hominis cause the majority of human cryptosporidiosis cases, other Cryptosporidium species are also capable of infecting humans, particularly when individuals are immunocompromised. Ten C. muris cases have been reported, primarily in human immunodeficiency virus (HIV) -positive patients with diarrhea. However, asymptomatic cases were reported in two HIV-negative children, and in another case, age and immune status were not described. This study examines the infectivity of C. muris in six healthy adults. Volunteers were challenged with 105 C. muris oocysts and monitored for 6 weeks for infection and/or illness. All six patients became infected. Two patients experienced a self-limited diarrheal illness. Total oocysts shed during the study ranged from 6.7 × 106 to 4.1 × 108, and the number was slightly higher in volunteers with diarrhea (2.8 × 108) than asymptomatic shedders (4.4 × 107). C. muris-infected subjects shed oocysts longer than occurred with other species studied in healthy volunteers. Three volunteers shed oocysts for 7 months. Physical examinations were normal, with no reported recurrence of diarrhea or other gastrointestinal complaints. Two persistent shedders were treated with nitazoxanide, and the infection was resolved. Thus, healthy adults are susceptible to C. muris, which can cause mild diarrhea and result in persistent, asymptomatic infection. PMID:25311695

  12. Inter-hospital transfers of acutely ill adults in Scotland.

    Science.gov (United States)

    Fried, M J; Bruce, J; Colquhoun, R; Smith, G

    2010-02-01

    The transfer of acutely ill adults who were transported between hospitals by the Scottish Ambulance Service was audited in order to determine the number of transfers and to quantify the incidence of adverse events. Patients over 16 years of age requiring intervention/vital signs monitoring during transfer or a nursing/medical escort from the outset were defined as acutely ill adults. Three thousand and forty-eight audit forms were received, of which 2396 were suitable for inclusion in the audit. Transfers primarily occurred for specialist management (1580; 66%) or specialist investigation (550; 23%). Clinicians escorted 825 (34%) patients and were away from their hospital a median (IQR [range]) of 2 h (01:24-3:30 [00:05-17:33]) h:min Clinical intervention was required in 84 transfers (4%). The median (IQR [range]) time for 248 transfers (10.3%) requiring assisted ventilation was 28 min (00:17-00:50 [00:04-02:55]). The incidence of unsecured medical equipment (in escorted transfers only) was significantly lower in dedicated transport teams (2/205, 1%) vs non-dedicated (113/620, 18%; p = 0.004). Medical equipment failures were less common in the transfer of patients requiring assisted ventilation (1/156, 0.6% vs 9/97, 9%; p = 0.001).

  13. Facing mortality: a qualitative in-depth interview study on illness perception, lay theories and coping strategies of adult patients with acute leukemia 1 week after diagnosis.

    Science.gov (United States)

    Koenigsmann, Michael; Koehler, Katharina; Regner, Andreas; Franke, Astrid; Frommer, Jörg

    2006-09-01

    In patients with acute leukemia we investigated the illness perceptions, lay theories and coping strategies 1 week after diagnosis. Semi-structured in-depth interviews were conducted with 12 patients. The transcribed interviews were analyzed by methods of qualitative research. Dramatic narrations of overwhelming threat in younger patients contrast to rationalization in elderly patients. Feelings of helplessness and efforts of normalization become apparent. Intense descriptions of physical injury due to invasive procedures allow verbalizing the fear of the disease. While coping strategies are complex, the overall importance of trust is recognized. Mortal fears are indirectly indicated. The results have consequences for psycho-oncological training and patient education.

  14. Adults' Explanations and Children's Understanding of Contagious Illnesses, Non-Contagious Illnesses, and Injuries

    Science.gov (United States)

    Toyama, Noriko

    2016-01-01

    The present study examined (1) whether children notice different causes for contagious illnesses, non-contagious illnesses, and injuries and (2) what information adults provide to children and to what extent this information is related to children's causal awareness. Studies 1 and 2 explored preschool teachers' and mothers' explanations of…

  15. Illness perceptions in patients with fibromyalgia

    NARCIS (Netherlands)

    van Ittersum, M.W.; van Wilgen, C.P.; Hilberdink, W.K.; Groothoff, J.W.; van der Schans, C.P.

    2009-01-01

    OBJECTIVE: Former studies in chronic diseases showed the importance of patients' beliefs and perceptions. The Revised Illness Perception Questionnaire was developed to assess these illness perceptions. Our goal was to investigate psychometric properties of the IPQ-R for Fibromyalgia Dutch language v

  16. Illness perceptions in patients with fibromyalgia

    NARCIS (Netherlands)

    Van Ittersum, M. W.; van Wilgen, C. P.; Hilberdink, W. K. H. A.; Groothoff, J. W.; van der Schans, C. P.

    2009-01-01

    Objective: Former studies in chronic diseases showed the importance of patients' beliefs and perceptions. The Revised Illness Perception Questionnaire was developed to assess these illness perceptions. Our goal was to investigate psychometric properties of the IPQ-R for Fibromyalgia Dutch language v

  17. 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.

  18. Jávea consensus guidelines for the treatment of Candida peritonitis and other intra-abdominal fungal infections in non-neutropenic critically ill adult patients.

    Science.gov (United States)

    Pemán, Javier; Aguilar, Gerardo; Valía, Juan Carlos; Salavert, Miguel; Navarro, David; Zaragoza, Rafael

    Although the management of the invasive candidiasis has improved in the last decade, controversial issues yet remain, especially in the diagnostic and therapeutic approaches to Candida peritonitis and other forms of intra-abdominal fungal infections. We sought to identify core clinical knowledge about intra-abdominal fungal infections and to achieve high-agreement recommendations required to care for critically ill adult patients with Candida peritonitis and other forms of intra-abdominal fungal infection. A biregional Spanish survey, to elucidate the consensus about the already mentioned fungal infections by means of the Delphi technique, was conducted anonymously by e-mail with 29 multidisciplinary experts in invasive fungal infections from 14 hospitals in the Valencia and Murcia communities during 2014. Respondents included intensivists, anesthesiologists, microbiologists, pharmacologists, and infectious disease specialists, who answered 31 questions prepared by a coordination group after a strict review of the literature from the 5 previous years. The educational objectives spanned 6 categories: epidemiology, microbiological diagnosis, clinical diagnosis, antifungal treatment, de-escalation therapy, and special situations. The agreement required among the panelists for each item to be selected had to be higher than 70%. After extracting the recommendations from the selected items, a meeting at which the experts were asked to validate the previously selected recommendations in a second round of scoring took place. After the second round, 36 recommendations were validated according to the following distribution: epidemiology (5), microbiological diagnosis (4), clinical diagnosis (4), antifungal treatment (3), de-escalation therapy (4), and special situations (16). Treatment of Candida peritonitis and other forms of intra-abdominal fungal infections in ICU patients requires a broad range of knowledge application and skills that our recommendations address. Based

  19. [Assessment and treatment of hyperglycemia in critically ill patients].

    Science.gov (United States)

    Viana, Marina Verçoza; Moraes, Rafael Barberena; Fabbrin, Amanda Rodrigues; Santos, Manoella Freitas; Gerchman, Fernando

    2014-01-01

    Hyperglycemia is a commonly encountered issue in critically ill patients in the intensive care setting. The presence of hyperglycemia is associated with increased morbidity and mortality, regardless of the reason for admission (e.g., acute myocardial infarction, status post-cardiovascular surgery, stroke, sepsis). However, the pathophysiology and, in particular, the treatment of hyperglycemia in the critically ill patient remain controversial. In clinical practice, several aspects must be taken into account in the management of these patients, including blood glucose targets, history of diabetes mellitus, the route of nutrition (enteral or parenteral), and available monitoring equipment, which substantially increases the workload of providers involved in the patients' care. This review describes the epidemiology, pathophysiology, management, and monitoring of hyperglycemia in the critically ill adult patient.

  20. Adult Smoking Among People with Mental Illness PSA (:60)

    Centers for Disease Control (CDC) Podcasts

    2013-02-05

    This 60 second public service announcement is based on the February 2013 CDC Vital Signs report, which shows that cigarette smoking is a serious problem among adults with mental illness. More needs to be done to help adults with mental illness quit smoking and make mental health facilities tobacco-free.  Created: 2/5/2013 by Centers for Disease Control and Prevention (CDC).   Date Released: 2/5/2013.

  1. [Épico project: Development of educational recommendations using the DELPHI technique on invasive candidiasis in non-neutropenic critically ill adult patients. Grupo Proyecto Épico].

    Science.gov (United States)

    Zaragoza, Rafael; Llinares, Pedro; Maseda, Emilio; Ferrer, Ricard; Rodríguez, Alejandro

    2013-01-01

    Although there has been an improved management of invasive candidiasis in the last decade, controversial issues still remain, especially in the diagnostic and therapeutic approaches. We sought to identify the core clinical knowledge and to achieve high level agreement recommendations required to care for critically ill adult patients with invasive candidiasis. A prospective Spanish survey reaching consensus by the DELPHI technique was made. It was anonymously conducted by electronic mail in a first term to 25 national multidisciplinary experts in invasive fungal infections from five national scientific societies, including intensivists, anesthesiologists, microbiologists, pharmacologists and infectious diseases specialists, who answered to 47 questions prepared by a coordination group after a strict review of the literature in the last five years. The educational objectives spanned five categories, including epidemiology, diagnostic tools, prediction rules, and treatment and de-escalation approaches. The level of agreement achieved among the panel experts in each item should exceed 75% to be selected. In a second term, after extracting recommendations from the selected items, a face to face meeting was performed where more than 80 specialists in a second round were invited to validate the preselected recommendations. In the first term, 20 recommendations were preselected (Epidemiology 4, Scores 3, Diagnostic tools 4, Treatment 6 and De-escalation approaches 3). After the second round, the following 12 were validated: (1) Epidemiology (2 recommendations): think about candidiasis in your Intensive Care Unit (ICU) and do not forget that non-Candida albicans-Candida species also exist. (2) Diagnostic tools (4 recommendations): blood cultures should be performed under suspicion every 2-3 days and, if positive, every 3 days until obtaining the first negative result. Obtain sterile fluid and tissue, if possible (direct examination of the sample is important). Use non

  2. ÉPICO project. Development of educational recommendations using the DELPHI technique on invasive candidiasis in non-neutropenic critically ill adult patients.

    Science.gov (United States)

    Zaragoza, R; Llinares, P; Maseda, E; Ferrer, R; Rodríguez, A

    2013-01-01

    Although there has been an improved management of invasive candidiasis in the last decade, controversial issues still remain, especially in the diagnostic and therapeutic approaches. We sought to identify the core clinical knowledge and to achieve high level agreement recommendations required to care for critically ill adult patients with invasive candidiasis. A prospective Spanish survey reaching consensus by the DELPHI technique was made. It was anonymously conducted by electronic mail in a first term to 25 national multidisciplinary experts in invasive fungal infections from five national scientific societies, including intensivists, anesthesiologists, microbiologists, pharmacologists and infectious diseases specialists, who answered to 47 questions prepared by a coordination group after a strict review of the literature in the last five years. The educational objectives spanned five categories, including epidemiology, diagnostic tools, prediction rules, and treatment and de-escalation approaches. The level of agreement achieved among the panel experts in each item should exceed 75% to be selected. In a second term, after extracting recommendations from the selected items, a face to face meeting was performed where more than 80 specialists in a second round were invited to validate the preselected recommendations. In the first term, 20 recommendations were preselected (Epidemiology 4, Scores 3, Diagnostic tools 4, Treatment 6 and De-escalation approaches 3). After the second round, the following 12 were validated: (1) Epidemiology (2 recommendations): think about candidiasis in your Intensive Care Unit (ICU) and do not forget that non-Candida albicans-Candida species also exist. (2) Diagnostic tools (4 recommendations): blood cultures should be performed under suspicion every 2-3 days and, if positive, every 3 days until obtaining the first negative result. Obtain sterile fluid and tissue, if possible (direct examination of the sample is important). Use non

  3. [Medicines reconciliation in critically ill patients].

    Science.gov (United States)

    Lopez-Martin, C; Aquerreta, I; Faus, V; Idoate, A

    2014-01-01

    Medicines reconciliation plays a key role in patient safety. However, there is limited data available on how this process affects critically ill patients. In this study, we evaluate a program of reconciliation in critically ill patients conducted by the Intensive Care Unit's (ICU) pharmacist. Prospective study about reconciliation medication errors observed in 50 patients. All ICU patients, excluding patients without regular treatment. Reconciliation process was carried out in the first 24h after ICU admission. Discrepancies were clarified with the doctor in charge of the patient. We analyzed the incidence of reconciliation errors, their characteristics and gravity, the interventions made by the pharmacist and their acceptance by physicians. A total of 48% of patients showed at least one reconciliation error. Omission of drugs accounted for 74% of the reconciliation errors, mainly involving antihypertensive drugs (33%). An amount of 58% of reconciliation errors detected corresponded to severity category D. Pharmacist made interventions in the 98% of patients with discrepancies. A total of 81% of interventions were accepted. The incidence and characteristics of reconciliation errors in ICU are similar to those published in non-critically ill patients, and they affect drugs with high clinical significance. Our data support the importance of the stablishment of medication reconciliation proceedings in critically ill patients. The ICU's pharmacist could carry out this procedure adequately. Copyright © 2013 Elsevier España, S.L. and SEMICYUC. All rights reserved.

  4. Perceived illness intrusion among patients on hemodialysis

    Directory of Open Access Journals (Sweden)

    Bapat Usha

    2009-01-01

    Full Text Available Dialysis therapy is extremely stressful as it interferes with all spheres of daily acti-vities of the patients. This study is aimed at understanding the perceived illness intrusion among pa-tients on hemodialysis (HD and to find the association between illness intrusion and patient demo-graphics as well as duration of dialysis. A cross sectional study involving 90 patients with chronic kidney disease (CKD stage V, on HD was performed during the period from 2005 to 2006. The subjects included were above 18 years of age, willing, stable and on dialysis for at least two months. Patients with psychiatric co-morbidity were excluded. A semi-structured interview schedule covering socio-demographics and a 13 item illness intrusion checklist covering the various aspects of life was ca-rried out. The study patients were asked to rate the illness intrusion and the extent. The data were ana-lyzed statistically. The mean age of the subjects was 50.28 ± 13.69 years, males were predominant (85%, 73% were married, 50% belonged to Hindu religion, 25% had pre-degree education, 25% were employed and 22% were housewives. About 40% and 38% of the study patients belonged to middle and upper socio-economic strata respectively; 86% had urban background and lived in nuclear fami-lies. The mean duration on dialysis was 24 ± 29.6 months. All the subjects reported illness intrusion to a lesser or greater extent in various areas including: health (44%, work (70% finance (55%, diet (50% sexual life (38% and psychological status (25%. Illness had not intruded in areas of rela-tionship with spouse (67%, friends (76%, family (79%, social (40% and religious functions (72%. Statistically significant association was noted between illness intrusion and occupation (P= 0.02.

  5. Illness perceptions of cancer patients: relationships with illness characteristics and effects on coping.

    NARCIS (Netherlands)

    Hopman, E.P.C.; Rijken, P.M.

    2013-01-01

    Background: Illness perceptions have proven to be predictive of coping and adjustment in many chronically ill patients. Insights into illness perceptions of cancer patients are however scarce. The purpose of the present study was to explore how people with cancer perceive their illness. Moreover, we

  6. Pancreatic Involvement in Critically ill Patients

    Directory of Open Access Journals (Sweden)

    Abhinav Agrawal

    2015-07-01

    Full Text Available Elevation of pancreatic enzymes is often observed in patients admitted to intensive care units in the United States. Elevated pancreatic enzymes can occur due to acute pancreatitis or numerous non-specific reasons. Non-specific enzyme elevation can be seen in patients with head injury, acute renal failure, diabetic ketoacidosis or patients on hemodialysis. Patients with severe acute pancreatitis can be admitted to the intensive care units for intensive care or patients admitted to the intensive care units for other critical illness can develop acute pancreatitis due to a variety of reasons like ischemia, hypoperfusion, drugs or hypercalcemia. It can be a challenging task to distinguish between acute pancreatitis and non-specific enzyme elevation, especially in critically ill patients with multiple co-morbidities admitted to the intensive care units in whom historical information may not be always available. In addition, the clinical consequences of pancreatic enzyme elevation in the critically ill patients are also not very clear. This review attempts to describe the complex interplay of various factors that can lead to either pancreatic inflammation and/or pancreatic enzyme elevation in the critically ill patients along with the clinical consequences and approach to patient with pancreatic enzyme elevation in the intensive care units.

  7. Cardiac troponin elevations among critically ill patients.

    NARCIS (Netherlands)

    Klein Gunnewiek, J.M.T.; Hoeven, J.G. van der

    2004-01-01

    PURPOSE OF THE REVIEW: Elevated levels of cardiac troponins, indicative of the presence of cardiac injury, have been reported in critically ill patients. In this review, the incidence, significance, and clinical relevance of elevated troponin levels among this group of patients will be discussed. RE

  8. Ketamine for analgosedation in critically ill patients.

    Science.gov (United States)

    Erstad, Brian L; Patanwala, Asad E

    2016-10-01

    The purpose of this narrative review is to provide practical and useful guidance for clinicians considering the use of intravenous ketamine for its analgosedative properties in adult, critically ill patients. MEDLINE was searched from inception until January 2016. Articles related to the pharmacological properties of ketamine were retrieved. Information pertaining to pharmacology, pharmacokinetics, dosing regimens, adverse effects, and outcomes was obtained from relevant studies. Although the primary mechanism for ketamine's pharmacological effects is N-methyl-d-aspartate blockade, there are several potential mechanisms of action. It has a very large volume of distribution due to its lipophilicity, which can lead to drug accumulation with sustained infusions. Ketamine has several advantages compared with conventional sedatives such as preserving pharyngeal and laryngeal protective reflexes, lowering airway resistance, increasing lung compliance, and being less likely to produce respiratory depression. It causes sympathetic stimulation, which is also unlike other sedatives and analgesics. There are psychotomimetic effects, which are a concern in terms of delirium. Dosing and monitoring recommendations are provided. Ketamine has a unique pharmacological profile compared with more traditional agents such as opioids, which makes it an appealing alternative agent for analgosedation in the intensive care unit setting. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Why critically ill patients are protein deprived.

    Science.gov (United States)

    Hoffer, L John; Bistrian, Bruce R

    2013-01-01

    Critical illness dramatically increases muscle proteolysis and more than doubles the dietary protein requirement. Yet surprisingly, most critically ill patients receive less than half the recommended amount of protein during their stay in a modern intensive care unit. What could explain the wide gap between the recommendations in clinical care guidelines and actual clinical practice? We suggest that an important aspect of the problem is the failure of guidelines to explain the pathophysiology of protein-energy malnutrition and the ways critical illness modifies protein metabolism. The difficulty created by the lack of a framework for reasoning about appropriate protein provision in critical illness is compounded by the many ambiguous and often contradictory ways the word malnutrition is used in the critical care literature. Failing to elucidate these matters, the recommendations for protein provision in the guidelines are incoherent, unconvincing, and easy to ignore.

  10. Diastolic dysfunction in the critically ill patient.

    Science.gov (United States)

    Suárez, J C; López, P; Mancebo, J; Zapata, L

    2016-11-01

    Left ventricular diastolic dysfunction is a common finding in critically ill patients. It is characterized by a progressive deterioration of the relaxation and the compliance of the left ventricle. Two-dimensional and Doppler echocardiography is a cornerstone in its diagnosis. Acute pulmonary edema associated with hypertensive crisis is the most frequent presentation of diastolic dysfunction critically ill patients. Myocardial ischemia, sepsis and weaning failure from mechanical ventilation also may be associated with diastolic dysfunction. The treatment is based on the reduction of pulmonary congestion and left ventricular filling pressures. Some studies have found a prognostic role of diastolic dysfunction in some diseases such as sepsis. The present review aims to analyze thoroughly the echocardiographic diagnosis and the most frequent scenarios in critically ill patients in whom diastolic dysfunction plays a key role. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  11. Disparities in appendicitis rupture rate among mentally ill patients

    Directory of Open Access Journals (Sweden)

    Bai Ya-Mei

    2007-11-01

    Full Text Available Abstract Background Many studies have been carried out that focus on mental patients' access to care for their mental illness, but very few pay attention on these same patients' access to care for their physical diseases. Acute appendicitis is a common surgical emergency. Our population-based study was to test for any possible association between mental illness and perforated appendicitis. We hypothesized that there are significant disparities in access to timely surgical care between appendicitis patients with and without mental illness, and more specifically, between patients with schizophrenia and those with another major mental illness. Methods Using the National Health Insurance (NHI hospital-discharge data, we compared the likelihood of perforated appendix among 97,589 adults aged 15 and over who were hospitalized for acute appendicitis in Taiwan between the years 1997 to 2001. Among all the patients admitted for appendicitis, the outcome measure was the odds of appendiceal rupture vs. appendicitis that did not result in a ruptured appendix. Results After adjusting for age, gender, ethnicity, socioeconomic status (SES and hospital characteristics, the presence of schizophrenia was associated with a 2.83 times higher risk of having a ruptured appendix (odds ratio [OR], 2.83; 95% confidence interval [CI], 2.20–3.64. However, the presence of affective psychoses (OR, 1.15; 95% CI: 0.77–1.73 or other mental disorders (OR, 1.58; 95% CI: 0.89–2.81 was not a significant predictor for a ruptured appendix. Conclusion These findings suggest that given the fact that the NHI program reduces financial barriers to care for mentally ill patients, they are still at a disadvantage for obtaining timely treatment for their physical diseases. Of patients with a major mental illness, schizophrenic patients may be the most vulnerable ones for obtaining timely surgical care.

  12. Psychoneuroimmunology in critically ill patients.

    Science.gov (United States)

    DeKeyser, Freda

    2003-02-01

    Psychoneuroimmunology is the study of the interactions among behavior, neural, and endocrine functions and the immune system. The purpose of this review is to briefly summarize the evidence concerning interactions among behavior, the neuroendocrine system, and the immune system, and to show how this evidence relates to critical care patients. It has been shown that the immune function of many patients in the intensive care unit is suppressed as a result of trauma, sepsis, or profound physiologic and psychological stress. Three of the most common stressors among patients in the intensive care unit are pain, sleep deprivation, and fear or anxiety. Findings have shown each of these stressors to be associated with decreased immune functioning. Nurses have an important responsibility to protect their patients from infection and promote their ability to heal. Several actions are suggested that can help the nurse achieve these goals. It is hoped that nurses would keep these interactions in mind while caring for their patients in the intensive care unit.

  13. Melatonin Secretion Pattern in Critically Ill Patients

    DEFF Research Database (Denmark)

    Boyko, Yuliya; Holst, René; Jennum, Poul

    2017-01-01

    Critically ill patients have abnormal circadian and sleep homeostasis. This may be associated with higher morbidity and mortality. The aims of this pilot study were (1) to describe melatonin secretion in conscious critically ill mechanically ventilated patients and (2) to describe whether melatonin...... secretion and sleep patterns differed in these patients with and without remifentanil infusion. Eight patients were included. Blood-melatonin was taken every 4th hour, and polysomnography was carried out continually during a 48-hour period. American Academy of Sleep Medicine criteria were used for sleep...... scoring if sleep patterns were identified; otherwise, Watson's classification was applied. As remifentanil was periodically administered during the study, its effect on melatonin and sleep was assessed. Melatonin secretion in these patients followed a phase-delayed diurnal curve. We did not observe any...

  14. Illness perceptions of cancer patients: relationships with illness characteristics and coping.

    NARCIS (Netherlands)

    Hopman, P.; Rijken, M.

    2015-01-01

    Objective: Illness perceptions have proven to be predictive of coping and adjustment in many chronically ill patients. However, insights into illness perceptions of cancer patients are scarce. The purpose of the present study was to explore how a heterogeneous sample of cancer patients perceive thei

  15. Illness behavior in patients with musculoskeletal disease

    NARCIS (Netherlands)

    Bot, A.G.J.

    2013-01-01

    This PhD thesis studies the influence of psychological factors in illness behavior in different hand and upper extremity conditions encountered in the practice of a hand surgeon. The importance of the language used by the patient and the amount of shared decision making in an orthopaedic practice is

  16. Pressure sore prevention in acutely ill patients.

    Science.gov (United States)

    James, H

    1997-03-01

    A wide range of factors affect the skin's ability to withstand pressure, friction and shear. Clinically validated pressure-relieving equipment is essential to prevent pressure sores in acutely ill patients. A successful pressure sore prevention strategy depends on sufficient resource allocation, appropriate levels and types of preventive equipment and evaluation.

  17. Sarcopenia in critically ill patients.

    Science.gov (United States)

    Kizilarslanoglu, Muhammet C; Kuyumcu, Mehmet E; Yesil, Yusuf; Halil, Meltem

    2016-10-01

    Sarcopenia occurring as a primary consequence of aging and secondary due to certain medical problems including chronic disease, malnutrition and inactivity is a progressive generalized loss of skeletal muscle mass, strength and function. The prevalence of sarcopenia increases with aging (approximately 5-13 % in the sixth and seventh decades). However, data showing the prevalence and clinical outcomes of sarcopenia in intensive care units (ICUs) are limited. A similar condition to sarcopenia in the ICU, called ICU-acquired weakness (ICU-AW), has been reported more frequently. Here, we aim to examine the importance of sarcopenia, especially ICU-AW, in ICU patients via related articles in Medline.

  18. Stigma and difficulty accessing medical care in a sample of adults with serious mental illness.

    Science.gov (United States)

    Ostrow, Laysha; Manderscheid, Ron; Mojtabai, Ramin

    2014-11-01

    Wellness of people with mental illness is increasingly a public health priority. This study examined factors associated with difficulties receiving medical care in adults with mental illness. In a sample of 1,670 adults with mental illness, we assessed difficulties in accessing medical care and stigma. A total of 465 (28%) participants reported difficulties in accessing medical care; 211 (13%) attributed difficulties in access to stigma. Lack of comprehensive medical care coverage and mental health symptoms were associated with increased odds of perceived difficulties in accessing medical care; personal empowerment was negatively associated with perceived difficulties attributed to stigma; education was positively associated. The findings highlight unmet need for medical care in this population and the need to recognize stigma as a barrier medical care. Interventions to empower patients and educate medical providers about wellness for people with serious mental illness could help to reduce barriers.

  19. Using Young Adult Literature To End Discrimination against Mental Illness.

    Science.gov (United States)

    Perez, Kathy

    In an effort to inform junior and senior high school students about mental illness, this document provides educators with an annotated bibliography of young adult fiction and a set of supporting activities. Included in the bibliography are nearly 100 current fiction titles, grouped according to the following topics: anorexia, drugs and alcohol,…

  20. Liberation From Mechanical Ventilation in Critically Ill Adults

    DEFF Research Database (Denmark)

    Schmidt, Gregory A; Girard, Timothy D; Kress, John P

    2017-01-01

    BACKGROUND: This clinical practice guideline addresses six questions related to liberation from mechanical ventilation in critically ill adults. It is the result of a collaborative effort between the American Thoracic Society (ATS) and the American College of Chest Physicians (CHEST). METHODS...

  1. Adiponectin in pulmonary disease and critically ill patients

    Science.gov (United States)

    Garcia, Pablo; Sood, Akshay

    2013-01-01

    Adiponectin is a predominantly anti-inflammatory protein produced by adipose tissue with possible signalling activity in the lung. It is increasingly associated with inflammatory pulmonary diseases, such as asthma and chronic obstructive pulmonary disease (COPD), and in critical illness. Although mouse studies indicate causative associations between adiponectin and asthma and COPD, the human literature in this regard is inconclusive. Some, but not all, studies demonstrate that serum adiponectin concentrations are inversely associated with asthma prevalence among premenopausal women and peripubertal girls. On the other hand, serum adiponectin concentrations are associated with lower asthma severity among boys but greater severity among men. Further, case-control studies demonstrate higher systemic and airway adiponectin concentrations in primarily male COPD patients than controls. Systemic adiponectin is positively associated with lung function in healthy adults but inversely associated in studies of male subjects with COPD. Murine and human studies further show contradictory associations of systemic adiponectin with critical illness. Higher premorbid systemic adiponectin concentrations are associated with improved survival from sepsis in mice. On the other hand, higher systemic adiponectin concentrations on day 1 of critical illness are associated with lower survival in critically ill patients with respiratory failure. In the absence of adequate longitudinal data, it is not possible to determine whether the adiponectin derangements are the consequence or the cause of the disease studied. Future research will determine whether modulation of adiponectin, independent of BMI, may be helpful in the prevention or treatment of asthma, COPD or critical illness. PMID:22876927

  2. The meaning of social support for the critically ill patient.

    Science.gov (United States)

    Hupcey, J E

    2001-08-01

    Social support has been shown to be important for the critically ill patient. However, what constitutes adequate support for these patients has not been investigated. Thus, the purpose of this qualitative study was to investigate patients' perceptions of their need for and adequacy of the social support received while they were critically ill. Thirty adult patients who were critical during some point of their stay in the intensive care unit (ICU) stay were interviewed, once stable. Interviews were tape-recorded and began with an open-ended question regarding the ICU experience. This was followed by open-ended focused questions regarding social support, such as 'Who were your greatest sources of social support while you were critically ill?' 'What did they do that was supportive or unsupportive?' Data were analyzed according to Miles and Huberman (1994). The categories that emerged were need for social support based on patient perceptions (not number of visitors), quality of support (based on perceptions of positive and negative behaviors of supporters) and lack of support. This study found that quality of support was more important than the actual number of visitors. Patients with few visitors may have felt supported, while those with numerous visitors felt unsupported. Patients who felt unsupported also were more critical of the staff and the care they received. Nurses need to individually assess patients regarding their need for support, and assist family/friends to meet these needs.

  3. Energy expenditure of acutely ill hospitalised patients

    Directory of Open Access Journals (Sweden)

    Gariballa Salah

    2006-03-01

    Full Text Available Abstract Objective To measure energy expenditure of acutely ill elderly patients in hospital and following discharge in the community. Design Sixty-three consecutive hospitalised acutely ill elderly patients were recruited. Eight patients were studied to assess the reliability of the Delta Tract Machine as a measure of energy expenditure; 35 patients had their energy expenditure studied in hospital on two occasions and 20 patients had their energy expenditure measured in hospital and at 6 weeks in the community Results Men had higher basal energy expenditure (BMR values compared to women however the difference was not statistically significant [Men, mean (SD 1405 (321 Kcal, women 1238 (322 kcal; mean difference (95% CI 166 kcal (-17 to 531, p = 0.075]. After adjusting for age, gender and body mass index both medication and C-reactive protein (CRP, concentrations showed significant correlation with measured energy expenditure in hospital, (r = -0.36, "p Conclusion Tissue inflammation and medications were associated with change in measured energy expenditure in acutely ill patients.

  4. Prolonged febrile illness and fever of unknown origin in adults.

    Science.gov (United States)

    Hersch, Elizabeth C; Oh, Robert C

    2014-07-15

    Fever of unknown origin has been described as a febrile illness (temperature of 101°F [38.3°C] or higher) for three weeks or longer without an etiology despite a one-week inpatient evaluation. A more recent qualitative definition requires only a reasonable diagnostic evaluation. Although there are more than 200 diseases in the differential diagnosis, most cases in adults are limited to several dozen possible causes. Fever of unknown origin is more often an atypical presentation of a common disease rather than an unusual disease. The most common subgroups in the differential are infection, malignancy, noninfectious inflammatory diseases, and miscellaneous. Clinicians should perform a comprehensive history and examination to look for potentially diagnostic clues to guide the initial evaluation. If there are no potentially diagnostic clues, the patient should undergo a minimum diagnostic workup, including a complete blood count, chest radiography, urinalysis and culture, electrolyte panel, liver enzymes, erythrocyte sedimentation rate, and C-reactive protein level testing. Further testing should include blood cultures, lactate dehydrogenase, creatine kinase, rheumatoid factor, and antinuclear antibodies. Human immunodeficiency virus and appropriate region-specific serologic testing (e.g., cytomegalovirus, Epstein-Barr virus, tuberculosis) and abdominal and pelvic ultrasonography or computed tomography are commonly performed. If the diagnosis remains elusive, 18F fluorodeoxyglucose positron emission tomography plus computed tomography may help guide the clinician toward tissue biopsy. Empiric antibiotics or steroids are generally discouraged in patients with fever of unknown origin.

  5. Attitudes toward patient expertise in chronic illness.

    Science.gov (United States)

    Thorne, S E; Ternulf Nyhlin, K; Paterson, B L

    2000-08-01

    Although it has become an accepted standard to acknowledge the patient as a full partner in health care decisions, replacing traditional authoritative relationships with those based on an emancipatory model, the experiences of persons living with chronic illness confirm that this paradigm shift is not yet apparent in many health care relationships. In this paper, the authors present a qualitative secondary analysis of combined data sets from their research into chronic illness experience with two quite different chronic diseases - Type I Diabetes (a socially legitimized chronic disease) and Environmental Sensitivities (a disease which is currently treated with considerable scepticism). Comparing the experiences of individuals with diseases that are quite differently socially constructed, it becomes possible to detect common underlying health professional values and attitudes that powerfully influence the experience of living with and negotiating health care for a chronic illness. In the discussion of findings from this study, the authors examine the implications of the spiral of behaviors that fuels mutual alienation in chronic illness care relationships if professionals are unable to value patient expertise.

  6. Enteral nutrition therapy for critically ill adult patients: critical review and algorithm creation Terapia nutricional enteral para pacientes adultos en estado crítico: análisis crítico de la literatura y la creación de algoritmo

    OpenAIRE

    Araújo-Junqueira, L.; Daurea A. De-Souza

    2012-01-01

    Introduction: Undernutrition directly affects critically ill patient's clinical outcome and mortality rates. Objective: Interdisciplinar algorithm creation aiming to optimize the enteral nutrition therapy for critically ill adult patients. Data source: Pubmed, SciELO, Scholar Google, Web of Science, Scopus, with research of these key words: protocols, enteral nutrition, nutritional support, critical care, undernutrition, fasting. Setting: Intensive Care Unit, Hospital de Clínicas, Federal Uni...

  7. Promoting and supporting self-management for adults living in the community with physical chronic illness: A systematic review of the effectiveness and meaningfulness of the patient-practitioner encounter.

    Science.gov (United States)

    Rees, Sally; Williams, Anne

    2009-01-01

    There has been a reported rise in the number of people with chronic illness (also referred to as long-term disease) in the Western world. One hundred million people in the United States have at least one chronic condition and in the United Kingdom (UK) as many as 17.5 million adults may be living with chronic disease. New models of care have been developed which recognise the complexities of managing care where there is overlap between the wider community, the health care system and provider organisations, for example, the Chronic Care Model and the Expert Patient Programme. These new models herald a shift away from the idea of chronically ill patients as passive recipients of care towards active engagement, in partnership with health professionals, in managing their own care.Partnership, ideally, involves collaborative care and self-management education. This may support self-care alongside medical, preventative and health maintenance interventions. In this context the nature of the patient-practitioner consultation in promoting self-care takes on a new importance. The overall objective of the review was to determine the best available evidence regarding the promotion and support of self-care management for adults living in the community with chronic illness during the patient-practitioner encounter. Specifically the review sought to determine: What is the effectiveness of the patient-practitioner encounter in promoting and supporting self-care management of people with chronic illness? What are the individual and organisational factors which help or hinder recognition, promotion and support of chronic disease self-care management strategies? What are the similarities and differences between how 'effectiveness' is defined in this context by patients and different practitioners? The review focussed on self-caring adults aged nineteen years and older living in the community, with a physical chronic illness, and not currently being treated as an in-patient. For

  8. Positive feelings among terminally ill cancer patients.

    Science.gov (United States)

    Van der Lee, M L; Swarte, N B; Van der Bom, J G; Van den Bout, J; Heintz, A P M

    2006-03-01

    For a realistic perspective on what it is like to have cancer and be in the last months of life, it is necessary to also study the positive feelings people may still experience. We set out to describe positive feelings experienced by terminally ill patients. The Depression Adjective Checklist was completed by 96 cancer patients with an estimated life expectancy of less than 3 months. On average patients endorsed 30% (3.6/12) of the positive mood items, and 25% (5.4/22) of the negative mood items. The larger part of terminally ill cancer patients with an estimated life expectancy of less than 3 months reported one or more positive mood states. A positive mood state such as 'being interested' was endorsed by more than half (65%) of the patients, other positive feelings were endorsed by a substantial proportion of patients, for example: 38% of patients endorsed feeling 'jovial' and 35% reported being 'optimistic'. Although having incurable cancer often leads to feelings of depression, mood is variable and many patients experience at least some positive feelings.

  9. Clinical use of lactate monitoring in critically ill patients

    NARCIS (Netherlands)

    J. Bakker (Jan); M.W.N. Nijsten (Maarten); T.C. Jansen (Tim)

    2013-01-01

    textabstractIncreased blood lactate levels (hyperlactataemia) are common in critically ill patients. Although frequently used to diagnose inadequate tissue oxygenation, other processes not related to tissue oxygenation may increase lactate levels. Especially in critically ill patients, increased gly

  10. [Illness behavior and depression in tinnitus patients].

    Science.gov (United States)

    Schönweiler, R; Neuschulte, C; Paar, G H

    1989-05-01

    Tinnitus patients often complain of psychosomatic disorders and of problems in social life. We intended to prove the modulation of tinnitus perception by psychosocial factors. We examined 48 tinnitus patients, 35 with and 13 without hearing loss. A control group of 48 patients without tinnitus, without hearing disorder and without tumor disease was adapted to correspond to the tinnitus group in respect of age, sex and social factors. A quantitative assessment of complaints as well as of the intensity of depression was made via questionaires (Giessener Beschwerdebogen and Beck Depression Inventory). In tinnitus patients, we found a statistically significantly higher degree of complaints even for non-otological symptoms. They were statistically more depressive than the controls, but less than patients with endogenic depression usually are. Nevertheless, in tinnitus patients it seems to be reasonable to inquire after general symptoms of illness to assess whether cooperation with a psychiatrist is required before initiating somatic treatment.

  11. Endocrine and metabolic considerations in critically ill patients 4: Thyroid function in critically ill patients

    OpenAIRE

    Fliers, Eric; Bianco, Antonio C.; Langouche, Lies; Boelen, Anita

    2015-01-01

    Patients in the intensive care unit (ICU) typically present with decreased concentrations of plasma tri-iodothyronine, low thyroxine, and normal range or slightly decreased concentration of thyroid-stimulating hormone. This ensemble of changes is collectively known as non-thyroidal illness syndrome (NTIS). The extent of NTIS is associated with prognosis, but no proof exists for causality of this association. Initially, NTIS is a consequence of the acute phase response to systemic illness and ...

  12. Glucose metabolism in critically ill patients

    DEFF Research Database (Denmark)

    Nielsen, Signe Tellerup; Krogh-Madsen, Rikke; Møller, Kirsten

    2015-01-01

    , stimulates insulin secretion and inhibits glucagon release both in healthy individuals and in patients with type 2 diabetes (T2DM). Compared to insulin, GLP-1 appears to be associated with a lower risk of severe hypoglycemia, probably because the magnitude of its insulinotropic action is dependent on blood...... characteristics and are, among other things, both characterized by different grades of systemic inflammation and insulin resistance. The GLP-1 might be a potential new treatment target in critically ill patients with stress-induced hyperglycemia....

  13. 807: melatonin secretion pattern in critically ill patients

    DEFF Research Database (Denmark)

    Boyko, Yuliya; Holst, René; Jennum, Poul Jørgen

    2016-01-01

    Learning Objectives: It is well recognized that delirium screening in the intensive care unit (ICU) is an essential component of care. The use of standardized delirium assessment tools have been validated for use in ICU patients. However, these tools, such as the Confusion Assessment Method...... for the ICU (CAM-ICU) have not been validated for use in neurocritically ill patients. Baseline daily screening rates in four adult ICUs at a single center identified a need to improve delirium assessments for all ICU patients, including Neuroscience ICU patients. Methods: A pilot project implementing CAM....... However, use of the CAM-ICU with Neuroscience ICU patients presented a challenge due to the need to the difficulty in differentiating delirium and clinical neurological deterioration. Currently, the results of this pilot project indicate that the CAM-ICU can be used in Neuroscience ICU patients...

  14. Supporting Muslim Patients During Advanced Illness.

    Science.gov (United States)

    Boucher, Nathan A; Siddiqui, Ejaz A; Koenig, Harold G

    2017-01-01

    Religion is an important part of many patients' cultural perspectives and value systems that influence them during advanced illness and toward the end of life when they directly face mortality. Worldwide violence perpetrated by people identifying as Muslim has been a growing fear for people living in the US and elsewhere. This fear has further increased by the tense rhetoric heard from the recent US presidential campaign and the new presidential administration. For many, this includes fear of all Muslims, the second-largest religious group in the world with 1.6 billion adherents and approximately 3.5 million in the US alone. Patient-centered care requires health professionals to look past news headlines and unchecked social media so they can deliver high-quality care to all patients. This article explores areas of importance in the context of advanced illness for practitioners of Islam. These include the conditions needed for prayer, the roles of medical treatment and religious authority, the importance of modesty, the religious concordance of clinicians, the role of family in medical decision making, advance care planning, and pain and symptom management. Initial recommendations to optimize care for Muslim patients and their families, informed by the described tenets of Muslim faith, are provided for clinicians and health systems administrators. These include Islamic cultural awareness training for staff, assessment of patients and families to determine needs, health education and decision-making outreach, and community health partnerships with local Islamic institutions.

  15. Cognitive impairment and depression predict mortality in medically ill older adults.

    Science.gov (United States)

    Arfken, C L; Lichtenberg, P A; Tancer, M E

    1999-03-01

    Depression and cognitive impairment are common in medically ill older adults. Few studies, however, have investigated the roles of both in predicting mortality for medically ill older adults. We used a cohort of consecutive patients aged 60 or older admitted to a rehabilitation hospital (N = 667) of whom 455 completed a standardized protocol measuring cognition (Dementia Rating Scale), depression (Geriatric Depression Scale), and disabilities (Functional Independence Measure). Burden of medical illnesses was measured with the Charlson Index. Vital status was assessed one year later. Those subjects who did not complete the screening were more likely to die (24% vs 17%; p = .02) during the one-year follow-up. Of those who completed the screening, male sex (odds ratio [OR] = 1.84), depression (mild OR = 1.64; moderate OR = 2.49), and more severe cognitive impairment (OR = 2.13) predicted mortality independent of age, medical illnesses, or disabilities. No interaction of cognitive impairment and depression was detected. In those subjects cognitively intact, moderate depression (OR = 4.95) and male sex (OR = 3.42) were independent risk factors for dying. In those subjects without depression, male sex (OR = 2.24) and elevated Charlson Index (OR = 1.42) predicted mortality. Depression and cognitive impairment are independent predictors of one-year mortality in this subgroup of medically ill older adults.

  16. Adult Basic Education Curriculum Guide for ABE Programs Serving Psychiatrically Ill Adult Students.

    Science.gov (United States)

    Collier, Ezma V.

    This curriculum guide is designed for use in adult basic education (ABE) programs serving psychiatrically ill adult students. Covered in the individual units are the following topics: personal hygiene and grooming, nutrition and health, money and money management, transportation and safety, government and law, values clarification, and…

  17. Antibiotic dose optimization in critically ill patients.

    Science.gov (United States)

    Cotta, M O; Roberts, J A; Lipman, J

    2015-12-01

    The judicious use of existing antibiotics is essential for preserving their activity against infections. In the era of multi-drug resistance, this is of particular importance in clinical areas characterized by high antibiotic use, such as the ICU. Antibiotic dose optimization in critically ill patients requires sound knowledge not only of the altered physiology in serious infections - including severe sepsis, septic shock and ventilator-associated pneumonia - but also of the pathogen-drug exposure relationship (i.e. pharmacokinetic/pharmacodynamic index). An important consideration is the fact that extreme shifts in organ function, such as those seen in hyperdynamic patients or those with multiple organ dysfunction syndrome, can have an impact upon drug exposure, and constant vigilance is required when reviewing antibiotic dosing regimens in the critically ill. The use of continuous renal replacement therapy and extracorporeal membrane oxygenation remain important interventions in these patients; however, both of these treatments can have a profound effect on antibiotic exposure. We suggest placing emphasis on the use of therapeutic drug monitoring and dose individualization when optimizing therapy in these settings. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  18. Should we mobilise critically ill patients? A review.

    LENUS (Irish Health Repository)

    O'Connor, Enda D

    2009-12-01

    Neuromuscular weakness, a frequent complication of prolonged bed rest and critical illness, is associated with morbidity and mortality. Mobilisation physiotherapy has widespread application in patients hospitalised with non-critical illness.

  19. Illness perception in Polish patients with chronic diseases: Psychometric properties of the Brief Illness Perception Questionnaire.

    Science.gov (United States)

    Nowicka-Sauer, Katarzyna; Banaszkiewicz, Dorota; Staśkiewicz, Izabela; Kopczyński, Piotr; Hajduk, Adam; Czuszyńska, Zenobia; Ejdys, Mariola; Szostakiewicz, Małgorzata; Sablińska, Agnieszka; Kałużna, Anna; Tomaszewska, Magda; Siebert, Janusz

    2016-08-01

    The study evaluates the psychometric properties of a Polish translation of the Brief Illness Perception Questionnaire. A total of 276 patients with chronic conditions (58.7% women) completed the Brief Illness Perception Questionnaire and the Hospital Anxiety and Depression Scale. The internal consistency of the Polish Brief Illness Perception Questionnaire measured with Cronbach's alpha was satisfactory (α = 0.74). Structural validity was demonstrated by significant inter-correlations between the Brief Illness Perception Questionnaire components. Discriminant validity was supported by the fact that the Brief Illness Perception Questionnaire enables patients with various conditions to be differentiated. Significant correlations were found between Brief Illness Perception Questionnaire and depression and anxiety levels. The Polish Brief Illness Perception Questionnaire thus evaluated is a reliable and valid tool.

  20. Risk factors for respiratory syncytial virus illness among patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Mehta, Jyotsna; Walsh, Edward E; Mahadevia, Parthiv J; Falsey, Ann R

    2013-06-01

    Respiratory syncytial virus (RSV), although not typically considered an important pathogen in adults, may cause acute exacerbation of chronic obstructive pulmonary disease (COPD). It is unclear which COPD patients are at highest risk for developing serious RSV illness. Our objective was to identify risk factors for RSV illness among adult patients with COPD. We conducted a pooled analysis of data from COPD patients in 2 previously published longitudinal studies that examined RSV infection in high risk adults for ≤ 2 RSV seasons. Risk factors for RSV illness studied included age, sex, race, smoking status, exposure to children, home oxygen use, inhaled or oral steroid use, instrumental activities of daily living scores, and co-morbid conditions. Outcomes studied included symptomatic and medically attended RSV illness. Logistic regression was used to identify significant risk factors for RSV illness among older adults with COPD. Among 379 patients with COPD, the rate of symptomatic RSV illness was 11.1% (42/379); almost half (20/42) of whom required medical attention. In multivariable analyses, congestive heart failure (odds ratio [OR] = 4.18; 95% CI: 1.38, 12.69) and exposure to children (OR = 2.38; 95% CI: 1.03, 5.51) were risk factors for symptomatic RSV illness. Congestive heart failure (OR = 4.16; 95% CI: 1.02, 17.01) was the only significant risk factor for developing medically attended RSV illness. Exposure to children and congestive heart failure are risk factors for RSV illness among adult patients with COPD. Future prospective, well-designed studies are needed to corroborate these findings and examine other risk factors, including history of exacerbations.

  1. Illness denial questionnaire for patients and caregivers

    Directory of Open Access Journals (Sweden)

    Rossi Ferrario S

    2017-03-01

    Full Text Available Silvia Rossi Ferrario,1 Ines Giorgi,2 Paola Baiardi,3 Laura Giuntoli,4 Gianluigi Balestroni,1 Paola Cerutti,1 Marina Manera,2 Paola Gabanelli,2 Valentina Solara,5 Roberta Fornara,6 Michela Luisetti,1 Pierangela Omarini,1 Giovanna Omarini,1 Giulio Vidotto4 1Psychology Unit, Istituti Clinici Scientifici Maugeri SpA SB, Veruno, NO, Italy; 2Psychology Unit, 3Scientific Direction, Istituti Clinici Scientifici Maugeri SpA SB, Pavia, Italy; 4Department of General Psychology, University of Padova, Padova, Italy; 5Department of Neurology, ALS Centre, “Maggiore della Carita`” University Hospital, Novara, Italy; 6Psychology Unit, SS Trinità Hospital, Borgomanero, NO, Italy Purpose: Interest in assessing denial is still present, despite the criticisms concerning its definition and measurement. We tried to develop a questionnaire (Illness Denial Questionnaire, IDQ assessing patients’ and caregivers’ denial in relation to their illness/disturbance. Patients and methods: After a preliminary study, a final version of 24 dichotomous items (true/false was selected. We hypothesized a theoretical model with three dimensions: denial of negative emotions, resistance to change, and conscious avoidance, the first two composing the actual Denial and the last representing an independent component of the illness denial behavior. The IDQ was administered to 400 subjects (219 patients and 181 caregivers together with the Anxiety–Depression Questionnaire – Reduced form (AD-R, in order to assess concurrent validity. Confirmatory factor analysis (CFA, internal consistency indices (Cronbach’s α and McDonald’s ω, and test–retest analysis were performed. Results: CFA and internal consistency indices (Cronbach’s α: 0.87–0.96 indicated a clear and meaningful three-factor structure of IDQ, for both patients and caregivers. Further analyses showed good concurrent validity, with Denial and its subscale negatively associated with anxiety and depression and

  2. Nitrogen Balance and Protein Requirements for Critically Ill Older Patients

    Directory of Open Access Journals (Sweden)

    Roland N. Dickerson

    2016-04-01

    Full Text Available Critically ill older patients with sarcopenia experience greater morbidity and mortality than younger patients. It is anticipated that unabated protein catabolism would be detrimental for the critically ill older patient. Healthy older subjects experience a diminished response to protein supplementation when compared to their younger counterparts, but this anabolic resistance can be overcome by increasing protein intake. Preliminary evidence suggests that older patients may respond differently to protein intake than younger patients during critical illness as well. If sufficient protein intake is given, older patients can achieve a similar nitrogen accretion response as younger patients even during critical illness. However, there is concern among some clinicians that increasing protein intake in older patients during critical illness may lead to azotemia due to decreased renal functional reserve which may augment the propensity towards worsened renal function and worsened clinical outcomes. Current evidence regarding protein requirements, nitrogen balance, ureagenesis, and clinical outcomes during nutritional therapy for critically ill older patients is reviewed.

  3. Nitrogen Balance and Protein Requirements for Critically Ill Older Patients.

    Science.gov (United States)

    Dickerson, Roland N

    2016-04-18

    Critically ill older patients with sarcopenia experience greater morbidity and mortality than younger patients. It is anticipated that unabated protein catabolism would be detrimental for the critically ill older patient. Healthy older subjects experience a diminished response to protein supplementation when compared to their younger counterparts, but this anabolic resistance can be overcome by increasing protein intake. Preliminary evidence suggests that older patients may respond differently to protein intake than younger patients during critical illness as well. If sufficient protein intake is given, older patients can achieve a similar nitrogen accretion response as younger patients even during critical illness. However, there is concern among some clinicians that increasing protein intake in older patients during critical illness may lead to azotemia due to decreased renal functional reserve which may augment the propensity towards worsened renal function and worsened clinical outcomes. Current evidence regarding protein requirements, nitrogen balance, ureagenesis, and clinical outcomes during nutritional therapy for critically ill older patients is reviewed.

  4. Nutritional Assessment in Critically Ill Patients

    Directory of Open Access Journals (Sweden)

    Najmeh Hejazi

    2016-05-01

    Full Text Available Background: Malnutrition is an important factor in the survival of critically ill patients. The purpose of the present study was to assess the nutritional status of patients in the intensive care unit (ICU on the days of admission and discharge via a detailed nutritional assessment. Methods: Totally, 125 patients were followed up from admission to discharge at 8ICUs in Shiraz, Iran. The patients’ nutritional status was assessed using subjective global assessment (SGA, anthropometric measurements, biochemical indices, and body composition indicators. Diet prescription and intake was also evaluated. Results: Malnutrition prevalence significantly increased on the day of discharge (58.62% compared to the day of admission (28.8% according to SGA (P<0.001. The patients’ weight, mid-upper-arm circumference, mid-arm muscle circumference, triceps skinfold thickness, and calf circumference decreased significantly as well (P<0.001. Lean mass weight and body cell mass also decreased significantly (P<0.001. Biochemical indices showed no notable changes except for magnesium, which decreased significantly (P=0.013. A negative significant correlation was observed between malnutrition on discharge day and anthropometric measurements. Positive and significant correlations were observed between the number of days without enteral feeding, days delayed from ICU admission to the commencement of enteral feeding, and the length of ICU stay and malnutrition on discharge day. Energy and protein intakes were significantly less than the prescribed diet (26.26% and 26.48%, respectively. Conclusion: Malnutrition on discharge day increased in the patients in the ICU according to SGA. Anthropometric measurements were better predictors of the nutritional outcome of our critically ill patients than were biochemical tests.

  5. Regional analgesia in postsurgical critically ill patients.

    Science.gov (United States)

    Moliner Velázquez, S; Rubio Haro, R; De Andrés Serrano, C; De Andrés Ibáñez, J

    2017-03-01

    Regional analgesia intrinsically, based on its physiological effects, is routinely used for the perioperative treatment of pain associated with surgical procedures. However, in other areas such as the non-surgical treatment of acute pain for patients in a critical condition, it has not been subjected to specific prospective studies. If we confine ourselves to the physiological effects of the nerve block, in a situation of stress, the indications for regional anaesthesia in this group of patients extend to the management of a wide variety of medical as well as postsurgical conditions, of trauma patients and of other painful procedures performed in the patient's bed. The critical patient certainly must be analyzed individually as their own primary conditions is of vital importance, as well as any associated conditions they have developed that can potentially increase the risk of systemic toxicity or morbidity, such as, coagulopathies, infection, immunosuppressive states, sedation and problems associated with mechanical ventilation. This review aims to assess the role of regional analgesia in critically ill patients, placing it within the algorithm decision tree of the professional responsible for patients in critical care units, all based on the evidence of potential benefits according to the published literature. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Defining Older Adults' Perceived Causes of Hypertension in the Brief Illness Perception Questionnaire

    Science.gov (United States)

    Duwe, Elise A. G.; Koerner, Kari M.; Madison, Anna M.; Falk, Nikki A.; Insel, Kathleen C.; Morrow, Daniel G.

    2014-01-01

    Objectives: This study sought to make the Brief Illness Perception Questionnaire (BIPQ) to be more informative about illness representation among older adults with hypertension. The authors developed categories for coding the open-ended question regarding cause of illness in the BIPQ--a pervasive quantitative measure for illness representation.…

  7. Defining Older Adults' Perceived Causes of Hypertension in the Brief Illness Perception Questionnaire

    Science.gov (United States)

    Duwe, Elise A. G.; Koerner, Kari M.; Madison, Anna M.; Falk, Nikki A.; Insel, Kathleen C.; Morrow, Daniel G.

    2014-01-01

    Objectives: This study sought to make the Brief Illness Perception Questionnaire (BIPQ) to be more informative about illness representation among older adults with hypertension. The authors developed categories for coding the open-ended question regarding cause of illness in the BIPQ--a pervasive quantitative measure for illness representation.…

  8. in Critically Ill Patients: Success and Limits

    Directory of Open Access Journals (Sweden)

    Filippo Mariano

    2011-01-01

    Full Text Available Citrate anticoagulation has risen in interest so it is now a real alternative to heparin in the ICUs practice. Citrate provides a regional anticoagulation virtually restricted to extracorporeal circuit, where it acts by chelating ionized calcium. This issue is particularly true in patients ongoing CRRT, when the “continuous” systemic anticoagulation treatment is per se a relevant risk of bleeding. When compared with heparin most of studies with citrate reported a longer circuit survival, a lower rate of bleeding complications, and transfused packed red cell requirements. As anticoagulant for CRRT, the infusion of citrate is prolonged and it could potentially have some adverse effects. When citrate is metabolized to bicarbonate, metabolic alkalosis may occur, or for impaired metabolism citrate accumulation leads to acidosis. However, large studies with dedicated machines have indeed demonstrated that citrate anticoagulation is well tolerated, safe, and an easy to handle even in septic shock critically ill patients.

  9. Remote psychotherapy for terminally ill cancer patients.

    Science.gov (United States)

    Cluver, Jeffrey S; Schuyler, Dean; Frueh, B Christopher; Brescia, Frank; Arana, George W

    2005-01-01

    We conducted a feasibility study of remote psychotherapy in 10 terminally ill cancer patients with diagnoses of adjustment disorder or major depression. Subjects received six sessions of individual cognitive therapy with the same therapist. Sessions alternated between face-to-face sessions and remote sessions delivered by analogue videophone. After each therapy session, a brief questionnaire was used to evaluate the subjects' level of satisfaction with the session, sense of connectedness to the therapist and overall progress being made in the therapy. Nine patients completed the study. Of 53 completed therapy sessions, 21 were by videophone and 32 were conducted face to face. Participants reported strong positive perceptions and acceptance after almost all therapy sessions, regardless of service delivery mode. The study suggests that there may be a role for the delivery of psychotherapy using low-bandwidth videophones.

  10. Infections in critically ill burn patients.

    Science.gov (United States)

    Hidalgo, F; Mas, D; Rubio, M; Garcia-Hierro, P

    2016-04-01

    Severe burn patients are one subset of critically patients in which the burn injury increases the risk of infection, systemic inflammatory response and sepsis. The infections are usually related to devices and to the burn wound. Most infections, as in other critically ill patients, are preceded by colonization of the digestive tract and the preventative measures include selective digestive decontamination and hygienic measures. Early excision of deep burn wound and appropriate use of topical antimicrobials and dressings are considered of paramount importance in the treatment of burns. Severe burn patients usually have some level of systemic inflammation. The difficulty to differentiate inflammation from sepsis is relevant since therapy differs between patients with and those without sepsis. The delay in prescribing antimicrobials increases morbidity and mortality. Moreover, the widespread use of antibiotics for all such patients is likely to increase antibiotic resistance, and costs. Unfortunately the clinical usefulness of biomarkers for differential diagnosis between inflammation and sepsis has not been yet properly evaluated. Severe burn injury induces physiological response that significantly alters drug pharmacokinetics and pharmacodynamics. These alterations impact antimicrobials distribution and excretion. Nevertheless the current available literature shows that there is a paucity of information to support routine dose recommendations.

  11. Personality and illness adaptation in adults with Type 1 diabetes : The intervening role of illness coping and perceptions

    NARCIS (Netherlands)

    Rassart, J.; Luyckx, K.; Klimstra, T.A.; Moons, P.; Weets, I.

    2014-01-01

    Inspired by the common sense model, the present cross-sectional study examined illness perceptions and coping as intervening mechanisms in the relationship between Big Five personality traits and illness adaptation in adults with Type 1 diabetes. A total of 368 individuals with Type 1 diabetes (18–3

  12. Disparities in oral cancer survival among mentally ill patients.

    Directory of Open Access Journals (Sweden)

    Ting-Shou Chang

    Full Text Available BACKGROUND: Many studies have reported excess cancer mortality in patients with mental illness. However, scant studies evaluated the differences in cancer treatment and its impact on survival rates among mentally ill patients. Oral cancer is one of the ten most common cancers in the world. We investigated differences in treatment type and survival rates between oral cancer patients with mental illness and without mental illness. METHODS: Using the National Health Insurance (NHI database, we compared the type of treatment and survival rates in 16687 oral cancer patients from 2002 to 2006. The utilization rate of surgery for oral cancer was compared between patients with mental illness and without mental illness using logistic regression. The Cox proportional hazards model was used for survival analysis. RESULTS: Oral cancer patients with mental disorder conferred a grave prognosis, compared with patients without mental illness (hazard ratios [HR] = 1.58; 95% confidence interval [CI] = 1.30-1.93; P<0.001. After adjusting for patients' characteristics and hospital characteristics, patients with mental illness were less likely to receive surgery with or without adjuvant therapy (odds ratio [OR] = 0.47; 95% CI = 0.34-0.65; P<0.001. In multivariate analysis, oral cancer patients with mental illness carried a 1.58-times risk of death (95% CI = 1.30-1.93; P<0.001. CONCLUSIONS: Oral cancer patients with mental illness were less likely to undergo surgery with or without adjuvant therapy than those without mental illness. Patients with mental illness have a poor prognosis compared to those without mental illness. To reduce disparities in physical health, public health strategies and welfare policies must continue to focus on this vulnerable group.

  13. Nosocomial pneumonia in critically ill patients

    Directory of Open Access Journals (Sweden)

    Dandagi Girish

    2010-01-01

    Full Text Available The care of critically ill patients in the intensive care unit (ICU is a primary component of modern medicine. ICUs create potential for recovery in patients who otherwise may not have survived. However, they may suffer from problems associated with of nosocomial infections. Nosocomial infections are those which manifest in patients 48 hours after admission to hospital. Nosocomial infections are directly related to diagnostic, interventional or therapeutic procedures a patient undergoes in hospital, and are also influenced by the bacteriological flora prevailing within a particular unit or hospital. Urinary tract infections are the most frequent nosocomial infection, accounting for more than 40% of all nosocomial infections. Critical care units increasingly use high technology medicine for patient care, hemodynamic monitoring, ventilator support, hemodialysis, parenteral nutrition, and a large battery of powerful drugs, particularly antibiotics to counter infection. It is indeed a paradox that the use of high-tech medicine has brought in its wake the dangerous and all too frequent complication of nosocomial infections

  14. Nutritional requirements of the critically ill patient.

    Science.gov (United States)

    Costa, Nuno André de Almeida; Marinho, Aníbal Defensor; Cançado, Luciana Ribeiro

    2012-09-01

    Given the inaccessibility of indirect calorimetry, intensive care units generally use predictive equations or recommendations that are established by international societies to determine energy expenditure. The aim of the present study was to compare the energy expenditure of critically ill patients, as determined using indirect calorimetry, to the values obtained using the Harris-Benedict equation. A retrospective observational study was conducted at the Intensive Care Unit 1 of the Centro Hospitalar do Porto. The energy requirements of hospitalized critically ill patients as determined using indirect calorimetry were assessed between January 2003 and April 2012. The accuracy (± 10% difference between the measured and estimated values), the mean differences and the limits of agreement were determined for the studied equations. Eighty-five patients were assessed using 288 indirect calorimetry measurements. The following energy requirement values were obtained for the different methods: 1,753.98±391.13 kcal/day (24.48 ± 5.95 kcal/kg/day) for indirect calorimetry and 1,504.11 ± 266.99 kcal/day (20.72±2.43 kcal/kg/day) for the Harris-Benedict equation. The equation had a precision of 31.76% with a mean difference of -259.86 kcal/day and limits of agreement between -858.84 and 339.12 kcal/day. Sex (p=0.023), temperature (p=0.009) and body mass index (p<0.001) were found to significantly affect energy expenditure. The Harris-Benedict equation is inaccurate and tends to underestimate energy expenditure. In addition, the Harris-Benedict equation is associated with significant differences between the predicted and true energy expenditure at an individual level.

  15. Optimizing antimicrobial therapy in critically ill patients

    Directory of Open Access Journals (Sweden)

    Vitrat V

    2014-10-01

    Full Text Available Virginie Vitrat,1 Serge Hautefeuille,2 Cécile Janssen,1 David Bougon,2 Michel Sirodot,2 Leonardo Pagani1,3 1Antimicrobial Stewardship Program, Infectious Diseases Unit, 2Intensive Care Unit, Annecy-Genevois Hospital Center (CHANGE, Annecy, France; 3Infectious Diseases Unit, Bolzano Central Hospital, Bolzano, Italy Abstract: Critically ill patients with infection in the intensive care unit (ICU would certainly benefit from timely bacterial identification and effective antimicrobial treatment. Diagnostic techniques have clearly improved in the last years and allow earlier identification of bacterial strains in some cases, but these techniques are still quite expensive and not readily available in all institutions. Moreover, the ever increasing rates of resistance to antimicrobials, especially in Gram-negative pathogens, are threatening the outcome for such patients because of the lack of effective medical treatment; ICU physicians are therefore resorting to combination therapies to overcome resistance, with the direct consequence of promoting further resistance. A more appropriate use of available antimicrobials in the ICU should be pursued, and adjustments in doses and dosing through pharmacokinetics and pharmacodynamics have recently shown promising results in improving outcomes and reducing antimicrobial resistance. The aim of multidisciplinary antimicrobial stewardship programs is to improve antimicrobial prescription, and in this review we analyze the available experiences of such programs carried out in ICUs, with emphasis on results, challenges, and pitfalls. Any effective intervention aimed at improving antibiotic usage in ICUs must be brought about at the present time; otherwise, we will face the challenge of intractable infections in critically ill patients in the near future. Keywords: ICU, antimicrobial therapies, antimicrobial stewardship, pharmacokinetics, pharmacodynamics, antimicrobial resistance, early diagnosis

  16. Leading indicators of community-based violent events among adults with mental illness.

    Science.gov (United States)

    Van Dorn, R A; Grimm, K J; Desmarais, S L; Tueller, S J; Johnson, K L; Swartz, M S

    2017-05-01

    The public health, public safety and clinical implications of violent events among adults with mental illness are significant; however, the causes and consequences of violence and victimization among adults with mental illness are complex and not well understood, which limits the effectiveness of clinical interventions and risk management strategies. This study examined interrelationships between violence, victimization, psychiatric symptoms, substance use, homelessness and in-patient treatment over time. Available data were integrated from four longitudinal studies of adults with mental illness. Assessments took place at baseline, and at 1, 3, 6, 9, 12, 15, 18, 24, 30 and 36 months, depending on the parent studies' protocol. Data were analysed with the autoregressive cross-lag model. Violence and victimization were leading indicators of each other and affective symptoms were a leading indicator of both. Drug and alcohol use were leading indicators of violence and victimization, respectively. All psychiatric symptom clusters - affective, positive, negative, disorganized cognitive processing - increased the likelihood of experiencing at least one subsequent symptom cluster. Sensitivity analyses identified few group-based differences in the magnitude of effects in this heterogeneous sample. Violent events demonstrated unique and shared indicators and consequences over time. Findings indicate mechanisms for reducing violent events, including trauma-informed therapy, targeting internalizing and externalizing affective symptoms with cognitive-behavioral and psychopharmacological interventions, and integrating substance use and psychiatric care. Finally, mental illness and violence and victimization research should move beyond demonstrating concomitant relationships and instead focus on lagged effects with improved spatio-temporal contiguity.

  17. Prolonged cannabis withdrawal in young adults with lifetime psychiatric illness.

    Science.gov (United States)

    Schuster, Randi Melissa; Fontaine, Madeleine; Nip, Emily; Zhang, Haiyue; Hanly, Ailish; Eden Evins, A

    2017-02-27

    Young adults with psychiatric illnesses are more likely to use cannabis and experience problems from use. It is not known whether those with a lifetime psychiatric illness experience a prolonged cannabis withdrawal syndrome with abstinence. Participants were fifty young adults, aged 18-25, recruited from the Boston-area in 2015-2016, who used cannabis at least weekly, completed the Structured Clinical Interview for DSM-IV to identify Axis I psychiatric diagnoses (PD+ vs PD-), and attained cannabis abstinence with a four-week contingency management protocol. Withdrawal symptom severity was assessed at baseline and at four weekly abstinent visits using the Cannabis Withdrawal Scale. Cannabis dependence, age of initiation, and rate of abstinence were similar in PD+ and PD- groups. There was a diagnostic group by abstinent week interaction, suggesting a difference in time course for resolution of withdrawal symptoms by group, F(4,46)=3.8, p=0.009, controlling for sex, baseline depressive and anxiety symptoms, and frequency of cannabis use in the prior 90days. In post hoc analyses, there was a difference in time-course of cannabis withdrawal. PD- had significantly reduced withdrawal symptom severity in abstinent week one [t(46)=-2.2, p=0.03], while PD+ did not report improved withdrawal symptoms until the second abstinent week [t(46)=-4.1, p=0.0002]. Cannabis withdrawal symptoms improved over four weeks in young people with and without a lifetime psychiatric diagnosis. However, those with a psychiatric illness reported one week delayed improvement in withdrawal symptom severity. Longer duration of cannabis withdrawal may be a risk factor for cannabis dependence and difficulty quitting. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Changing Landscape of Dysglycemia Management in Critically Ill Patients

    OpenAIRE

    Sarvin Sanaie

    2015-01-01

    At present, the body of evidence for blood glucose management in critically ill adults and children is not available beyond the point of proof of efficacy. Intensive blood glucose management did not pass the milestones of effectiveness and efficiency, because the multicenter trials could not confirm the results of the single-center studies. A recent review on the glucose management in critically ill adults and children suggests that use of any drug other than insulin for glucose control in in...

  19. Neuropsychological assessment of patients with dementing illness.

    Science.gov (United States)

    Fields, Julie A; Ferman, Tanis J; Boeve, Bradley F; Smith, Glenn E

    2011-11-01

    Neuropsychological assessment has a distinct role in the detection and monitoring of cognitive and functional changes associated with dementing illness. Molecular, structural and functional neuroimaging studies have advanced our understanding of the anatomy and physiology underlying neurodegenerative disease; however, the overlap in pathological features of different dementia-associated diseases limits the information that can be obtained by these methods. Incorporation of information obtained from multiple sources can help to increase diagnostic and prognostic accuracy. Neuropsychological test findings provide unique value as biomarkers of dementia, as differentiators of disease topography and in the estimation of disease risk and trajectory. However, psychometric test properties--such as construct validity, stability and the use of appropriate norms--must be understood, because they influence both the application of neuropsychological tests and the interpretation of their results. Finally, measurement of cognitive strengths and weaknesses in patients at risk of dementia can be helpful to predict changes in functional abilities, design appropriate and effective interventions, and assist family and health-care providers in the planning of the patient's future care needs. This Review describes the key characteristics of neuropsychological testing in the assessment of patients at risk of dementia.

  20. Listening to Older Adult Parents of Adult Children with Mental Illness

    Science.gov (United States)

    Smith, Judith R.

    2012-01-01

    This article uses qualitative research and narrative analysis to examine the experience of women age 55 and older who are parents caring for adult children with mental illness. Knowledge about the conflicts of older parents with dependent children is underdeveloped. In this study, analysis of women's stories about parenting in later life reveal…

  1. Coping mediates the relationship between disease severity and illness intrusiveness among chronically ill patients.

    Science.gov (United States)

    Hundt, Natalie E; Bensadon, Benjamin A; Stanley, Melinda A; Petersen, Nancy J; Kunik, Mark E; Kauth, Michael R; Cully, Jeffrey A

    2015-09-01

    Reducing perceptions of illness intrusiveness may improve quality of life and mental health among patients with cardiopulmonary disease. To better understand relationships between coping style, locus of control, perceived illness intrusiveness, and disease severity, we analyzed data from 227 older Veterans with chronic obstructive pulmonary disease or congestive heart failure. Regressions revealed illness intrusiveness to be associated with younger age and greater disease severity, less internal locus of control, and avoidant/emotion-focused coping. Avoidant/emotion-focused coping but not active coping mediated the relationship between illness severity and illness intrusiveness. Findings suggest that supportive psychological interventions may reduce illness intrusiveness by targeting an avoidant/emotion-focused coping style and associated behaviors. © The Author(s) 2013.

  2. Telehomecare for patients with multiple chronic illnesses

    Science.gov (United States)

    Liddy, Clare; Dusseault, Joanne J.; Dahrouge, Simone; Hogg, William; Lemelin, Jacques; Humber, Jennie

    2008-01-01

    OBJECTIVE To examine the feasibility and efficacy of integrating home health monitoring into a primary care setting. DESIGN A mixed method was used for this pilot study. It included in-depth interviews, focus groups, and surveys. SETTING A semirural family health network in eastern Ontario comprising 8 physicians and 5 nurses caring for approximately 10 000 patients. PARTICIPANTS Purposeful sample of 22 patients chosen from the experimental group of 120 patients 50 years old or older in a larger randomized controlled trial (N = 240). These patients had chronic illnesses and were identified as being at risk based on objective criteria and physician assessment. INTERVENTIONS Between November 2004 and March 2006, 3 nurse practitioners and a pharmacist installed telehomecare units with 1 or more peripheral devices (eg, blood-pressure monitor, weight scale, glucometer) in patients’ homes. The nurse practitioners incorporated individualized instructions for using the unit into each patient’s care plan. Patients used the units every morning for collecting data, entering values into the system either manually or directly through supplied peripherals. The information was transferred to a secure server and was then uploaded to a secure Web-based application that allowed care providers to access and review it from any location with Internet access. The devices were monitored in the office on weekdays by the nurse practitioners. MAIN OUTCOME MEASURES Acceptance and use of the units, patients’ and care providers’ satisfaction with the system, and patients’ demographic and health characteristics. RESULTS All 22 patients, 12 men and 10 women with an average age of 73 years (range 60 to 88 years), agreed to participate. Most were retired, and a few were receiving community services. Common diagnoses included hypertension, diabetes, cardiovascular disease, and chronic obstructive pulmonary disease. All patients had blood pressure monitors installed, 11 had wired weight

  3. The Feasibility of performing resistance exercise with acutely ill hospitalized older adults

    Directory of Open Access Journals (Sweden)

    Rockwood Kenneth

    2003-10-01

    Full Text Available Abstract Background For older adults, hospitalization frequently results in deterioration of mobility and function. Nevertheless, there are little data about how older adults exercise in the hospital and definitive studies are not yet available to determine what type of physical activity will prevent hospital related decline. Strengthening exercise may prevent deconditioning and Pilates exercise, which focuses on proper body mechanics and posture, may promote safety. Methods A hospital-based resistance exercise program, which incorporates principles of resistance training and Pilates exercise, was developed and administered to intervention subjects to determine whether acutely-ill older patients can perform resistance exercise while in the hospital. Exercises were designed to be reproducible and easily performed in bed. The primary outcome measures were adherence and participation. Results Thirty-nine ill patients, recently admitted to an acute care hospital, who were over age 70 [mean age of 82.0 (SD= 7.3] and ambulatory prior to admission, were randomized to the resistance exercise group (19 or passive range of motion (ROM group (20. For the resistance exercise group, participation was 71% (p = 0.004 and adherence was 63% (p = 0.020. Participation and adherence for ROM exercises was 96% and 95%, respectively. Conclusion Using a standardized and simple exercise regimen, selected, ill, older adults in the hospital are able to comply with resistance exercise. Further studies are needed to determine if resistance exercise can prevent or treat hospital-related deterioration in mobility and function.

  4. [Anemia in the critically ill child and adult: a narrative review].

    Science.gov (United States)

    Demaret, P; Loeckx, I; Mulder, A; Devos, P; Lebrun, F

    2014-01-01

    Anemia is frequent in the pediatric and adult intensive care unit. Anemia decreases oxygen transport which can be harmful in the critically ill patient; it is independently associated with a poor prognosis. The major prophylactic measure against anemia is the limitation of blood draws: several approaches can be used to limit phlebotomy overdraw without harming the patient. Red blood cell transfusion is the quickest way to increase the hemoglobin level, but it is not without risk. It is therefore important to promote the use of evidence-based transfusion strategies. Iron could be useful in case of iron deficiency, but this condition is difficult to diagnose in the critically ill patient. Erythropoietin is no longer relevant in the intensive care unit in the era of restrictive transfusion practice, at least for its hematological effects. Several questions remain to be addressed in order to improve anemia management in the intensive care unit.

  5. The progress of light sedation for critically ill adult patients in intensive care unit%重症加强治疗病房成人患者浅镇静治疗进展

    Institute of Scientific and Technical Information of China (English)

    李双玲; 王东信; 杨拔贤

    2016-01-01

    The latest advance of sedation for critically ill adult patients in intensive care unit (ICU) was reviewed in order to provide certain clinical information for the ICU physicians about sedation. Guidelines, clinical research, Meta-analysis, and reviews in recent years were collected using electronic data base. Discussions included: ① the definition of light sedation, and its effects on clinical outcome, stress, sleep and delirium; ② light sedation strategies included: the target population, the target sedation strategy and daily sedation interruption, clinical assessment and monitoring of sedation, selection of sedative drugs, light sedation extenuation; ③ light sedation strategies and pain, agitation, delirium control bundles; ④ the problems and prospects of light sedation. Light sedation is the main principle of currently ICU sedation strategy in critically ill adult patients. Goal-directed light sedation should be considered as a routine therapy in most clinical situation, and its goal should be achieved as early as possible in the early stage of sedation. Routine use of benzodiazepines should be avoided, especially in patients with or at a risk of delirium. Prevention and treatment of agitation with a combination of non-pharmacologic or pharmacologic methods; ICU specification rules for pain, agitation and delirium prevention and treatment should be made. Light sedation is the main ICU sedation strategy in adult patients now, but must be individualized for each patient.%对重症加强治疗病房(ICU)成人患者镇静方面的最新进展进行综述,强调浅镇静策略是目前ICU危重患者镇静的主要治疗原则,其主要内容包括:①目标导向的浅镇静应常规化,尽可能在镇静早期即达标;②应摒弃常规使用苯二氮类药物,尤其对有谵妄风险或已经有谵妄的患者;③联合药物或非药物的有效方法预防和治疗躁动;④制定纳入疼痛、躁动和谵

  6. Anemia and Blood Transfusions in Critically Ill Patients

    Directory of Open Access Journals (Sweden)

    M. Kamran Athar

    2012-01-01

    Full Text Available Anemia is common in critically ill patients. As a consequence packed red blood cell (PRBC transfusions are frequent in the critically ill. Over the past two decades a growing body of literature has emerged, linking PRBC transfusion to infections, immunosuppression, organ dysfunction, and a higher mortality rate. However, despite growing evidence that risk of PRBC transfusion outweighs its benefit, significant numbers of critically ill patients still receive PRBC transfusion during their intensive care unit (ICU stay. In this paper, we summarize the current literature concerning the impact of anemia on outcomes in critically ill patients and the potential complications of PRBC transfusions.

  7. Copeptin Predicts Mortality in Critically Ill Patients

    Science.gov (United States)

    Krychtiuk, Konstantin A.; Honeder, Maria C.; Lenz, Max; Maurer, Gerald; Wojta, Johann; Heinz, Gottfried; Huber, Kurt; Speidl, Walter S.

    2017-01-01

    Background Critically ill patients admitted to a medical intensive care unit exhibit a high mortality rate irrespective of the cause of admission. Besides its role in fluid and electrolyte balance, vasopressin has been described as a stress hormone. Copeptin, the C-terminal portion of provasopressin mirrors vasopressin levels and has been described as a reliable biomarker for the individual’s stress level and was associated with outcome in various disease entities. The aim of this study was to analyze whether circulating levels of copeptin at ICU admission are associated with 30-day mortality. Methods In this single-center prospective observational study including 225 consecutive patients admitted to a tertiary medical ICU at a university hospital, blood was taken at ICU admission and copeptin levels were measured using a commercially available automated sandwich immunofluorescent assay. Results Median acute physiology and chronic health evaluation II score was 20 and 30-day mortality was 25%. Median copeptin admission levels were significantly higher in non-survivors as compared with survivors (77.6 IQR 30.7–179.3 pmol/L versus 45.6 IQR 19.6–109.6 pmol/L; p = 0.025). Patients with serum levels of copeptin in the third tertile at admission had a 2.4-fold (95% CI 1.2–4.6; p = 0.01) increased mortality risk as compared to patients in the first tertile. When analyzing patients according to cause of admission, copeptin was only predictive of 30-day mortality in patients admitted due to medical causes as opposed to those admitted after cardiac surgery, as medical patients with levels of copeptin in the highest tertile had a 3.3-fold (95% CI 1.66.8, p = 0.002) risk of dying independent from APACHE II score, primary diagnosis, vasopressor use and need for mechanical ventilation. Conclusion Circulating levels of copeptin at ICU admission independently predict 30-day mortality in patients admitted to a medical ICU. PMID:28118414

  8. Secondary sclerosing cholangitis in a critically ill patient.

    Science.gov (United States)

    Weiss, Krista E; Willmann, Juergen K; Jeffrey, R Brooke; Desser, Terry S

    2016-04-01

    Critically ill patients are commonly imaged for liver dysfunction. An often fatal condition, secondary sclerosing cholangitis, is an important and likely under-recognized hepatic condition in these patients. In presenting this case report, we hope to raise awareness of this condition amongst radiologists as well as other physicians caring for the critically ill.

  9. Coagulopathy and plasma transfusion in critically ill patients

    NARCIS (Netherlands)

    M.C.A. Müller

    2014-01-01

    In this thesis, we studied the value of viscoelastic tests (TEG/ROTEM) to assess coagulation status in different critically ill patient populations. In addition, we investigated the effects of prophylactic fresh frozen plasma (FFP) transfusion in critically ill patients with a coagulopathy. Furtherm

  10. Brief Potentially Ictal Rhythmic Discharges [B(I)RDs] in Noncritically Ill Adults.

    Science.gov (United States)

    Yoo, Ji Yeoun; Marcuse, Lara V; Fields, Madeline C; Rosengard, Jillian L; Traversa, Maria Vittoria; Gaspard, Nicolas; Hirsch, Lawrence J

    2017-05-01

    Brief potentially ictal rhythmic discharges (B(I)RDs) have been described in neonates and critically ill adults, and their association with seizures has been demonstrated. Their significance in noncritically ill adults remains unclear. We aimed to investigate their prevalence, electrographic characteristics, and clinical significance. We identified adult patients with B(I)RDs who received long-term EEG recordings either in the epilepsy monitoring unit or in the ambulatory setting. Patients with acute findings on imaging or status epilepticus were excluded. B(I)RDs were defined as very brief (<10 seconds) runs of focal or generalized sharply contoured rhythmic activity greater than 4 Hz, with or without evolution, that were not consistent with any known normal or benign pattern. The clinical history, EEG, and imaging results were retrieved. Each patient with B(I)RDs was matched by age and etiology to a control group with epileptiform discharges but without B(I)RDs in a 1:2 ratio. We identified B(I)RDs in 15 patients of 1,230 EEGs (1.2%). The pattern typically consisted of 0.5 to 4 second runs of sharply contoured alpha activity without evolution. All patients with B(I)RDs had epilepsy, and, when compared with controls with epilepsy but without BIRDs, were more likely to be medically refractory (10 of 15 [67%] vs. 5 of 30 [17%]; P < 0.01). All seizure onsets colocalized to the B(I)RDs, and most were morphologically similar. In noncritically ill patients, B(I)RDs are associated with refractory epilepsy and their location is correlated with the seizure onset area.

  11. Brief Potentially Ictal Rhythmic Discharges [B(I)RDs] in Non-critically Ill Adults.

    Science.gov (United States)

    Yoo, Ji Yeoun; Marcuse, Lara V; Fields, Madeline C; Rosengard, Jillian; Traversa, Maria Vittoria; Gaspard, Nicolas; Hirsch, Lawrence J

    2016-10-19

    Brief potentially ictal rhythmic discharges (B(I)RDs) have been described in neonates and critically ill adults, and their association with seizures has been demonstrated. Their significance in non-critically ill adults remains unclear. We aimed to investigate their prevalence, electrographic characteristics and clinical significance. We identified adult patients with B(I)RDs who received long term EEG recordings either in the epilepsy monitoring unit or in the ambulatory setting. Patients with acute findings on imaging or status epilepticus were excluded. B(I)RDs were defined as very brief (<10 seconds) runs of focal or generalized sharply contoured rhythmic activity greater than 4 Hz, with or without evolution, that were not consistent with any known normal or benign pattern. The clinical history, EEG and imaging results were retrieved. Each patient with B(I)RDs was matched by age and etiology to a control group with epileptiform discharges but without B(I)RDs in a 1:2 ratio. We identified B(I)RDs in 15 patients out of 1230 EEGs (1.2%). The pattern typically consisted of 0.5-4 second runs of sharply contoured alpha activity without evolution. All patients with B(I)RDs had epilepsy, and, when compared to controls with epilepsy but without BIRDs, were more likely to be medically refractory (10 of 15 [67%] vs. 5 of 30 [17%]; p<0.01). All seizure onsets co-localized to the B(I)RDs, and most were morphologically similar. In non-critically ill patients, B(I)RDs are associated with refractory epilepsy and their location is correlated with the seizure onset area.

  12. [Mental disorder and suicide prevention in patients with physical illness].

    Science.gov (United States)

    Inagaki, Masatoshi; Ohtsuki, Tsuyuka

    2012-01-01

    Suicide rate in Japan is 25/100,000 in a year. The rate is higher than those in other developed countries. Physical illness is a risk factor for suicide. To prevent suicide in patients with physical illness, identification of mental illness, such as depression, is important. In addition, palliative care for distressing physical and psychological symptoms is also important. In process of identification of mental illness and distressing physical symptoms, communications between medical staff and patients are essential. Enhancing communication skills of medical staff may be a key point to prevent suicide.

  13. Illness perceptions, negative emotions, and pain in patients with noncardiac chest pain.

    Science.gov (United States)

    Israel, Jared I; White, Kamila S; Gervino, Ernest V

    2015-03-01

    Illness-specific cognitions are associated with outcomes in numerous health conditions, however, little is known about their role in noncardiac chest pain (NCCP). NCCP is prevalent, impairing, and associated with elevated health care utilization. Our objective was to investigate the relations between illness perceptions, emotion, and pain in a sample of 196 adult patients diagnosed with NCCP. We found that negative illness perceptions were associated with greater anxiety, depression, chest pain, and pain-related life interference while controlling for the effects of demographic and pain-related variables. These results expand current NCCP theory and may inform future treatment development.

  14. Prevalence and diagnosis rate of intra-abdominal hypertension in critically ill adult patients: A single-center cross-sectional study

    Institute of Scientific and Technical Information of China (English)

    Hua-Yu Zhang; Dong Liu; Hao Tang; Shi-Jin Sun; Shan-Mu Ai; Wen-Qun Yang; Dong-Po Jiang

    2015-01-01

    Purpose: To investigate the prevalence and diagnosis rate of intra-abdominal hypertension (IAH) in a mixed-population intensive care unit (ICU), and to investigate the knowledge of ICU staff regarding the guidelines published by the World Society of Abdominal Compartment Syndrome (WSACS) in 2013.Methods: A one-day cross-sectional study based on the WSACS 2013 guidelines was conducted in the general ICU of a tertiary teaching hospital in Chongqing, China.The included patients were divided into intravesical pressure (IVP) measured group and IVP unmeasured group.The epidemiologic data were recorded, and potential IAH risk factors (RFs) were collected based on the guidelines.IVP measurements were conducted by investigators every 4 h and the result was compared to that measured by the ICU staff to evaluate the diagnosis rate.Besides, a questionnaire was used to investigate the understanding of the guidelines among ICU staff.Results: Thirty-two patients were included, 14 in the IVP measured group and 18 in the IVP unmeasured group.The prevalence of IAH during the survey was 15.63% (5/32), 35.71% (5/14) in IVP measured group.Only one case of IAH had been diagnosed by the ICU physician and the diagnosis rate was as low as 20.00%.Logistic regression analysis showed that sequential organ failure assessment (SOFA) score was an independent RF for IAH (OR: 1.532, 95% CI: 1.029-2.282, p =0.036.Fourteen doctors and 5 nurses were investigated and the response rate was 67.86%.The average scores of the doctors and nurses were 27.14 ± 20.16 and 16.00 ± 8.94 respectively.None of them had studied the WSACS 2013 guidelines thoroughly.Conclusion: Patients with a higher SOFA score has a higher incidence of IAH.The IAH prevalence in 14 ICU patients with indwelling catheter was 35.71%.Strengthening the wide and rational use of WSACS guideline is important to improve the diagnosis of IAH.

  15. Illness Beliefs Predict Mortality in Patients with Diabetic Foot Ulcers

    Science.gov (United States)

    Vedhara, Kavita; Dawe, Karen; Miles, Jeremy N. V.; Wetherell, Mark A.; Cullum, Nicky; Dayan, Colin; Drake, Nicola; Price, Patricia; Tarlton, John; Weinman, John; Day, Andrew; Campbell, Rona; Reps, Jenna; Soria, Daniele

    2016-01-01

    Background Patients’ illness beliefs have been associated with glycaemic control in diabetes and survival in other conditions. Objective We examined whether illness beliefs independently predicted survival in patients with diabetes and foot ulceration. Methods Patients (n = 169) were recruited between 2002 and 2007. Data on illness beliefs were collected at baseline. Data on survival were extracted on 1st November 2011. Number of days survived reflected the number of days from date of recruitment to 1st November 2011. Results Cox regressions examined the predictors of time to death and identified ischemia and identity beliefs (beliefs regarding symptoms associated with foot ulceration) as significant predictors of time to death. Conclusions Our data indicate that illness beliefs have a significant independent effect on survival in patients with diabetes and foot ulceration. These findings suggest that illness beliefs could improve our understanding of mortality risk in this patient group and could also be the basis for future therapeutic interventions to improve survival. PMID:27096609

  16. Repeatability of Blood Gas Parameters, Pco2 Gap, and Pco2 Gap to Arterial-to-Venous Oxygen Content Difference in Critically Ill Adult Patients

    Science.gov (United States)

    Mallat, Jihad; Lazkani, Ali; Lemyze, Malcolm; Pepy, Florent; Meddour, Mehdi; Gasan, Gaëlle; Temime, Johanna; Vangrunderbeeck, Nicolas; Tronchon, Laurent; Thevenin, Didier

    2015-01-01

    Abstract The objective of this study was to examine the repeatability of blood gas (BG) parameters and their derived variables such as the central venous-to-arterial carbon dioxide tension difference (▵Pco2) and the ratio of ▵Pco2 over the central arteriovenous oxygen content difference (▵Pco2/C(a-cv)O2) and to determine the smallest detectable changes in individual patients. A total of 192 patients with arterial and central venous catheters were included prospectively. Two subsequent arterial and central venous blood samples were collected immediately one after the other and analyzed using the same point-of-care BG analyzer. The samples were analyzed for arterial and venous BG parameters, ▵Pco2, and ▵Pco2/C(a-cv)O2 ratio. Repeatability was expressed as the smallest detectable difference (SDD) and the least significant change (LSC). A change in value of these parameters exceeding the SDD or the LSC should be regarded as real. The SDDs for arterial carbon dioxide tension, arterial oxygen saturation, central venous oxygen saturation (ScvO2), and ▵Pco2 were small: ±2.06 mm Hg, ±1.23%, 2.92%, and ±1.98 mm Hg, respectively, whereas the SDDs for arterial oxygen tension (Pao2) and ▵Pco2/C(a-cv)O2 were high: ±9.09 mm Hg and ±0.57 mm Hg/mL, respectively. The LSCs (%) for these variables were 5.06, 1.27, 4.44, 32.4, 9.51, and 38.5, respectively. The repeatability of all these variables was good except for Pao2 and ▵Pco2/C(a-cv)O2 ratio for which we observed an important inherent variability. Expressed as SDD, a ScvO2 change value of at least ±3% should be considered as true. The clinician must be aware that an apparent change in these variables in an individual patient might represent only an inherent variation. PMID:25621691

  17. Head-to-head comparison of procalcitonin and presepsin for the diagnosis of sepsis in critically ill adult patients: a protocol for a systematic review and meta-analysis

    Science.gov (United States)

    Hayashida, Kei; Kondo, Yutaka; Hara, Yoshitaka; Aihara, Morio; Yamakawa, Kazuma

    2017-01-01

    Introduction Early diagnosis and immediate therapeutic intervention, including appropriate antibiotic therapy and goal-directed resuscitation, are necessary to reduce mortality in patients with sepsis. However, a single clinical or biological marker indicative of sepsis has not been adopted unanimously. Although procalcitonin and presepsin are promising biomarkers that can effectively differentiate between sepsis/infection and systemic inflammatory response syndrome of non-infectious origin, little is known about which marker is superior. Methods and analysis We will conduct a systematic review and meta-analysis of procalcitonin and presepsin for the diagnosis of sepsis/infection in critically ill adult patients. The primary objective is to evaluate the diagnostic accuracy of these 2 biomarkers to a reference standard of sepsis/infection and to compare the diagnostic accuracy with each other. We will search electronic bibliographic databases such as MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials for retrospective and prospective diagnostic test studies. We will assign 2 reviewers to review all collected titles and associated abstracts, review full articles, and extract study data. We will use the Quality of Diagnostic Accuracy Studies-II tool to report study characteristics and to evaluate methodological quality. If pooling is possible, we will use bivariate random effects and hierarchical summary receiver operating characteristic (ROC) models to calculate parameter estimates to output summary ROCs, pooled sensitivity and specificity data, and 95% CIs around the summary operating point. We will also assess heterogeneity via clinical and methodological subgroup and sensitivity analyses. Ethics and dissemination This systematic review will provide guidance on the triage of these tests, help to determine whether existing tests should be revised or replaced, and may also identify knowledge gaps in sepsis diagnosis that could direct further research

  18. Complications in critically ill adult patients’ transportations reported in the recent literature

    Directory of Open Access Journals (Sweden)

    Stefano Bambi

    2015-06-01

    Full Text Available The transport of critically ill patients is a complex process, made up by several phases involving the healthcare professionals. It requires a careful planning for the prevention of potential complications undermining the patients’ safety outside critical care environment. Literature review about complications and adverse events reported during intra and inter-hospital transport of critically ill adult patients. Intra-hospital transfers are affected by adverse events rates ranging from 22.2 to 75.7% in the published literature. Major adverse events, defined as life threatening conditions that require urgent therapeutic intervention, vary from 4.2 to 31%. Death is a rare occurrence. Adverse events during interhospital have a maximum rate of 34%. Technical incidents represent a typical feature of these transports. Authors reported problems to gas supply, ambulance electric system, equipment. There is a lack of studies about the complications related to rotary wing inter-hospital transports. While extracorporeal membrane oxygenation/extracorporeal life support patients seem to be the most complex category of critically ill to be transported outside the hospital, 11 papers revealed only 29 adverse events ranging from 0 to 17%. No deaths were recorded. Currently, research must explore more accurately how much transports affect the outcome of patients, and what are the most appropriate time-frames to assess the consequences of transfers on patients’ clinical conditions.

  19. Do illness perceptions predict health outcomes in primary care patients?

    DEFF Research Database (Denmark)

    Frostholm, Lisbeth; Oernboel, Eva; Christensen, Kaj S

    2007-01-01

    patients, (2) patients without chronic disorders presenting physical disease, and (3) patients presenting medically unexplained symptoms (MUS). RESULTS: Negative illness perceptions were associated with poor physical and mental health at baseline. They most strongly predicted changes in health status......OBJECTIVE: Little is known about whether illness perceptions affect health outcomes in primary care patients. The aim of this study was to examine if patients' illness perceptions were associated with their self-rated health in a 2-year follow-up period. METHODS: One thousand seven hundred eighty......-five primary care patients presenting a new or recurrent health problem completed an adapted version of the illness perception questionnaire and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) at baseline and 3, 12, and 24 months' follow-up. Linear regressions were performed for (1) all...

  20. Suicidal behaviour among terminally ill cancer patients in India

    OpenAIRE

    Latha, K. S.; Bhat, S.M.

    2005-01-01

    Background: Passive suicidal thoughts are relatively common in patients with terminal cancer. There is a need for more information about the factors that influence these patients to desire death. Aim: To examine the prevalence of suicidal ideation among terminally ill cancer patients. Methods: Fifty-four terminally ill inpatients (27 men and 27 women) from the palliative care unit of the Oncology department of Kasturba Hospital, Manipal were evaluated on various rating scales for depression, ...

  1. Thrombo-prophylaxis in acutely ill medical and critically ill patients

    Directory of Open Access Journals (Sweden)

    Saurabh Saigal

    2014-01-01

    Full Text Available Thrombo-prophylaxis has been shown to reduce the incidence of pulmonary embolism (PE and mortality in surgical patients. The purpose of this review is to find out the evidence-based clinical practice criteria of deep vein thrombosis (DVT prophylaxis in acutely ill medical and critically ill patients. English-language randomized controlled trials, systematic reviews, and meta-analysis were included if they provided clinical outcomes and evaluated therapy with low-dose heparin or related agents compared with placebo, no treatment, or other active prophylaxis in the critically ill and medically ill population. For the same, we searched MEDLINE, PUBMED, Cochrane Library, and Google Scholar. In acutely ill medical patients on the basis of meta-analysis by Lederle et al. (40 trials and LIFENOX study, heparin prophylaxis had no significant effect on mortality. The prophylaxis may have reduced PE in acutely ill medical patients, but led to more bleeding events, thus resulting in no net benefit. In critically ill patients, results of meta-analysis by Alhazzani et al. and PROTECT Trial indicate that any heparin prophylaxis compared with placebo reduces the rate of DVT and PE, but not symptomatic DVT. Major bleeding risk and mortality rates were similar. On the basis of MAGELLAN trial and EINSTEIN program, rivaroxaban offers a single-drug approach to the short-term and continued treatment of venous thrombosis. Aspirin has been used as antiplatelet agent, but when the data from two trials the ASPIRE and WARFASA study were pooled, there was a 32% reduction in the rate of recurrence of venous thrombo-embolism and a 34% reduction in the rate of major vascular events.

  2. Communication with older, seriously ill patients.

    NARCIS (Netherlands)

    Vliet, L.M. van; Lindenberger, E.; Weert, J.C.M. van

    2015-01-01

    This article aims to provide more insight into effective communication with older people with serious illness and their surrogates/caregivers. To do so, if focusses on specific skills in three core functions of communication (i) empathic behavior, (ii) information provision and (iii) enabling decisi

  3. Illnesses in siblings of US patients with bipolar disorder relate to multigenerational family history and patients severity of illness

    NARCIS (Netherlands)

    Post, Robert M.; Altshuler, Lori L.; Kupka, Ralph; McElroy, Susan L.; Frye, Mark A.; Rowe, Michael; Grunze, Heinz; Suppes, Trisha; Keck, Paul E.; Nolen, Willem A.

    2017-01-01

    Background: Patients with bipolar disorder from the US have more early-onset illness and a greater familial loading for psychiatric problems than those from the Netherlands or Germany (abbreviated here as Europe). We hypothesized that these regional differences in illness burden would extend to the

  4. [Citomegalovirus reactivation in critical ill intensive care patients].

    Science.gov (United States)

    Carrillo Esper, Raúl

    2011-01-01

    Cytomegalovirus (CMV) is a β herpesvirus and a significant human pathogen. After primary infection establishes life long latency. In immunocompetent individuals cell-mediated host immune responses prevent the development of overt CMV disease. It has increasingly come to be recognized that critically ill patients are at risk for CMV reactivation from the latency. The risk factors associated to CMV reactivation in the critically ill are infection, sepsis, trauma, transfusions, major surgery, prolonged mechanical ventilation, steroids and vasopressors. In the pathogenesis are involved immunodysfunction and imbalance in immunomodulatory mediators principally tumor necrosis factor (TNF) and nuclear factor κB (NF-κB). Several studies have shown an association between CMV reactivation in immunocompetent critically ill patients and poor clinical outcomes. Further studies are warranted to identify subsets of patients who are at risk of developing CMV reactivation and to determine the role of antiviral agents on clinically outcomes in critically ill patients.

  5. Attitudes and beliefs about mental illness among relatives of patients ...

    African Journals Online (AJOL)

    2017-08-03

    Aug 3, 2017 ... participants many had positive attitude towards letting the patients be part of ... Keywords: schizophrenia, mental illness, sfigma, attitudes, beliefs ... (CAMI) scale [8]. ..... Conflict of interest: All authors have declared that there.

  6. Delirium in Critically Ill Patients Epidemiology, Pathophysiology, Diagnosis and Management

    NARCIS (Netherlands)

    Zaal, Irene J.; Slooter, Arjen J. C.

    2012-01-01

    Delirium is commonly observed in critically ill patients and is associated with negative outcomes. The pathophysiology of delirium is not completely understood. However, alterations to neurotransmitters, especially acetylcholine and dopamine, inflammatory pathways and an aberrant stress response are

  7. 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....

  8. Cooling by convection vs cooling by conduction for treatment of fever in critically ill adults.

    Science.gov (United States)

    Creechan, T; Vollman, K; Kravutske, M E

    2001-01-01

    Cooling with water-flow blankets, which are difficult to manipulate and interfere with patients' care, may be ineffective in controlling fever. To compare the effectiveness of cooling via convective airflow blankets with cooling via conductive water-flow blankets for treatment of fever in critically ill adults. A 2-group experimental design was used to compare cooling via convection (n = 20) with cooling via conduction (n = 17) in critically ill adults with an infection-related fever of 38.5 degrees C or greater. Esophageal temperature was measured every 15 minutes until a temperature of 38.0 degrees C was reached or 8 hours had elapsed. Alternative cooling measures were withheld unless the temperature increased to more than 40.0 degrees C. Data on nurses' satisfaction were collected, and complications related to each cooling method were examined. Temperatures decreased more rapidly in the airflow group (mean decrease, 0.377 degree C/h) than in the water-flow group (mean decrease, 0.163 degree C/h). A temperature of 38.0 degrees C was achieved more often in the airflow group (75% vs 47.1%). Fever (temperature > 38.5 degrees C) recurred sooner in the water-flow group (6.6 hours) than in the airflow group (22.2 hours). Both methods were easy to use. Compared with the water-flow blanket, the airflow blanket was recommended for future use twice as often and interfered less with patients' care. In critically ill adults with an infection or a suspected infection, cooling with an airflow blanket is more effective and more preferred for cooling than is cooling with a water-flow blanket.

  9. [Illness Concepts of Patients with Schizophrenia: A Triangulation Study].

    Science.gov (United States)

    Wigand, Moritz E; Reichhardt, Lea; Lang, Fabian U; Krumm, Silvia; Jäger, Markus

    2017-04-03

    Objective Therapists' and patients' concepts of illness often show severe discrepancies. This study explores the illness concepts of patients with schizophrenic disorders (n = 40). Methods Two German scales were used, the "Causal Belief Questionnaire" and the "Illness Concept Scale for Schizophrenic Patients". We compared our data with data published previously. A semi structured interview was performed in a convenience sample (n = 7). Results The domains "trust in medication" and "trust in the treating physician" yielded high scores, yet in comparison with data published 30 years ago, trust in medication is unaltered, while trust in psychiatrists is even slightly lower. Recent psychosocial factors scored high as a possible cause of mental illness. Several patients felt responsible for being mentally ill. No patient in the interview mentioned the neurotransmitter hypothesis of schizophrenia. Conclusion Illness concepts of patients with schizophrenic disorders are a complex phenomenon. Triangulation of quantitative and qualitative methods proves to be a promising approach for future studies. © Georg Thieme Verlag KG Stuttgart · New York.

  10. Epidemiological, humanistic, and economic burden of illness of lower limb spasticity in adults: a systematic review

    Directory of Open Access Journals (Sweden)

    Martin A

    2014-01-01

    Full Text Available Alison Martin,1 Seye Abogunrin,1 Hannah Kurth,2 Jerome Dinet2 1Evidera, London, UK; 2Ipsen, Boulogne Billancourt Cedex, France Background: The purpose of this study was to investigate the epidemiological, humanistic, and economic burden of illness associated with adult lower limb spasticity (LLS and its complications. Methods: A systematic search of MEDLINE and EMBASE identified 23 studies published between January 2002 and October 2012 that assessed the epidemiology, impact, and resource use associated with LLS. A hand-search of four neurology conferences identified abstracts published between 2010 and 2012. Results: LLS was found to occur in one third of adults after stroke, half to two thirds with multiple sclerosis, and three quarters with cerebral palsy. LLS limits mobility and reduces quality of life. No clear association was found between LLS and occurrence of pain, development of contractures, or risk of falls. Conclusion: The evidence on the burden of LLS and its complications is surprisingly limited given the condition's high prevalence among adults with common disorders, such as stroke. Further research is needed to clarify the impact of LLS, including the likelihood of thrombosis in spastic lower limbs. The dearth of high-quality evidence for LLS suggests a lack of awareness of, and interest in, the problem, and therefore, the unmet need among patients and their carers. Keywords: muscle spasticity, cost of illness, complications, quality of life

  11. Illness perception patterns in patients with Coronary Artery Disease.

    Science.gov (United States)

    Kunschitz, E; Friedrich, O; Schöppl, Ch; Maitz, J; Sipötz, J

    2017-09-01

    The purpose of this study is to identify patterns of illness perception in patients with angiografically verified Coronary Artery Disease. A total of 166 patients (age: 64.4 ± 12.1, 80.7% male) were recruited after angiography. Cluster analysis on the items of the Brief Illness Perception Questionnaire was used to identify patterns of illness perception. The resulting groups were characterized with regard to Quality of Life (MacNew), anxiety and depression (GAD-7 and PHQ-9) and resilience (RS-13). The analysis revealed 4 distinct groups differing with regard to the items covering the perception of the physical and emotional impact of disease. Stronger perceptions in these domains were associated with lower Health Related Quality of Life and higher levels of emotional distress. Group 1 (33.1%) reported the strongest perceptions of the physical and emotional impact of disease and expressed low treatment control, high chronic timeline and significantly higher levels of depression than the other groups. Group 2 (27.7%) was characterized by more moderate perceptions of the emotional and physical impact of disease together with low scores on illness coherence and chronic timeline. Groups 3 (25.3%) and 4 (13.9%) reported smaller physical and emotional impact of illness but differed in chronic timeline. Our results correspond largely to recent findings in patients with other chronic diseases. Further research is needed to explore if stratification of patients according patterns of illness perception can help to inform patient-physician communication strategies.

  12. Emergency team calls for critically ill non-trauma patients in the emergency department

    DEFF Research Database (Denmark)

    Jensen, Søren Marker; Do, Hien Quoc; Rasmussen, Søren W.

    2015-01-01

    BACKGROUND: Handling critically ill patients is a complex task for Emergency Department (ED) personnel. Initial treatment is of major importance and requires adequately experienced ED doctors to initiate and decide for the right medical or surgical treatment. Our aim was, with regard to clinical...... presentation, management and mortality to describe adult non-trauma patients that upon ED arrival elicited emergency team calls. METHODS: An observational study of adult patients (≥ 18 years) admitted to a regional ED with conditions that elicited acute team activation and additional emergency team.......004). Additionally, 115 adult patients were admitted to the ICU directly from the ED without eliciting an emergency team call during the study period. These patients mainly comprised patients who were intoxicated, were unconscious or had respiratory failure. CONCLUSION: The majority of emergency team call patients...

  13. Illness perceptions of adults with congenital heart disease and their predictive value for quality of life two years later

    NARCIS (Netherlands)

    Schoormans, D.; Mulder, B.J.; Melle, J.P. van; Pieper, P.G.; Dijk, A.P.J. van; Sieswerda, G.T.; Hulsbergen-Zwarts, M.S.; Plokker, T.H.; Brunninkhuis, L.G.; Vliegen, H.W.; Sprangers, M.A.G.

    2014-01-01

    BACKGROUND: To improve patients' quality of life (QoL) we need to identify modifiable determinants, such as illness perceptions. Patients' illness perceptions are known to regulate emotional responses and health-behaviour. Illness perceptions comprise several components: consequences, control,

  14. Diagnosis of overt disseminated intravascular coagulation in critically Ill adults by Sonoclot coagulation analysis.

    Science.gov (United States)

    Wan, Peng; Tong, Hua-Sheng; Zhang, Xing-Qin; Duan, Peng-Kai; Tang, You-Qing; Su, Lei

    2014-08-01

    Disseminated intravascular coagulation (DIC) diagnosis is hampered by the limited availability of reliable clinical or laboratory tests. Currently available tests are time consuming and expensive. We investigated whether coagulation and platelet function analyses using the Sonoclot system were suitable for overt DIC diagnosis in critically ill adults. This was an observational diagnostic study performed in 498 patients presenting with an underlying disorder associated with DIC. Overt DIC patients were identified according to an International Society on Thrombosis and Hemostasis (ISTH) score of >5. Coagulation and platelet parameters were analyzed using the Sonoclot system, and compared with ISTH as the gold standard. Receiver operating characteristic curves and area under the curves were used to evaluate the value of the Sonoclot parameters. There were no differences for age or gender between the groups. Significant correlations were observed between activated clotting time (ACT) and ISTH score (r = 0.7; P coagulation dysfunction in patients with overt DIC.

  15. An exploratory study of the personal health records adoption model in the older adult with chronic illness

    OpenAIRE

    Logue, Melanie D.; Effken, Judith A.

    2013-01-01

    Background Despite international efforts moving toward integrated care using health information technologies and the potential of electronic PHRs to help us better coordinate patient-centered care, PHR adoption in the United States remains low among patients who have been offered free access to them from private-sector companies. If older adult stand to benefit from the use of PHRs for its usefulness in self-managing chronic illness, why have they not been more readily adopted? Since the chro...

  16. Profiles of Chronic Illness Knowledge in a Community Sample of American Adults

    Science.gov (United States)

    Jackson, Todd

    2009-01-01

    The author identified profiles of chronic illness knowledge (i.e., heart disease, cancer, diabetes) in a community sample of American adults and examined the effect of sociodemographic influences on relations of illness knowledge to health practices and well-being. Participants were 181 women and 120 men who completed measures of illness…

  17. Psychiatric Illness in a Cohort of Adults with Prader-Willi Syndrome

    Science.gov (United States)

    Sinnema, Margje; Boer, Harm; Collin, Philippe; Maaskant, Marian A.; van Roozendaal, Kees E. P.; Schrander-Stumpel, Constance T. R. M.; Curfs, Leopold M. G.

    2011-01-01

    Previous studies have suggested an association between PWS and comorbid psychiatric illness. Data on prevalence rates of psychopathology is still scarce. This paper describes a large-scale, systematic study investigating the prevalence of psychiatric illness in a Dutch adult PWS cohort. One hundred and two individuals were screened for psychiatric…

  18. Vital Signs – Adult Smoking Among People with Mental Illness

    Centers for Disease Control (CDC) Podcasts

    2013-02-05

    This podcast is based on the February 2013 CDC Vital Signs report, which shows that cigarette smoking is a serious problem among adults with mental illness. More needs to be done to help adults with mental illness quit smoking and make mental health facilities tobacco-free.  Created: 2/5/2013 by Centers for Disease Control and Prevention (CDC).   Date Released: 2/5/2013.

  19. A qualitative study examining health literacy and chronic illness self-management in Hispanic and non-Hispanic older adults

    Directory of Open Access Journals (Sweden)

    Jacobs RJ

    2017-04-01

    Full Text Available Robin J Jacobs,1 Raymond L Ownby,2 Amarilis Acevedo,3 Drenna Waldrop-Valverde4 1Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, 2College of Osteopathic Medicine, 3College of Psychology, Nova Southeastern University, Fort Lauderdale, FL, 4Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA Purpose: Chronic illness and low levels of health literacy affect health outcomes for many individuals, particularly older adults and racial/ethnic minorities. This study sought to understand the knowledge, strengths, and areas of need regarding self-management of chronic illness in order to lay the groundwork for content development of an intervention to increase health literacy and maximize patient engagement in chronic disease self-care.Patients and methods: In-depth, qualitative interviews were conducted in Spanish and English with 25 older adults with various chronic illnesses. Topics included knowledge and understanding of chronic conditions, medications, and disease self-management skills. Qualitative data were coded by searching text and conducting cross-case analysis. An inductive analysis was then employed to allow for the patterns and themes to emerge.Results: Emerged themes included 1 social support, 2 coping strategies, 3 spirituality, 4 chronic disease health literacy, 5 anger, and 6 depression. While participants had a general overall knowledge of chronic illness, they had deficits in knowledge regarding their own illnesses and medications.Conclusion: Chronic illness self-management is a complex and dynamic behavioral process. This study identified themes that leverage patient motivation to engage in self-care in a personalized manner. This information will guide the development of an intervention to promote health literacy and optimal disease self-management. Keywords: health disparities, older adults, resilience, computer interventions, comorbidity, multimorbidity

  20. Prophylactic use of laxative for constipation in critically ill patients

    Directory of Open Access Journals (Sweden)

    Masri Yasser

    2010-01-01

    Full Text Available Background : This study was designed to evaluate the use of laxative prophylaxis for constipation in intensive care unit (ICU and the impact of early versus late bowel movement on patient′s outcome. Methods : The study was a prospective, randomized controlled trial in critically ill ventilated adult patients, who were expected to stay on ventilator for >72 h. Control group did not receive any intervention for bowel movement for the first 72 h, whereas interventional group received prophylactic dose of lactulose 20 cc enterally every 12 h for the first 72 h. The parameters measured during the study were admission diagnosis, age, gender, comorbid conditions, admission Simplified Acute Physiologic Score (SAPS II, sedative and narcotic agents with doses and duration, timing and tolerance of nutrition, daily assessment of bowel movement, total use of prokinetic, doses of suppositories, and enema for first bowel movement, total number of days on ventilator, weaning failures, extubation or tracheostomy, ICU length of stay, and death or discharge. Results : A total of 100 patients were enrolled, 50 patients in each control and interventional group. Mean age was 38.8 years, and both groups had male predominance. Mean SAPS II score for both was 35. Mean dose of Fentanyl (323.8 ± 108.89 mcg/h in control and 345.83 ± 94.43 mcg/h in interventional group and mean dose of Midazolam (11.1 ± 4.04 mg/h in control and 12.4 ± 3.19 mg/h in interventional group. There were only two (4% patients in control, while nine (18% patients in interventional group who had bowel movement in <72 h (P < 0.05. Mean ventilator days were 16.19, and 17.36 days in control and interventional groups, respectively. Subgroup analysis showed that the patients who moved bowel in <5 days in both groups had mean ventilator days of 18.5, whereas it was 15.88 days for the patients who moved bowel after 5 days in both groups (P< 0.05. Mean ICU days for control was 21.15 ± 10.44 and 20

  1. [Role of voriconazole in critically ill patients with invasive mycoses].

    Science.gov (United States)

    Alvarez Lerma, Francisco

    2007-09-30

    This observational study of the use of voriconazole conducted in Spain has identified reasons, characteristics, and forms of use of voriconazole in critically ill patients admitted to the ICU. Voriconale was used for directed treatment (63%), by the intravenous route (75%), as rescue treatment (41%) in severely ill patients (APACHE 21) with high need of resources and therapeutic interventions. Satisfactory clinical response was obtained in 50% of cases, related adverse events were scarce (16%), and withdrawal of voriconazole was not necessary. Clinical indications included empirical, etiologic, and rescue treatment of infections caused by Aspergillus, Candida albicans and most species different than C. albicans. Voriconazole can be used for preemptive therapy in patients at risk of invasive candidasis. When selecting voriconazole, liver function, renal function (i.v. formulation) and history of azoles use should be considered, although none of these circumstances is an absolute contraindication for the prescription of voriconazole in critically ill patients.

  2. DIFFERENCES IN ILLNESS REPRESENTATIONS IN PATIENTS WITH CHRONIC KIDNEY DISEASE.

    Science.gov (United States)

    Pagels, Agneta A; Söderquist, Birgitta Klang; Heiwe, Susanne

    2015-09-01

    To explore the impact of chronic kidney disease (CKD) on individual illness representations, including symptoms and causal attributions. Fifty-four patients responded to the Illness Perception Questionnaire (IPQ-R) and a further seven patients undertook cognitive interviews regarding the IPQ-R. All respondents had CKD stage 2-5, not undergoing renal replacement therapy. Those in earlier CKD stages and those with fewer symptoms perceived a significantly different understanding of their condition than those in more advanced disease stages or with more symptoms. Behavioural and psychological attributions were commonly referred to as contributing causes to CKD. These attributions were associated to negative illness representations. An uncertainty assessing symptoms attributed to CKD was indicated, especially in earlier disease stages. Illness representations differ with CKD stages and symptom burden. The patients in earlier disease stages or with fewer symptoms did not hold as strong beliefs about their illness as being a threat as those in advanced stages or with more symptoms. Self-blame emerged as a common causal attribution. Patients did not always relate symptoms to CKD, therefore this study identifies a gap in patients' disease knowledge, especially in earlier stages of the condition. © 2015 European Dialysis and Transplant Nurses Association/European Renal Care Association.

  3. Potentially inappropriate prescribing and the risk of adverse drug reactions in critically ill older adults

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  5. Developing Navigation Competencies to Care for Older Rural Adults with Advanced Illness.

    Science.gov (United States)

    Duggleby, Wendy; Robinson, Carole A; Kaasalainen, Sharon; Pesut, Barbara; Nekolaichuk, Cheryl; MacLeod, Roderick; Keating, Norah C; Santos Salas, Anna; Hallstrom, Lars K; Fraser, Kimberly D; Williams, Allison; Struthers-Montford, Kelly; Swindle, Jennifer

    2016-06-01

    Navigators help rural older adults with advanced illness and their families connect to needed resources, information, and people to improve their quality of life. This article describes the process used to engage experts - in rural aging, rural palliative care, and navigation - as well as rural community stakeholders to develop a conceptual definition of navigation and delineate navigation competencies for the care of this population. A discussion paper on the important considerations for navigation in this population was developed followed by a four-phased Delphi process with 30 expert panel members. Study results culminated in five general navigation competencies for health care providers caring for older rural persons and their families at end of life: provide patient/family screening; advocate for the patient/family; facilitate community connections; coordinate access to services and resources; and promote active engagement. Specific competencies were also developed. These competencies provide the foundation for research and curriculum development in navigation.

  6. 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.

  7. Nutrition intervention in the critically ill cardiothoracic patient.

    Science.gov (United States)

    Cresci, Gail; Hummell, A Christine; Raheem, Sulieman Abdal; Cole, Denise

    2012-06-01

    Despite acute myocardial infarction and cardiac surgery accounting for 2 of the most common reasons patients are admitted to the intensive care unit, little attention and investigation have been directed specifically for these patients. This patient population therefore deserves special attention as they are often malnourished but require emergent interventions, making nutrition intervention challenging. This article reviews current medical interventions implemented in critically ill cardiothoracic patients and discusses evidence-based nutrition therapy, including enteral and parenteral feeding, glycemic control, and antioxidant provision.

  8. A pilot study of transformation, attributed meanings to the illness, and spiritual well-being for terminally ill cancer patients.

    Science.gov (United States)

    Ando, Michiyo; Morita, Tatsuya; Lee, Virginia; Okamoto, Takuya

    2008-12-01

    The present study investigated what types of transformation terminally ill cancer patients experienced from diagnosis until the terminal stage, what meanings terminally ill cancer patients attributed to their illness, and whether or not those who attributed positive meaning to their illness achieved high levels of spiritual well-being as a preliminary study. Ten terminally ill cancer patients in the hospice wards of two general hospitals participated. A clinical psychologist conducted a semistructured interview with the patients individually for about 60 min. Patients completed the FACIT-Sp and HADS before the interview and talked about the meanings of cancer experience. The contents of the interviews were analyzed qualitatively. Patients were separated into high and low levels of spiritual-well being by the median of FACIT-Sp scores. Three types of transformation were extracted: "group with peaceful mind," "group with both positive attitude and uneasy feeling," and "groups with uneasy feeling." As attributed meanings to the illness, five categories were extracted: "positive meaning," "natural acceptance," "negative acceptance," "search for meaning," and "regret and sorrow." Patients in the high level spiritual well-being group attributed the meaning of illness to "positive meaning" and "natural acceptance," and those in the low level spiritual well-being group attributed it to "regret and sorrow" and "search for meaning." Some Japanese terminally ill cancer patients experienced positive transformation, and patients who attributed "positive meaning" and "natural acceptance" to their illness experience achieved high levels of spiritual well-being.

  9. Helping at the bedside: spouses' preferences for helping critically ill patients.

    Science.gov (United States)

    Eldredge, Deborah

    2004-10-01

    Spouses of patients in intensive care units (ICU) need to be close and helpful to ill partners. According to adult attachment theory, emotional responses may be related to preferences for closeness and helpfulness, and according to control theory optimism also may influence spouses' emotional responses. Spouses' goals and helping behaviors were assessed in 88 spouses of ICU patients. Using a repeated-measures design, the relationships of closeness, helpfulness, and optimism to emotional outcomes were assessed. Preferences for closeness and helpfulness were strongly related, and together with optimism, predicted spouses' mood at some point of the illness trajectory. Spouses who were over-involved with partners' care requirements were at greater risk for emotional distress. Results suggest that closeness and helpfulness are integrated concepts, and that attachment dimensions of a relationship and optimism are useful for understanding spouses' emotional responses to critical illness.

  10. Early Mobilization and Rehabilitation of Patients Who Are Critically Ill.

    Science.gov (United States)

    Hashem, Mohamed D; Parker, Ann M; Needham, Dale M

    2016-09-01

    Neuromuscular disorders are increasingly recognized as a cause of both short- and long-term physical morbidity in survivors of critical illness. This recognition has given rise to research aimed at better understanding the risk factors and mechanisms associated with neuromuscular dysfunction and physical impairment associated with critical illness, as well as possible interventions to prevent or treat these issues. Among potential risk factors, bed rest is an important modifiable risk factor. Early mobilization and rehabilitation of patients who are critically ill may help prevent or mitigate the sequelae of bed rest and improve patient outcomes. Research studies and quality improvement projects have demonstrated that early mobilization and rehabilitation are safe and feasible in patients who are critically ill, with potential benefits including improved physical functioning and decreased duration of mechanical ventilation, intensive care, and hospital stay. Despite these findings, early mobilization and rehabilitation are still uncommon in routine clinical practice, with many perceived barriers. This review summarizes potential risk factors for neuromuscular dysfunction and physical impairment associated with critical illness, highlights the potential role of early mobilization and rehabilitation in improving patient outcomes, and discusses some of the commonly perceived barriers to early mobilization and strategies for overcoming them.

  11. Relatives to Critically Ill Patients Have No Sense of Coherence

    DEFF Research Database (Denmark)

    Laursen, Jannie; Andresen, Kristoffer; Rosenberg, Jacob

    2016-01-01

    shown that relatives do not always receive the attention they need from health professionals. There is a lack of studies that focus on relatives' satisfaction and involvement during their family members' hospitalization. Design. A mixed methods design was chosen. Methods. A quantitative study......Aims and Objective. To investigate the relatives' satisfaction and involvement on a general surgery ward regarding the critically ill patient. Introduction. Relatives to critically ill patients are affected both physically and mentally during the hospitalization of a family member. Research has...... was conducted with 27 relatives to critically ill patients. All participated in a questionnaire and out of the 27 relatives, six participated in qualitative in-depth interviews. Results. The questionnaire revealed that relatives were dissatisfied with care and involvement. For further exploration...

  12. Attitudes of acutely ill patients towards euthanasia in Hong Kong.

    Science.gov (United States)

    Lam, R C S; Chien, Wai-Tong

    2007-01-01

    The global euthanasia debate by health care professionals has raised important ethical issues concerning the professional duties and responsibilities of nurses caring for terminal patients. The purpose of this study was to examine the attitudes of acutely ill patients towards the practice of euthanasia in Hong Kong. A modified form of the 23-item Questionnaire for General Household Survey scale was used. This cross-sectional survey study was conducted with a stratified sample of in-patients recruited from a wide variety of departments in a regional, acute general hospital. Seventy-seven out of 129 patients responded (59.7%) and a high proportion of patients agreed with the use of euthanasia in the following circumstances: 'where they were a third party', if 'someone they loved' was affected, or if 'they themselves were the patient'. Of the 77 patients, 54 agreed with active euthanasia (70.1%) and 65 with passive (84.4%). The results also indicated that a few socio-demographic characteristics (such as age, gender and household income) statistically significantly correlated with patients' attitudes towards euthanasia. These findings highlight that Chinese patients with acute illness generally accept the use of euthanasia. Further research on the attitudes and perceptions of patients towards the use of euthanasia is recommended, particularly in diverse groups of Chinese and Asian patients with acute or terminal illness.

  13. Are atypical lymphocytes present with viral influenza-like illnesses (ILIs) in hospitalized adults?

    Science.gov (United States)

    Cunha, B A; Connolly, J J; Irshad, N

    2016-09-01

    The purpose of this investigation was to determine if atypical lymphocytes were of diagnostic value in viral influenza-like illnesses (ILIs) in hospitalized adults during the influenza season. Are atypical lymphocytes present with viral ILIs in hospitalized adults? During the influenza season, hospitals are inundated with influenza and viral ILIs, e.g., human parainfluenza virus-3 (HPIV-3). Without specific testing, clinically, it is difficult to differentiate influenza from ILIs, and surrogate influenza markers have been used for this purpose, e.g., relative lymphopenia. The diagnostic significance of atypical lymphocytes with ILIs is not known. We retrospectively reviewed the charts of 35 adults admitted with pneumonia due to viral ILI. The diagnosis of 14 patients was by respiratory virus polymerase chain reaction (PCR). During the 2015 influenza A season with ILIs, atypical lymphocytes were not present in influenza A (H3N2) patients but atypical lymphocytes were present in some ILIs, particularly HPIV-3. With viral ILIs, atypical lymphocytes should suggest a non-influenza viral diagnosis.

  14. Nursing the critically ill surgical patient in Zambia.

    Science.gov (United States)

    Carter, Chris; Snell, David

    2016-11-10

    Critical illness in the developing world is a substantial burden for individuals, families, communities and healthcare services. The management of these patients will depend on the resources available. Simple conditions such as a fractured leg or a strangulated hernia can have devastating effects on individuals, families and communities. The recent Lancet Commission on Global Surgery and the World Health Organization promise to strengthen emergency and essential care will increase the focus on surgical services within the developing world. This article provides an overview of nursing the critically ill surgical patient in Zambia, a lower middle income country (LMIC) in sub-Saharan Africa.

  15. Echocardiographic approach to cardiac tamponade in critically ill patients.

    Science.gov (United States)

    McCanny, Peter; Colreavy, Frances

    2016-12-24

    Cardiac tamponade should be considered in a critically ill patient in whom the cause of haemodynamic shock is unclear. When considering tamponade, transthoracic echocardiography plays an essential role and is the initial investigation of choice. Diagnostic sensitivity of transthoracic echocardiography is dependent on image quality, and in some cases a transoesophageal approach may be required to confirm the diagnosis. Knowledge of the pathophysiology and echocardiographic features of cardiac tamponade are essential for the practicing Intensivist. This review presents an approach to the recognition, diagnosis, and treatment of cardiac tamponade in critically ill patients.

  16. [Patient-caregiver relationship: when illness blogs step in].

    Science.gov (United States)

    Rondi, Céline; Berney, Alexandre

    2014-02-12

    The use of social media as a communication tool is rapidly growing in the community, and more specifically in patients, through illness blogs. This has been true for several years in North America, but is becoming a reality in Europe as well. We report here the first results of studies on the putative psychological benefits and risks of illness blogs for their authors. We also explore the possible impact of blogging on the patient-caregiver relationship. Social media are expected to have a growing influence in certain areas of health care. Physicians should therefore stay informed about them, take advantage of their benefits, and anticipate their risks.

  17. Prolonged shedding of rhinovirus and re-infection in adults with respiratory tract illness.

    Science.gov (United States)

    Zlateva, Kalina T; de Vries, Jutte J C; Coenjaerts, Frank E J; van Loon, Anton M; Verheij, Theo; Little, Paul; Butler, Christopher C; Goossens, Herman; Ieven, Margareta; Claas, Eric C J

    2014-07-01

    Rhinovirus infections occur frequently throughout life and have been reported in about one-third of asymptomatic cases. The clinical significance of sequential rhinovirus infections remains unclear. To determine the incidence and clinical relevance of sequential rhinovirus detections, nasopharyngeal samples from 2485 adults with acute cough/lower respiratory illness were analysed. Patients were enrolled prospectively by general practitioners from 12 European Union countries during three consecutive years (2007-2010). Nasopharyngeal samples were collected at the initial general practitioner consultation and 28 days thereafter and symptom scores were recorded by patients over that period. Rhinovirus RNA was detected in 444 (18%) out of 2485 visit one samples and in 110 (4.4%) out of 2485 visit two respiratory samples. 21 (5%) of the 444 patients had both samples positive for rhinovirus. Genotyping of both virus detections was successful for 17 (81%) out of 21 of these patients. Prolonged rhinovirus shedding occurred in six (35%) out of 21 and re-infection with a different rhinovirus in 11 (65%) out of 21. Rhinovirus re-infections were significantly associated with chronic obstructive pulmonary disease (p=0.04) and asthma (p=0.02) and appeared to be more severe than prolonged infections. Our findings indicate that in immunocompetent adults rhinovirus re-infections are more common than prolonged infections, and chronic airway comorbidities might predispose to more frequent rhinovirus re-infections.

  18. The critically ill obstetric patient - Recent concepts

    Directory of Open Access Journals (Sweden)

    Anjan Trikha

    2010-01-01

    Full Text Available Obstetric patients admitted to an Intensive Care Unit (ICU present a challenge to an intensivist because of normal physiological changes associated with pregnancy and puerperium, the specific medical diseases peculiar to pregnancy and the need to take care of both the mother and the foetus. Most common causes of admission to an ICU for obstetric patients are eclampsia, severe preeclampsia, haemorrhage, congenital and valvular heart disease, septic abortions, severe anemia, cardiomyopathy and non-obstetric sepsis. The purpose of this review is to present the recent concepts in critical care management of obstetric patients with special focus mainly on ventilatory strategies, treatment of shock and nutrition. The details regarding management of individual diseases would not be discussed as these would be beyond the purview of this article. In addition, some specific issues of importance while managing such patients would also be highlighted.

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

    Science.gov (United States)

    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.

  20. Conceptualizing Social Integration among Formerly Homeless Adults with Severe Mental Illness

    Science.gov (United States)

    Tsai, Jack; Rosenheck, Robert A.

    2012-01-01

    The multiple dimensions of social integration among formerly homeless adults with severe mental illness have not been well-studied. Previous studies have focused on clinical measures or narrow components of social integration. We used a multisite study of chronically homeless adults who were provided housing to (a) identify the main factors…

  1. The Overweight: Obesity and Plasma Lipids in Adults with Intellectual Disability and Mental Illness

    Science.gov (United States)

    Gazizova, D.; Puri, B. K.; Singh, I.; Dhaliwal, R.

    2012-01-01

    Background: Previous studies in adults with intellectual disabilities (ID) have reported a higher prevalence of obesity than in the general population, and a trend to an increase in the prevalence of excess weight. However, little information is available on body weight status and lipids levels of adults with ID and co-existing mental illness. The…

  2. The Prevalence and Incidence of Mental Ill-Health in Adults with Down Syndrome

    Science.gov (United States)

    Mantry, D.; Cooper, S. -A.; Smiley, E.; Morrison, J.; Allan, L.; Williamson, A.; Finlayson, J.; Jackson, A.

    2008-01-01

    Background: While there is considerable literature on adults with Down syndrome who have dementia, there is little published on the epidemiology of other types of mental ill-health in this population. Method: Longitudinal cohort study of adults with Down syndrome who received detailed psychiatric assessment (n = 186 at the first time point; n =…

  3. The Overweight: Obesity and Plasma Lipids in Adults with Intellectual Disability and Mental Illness

    Science.gov (United States)

    Gazizova, D.; Puri, B. K.; Singh, I.; Dhaliwal, R.

    2012-01-01

    Background: Previous studies in adults with intellectual disabilities (ID) have reported a higher prevalence of obesity than in the general population, and a trend to an increase in the prevalence of excess weight. However, little information is available on body weight status and lipids levels of adults with ID and co-existing mental illness. The…

  4. Silence or Sanism: A Review of the Dearth of Discussions on Mental Illness in Adult Education

    Science.gov (United States)

    Procknow, Greg

    2017-01-01

    This literature review engages mental illness in adult education (AE) to locate what research exists and to suggest a research agenda moving forward. This structured review located research related to mental health issues published in the conference proceedings of the Canadian Association for the Study of Adult Education (CASAE) and the Adult…

  5. Initial ventilator settings for critically ill patients.

    Science.gov (United States)

    Kilickaya, Oguz; Gajic, Ognjen

    2013-03-12

    The lung-protective mechanical ventilation strategy has been standard practice for management of acute respiratory distress syndrome (ARDS) for more than a decade. Observational data, small randomized studies and two recent systematic reviews suggest that lung protective ventilation is both safe and potentially beneficial in patients who do not have ARDS at the onset of mechanical ventilation. Principles of lung-protective ventilation include: a) prevention of volutrauma (tidal volume 4 to 8 ml/kg predicted body weight with plateau pressurerespiratory rate 20 to 35 breaths per minute); and d) prevention of hyperoxia (titrate inspired oxygen concentration to peripheral oxygen saturation (SpO2) levels of 88 to 95%). Most patients tolerate lung protective mechanical ventilation well without the need for excessive sedation. Patients with a stiff chest wall may tolerate higher plateau pressure targets (approximately 35 cmH2O) while those with severe ARDS and ventilator asynchrony may require a short-term neuromuscular blockade. Given the difficulty in timely identification of patients with or at risk of ARDS and both the safety and potential benefit in patients without ARDS, lung-protective mechanical ventilation is recommended as an initial approach to mechanical ventilation in both perioperative and critical care settings.

  6. The incretin effect in critically ill patients

    DEFF Research Database (Denmark)

    Nielsen, Signe Tellerup; Janum, Susanne; Krogh-Madsen, Rikke;

    2015-01-01

    with control subjects, proinflammatory cytokines, tumour necrosis factor α and interleukin 6, were higher in patients than in control subjects. The endogenous response of GIP and glucagon, but not GLP-1, to the OGTT was greater in patients. The insulin response to the OGTT did not differ between groups......) followed by an intravenous glucose infusion (IVGI) on the next day to mimic the blood glucose profile from the OGTT. Blood glucose, serum insulin, serum C-peptide and plasma levels of GLP-1, GIP, glucagon and proinflammatory cytokines were measured intermittently. The incretin effect was calculated...

  7. Enteral nutrition with simultaneous gastric decompression in critically ill patients.

    Science.gov (United States)

    Gentilello, L M; Cortes, V; Castro, M; Byers, P M

    1993-03-01

    Early enteral nutrition is an important adjunct in the care of critically ill patients. A double-lumen gastrostomy tube with a duodenal extension has been reported to enable early enteral feeding with simultaneous gastroduodenal decompression. We tested the ability of this device to achieve these goals in critically ill patients. Noncomparative, descriptive case series. Surgical intensive care unit in a university hospital. Fifteen consecutive critically ill patients, who, at the time of laparotomy, were assessed likely to need long-term nutritional support and gastric decompression, underwent tube placement. Mean age was 47 +/- 21 yrs. Mean Acute Physiology and Chronic Health Evaluation (APACHE II) and Therapeutic Intervention Scores were 15 +/- 7.3 (SD) and 29 +/- 10.2, respectively, and the mean Injury Severity Score of 11 trauma patients in the group was 27 +/- 7.4. Correct tube positioning was verified by radiograph or endoscopy. Caloric and protein requirements, nutritional parameters, and problems encountered with the device were recorded. The correlation between the volume of feeding port input and suction port output was noted, and this correlation was considered significant if r2 was > or = .5. Only three (20%) of 15 patients reached full enteral nutritional support via the enteral route. None of these patients achieved this level of nutritional support within the first postoperative week. In 67% of the patients, large quantities of enteral feeding solution appeared in the gastroduodenal suction port effluent. When feeding port input was plotted against effluent volume, a correlation coefficient of > .71 (r2 = > or = .5) was found in 40% of the patients. Other complications included: a) excessive gastroduodenal drainage requiring fluid/electrolyte replacement in eight (53.3%) patients; and b) skin ulceration at the tube entrance site in seven (46.7%) patients. These data do not support the use of this device for early enteral feeding and simultaneous

  8. Preference for place-of-death among terminally ill cancer patients in Denmark

    DEFF Research Database (Denmark)

    Neergaard, Mette Asbjørn; Jensen, Anders Bonde; Sondergaard, Jens

    2011-01-01

    Scand J Caring Sci; 2011 Preference for place-of-death among terminally ill cancer patients in Denmark Achieving home death is often seen as an important endpoint in palliative care, but no studies of the preferred place-of-death have yet been conducted in Scandinavia. Furthermore, we do not know...... if professionals' report on deceased patients' preference of place-of-death is a valid information. The aim of this study was to describe where terminally ill Danish cancer patients prefer to die and to determine if their preference changed during the palliative period, as reported retrospectively by bereaved...... relatives, general practitioners (GPs) and community nurses (CNs) and to assess the agreement of their accounts. The study was a population-based, cross-sectional combined register and questionnaire study in Aarhus County, Denmark. The population comprised 599 deceased adult cancer patients who had died...

  9. Management of parenteral nutrition in critically ill patients.

    Science.gov (United States)

    Cotogni, Paolo

    2017-02-04

    Artificial nutrition (AN) is necessary to meet the nutritional requirements of critically ill patients at nutrition risk because undernutrition determines a poorer prognosis in these patients. There is debate over which route of delivery of AN provides better outcomes and lesser complications. This review describes the management of parenteral nutrition (PN) in critically ill patients. The first aim is to discuss what should be done in order that the PN is safe. The second aim is to dispel "myths" about PN-related complications and show how prevention and monitoring are able to reach the goal of "near zero" PN complications. Finally, in this review is discussed the controversial issue of the route for delivering AN in critically ill patients. The fighting against PN complications should consider: (1) an appropriate blood glucose control; (2) the use of olive oil- and fish oil-based lipid emulsions alternative to soybean oil-based ones; (3) the adoption of insertion and care bundles for central venous access devices; and (4) the implementation of a policy of targeting "near zero" catheter-related bloodstream infections. Adopting all these strategies, the goal of "near zero" PN complications is achievable. If accurately managed, PN can be safely provided for most critically ill patients without expecting a relevant incidence of PN-related complications. Moreover, the use of protocols for the management of nutritional support and the presence of nutrition support teams may decrease PN-related complications. In conclusion, the key messages about the management of PN in critically ill patients are two. First, the dangers of PN-related complications have been exaggerated because complications are uncommon; moreover, infectious complications, as mechanical complications, are more properly catheter-related and not PN-related complications. Second, when enteral nutrition is not feasible or tolerated, PN is as effective and safe as enteral nutrition.

  10. Management of parenteral nutrition in critically ill patients

    Science.gov (United States)

    Cotogni, Paolo

    2017-01-01

    Artificial nutrition (AN) is necessary to meet the nutritional requirements of critically ill patients at nutrition risk because undernutrition determines a poorer prognosis in these patients. There is debate over which route of delivery of AN provides better outcomes and lesser complications. This review describes the management of parenteral nutrition (PN) in critically ill patients. The first aim is to discuss what should be done in order that the PN is safe. The second aim is to dispel “myths” about PN-related complications and show how prevention and monitoring are able to reach the goal of “near zero” PN complications. Finally, in this review is discussed the controversial issue of the route for delivering AN in critically ill patients. The fighting against PN complications should consider: (1) an appropriate blood glucose control; (2) the use of olive oil- and fish oil-based lipid emulsions alternative to soybean oil-based ones; (3) the adoption of insertion and care bundles for central venous access devices; and (4) the implementation of a policy of targeting “near zero” catheter-related bloodstream infections. Adopting all these strategies, the goal of “near zero” PN complications is achievable. If accurately managed, PN can be safely provided for most critically ill patients without expecting a relevant incidence of PN-related complications. Moreover, the use of protocols for the management of nutritional support and the presence of nutrition support teams may decrease PN-related complications. In conclusion, the key messages about the management of PN in critically ill patients are two. First, the dangers of PN-related complications have been exaggerated because complications are uncommon; moreover, infectious complications, as mechanical complications, are more properly catheter-related and not PN-related complications. Second, when enteral nutrition is not feasible or tolerated, PN is as effective and safe as enteral nutrition. PMID

  11. Consent for Dental Therapy in Severely Ill Patients.

    Science.gov (United States)

    Litch, C. Scott; Liggett, Martha L.

    1992-01-01

    Legal standards for informed consent are discussed in the context of dental care for the elderly and severely ill. Variations in state common law and legislation are analyzed, focusing on differences between practitioner-oriented and patient-oriented approaches to informed consent. Implications for educators and practitioners are examined.…

  12. Immune Effects of RBC Storage in Critically Ill Patients

    Science.gov (United States)

    2012-12-01

    serious thrombotic events and nosocomial infections , and ICU and hospital length of stay. Prospective clinical studies investigating the mechanisms...specifically at risk of adverse effects resulting from the use of RBCs of increased storage age. A large multicenter randomized controlled trial in 30...units will affect both inflammation and coagulation factors in critically ill patients and these parameters will be positively associated with

  13. The Additional value of microcirculatory imaging in critically ill patients

    NARCIS (Netherlands)

    E. Klijn (Eva)

    2015-01-01

    markdownabstractAbstract Hemodynamic monitoring is essential in the care of every critically ill patient. One of the main goals of hemodynamic support is to preserve tissue perfusion. It is however known that tissue perfusion is more related to microcirculatory perfusion than systemic hemodynamic p

  14. Transferring the critically ill patient : are we there yet?

    NARCIS (Netherlands)

    Droogh, Joep M.; Smit, Marije; Absalom, Anthony R.; Ligtenberg, Jack J. M.; Zijlstra, Jan G.

    2015-01-01

    During the past few decades the numbers of ICUs and beds has increased significantly, but so too has the demand for intensive care. Currently large, and increasing, numbers of critically ill patients require transfer between critical care units. Inter-unit transfer poses significant risks to critica

  15. Antithrombin III for critically ill patients

    DEFF Research Database (Denmark)

    Allingstrup, Mikkel; Wetterslev, Jørn; Ravn, Frederikke B

    2016-01-01

    PURPOSE: Antithrombin III (AT III) is an anticoagulant with anti-inflammatory properties. We assessed the benefits and harms of AT III in critically ill patients. METHODS: We searched from inception to 27 August 2015 in CENTRAL, MEDLINE, EMBASE, CAB, BIOSIS and CINAHL. We included randomized cont...

  16. Coagulation and complement system in critically ill patients.

    Science.gov (United States)

    Helling, H; Stephan, B; Pindur, G

    2015-01-01

    Activation of coagulation and inflammatory response including the complement system play a major role in the pathogenesis of critical illness. However, only limited data are available addressing the relationship of both pathways and its assessment of a predictive value for the clinical outcome in intense care medicine. Therefore, parameters of the coagulation and complement system were studied in patients with septicaemia and multiple trauma regarded as being exemplary for critical illness. 34 patients (mean age: 51.38 years (±16.57), 15 females, 19 males) were investigated at day 1 of admittance to the intensive care unit (ICU). Leukocytes, complement factors C3a and C5a were significantly (p complement system as part of the inflammatory response is a significant mechanism in septicaemia, whereas loss and consumption of blood components including parts of the coagulation and complement system is more characteristic for multiple trauma. Protein C in case of severe reduction might be of special concern for surviving in sepsis. Activation of haemostasis was occurring in both diseases, however, overt DIC was not confirmed in this study to be a leading mechanism in critically ill patients. MOF score, lactate, C1-inhibitor and prothrombin time have been the only statistically significant predictors for lethal outcome suggesting that organ function, microcirculation, haemostasis and inflammatory response are essential elements of the pathomechanism and clinical course of diseases among critically ill patients.

  17. Inter-hospital transport of critically ill patients; expect surprises

    NARCIS (Netherlands)

    Droogh, Joep M.; Smit, Marije; Hut, Jakob; de Vos, Ronald; Ligtenberg, Jack J. M.; Zijlstra, Jan G.

    2012-01-01

    Introduction: Inter-hospital transport of critically ill patients is increasing. When performed by specialized retrieval teams there are less adverse events compared to transport by ambulance. These transports are performed with technical equipment also used in an Intensive Care Unit (ICU). As a

  18. Computer-assisted glucose control in critically ill patients

    NARCIS (Netherlands)

    Vogelzang, Mathijs; Loef, Bert G.; Regtien, Joost G.; van der Horst, Iwan C. C.; van Assen, Hein; Zijlstra, Felix; Nijsten, Maarten W. N.

    2008-01-01

    Objective: Intensive insulin therapy is associated with the risk of hypoglycemia and increased costs of material and personnel. We therefore evaluated the safety and efficiency of a computer-assisted glucose control protocol in a large population of critically ill patients. Design and setting: Obser

  19. Hyperglycaemia in critically ill patients : marker or mediator of mortality?

    NARCIS (Netherlands)

    Corstjens, Anouk M.; van der Horst, Iwan C. C.; Groeneveld, A. B. Johan; Zijlstra, Felix; Tulleken, Jaap E.; Ligtenberg, Jack J. M.; Zijlstra, Jan

    2006-01-01

    Acute hyperglycaemia has been associated with complications, prolonged intensive care unit and hospital stay, and increased mortality. We made an inventory of the prevalence and prognostic value of hyperglycaemia, and of the effects of glucose control in different groups of critically ill patients.

  20. Reducing Psychotropic Polypharmacy in patients with severe mental illness

    DEFF Research Database (Denmark)

    Hjorth, P; Davidsen, Annette Sofie; Killian, R.;

    2015-01-01

    BACKGROUND: Many patients with mental illness receive psychotropic medicine in high dosages and from more than one drug. One of the consequences of this practice is obesity, which is a contributing factor to increased physical morbidity and premature death. METHODS: Our study was a cluster...

  1. Transferring the critically ill patient : are we there yet?

    NARCIS (Netherlands)

    Droogh, Joep M.; Smit, Marije; Absalom, Anthony R.; Ligtenberg, Jack J. M.; Zijlstra, Jan G.

    2015-01-01

    During the past few decades the numbers of ICUs and beds has increased significantly, but so too has the demand for intensive care. Currently large, and increasing, numbers of critically ill patients require transfer between critical care units. Inter-unit transfer poses significant risks to

  2. Human factors in the management of the critically ill patient.

    Science.gov (United States)

    Bion, J F; Abrusci, T; Hibbert, P

    2010-07-01

    Unreliable delivery of best practice care is a major component of medical error. Critically ill patients are particularly susceptible to error and unreliable care. Human factors analysis, widely used in industry, provides insights into how interactions between organizations, tasks, and the individual worker impact on human behaviour and affect systems reliability. We adopt a human factors approach to examine determinants of clinical reliability in the management of critically ill patients. We conducted a narrative review based on a Medline search (1950-March 2010) combining intensive/critical care (units) with medical errors, patient safety, or delivery of healthcare; keyword and Internet search 'human factors' or 'ergonomics'. Critical illness represents a high-risk, complex system spanning speciality and geographical boundaries. Substantial opportunities exist for improving the safety and reliability of care of critically ill patients at the level of the task, the individual healthcare provider, and the organization or system. Task standardization (best practice guidelines) and simplification (bundling or checklists) should be implemented where scientific evidence is strong, or adopted subject to further research ('dynamic standardization'). Technical interventions should be embedded in everyday practice by the adjunctive use of non-technical (behavioural) interventions. These include executive 'adoption' of clinical areas, systematic methods for identifying hazards and reflective learning from error, and a range of techniques for improving teamworking and communication. Human factors analysis provides a useful framework for understanding and rectifying the causes of error and unreliability, particularly in complex systems such as critical care.

  3. Psychiatric morbidity among physically ill patients in a Ugandan ...

    African Journals Online (AJOL)

    EB

    Methods: This was a cross sectional descriptive study. Psychiatric ... of all the psychiatrically diagnosed patients were recognized by their treating doctors as having mental illness. ... Previous studies conducted at Mulago national ... this relationship. ... parent wards. .... major depression, one had anxiety disorder, and two.

  4. Sleep disturbances in critically ill patients in ICU

    DEFF Research Database (Denmark)

    Boyko, Yuliya; Ording, H; Jennum, P

    2012-01-01

    Sleep disturbances in the intensive care unit (ICU) seem to lead to development of delirium, prolonged ICU stay, and increased mortality. That is why sufficient sleep is important for good outcome and recovery in critically ill patients. A variety of small studies reveal pathological sleep patterns...

  5. Computer-assisted glucose control in critically ill patients

    NARCIS (Netherlands)

    Vogelzang, Mathijs; Loef, Bert G.; Regtien, Joost G.; van der Horst, Iwan C. C.; van Assen, Hein; Zijlstra, Felix; Nijsten, Maarten W. N.

    Objective: Intensive insulin therapy is associated with the risk of hypoglycemia and increased costs of material and personnel. We therefore evaluated the safety and efficiency of a computer-assisted glucose control protocol in a large population of critically ill patients. Design and setting:

  6. Predictors of reintubation in critically ill patients.

    Science.gov (United States)

    Miu, Timothy; Joffe, Aaron M; Yanez, N David; Khandelwal, Nita; Dagal, Armagan Hc; Deem, Steven; Treggiari, Miriam M

    2014-02-01

    Assessment of a patient's readiness for removal of the endotracheal tube in the ICU is based on respiratory, airway, and neurological measures. However, nearly 20% of patients require reintubation. We created a prediction model for the need for reintubation, which incorporates variables importantly contributing to extubation failure. This was a cohort study of 2,007 endotracheally intubated subjects who required ICU admission at a tertiary care center. Data collection included demographic, hemodynamic, respiratory, and neurological variables preceding extubation. Data were compared between subjects extubated successfully and those who required reintubation, using bivariate logistic regression models, with the binary outcome reintubation and the baseline characteristics as predictors. Multivariable logistic regression analysis with robust variance was used to build the prediction model. Of the 2,007 subjects analyzed, 376 (19%) required reintubation. In the bivariate analysis, admission Simplified Acute Physiology Score II, minute ventilation, breathing frequency, oxygenation, number of prior SBTs, rapid shallow breathing index, airway-secretions suctioning frequency and quantity, heart rate, and diastolic blood pressure differed significantly between the extubation success and failure groups. In the multivariable analysis, higher Simplified Acute Physiology Score II and suctioning frequency were associated with failed extubation. The area under the receiver operating characteristic curve was 0.68 for failure at any time, and 0.71 for failure within 24 hours. However, prior failed SBT, minute ventilation, and diastolic blood pressure were additional independent predictors of failure at any time, whereas oxygenation predicted extubation failure within 24 hours. A small number of independent variables explains a substantial portion of the variability of extubation failure, and can help identify patients at high risk of needing reintubation. These characteristics

  7. Feasibility and safety of virtual-reality-based early neurocognitive stimulation in critically ill patients.

    Science.gov (United States)

    Turon, Marc; Fernandez-Gonzalo, Sol; Jodar, Mercè; Gomà, Gemma; Montanya, Jaume; Hernando, David; Bailón, Raquel; de Haro, Candelaria; Gomez-Simon, Victor; Lopez-Aguilar, Josefina; Magrans, Rudys; Martinez-Perez, Melcior; Oliva, Joan Carles; Blanch, Lluís

    2017-12-01

    Growing evidence suggests that critical illness often results in significant long-term neurocognitive impairments in one-third of survivors. Although these neurocognitive impairments are long-lasting and devastating for survivors, rehabilitation rarely occurs during or after critical illness. Our aim is to describe an early neurocognitive stimulation intervention based on virtual reality for patients who are critically ill and to present the results of a proof-of-concept study testing the feasibility, safety, and suitability of this intervention. Twenty critically ill adult patients undergoing or having undergone mechanical ventilation for ≥24 h received daily 20-min neurocognitive stimulation sessions when awake and alert during their ICU stay. The difficulty of the exercises included in the sessions progressively increased over successive sessions. Physiological data were recorded before, during, and after each session. Safety was assessed through heart rate, peripheral oxygen saturation, and respiratory rate. Heart rate variability analysis, an indirect measure of autonomic activity sensitive to cognitive demands, was used to assess the efficacy of the exercises in stimulating attention and working memory. Patients successfully completed the sessions on most days. No sessions were stopped early for safety concerns, and no adverse events occurred. Heart rate variability analysis showed that the exercises stimulated attention and working memory. Critically ill patients considered the sessions enjoyable and relaxing without being overly fatiguing. The results in this proof-of-concept study suggest that a virtual-reality-based neurocognitive intervention is feasible, safe, and tolerable, stimulating cognitive functions and satisfying critically ill patients. Future studies will evaluate the impact of interventions on neurocognitive outcomes. Trial registration Clinical trials.gov identifier: NCT02078206.

  8. Acculturation, Health Literacy, and Illness Perceptions of Hypertension among Hispanic Adults.

    Science.gov (United States)

    Perez, Amelia

    2015-09-01

    Hypertension treatment rates are disproportionately lower among Hispanics compared to non-Hispanic Whites and non-Hispanic Blacks. The purpose of this study was to examine the relationship among acculturation, health literacy, and illness perceptions of hypertension among Hispanics. A cross-sectional correlational design was used, including 144 Hispanic adults with a self-reported diagnosis of hypertension. The instruments used included the Short Acculturation Scale for Hispanics, the Newest Vital Sign instrument to measure health literacy, and the Brief Illness Perception Questionnaire. Significant relationships were found among acculturation, health literacy, and several illness perceptions (consequences, control, symptoms, and emotions). Acculturation and health literacy play an important role in illness perceptions of hypertension among Hispanics. Findings could be helpful in the development of tailored health promotion interventions to improve hypertension management among Hispanic adults. © The Author(s) 2014.

  9. WITHDRAWN: Interventions for fatigue and weight loss in adults with advanced progressive illness.

    Science.gov (United States)

    Payne, Cathy; Wiffen, Philip J; Martin, Suzanne

    2017-04-07

    Fatigue and unintentional weight loss are two of the commonest symptoms experienced by people with advanced progressive illness. Appropriate interventions may bring considerable improvements in function and quality of life to seriously ill people and their families, reducing physical, psychological and spiritual distress. To conduct an overview of the evidence available on the efficacy of interventions used in the management of fatigue and/or unintentional weight loss in adults with advanced progressive illness by reviewing the evidence contained within Cochrane reviews. We searched the Cochrane Database of Systematic Reviews (CDSR) for all systematic reviews evaluating any interventions for the management of fatigue and/or unintentional weight loss in adults with advanced progressive illness (The Cochrane Library 2010, Issue 8). We reviewed titles of interest by abstract. Where the relevance of a review remained unclear we reached a consensus regarding the relevance of the participant group and the outcome measures to the overview. Two overview authors extracted the data independently using a data extraction form. We used the measurement tool AMSTAR (Assessment of Multiple SysTemAtic Reviews) to assess the methodological quality of each systematic review. We included 27 systematic reviews (302 studies with 31,833 participants) in the overview. None of the included systematic reviews reported quantitative data on the efficacy of interventions to manage fatigue or weight loss specific to people with advanced progressive illness. All of the included reviews apart from one were deemed of high methodological quality. For the remaining review we were unable to ascertain the methodological quality of the research strategy as it was described. None of the systematic reviews adequately described whether conflict of interests were present within the included studies. Management of fatigueAmyotrophic lateral sclerosis/motor neuron disease (ALS/MND) - we identified one

  10. [Meaning and spirituality in patients with chronic somatic illness].

    Science.gov (United States)

    Mehnert, A

    2006-08-01

    Issues of the meaning of life and spirituality are particularly important subjects given the threat of a serious illness and the confrontation with the finiteness of one's own life. Thus, addressing questions of meaning and spiritual domains of supportive care has been identified as essential by patients as well as by health care professionals. In recent years more research has focussed on theoretical conceptualization, empirical examination as well as on the development of meaning-centred interventions in somatically ill patients. Theoretical models for the understanding, development and adaptation of concepts and interventions addressing meaning and spirituality in the chronically ill are offered by the philosophical tradition of existentialism, logotherapy as well as by cognitive and developmental psychology, in particular studies on autobiographical memory and life story. However, the current state of empirical research focussing on the association between meaning, spirituality and physical as well as mental health and underlying mechanisms is not sufficient to draw reliable conclusions. With regard to psychosocial care, meaning-centred interventions have been developed in recent years primarily within the context of palliative care. These interventions are intended to support patients to find meaning in life in the face of a serious illness and to experience their life as fulfilled.

  11. Comparing neighborhoods of adults with serious mental illness and of the general population: research implications.

    Science.gov (United States)

    Byrne, Thomas; Prvu Bettger, Janet; Brusilovskiy, Eugene; Wong, Yin-Ling Irene; Metraux, Stephen; Salzer, Mark S

    2013-08-01

    The International Classification of Functioning, Disability and Health emphasizes the importance of assessing the impact of environmental factors on functioning and disability. Drawing on this emphasis, this study used a set of objective measures to compare the characteristics of neighborhoods of adults with serious mental illness and of the general population. It also examined the relationship between neighborhood characteristics and neighborhood concentration of persons with serious mental illness. The sample comprised 15,246 adults who were treated for serious mental illness in Philadelphia between 1997 and 2000. Principal-components analysis of 22 neighborhood characteristics resulted in an ideal-factor solution of six components. The mean values of each component in neighborhoods of persons with serious mental illness were compared with values in an equally sized group of neighborhoods created by randomly generated addresses representative of the city's general population. Ordinary least-squares regression was used to assess the association between neighborhood characteristics and neighborhood concentration of persons with serious mental illness. Neighborhoods in which adults with serious mental illness resided had higher levels of physical and structural inadequacy, drug-related activity, and crime than comparison neighborhoods. Higher levels of physical and structural inadequacy, crime, drug-related activity, social instability, and social isolation were associated with higher concentration of persons with serious mental illness in the neighborhood's adult population. The differences in neighborhood characteristics identified in this study point to factors that merit closer attention as potential barriers or facilitators in the functioning, participation, and community integration of persons with serious mental illness.

  12. Illness perceptions of adults with congenital heart disease and their predictive value for quality of life two years later.

    Science.gov (United States)

    Schoormans, Dounya; Mulder, Barbara J M; van Melle, Joost P; Pieper, Petronella G; van Dijk, Arie P J; Sieswerda, Gertjan Tj; Hulsbergen-Zwarts, Mariët S; Plokker, Thijs H W M; Brunninkhuis, Leo G H; Vliegen, Hubert W; Sprangers, Mirjam A G

    2014-02-01

    To improve patients' quality of life (QoL) we need to identify modifiable determinants, such as illness perceptions. Patients' illness perceptions are known to regulate emotional responses and health-behaviour. Illness perceptions comprise several components: consequences, control, coherence, changeability and emotional representations. To examine (a) the relation between patient characteristics and illness perceptions, and (b) the independent predictive value of illness perceptions for future QoL. A longitudinal study in 845 patients with congenital heart disease was conducted. Patients completed three questionnaires: the IPQ-R (illness perceptions) and two years later the SF-36 and TAAQOL-CHD (QoL). Linear regression analyses were performed relating illness perceptions to patient characteristics (sex, age, disease complexity and functional status) and QoL. Patients with a complex defect or poor functional status reported poor illness perceptions. Independent of patient characteristics, poor illness perceptions (i.e. a strong belief that the illness has severe consequences; a weak belief that you have a coherent illness understanding and that the illness can be controlled by treatment; and a strong belief that the illness is changeable and causes negative emotions) were predictive of future QoL. Illness perceptions independently predict QoL, suggesting that QoL may be improved by altering patients' beliefs about their illness. For example, increasing patients' knowledge regarding their disease and informing them about treatment opportunities may enhance their QoL.

  13. Optimizing nutrition therapy to enhance mobility in critically ill patients.

    Science.gov (United States)

    Cherry-Bukowiec, Jill R

    2013-01-01

    Critically ill patients are at high risk of malnutrition and lean body mass loss. Screening for malnutrition and performing detailed assessment of energy needs should be routine for patients admitted to intensive care units. Providing adequate calorie and protein provisions can attenuate muscle loss in many at-risk patients. Enteral nutrition is associated with decreased risks of morbidity and infections and is therefore preferred to parenteral nutrition in hemodynamically stable patients with favorable anatomy. Judicious use of steroids and paralytics in combination with adequate glucose control may decrease the risk of developing critical illness polyneuromyopathy. There is growing evidence for the potential immune-enhancing benefits of many micronutrients and vitamins in the critically ill, but more research is needed to determine which nutrients are most effective in which disease processes and what dosing regimens are safe and effective. Elderly, obese, and very young patients pose unique challenges for nutrition therapy and early mobility programs. Pairing early mobility programs with optimal nutrition therapy can help reduce morbidity, limit muscle loss, and speed recovery in intensive care unit patients.

  14. Perception and beliefs about mental illness among adults in Karfi village, northern Nigeria

    Directory of Open Access Journals (Sweden)

    Kabir Mohammed

    2004-08-01

    Full Text Available Abstract Background This study was designed to examine the knowledge, attitude and beliefs about causes, manifestations and treatment of mental illness among adults in a rural community in northern Nigeria. Methods A cross sectional study design was used. A pre-tested, semi-structured questionnaire was administered to 250 adults residing in Karfi village, northern Nigeria. Results The most common symptoms proffered by respondents as manifestations of mental illness included aggression/destructiveness (22.0%, loquaciousness (21.2%, eccentric behavior (16.1% and wandering (13.3%. Drug misuse including alcohol, cannabis, and other street drugs was identified in 34.3% of the responses as a major cause of mental illness, followed by divine wrath/ God's will (19%, and magic/spirit possession (18.0%. About 46% of respondents preferred orthodox medical care for the mentally sick while 34% were more inclined to spiritual healing. Almost half of the respondents harbored negative feelings towards the mentally ill. Literate respondents were seven times more likely to exhibit positive feelings towards the mentally ill as compared to non-literate subjects (OR = 7.6, 95% confidence interval = 3.8–15.1. Conclusions Our study demonstrates the need for community educational programs in Nigeria aimed at demystifying mental illness. A better understanding of mental disorders among the public would allay fear and mistrust about mentally ill persons in the community as well as lessen stigmatization towards such persons.

  15. Illness trajectories and their relevance to the care of adults with kidney disease.

    Science.gov (United States)

    Schell, Jane O; O'Hare, Ann M

    2013-05-01

    Existing practice guidelines for chronic kidney disease advocate a stage-based approach to management, in which treatment recommendations are based largely on the severity of kidney disease, and future risk for adverse health outcomes. However, the course of kidney disease can vary widely among patients with similar levels of kidney function, and each patient will experience their illness in unique ways. We summarize recent studies of patterns of kidney function over time among patients with chronic kidney disease, and discuss these findings in the context of relevant conceptual models of illness and communication. Although knowledge of disease severity can provide useful information on life expectancy and risk for future health events, an understanding of each patient's illness trajectory and their unique experience of illness is essential in supporting patient-centered care for patients with kidney disease. This information can be helpful in setting realistic expectations for the future, in communicating about prognosis and in aligning treatment decisions with each patient's goals and preferences. We here explain how an understanding of illness trajectories may be useful in predicting and guiding care and decision-making in patients with kidney disease. We highlight the importance of competing disease trajectories, the heterogeneity in renal function trajectories among patients with kidney disease, and the variability in these trajectories over time in individual patients. We discuss how individual disease trajectories can shape each patient's experience of illness. Finally, we explain how an understanding of an individual patient's illness trajectory and experience of illness may be useful in guiding discussions about prognosis and treatment decisions and in supporting a patient-centered approach to care.

  16. An exploratory study of the personal health records adoption model in the older adult with chronic illness

    Directory of Open Access Journals (Sweden)

    Melanie D Logue

    2013-05-01

    Full Text Available Background Despite international efforts moving toward integrated care using health information technologies and the potential of electronic PHRs to help us better coordinate patient-centered care, PHR adoption in the United States remains low among patients who have been offered free access to them from private-sector companies. If older adult stand to benefit from the use of PHRs for its usefulness in self-managing chronic illness, why have they not been more readily adopted? Since the chronically ill older adult has unique circumstances that impact their decision to participate in self-directed care, a theoretical framework to help understand factors that influence the adoption of PHRs is important. Here we describe the results of an exploratory study that provided an initial test of such a framework.Methods The study used a descriptive survey methodology with 38 older adults. The survey questionnaire asked about the personal barriers and facilitators associated with personal health record adoption and included items measuring each of the PHRAM’s four interacting factors (environmental factors, personal factors, technology factors, and self-management, and the resulting behavioural outcome.Results Younger seniors had a more positive attitude toward computers, knew what health resources were available on the internet, agreed that they had the resources in place to use PHRs, and would be more influenced by a family member than a healthcare provider to use them. Conversely, older seniors reported less confidence in their ability to use Internet-based PHRs and did not perceive that they had the resources in place to use them.Conclusions The results of this study indicated that personal, environmental, technology, chronic illness, and behavioral factors operated concurrently as personal barriers and/or facilitators to the adoption of PHRs among the older adult with chronic illness. These factors cannot be isolated because the person commonly

  17. The illness trajectory experienced by patients having spine fusion surgery

    DEFF Research Database (Denmark)

    Damsgaard, Janne Brammer; Bastrup, Lene; Norlyk, Annelise

    system and healthcare professionals are often dismissed as irrelevant. It is also evident that spine fusion patients are denied the opportunity to verbalise what it feels like to, for example, be ”a person in constant pain” or someone who ”holds back” to avoid being an inconvenience. These feelings......The illness trajectory of spine fusion patients. A feeling of being (in)visible Background Research shows that being a back patient is associated with great personal cost, and that back patients who undergo so-called spine fusion often experience particularly long and uncoordinated trajectories...

  18. How music-inspired weeping can help terminally ill patients.

    Science.gov (United States)

    Norton, Kay

    2011-09-01

    Music's power to improve the 'human condition' has been acknowledged since ancient times. Something as counter-intuitive as weeping in response to music can ameliorate suffering for a time even for terminally ill patients. Several benefits-including catharsis, communication, and experiencing vitality-can be associated with grieving in response to "sad" music. In addressing the potential rewards of such an activity for terminally ill patients, this author combines concepts from philosopher Jerrold R. Levinson's article, entitled "Music and Negative Emotion," an illustration from a major motion picture, and supporting research from medical reports and aesthetic writings. Carefully offering this experience is recommended for patients who retain the capacity to express preference.

  19. [Evaluation and treatment of the critically ill cirrhotic patient].

    Science.gov (United States)

    Fernández, Javier; Aracil, Carles; Solà, Elsa; Soriano, Germán; Cinta Cardona, Maria; Coll, Susanna; Genescà, Joan; Hombrados, Manoli; Morillas, Rosa; Martín-Llahí, Marta; Pardo, Albert; Sánchez, Jordi; Vargas, Victor; Xiol, Xavier; Ginès, Pere

    2016-11-01

    Cirrhotic patients often develop severe complications requiring ICU admission. Grade III-IV hepatic encephalopathy, septic shock, acute-on-chronic liver failure and variceal bleeding are clinical decompensations that need a specific therapeutic approach in cirrhosis. The increased effectiveness of the treatments currently used in this setting and the spread of liver transplantation programs have substantially improved the prognosis of critically ill cirrhotic patients, which has facilitated their admission to critical care units. However, gastroenterologists and intensivists have limited knowledge of the pathogenesis, diagnosis and treatment of these complications and of the prognostic evaluation of critically ill cirrhotic patients. Cirrhotic patients present alterations in systemic and splanchnic hemodynamics, coagulation and immune dysfunction what further increase the complexity of the treatment, the risk of developing new complications and mortality in comparison with the general population. These differential characteristics have important diagnostic and therapeutic implications that must be known by general intensivists. In this context, the Catalan Society of Gastroenterology and Hepatology requested a group of experts to draft a position paper on the assessment and treatment of critically ill cirrhotic patients. This article describes the recommendations agreed upon at the consensus meetings and their main conclusions. Copyright © 2015 Elsevier España, S.L.U. y AEEH y AEG. All rights reserved.

  20. Physical and mental illness burden: disability days among working adults.

    Science.gov (United States)

    Anesetti-Rothermel, Andrew; Sambamoorthi, Usha

    2011-10-01

    This study examines the association between physical and mental health conditions and disability days among a nationally representative working population, after controlling for basic sociodemographic variables, moderating variables, and comorbidities. Cross-sectional data from the Medical Expenditure Panel Survey (MEPS) for 2007 was used. T tests and linear regressions were used to examine differences in disability days by comorbidities. The average number of disability days by condition ranged from 4 days for impulse control disorders to a maximum of 18 days for stroke. Comorbidities explain all of the disability days for allergies. The contribution of comorbidities to disability days varied from 0% for stroke and 14% for cancer to 72% for diabetes and 77% for asthma. Among those with mental illnesses, comorbidities contributed 64% of the disability days for anxiety and only 18% for depression. The associations between comorbidities and disability days varied by type of physical and mental condition. Except for stroke, cancer, and depression, illness burden was exacerbated by comorbidities. Treatment strategies and plans must focus on comanagement of chronic conditions to reduce disability days.

  1. Candida colonization and subsequent infections in critically ill surgical patients.

    Science.gov (United States)

    Pittet, D; Monod, M; Suter, P M; Frenk, E; Auckenthaler, R

    1994-01-01

    OBJECTIVE. The authors determined the role of Candida colonization in the development of subsequent infection in critically ill patients. DESIGN. A 6-month prospective cohort study was given to patients admitted to the surgical and neonatal intensive care units in a 1600-bed university medical center. METHODS. Patients having predetermined criteria for significant Candida colonization revealed by routine microbiologic surveillance cultures at different body sites were eligible for the study. Risk factors for Candida infection were recorded. A Candida colonization index was determined daily as the ratio of the number of distinct body sites (dbs) colonized with identical strains over the total number of dbs tested; a mean of 5.3 dbs per patient was obtained. All isolates (n = 322) sequentially recovered were characterized by genotyping using contour-clamped homogeneous electrical field gel electrophoresis that allowed strain delineation among Candida species. RESULTS. Twenty-nine patients met the criteria for inclusion; all were at high risk for Candida infection; 11 patients (38%) developed severe infections (8 candidemia); the remaining 18 patients were heavily colonized, but never required intravenous antifungal therapy. Among the potential risk factors for candida infection, three discriminated the colonized from the infected patients--i.e., length of previous antibiotic therapy (p < 0.02), severity of illness assessed by APACHE II score (p < 0.01), and the intensity of Candida spp colonization (p < 0.01). By logistic regression analysis, the latter two who were the independent factors that predicted subsequent candidal infection. Candida colonization always preceded infection with genotypically identical Candida spp strain. The proposed colonization indexes reached threshold values a mean of 6 days before Candida infection and demonstrated high positive predictive values (66 to 100%). CONCLUSIONS. The intensity of Candida colonization assessed by systematic

  2. Young adult outcomes of children growing up with chronic illness: an analysis of the National Longitudinal Study of Adolescent Health.

    Science.gov (United States)

    Maslow, Gary R; Haydon, Abigail A; Ford, Carol Ann; Halpern, Carolyn Tucker

    2011-03-01

    To examine young adult outcomes in a nationally representative US cohort of young adults growing up with a chronic illness. Secondary analysis of nationally representative data from wave III (in 2001) of the National Longitudinal Study of Adolescent Health. United States. The analytic sample comprised 13 236 young adults aged 18 to 28 years at wave III. Self-report of a chronic physical illness (asthma, cancer, diabetes mellitus, or epilepsy) in adolescence. Respondents with asthma or nonasthmatic chronic illness (cancer, diabetes mellitus, or epilepsy) were compared with individuals without these conditions. Self-report of high school graduation, ever having employment, currently having employment, living with a parent/guardian, and ever receiving public assistance. Three percent of young adults had nonasthmatic chronic illness (cancer, diabetes, or epilepsy), and 16.0% had asthma. Most young adults with chronic illness graduated high school (81.3%) and currently had employment (60.4%). However, compared with healthy young adults, those with nonasthmatic chronic illness were significantly less likely to graduate high school, ever have had employment, or currently have employment and were more likely to receive public assistance. Compared with young adults with asthma, those with nonasthmatic chronic illness again had significantly worse young adult outcomes on all measures. Most young adults growing up with a chronic illness graduate high school and have employment. However, these young adults are significantly less likely than their healthy peers to achieve these important educational and vocational milestones.

  3. Experiences of critically ill patients in the ICU.

    Science.gov (United States)

    Hofhuis, José G M; Spronk, Peter E; van Stel, Henk F; Schrijvers, Augustinus J P; Rommes, Johannes H; Bakker, Jan

    2008-10-01

    Experiences of critically ill patients are an important aspect of the quality of care in the intensive care (ICU). The aims of the study were firstly, to evaluate the perceptions of patients regarding nursing care in the ICU, and secondly, to explore patients' perceptions and experiences of ICU stay. A qualitative approach using a semi-structured focused interview in 11 patients was used (phase 1), followed by a quantitative approach using a self-reported questionnaire in 100 patients, 62 were returned and 50 could be evaluated (phase 2). A number of themes emerged from the interviews (phase 1), although support dominated as an important key theme. This was experienced as a continuum from the feeling being supported by the nurse to not being supported. This key theme was central to each of the three categories emerging from the data pertaining to: (1) providing the seriously ill patient with information and explanation, (2) placing the patient in a central position and (3) personal approach by the nurse. The responders to the subsequent questionnaire (phase 2) predominantly experienced sleeping disorders (48%), mostly related to the presence of noise (54%). Psychological problems after ICU stay were reported by 11% of the patients, i.e. fear, inability to concentrate, complaints of depression and hallucinations. Although the nurses' expertise and technical skills are considered important, caring behaviour, relieving the patient of fear and worries were experienced as most valuable in bedside critical care.

  4. Decision-making capacity in elderly, terminally ill patients with cancer.

    Science.gov (United States)

    Sorger, Brooke Myers; Rosenfeld, Barry; Pessin, Hayley; Timm, Anne Kosinski; Cimino, James

    2007-01-01

    Despite the importance and complexity of evaluating decision-making capacity at the end of life, little research has focused on terminally ill patients' decision-making ability. The purpose of this study was to explore the decision-making capacity of elderly, terminally ill patients and the psychological and physical factors that affect decision making. Decision-making capacity and cognitive abilities were assessed using four measures: the Hopkins Competency Assessment Kit, the Bechara Gambling Task, the Concept Assessment Kit, and the Mini Mental Status Exam. In addition, symptoms of depression, level of physical functioning, and extent of physical symptoms were evaluated in order to identify correlates of decision-making ability. Two samples were compared: elderly, terminally ill patients with cancer (n = 43) and elderly, physically healthy adults living in supportive community residence (n = 35). Results revealed significantly poorer decision-making abilities among the terminal ill sample compared with healthy comparisons, but no association between demographic variables (e.g., age, race, or education) or clinical variables (depression or physical symptoms) and decision making. Implications for evaluating decision-making capacity are addressed.

  5. Complete mental health in adult siblings of those with a chronic illness or disability.

    Science.gov (United States)

    Hallion, Madeleine; Taylor, Amanda; Roberts, Rachel

    2016-11-16

    Sibling relationships have lifelong significance and childhood chronic illness and disability can have considerable impacts on healthy siblings, influencing development into adulthood. Research has not yet assessed well-being in this population using measures of both mental health and mental illness. Thus, this study assessed well-being in a comprehensive manner using the complete mental health (CMH) model. Participants (N = 144) included both adult siblings of those with chronic illness or disability and adults with healthy siblings. Measures of positive social, psychological and emotional well-being were used to assess mental health and a measure of depression, anxiety, and stress was used to assess mental illness. A high proportion of participants, both with and without siblings with a chronic illness or disability, were experiencing symptoms of mental illness, accompanied by high wellbeing. This indicates that many participants fit into the struggling category of the CMH model. The present research highlights the need for early intervention services to ensure that siblings of those with a chronic illness or disability are well supported in developing strengths, as well as managing difficulties. Results also indicate that targeting students in mental health promotion is important to encourage participation in services. Implications for rehabilitation Siblings of those with a chronic illness or disability need to be included in assessments in order to understand the experience of the family unit. It is important for families and clinicians to be aware of the needs of healthy siblings and encourage them to interact with support services in order to maximise and maintain well-being. Skills-based support could be beneficial, particularly for providing caregivers with strategies to meet the needs of both their child with a chronic illness or disability and their healthy children.

  6. Impact of early elective tracheotomy in critically ill patients

    Directory of Open Access Journals (Sweden)

    Isabel Araújo Marques Correia

    2014-10-01

    Full Text Available INTRODUCTION: Tracheotomy is one of the most frequent surgical procedures performed in critically ill patients hospitalized at intensive care units. The ideal timing for a tracheotomy is still controversial, despite decades of experience. OBJECTIVE: To determine the impact of performing early tracheotomies in critically ill patients on duration of mechanical ventilation, intensive care unit stay, overall hospital stay, morbidity, and mortality. METHODS: Retrospective and observational study of cases subjected to elective tracheotomy at one of the intensive care units of this hospital during five consecutive years. The patients were stratified into two groups: early tracheotomy group (tracheotomy performed from day one up to and including day seven of mechanical ventilation and late tracheotomy group (tracheotomy performed after day seven. The outcomes of the groups were compared. RESULTS: In the early tracheotomy group, there was a statistically significant reduction in duration of mechanical ventilation (6 days vs. 19 days; p < 0.001, duration of intensive care unit stay (10 days vs. 28 days; p = 0.001, and incidence of ventilator-associated pneumonia (1 case vs. 44 cases; p = 0.001. CONCLUSION: Early tracheotomy has a significant positive impact on critically ill patients hospitalized at this intensive care unit. These results support the tendency to balance the risk-benefit analysis in favor of early tracheotomy.

  7. [Impact of early elective tracheotomy in critically ill patients].

    Science.gov (United States)

    Correia, Isabel Araújo Marques; Sousa, Vítor; Pinto, Luis Marques; Barros, Ezequiel

    2014-01-01

    Tracheotomy is one of the most frequent surgical procedures performed in critically ill patients hospitalized at intensive care units. The ideal timing for a tracheotomy is still controversial, despite decades of experience. To determine the impact of performing early tracheotomies in critically ill patients on duration of mechanical ventilation, intensive care unit stay, overall hospital stay, morbidity, and mortality. Retrospective and observational study of cases subjected to elective tracheotomy at one of the intensive care units of this hospital during five consecutive years. The patients were stratified into two groups: early tracheotomy group (tracheotomy performed from day one up to and including day seven of mechanical ventilation) and late tracheotomy group (tracheotomy performed after day seven). The outcomes of the groups were compared. In the early tracheotomy group, there was a statistically significant reduction in duration of mechanical ventilation (6 days vs. 19 days; p<0.001), duration of intensive care unit stay (10 days vs. 28 days; p=0.001), and incidence of ventilator-associated pneumonia (1 case vs. 44 cases; p=0.001). Early tracheotomy has a significant positive impact on critically ill patients hospitalized at this intensive care unit. These results support the tendency to balance the risk-benefit analysis in favor of early tracheotomy. Copyright © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  8. Patients' and partners' perspectives of chronic illness and its management.

    Science.gov (United States)

    Checton, Maria G; Greene, Kathryn; Magsamen-Conrad, Kate; Venetis, Maria K

    2012-06-01

    are significant differences in (a) how patients and partners experience illness uncertainty and illness interference and (b) how appraisals of illness uncertainty and illness interference influence communication efficacy and health condition management. We discuss the findings and implications of the study.

  9. Echocardiographic Assessment of Preload Responsiveness in Critically Ill Patients

    Directory of Open Access Journals (Sweden)

    Alexander Levitov

    2012-01-01

    Full Text Available Fluid challenges are considered the cornerstone of resuscitation in critically ill patients. However, clinical studies have demonstrated that only about 50% of hemodynamically unstable patients are volume responsive. Furthermore, increasing evidence suggests that excess fluid resuscitation is associated with increased mortality. It therefore becomes vital to assess a patient's fluid responsiveness prior to embarking on fluid loading. Static pressure (CVP, PAOP and echocardiographic (IVC diameter, LVEDA parameters fails to predict volume responsiveness. However, a number of dynamic echocardiographic parameters which are based on changes in vena-caval dimensions or cardiac function induce by positive pressure ventilation or passive leg raising appear to be highly predictive of volume responsiveness.

  10. Practicing shared decision making in the outpatient psychiatric care of adults with severe mental illnesses: redesigning care for the future.

    Science.gov (United States)

    Torrey, William C; Drake, Robert E

    2010-10-01

    Psychiatrist outpatient office visits have the potential to support the recovery of adults with severe mental illnesses by engaging them in a collaborative process of evaluating, selecting, and trying individually-tailored therapeutic options. Evidence-informed shared decision making is difficult for psychiatrists to offer within the framework of care as it is delivered today: it requires time, easy access to relevant scientific information, and extensive communication between patients and psychiatrists. In this paper, we describe the current structural obstacles to collaborative psychiatric care and envision a redesigned office visit process that facilitates active informed patient involvement.

  11. HIV testing among adults with mental illness in the United States.

    Science.gov (United States)

    Yehia, Baligh R; Cui, Wanjun; Thompson, William W; Zack, Matthew M; McKnight-Eily, Lela; DiNenno, Elizabeth; Rose, Charles E; Blank, Michael B

    2014-12-01

    Nationally representative data from the 2007 National Health Interview Survey (NHIS) were used to compare HIV testing prevalence among US adults with mental illness (schizophrenia spectrum disorder, bipolar disorder, depression, and/or anxiety) to those without, providing an update of prior work using 1999 and 2002 NHIS data. Logistic regression modeling was used to estimate the probability of ever being tested for HIV by mental illness status, adjusting for age, sex, race/ethnicity, marital status, substance abuse, excessive alcohol or tobacco use, and HIV risk factors. Based on data from 21,785 respondents, 15% of adults had a psychiatric disorder and 37% ever had an HIV test. Persons with schizophrenia (64%), bipolar disorder (63%), and depression and/or anxiety (47%) were more likely to report ever being tested for HIV than those without mental illness (35%). In multivariable models, individuals reporting schizophrenia (adjusted prevalence ratio=1.68, 95% confidence interval=1.33-2.13), bipolar disease (1.58, 1.39-1.81), and depression and/or anxiety (1.31, 1.25-1.38) were more likely to be tested for HIV than persons without these diagnoses. Similar to previous analyses, persons with mental illness were more likely to have been tested than those without mental illness. However, the elevated prevalence of HIV in populations with mental illness suggests that high levels of testing along with other prevention efforts are needed.

  12. Use of inotropes and vasopressor agents in critically ill patients

    OpenAIRE

    Bangash, Mansoor N; Kong, Ming-Li; Pearse, Rupert M

    2012-01-01

    Inotropes and vasopressors are biologically and clinically important compounds that originate from different pharmacological groups and act at some of the most fundamental receptor and signal transduction systems in the body. More than 20 such agents are in common clinical use, yet few reviews of their pharmacology exist outside of physiology and pharmacology textbooks. Despite widespread use in critically ill patients, understanding of the clinical effects of these drugs in pathological stat...

  13. Illness perception differences between Russian- and Hebrew-speaking Israeli oncology patients.

    Science.gov (United States)

    Popov, Nadia; Heruti, Irit; Levy, Sigal; Lulav-Grinwald, Doron; Bar-Sela, Gil

    2014-03-01

    Illness perception influences health and illness behaviors. This study was designed to estimate illness perception differences between Russian-speaking and Hebrew-speaking Israeli oncology patients. Changes in illness perception associated with time spent in Israel among Russian-speaking patients were also evaluated. Additionally, we evaluated differences in illness perception of patients exposed to Chernobyl's consequences. A total of 144 oncology patients (77 Hebrew-speaking, 67 Russian-speaking) completed personal data questionnaires and The illness perception questionnaire revised, translated into Russian for this study. Significantly more Russian-speaking oncology patients perceived their illness as chronic and having negative consequences on life (p speaking oncology patients tend to have a more negative perception of cancer compared to Hebrew-speaking patients. Time spent in Israel may create more positive perceptions of cancer among these patients. No illness perception differences were found concerning Chernobyl consequences.

  14. Attitudes toward mental illness in adults by mental illness-related factors and chronic disease status: 2007 and 2009 Behavioral Risk Factor Surveillance System.

    Science.gov (United States)

    Kobau, Rosemarie; Zack, Matthew M

    2013-11-01

    We examined how attitudes toward mental illness treatment and its course differ by serious psychological distress, mental illness treatment, chronic disease, and sociodemographic factors using representative state-based data. Using data from jurisdictions supporting the Behavioral Risk Factor Surveillance System's Mental Illness and Stigma Module (35 states, the District of Columbia, and Puerto Rico), we compared adjusted proportions of adults agreeing that "Treatment can help people with mental illness lead normal lives" (treatment effectiveness) and that "People are generally caring and sympathetic to people with mental illness" (supportive environment), by demographic characteristics, serious psychological distress, chronic disease status, and mental illness treatment. Attitudes regarding treatment effectiveness and a supportive environment for people with mental illness varied within and between groups. Most adults receiving mental illness treatment agreed that treatment is effective. Fewer adults with serious psychological distress than those without such distress agreed that treatment is effective. Fewer of those receiving treatment, those with psychological distress, and those with chronic disease perceived the environment as supportive. These data can be used to target interventions for population subgroups with less favorable attitudes and for surveillance.

  15. Endocrine and metabolic considerations in critically ill patients 4

    Science.gov (United States)

    Fliers, Eric; Bianco, Antonio C; Langouche, Lies; Boelen, Anita

    2016-01-01

    Patients in the intensive care unit (ICU) typically present with decreased concentrations of plasma tri-iodothyronine, low thyroxine, and normal range or slightly decreased concentration of thyroid-stimulating hormone. This ensemble of changes is collectively known as non-thyroidal illness syndrome (NTIS). The extent of NTIS is associated with prognosis, but no proof exists for causality of this association. Initially, NTIS is a consequence of the acute phase response to systemic illness and macronutrient restriction, which might be beneficial. Pathogenesis of NTIS in long-term critical illness is more complex and includes suppression of hypothalamic thyrotropin-releasing hormone, accounting for persistently reduced secretion of thyroid-stimulating hormone despite low plasma thyroid hormone. In some cases distinguishing between NTIS and severe hypothyroidism, which is a rare primary cause for admission to the ICU, can be difficult. Infusion of hypothalamic-releasing factors can reactivate the thyroid axis in patients with NTIS, inducing an anabolic response. Whether this approach has a clinical benefit in terms of outcome is unknown. In this Series paper, we discuss diagnostic aspects, pathogenesis, and implications of NTIS as well as its distinction from severe, primary thyroid disorders in patients in the ICU. PMID:26071885

  16. Successful intraosseous infusion in the critically ill patient does not require a medullary cavity.

    LENUS (Irish Health Repository)

    McCarthy, Gerard

    2012-02-03

    OBJECTIVES: To demonstrate that successful intraosseous infusion in critically ill patients does not require bone that contains a medullary cavity. DESIGN: Infusion of methyl green dye via standard intraosseous needles into bones without medullary cavity-in this case calcaneus and radial styloid-in cadaveric specimens. SETTING: University department of anatomy. PARTICIPANTS: Two adult cadaveric specimens. MAIN OUTCOME MEASURES: Observation of methyl green dye in peripheral veins of the limb in which the intraosseous infusion was performed. RESULTS: Methyl green dye was observed in peripheral veins of the chosen limb in five out of eight intraosseous infusions into bones without medullary cavity-calcaneus and radial styloid. CONCLUSIONS: Successful intraosseous infusion does not always require injection into a bone with a medullary cavity. Practitioners attempting intraosseous access on critically ill patients in the emergency department or prehospital setting need not restrict themselves to such bones. Calcaneus and radial styloid are both an acceptable alternative to traditional recommended sites.

  17. Prenatal teratogens and the development of adult mental illness.

    Science.gov (United States)

    Watson, J B; Mednick, S A; Huttunen, M; Wang, X

    1999-01-01

    Our findings in the Helsinki Influenza Study and the Danish Forty Year Study lead us to conclude that a 2nd-trimester maternal influenza infection may increase risk for adult schizophrenia or adult major affective disorder. More recently we have also reported an increase of unipolar depression among offspring who were exposed prenatally to a severe earthquake (7.8 on the Richter scale) in Tangshan, China. Among the earthquake-exposed males (but not the females), we observed a significantly greater depression response for those individuals exposed during the 2nd trimester of gestation. These findings suggest that maternal influenza infection and severe maternal stress may operate (in different ways) as teratogens, disrupting the development of the fetal brain and increasing risk for developing schizophrenia or depression in adulthood.

  18. [Mental health of children, adolescents and young adults--part 1: prevalence, illness persistence, adversities, service use, treatment delay and consequences].

    Science.gov (United States)

    Lambert, M; Bock, T; Naber, D; Löwe, B; Schulte-Markwort, M; Schäfer, I; Gumz, A; Degkwitz, P; Schulte, B; König, H H; Konnopka, A; Bauer, M; Bechdolf, A; Correll, C; Juckel, G; Klosterkötter, J; Leopold, K; Pfennig, A; Karow, A

    2013-11-01

    Numerous birth-control studies, epidemiological studies, and observational studies have investigated mental health and health care in childhood, adolescence and early adulthood, including prevalence, age at onset, adversities, illness persistence, service use, treatment delay and course of illness. Moreover, the impact of the burden of illness, of deficits of present health care systems, and the efficacy and effectiveness of early intervention services on mental health were evaluated. According to these data, most mental disorders start during childhood, adolescence and early adulthood. Many children, adolescents and young adults are exposed to single or multiple adversities, which increase the risk for (early) manifestations of mental diseases as well as for their chronicity. Early-onset mental disorders often persist into adulthood. Service use by children, adolescents and young adults is low, even lower than for adult patients. Moreover, there is often a long delay between onset of illness and first adequate treatment with a variety of linked consequences for a poorer psychosocial prognosis. This leads to a large burden of illness with respect to disability and costs. As a consequence several countries have implemented so-called "early intervention services" at the interface of child and adolescent and adult psychiatry. Emerging studies show that these health-care structures are effective and efficient. Part 1 of the present review summarises the current state of mental health in childhood, adolescence and early adulthood, including prevalence, age at onset, adversities, illness persistence, service use, and treatment delay with consequences.

  19. Diagnostic accuracy of procalcitonin in critically ill immunocompromised patients

    Directory of Open Access Journals (Sweden)

    Legriel Stéphane

    2011-08-01

    Full Text Available Abstract Background Recognizing infection is crucial in immunocompromised patients with organ dysfunction. Our objective was to assess the diagnostic accuracy of procalcitonin (PCT in critically ill immunocompromised patients. Methods This prospective, observational study included patients with suspected sepsis. Patients were classified into one of three diagnostic groups: no infection, bacterial sepsis, and nonbacterial sepsis. Results We included 119 patients with a median age of 54 years (interquartile range [IQR], 42-68 years. The general severity (SAPSII and organ dysfunction (LOD scores on day 1 were 45 (35-62.7 and 4 (2-6, respectively, and overall hospital mortality was 32.8%. Causes of immunodepression were hematological disorders (64 patients, 53.8%, HIV infection (31 patients, 26%, and solid cancers (26 patients, 21.8%. Bacterial sepsis was diagnosed in 58 patients and nonbacterial infections in nine patients (7.6%; 52 patients (43.7% had no infection. PCT concentrations on the first ICU day were higher in the group with bacterial sepsis (4.42 [1.60-22.14] vs. 0.26 [0.09-1.26] ng/ml in patients without bacterial infection, P 0.5 ng/ml had 100% sensitivity but only 63% specificity for diagnosing bacterial sepsis. The area under the receiver operating characteristic (ROC curve was 0.851 (0.78-0.92. In multivariate analyses, PCT concentrations > 0.5 ng/ml on day 1 independently predicted bacterial sepsis (odds ratio, 8.6; 95% confidence interval, 2.53-29.3; P = 0.0006. PCT concentrations were not significantly correlated with hospital mortality. Conclusion Despite limited specificity in critically ill immunocompromised patients, PCT concentrations may help to rule out bacterial infection.

  20. Clinical review: Strict or loose glycemic control in critically ill patients - implementing best available evidence from randomized controlled trials

    NARCIS (Netherlands)

    Schultz, M.J.; Harmsen, R.E.; Spronk, P.E.

    2010-01-01

    Glycemic control aiming at normoglycemia, frequently referred to as 'strict glycemic control' (SGC), decreased mortality and morbidity of adult critically ill patients in two randomized controlled trials (RCTs). Five successive RCTs, however, failed to show benefit of SGC with one trial even reporti

  1. General Psychiatric Services for Adults with Intellectual Disability and Mental Illness

    Science.gov (United States)

    Chaplin, R.

    2004-01-01

    Adults with intellectual disability (ID) and mental illness may use general or specialist psychiatric services. This review aims to assess if there is evidence for a difference in outcome between them. A literature review was conducted using a variety of electronic databases and hand-search strategies to identify all studies evaluating the outcome…

  2. Dysphagia is a common and serious problem for adults with mental illness: a systematic review.

    Science.gov (United States)

    Aldridge, Kristy J; Taylor, Nicholas F

    2012-03-01

    Adults with mental illness may experience a higher incidence of dysphagia and choking due to factors such as medication side effects and behavioural abnormalities. The aim of this study was to determine the frequency of dysphagia and the most effective interventions for this population. Studies published up to August 2010 were sought via a comprehensive electronic database search (CINAHL, PsycINFO, MEDLINE, PubMed, Cochrane, and Embase). Studies reporting dysphagia frequency or dysphagia intervention outcomes in adults with mental illness were included. Two reviewers independently assessed study eligibility and quality, and the results were synthesised descriptively. Ten studies were identified, each describing dysphagia frequency or death due to choking asphyxiation. No studies evaluating intervention effectiveness were identified. Study quality was limited by subjective assessment of outcomes. Six studies presented dysphagia frequencies ranging from 9 to 42% in varying subgroups. Four studies presented the frequency of choking asphyxiation death, including a large survey that concluded that adults with organic mental illness were 43 times more likely to die of this cause than the general population. Dysphagia is a common and significant cause of morbidity and mortality in adults with mental illness and our review found that there is a lack of studies evaluating the effectiveness of intervention techniques.

  3. New Research into General Psychiatric Services for Adults with Intellectual Disability and Mental Illness

    Science.gov (United States)

    Chaplin, R.

    2009-01-01

    Background: There are a variety of models for the mental health care of adults with comorbid intellectual disability (ID) and mental illness. There has been a long-running debate as to whether this should be provided by general psychiatric or specialised ID services. A previous review concluded that there was no clear evidence to support either…

  4. A Bibliography of Children's and Young Adult's Books about Illness Issues.

    Science.gov (United States)

    Cothern, Nancy B.

    This bibliography presents a list of approximately 360 works of children's and young adult's literature that deal with illness issues or issues connected with adverse life conditions such as various forms of child abuse, alcoholism, AIDS, blindness, cancer, death, handicaps, suicide, and surgery. The bibliography is divided into 42 sections, each…

  5. The development of a model of dignity in illness based on qualitative interviews with seriously ill patients.

    Science.gov (United States)

    van Gennip, Isis E; Pasman, H Roeline W; Oosterveld-Vlug, Mariska G; Willems, Dick L; Onwuteaka-Philipsen, Bregje D

    2013-08-01

    While knowledge on factors affecting personal dignity of patients nearing death is quite substantial, far less is known about how patients living with a serious disease understand dignity. To develop a conceptual model of dignity that illuminates the process by which serious illness can undermine patients' dignity, and that is applicable to a wide patient population. Qualitative interview study. 34 patients with either cancer, early stage dementia, or a severe chronic illness were selected from an extensive cohort study into advance directives. In-depth interviews were carried out exploring the experiences of seriously ill patients with regard to their personal dignity. The interview transcripts were analyzed using thematic analysis and a conceptual model was constructed based on the resulting themes. We developed a two-step dignity model of illness. According to this model, illness related conditions do not affect patients' dignity directly but indirectly by affecting the way patients perceive themselves. We identified three components shaping self-perception: (a) the individual self: the subjective experiences and internally held qualities of the patient; (b) the relational self: the self within reciprocal interaction with others; and, (c) the societal self: the self as a social object in the eyes of others. The merits of the model are two-folded. First, it offers an organizing framework for further research into patients' dignity. Secondly, the model can serve to facilitate care for seriously ill patients in practice by providing insight into illness and dignity at the level of the individual patient where intervention can be effectively targeted. Copyright © 2013 Elsevier Ltd. All rights reserved.

  6. Semiology of subtle motor phenomena in critically ill patients.

    Science.gov (United States)

    Florea, Bogdan; Beniczky, Simona Alexandra; Demény, Helga; Beniczky, Sándor

    2017-05-01

    to investigate the semiology of subtle motor phenomena in critically ill patients, with- versus without nonconvulsive status epilepticus (NCSE). 60 consecutive comatose patients, in whom subtle motor phenomena were observed in the intensive care unit (ICU), were analysed prospectively. The semiology of the subtle phenomena was described from video-recordings, blinded to all other data. For each patient, the type, location and occurrence-pattern/duration were described. EEGs recorded in the ICU were classified using the Salzburg criteria for NCSE. only 23% (14/60) of the patients had NCSE confirmed by EEG. None of the semiological features could distinguish between patients with NCSE and those without. In both groups, the following phenomena were most common: discrete myoclonic muscle twitching and discrete tonic muscle activation. Besides these, automatisms and eye deviation were observed in both groups. subtle motor phenomena in critically ill patients can raise the suspicion of NCSE. Nevertheless, EEG is needed to confirm the diagnosis, since none of the semiological features are specific. Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  7. Disseminating Evidence-Based Practices for Adults with PTSD and Severe Mental Illness in Public-Sector Mental Health Agencies

    Science.gov (United States)

    Frueh, B. Christopher; Grubaugh, Anouk L.; Cusack, Karen J.; Elhai, Jon D.

    2009-01-01

    Posttraumatic stress disorder (PTSD) remains largely untreated among adults with severe mental illnesses (SMI). The treatment of psychotic symptoms usually takes precedence in the care of adults with SMI. Such oversight is problematic in that PTSD in SMI populations is common (19%-43%), contributes a significant illness burden, and hinders mental…

  8. The Other Side of Caring: Adult Children with Mental Illness as Supports to Their Mothers in Later Life.

    Science.gov (United States)

    Greenberg, Jan Steven

    1995-01-01

    Discusses the role of adult children with serious mental illness as a source of support to their aging parents. Most mothers reported that their mentally-ill children provided at least some ongoing help with daily living tasks. The adult child's assistance related significantly to lower levels of maternal subjective burden. (RJM)

  9. Helping Aging Parents of Adult Children with Serious Mental Illness.

    Science.gov (United States)

    Kaufman, Allan V; Scogin, Forrest; Macneil, Gordon; Leeper, James; Wimberly, Joshua

    2010-10-01

    This manuscript reports the results of a study that pilot tested a home-delivered, multi-dimensional problem-solving intervention aimed at helping aging parental caregivers of adult children with schizophrenia. The results indicate that the participants (N=5) who received the 10-session intervention showed increased life satisfaction and emotional well being, and reduced feelings of burden, compared to those participants in the control group (N=10). If a planned larger scale evaluation of the intervention provides evidence of its effectiveness, practitioners could have a valuable new treatment tool to provide assistance to this caregiver population.

  10. Dissimilary in patients' and spouses' representations of chronic illness: exploration of relations to patient adaptation.

    NARCIS (Netherlands)

    Heijmans, M.; Ridder, D. de; Bensing, J.

    1999-01-01

    In this cross-sectional study, the illness representations of patients suffering from Chronic Fatigue Syndrome (n=49) and Addison's Disease (n=52) and those of their spouses were compared. Couples generally held similar views with regard to the dimensions of illness identity and cause but disagreed

  11. Dissimilary in patients' and spouses' representations of chronic illness: exploration of relations to patient adaptation.

    NARCIS (Netherlands)

    Heijmans, M.; Ridder, D. de; Bensing, J.

    1999-01-01

    In this cross-sectional study, the illness representations of patients suffering from Chronic Fatigue Syndrome (n=49) and Addison's Disease (n=52) and those of their spouses were compared. Couples generally held similar views with regard to the dimensions of illness identity and cause but disagreed

  12. Enteral nutrition intolerance in critically ill septic burn patients.

    Science.gov (United States)

    Lavrentieva, Athina; Kontakiotis, Theodore; Bitzani, Militsa

    2014-01-01

    The purpose of this study was to investigate the frequency of enteral feeding intolerance in critically ill septic burn patients, the effect of enteral feeding intolerance on the efficacy of feeding, the correlation between the infection marker (procalcitonin [PCT]) and the nutrition status marker (prealbumin) and the impact of feeding intolerance on the outcome of septic burn patients. From January 2009 to December 2012 the data of all burn patients with the diagnosis of sepsis who were placed on enteral nutrition were analyzed. Septic patients were divided into two groups: group A, septic patients who developed feeding intolerance; group B, septic patients who did not develop feeding intolerance. Demographic and clinical characteristics of patients were analyzed and compared. The diagnosis of sepsis was applied to 29% of all patients. Of these patients 35% developed intolerance to enteral feeding throughout the septic period. A statistically significant increase in mean PCT level and a decrease in prealbumin level was observed during the sepsis period. Group A patients had statistically significant lower mean caloric intake, higher PCT:prealbumin ratio, higher pneumonia incidence, higher Sequential Organ Failure Assessment Maximum Score, a longer duration of mechanical ventilation, and a higher mortality rate in comparison with the septic patients without gastric feeding intolerance. The authors concluded that a high percentage of septic burn patients developed enteral feeding intolerance. Enteral feeding intolerance seems to have a negative impact on the patients' nutritional status, morbidity, and mortality.

  13. Mental Representations of Illness in Patients with Gestational Trophoblastic Disease: How Do Patients Perceive Their Condition?

    Science.gov (United States)

    Di Mattei, Valentina E; Carnelli, Letizia; Mazzetti, Martina; Bernardi, Martina; Di Pierro, Rossella; Bergamini, Alice; Mangili, Giorgia; Candiani, Massimo; Sarno, Lucio

    2016-01-01

    Gestational Trophoblastic Disease comprises a group of benign and malignant disorders that derive from the placenta. Using Leventhal's Common-Sense Model as a theoretical framework, this paper examines illness perception in women who have been diagnosed with this disease. Thirty-one women diagnosed with Gestational Trophoblastic Disease in a hospital in Italy were asked to complete the Illness Perception Questionnaire-Revised to measure the following: illness Identity, illness opinions and causes of Gestational Trophoblastic Disease. High mean scores were observed in the Emotional representations and Treatment control subscales. A significant difference emerged between hydatidiform mole patients and those with gestational trophoblastic neoplasia on the Identity subscale. A significant correlation emerged between "time since diagnosis" and the Treatment control subscale. This study is the first to investigate illness perception in Gestational Trophoblastic Disease. From a clinical perspective the results highlight the need for multidisciplinary support programs to promote a more realistic illness perception.

  14. Interpretation of illness in patients with chronic diseases from Shanghai and their associations with life satisfaction, escape from illness, and ability to reflect the implications of illness

    Institute of Scientific and Technical Information of China (English)

    Arndt Bssing; Ariane von Bergh; Xiao-feng Zhai; Chang-quan Ling

    2014-01-01

    OBJECTIVE:The aim of this study is to analyze how patients with chronic diseases from Shanghai interpret their disease, and how these interpretations inlfuence patients’ life satisfaction, intention to escape from their illness and their ability to relfect on the implications of their illness. METHODS:A cross-sectional study enrolling 142 patients (mean age (50 ± 16) years;63%men, 37%women) with chronic diseases (60%cancer) was recruited in the Changhai Hospital of Traditional Chinese Medicine, Shanghai, China and surveyed using standardized questionnaires. RESULTS: Patients with chronic diseases from Shanghai interpreted their illness mostly as an Adverse Interruption of Life (55%), as a Threat/Enemy (50%), but also as a Challenge (49%), and only rarely as a Call for Help (18%) or as a Punishment (13%). Particularly fatalistic negative (i.e., Threat/Enemy, Adverse Interruption of Life) and strategy-associated disease interpretations (i.e., Relieving Break, Call for Help) were moderately associated with patients’ intention to escape from illness. In contrast, positive interpretations (i.e., something of Value, Challenge) and also the guilt-associated negative interpretation Failure were moderately related with patients’ ability to relfect on their illness. However, life satisfaction was weakly associated only with the view that il ness might be a Chal enge. Interestingly, 58%of those who would see their il ness as an Adverse Interruption (AI+) could see it also as a Challenge (Ch+). Detailed analyses showed that AI+Ch+patients differ from their AI+Ch- counterparts signiifcantly with respect to their ability to relfect life and implications of illness (F=9.1;P=0.004). CONCLUSION: The observed interpretations of illness, particularly the negative perceptions, could be used as indicators that patients require further psychological assistance to cope with their burden. Helping AI+patients see their illness also as a Challenge, and thus develop a higher

  15. Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults.

    Science.gov (United States)

    Kaddourah, Ahmad; Basu, Rajit K; Bagshaw, Sean M; Goldstein, Stuart L

    2017-01-05

    Background The epidemiologic characteristics of children and young adults with acute kidney injury have been described in single-center and retrospective studies. We conducted a multinational, prospective study involving patients admitted to pediatric intensive care units to define the incremental risk of death and complications associated with severe acute kidney injury. Methods We used the Kidney Disease: Improving Global Outcomes criteria to define acute kidney injury. Severe acute kidney injury was defined as stage 2 or 3 acute kidney injury (plasma creatinine level ≥2 times the baseline level or urine output <0.5 ml per kilogram of body weight per hour for ≥12 hours) and was assessed for the first 7 days of intensive care. All patients 3 months to 25 years of age who were admitted to 1 of 32 participating units were screened during 3 consecutive months. The primary outcome was 28-day mortality. Results A total of 4683 patients were evaluated; acute kidney injury developed in 1261 patients (26.9%; 95% confidence interval [CI], 25.6 to 28.2), and severe acute kidney injury developed in 543 patients (11.6%; 95% CI, 10.7 to 12.5). Severe acute kidney injury conferred an increased risk of death by day 28 after adjustment for 16 covariates (adjusted odds ratio, 1.77; 95% CI, 1.17 to 2.68); death occurred in 60 of the 543 patients (11.0%) with severe acute kidney injury versus 105 of the 4140 patients (2.5%) without severe acute kidney injury (P<0.001). Severe acute kidney injury was associated with increased use of mechanical ventilation and renal-replacement therapy. A stepwise increase in 28-day mortality was associated with worsening severity of acute kidney injury (P<0.001 by log-rank test). Assessment of acute kidney injury according to the plasma creatinine level alone failed to identify acute kidney injury in 67.2% of the patients with low urine output. Conclusions Acute kidney injury is common and is associated with poor outcomes, including increased

  16. Sociodrama in the rehabilitation of chronic mentally ill patients.

    Science.gov (United States)

    Hickling, F W

    1989-04-01

    Sociodrama, a synthesis of group psychotherapy and theatrical presentation, was used from 1978 to 1981 to promote rehabilitation of chronic mentally ill patients at Bellevue Mental Hospital in Jamaica. Staff and patients collectively analyzed their recollections of the hospital's history, then wrote and staged dramatic productions based on the insights derived from those analyses. Changes in the major themes that emerged from the process reflected improvement in therapeutic attitudes and practices and in patient-staff communication over the four-year period. Patients who participated in the sociodramas had greater decreases in medication dosage and psychosocial disability scores and higher rates of improvement and discharge than a matched group of patients who did not participate.

  17. Metabolic syndrome in patients with severe mental illness undergoing psychiatric rehabilitation receiving high dose antipsychotic medication

    Directory of Open Access Journals (Sweden)

    Bapu V Ravindranath

    2012-01-01

    Full Text Available Background: To review evidence of chronic antipsychotic medication and the association with metabolic syndrome in mentally ill patients. This evidence was used to analyse a cohort of patients with severe mental illness and to deduce a correlation between the prevalence of metabolic syndrome and their dose regimens. Materials and Methods: Twenty-four male patients undergoing Psychiatric rehabilitation underwent a review of current medication and assessment of risk factors for metabolic syndrome. Assessment criteria was based upon National Cholesterol Education Programme expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III (NCEP ATP III criteria, incorporating waist circumference, raised triglycerides, reduced high density lipoprotein, raised blood pressure and fasting blood glucose. PubMed, Nature and Science Direct databases have been used to compile the medical and scientific background on metabolic syndrome and antipsychotic medication and the effect on patients particularly on high dose. Results: Out of 24 patients, 10 patients (41.7% were receiving high dose antipsychotics (HDA and four were on maximum dosage limits of 100%. 8.3% (2/24 patients were receiving only one first generation antipsychotics (FGA, 37.5% (9/24 patients were receiving only one second generation antipsychotic (SGA, 45.8% patients (11/24 were receiving two or more SGA only, and only one patient was receiving two or more FGA. One patient was receiving a combination of FGA and SGA. PRN ("as needed" therapy was not included in this study as their usage was limited. Clozapine was mostly prescribed in these patients (10/24, 41.6%. Four out of the 24 patients refused blood tests therefore were excluded from the following results. In the patients evaluated, 55% (11/20 had confirmed metabolic syndrome. In these patients with metabolic syndrome, 45.4% (5/11 were on HDA and 27.3% (3/11 were on maximum British National

  18. The Phosphate Levels of Critically ill Patients with Respiratory Failure

    Directory of Open Access Journals (Sweden)

    Mehmet Turan İnal

    2011-04-01

    Full Text Available Objective: The incidence of hypophosphatemia is higher in critically ill patients and prolonged the length of ICU stay and duration of mechanical ventilation. This study evaluated the prognostic value of phosphate levels in critically ill patients. Materials and Methods: All patients admitted to the general and surgical intensive care unit (ICU of Trakya University Medical Faculty, with respiratory failure during 1 year period (from January 1, 2009, to December 31, 2009, were retrospectively enrolled. The phosphate levels, age, gender, length of ICU stay, duration of mechanical ventilation, APACHE II scores, medical drug usage and prognosis were recorded. Hypophosphataemia was defined as a level under 2.5 mg/dL and normophosphatemia was defined as a level between 2.5-4.7 mg/dL. Results: 139 patients were retrospectively enrolled into the study, of these, 41% had hypophosphataemia. There was no statistically significant difference in age, gender and APACHE II scores. The length of ICU stay was 20.16±16.31 days in hypophosphatemic patients and 12.62±12.43 days in normophosphatemic patients (p<0.05. The duration of mechanical ventilation was 17.54±16.27 days in hypophosphatemic patients and 9.94±11.55 days in normophosphatemic patients (p<0.05. The usage of catecholamines, beta adrenergic receptor agonists, diuretics and glucocorticoids were higher in hypophosphatemic patients (p<0.05. Conclusion: The duration of mechanical ventilation and the length of ICU stay was prolonged in hypophosphatemic patients with respiratory failure. We suggested to follow the phosphate levels tightly for early diagnosis and treatment of phosphate deficiency. (Journal of the Turkish Society of Intensive Care 2011; 9: 19-22

  19. Care fragmentation, quality, and costs among chronically ill patients.

    Science.gov (United States)

    Frandsen, Brigham R; Joynt, Karen E; Rebitzer, James B; Jha, Ashish K

    2015-05-01

    To assess the relationship between care fragmentation and both quality and costs of care for commercially insured, chronically ill patients. We used claims data from 2004 to 2008 for 506,376 chronically ill, privately insured enrollees of a large commercial insurance company to construct measures of fragmentation. We included patients in the sample if they had chronic conditions in any of the following categories: cardiovascular disease, diabetes, asthma, arthritis, or migraine. We assigned each patient a fragmentation index based on the patterns of care of their primary care provider (PCP), with care patterns spread across a higher number of providers considered to be more fragmented. We used regression analysis to examine the relationship between fragmentation and both quality and cost outcomes. Patients of PCPs in the highest quartile of fragmentation had a higher chance of having a departure from clinical best practice (32.8%, vs 25.9% among patients of PCPs in the lowest quartile of fragmentation; P fragmentation had higher rates of preventable hospitalizations (9.1% in highest quartile vs 7.1% in lowest quartile; P fragmentation was associated with $4542 higher healthcare spending ($10,396 in the highest quartile vs $5854 in the lowest quartile; P fragmented care more often experience lapses in care quality and incur greater healthcare costs.

  20. The Association of Health Literacy with Illness and Medication Beliefs Among Older Adults with Asthma

    Science.gov (United States)

    Federman, Alex D.; Wolf, Michael; Sofianou, Anastasia; Wilson, Elizabeth A.H.; Martynenko, Melissa; Halm, Ethan A.; Leventhal, Howard; Wisnivesky, Juan P.

    2013-01-01

    Background Suboptimal health literacy (HL) and asthma beliefs are associated with poor asthma self-management and outcomes. We tested the hypothesis that low HL is associated with inaccurate beliefs. Methods Asthmatics ≥ 60 were recruited from hospital and community practices in New York, NY and Chicago, IL (n=420). HL was measured with the Short Test of Functional Health Literacy in Adults; validated instruments derived from the Self Regulation model were used to assess beliefs. The association of beliefs with HL was evaluated with multivariate models. Results Thirty-six percent of patients had low HL; 54% believed they only have asthma when symptoms are present, 29% believed they will not always have asthma and 20% believed that their doctor can cure asthma. HL was associated with beliefs of not having asthma all the time and that asthma can be cured (OR: 1.84, 95% CI: 1.2 to 2.82; OR: 2.22, 95% CI: 1.29 to 3.82, respectively). Patients with low HL were also more likely to be concerned about medication use (β = 0.92, p = .05), despite recognizing their necessity (β = -1.36, p = .01). Conclusions Older asthmatics with low HL endorse erroneous asthma beliefs. Practice implications Health communications for improving self-management behaviors in asthma should employ both health literacy-appropriate strategies and messages to counter illness-related misconceptions. PMID:23523196

  1. Meaning and Practice of Palliative Care for Hospitalized Older Adults with Life Limiting Illnesses

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    Bethel Ann Powers

    2011-01-01

    Full Text Available Objective. To illustrate distinctions and intersections of palliative care (PC and end-of-life (EOL services through examples from case-centered data of older adults cared for during a four-year ethnographic study of an acute care hospital palliative care consultation service. Methods. Qualitative narrative and thematic analysis. Results. Description of four practice paradigms (EOL transitions, prognostic uncertainty, discharge planning, and patient/family values and preferences and identification of the underlying structure and communication patterns of PC consultation services common to them. Conclusions. Consistent with reports by other researchers, study data support the need to move beyond equating PC with hospice or EOL care and the notion that EOL is a well-demarcated period of time before death. If professional health care providers assume that PC services are limited to assisting with and helping patients and families prepare for dying, they miss opportunities to provide care considered important to older individuals confronting life-limiting illnesses.

  2. Prophylactic Plasma Transfusion Is Not Associated With Decreased Red Blood Cell Requirements in Critically Ill Patients.

    Science.gov (United States)

    Warner, Matthew A; Chandran, Arun; Jenkins, Gregory; Kor, Daryl J

    2017-05-01

    Critically ill patients frequently receive plasma transfusion under the assumptions that abnormal coagulation test results confer increased risk of bleeding and that plasma transfusion will decrease this risk. However, the effect of prophylactic plasma transfusion remains poorly understood. The objective of this study was to determine the relationship between prophylactic plasma transfusion and bleeding complications in critically ill patients. This is a retrospective cohort study of adults admitted to the intensive care unit (ICU) at a single academic institution between January 1, 2009 and December 31, 2013. Inclusion criteria included age ≥18 years and an international normalized ratio measured during ICU admission. Multivariable propensity-matched analyses were used to evaluate associations between prophylactic plasma transfusion and outcomes of interest with a primary outcome of red blood cell transfusion in the ensuing 24 hours and secondary outcomes of hospital- and ICU-free days and mortality within 30 days of ICU discharge. A total of 27,561 patients were included in the investigation with 2472 (9.0%) receiving plasma therapy and 1105 (44.7%) for which plasma transfusion was prophylactic in nature. In multivariable propensity-matched analyses, patients receiving plasma had higher rates of red blood cell transfusion (odds ratio: 4.3 [95% confidence interval: 3.3-5.7], P plasma in the critically ill was not associated with improved clinical outcomes. Further investigation examining the utility of plasma transfusion in this population is warranted.

  3. Feeding the critically ill obese patient: a systematic review protocol.

    Science.gov (United States)

    Secombe, Paul; Harley, Simon; Chapman, Marianne; Aromataris, Edoardo

    2015-10-01

    The objective of this review is to identify effective enteral nutritional regimens targeting protein and calorie delivery for the critically ill obese patient on morbidity and mortality.More specifically, the review question is:In the critically ill obese patient, what is the optimal enteral protein and calorie target that improves mortality and morbidity? The World Health Organization (WHO) defines obesity as abnormal or excessive fat accumulation that may impair health, or, empirically, as a body mass index (BMI) ≥ 30 kg/m. Twenty-eight percent of the Australian population is obese with the prevalence rising to 44% in rural areas, and there is evidence that rates of obesity are increasing. The prevalence of obese patients in intensive care largely mirrors that of the general population. There is concern, however, that this may also be rising. A recently published multi-center nutritional study of critically ill patients reported a mean BMI of 29 in their sample, suggesting that just under 50% of their intensive care population is obese. It is inevitable, therefore, that the intensivist will care for the critically ill obese patient.Managing the critically ill obese patient is challenging, not least due to the co-morbid diseases frequently associated with obesity, including diabetes mellitus, cardiovascular disease, dyslipidaemia, sleep disordered breathing and respiratory insufficiency, hepatic steatohepatitis, chronic kidney disease and hypertension. There is also evidence that metabolic processes differ in the obese patient, particularly those with underlying insulin resistance, itself a marker of the metabolic syndrome, which may predispose to futile cycling, altered fuel utilization and protein catabolism. These issues are compounded by altered drug pharmacokinetics, and the additional logistical issues associated with prophylactic, therapeutic and diagnostic interventions.It is entirely plausible that the altered metabolic processes observed in the obese

  4. Psychiatric Illness and Behavioural Problems in Adults with Learning Disability and Epilepsy

    Directory of Open Access Journals (Sweden)

    Shoumitro Deb

    1999-01-01

    Full Text Available We retrospectively collected data on the rate and type of psychiatric illness and behavioural problems on 143 adults with learning disability and epilepsy. 55% behavioural problems. 19% verbal aggression and temper tantrums, and 13% injurious behaviour. The overall rates of behavioural problems and different types of behaviours found in the current study cohort are similar to what was found before in learning disabled adults in general, as well as in epileptic and non-epileptic learning disabled adults. Psychiatric diagnosis was made in 12.6% combined diagnosis of schizophrenia, delusional disorder and schizo-affective disorder was most common (5% diagnosis of depressive episode (3% bipolar affective disorder.

  5. Targeted ethnography as a critical step to inform cultural adaptations of HIV prevention interventions for adults with severe mental illness.

    Science.gov (United States)

    Wainberg, Milton L; Alfredo González, M; McKinnon, Karen; Elkington, Katherine S; Pinto, Diana; Gruber Mann, Claudio; Mattos, Paulo E

    2007-07-01

    As in other countries worldwide, adults with severe mental illness (SMI) in Brazil are disproportionately infected with HIV relative to the general population. Brazilian psychiatric facilities lack tested HIV prevention interventions. To adapt existing interventions, developed only in the US, we conducted targeted ethnography with adults with SMI and staff from two psychiatric institutions in Brazil. We sought to characterize individual, institutional, and interpersonal factors that may affect HIV risk behavior in this population. We conducted 350 hours of ethnographic field observations in two mental health service settings in Rio de Janeiro, and 9 focus groups (n=72) and 16 key-informant interviews with patients and staff in these settings. Data comprised field notes and audiotapes of all exchanges, which were transcribed, coded, and systematically analyzed. The ethnography identified and/or characterized the institutional culture: (1) patients' risk behaviors; (2) the institutional setting; (3) intervention content; and (4) intervention format and delivery strategies. Targeted ethnography also illuminated broader contextual issues for development and implementation of HIV prevention interventions for adults with SMI in Brazil, including an institutional culture that did not systematically address patients' sexual behavior, sexual health, or HIV sexual risk, yet strongly impacted the structure of patients' sexual networks. Further, ethnography identified the Brazilian concept of "social responsibility" as important to prevention work with psychiatric patients. Targeted ethnography with adults with SMI and institutional staff provided information critical to the adaptation of tested US HIV prevention interventions for Brazilians with SMI.

  6. Effects of IV Acetaminophen on Core Body Temperature and Hemodynamic Responses in Febrile Critically Ill Adults: A Randomized Controlled Trial.

    Science.gov (United States)

    Schell-Chaple, Hildy M; Liu, Kathleen D; Matthay, Michael A; Sessler, Daniel I; Puntillo, Kathleen A

    2017-07-01

    To determine the effects of IV acetaminophen on core body temperature, blood pressure, and heart rate in febrile critically ill patients. Randomized, double-blind, placebo-controlled clinical trial. Three adult ICUs at a large, urban, academic medical center. Forty critically ill adults with fever (core temperature, ≥ 38.3°C). An infusion of acetaminophen 1 g or saline placebo over 15 minutes. Core temperature and vital signs were measured at baseline and at 5-15-minute intervals for 4 hours after infusion of study drug. The primary outcome was time-weighted average core temperature adjusted for baseline temperature. Secondary outcomes included adjusted time-weighted average heart rate, blood pressure, and respiratory rate, along with changes-over-time for each. Baseline patient characteristics were similar in those given acetaminophen and placebo. Patients given acetaminophen had an adjusted time-weighted average temperature that was 0.47°C less than those given placebo (95% CI, -0.76 to -0.18; p = 0.002). The acetaminophen group had significantly lower adjusted time-weighted average systolic blood pressure (-17 mm Hg; 95% CI, -25 to -8; p acetaminophen decreased temperature, blood pressure, and heart rate. IV acetaminophen thus produces modest fever reduction in critical care patients, along with clinically important reductions in blood pressure.

  7. Procalcitonin Clearance for Early Prediction of Survival in Critically Ill Patients with Severe Sepsis

    Directory of Open Access Journals (Sweden)

    Mohd Basri Mat Nor

    2014-01-01

    Full Text Available Introduction. Serum procalcitonin (PCT diagnosed sepsis in critically ill patients; however, its prediction for survival is not well established. We evaluated the prognostic value of dynamic changes of PCT in sepsis patients. Methods. A prospective observational study was conducted in adult ICU. Patients with systemic inflammatory response syndrome (SIRS were recruited. Daily PCT were measured for 3 days. 48 h PCT clearance (PCTc-48 was defined as percentage of baseline PCT minus 48 h PCT over baseline PCT. Results. 95 SIRS patients were enrolled (67 sepsis and 28 noninfectious SIRS. 40% patients in the sepsis group died in hospital. Day 1-PCT was associated with diagnosis of sepsis (AUC 0.65 (95% CI, 0.55 to 0.76 but was not predictive of mortality. In sepsis patients, PCTc-48 was associated with prediction of survival (AUC 0.69 (95% CI, 0.53 to 0.84. Patients with PCTc-48 > 30% were independently associated with survival (HR 2.90 (95% CI 1.22 to 6.90. Conclusions. PCTc-48 is associated with prediction of survival in critically ill patients with sepsis. This could assist clinicians in risk stratification; however, the small sample size, and a single-centre study, may limit the generalisability of the finding. This would benefit from replication in future multicentre study.

  8. Correlates of sport participation in adults with long-standing illness or disability.

    OpenAIRE

    Heron, Neil; Kee, Frank; Cupples, Margaret E; Tully, Mark A.

    2015-01-01

    Background: Little is known about why people with a long-standing illness/disability are less likely to participate in sport than others. This study aimed to identify for the first time sport participation levels and their correlates among Northern Ireland (NI) adults who report a long-standing illness/disability. Method Using data collected in the Continuous Household Survey, an annual survey of a random sample of the NI population, during 2007–2011, we examined responses for the total sampl...

  9. Nutritional risk assessment in critically ill cancer patients: systematic review

    Science.gov (United States)

    Fruchtenicht, Ana Valéria Gonçalves; Poziomyck, Aline Kirjner; Kabke, Geórgia Brum; Loss, Sérgio Henrique; Antoniazzi, Jorge Luiz; Steemburgo, Thais; Moreira, Luis Fernando

    2015-01-01

    Objective To systematically review the main methods for nutritional risk assessment used in critically ill cancer patients and present the methods that better assess risks and predict relevant clinical outcomes in this group of patients, as well as to discuss the pros and cons of these methods according to the current literature. Methods The study consisted of a systematic review based on analysis of manuscripts retrieved from the PubMed, LILACS and SciELO databases by searching for the key words “nutritional risk assessment”, “critically ill” and “cancer”. Results Only 6 (17.7%) of 34 initially retrieved papers met the inclusion criteria and were selected for the review. The main outcomes of these studies were that resting energy expenditure was associated with undernourishment and overfeeding. The high Patient-Generated Subjective Global Assessment score was significantly associated with low food intake, weight loss and malnutrition. In terms of biochemical markers, higher levels of creatinine, albumin and urea were significantly associated with lower mortality. The worst survival was found for patients with worse Eastern Cooperative Oncologic Group - performance status, high Glasgow Prognostic Score, low albumin, high Patient-Generated Subjective Global Assessment score and high alkaline phosphatase levels. Geriatric Nutritional Risk Index values Nutritional Index score was associated with abnormal nutritional status in critically ill cancer patients. Among the reviewed studies that examined weight and body mass index alone, no significant clinical outcome was found. Conclusion None of the methods reviewed helped to define risk among these patients. Therefore, assessment by a combination of weight loss and serum measurements, preferably in combination with other methods using scores such as Eastern Cooperative Oncologic Group - performance status, Glasgow Prognostic Score and Patient-Generated Subjective Global Assessment, is suggested given that

  10. Hyperglycemia has a stronger relation trauma patients than in other critically with outcome in ill patients

    NARCIS (Netherlands)

    Vogelzang, M; Nijboer, JMM; van der Horst, ICC; Zijlstra, F; ten Duis, HJ; Nijsten, MWN

    2006-01-01

    Background. Acute hyperglycemia is associated with adverse outcome in critically ill patients. Glucose control with insulin improves outcome in surgical intensive care unit (SICU) patients, but the effect in trauma patients is unknown. We investigated hyperglycemia and outcome in SICU patients with

  11. Clostridium Difficile and Fecal Microbial Transplant in Critically Ill Patients

    Directory of Open Access Journals (Sweden)

    Sarvin Sanaie

    2014-07-01

    Full Text Available Critically-ill patients constitute majority of the patients hospitalized in ICU wards (1, 2. This group of patients demands special considerations and measures of care (3-6. Clostridium difficile infection causes dangerous, painful and persistent diarrhea in critically ill patients. Its treatment consists of enteral metronidazol or vancomycin in combination with IV antibiotics cessation. Recently, probiotics have been considered as an alternative treatment for pseudomembranous colitis. In 1958, fecal microbial transplant was first described from healthy individuals to sick patients to displace pathogenic microbes from the intestine by re-establishing a healthy microbial community. Since then, it has gained value as “express stool treatment” or currently known as “fecal transplant”. Last year, FDA classified stool as drug, which typically requires an Investigational New Drug application (IND. However, in July 2013, the FDA issued guidance stating that it would exercise enforcement discretion for physicians administering FMT to treat patients with recurrent Clostridium difficile infection. Accordingly, considering stool as a tissue product or giving it its own classification, as FDA approved for blood, would keep patients safe, ensure broad access and facilitate research (7. It should be taken into consideration that some complications might accompany fecal microbial transplant such as making patients susceptible for conditions like obesity or autoimmune disorders. Safety and quality assurance starts from pre-enrollment donor screening, donor testing (17 serological and stool-based assays, donor monitoring and process control. The composition of the bacterial community has been shown to change when stored at -80oC compared to the samples stored at -20oC and it has been recommended to store the samples of intestinal content at -20oC before use for bacterial community analysis, instead of the current practice at -80oC (7, 8. However, if

  12. Illness perceptions of adults with congenital heart disease and their predictive value for quality of life two years later

    NARCIS (Netherlands)

    Schoormans, D.; Mulder, B.J.; Melle, J.P. van; Pieper, P.G.; Dijk, A.P.J. van; Sieswerda, G.T.; Hulsbergen-Zwarts, M.S.; Plokker, T.H.; Brunninkhuis, L.G.; Vliegen, H.W.; Sprangers, M.A.G.

    2014-01-01

    BACKGROUND: To improve patients' quality of life (QoL) we need to identify modifiable determinants, such as illness perceptions. Patients' illness perceptions are known to regulate emotional responses and health-behaviour. Illness perceptions comprise several components: consequences, control, coher

  13. An audit of airway management in critically ill patients in a sub-Saharan tertiary hospital

    Directory of Open Access Journals (Sweden)

    Oyebola Olubodun Adekola

    2016-01-01

    Full Text Available Critically ill patients have poor physiological reserves, and are at increased risk of cardiopulmonary complications such as hypoxia, hypotension, arrhythmias and cardiac arrest when undergoing airway management. This study audited airway management in critically ill patients. Patients Method: A Prospective observational study in 120 critically ill adult patients who required endotracheal intubation over a one year period. Induction was with IV midazolam (0.15mg/kg, and suxamethonium (1.5mg/kg. Data collected included immediate complications (complications during intubation, and early complications (complications on days one to seven of tube insertion. Results: The median age was 32 years, males constituted 68 (56.6% and female 52 (43.4%. One hundred and fifty-eight intubation attempts were recorded, one attempt to success in 93 (77.5%, and 2 attempts in 22 (18.33%. Difficult intubation occurred in 17 (10.49%, of whom 5 subjects had more than 3 intubation attempts, and 2 had surgical tracheostomy performed. The intubation aids used included stylet in 86.67%, bougie (3.33%, and laryngeal mask airway (1.67%. There was a significant association between the number of attempts at intubation, and trauma, bleeding, oesophageal intubation, aspiration or cardiac arrest, P<0.05. Tubal blockade occurred in 65 (36.31% subjects after a median duration of 38.5 hours. Conclusion: This study elicited the need to review the airway management of critically ill patients in our institution, provide different airway and intubating devices during difficult intubation, and ensure appropriate training in airway skills.

  14. Caregivers' Illness Perceptions Contribute to Quality of Life in Head and Neck Cancer Patients at Diagnosis.

    Science.gov (United States)

    Richardson, Amy E; Morton, Randall; Broadbent, Elizabeth

    2015-01-01

    This study investigated the contribution of patient and caregiver illness perceptions to the quality of life of head and neck cancer (HNC) patients. Ninety-eight patients and their caregivers (n = 80) completed questionnaires at diagnosis. Caregivers' illness perceptions were significantly more negative than patients with respect to consequences, timeline, treatment, concern, and the emotional impact of HNC. The interaction between some patient and caregiver illness perceptions explained additional variance in patient quality of life, above and beyond patients' own illness perceptions. These findings suggest that caregivers should be included in psychological interventions to improve HNC patient quality of life.

  15. [Subjective feeling of patient on his illness and his treatment].

    Science.gov (United States)

    Llorca, P-M

    2013-09-01

    Subjective feeling of schizophrenic patients has been underestimated in the study of this illness. Subjective experience associated with the onset of the disease is of interest in a clinical point of view but also in the study of the underlying mechanisms. The fields of cognitive psychology, but also neuroscientific inputs, provide new paradigms to understand schizophrenia. In a more global perspective, subjective experience has an important impact on quality of life and is highly related to symptomatology and treatments. Identification of these subjective dimensions is needed to develop more efficacious strategies. Copyright © 2013 L’Encéphale. Published by Elsevier Masson SAS.. All rights reserved.

  16. The critically ill patient with ataxia-telangiectasia: a case series.

    Science.gov (United States)

    Lockman, Justin L; Iskander, Andrew J; Bembea, Melania; Crawford, Thomas O; Lederman, Howard M; McGrath-Morrow, Sharon; Easley, R Blaine

    2012-03-01

    To describe the presentation, clinical course, and outcomes of critically ill patients with ataxia-telangiectasia. Retrospective case series. Adult and pediatric intensive care units at an urban tertiary academic center. Seven consecutive patients with confirmed diagnosis of ataxia-telangiectasia had nine intensive care admissions between January 1995 and December 2009. None. Mean age at time of admission 15.9 yrs (median, 13.9 yrs; range, 7.3-33.9 yrs). Mean duration of intensive care unit stay was 17 days (median, 9 days; range, 2-39 days). The most common admitting diagnosis was respiratory distress (six of seven patients). There was no difference in ventilator settings or duration of intensive care unit stay between survivors and nonsurvivors (p > .05). Forty-three percent (three of seven patients) survived to intensive care unit discharge with a 3-yr survival that was 14% (one of seven patients). Critically ill patients with ataxia-telangiectasia have complex, multisystem diseases. In this case series, the most common intensive care unit admission diagnosis was respiratory failure. Suspected or confirmed bacterial infections were prevalent. Neuropathologic autopsy findings were similar to those previously reported. Special considerations for the critical care of patients with ataxia-telangiectasia are discussed.

  17. The role of patients' illness representations in coping and functioning with Addison's disease.

    NARCIS (Netherlands)

    Heijmans, M.

    1999-01-01

    Objective: To examine the relationship between illness representations, coping behaviour and adaptive outcome in patients with Addison's disease (AD). Design: Cross-sectional. Following Leventhal's self-regulation model (Leventhal, Meyer & Nerenz, 1980), it was hypothesized that illness representati

  18. The role of patients' illness representations in coping and functioning with Addison's disease.

    NARCIS (Netherlands)

    Heijmans, M.

    1999-01-01

    Objective: To examine the relationship between illness representations, coping behaviour and adaptive outcome in patients with Addison's disease (AD). Design: Cross-sectional. Following Leventhal's self-regulation model (Leventhal, Meyer & Nerenz, 1980), it was hypothesized that illness

  19. The role of patients' illness representations in coping and functioning with Addison's disease.

    NARCIS (Netherlands)

    Heijmans, M.

    1999-01-01

    Objective: To examine the relationship between illness representations, coping behaviour and adaptive outcome in patients with Addison's disease (AD). Design: Cross-sectional. Following Leventhal's self-regulation model (Leventhal, Meyer & Nerenz, 1980), it was hypothesized that illness representati

  20. Relationship between uncertainty in illness, mood state and coping style in patients with temporomandibular disorders

    Directory of Open Access Journals (Sweden)

    Dong-ye Yang

    2015-12-01

    Conclusions: Both uncertainty in illness and mood state were related to coping style. These data suggest that nurses should be trained to offer appropriate guidance to help decrease patients' uncertainty in illness and relieve their negative emotions.

  1. Hypocaloric, high-protein nutrition therapy in older vs younger critically ill patients with obesity.

    Science.gov (United States)

    Dickerson, Roland N; Medling, Theresa L; Smith, Ashley C; Maish, George O; Croce, Martin A; Minard, Gayle; Brown, Rex O

    2013-01-01

    Older patients require more protein than younger patients to achieve anabolism, but age-associated renal dysfunction may limit the amount of protein that can be safely provided. This study examined whether older, critically ill trauma patients with obesity can safely achieve nitrogen equilibrium and have positive clinical outcomes similar to younger obese patients during hypocaloric, high-protein nutrition therapy. Adult patients with traumatic injury and obesity (body mass index [BMI] >30 kg/m(2)), admitted to the Presley Trauma Center from January 2009 to April 2011, were evaluated. Patients were targeted to receive hypocaloric, high-protein nutrition therapy (2 g/kg IBW/d of protein) for >10 days. Patients were stratified as older (≥60 years) or younger (18-59 years). Seventy-four patients (33 older, 41 younger) were studied. Older and younger patients were similar in BMI and injury severity. When given isonitrogenous regimens (2.3 ± 0.2 g/kg IBW/d), nitrogen balance was similar between older and younger patients (-3.2 ± 5.7 g/d vs -4.9 ± 9.0 g/d; P = .363). Older patients experienced a greater mean serum urea nitrogen concentration than younger patients (30 ± 14 mg/dL vs 20 ± 9 mg/dL; P = .001) during nutrition therapy. Clinical outcomes were not different between groups. Older critically ill trauma patients exhibited an equivalent net protein response as younger patients during hypocaloric, high-protein nutrition therapy. Older patients are at greater risk for developing azotemia. Close monitoring is warranted.

  2. Concept analysis of good death in terminally ill patients.

    Science.gov (United States)

    Granda-Cameron, Clara; Houldin, Arlene

    2012-12-01

    The purpose of this concept analysis of good death was to examine the attributes of a good death and explore the changes of the concept over time and its impact on terminally ill patients. The method used for this analysis was the Rodgers' evolutionary method. A literature search was completed using Medline Ovid and Journal Storage (JSTOR).The findings describe the evolution of the good death concept over time from the prehistoric era followed by premodern, modern, and postmodern times. In addition, information is presented about surrogate terms, attributes, antecedents, and consequences associated with good death followed by analysis and discussion of the findings. General attributes of a good death include pain and symptom management, awareness of death, patient's dignity, family presence, family support, and communication among patient, family, and health care providers.

  3. An assessment tool for acutely ill medical patients.

    LENUS (Irish Health Repository)

    Gleeson, Margaret

    2012-01-31

    This article reports the implementation and impact of a standardized systematic evidence-based predictive score for the initial assessment of acutely ill medical patients. The Simple Clinical Score (SCS) was introduced in the A&E department and the medical floor of the authors\\' hospital between June 2007 and July 2008. The SCS was well received by the staff - 67% felt it greatly improved patient assessment and was very valuable for ensuring appropriate placement of the patient after admission and improved the quality of care. This article describes the change process, the pilot evaluation and the training programme undertaken during the implementation of the SCS. It is hoped that this experience will be of value to other project teams who are undertaking similar initiatives.

  4. An assessment tool for acutely ill medical patients.

    LENUS (Irish Health Repository)

    Gleeson, Margaret

    2012-01-26

    This article reports the implementation and impact of a standardized systematic evidence-based predictive score for the initial assessment of acutely ill medical patients. The Simple Clinical Score (SCS) was introduced in the A&E department and the medical floor of the authors\\' hospital between June 2007 and July 2008. The SCS was well received by the staff - 67% felt it greatly improved patient assessment and was very valuable for ensuring appropriate placement of the patient after admission and improved the quality of care. This article describes the change process, the pilot evaluation and the training programme undertaken during the implementation of the SCS. It is hoped that this experience will be of value to other project teams who are undertaking similar initiatives.

  5. Annotation: New research into general psychiatric services for adults with intellectual disability and mental illness.

    Science.gov (United States)

    Chaplin, R

    2009-03-01

    There are a variety of models for the mental health care of adults with comorbid intellectual disability (ID) and mental illness. There has been a long-running debate as to whether this should be provided by general psychiatric or specialised ID services. A previous review concluded that there was no clear evidence to support either model with research being often of a poor quality, lacking replication, and outcome measures were often inappropriate or varied between studies. This review aims assess differences in outcome for patients with ID and mental disorders treated in general or specialised ID mental health services. A literature review was conducted using electronic databases and websites of ID and mental health organisations to locate all references where people with ID receive mental health care in general psychiatric services from 2003. No meta-analysis was attempted because of the divergent nature of the studies. People with ID (especially severe ID) have reduced access to general psychiatric services. General psychiatric inpatient care is unpopular especially with carers but can be improved by providing specially trained staff and in-reach from community ID teams. Opportunities may exist to enhance the care of people with borderline intellectual functioning within general psychiatric services. Although no new randomised controlled trials have been published, the weight of research is accumulating to suggest that provision of general psychiatric services without extra help is not sufficient to meet the needs of people with ID.

  6. Attitudes of terminally ill older adults toward complementary and alternative medicine therapies.

    Science.gov (United States)

    Grief, Cindy J; Grossman, Daphna; Rootenberg, Mark; Mah, Linda

    2013-01-01

    The aim of this study was to characterize the attitudes of older adults on an inpatient palliative care unit toward complementary and alternative medicine (CAM) therapies. A consecutive sample of 33 inpatients (61 to 98 years old) completed a questionnaire that examined their attitudes toward CAM to determine the acceptability of these therapies. Corresponding questionnaires were gathered from 10 substitute decision makers (SDMs). Preferences for specific CAM modalities were identified. Correlational analyses were performed between interest in CAM therapies and demographic variables and clinical status, including physical and psychological distress. A total of 27 patients (82 percent) were interested in trying CAM therapies. The greatest interest was shown in music therapy (61 percent) and massage therapy (58 percent). All of the SDMs were interested in having CAM therapies available for their loved ones to try. Attitudes toward CAM therapies of terminally ill older inpatients and their SDMs are highly favourable. CAM treatments merit closer evaluation as a means of enhancing end-of-life care.

  7. Pontine-to-midbrain ratio indexes ocular-motor function and illness stage in adult Niemann-Pick disease type C.

    Science.gov (United States)

    Walterfang, M; Macfarlane, M D; Looi, J C L; Abel, L; Bowman, E; Fahey, M C; Desmond, P; Velakoulis, D

    2012-03-01

    Niemann-Pick disease type C (NPC) is a progressive neurovisceral disorder associated with dystonia, ataxia and a characteristic gaze palsy. Neuropathological studies have demonstrated brainstem atrophy associated with neuronal inclusions and loss, and neurofibrillary tangles, although it is not known whether this pathology can be detected in vivo or how these changes relate to illness variables, particularly ocular-motor changes. Our aim was to utilize a method for brainstem atrophy, validated in progressive supranuclear palsy (PSP), in a group of adult patients with NPC, and explore its relationship to illness variables and ocular-motor functioning. We calculated the midbrain and pontine area, and pontine-to-midbrain ratio (PMR) from midsagittal images of 10 adult patients with NPC and 27 age- and gender-matched controls. Measures were correlated with illness variables, and measures of horizontal saccadic functioning. Pontine-to-midbrain ratio was 14% higher in the NPC group, but this difference was not significant. However, PMR showed a significant positive correlation with duration of illness and a measure of illness severity. Furthermore, PMR was significantly negatively correlated with saccadic peak velocity and gain, and self-paced saccadic performance. Pontine-to-midbrain ratio was increased in adult patients with NPC compared to controls, although not to the same degree as previously described in PSP, which also presents with significant gaze palsy. These changes were driven predominantly by progressive midbrain atrophy. The strong correlation with illness and ocular-motor variables suggests that it may be a useful marker for illness progression in NPC. © 2011 The Author(s). European Journal of Neurology © 2011 EFNS.

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

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    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

  9. What can we learn? Adult outcomes in children of seriously mentally ill mothers.

    Science.gov (United States)

    O'Connell, Kathleen LeClear

    2008-05-01

    Information is lacking about the experiences, needs of, and interventions for children of seriously mentally ill mothers. Quantitative and qualitative methods of inquiry were used to retrospectively explore the characteristics and needs of adult children of seriously mentally ill mothers. The sample (N = 40) was recruited by referral and media advertisements. Childhood variables related to attachment, family environment, and parenting were compared to adult well-being outcomes of depression, quality of life, sense of coherence, and self-esteem. Participants also responded to the question "What other question should have been included in this study about your experience as the child of a seriously mentally ill mother?" and, additionally, spontaneously added their own clarifications of their answers to the survey questions. It was apparent that the childhoods of participants were disruptive and often painful. Over half of the sample reported having their own diagnosis of depression in adulthood. Despite these factors, most members of the study sample were functioning well in adulthood, most often as a result of their own initiative. A high rate of depression in adulthood and participants' own descriptions of their painful memories and experiences of childhood identifies that more can and should be done to assist children of mentally ill mothers to cope with their environments. Interventions at various times in childhood are described.

  10. Care burden of parents of adult children with mental illness: The role of associative stigma.

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    Park, Keunwoo; Seo, Mikyung

    2016-10-01

    Parents of offspring with mental illness must endure endless child care burden despite their old age, and must cope with associative stigma. This study analyzed the mediator effect of associative stigma on relationships between the main stressors, psychiatric symptoms and lowered social function of offspring with mental illness, assessed by the parents, and their care burden. 215 parents caring for an adult child with mental illness in Korea were surveyed (Mage=60.68, SD=13.58; 74.4% mothers). They were asked to assess the psychiatric symptoms and social function of their offspring, the stigma they experienced, and the objective/subjective care burdens they felt. Our findings suggest that the symptoms and function of offspring directly affect the care burden of parents, but also have an indirect effect mediated by associative stigma. Among the predictor variables, symptoms have a greater effect on the subjective/objective burden and associative stigma than social function. We suggest strategies for parents to overcome associative stigma and emphasize the professional endeavor required to meet the service needs of elderly parents taking care of an adult child with mental illness. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Altered hippocampal morphology in unmedicated patients with major depressive illness

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    Carrie E Bearden

    2009-11-01

    Full Text Available Despite converging evidence that major depressive illness is associated with both memory impairment and hippocampal pathology, findings vary widely across studies and it is not known whether these changes are regionally specific. In the present study we acquired brain MRIs (magnetic resonance images from 31 unmedicated patients with MDD (major depressive disorder; mean age 39.2±11.9 years; 77% female and 31 demographically comparable controls. Three-dimensional parametric mesh models were created to examine localized alterations of hippocampal morphology. Although global volumes did not differ between groups, statistical mapping results revealed that in MDD patients, more severe depressive symptoms were associated with greater left hippocampal atrophy, particularly in CA1 (cornu ammonis 1 subfields and the subiculum. However, previous treatment with atypical antipsychotics was associated with a trend towards larger left hippocampal volume. Our findings suggest effects of illness severity on hippocampal size, as well as a possible effect of past history of atypical antipsychotic treatment, which may reflect prolonged neuroprotective effects. This possibility awaits confirmation in longitudinal studies.

  12. Practice of strict glycemic control in critically ill patients.

    Science.gov (United States)

    Schultz, Marcus J; de Graaff, Mart J; Royakkers, Annic A N M; van Braam Houckgeest, Floris; van der Sluijs, Johannes P; Kieft, Hans; Spronk, Peter E

    2008-11-01

    Blood glucose control aiming at normoglycemia, frequently referred to as "strict glycemic control", decreases mortality and morbidity of critically ill patients. We searched the medical literature for export opinions, surveys, and clinical reports on blood glucose control in intensive care medicine. While strict glycemic control has been recommended standard of care for critically ill patients, the risk of severe hypoglycemia with strict glycemic control is frequently mentioned by experts. Some rationalize this risk, though others strongly point out the high incidence of hypoglycemia to be (one) reason not to perform strict glycemic control. Implementation of strict glycemic control is far from complete in intensive care units across the world. Frequently local guidelines accept higher blood glucose levels than those with strict glycemic control. Only a minority of retrieved manuscripts are on blood glucose regimens with the lower targets as with strict glycemic control. Hypoglycemia certainly is encountered with blood glucose control, in particular with strict glycemic control. Reports show intensive care-nurses can adequately and safely perform strict glycemic control. Implementation of strict glycemic control is far from complete, at least in part because of the feared risks of hypoglycemia. The preference for hyperglycemia over intermittent hypoglycemia is irrational, however, because there is causal evidence of harm for the former but only associative evidence of harm for the latter. For several reasons it is wise to have strict glycemic control being a nurse-based strategy.

  13. Family needs of critically ill patients in the emergency department.

    Science.gov (United States)

    Hsiao, Ping-Ru; Redley, Bernice; Hsiao, Ya-Chu; Lin, Chun-Chih; Han, Chin-Yen; Lin, Hung-Ru

    2017-01-01

    Family members' experience a range of physiological, psychological and emotional impacts when accompanying a critically ill relative in the emergency department. Family needs are influenced by their culture and the context of care, and accurate clinician understanding of these needs is essential for patient- and family-centered care delivery. The aim of this study was to describe the needs of Taiwanese family members accompanying critically ill patients in the emergency department while waiting for an inpatient bed and compare these to the perceptions of emergency nurses. A prospective cross-sectional survey was conducted in a large medical center in Taiwan. Data were collected from 150 family members and 150 emergency nurses who completed a Chinese version of the Critical Care Family Needs Inventory. Family members ranked needs related to 'communication with family members,' as most important, followed by 'family member participation in emergency department care', 'family member support' and 'organizational comfort'; rankings were similar to those of emergency nurses. Compared to nurses, family members reported higher scores for the importance of needs related to 'communication with family members' and 'family members' participation in emergency department care'. Family members place greater importance than emergency nurses on the need for effective communication. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Correlation between the severity of critically ill patients and clinical predictors of bronchial aspiration

    Science.gov (United States)

    de Medeiros, Gisele Chagas; Sassi, Fernanda Chiarion; Zambom, Lucas Santos; de Andrade, Claudia Regina Furquim

    2016-01-01

    Objective: To determine whether the severity of non-neurological critically ill patients correlates with clinical predictors of bronchial aspiration. Methods: We evaluated adults undergoing prolonged orotracheal intubation (> 48 h) and bedside swallowing assessment within the first 48 h after extubation. We collected data regarding the risk of bronchial aspiration performed by a speech-language pathologist, whereas data regarding the functional level of swallowing were collected with the American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) scale and those regarding health status were collected with the Sequential Organ Failure Assessment (SOFA). Results: The study sample comprised 150 patients. For statistical analyses, the patients were grouped by ASHA NOMS score: ASHA1 (levels 1 and 2), ASHA2 (levels 3 to 5); and ASHA3 (levels 6 and 7). In comparison with the other patients, those in the ASHA3 group were significantly younger, remained intubated for fewer days, and less severe overall clinical health status (SOFA score). The clinical predictors of bronchial aspiration that best characterized the groups were abnormal cervical auscultation findings and cough after swallowing. None of the patients in the ASHA 3 group presented with either of those signs. Conclusions: Critically ill patients 55 years of age or older who undergo prolonged orotracheal intubation (≥ 6 days), have a SOFA score ≥ 5, have a Glasgow Coma Scale score ≤ 14, and present with abnormal cervical auscultation findings or cough after swallowing should be prioritized for a full speech pathology assessment. PMID:27167432

  15. Clinical associations of host genetic variations in the genes of cytokines in critically ill patients.

    Science.gov (United States)

    Belopolskaya, O B; Smelaya, T V; Moroz, V V; Golubev, A M; Salnikova, L E

    2015-06-01

    Host genetic variations may influence a changing profile of biochemical markers and outcome in patients with trauma/injury. The objective of this study was to assess clinical associations of single nucleotide polymorphisms (SNPs) in the genes of cytokines in critically ill patients. A total of 430 patients were genotyped for SNPs in the genes of pro- (IL1B, IL6, IL8) and anti-inflammatory (IL4, IL10, IL13) cytokines. The main end-points were sepsis, mortality and adult respiratory distress syndrome (ARDS). We evaluated the dynamic levels of bilirubin, blood urea nitrogen, creatine kinase, creatinine and lactate dehydrogenase in five points of measurements (between 1 and 14 days after admission) and correlated them with SNPs. High-producing alleles of proinflammatory cytokines protected patients against sepsis (IL1B -511A and IL8 -251A) and mortality (IL1B -511A). High-producing alleles of anti-inflammatory cytokines IL4 -589T and IL13 431A (144Gln) were less frequent in ARDS patients. The carriers of IL6 -174C/C genotypes were prone to the increased levels of biochemical markers and acute kidney and liver insufficiency. Genotype-dependent differences in the levels of biochemical indicators gradually increased to a maximal value on the 14th day after admission. These findings suggest that genetic variability in pro- and anti-inflammatory cytokines may contribute to different clinical phenotypes in patients at high risk of critical illness.

  16. Unfinished Business in Families of Terminally Ill with Cancer Patients.

    Science.gov (United States)

    Yamashita, Ryoko; Arao, Harue; Takao, Ayumi; Masutani, Eiko; Morita, Tatsuya; Shima, Yasuo; Kizawa, Yoshiyuki; Tsuneto, Satoru; Aoyama, Maho; Miyashita, Mitsunori

    2017-08-11

    Unfinished business often causes psychological issues after bereavement. Providing care for families of terminally ill patients with cancer to prevent unfinished business is important. To clarify the prevalence and types of unfinished business in families of end-of-life patients with cancer admitted to palliative care units (PCUs), explore depression and grief associated with unfinished business, and explore the factors affecting unfinished business. We conducted a cross-sectional, anonymous, self-report questionnaire survey with 967 bereaved families of patients with cancer admitted to PCUs. The questionnaire assessed the presence/absence of unfinished business, content of unfinished business, depression, grief, process of preparedness, condition of the family and patient, and the degree of involvement of healthcare professionals. Questionnaires were sent to 967 families and 73.0% responded. In total, 26% of families had some unfinished business, with improvement of the patient-family relationship being a common type of unfinished business. Families with unfinished business had significantly higher depression and grief scores after bereavement compared with those without. Factors that influenced the presence/absence of unfinished business were preparedness for the patient's death (p=.001); discussion between the patient and family about the disease trajectory and way to spend daily life (pbusiness. Healthcare professionals should coordinate the appropriate timing for what the family wishes to do, with consideration of family dynamics including the family's preparedness, communication pattern, and relationships. Copyright © 2017. Published by Elsevier Inc.

  17. Illness perceptions in patients with systemic lupus erythematosus and proliferative lupus nephritis.

    Science.gov (United States)

    Daleboudt, G M N; Broadbent, E; Berger, S P; Kaptein, A A

    2011-03-01

    This study investigated the illness perceptions of patients with systemic lupus erythematosus (SLE) and whether perceptions are influenced by type of treatment for proliferative lupus nephritis. In addition, the illness perceptions of SLE patients were compared with those of patients with other chronic illnesses. Thirty-two patients who had experienced at least one episode of proliferative lupus nephritis were included. Patients were treated with either a high or low-dose cyclophosphamide (CYC) regimen (National Institutes of Health [NIH] vs. Euro-Lupus protocol). Illness perceptions were measured with the Brief Illness Perception Questionnaire (B-IPQ) and a drawing assignment. The low-dose CYC group perceived their treatment as more helpful than the high-dose CYC group. In comparison with patients with asthma, SLE patients showed more negative illness perceptions on five of the eight illness perception domains. Drawings of the kidney provided additional information about perceptions of treatment effectiveness, kidney function and patients' understanding of their illness. Drawing characteristics showed associations with perceptions of consequences, identity, concern and personal control. These findings suggest that the type of treatment SLE patients with proliferative lupus nephritis receive may influence perceptions of treatment effectiveness. In addition, patients' drawings reveal perceptions of damage caused by lupus nephritis to the kidneys and the extent of relief provided by treatment. The finding that SLE is experienced as a more severe illness than other chronic illnesses supports the need to more frequently assess and aim to improve psychological functioning in SLE patients.

  18. Adaptation to a spouse's disability by parents of adult children with mental illness or developmental disability.

    Science.gov (United States)

    Ghosh, Subharati; Greenberg, Jan S; Seltzer, Marsha Mailick

    2012-11-01

    This study examined the effects on well-being of a spouse's disability among aging parents already serving as caregivers of adult children with severe mental illness or a developmental disability. The study sample consisted of two groups of participants in the Wisconsin Longitudinal Study of 1957 high school graduates and their randomly selected siblings-those who had a child with a disability (N=227) and a matched comparison group of parents who did not have a child with a disability (N=1,463). The participants were surveyed in 1992-1994 and 2004-2006, and participants with a spouse with a disability in 1992-1994 were excluded from the analysis. The effect of multiple caregiving roles was investigated by using regression analysis. Parents of adult children with severe mental illness were more likely than either parents of adult children with developmental disabilities or the comparison group to report that their spouse developed a disability in the early retirement years. The experience of caring for a spouse with a disability and the experience of caring for an adult child with disabilities had additive effects in eroding the well-being of older adults. Parents of adult children with severe mental illness in general had the lowest levels of well-being. As they move into their retirement years, aging parents who care for children with long-term disabilities are likely to experience multiple caregiving responsibilities. Service providers must address the needs of these aging parents and develop interventions to help them cope and plan for their future.

  19. [Tissue oxygen saturation in the critically ill patient].

    Science.gov (United States)

    Gruartmoner, G; Mesquida, J; Baigorri, F

    2014-05-01

    Hemodynamic resuscitation seeks to correct global macrocirculatory parameters of pressure and flow. However, current evidence has shown that despite the normalization of these global parameters, microcirculatory and regional perfusion alterations can persist, and these alterations have been independently associated with a poorer patient prognosis. This in turn has lead to growing interest in new technologies for exploring regional circulation and microcirculation. Near infra-red spectroscopy allows us to monitor tissue oxygen saturation, and has been proposed as a noninvasive, continuous and easy-to-obtain measure of regional circulation. The present review aims to summarize the existing evidence on near infra-red spectroscopy and its potential clinical role in the resuscitation of critically ill patients in shock. Copyright © 2013 Elsevier España, S.L. and SEMICYUC. All rights reserved.

  20. Screening for depression in terminally ill cancer patients in Japan.

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    Akechi, Tatsuo; Okuyama, Toru; Sugawara, Yuriko; Shima, Yasuo; Furukawa, Toshiaki A; Uchitomi, Yosuke

    2006-01-01

    This study attempted to assess the performance of several screening instruments for adjustment disorders (ADs) and major depression (MD) among terminally ill Japanese cancer patients. Two hundred and nine consecutive patients were assessed for ADs and MD using a structured clinical interview at the time of their registration with a palliative care unit, and two single-item interviews ("Are you depressed?" and "Have you lost interest?") and the Hospital Anxiety and Depression Scale (HADS) were administered. Screening performance was investigated by calculating sensitivity, specificity, the positive predictive value, negative predictive value, likelihood ratio, and stratum-specific likelihood ratios. When the screening target included both an AD and MD, the HADS is a more useful screening method than the single-item interviews. Regarding screening for MD, both single-item interviews and the HADS possess useful screening performance. Different screening instruments may be recommended depending on the depressive disorders and specific populations.

  1. Comparison of sedation strategies for critically ill patients

    DEFF Research Database (Denmark)

    Hutton, Brian; Burry, Lisa D; Kanji, Salmaan

    2016-01-01

    BACKGROUND: Sedatives and analgesics are administered to provide sedation and manage agitation and pain in most critically ill mechanically ventilated patients. Various sedation administration strategies including protocolized sedation and daily sedation interruption are used to mitigate drug...... of interest include duration of mechanical ventilation, time to first extubation, ICU and hospital length of stay, re-intubation, tracheostomy, mortality, total sedative and opioid exposure, health-related quality of life, and adverse events. To inform our NMA, we will first conduct conventional pair......-wise meta-analyses using random-effects models. Where appropriate, we will perform Bayesian NMA using WinBUGS software. DISCUSSION: There are multiple strategies to optimize sedation for mechanically ventilated patients. Current ICU guidelines recommend protocolized sedation or daily sedation interruption...

  2. Legacy Making Through Illness Blogs: Online Spaces for Young Adults Approaching the End-of-Life.

    Science.gov (United States)

    Keim-Malpass, Jessica; Adelstein, Katharine; Kavalieratos, Dio

    2015-12-01

    Little is known about young adults with cancer at the end-of-life, but life review and legacy making may be important modalities to process the emotions associated with anticipatory grief. The study analyzed the illness blogs of five young women (aged 25-39 years) at the end-of-life using a narrative approach. Key elements of legacy making and grief processing were explored. The women had varying experiences before their death, but uniform posthumous occurrences with the use of the blog for a space of grief for loved ones. The use of online blogs among adolescents and young adults with advanced cancer is an area of needed further study.

  3. Rationality of Prescriptions for Patients Admitted With Common Illnesses in a Children’s Hospital

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    Shiva

    2016-05-01

    Full Text Available Background Recent advances in medicine and the pharmaceutical industry have led to a multitude of treatment options for the management of illness in both adults and children. Objectives To identify prescribing patterns for children hospitalized with common acute illnesses in a tertiary-care children’s hospital. Materials and Methods Case notes of children hospitalized from October 2013 to September 2014 with urinary tract infection, respiratory distress, pneumonia, acute gastroenteritis, febrile convulsions, acute bacterial meningitis, and fever with rash or without a localized source, as well as case notes of previously healthy children scheduled for surgery, were reviewed. Relevant data regarding diagnoses, hospital course, and treatment were documented on information sheets and reviewed independently by two members of the faculty (pediatric infectious disease specialists to evaluate the appropriateness of prescriptions given for each patient. Results A total of 227 case notes were reviewed, 129 (56.8% of which belonged to male patients. No medication was prescribed for 13 patients, whereas 697 drug prescriptions (excluding intravenous fluids were given for 214 patients, equaling 3.25 drugs/patient; antibiotics were prescribed for 161 children (70.92%. Overall, 87.96% of drugs were prescribed by their generic names; 20% of prescribed medications were unnecessary; the dose was incorrect in 15% of prescriptions; and the duration of treatment was inappropriate in about 27% of prescriptions. Only 29% of children with acute diarrhea received oral rehydration therapy. Conclusions Findings reveal a significant degree of prescription errors, emphasizing the need for stringent surveillance.

  4. Caring for Acutely Ill Patients in General Wards: A Qualitative Study.

    Science.gov (United States)

    Jeddian, Ali Reza; Lindenmeyer, Antje; Marshall, Tom; Rashidian, Arash; Sayadi, Leila; Jafari, Nazila

    2016-09-01

    The number of acutely ill patients has risen in general wards due to the aging population, more advanced and complicated therapeutic methods, economic changes in the health system, therapeutic choices and shortage of intensive care unit beds. This may lead to adverse events and outcomes with catastrophic results. The purpose of this study was to describe the conditions of acutely ill patients, from the perspective of caregivers. The study was conducted in Tehran University of Medical Sciences and its two affiliated general teaching hospitals. Ten nurses and physicians participated in interviews, which were analyzed using qualitative content analysis methods. Four main categories of difficulties in caring for acutely ill patients in general wards were described: problems in identifying acutely ill patients, problems in clinical management of acutely ill patients, inappropriate use of Intensive Care Unit (ICU) beds, and poor structure for mortality control. The staff do not appropriately diagnose the signs of deterioration. There are problems with the appropriate management of acutely ill patients, even if they are considered to be acutely ill and in need of special attention in general wards. Many shortcomings exist caring for acutely ill patients, ranging from identification to clinical management; there are also structural and contextual problems. An immediate plan is necessary to circumvent the challenges and to improve the care for acutely ill patients. These challenges highlight the need for changes in current levels of care for acutely ill patients, as well as the need for appropriate support systems.

  5. Amikacin Population Pharmacokinetics in Critically Ill Kuwaiti Patients

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    Kamal M. Matar

    2013-01-01

    Full Text Available Amikacin pharmacokinetic data in Kuwaiti (Arab intensive care unit (ICU patients are lacking. Fairly sparse serum amikacin peak and trough concentrations data were obtained from adult Kuwaiti ICU patients. The data were analysed using a nonparametric adaptive grid (NPAG maximum likelihood algorithm. The estimations of the developed model were assessed using mean error (ME as a measure of bias and mean squared error (MSE as a measure of precision. A total of 331 serum amikacin concentrations were obtained from 56 patients. The mean (±SD model parameter values found were Vc = 0.2302 ± 0.0866 L/kg, kslope = 0.004045 ± 0.00705 min per unit of creatinine clearance, k12 = 2.2121 ± 5.506 h−1, and k21 = 1.431 ± 2.796 h−1. The serum concentration data were estimated with little bias (ME = −0.88 and good precision (MSE = 13.08. The present study suggests that amikacin pharmacokinetics in adult Kuwaiti ICU patients are generally rather similar to those found in other patients. This population model would provide useful guidance in developing initial amikacin dosage regimens for such patients, especially using multiple model (MM dosage design, followed by appropriate Bayesian adaptive control, to optimize amikacin dosage regimens for each individual patient.

  6. Relating illness complexity to reimbursement in CKD patients

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    Bessette RW

    2011-09-01

    Full Text Available Russell W Bessette1, Randy L Carter2,3 1Department of Health Sciences, Institute for Healthcare Informatics, 2Department of Biostatistics, 3Population Health Observatory, University at Buffalo, State University of New York, Buffalo, NY, USA Background: Despite significant investments of federal and state dollars to transition patient medical records to an all-electronic system, a chasm still exists between health care quality and payment for it. A major reason for this gap is the difficulty in evaluating health care outcomes based on claims data. Since both payers and patients may not appreciate how illness complexity impacts treatment outcomes, it is difficult to determine fair provider compensation. Objectives: Chronic kidney disease (CKD typifies these problems and is often associated with comorbidities that impact cost, health, and work productivity. Thus, the objective of this study was to evaluate an illness complexity score (ICS based on a linear regression of select blood values that might assist in predicting average monthly reimbursements in CKD patients. A second objective was to compare the results of this ICS prediction to results obtained by prediction of average monthly reimbursement using CKD stage. A third objective was to analyze the relationship between the change in ICS, estimated glomerular filtration rate (eGFR, and CKD stage over time to average monthly reimbursement. Methods: We calculated parsimonious values for select variables associated with CKD patients and compared the ICS to ordinal staging of renal disease. Data from 177 de-identified patients over 13 months was collected, which included 15 blood chemistry observations along with complete claims data for all medical expenses. To test for the relationship between average blood chemistry values, stages of CKD, age, and average monthly reimbursement, we modeled an association through a linear regression function of age, eGFR, and the Z-scores calculated from average

  7. Adaptation to different noninvasive ventilation masks in critically ill patients

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    Renata Matos da Silva

    2013-06-01

    Full Text Available OBJECTIVE: To identify which noninvasive ventilation (NIV masks are most commonly used and the problems related to the adaptation to such masks in critically ill patients admitted to a hospital in the city of São Paulo, Brazil. METHODS: An observational study involving patients ≥ 18 years of age admitted to intensive care units and submitted to NIV. The reason for NIV use, type of mask, NIV regimen, adaptation to the mask, and reasons for non-adaptation to the mask were investigated. RESULTS: We evaluated 245 patients, with a median age of 82 years. Acute respiratory failure was the most common reason for NIV use (in 71.3%. Total face masks were the most commonly used (in 74.7%, followed by full face masks and near-total face masks (in 24.5% and 0.8%, respectively. Intermittent NIV was used in 82.4% of the patients. Adequate adaptation to the mask was found in 76% of the patients. Masks had to be replaced by another type of mask in 24% of the patients. Adequate adaptation to total face masks and full face masks was found in 75.5% and 80.0% of the patients, respectively. Non-adaptation occurred in the 2 patients using near-total facial masks. The most common reason for non-adaptation was the shape of the face, in 30.5% of the patients. CONCLUSIONS: In our sample, acute respiratory failure was the most common reason for NIV use, and total face masks were the most commonly used. The most common reason for non-adaptation to the mask was the shape of the face, which was resolved by changing the type of mask employed.

  8. Should blood cultures be performed in terminally Ill cancer patients?

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    Nobuhiro Asai

    2015-04-01

    Full Text Available Background: No evidence-based guidelines or protocols to treat the infection-related symptoms in cancer patients with terminal stages have been established. Materials and Methods: We retrospectively analyzed all the patients with terminal stage cancer who died between April 2009 and March 2010. The patients' background, the prevalence of infection and clinical outcomes, pathogens isolated, antibiotics used, and whether blood cultures and some of examinations were performed or not were evaluated. Results: A total of 62 (44 males and 18 females patients were included in this study. The median age was 73 years (35-98 years. The most common cancer was that of the lung (n =59, 95.2%. A total of 32 patients were diagnosed with the following infections: Infection of respiratory tract in 27 (84.4%, of urinary tract in 4 (12.5%, and cholangitis in 1 (3.1%. Two cases (6.3% had pneumonia complicated with urinary tract infection. Blood cultures and antibiotic therapies were performed in 28 and 30 cases, respectively. Four (14.3% positive cultures were isolated from the blood obtained from 28 individual patients. As for clinical course, 3 (10% of them experienced improved symptoms after antibiotic therapy. Twenty-seven (90% patients were not confirmed as having any symptom improvement. Conclusions: Blood cultures and antibiotic therapy were limited, and might not be effective in terminally ill cancer patients with lung cancer. We suggest that administering an antibiotic therapy without performing a blood culture would be one of choices in those with respiratory tract infections if patients' life expectancy is short.

  9. Recurrent brain tumour: the impact of illness on patient's life.

    Science.gov (United States)

    Lamperti, Elena; Pantaleo, Giuseppe; Finocchiaro, Claudia Yvonne; Silvani, Antonio; Botturi, Andrea; Gaviani, Paola; Sarno, Lucio; Salmaggi, Andrea

    2012-06-01

    Despite advances in therapies that offer improved survival rates, clinical course of brain tumours leads to a progressive functional deterioration in patients with modifications in their psychological reaction to the disease. Patients with brain tumours are rarely assessed for quality of life and psychological variables, and even fewer studies have assessed patients who have experienced a recurrence of brain tumours. Therefore, the aim of the present study is to investigate the patients with recurrent brain tumours and their reaction to the illness. We enrolled 81 patients with recurrent CNS tumours. Karnofsky Performance Status scale (KPS) was used to evaluate functional status of patients; the multidimensional aspect of quality of life was assessed through "Functional Assessment of Cancer Therapy-Brain" (FACT-Br), "Hospital Anxiety and Depression Scale" and "Psychological Distress Inventory". These were all used as tests of psychological well-being. Distress and almost all mean FACT-Br subscale scores seemed to be significantly lower in patients, in comparison with normative data. Surprisingly, the emotional well-being mean score was significantly higher in our recurrence sample than in patients with brain tumours at first diagnosis. Anxiety seemed not to be influenced by a relapse diagnosis; instead, depression was higher and differed significantly from normative data. Low correlation between KPS and FACT-Br total and some sub-scores was found. Apparent dissociation between patients' judgment on their quality of life (bad except for emotional) and their reported distress (low) is the most intriguing finding, suggesting highly preserved coping strategies in the emotional sphere, despite intact judgment and disease awareness.

  10. Continuous infusion of antibiotics in critically ill patients.

    Science.gov (United States)

    Smuszkiewicz, Piotr; Szałek, Edyta; Tomczak, Hanna; Grześkowiak, Edmund

    2013-02-01

    Antibiotics are the most commonly used drugs in intensive care unit patients and their supply should be based on pharmacokinetic/pharmacodynamic rules. The changes that occur in septic patients who are critically ill may be responsible for subtherapeutic antibiotic concentrations leading to poorer clinical outcomes. Evolving in time the disturbed pathophysiology in severe sepsis (high cardiac output, glomerular hyperfiltration) and therapeutic interventions (e.g. haemodynamically active drugs, mechanical ventilation, renal replacement therapy) alters antibiotic pharmacokinetics mainly through an increase in the volume of distribution and altered drug clearance. The lack of new and efficacious drugs and increased bacterial resistance are current problems of contemporary antibiotic therapy. Although intermittent administration is a standard clinical practice, alternative methods of antibiotic administration are sought, which may potentialise effects and reduce toxicity as well as contribute to inhibition of bacterial resistance. A wide range of studies prove that the application of continuous infusion of time-dependent antibiotics (beta-lactams, glycopeptides) is more rational than standard intermittent administration. However, there are also studies which do not confirm the advantage of one method over the other. In spite of controversy the continuous administration of this group of antibiotics is common practice, because the results of both studies point to the higher efficacy of this method in critically ill patients. Authors reviewed the literature to determine whether any clinical benefits exist for administration of time-dependent antibiotics by continuous infusion. Definite specification of the clinical advantage of administration this way over standard dosage requires a large-scale multi-centre randomised controlled trial.

  11. Regenerative Endodontics for Adult Patients.

    Science.gov (United States)

    He, Ling; Kim, Sahng G; Gong, Qimei; Zhong, Juan; Wang, Sainan; Zhou, Xuedong; Ye, Ling; Ling, Junqi; Mao, Jeremy J

    2017-09-01

    The goal of endodontics is to save teeth. Since inception, endodontic treatments are performed to obturate disinfected root canals with inert materials such as gutta-percha. Although teeth can be saved after successful endodontic treatments, they are devitalized and therefore susceptible to reinfections and fractures. The American Association of Endodontists (AAE) has made a tremendous effort to revitalize disinfected immature permanent teeth in children and adolescents with diagnoses including pulp necrosis or apical periodontitis. The American Dental Association (ADA) in 2011 issued several clinical codes for regenerative endodontic procedures or apical revascularization in necrotic immature permanent teeth in children and adolescents. These AAE and ADA initiatives have stimulated robust interest in devising a multitude of tissue engineering approaches for dental pulp and dentin regeneration. Can the concept of regenerative endodontics be extended to revitalize mature permanent teeth with diagnoses including irreversible pulpitis and/or pulp necrosis in adults? The present article was written not only to summarize emerging findings to revitalize mature permanent teeth in adult patients but also to identify challenges and strategies that focus on realizing the goal of regenerative endodontics in adults. We further present clinical cases and describe the biological basis of potential regenerative endodontic procedures in adults. This article explores the frequently asked question if regenerative endodontic therapies should be developed for dental pulp and/or dentin regeneration in adults, who consist of the great majority of endodontic patients. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  12. A Novel Approach to Identifying a Neuroimaging Biomarker for Patients With Serious Mental Illness.

    Science.gov (United States)

    Madan, Alok; Fowler, J Christopher; Patriquin, Michelle A; Salas, Ramiro; Baldwin, Philip R; Velasquez, Kenia M; Viswanath, Humsini; Molfese, David L; Sharp, Carla; Allen, Jon G; Hardesty, Susan; Oldham, John M; Frueh, B Christopher

    2017-02-27

    Serious mental illness (SMI) is disabling, and current interventions are ineffective for many. This exploratory study sought to demonstrate the feasibility of applying topological data analysis (TDA) to resting-state functional connectivity data obtained from a heterogeneous sample of 235 adult inpatients to identify a biomarker of treatment response. TDA identified two groups based on connectivity between the prefrontal cortex and striatal regions: patients admitted with greater functional connectivity between these regions evidenced less improvement from admission to discharge than patients with lesser connectivity between them. TDA identified a potential biomarker of an attenuated treatment response among inpatients with SMI. Insofar as the observed pattern of resting-state functional connectivity collected early during treatment is replicable, this potential biomarker may indicate the need to modify standard of care for a small, albeit meaningful, percentage of patients.

  13. 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 litt

  14. 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

  15. Metabolic effects of intensive insulin therapy in critically ill patients.

    Science.gov (United States)

    Whyte, M B; Jackson, N C; Shojaee-Moradie, F; Treacher, D F; Beale, R J; Jones, R H; Umpleby, A M

    2010-03-01

    Our aim was to investigate the effects of glycemic control and insulin concentration on lipolysis, glucose, and protein metabolism in critically ill medical patients. For our methods, the patients were studied twice. In study 1, blood glucose (BG) concentrations were maintained between 7 and 9 mmol/l with intravenous insulin. After study 1, patients entered one of four protocols for 48 h until study 2: low-insulin high-glucose (LIHG; variable insulin, BG of 7-9 mmol/l), low-insulin low-glucose (LILG; variable insulin of BG 4-6 mmol/l), high-insulin high-glucose [HIHG; insulin (2.0 mU . kg(-1).min(-1) plus insulin requirement from study 1), BG of 7-9 mmol/l], or high-insulin low-glucose [HILG; insulin (2.0 mU.kg(-1).min(-1) plus insulin requirement from study 1), BG of 4-6 mmol/l]. Age-matched healthy control subjects received two-step euglycemic hyperinsulinemic clamps achieving insulin levels similar to the LI and HI groups. In our results, whole body proteolysis was higher in patients in study 1 (P patients. Endogenous glucose production rate (R(a)), glucose disposal, and lipolysis were not different in all patients in study 1 compared with control subjects at comparable insulin concentrations. Glucose R(a) and lipolysis did not change in any of the study 2 patient groups. HI increased glucose disposal in the patients (HIHG, P = 0.001; HILG, P = 0.07 vs. study 1), but this was less than in controls receiving HI (P protein-sparing effect.

  16. ACUTE UNDIFFERENTIATED FEBRILE ILLNESS AMONG ADULTS – A HOSPITAL BASED OBSERVATIONAL STUDY

    Directory of Open Access Journals (Sweden)

    Shivkumar

    2013-04-01

    Full Text Available ABSTRACT. BACKGROUND: Fever is a burning issue in the tropics and the mos t common cause of morbidity. Quite frequently this fever goes undi agnosed because of many reasons like the lack of diagnostic facilities, insufficient epidemi ological data available on causes of fever, and so on. This research study was aimed to find out the e tiology and clinical markers of Acute Undifferentiated Febrile Illness [AUFI] among the r ural population of Southern India. METHODOLOGY: This prospective, observational study was conducted at Government Villupuram Medical College and Hospital, a rural ter tiary care centre in Tamil Nadu, India. Consecutive hospitalised adult patients [>16 years] with AUFI[5-14 days fever] were enrolled into the study from August 2010 to February 2012 [1 8 months].Upon enrollment, detailed history was recorded, physical examination done and basic blood tests including biochemical examination, smear study for malaria, blood culture s and serology for the commonly encountered infections were done according to study protocol. The patients were followed up until clinical recovery and convalescence. The data were entered in MS excel and analyzed using Epi-info software 2008 version. RESULTS: A total of 403 patients were included in the study . The distribution of AUFI included Malaria 133[33%], Typhoid 83[20.59%], Dengue 42[10.4%], Leptospirosis 25[6.2%], and other causes 36[8.9%] and unknown cause 84[20.84%]. Malaria patients were significantly associated with jaundice , altered mentation, travel outside the district, elevated AST/ALT levels, thrombocytopenia and splenomegaly. Typhoid fever was associated with longer fever duration, abdominal pai n, coated tongue, relative bradycardia, normal platelet counts and low leucocyte count. Deng ue fever could be predicted by rash, pruritis, petechiae ,retro-orbital pain and low platele t counts. Leptospirosis patients showed significant association with conjunctival suffusion , muscle

  17. Knowledge and attitude on ill effects of smoking among adults residing in Lekhnath, Kaski, Nepal

    Directory of Open Access Journals (Sweden)

    Gnanakshi D

    2014-09-01

    Full Text Available Background: Worldwide opinion says, “Smoking is injurious to health”. It is positively injurious in many ways not only to the health of smoker but also to the health of the people around him or her known as the passive smokers. The three main components of inhaled cigarette smoke are nicotine, carbon monoxide and tar, which can cause disease. If this nicotine is absorbed in the blood stream and left within 10 seconds it increases the heart rate and blood pressure by stimulating the release of hormones such as adrenaline and constricting blood vessels [1]. Aim: To assess knowledge and attitude on ill effects of smoking among adults residing in Lekhnath municipality, ward no.12, Khudi, Kaski”. Material & Method: A survey approach with the descriptive design was selected to achieve the objectives of the study. Convenient sampling technique was used to select the samples. The sample size was 100 adults of 20 years & above. Data was collected from 10/03/2013-10/04/2013 by interview technique regarding ill effects of smoking by using questionnaire and finally the data was analyzed using Excel 2007 & SPSS for Windows Version 16.0. Results: The major findings of the present study were as follows: Most of the participants (58% were having good level of knowledge, 31% were having average level of knowledge and remaining 11% were having poor level of knowledge towards ill effects of smoking. Majority of participants had favorable attitude (81% towards ill effects of smoking. The correlation between knowledge and attitude was found to be positive at the significance level of P>0.01.Significant association of knowledge was found with gender, marital status and education level regarding ill effects of smoking. Significant association of attitude was found with family type and source of information regarding ill effects of smoking. Conclusion: Hence, still few people residing in the community are having poor knowledge and attitude on ill effects of

  18. Nosocomial Candiduria in Critically Ill Patients Admitted to Intensive Care Units in Qazvin, Iran

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    Ghiasian

    2014-08-01

    Full Text Available Background A broad variety of fungi, especially Candida species, are becoming increasingly common causes of urinary tract infections in hospital settings. Objectives The current cross-sectional descriptive study aimed to determine the causative agents, risk factors and incidence rate of candiduria in critically ill patients, hospitalized in intensive care units (ICUs of four Iranian hospitals. Patients and Methods A total of 155 children and adult patients, admitted to ICUs of the four university educational hospitals, who demonstrated Candida-positive urine cultures, were examined. Samples were processed via mycological procedures by direct microscopy and culture. Results Candiduria was confirmed in 50 (32.26 % patients and Candida albicans was the most frequently isolated species representing 60.0% of isolates, followed by 14.0% C. glabrata, 12.0% C. parapsilosis, 10.0% C. krusei, and 4.0% C. tropicalis. Most patients were female (58% with a mean age of 46.7 years old. Generally, 39.7% and 62% of adults and children showed candiduria, respectively. The commonest predisposing factors were antibiotic therapy (98.0%, urinary catheterization (92.0%, corticotherapy (84.0%, being female (42.6 %, use of feeding tube (56%, and extended hospitalization, respectively. Conclusions The high frequency of candiduria in ICU patients can be decreased by shortening the duration of urinary catheterization, avoiding extra antibiotics and corticosteroids, as well as controlling the predisposing factors and underlying conditions.

  19. Original article Rehabilitation model program for seriously ill patients

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    Adrienne Kegye

    2014-10-01

    Full Text Available Background Patients receiving cancer treatment start lifestyle changes mostly at the end of the treatment during the rehabilitation period. Most often, the first step is a dietary change and physical exercises built into the daily routine. Patients who do this in groups led by qualified therapists and based on professional counseling can build more effective and more permanent changes into their life. To develop a complex rehabilitation program which, in the short term, aims to familiarize patients with a lifestyle which harmonizes the physical, mental, spiritual and social spheres of life and, in the long term, to build it into their everyday life in order to ameliorate the physical and mental state and reduce the psychological symptoms and the isolation of patients. The physical component focuses on diet and exercise. The psycho-social-spiritual support focuses on discovering inner sources of strength, developing active coping mechanisms and helping to achieve more open communication. Participants and procedure In February and March 2011, 8 patients treated for malignant tumors participated in the model program. The components of the model program were psychotherapy, physiotherapy, cancer consultation, nutrition counseling, creative activities and walking. Results During the period of the model program the isolation of the patients decreased and their social support and ability of coping with the illness ameliorated. They reported an ease in anxiety and depression in their everyday activities. According to feedback, their communication with each other, with the staff and with their relatives became more open. Altogether this had advantageous effects on the functioning of the ward and the mood of the staff. Conclusions The rehabilitation program confirmed that beside individual psycho-social support, beneficial and economic psycho-social support can be provided for the patients in group form along with the most effective assignment of the

  20. 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

    in 2006-2008 with follow-up through 2009, and 2 matched comparison cohorts from hospitalized patients and from the general population. EXPOSURES: Critical illness defined as intensive care unit admission with mechanical ventilation. MAIN OUTCOMES AND MEASURES: Adjusted prevalence ratios (PRs......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 patients......) of psychiatrist-diagnosed psychiatric illnesses and prescriptions for psychoactive medications in the 5 years before critical illness. For patients with no psychiatric history, quarterly cumulative incidence (risk) and adjusted hazard ratios (HRs) for diagnoses and medications in the following year, using Cox...

  1. Autovideography: The Lived Experience of Recovery for Adults with Serious Mental Illness.

    Science.gov (United States)

    Petros, Ryan; Solomon, Phyllis; Linz, Sheila; DeCesaris, Marissa; Hanrahan, Nancy P

    2016-09-01

    Mental health services have been transforming toward a recovery orientation for more than a decade, yet a robust understanding of recovery eludes many providers, and consensus on a conceptual definition has yet to be reached. This article examines mental health consumers' lived experience of recovery and evaluates the usefulness and comprehensiveness of CHIME, a major framework conceptually defining recovery for adults with serious mental illness. Researchers partnered with a mental health association in a major US city to engage in research with graduates of a recovery and education class for adults diagnosed with serious mental illness. Twelve participants were loaned video cameras and invited to "Tell us about your recovery" through autovideography. Of the 12 participants, six produced videos directly responding to the overall research question and were subsequently included in the present analysis. Data were analyzed thematically, and CHIME adequately represented the major domains presented in consumer videos with two notable modifications: subdomains of "reciprocity" within relationships and "contributing to others" were added to comprehensively represent consumer perspectives about recovery. Adding two subdomains to CHIME more effectively represents consumer narratives about recovery, contributes to the social construction of the personhood of people with serious mental illness, and offers a more robust description of the process of recovery.

  2. Maternal outcomes in critically ill obstetrics patients: A unique challenge

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    Rakesh Bhadade

    2012-01-01

    Full Text Available Background: A pregnant woman is usually young and in good health until she suffers from some acute injury. Her prognosis will hopefully be better if she receives timely intensive care. Materials and Methods: The aims of this study were to study the indications of medical intensive care unit (MICU transfers for critically ill pregnant and postpartum females, biochemical and hematological profile, organ failure, ICU interventions, outcome of mother/fetus, APACHE II score and its correlation with mortality. Study Design and Setting: It is a prospective observational study, carried out in the MICU of a tertiary care teaching hospital over a period of 18 months. One hundred and twenty-two pregnant and postpartum females (up to 42 days after delivery were studied. Results and Conclusion: Maternal age >30 years was associated with high mortality (68.2%. Majority of the females were admitted in the third trimester (50 patients and postpartum period (41 patients, and mortality was highest in the postpartum period (39%. Increasing parity and gravida was associated with significantly high mortality (59.5%. Acute viral hepatitis E (45 patients was most common indication for MICU transfer, followed by malaria and pregnancy-induced hypertension. The mortality rate was 30.3%. The most common cause of death was acute viral hepatitis E (24 patients, with hepatic failure (53 patients being the most common organ failure. Majority of the females (88 patients were ANC registered. Low Glasgow coma score and high APACHE II score on admission were associated with significantly high mortality (85.2%. Prompt treatment with oseltamivir in H1N1 infection was associated with good maternal and fetal outcomes.

  3. Associations between perceived chronic care quality, perceived patient centeredness, and illness representations among persons with diabetes.

    Science.gov (United States)

    Thomas, Joseph; Iyer, Neeraj N; Collins, William B

    2014-01-01

    Patient beliefs about their illness can motivate behaviors consistent with good disease management. Perceived high-quality chronic care would be expected to increase likelihood of having such beliefs. Associations between perceived quality of chronic care and illness representations, and associations between patient centeredness and illness representations were assessed among persons with diabetes. A mail survey of diabetic patients visiting a multispecialty physician network serving urban and suburban populations in a large midwestern city was conducted. The Patient Assessment of Chronic Illness Care-5A questionnaire was used to assess perceived chronic care quality and patient centeredness. The Brief Illness Perception Questionnaire was used to assess illness representations. Of 500 mailed surveys, 89 completed surveys were returned. The sample consisted mostly of retirees (61%), Whites (81%), and women (60%). Higher perceived chronic care quality was associated with better disease understanding of diabetes (0.24, p = .05). Patients reporting higher patient centeredness (or lower patient-centeredness scores) indicated better disease understanding (-0.26, p = .04) and those reporting higher patient centeredness (or lower patient-centeredness scores) perceived less impact of illness (0.29, p = .02). Chronic care quality as defined in the Chronic Care Model and consistency of chronic care with patient expectations (patient centeredness) was associated with illness representations favorable for good self-care management.

  4. Individualized plans of care to improve outcomes among children and adults with chronic illness: a systematic review.

    Science.gov (United States)

    Lion, K Casey; Mangione-Smith, Rita; Britto, Maria T

    2014-01-01

    Adults and children with chronic illness often require services from multiple providers. Individualized plans of care (IPCs) are sometimes developed to improve care coordination. However, their association with improved outcomes is unknown. We searched literature published between January 2001 and October 2011, using Medline, CINAHL, EMBASE, PsychINFO, and bibliographic review. Eligible studies involved an IPC with input from the patient and/or family of individuals with chronic illness, evaluated outcomes, and were conducted in the United States. We assessed evidence quality using Oxford Centre for Evidence-Based Medicine criteria. 15 studies met inclusion criteria. Studies were heterogeneous regarding populations and outcomes examined and were generally low quality. Most described IPC use within a multifaceted care coordination intervention. The strongest evidence links IPC use and symptom improvement in depressed adults; the weakest evidence exists for outcomes in children. Vague descriptions of the IPCs' limited analysis. Current evidence supporting an association between IPC use and improved outcomes, particularly among children, is sparse. Well-designed evaluations of clearly described IPCs are needed to examine who should be involved in their development, what they should include, and how often they should be updated to improve outcomes of care for this vulnerable population.

  5. Does Mental Illness Stigma Contribute to Adolescent Standardized Patients' Discomfort With Simulations of Mental Illness and Adverse Psychosocial Experiences?

    Science.gov (United States)

    Hanson, Mark D.; Johnson, Samantha; Niec, Anne; Pietrantonio, Anna Marie; High, Bradley; MacMillan, Harriet; Eva, Kevin W.

    2008-01-01

    Objective: Adolescent mental illness stigma-related factors may contribute to adolescent standardized patients' (ASP) discomfort with simulations of psychiatric conditions/adverse psychosocial experiences. Paradoxically, however, ASP involvement may provide a stigma-reduction strategy. This article reports an investigation of this hypothetical…

  6. Does Mental Illness Stigma Contribute to Adolescent Standardized Patients' Discomfort With Simulations of Mental Illness and Adverse Psychosocial Experiences?

    Science.gov (United States)

    Hanson, Mark D.; Johnson, Samantha; Niec, Anne; Pietrantonio, Anna Marie; High, Bradley; MacMillan, Harriet; Eva, Kevin W.

    2008-01-01

    Objective: Adolescent mental illness stigma-related factors may contribute to adolescent standardized patients' (ASP) discomfort with simulations of psychiatric conditions/adverse psychosocial experiences. Paradoxically, however, ASP involvement may provide a stigma-reduction strategy. This article reports an investigation of this hypothetical…

  7. Substance use, mental illness and violence: the co-occurrence of problem behaviors among young adults.

    Science.gov (United States)

    Van Dorn, Richard A; Williams, James Herbert; Del-Colle, Melissa; Hawkins, J David

    2009-10-01

    A paucity of research exists in which the co-occurrence of substance use, mental illness, and violence in young adults is examined. Concurrently, there is also a lack of research explicating the contribution of theoretically based risk factors for these problematic outcomes in this population. This lack of both outcome and explanatory research equally affects the utility of theories and interventions for this population. This article utilizes a sample of N = 633 21-year-olds to examine the prevalence of (1) violence and substance use, (2) mental illness (i.e., mood and anxiety disorders) and substance use, and (3) the use of multiple substances and investigates the relationship between various social determinants and said outcomes. Overall, the prevalence rates for the comorbid conditions were low; although on average males had higher rates than did females. Individual attitudes, perceived opportunities, and recent stressful life events were associated with the co-occurrence of outcomes. Implications for behavioral health are explored.

  8. Metformin: An Old Taboo yet a New Friend for Targeted Glucose Control in Critically Ill Patients

    Directory of Open Access Journals (Sweden)

    Sarvi Sanaie

    2016-04-01

    Full Text Available Glucose management in critically ill adults and children has always been controversial. A few recent studies mention that the use of any drug other than insulin for glucose control in intensive care unit is not recommended anymore1. Increased levels of counter-regulatory hormones and insulin resistance at organ levels contribute immensely to the emergence of hyperglycemia in these patients. Consequently, in some patients higher doses of insulin are required for the maintenance of normoglycemia and in such scenarios incidence of hypoglycemia becomes a real concern. Moreover, insulin therapy might lead to hypokalaemia and hypomagnesaemia which in turns promote insulin resistance and higher blood glucose level (BGL. All these events make insulin administration unavoidable; thereby, beginning a vicious cycle with adverse outcomes. One of therapeutic options in this scenario is using insulin sensitizing agents as an adjunct therapy for glycemic control in critically ill patients. Different studies have shown that metformin, similar to insulin, is of anti-inflammatory and antioxidant properties, improves lipid profile, decreases nursing workload and lowers the incidence of adverse effects related to high-dose insulin therapy without being associated with the increased risk of lactic acidosis or hypoglycemia2-4. Panahi et al., in their study, showed that metformin therapy in hyperglycemic critically ill patients resulted in similar outcomes with insulin thersapy5. Also, there are some studies reporting that metformin limits ischemia reperfusion injury, modulates inflammation; it consequently contributes to the survival benefits probably through increasing adenosine receptor stimulation6-8. In sepsis, there is a biphasic inflammatory response; Systemic Inflammatory Response Syndrome (SIRS, as an initial hyperinflammatory phase, and Counterregulatory anti-inflammatory response syndrome as a later hypoactive phase. Therefore, anti-inflammatory drugs like

  9. Pharmacokinetics of sufentanil during long-term infusion in critically ill pediatric patients.

    Science.gov (United States)

    Bartkowska-Śniatkowska, Alicja; Bienert, Agnieszka; Wiczling, Paweł; Rosada-Kurasińska, Jowita; Zielińska, Marzena; Warzybok, Justyna; Borsuk, Agnieszka; Tibboel, Dick; Kaliszan, Roman; Grześkowiak, Edmund

    2016-01-01

    The aim of this study was to develop a population pharmacokinetic model of sufentanil and to assess the influence of covariates in critically ill children admitted to a pediatric intensive care unit. After institutional approval, 41 children were enrolled in the study. Blood samples for pharmacokinetic (PK) assessment were collected from routinely placed arterial catheters during and after discontinuation of infusion. Population nonlinear mixed-effects modeling was performed using NONMEM. A 2-compartment model described sufentanil PK sufficiently. Typical values of the central and peripheral volume of distribution and the metabolic and intercompartmental clearance for a theoretical patient weighing 70 kg were VC = 7.90 l, VT  = 481 L, Cl =  5.3 L/h, and Q = 38.3 L/h, respectively. High interindividual variability of all PK parameters was noted. Allometric/isometric principles to scale sufentanil PK revealed that to achieve the same steady-state sufentanil concentrations in plasma for pediatric patients of different body weights, the infusion rate should follow the formula (infusion rate for a 70-kg adult patient, μg/h) × (body weight/70 kg)(0.75). Severity of illness described by PRISM score, the monitored physiological and laboratory parameters, and coadministered drugs such as vasopressors were not found to be significant covariates.

  10. Mental illness, problem behaviour, needs and service use in adults with intellectual disability.

    Science.gov (United States)

    Schützwohl, Matthias; Koch, Andrea; Koslowski, Nadine; Puschner, Bernd; Voß, Elke; Salize, Hans Joachim; Pfennig, Andrea; Vogel, Anke

    2016-05-01

    Mental ill health in adults with intellectual disability (ID) is a neglected field in psychiatry and thus still widely understudied. This paper provides data on the prevalence of mental illness and problem behaviour and analyses support needs, mental health service use and psychotropic medication in a representative sample of adults with mild to moderate ID. A set of well-established instruments was used to assess the main parameters in n = 371 participants recruited within a cross-sectional epidemiological multicentre study using a stratified randomised cluster sampling. Point prevalence of mental disorders was 10.8 %, that of problem behaviour 45.3 %. Most study participants needed help in specific lower order need areas (e.g., money budgeting, food, accommodation), and these need areas were mostly rated as met. The highest ratios of unmet to met need were found with respect to sexuality issues and with respect to mental health problems. The focus of psychiatric treatment was psychotropic medication. Referring to ICD-10 based diagnostic criteria and consequently avoiding confusing problem behaviour with mental disorders, point prevalence of mental disorders was lower than in the general population. A systematic deficit in meeting mental health problems in adults with ID indicates the need for implementing strategies to maximise the quality of identification and management of mental disorders.

  11. Monocyte Profiles in Critically Ill Patients With Pseudomonas Aeruginosa Sepsis

    Science.gov (United States)

    2017-02-02

    Pseudomonas Infections; Pseudomonas Septicemia; Pseudomonas; Pneumonia; Pseudomonal Bacteraemia; Pseudomonas Urinary Tract Infection; Pseudomonas Gastrointestinal Tract Infection; Sepsis; Sepsis, Severe; Critically Ill

  12. Mental Representations of Illness in Patients with Gestational Trophoblastic Disease: How Do Patients Perceive Their Condition?

    Science.gov (United States)

    Di Mattei, Valentina E.; Carnelli, Letizia; Mazzetti, Martina; Bernardi, Martina; Di Pierro, Rossella; Bergamini, Alice; Mangili, Giorgia; Candiani, Massimo; Sarno, Lucio

    2016-01-01

    Background Gestational Trophoblastic Disease comprises a group of benign and malignant disorders that derive from the placenta. Using Leventhal’s Common-Sense Model as a theoretical framework, this paper examines illness perception in women who have been diagnosed with this disease. Methods Thirty-one women diagnosed with Gestational Trophoblastic Disease in a hospital in Italy were asked to complete the Illness Perception Questionnaire-Revised to measure the following: illness Identity, illness opinions and causes of Gestational Trophoblastic Disease. Results High mean scores were observed in the Emotional representations and Treatment control subscales. A significant difference emerged between hydatidiform mole patients and those with gestational trophoblastic neoplasia on the Identity subscale. A significant correlation emerged between “time since diagnosis” and the Treatment control subscale. Discussion This study is the first to investigate illness perception in Gestational Trophoblastic Disease. From a clinical perspective the results highlight the need for multidisciplinary support programs to promote a more realistic illness perception. PMID:27101144

  13. Different faces of discrimination: perceived discrimination among homeless adults with mental illness in healthcare settings.

    Science.gov (United States)

    Skosireva, Anna; O'Campo, Patricia; Zerger, Suzanne; Chambers, Catharine; Gapka, Susan; Stergiopoulos, Vicky

    2014-09-07

    Research on discrimination in healthcare settings has primarily focused on health implications of race-based discrimination among ethno-racial minority groups. Little is known about discrimination experiences of other marginalized populations, particularly groups facing multiple disadvantages who may be subjected to other/multiple forms of discrimination. (1) To examine the prevalence of perceived discrimination due to homelessness/poverty, mental illness/alcohol/drug related problems, and race/ethnicity/skin color while seeking healthcare in the past year among racially diverse homeless adults with mental illness; (2) To identify whether perceiving certain types of discrimination is associated with increased likelihood of perceiving other kinds of discrimination; and (3) To examine association of these perceived discrimination experiences with socio-demographic characteristics, self-reported measures of psychiatric symptomatology and substance use, and Emergency Department utilization. We used baseline data from the Toronto site of the At Home/Chez Soi randomized controlled trial of Housing First for homeless adults with mental illness (n = 550). Bivariate statistics and multivariable logistic regression models were used for the analysis. Perceived discrimination related to homelessness/poverty (30.4%) and mental illness/alcohol/substance use (32.5%) is prevalent among ethnically diverse homeless adults with mental illness in healthcare settings. Only 15% of the total participants reported discrimination due to race/ethnicity/skin color. After controlling for relevant confounders and presence of psychosis, all types of discrimination in healthcare settings were associated with more frequent ED use, a greater - 3 - severity of lifetime substance abuse, and mental health problems. Perceiving discrimination of one type was associated with increased likelihood of perceiving other kinds of discrimination. Understanding the experience of discrimination in healthcare

  14. Estimating the number of adults with severe and persistent mental illness who have complex, multi-agency needs.

    Science.gov (United States)

    Whiteford, Harvey; Buckingham, Bill; Harris, Meredith; Diminic, Sandra; Stockings, Emily; Degenhardt, Louisa

    2017-08-01

    A population health approach to mental health service planning requires estimates that align interventions with the needs of people with mental illness. The primary objective was to estimate the number of people in Australia living with severe and persistent mental illness who have complex, multi-agency needs. The secondary objective was to describe the possible service needs of individuals with severe mental illness. We disaggregated the estimated 12-month prevalence of adults with severe mental illness into needs-based sub-groups, using multiple data sources. Possible service needs of 1825 adults with psychotic disorders and 334 adults with severe past-year affective and/or anxiety disorders were described using data from the 2010 Survey of High Impact Psychosis and 2007 National Survey of Mental Health and Wellbeing, respectively. Using best available data, we estimated that 3.3% of adults experience a severe mental illness each year, of whom one-third (1.1% of adults) experience a persistent mental illness that requires ongoing services to address residual disability. Among those with severe and persistent mental illness, one-third of adults (0.4% or 59,000 adults in 2015) have complex needs requiring multi-agency support to maximise their health, housing, social participation and personal functioning. Survey of High Impact Psychosis data indicated that among adults with psychotic disorders, use of accommodation (40%), non-government (30%) services and receipt of income support (85%) services were common, as were possible needs for support with socialising, personal care and employment. National Survey of Mental Health and Wellbeing data indicated that among individuals with severe affective and anxiety disorders, receipt of income support (37%) was common (information on accommodation and non-government support services was not available), as were possible needs for financial management and employment support. Agreed indicators of complex, multi-agency needs

  15. Illness perceptions, mood and health-related quality of life in patients with amyotrophic lateral sclerosis.

    Science.gov (United States)

    Miglioretti, Massimo; Mazzini, Letizia; Oggioni, Gaia D; Testa, Lucia; Monaco, Francesco

    2008-12-01

    To divide amyotrophic lateral sclerosis (ALS) patients in two clusters according to their illness representation, and to identify, between the two clusters, the differences in functional state, mood, and quality of life. Seventy-four patients with ALS were recruited at our ALS Centre from different Italian regions, having been for multidisciplinary consultations. The patients' functional impairment was evaluated by the ALS Functional Rating Scale as well as the Bulbar Score and Forced Vital Capacity. Psychological Characteristics and quality of life of ALS patients were evaluated by Profile of Mood State, Illness Perception Questionnaire, and 36-item Short Form Health Survey. Only few of the ALS patients studied showed critical mood ratings. On the whole, the perceived quality of life, mood state, and the dimensions relating to their illness representation seem to be correlated to the functional state and respiratory capacity. The clustering of patients according to their illness representations allowed to highlight that ALS patients can be divided into two groups: adaptors and nonadaptors. The patients of the two groups, adaptors and nonadaptors, differed in respiratory capacity as well as in their mood and health-related quality of life. This study supports the Common Sense Model (CSM) of illness representation when considering ALS patients. Their psychological reactions to illness and quality of life depend not only on the severity of the illness but also on the way the illness is represented. Therefore, CSM could become the theoretical framework for psychological interventions in ALS patients.

  16. Understanding the relationship transitions and associated end of life clinical needs of young adults with life-limiting illnesses: A triangulated longitudinal qualitative study

    Directory of Open Access Journals (Sweden)

    Bridget Johnston

    2016-10-01

    Full Text Available Background: Care of young adults with life-limiting illnesses can often be complex due to the fact that they are growing and developing within the continuing presence of their illness. There is little research conducted nationally and internationally, which has examined the life issues of young adults or taken a longitudinal approach to understand such issues over a period of time. Aim: To gain clear understanding of one particular and pertinent life issue—relationship transition—occurring in the context of being a young adult with a life-limiting illness and the clinical needs arising from this. Design: This was a triangulated, longitudinal, qualitative study involving young adults with life-limiting illnesses and their significant others, namely, family members and healthcare professionals. Semi-structured interviews were conducted with participants and analysed using thematic analysis. Clinical case note reviews were also carried out. Setting/participants: A total of 12 young adults (aged between 17 and 23 years from 2 hospices and 22 nominated significant others participated in a total of 58 interviews. Results: Thematic analysis revealed 4 main themes and 11 subthemes. The main themes were ‘Dependence dichotomy’, ‘In it together’, ‘Biographical uncertainty’, and ‘Conserving integrity’. These themes helped to establish the nature of relationship transitions that the young adult participants from the study experienced and additionally allowed insight into their possible needs at their end of life. Conclusion: This study has identified the nature of relationship transitions pertinent to young adults and has highlighted associated end of life clinical needs. This study can influence further research into the transitions and end of life needs of this particular patient group receiving palliative care, while informing the lacking evidence base which exists internationally.

  17. Understanding the relationship transitions and associated end of life clinical needs of young adults with life-limiting illnesses: A triangulated longitudinal qualitative study

    Science.gov (United States)

    Johnston, Bridget; Jindal-Snape, Divya; Pringle, Jan; Gold, Libby; Grant, Jayne; Dempsey, Raymond; Scott, Ros; Carragher, Pat

    2016-01-01

    Background: Care of young adults with life-limiting illnesses can often be complex due to the fact that they are growing and developing within the continuing presence of their illness. There is little research conducted nationally and internationally, which has examined the life issues of young adults or taken a longitudinal approach to understand such issues over a period of time. Aim: To gain clear understanding of one particular and pertinent life issue—relationship transition—occurring in the context of being a young adult with a life-limiting illness and the clinical needs arising from this. Design: This was a triangulated, longitudinal, qualitative study involving young adults with life-limiting illnesses and their significant others, namely, family members and healthcare professionals. Semi-structured interviews were conducted with participants and analysed using thematic analysis. Clinical case note reviews were also carried out. Setting/participants: A total of 12 young adults (aged between 17 and 23 years) from 2 hospices and 22 nominated significant others participated in a total of 58 interviews. Results: Thematic analysis revealed 4 main themes and 11 subthemes. The main themes were ‘Dependence dichotomy’, ‘In it together’, ‘Biographical uncertainty’, and ‘Conserving integrity’. These themes helped to establish the nature of relationship transitions that the young adult participants from the study experienced and additionally allowed insight into their possible needs at their end of life. Conclusion: This study has identified the nature of relationship transitions pertinent to young adults and has highlighted associated end of life clinical needs. This study can influence further research into the transitions and end of life needs of this particular patient group receiving palliative care, while informing the lacking evidence base which exists internationally. PMID:27781097

  18. Quality of pharmacokinetic studies in critically ill patients receiving continuous renal replacement therapy.

    Science.gov (United States)

    Vaara, S; Pettila, V; Kaukonen, K-M

    2012-02-01

    Continuous renal replacement therapy (CRRT) is the preferred renal replacement therapy modality in the critically ill. We aimed to reveal the literature on the pharmacokinetic studies in critically ill patients receiving CRRT with special reference to quality assessment of these studies and the CRRT dose. We conducted a systematic review by searching the MEDLINE, EMBASE, and the Cochrane databases to December 2009 and bibliographies of relevant review articles. We included original studies reporting from critically ill adult subjects receiving CRRT because of acute kidney injury with a special emphasis on drug pharmacokinetics. We used the minimum reporting criteria for CRRT studies by Acute Dialysis Quality Initiative (ADQI) and, second, the Downs and Black checklist to assess the quality of the studies. We calculated the CRRT dose per study. We included pharmacokinetic parameters, residual renal function, and recommendations on drug dosing. Of 182 publications, 95 were considered relevant and 49 met the inclusion criteria. The median [interquartile range (IQR)] number of reported criteria by ADQI was 7.0 (5.0-8.0) of 12. The median (IQR) Downs and Black quality score was 15 (14-16) of 32. None of the publications reported CRRT dose directly. The median (IQR) weighted CRRT dose was 23.7 (18.8-27.9) ml/kg/h. More attention should be paid both to standardizing the CRRT dose and reporting of the CRRT parameters in pharmacokinetic studies. The general quality of the studies during CRRT in the critically ill was only moderate and would be greatly improved by reports in concordant with the ADQI recommendations. © 2011 The Authors Acta Anaesthesiologica Scandinavica © 2011 The Acta Anaesthesiologica Scandinavica Foundation.

  19. Colloids versus crystalloids for fluid resuscitation in critically ill patients.

    Science.gov (United States)

    Perel, Pablo; Roberts, Ian; Ker, Katharine

    2013-02-28

    Colloid solutions are widely used in fluid resuscitation of critically ill patients. There are several choices of colloid, and there is ongoing debate about the relative effectiveness of colloids compared to crystalloid fluids. To assess the effects of colloids compared to crystalloids for fluid resuscitation in critically ill patients. We searched the Cochrane Injuries Group Specialised Register (17 October 2012), the Cochrane Central Register of Controlled Trials (The Cochrane Library) (Issue 10, 2012), MEDLINE (Ovid) 1946 to October 2012, EMBASE (Ovid) 1980 to October 2012, ISI Web of Science: Science Citation Index Expanded (1970 to October 2012), ISI Web of Science: Conference Proceedings Citation Index-Science (1990 to October 2012), PubMed (October 2012), www.clinical trials.gov and www.controlled-trials.com. We also searched the bibliographies of relevant studies and review articles. Randomised controlled trials (RCTs) of colloids compared to crystalloids, in patients requiring volume replacement. We excluded cross-over trials and trials involving pregnant women and neonates. Two review authors independently extracted data and rated quality of allocation concealment. We analysed trials with a 'double-intervention', such as those comparing colloid in hypertonic crystalloid to isotonic crystalloid, separately. We stratified the analysis according to colloid type and quality of allocation concealment. We identified 78 eligible trials; 70 of these presented mortality data.COLLOIDS COMPARED TO CRYSTALLOIDS: Albumin or plasma protein fraction - 24 trials reported data on mortality, including a total of 9920 patients. The pooled risk ratio (RR) from these trials was 1.01 (95% confidence interval (CI) 0.93 to 1.10). When we excluded the trial with poor-quality allocation concealment, pooled RR was 1.00 (95% CI 0.92 to 1.09). Hydroxyethyl starch - 25 trials compared hydroxyethyl starch with crystalloids and included 9147 patients. The pooled RR was 1.10 (95% CI 1

  20. Controversies in the temperature management of critically ill patients.

    Science.gov (United States)

    Nakajima, Yasufumi

    2016-10-01

    Although body temperature is a classic primary vital sign, its value has received little attention compared with the others (blood pressure, heart rate, and respiratory rate). This may result from the fact that unlike the other primary vital signs, aging and diseases rarely affect the thermoregulatory system. Despite this, when humans are exposed to various anesthetics and analgesics and acute etiologies of non-infectious and infectious diseases in perioperative and intensive care settings, abnormalities may occur that shift body temperature up and down. A recent upsurge in clinical evidence in the perioperative and critical care field resulted in many clinical trials in temperature management. The results of these clinical trials suggest that aggressive body temperature modifications in comatose survivors after resuscitation from shockable rhythm, and permissive fever in critically ill patients, are carried out in critical care settings to improve patient outcomes; however, its efficacy remains to be elucidated. A recent, large multicenter randomized controlled trial demonstrated contradictory results, which may disrupt the trends in clinical practice. Thus, updated information concerning thermoregulatory interventions is essential for anesthesiologists and intensivists. Here, recent controversies in therapeutic hypothermia and fever management are summarized, and their relevance to the physiology of human thermoregulation is discussed.

  1. CONTRA: Hydroxyethyl starch solutions are unsafe in critically ill patients.

    Science.gov (United States)

    Hartog, Christiane; Reinhart, Konrad

    2009-08-01

    To describe the risk-benefit profile of hydroxyethyl starch (HES). Narrative review. (1) EFFICACY: no single clinical study or systemic review has shown that administration of any HES solution confers a clinically relevant benefit compared to crystalloids in critically ill patients or surgical patients in need of volume replacement. Contrary to beliefs expecting a ratio of 4:1 or more for crystalloid to colloid volume need, recent studies of goal-directed resuscitation observed much lower ratios of between 1 and 1.6. (2) SAFETY: HES administration is associated with coagulopathy, nephrotoxicity, pruritus and increased long-term mortality. Clinical studies claiming that modern HES 130/0.4 is safe have serious methodological drawbacks and do not adequately address the safety concerns. Given the complete lack of superiority in clinical utility studies and the wide spectrum of severe side effects, the use of HES in the ICU should be stopped. The belief that four times as much crystalloid as colloid fluid volume is needed for successful resuscitation is being seriously questioned.

  2. Critical energy deficit and mortality in critically ill patients

    Directory of Open Access Journals (Sweden)

    Marcia Carolina Siqueira-Paese

    Full Text Available Objective: We investigate the influence of caloric and protein deficit on mortality and length of hospital stay of critically ill patients. Methods: A cohort prospective study including 100 consecutive patients in a tertiary intensive care unit (ICU receiving enteral or parenteral nutrition. The daily caloric and protein deficit were collected each day for a maximum of 30 days. Energy deficits were divided into critical caloric deficit (≥ 480 kcal/day and non-critical caloric deficit (≤ 480 kcal/day; and in critical protein deficit (≥ 20 g/day and non-critical protein deficit (≤ 20 g/day. The findings were correlated with hospital stay and mortality. Results: The mortality rate was 33%. Overall, the patients received 65.4% and 67.7% of the caloric and protein needs. Critical caloric deficit was found in 72% of cases and critical protein deficit in 70% of them. There was a significant correlation between length of stay and accumulated caloric deficit (R = 0.37; p < 0.001 and protein deficit (R = 0.28; p < 0.001. The survival analysis showed that mortality was greater in patients with both critical caloric (p < 0.001 and critical protein deficits (p < 0.01. The Cox regression analysis showed that critical protein deficit was associated with higher mortality (HR 0.25, 95% CI 0.07-0.93, p = 0.03. Conclusions: The incidence of caloric and protein deficit in the ICU is high. Both caloric and protein deficits increase the length of hospital stay, and protein deficit greater than 20 g/day is an independent factor for mortality in critical care unit.

  3. Optimism, Symptom Distress, Illness Appraisal, and Coping in Patients With Advanced-Stage Cancer Diagnoses Undergoing Chemotherapy Treatment.

    Science.gov (United States)

    Sumpio, Catherine; Jeon, Sangchoon; Northouse, Laurel L; Knobf, M Tish

    2017-05-01

    To explore the relationships between optimism, self-efficacy, symptom distress, treatment complexity, illness appraisal, coping, and mood disturbance in patients with advanced-stage cancer.
. Cross-sectional study.
. Smilow Cancer Hospital at Yale New Haven in Connecticut, an outpatient comprehensive cancer center.
. A convenience sample of 121 adult patients with stages III-IV cancer undergoing active chemotherapy.
. Participants completed common self-report questionnaires to measure variables. Treatment hours and visits were calculated from data retrieved from medical record review. Mediation and path analysis were conducted to identify direct and indirect pathways from the significant antecedent variables to mood disturbance.
. Dispositional optimism, self-efficacy, social support, treatment complexity, symptom distress, illness appraisal, coping, and mood disturbance.
. Greater optimism and self-efficacy were associated with less negative illness appraisal, less avoidant coping, and decreased mood disturbance. Conversely, greater symptom distress was associated with greater negative illness appraisal, greater avoidant coping, and greater mood disturbance. In the final model, optimism and symptom distress had direct and indirect effects on mood disturbance. Indirect effects were partially mediated by illness appraisal.
. Mood disturbance resulted from an interaction of disease stressors, personal resources, and cognitive appraisal of illness. Avoidant coping was associated with greater disturbed mood, but neither avoidant nor active coping had a significant effect on mood in the multivariate model. 
. Illness appraisal, coping style, and symptom distress are important targets for intervention. Optimism is a beneficial trait and should be included, along with coping style, in comprehensive nursing assessments of patients with cancer.

  4. Music therapy as grief therapy for adults with mental illness and complicated grief: a pilot study.

    Science.gov (United States)

    Iliya, Yasmine A

    2015-01-01

    This randomized, controlled, mixed-methods pilot study examined the effectiveness and experiences of grief-specific music therapy, in addition to standard care, with adults (N=10) who have complicated grief (CG) and mental illness, as compared to standard care alone. The study tested Worden's (2009) theories of grief therapy as well as a new grief-specific music therapy intervention, based on Shear, Frank, Houck, and Reynolds' (2005) imaginal dialogue intervention and Austin's (2008) method of vocal psychotherapy. Results demonstrated that participants in the experimental group had a greater decrease of grief symptoms, as measured by the ICG-R, as compared with the control group.

  5. Diabetes Knowledge Among Adults with Serious Mental Illness and Comorbid Diabetes Mellitus.

    Science.gov (United States)

    Wykes, Thomas L; Lee, Aaron A; Bourassa, Katelynn; Kitchen, Katherine A; McKibbin, Christine L

    2017-04-01

    This study examined the association between psychiatric symptoms and diabetes knowledge (DK) among 90 adults with serious mental illness (SMI) and type 2 diabetes. The relationship between DK and glucose control (i.e., A1C) was also examined. In a hierarchical linear regression, greater negative symptom severity and lower cognitive functioning both predicted lower DK, though cognitive functioning superseded negative symptom severity when analyzed simultaneously. A Pearson correlation showed no significant relationship between DK and A1C. Although symptom severity and cognitive functioning are both related to DK among this population, cognitive functioning maybe particularly important. Copyright © 2016. Published by Elsevier Inc.

  6. [Depression in older adults: the National Mental Care Project for People with Physical Illness].

    Science.gov (United States)

    Ito, Hiroto; Fukuda, Koji; Hattori, Hideyuki

    2013-01-01

    Political attention is being increasingly directed to mental health in Japan. Mental disorders are now the fifth priority disease after cancer, stroke, acute myocardial infarction and diabetes for national medical services since April 2013. Each prefecture has to implement strategic mental healthcare plans at the regional level. With the increase in co-morbid mental and physical illnesses, patient information should be shared between psychiatric and non-psychiatric healthcare providers, and coordination is required in the healthcare systems. A better understanding of mental health between patients and medical staffs could contribute to improved access to psychiatric services in the integrated mental health care system. Collaborative care programs focusing on depression screening and management in the Mental Health Care Project for Patients with Physical Illness have been launched among six national specialized care and research centers (cancer, cardiovascular disease, diabetes, child care, geriatric care and neurology and psychiatry) since 2012. These efforts to integrate mental health care into the general health care system would help to improve psychiatric care for elderly patients with physical illnesses.

  7. Comparison of the burden of illness for adults with ADHD across seven countries: a qualitative study

    Directory of Open Access Journals (Sweden)

    Brod Meryl

    2012-05-01

    Full Text Available Abstract Background The purpose of this study was to expand the understanding of the burden of illness experienced by adults with Attention Deficit-Hyperactivity Disorder (ADHD living in different countries and treated through different health care systems. Methods Fourteen focus groups and five telephone interviews were conducted in seven countries in North America and Europe, comprised of adults who had received a diagnosis of ADHD. The countries included Canada, France, Germany, Italy, The Netherlands, United Kingdom, and United States (two focus groups in each country. There were 108 participants. The focus groups were designed to elicit narratives of the experience of ADHD in key domains of symptoms, daily life, and social relationships. Consonant with grounded theory, the transcripts were analyzed using descriptive coding and then themed into larger domains. Results Participants’ statements regarding the presentation of symptoms, childhood experience, impact of ADHD across the life course, addictive and risk-taking behavior, work and productivity, finances, relationships and psychological health impacts were similarly themed across all seven countries. These similarities were expressed through the domains of symptom presentation, childhood experience, medication treatment issues, impacts in adult life and across the life cycle, addictive and risk-taking behavior, work and productivity, finances, psychological and social impacts. Conclusions These data suggest that symptoms associated with adult ADHD affect individuals similarly in different countries and that the relevance of the diagnostic category for adults is not necessarily limited to certain countries and sociocultural milieus.

  8. Understanding the mechanisms of glutamine action in critically ill patients

    Directory of Open Access Journals (Sweden)

    Gisele P. Oliveira

    2010-06-01

    Full Text Available Glutamine (Gln is an important energy source and has been used as a supplementary energy substrate. Furthermore, Gln is an essential component for numerous metabolic functions, including acid-base homeostasis, gluconeogenesis, nitrogen transport and synthesis of proteins and nucleic acids. Therefore, glutamine plays a significant role in cell homeostasis and organ metabolism. This article aims to review the mechanisms of glutamine action during severe illnesses. In critically ill patients, the increase in mortality was associated with a decreased plasma Gln concentration. During catabolic stress, Gln consumption rate exceeds the supply, and both plasma and skeletal muscle pools of free Gln are severely reduced. The dose and route of Gln administration clearly influence its effectiveness: high-dose parenteral appears to be more beneficial than low-dose enteral administration. Experimental studies reported that Gln may protect cells, tissues, and whole organisms from stress and injury through the following mechanisms: attenuation of NF (nuclear factor-kB activation, a balance between pro- and anti-inflammatory cytokines, reduction in neutrophil accumulation, improvement in intestinal integrity and immune cell function, and enhanced of heat shock protein expression. In conclusion, high-doses of parenteral Gln (>0.50 g/kg/day demonstrate a greater potential to benefit in critically ill patients, although Gln pathophysiological mechanisms requires elucidation.A glutamina (Gln é uma importante fonte de energia e tem sido usada como substrato energético suplementar. Além disso, a Gln é um componente essencial para numerosas funções metabólicas tais como: homeostase ácido-base, gliconeogênese, transporte de nitrogênio e síntese de proteínas e ácidos nucléicos. Portanto, a glutamina desempenha um papel importante na homeostase celular e no metabolismo dos órgãos. Esse artigo objetiva rever os mecanismos de ação da glutamina na doen

  9. Illness Perception and Information Behaviour of Patients with Rare Chronic Diseases

    Science.gov (United States)

    Katavic, Snježana Stanarevic; Tanackovic, Sanjica Faletar; Badurina, Boris

    2016-01-01

    Introduction: This study examined possible correlations between health information behaviour and illness perception among patients with rare chronic diseases. Illness perception is related to coping strategies used by patients, and some health information behaviour practices may be associated with better coping and more positive perception of…

  10. PTSD in Latino patients: illness beliefs, treatment preferences, and implications for care.

    Science.gov (United States)

    Eisenman, David P; Meredith, Lisa S; Rhodes, Hilary; Green, Bonnie L; Kaltman, Stacey; Cassells, Andrea; Tobin, Jonathan N

    2008-09-01

    Little is known about how Latinos with post-traumatic stress disorder (PTSD) understand their illness and their preferences for mental health treatment. To understand the illness beliefs and treatment preferences of Latino immigrants with PTSD. Semi-structured, face-to-face interviews. Sixty foreign-born, Latino adults recruited from five primary care centers in New York and New Jersey and screened for PTSD. Content analytic methods identified common themes, their range, and most frequent or typical responses. Participants identified their primary feelings as sadness, anxiety, nervousness, and fear. The most common feeling was "sad" (triste). Other words frequently volunteered were "angry" (enojada), "nervous" (nerviosa), and "scared" (miedo). Participants viewed their PTSD as impairing health and functioning. They ascribed their somatic symptoms and their general medical problems to the "stress" from the trauma and its consequences on their lives. The most common reason participants volunteered for their work and school functioning being impaired was their poor concentration, often due to intrusive thoughts. Most expressed their desire to receive mental health treatment, to receive it within their primary care center, and preferred psychotherapy over psychotropic medications. Among participants who did not report wanting treatment, most said it was because the trauma was "in the past." Clinicians may consider enquiring about PTSD in Latino patients who report feeling sad, anxious, nervous, or fearful. Our study suggests topics clinicians may include in the psychoeducation of patients with PTSD.

  11. Use of an Auditory Hallucination Simulation to Increase Student Pharmacist Empathy for Patients with Mental Illness.

    Science.gov (United States)

    Skoy, Elizabeth T; Eukel, Heidi N; Frenzel, Jeanne E; Werremeyer, Amy; McDaniel, Becky

    2016-10-25

    Objective. To increase student pharmacist empathy through the use of an auditory hallucination simulation. Design. Third-year professional pharmacy students independently completed seven stations requiring skills such as communication, following directions, reading comprehension, and cognition while listening to an audio recording simulating what one experiencing auditory hallucinations may hear. Following the simulation, students participated in a faculty-led debriefing and completed a written reflection. Assessment. The Kiersma-Chen Empathy Scale was completed by each student before and after the simulation to measure changes in empathy. The written reflections were read and qualitatively analyzed. Empathy scores increased significantly after the simulation. Qualitative analysis showed students most frequently reported feeling distracted and frustrated. All student participants recommended the simulation be offered to other student pharmacists, and 99% felt the simulation would impact their future careers. Conclusions. With approximately 10 million adult Americans suffering from serious mental illness, it is important for pharmacy educators to prepare students to provide adequate patient care to this population. This auditory hallucination simulation increased student pharmacist empathy for patients with mental illness.

  12. Use of an Auditory Hallucination Simulation to Increase Student Pharmacist Empathy for Patients with Mental Illness

    Science.gov (United States)

    Eukel, Heidi N.; Frenzel, Jeanne E.; Werremeyer, Amy; McDaniel, Becky

    2016-01-01

    Objective. To increase student pharmacist empathy through the use of an auditory hallucination simulation. Design. Third-year professional pharmacy students independently completed seven stations requiring skills such as communication, following directions, reading comprehension, and cognition while listening to an audio recording simulating what one experiencing auditory hallucinations may hear. Following the simulation, students participated in a faculty-led debriefing and completed a written reflection. Assessment. The Kiersma-Chen Empathy Scale was completed by each student before and after the simulation to measure changes in empathy. The written reflections were read and qualitatively analyzed. Empathy scores increased significantly after the simulation. Qualitative analysis showed students most frequently reported feeling distracted and frustrated. All student participants recommended the simulation be offered to other student pharmacists, and 99% felt the simulation would impact their future careers. Conclusions. With approximately 10 million adult Americans suffering from serious mental illness, it is important for pharmacy educators to prepare students to provide adequate patient care to this population. This auditory hallucination simulation increased student pharmacist empathy for patients with mental illness. PMID:27899838

  13. Housing preferences and choices among adults with mental illness and substance use disorders: a qualitative study.

    Science.gov (United States)

    Tsai, Jack; Bond, Gary R; Salyers, Michelle P; Godfrey, Jenna L; Davis, Kristin E

    2010-08-01

    Housing is a crucial issue for adults with severe mental illness and co-occurring substance use disorders, as this population is particularly susceptible to housing instability and homelessness. We interviewed 40 adults with dual disorders, living in either supervised or independent housing arrangements, to examine housing preferences, decision making processes surrounding housing choices, and perceived barriers to housing. We found that many clients indicated their housing preferences had changed over time, and some clients related housing preferences to recovery. Although the majority of clients preferred independent housing, many also described benefits of supervised housing. Clients' current living situations appeared to be driven primarily by treatment provider recommendations and availability of housing. Common barriers to obtaining desired housing were lack of income and information. These findings have implications for supported housing models and approaches to providing housing for clients.

  14. Abdominal CT scanning in critically ill surgical patients.

    Science.gov (United States)

    Norwood, S H; Civetta, J M

    1985-01-01

    Clinical parameters, intensive care unit (ICU) course, abdominal computed tomography (CT) scans, and the clinical decisions of 53 critically ill patients were reviewed to determine the influence of the CT scan. No scans were positive before the eighth day. Sensitivity was 48% and specificity, 64%. Seventeen (23%) scans of the 72 provided beneficial results: eight localized abscesses that were drained; nine were negative and not operated on. Five (7%) scans provided detrimental information: scan negative with abscess discovered or scan positive but negative laparotomy. Fifty (70%) scans were either of no help or not used in management. The mortality rate was 50% when CT led to an intervention, and 47% in the entire group. Hospital charges were +33,408. Personnel time and cost were 497 hours and +3658; of the total +37,066, 77% (+28,541) could be considered wasted. From these data, it was concluded that CT scans should be used to confirm abscesses, not to search for a source of sepsis. PMID:4015222

  15. Vitamin B1 in critically ill patients: needs and challenges.

    Science.gov (United States)

    Collie, Jake T B; Greaves, Ronda F; Jones, Oliver A H; Lam, Que; Eastwood, Glenn M; Bellomo, Rinaldo

    2017-04-22

    Thiamine has a crucial role in energy production, and consequently thiamine deficiency (TD) has been associated with cardiac failure, neurological disorders, oxidative stress (lactic acidosis and sepsis) and refeeding syndrome (RFS). This review aims to explore analytical methodologies of thiamine compound quantification and highlight similarities, variances and limitations of current techniques and how they may be relevant to patients. An electronic search of Medline, PubMed and Embase databases for original articles published in peer-reviewed journals was conducted. MethodsNow was used to search for published analytical methods of thiamine compounds. Keywords for all databases included "thiamine and its phosphate esters", "thiamine methodology" and terms related to critical illness. Enquiries were also made to six external quality assurance (EQA) programme organisations for the inclusion of thiamine measurement. A total of 777 published articles were identified; 122 were included in this review. The most common published method is HPLC with florescence detection. Two of the six EQA organisations include a thiamine measurement programme, both measuring only whole-blood thiamine pyrophosphate (TPP). No standard measurement procedure for thiamine compound quantification was identified. Overall, there is an absence of standardisation in measurement methodologies for thiamine in clinical care. Consequently, multiple variations in method practises are prohibiting the comparison of study results as they are not traceable to any higher order reference. Traceability of certified reference materials and reference measurement procedures is needed to provide an anchor to create the link between studies and help bring consensus on the clinical importance of thiamine.

  16. Persisting Barriers to Employment for Recently Housed Adults with Mental Illness Who Were Homeless.

    Science.gov (United States)

    Poremski, Daniel; Woodhall-Melnik, Julia; Lemieux, Ashley J; Stergiopoulos, Vicky

    2016-02-01

    Adults with mental illness who are homeless experience multiple barriers to employment, contributing to difficulties securing and maintaining housing. Housing First programs provide quick, low-barrier access to housing and support services for this population, but their success in improving employment outcomes has been limited. Supported employment interventions may augment Housing First programs and address barriers to employment for homeless adults with mental illness. The present paper presents data from qualitative interviews to shed light on the persisting barriers to employment among people formerly homeless. Once housed, barriers to employment persisted, including the following: (1) worries about disclosing sensitive information, (2) fluctuating motivation, (3) continued substance use, and (4) fears about re-experiencing homelessness-related trauma. Nevertheless, participants reported that their experiences of homelessness helped them develop interpersonal strength and resilience. Discussing barriers with an employment specialist helps participants develop strategies to overcome them, but employment specialists must be sensitive to specific homelessness-related experiences that may not be immediately evident. Supported housing was insufficient to help people return to employment. Supported employment may help people return to work by addressing persisting barriers.

  17. Proximal gastric motility in critically ill patients with type 2 diabetes mellitus

    Institute of Scientific and Technical Information of China (English)

    Nam Q Nguyen; Robert J Fraser; Laura K Bryant; Marianne Chapman; Richard H Holloway

    2007-01-01

    AIM: To investigate the proximal gastric motor response to duodenal nutrients in critically ill patients with longstanding type 2 diabetes mellitus.METHODS: Proximal gastric motility was assessed (using a barostat) in 10 critically ill patients with type 2 diabetes mellitus (59 ± 3 years) during two 60-min duodenal infusions of Ensure(R) (1 and 2 kcal/min), in random order,separated by 2h fasting. Data were compared with 15 non-diabetic critically ill patients (48 ± 5 years) and 10 healthy volunteers (28 ± 3 years).RESULTS: Baseline proximal gastric volumes were similar between the three groups. In diabetic patients,proximal gastric relaxation during 1 kcal/min nutrient infusion was similar to non-diabetic patients and healthy controls. In contrast, relaxation during 2 kcal/min infusion was initially reduced in diabetic patients (P < 0.05) but increased to a level similar to healthy humans, unlike non-diabetic patients where relaxation was impaired throughout the infusion. Duodenal nutrient stimulation reduced the fundic wave frequency in a dose-dependent fashion in both the critically ill diabetic patients and healthy subjects, but not in critically ill patients without diabetes. Fundic wave frequency in diabetic patients and healthy subjects was greater than in non-diabetic patients.CONCLUSION: In patients with diabetes mellitus,proximal gastric motility is less disturbed than nondiabetic patients during critical illness, suggesting that these patients may not be at greater risk of delayed gastric emptying.

  18. Comparison of pharmacological and non-pharmacological interventions to prevent delirium in critically ill patients

    DEFF Research Database (Denmark)

    Burry, L. D.; Hutton, Brian; Guenette, M.

    2016-01-01

    Background: Delirium is characterized by acute changes in mental status including inattention, disorganized thinking, and altered level of consciousness, and is highly prevalent in critically ill adults. Delirium has adverse consequences for both patients and the healthcare system; however......, at this time, no effective treatment exists. The identification of effective prevention strategies is therefore a clinical and research imperative. An important limitation of previous reviews of delirium prevention is that interventions were considered in isolation and only direct evidence was used. Our...... the PROSPERO registry for protocols and the Cochrane Library for published systematic reviews. We will examine reference lists of pertinent reviews and search grey literature and the International Clinical Trials Registry Platform for unpublished studies and ongoing trials. We will include randomized and quasi...

  19. Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers

    Science.gov (United States)

    Gomes, Barbara; Calanzani, Natalia; Curiale, Vito; McCrone, Paul; Higginson, Irene J

    2013-01-01

    Background Extensive evidence shows that well over 50% of people prefer to be cared for and to die at home provided circumstances allow choice. Despite best efforts and policies, one-third or less of all deaths take place at home in many countries of the world. Objectives 1. To quantify the effect of home palliative care services for adult patients with advanced illness and their family caregivers on patients' odds of dying at home; 2. to examine the clinical effectiveness of home palliative care services on other outcomes for patients and their caregivers such as symptom control, quality of life, caregiver distress and satisfaction with care; 3. to compare the resource use and costs associated with these services; 4. to critically appraise and summarise the current evidence on cost-effectiveness. Search methods We searched 12 electronic databases up to November 2012. We checked the reference lists of all included studies, 49 relevant systematic reviews, four key textbooks and recent conference abstracts. We contacted 17 experts and researchers for unpublished data. Selection criteria We included randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series (ITSs) evaluating the impact of home palliative care services on outcomes for adults with advanced illness or their family caregivers, or both. Data collection and analysis One review author assessed the identified titles and abstracts. Two independent reviewers performed assessment of all potentially relevant studies, data extraction and assessment of methodological quality. We carried out meta-analysis where appropriate and calculated numbers needed to treat to benefit (NNTBs) for the primary outcome (death at home). Main results We identified 23 studies (16 RCTs, 6 of high quality), including 37,561 participants and 4042 family caregivers, largely with advanced cancer but also congestive heart failure (CHF), chronic obstructive

  20. A mixed-methods systematic review protocol to examine the use of physical restraint with critically ill adults and strategies for minimizing their use.

    Science.gov (United States)

    Rose, Louise; Dale, Craig; Smith, Orla M; Burry, Lisa; Enright, Glenn; Fergusson, Dean; Sinha, Samir; Wiesenfeld, Lesley; Sinuff, Tasnim; Mehta, Sangeeta

    2016-11-21

    Critically ill patients frequently experience severe agitation placing them at risk of harm. Physical restraint is common in intensive care units (ICUs) for clinician concerns about safety. However, physical restraint may not prevent medical device removal and has been associated with negative physical and psychological consequences. While professional society guidelines, legislation, and accreditation standards recommend physical restraint minimization, guidelines for critically ill patients are over a decade old, with recommendations that are non-specific. Our systematic review will synthesize evidence on physical restraint in critically ill adults with the primary objective of identifying effective minimization strategies. Two authors will independently search from inception to July 2016 the following: Ovid MEDLINE, CINAHL, Embase, Web of Science, Cochrane Library, PROSPERO, Joanna Briggs Institute, grey literature, professional society websites, and the International Clinical Trials Registry Platform. We will include quantitative and qualitative study designs, clinical practice guidelines, policy documents, and professional society recommendations relevant to physical restraint of critically ill adults. Authors will independently perform data extraction in duplicate and complete risk of bias and quality assessment using recommended tools. We will assess evidence quality for quantitative studies using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and for qualitative studies using the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) guidelines. Outcomes of interest include (1) efficacy/effectiveness of physical restraint minimization strategies; (2) adverse events (unintentional device removal, psychological impact, physical injury) and associated benefits including harm prevention; (3) ICU outcomes (ventilation duration, length of stay, and mortality); (4) prevalence, incidence, patterns of use

  1. Coping with the Personal Loss of Having a Parent with Mental Illness: Young Adults' Narrative Accounts of Spiritual Struggle and Strength

    Science.gov (United States)

    Maunu, Aleisha; Stein, Catherine H.

    2010-01-01

    The present study examines the personal accounts of nine young adults who have parents living with mental illness. Adults' experience of personal loss due to their parents' mental illness and perceptions of their religious faith journey and spiritual struggles are described. Overall, young adults who reported experiencing more personal loss due to…

  2. Favored subjects and psychosocial needs in music therapy in terminally ill cancer patients: a content analysis

    OpenAIRE

    Preissler, Pia; Kordovan, Sarah; Ullrich, Anneke; Bokemeyer, Carsten; Oechsle, Karin

    2016-01-01

    Background Research has shown positive effects of music therapy on the physical and mental well-being of terminally ill patients. This study aimed to identify favored subjects and psychosocial needs of terminally ill cancer patients during music therapy and associated factors. Methods Forty-one Patients receiving specialized inpatient palliative care prospectively performed a music therapy intervention consisting of at least two sessions (total number of sessions: 166; per patient average: 4,...

  3. Belief in supernatural causes of mental illness among Malay patients: impact on treatment.

    Science.gov (United States)

    Razali, S M; Khan, U A; Hasanah, C I

    1996-10-01

    The concept of aetiology of mental illness in 134 Malay patients was investigated by means of a 20-item checklist. About 53% of the patients attributed their illnesses to supernatural agents. Witchcraft and possession by evil spirits were regarded as common causes of illness. The number of patients who believed in supernatural causes of their mental illness was significantly higher among those who had consulted bomohs (Malay traditional healers) than among those who had not consulted them. The belief that mental illness is caused by supernatural agents is firmly held by bomohs, who reinforce this notion in those who seek their advice. Belief in supernatural causes of mental illness was not significantly associated with age, gender, level of education or occupation of the patients. Patients who believed in supernatural causes of mental illness were also found to show poor drug compliance, and the number of such patients at 6 months follow-up was significantly lower than the corresponding figure for those who did not believe in supernatural causes. The importance of understanding the patients' cultural background when treating psychiatric patients is highlighted.

  4. Family contact and health status among older adults with serious mental illnesses.

    Science.gov (United States)

    Aschbrenner, Kelly A; Mueser, Kim T; Bartels, Stephen J; Pratt, Sarah I

    2011-01-01

    The purpose of this study was to explore the amount of family contact among older persons with serious mental illnesses (SMI), and to examine its relationship to health and mental health. An analysis of baseline data was conducted from a treatment study including 180 adults age 50 and older. The amount of family contact was examined with descriptive statistics. Differences in health and mental health were examined between participants with low, moderate, or high levels of family contact. Analyses also compared these groups on health and mental health functioning, controlling for psychiatric symptoms and the number and severity of medical diseases, respectively. Over three-quarters of respondents (77.8%) reported speaking on the phone with a relative and two-thirds (67.2%) reported seeing a relative at least once during the past month. Older adults who lived with a family member had more severe mood symptoms and poorer mental health functioning. Those who lived with family or had moderate levels of family contact had more comorbid diseases and more disease severity than those with less family contact. These relationships remained significant after controlling for medical conditions or psychiatric symptoms. The majority of older persons have regular family contact and those with the highest levels of family contact appear to have more compromised physical and mental health. Study findings provide new knowledge for practitioners regarding the importance of using family interventions to target physical health and mental illness management for older consumers who may need assistance to access medical care and treatment. Further research on the role of families in psychiatric and physical health management will provide a foundation for family interventions aimed at supporting community living among older adults.

  5. Simulated job interview improves skills for adults with serious mental illnesses.

    Science.gov (United States)

    Humm, Laura Boteler; Olsen, Dale; Be, Morris; Fleming, Michael; Smith, Matthew

    2014-01-01

    Adults with serious mental illnesses (e.g., Autism Spectrum Disorder [ASD], schizophrenia, post-traumatic stress disorder [PTSD]) often have difficulties obtaining employment. The Job Interview Training System with Molly Porter, developed in collaboration with Yale and Northwestern Universities and vocational rehabilitation specialists with funding from The National Institutes of Health (R43/44MH080496), allows learners to practice job interviews on computers in a stress free environment. The system includes user-driven educational materials, an interactive job application, a practice simulation with a fictional interviewer (Molly Porter), and extensive feedback. SIMmersion's PeopleSIM™ technology allows each conversation with Molly to provide a unique interview experience, enabling users to gain confidence while building skills. The on-screen coach provides insight during the conversation, and a comprehensive after-action review provides learners with feedback on the entire interview. In a randomized control trial, the system was proven effective at improving participants' interview skills and confidence. Ninety-six (96) unemployed adults with ASD (n=26), schizophrenia/other (n=37) or PTSD (n=33) were recruited. Participants were randomized into control (n=32) and experimental (n=64) conditions. The control group was "wait-listed" to receive training, and the experimental group used the training system with Molly Porter. Both groups completed pre- and post-intervention role-play interviews and self-assessment questionnaires. Analyses of covariance showed that the simulation provided a highly significant training effect, with experimental group participants scoring better in the role-play interviews and self-assessing higher than control group participants. By increasing skills and confidence, this system may ultimately reduce the length of unemployment for adults with mental illnesses.

  6. Patients' narratives of chronic illnesses and the notion of biographical disruption.

    Science.gov (United States)

    Delbene, Roxana

    2011-01-01

    Bury's (1982) argument that the onset of a chronic illness represents a biographical disruption has become paradigmatic in the sociology of illness studies. More recently Bury (1991, 1997) himself Williams (2000) and other medical sociologists have argued that the notion of illness as biographical disruption needs re-examination. Following a phenomenological approach, in this paper the author draws on different narrative models (Labov and Waletzky 1967 and Ricoeur 1980) to analyze how patients orient to the onset of chronic illness as the complicating action. The data comprise eight narratives collected in South America: three correspond to patients with renal failure, and five to patients with HIV/AIDS disease. It is observed that in some cases, patients' complicating actions are rather oriented to experiences of poverty, drug addiction, and criminality that took place prior to their onset of their illnesses. These experiences, instead of the onset of their illnesses, occupy the place of the complicating action in these patients' narratives. The author discusses that in the studies of illness narratives, it is difficult to operate from a different paradigm, but argues that conflating the onset of chronic illness with a biographical disruption may confuse the episodic dimension of narrative with the configurational dimension.

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

    Directory of Open Access Journals (Sweden)

    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

  8. Inspiratory muscle training is ineffective in mechanically ventilated critically ill patients

    Directory of Open Access Journals (Sweden)

    Caruso Pedro

    2005-01-01

    Full Text Available PURPOSE: Invasive mechanical ventilation is associated with complications, and its abbreviation is desirable. The imbalance between increased workload, decreased inspiratory muscle strength and endurance is an important determinant of ventilator dependence. Low endurance may be present due to respiratory muscle atrophy, critical illness, or steroid use. Specific inspiratory muscle training may increase or preserve endurance. The objective of the study was to test the hypothesis that inspiratory muscle training from the beginning of mechanical ventilation would abbreviate the weaning duration and decrease reintubation rate. As a secondary objective, we described the evolution of inspiratory muscle strength with and without inspiratory muscle training. METHODS: Prospective, randomized clinical trial in an adult clinical-surgical intensive care unit. Twelve patients trained the inspiratory muscles twice a day, and 13 patients did not (control. Training was performed adjusting the sensitivity of the ventilator based on the maximal inspiratory pressure. Patients underwent daily surveillance of the maximal inspiratory pressure. RESULTS: The weaning duration (31 ± 22 hr, control and 23 ± 11 hr, training group; P = .24 and reintubation rate (5 control and 3 training group; P = .39 were not statistically different. The maximal inspiratory pressure of the control group showed a trend toward a modest increase. In contrast, the training group showed a small decrease (P = .34. CONCLUSIONS: In acute critically ill patients, inspiratory muscle training from the beginning of mechanical ventilation neither abbreviated the weaning duration, nor decreased the reintubation rate. Inspiratory muscle strength tended to stay constant, along the mechanical ventilation, with or without this specific inspiratory muscle training.

  9. Assessment of accuracy of Cockcroft-Gault and MDRD formulae in critically ill Indian patients

    Directory of Open Access Journals (Sweden)

    Mohit Kharbanda

    2013-01-01

    Full Text Available Background: Cockroft-Gault (CG and Modification of Diet in Renal Disease (MDRD formulae have not been validated in critically ill Indian patients. We sought to quantify the discrepancy, if any, in Glomerular Filteration Rate (GFR estimated by CG and MDRD formulae with 24 hrs urine Creatinine Clearance (Cr Cl. Materials and Methods: Prospective cohort study in 50 adult patients in a mixed medical-surgical intensive care unit. Inclusion criteria: Intensive Therapy Unit (ITU stay >48 hrs and indwelling urinary catheter. Exclusion criteria: Age <18 years, pregnancy, dialysis, urine output <400 ml/day and patients receiving ranitidine, cefoxitin, trimethoprim or diuretics. We estimated Creatinine Clearance by CG and MDRD formula and measured GFR by 24 hrs urine creatinine clearance. Bland Altman plot was used to find the difference between the paired observations. The association between the methods was measured by the product moment correlation coefficient. Result: The mean GFR as calculated by Creatinine Clearance was 79.76 ml/min/1.73 m 2 [95% Confidence Interval (CI 65.79 to 93.72], that by CG formula was 90.05 ml/min/1.73 m 2 [95% CI: 74.50 to 105.60], by MDRD was 85.92 ml/min/1.73 m 2 [95% CI: 71.25 to 100.59]. The Bias and Precision between CG and Cr Cl were -4.5 and 140.24 respectively, between MDRD and Cr Cl was -6.1 and 122.52. The Correlation coefficient of CG formula as a measure of GFR was 0.65 ( P < 0.0001, that of MDRD was 0.70 ( P < 0.0001. Conclusion: We conclude that CG and MDRD formulae have a strong correlation with measured GFR but are not a reliable measure and overestimate GFR in critically ill Indian patients.

  10. Compliance to treatment in patients with chronic illness: A concept exploration.

    Science.gov (United States)

    Rafii, Forough; Fatemi, Naima Seyed; Danielson, Ella; Johansson, Christina Melin; Modanloo, Mahnaz

    2014-03-01

    Patients' compliance to treatment is an important indicator for evaluating the successful management in chronic illnesses. Despite the fact an applicable definition of compliance is required to suitable intervention and research, this concept is not clear and there is no consensus concerning its meaning, definition, and measurement. The aim of this study was to explore the concept of compliance and to formulate a working definition. Theoretical phase of Schwartz-Barcott and Kim's Hybrid Model of concept analysis was used to analyze the concept of compliance. Data were collected by using literature reviews. Medline, CINAHL, Ovid, Elsevier, Pro Quest and Blackwell databases were searched from 1975 to 2010 using the keywords "Compliance," "Non-compliance," "Adherence," and "Concordance." Articles published in English were selected if they included adult patients with chronic illnesses and reported attributes of compliance; 23 such relevant articles were chosen. The attributes of compliance included patient obedience, ability to implement medical advice, flexibility, responsibility, collaboration, participation, and persistence in implementing the advices. Antecedents are organized into two interacting categories: Internal factors refer to the patient, disease, and treatment characteristics and external factors refer to the healthcare professionals, healthcare system, and socioeconomic factors. Compliance may lead to desirable and undesirable consequences. A working definition of compliance was formulated by comparing and contrasting the existing definitions with regard to its attributes which are useful in clinical practice and research. This finding will be useful in clinical practice and research. But this working definition has to be tested in a clinical context and a broad view of its applicability has to be obtained.

  11. Strategies to reduce the risk of iatrogenic illness in complex older adults

    OpenAIRE

    2013-01-01

    Older patients are particularly vulnerable to adverse drug reactions (ADRs) because age is associated with changes in pharmacokinetics and pharmacodynamics that may alter drug metabolism. In addition, other conditions, commonly observed in older adults, may increase the risk of ADRs in the older population (including polypharmacy, comorbidity, cognitive and functional limitations). ADRs in older adults are frequently preventable, suggesting that screening and prevention programmes aimed at re...

  12. Food safety for the solid organ transplant patient: preventing foodborne illness while on chronic immunosuppressive drugs.

    Science.gov (United States)

    Obayashi, Patricia A C

    2012-12-01

    Issues regarding food safety are seen increasingly in the news; outbreaks of foodborne illness have been associated with public health concerns ranging from mild illness to death. For the solid organ transplant patient, immunosuppressive and antibacterial drugs, which maintain transplant organ function, can expose the transplant patient to increased risk of foodborne illness from bacteria, viruses, fungi, and parasites. This review article describes the clinical consequences, sources of foodborne illness, and food safety practices needed to minimize risks to the solid organ transplant patient who must take lifelong immunosuppressive drugs. All members of the transplant team share responsibility for education of the solid organ transplant patient in preventing infections. The registered dietitian, as part of the transplant team, is the recognized expert in providing food safety education in the context of medical nutrition therapy to solid organ transplant patients, the patients' caregivers, and other healthcare providers.

  13. Quality Nursing Care for Hospitalized Patients with Advanced Illness: Concept Development

    Science.gov (United States)

    Izumi, Shigeko; Baggs, Judith G.; Knafl, Kathleen A.

    2011-01-01

    The quality of nursing care as perceived by hospitalized patients with advanced illness has not been examined. A concept of quality nursing care for this population was developed by integrating the literature on constructs defining quality nursing care with empirical findings from interviews of 16 patients with advanced illness. Quality nursing care was characterized as competence and personal caring supported by professionalism and delivered with an appropriate demeanor. Although the attributes of competence, caring, professionalism, and demeanor were identified as common components of quality care across various patient populations, the caring domain increased in importance when patients with advanced illness perceived themselves as vulnerable. Assessment of quality nursing care for patients with advanced illness needs to include measures of patient perceptions of vulnerability. PMID:20572095

  14. A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness

    DEFF Research Database (Denmark)

    Petersen, Lone Bente; Jeppesen, Pia; Thorup, Anne;

    2005-01-01

    To evaluate the effects of integrated treatment for patients with a first episode of psychotic illness.......To evaluate the effects of integrated treatment for patients with a first episode of psychotic illness....

  15. More illness in offspring of bipolar patients from the US compared to Europe

    NARCIS (Netherlands)

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

    Background: Evidence suggests that patients with bipolar disorder from the United States have an earlier age of onset and a more difficult course of illness than those from Germany and the Netherlands. These characteristics were related to a greater family burden of psychiatric illness and the

  16. More illness in offspring of bipolar patients from the US compared to Europe

    NARCIS (Netherlands)

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

    2016-01-01

    Background: Evidence suggests that patients with bipolar disorder from the United States have an earlier age of onset and a more difficult course of illness than those from Germany and the Netherlands. These characteristics were related to a greater family burden of psychiatric illness and the exper

  17. Assessing Patient Management Plans of Doctors and Medical Students: An Illness Script Perspective

    Science.gov (United States)

    Monajemi, Alireza; Schmidt, Henk G.; Rikers, Remy M. J. P.

    2012-01-01

    Introduction: Illness script theory offers explanations for expert-novice differences in clinical reasoning. However, it has mainly focused on diagnostic (Dx) performance, while patient management (Mx) has been largely ignored. The aim of the present study was to show the role of Mx knowledge in illness script development and how it relates to…

  18. Can the common-sense model predict adherence in chronically ill patients? A meta-analysis

    NARCIS (Netherlands)

    K. Brandes; B. Mullan

    2013-01-01

    The aim of this meta-analysis was to explore whether mental representations, derived from the common-sense model of illness representations (CSM), were able to predict adherence in chronically ill patients. Electronic databases were searched for studies that used the CSM and measured adherence behav

  19. Hormones in the critically ill patient : to intervene or not to intervene?

    NARCIS (Netherlands)

    Ligtenberg, JJM; Girbes, ARJ; Beentjes, JAM; Tulleken, JE; van der Werf, TS; Zijlstra, JG

    2001-01-01

    Critically ill patients show a variety of hormonal changes that appear to differ considerably in acute and prolonged critical illness. Whether these endocrine alterations serve as physiological adaptation or contribute to further deterioration remains an intriguing question. We review the recent lit

  20. Illness perceptions in dialysis patients and their association with quality of life.

    NARCIS (Netherlands)

    Timmers, L.; Thong, M.; Dekker, F.W.; Boeschoten, E.W.; Heijmans, M.; Rijken, M.; Weinman, J.; Kaptein, A.

    2008-01-01

    The present study explored illness perceptions of end stage renal disease (ESRD) patients on both haemodialysis (HD) and peritoneal dialysis (PD) treatment, and their associations with quality of life. Leventhal's self-regulation model (SRM) was used as a theoretical framework. Illness perceptions a

  1. Clinical studies to investigate pharmacokinetics of antimicrobial agents in critically ill patients

    NARCIS (Netherlands)

    S.L.C.E. Buijk (Steven)

    2003-01-01

    markdownabstract__Abstract__ The intensive care unit (ICU) is an essential part of the surgical department, providing an environment for surveillance and treatment of the critically ill. Patients are admitted either with a life threatening condition due to a critical illness or they need observatio

  2. Theophylline toxicity leading to suicidal ideation in a patient with no prior psychiatric illness

    Directory of Open Access Journals (Sweden)

    Sumit Kapoor

    2015-04-01

    Full Text Available Suicidal behavior is a common psychiatric emergency and is associated with psychiatric illness and history of prior suicide attempts. Neuropsychiatric manifestations related to theophylline toxicity are well described in literature. We report a case of theophylline toxicity manifesting as suicidal ideation in a patient with no prior psychiatric illness.

  3. Family Support, Age, and Emotional States of Terminally Ill Cancer Patients.

    Science.gov (United States)

    Wu, Kitty K. Y.

    1991-01-01

    Explored emotional states of dying patients, age, and family support. Findings from 26 terminally ill female cancer patients revealed that younger patients expressed more bargaining and complaints than older patients who revealed more depression and acceptance. Patients with immediate family support expressed less depression and more fears than…

  4. The illness experience of youth with lupus/mixed connective tissue disease: a mixed methods analysis of patient and parent perspectives.

    Science.gov (United States)

    Knight, A; Vickery, M; Fiks, A G; Barg, F K

    2016-08-01

    We aimed to develop a model of the illness experience for youth with systemic lupus erythematosus (SLE)/mixed connective tissue disease (MCTD). We conducted 32 semi-structured interviews with 16 outpatient youth with SLE/MCTD, age 11 to 22 years, and their parents. We qualitatively defined key features of illness for families and distinguished profiles of youth adapting well vs poorly to SLE/MCTD. We then related these profiles to features of illness, patient-level attributes and outcomes. Experiences with SLE/MCTD grouped into five themes: managing disease, limitations, stigma, illness uncertainty and psychological coping. Youth adapting well experienced minimal challenges in these areas. Youth adapting poorly (4/16) experienced significant challenges in >1 thematic area, and were older with lower socioeconomic status, quality of life and psychosocial functioning, and increased disease-related morbidity. They also described suboptimal treatment adherence, healthcare utilization and transition to adult care. These findings support a dynamic model in which illness adaptation and outcomes are shaped by patient characteristics and five central illness-related challenges. Further testing of our model of illness experience may help guide comprehensive and personalized care of youth with SLE/MCTD, with targeted supports for youth at risk for negative adaptation to illness and poor outcomes. © The Author(s) 2016.

  5. Diet and exercise effects on aerobic fitness and body composition in seriously mentally ill adults.

    Science.gov (United States)

    Giannopoulou, Ifigenia; Botonis, Petros; Kostara, Christina; Skouroliakou, Maria

    2014-01-01

    Low exercise capacity and high obesity levels are the main characteristics of people with serious mental illness (SMI). We conducted a pilot study on the effects of a 3-month exercise and dietary intervention on the aerobic capacity and body composition of obese adults with SMI taking Olanzapine, a second generation antipsychotic medication known to induce weight increments. Fifty adults with SMI (15 males and 35 females) followed a 3-month weight loss intervention programme based on exercise and diet. Pre- and post-intervention, a submaximal [Formula: see text]O2 exercise test was performed in order to assess [Formula: see text]O2max anthropometric and body composition measurements were also performed. All participants were obese (body mass index (BMI): 33.61 ± 0.91 kg/m(2)). Pre- and post-intervention, a submaximal [Formula: see text]O2 exercise test on the treadmill was performed in order to assess [Formula: see text]O2max anthropometric and body composition measurements were also performed. Significant reductions in body weight, BMI, body fat and waist circumference were found from pre to post (p diet improves the aerobic capacity and body composition of obese adults with SMI, despite the use of Olanzapine.

  6. Changes in circulating blood volume after infusion of hydroxyethyl starch 6% in critically ill patients

    DEFF Research Database (Denmark)

    Christensen, P; Andersson, J; Rasmussen, S E;

    2001-01-01

    The cardiovascular response to a volume challenge with hydroxyethyl starch (HES) (200/0.5) 6% depends on the relation between the volume of HES 6% infused and the expansion of the blood volume in critically ill patients. However, only relatively limited data exist on the plasma expanding effect...... of infusion of HES 6% in critically ill patients. The purpose of the study was to evaluate the variation in the expansion of the circulating blood volume (CBV) in critically ill patients after infusion of 500 ml of colloid (HES (200/0.5) 6%) using the carbon monoxide method....

  7. Splenic artery embolization: An alternative approach in a critically ill patient with autoimmune hemolytic anemia

    Directory of Open Access Journals (Sweden)

    Mine Durusu Tanrıöver

    2011-06-01

    Full Text Available Assessment of general health status and hematological parameters usually precedes the use of invasive diagnostic and therapeutic procedures in critically ill patients. Angiography can be effective and safe as a substitute for major surgical procedures, or as a bridging therapy in such cases. We present a critically ill patient with hemolytic anemia that underwent splenic artery embolization as a bridging therapy. We aimed to emphasize that minimally invasive approaches and multidisciplinary care can be utilized in the treatment of critically ill patients with accompanying hematological disease.

  8. Clinical outcomes of a specialised inpatient unit for adults with mild to severe intellectual disability and mental illness.

    Science.gov (United States)

    Lunsky, Y; White, S E; Palucka, A M; Weiss, J; Bockus, S; Gofine, T

    2010-01-01

    Limitations of general psychiatric services have led to the development of specialised psychiatric programmes for patients with intellectual disability (ID) and mental health needs. Few studies have examined treatment outcomes of specialised inpatient units, and no studies have explored how the effects of intervention may differ for individuals at varying levels of cognitive ability. The present study examined clinical outcomes of inpatients with mild ID in contrast to inpatients with moderate to severe ID within the same service. Thirty-three patients (17 with mild ID and 16 with moderate to severe ID) discharged between 2006 and 2008 from a specialised inpatient unit in Canada for adults with ID and mental illness were studied. In addition to examining change in scores on clinical measures, outcomes with regard to length of stay, diagnostic change, residential change and re-admission to hospital were explored. Both groups demonstrated clinical improvement from admission to discharge. However, only patients with mild ID demonstrated improvements on the Global Assessment of Functioning. This study is one of the first to consider outcomes of higher and lower functioning individuals with ID on a specialised inpatient unit. Results suggest that outcomes may be different for these groups, and some clinical measures may be more sensitive to changes in patients with more severe disabilities.

  9. Alterations in brain structure in adults with anorexia nervosa and the impact of illness duration.

    Science.gov (United States)

    Fonville, L; Giampietro, V; Williams, S C R; Simmons, A; Tchanturia, K

    2014-07-01

    Brain structure alterations have been reported in anorexia nervosa, but findings have been inconsistent. This may be due to inadequate sample size, sample heterogeneity or differences in methodology. High resolution magnetic resonance images were acquired of 33 adult participants with anorexia nervosa and 33 healthy participants, the largest study sample to date, in order to assess whole-brain volume, ventricular cerebrospinal fluid, white matter and grey matter volume. Voxel-based morphometry was conducted to assess regional grey matter volume. Levels of depression, anxiety, obsessionality and eating disorder-related symptoms were measured and used to explore correlations with brain structure. Participants with anorexia nervosa had smaller brain volumes as well as a global decrease in grey matter volume with ventricular enlargement. Voxel-based morphometry revealed a decrease in grey matter volume spanning across the cerebellum, temporal, frontal and occipital lobes. A correlation was found between grey matter volume loss and duration of illness in the cerebellum and mesencephalon. No correlations were found with clinical measures. Findings are in accordance with several previous studies on brain structure and match functional studies that have assessed the symptomatology of anorexia nervosa, such as body image distortion and cognitive bias to food. The correlation with duration of illness supports the implication of cerebellar atrophy in the maintenance of low weight and disrupted eating behaviour and illustrates its role in the chronic phase of anorexia nervosa. The lack of other correlations suggests that these findings are not related to the presence of co-morbid disorders.

  10. Head-of-bed elevation in critically ill patients: a review.

    Science.gov (United States)

    Metheny, Norma A; Frantz, Rita A

    2013-06-01

    Clinicians are confused by conflicting guidelines about the use of head-of-bed elevation to prevent aspiration and pressure ulcers in critically ill patients. Research-based information in support of guidelines for head-of-bed elevation to prevent either condition is limited. However, positioning of the head of the bed has been studied more extensively for the prevention of aspiration than for the prevention of pressure ulcers, especially in critically ill patients. More research on pressure ulcers has been conducted in healthy persons or residents of nursing homes than in critically ill patients. Thus, the optimal elevation for the head of the bed to balance the risks for aspiration and pressure ulcers in critically ill patients who are receiving mechanical ventilation and tube feedings is unknown. Currently available information provides some indications of how to position patients; however, randomized controlled trials where both outcomes are evaluated simultaneously at various head-of-bed positions are needed.

  11. Management of critically ill patients with type 2 diabetes:The need for personalised therapy

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Critical illness in patients with pre-existing diabetesfrequently causes deterioration in glycaemic control.Despite the prevalence of diabetes in patients admittedto hospital and intensive care units, the idealmanagement of hyperglycaemia in these groups isuncertain. There are data that suggest that acutehyperglycaemiain critically ill patients without diabetesis associated with increased mortality and morbidity.Exogenous insulin to keep blood glucose concentrations〈 10 mmol/L is accepted as standard of care in thisgroup. However, preliminary data have recently beenreported that suggest that chronic hyperglycaemia mayresult in conditioning, which protects these patientsagainst damage mediated by acute hyperglycaemia.Furthermore, acute glucose-lowering to 〈 10 mmol/Lin patients with diabetes with inadequate glycaemiccontrol prior to their critical illness appears to havethe capacity to cause harm. This review focuses onglycaemic control in critically ill patients with type 2diabetes, the potential for harm from glucose-loweringand the rationale for personalised therapy.

  12. Anticipated stigma in chronic illness patients in Cambodia, Myanmar and Vietnam.

    Science.gov (United States)

    Peltzer, Karl; Pengpid, Supa

    2016-12-01

    The aim of this study was to explore the prevalence and relationship of anticipated chronic illness stigma among patients diagnosed with a variety of chronic diseases in three Southeast Asian countries (Cambodia, Myanmar and Vietnam). A cross-sectional survey was conducted in 4,803 adult chronic disease patients (mean age 49.3 years; SD=16.5) recruited systematically from health facilities. Overall, the results indicate that 20.7% of patients reported that for any of the 12 stigma items, they anticipated they were likely or very likely to experience chronic disease stigma. A multivariate analysis of sociodemographics revealed the following were associated with anticipated chronic disease stigma: older versus younger age, OR (odds ratio) = 0.71; 95% Confidence Interval (CI) [0.58, 0.87]; higher versus lower education, OR = 2.23; 95% CI [1.81, 2.75]; origin from Myanmar or Vietnam, being single, divorced or widowed, rural residence, and health status (having three or more chronic conditions versus having one chronic condition), OR = 1.93; 95% CI [1.58, 2.35]; lower versus higher quality of life, OR = 0.73; 95% CI [0.63, 0.85]); health risk behavior (physical inactivity, poor diet, current smoking, and problem drinking) and low versus medium or high medication adherence (OR = 0.69; 95% CI [0.55,0.86]). This study demonstrated the possible consequences of anticipated stigma on the health and behavior of people living with chronic diseases, and several factors for chronic disease stigma were identified that can help guide interventions to reduce chronic illness stigma in this population.

  13. Timing of tracheostomy in critically ill patients: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Huibin Huang

    Full Text Available OBJECTIVE: To compare important outcomes between early tracheostomy (ET and late tracheostomy (LT or prolonged intubation (PI for critically ill patients receiving long-term ventilation during their treatment. METHOD: We performed computerized searches for relevant articles on PubMed, EMBASE, and the Cochrane register of controlled trials (up to July 2013. We contacted international experts and manufacturers. We included in the study randomized controlled trials (RCTs that compared ET (performed within 10 days after initiation of laryngeal intubation and LT (after 10 days of laryngeal intubation or PI in critically ill adult patients admitted to intensive care units (ICUs. Two investigators evaluated the articles; divergent opinions were resolved by consensus. RESULTS: A meta-analysis was evaluated from nine randomized clinical trials with 2,072 participants. Compared to LT/PI, ET did not significantly reduce short-term mortality [relative risks (RR = 0.91; 95% confidence intervals (CIs = 0.81-1.03; p = 0.14] or long-term mortality (RR = 0.90; 95% CI = 0.76-1.08; p = 0.27. Additionally, ET was not associated with a markedly reduced length of ICU stay [weighted mean difference (WMD = -4.41 days; 95% CI = -13.44-4.63 days; p = 0.34], ventilator-associated pneumonia (VAP (RR = 0.88; 95% CI = 0.71-1.10; p = 0.27 or duration of mechanical ventilation (MV (WMD = - 2.91 days; 95% CI = -7.21-1.40 days; p = 0.19. CONCLUSION: Among the patients requiring prolonged MV, ET showed no significant difference in clinical outcomes compared to that of the LT/PI group. But more rigorously designed and adequately powered RCTs are required to confirm it in future.

  14. Accuracy of a novel noninvasive transdermal continuous glucose monitor in critically ill patients.

    Science.gov (United States)

    Saur, Nicole M; England, Michael R; Menzie, Wayne; Melanson, Ann Marie; Trieu, My-Quyen; Berlin, Jason; Hurley, James; Krystyniak, Keith; Kongable, Gail L; Nasraway, Stanley A

    2014-09-01

    Stress hyperglycemia and hypoglycemia are associated with increased morbidity and mortality in the critically ill. Intermittent, random blood glucose (BG) measurements can miss episodes of hyper- and hypoglycemia. The purpose of this study was to determine the accuracy of the Symphony® continuous glucose monitor (CGM) in critically ill cardiac surgery patients. Fifteen adult cardiac surgery patients were evaluated immediately postoperatively in the intensive care unit. Prelude® SkinPrep prepared the skin and a sensor was applied to 2 test sites on each subject to monitor interstitial fluid glucose. Reference BG was sampled at 30- to 60-minute intervals. The skin at the test sites was inspected for adverse effects. Accuracy of the retrospectively analyzed CGM data relative to reference BG values was determined using continuous glucose-error grid analysis (CG-EGA) and mean absolute relative difference (MARD). Using 570 Symphony CGM glucose readings paired with reference BG measurements, CG-EGA showed that 99.6% of the readings were within zones A and B. BG measurements ranged from 73 to 251 mg/dL. The MARD was 12.3%. No adverse device effects were reported. The Symphony CGM system is able to safely, continuously, and noninvasively monitor glucose in the transdermal interstitial fluid of cardiac surgery intensive care unit patients with accuracy similar to that reported with other CGM systems. Future versions of the system will need real-time data analysis, fast warm-up, and less frequent calibrations to be used in the clinical setting. © 2014 Diabetes Technology Society.

  15. Tissue Doppler Septal Tei Index Indicates Severity of Illness in Pediatric Patients with Congestive Heart Failure

    Science.gov (United States)

    Mejia, Aura A Sanchez; Simpson, Kathleen E.; Hildebolt, Charles F; Pahl, Elfriede; Matthews, Kathleen L; Rainey, Cheryl A; Canter, Charles E; Jay, Patrick Y; Johnson, Mark C

    2013-01-01

    Background: The Doppler Tei index is an independent predictor of outcomes in adult heart failure. Tissue Doppler imaging (TDI) may be a superior method to measure the Tei index in children, as it is less affected by heart rate variability. We hypothesized that the TDI Tei index reflects severity of illness in pediatric heart failure. Methods: Twenty-five pediatric heart failure patients were prospectively enrolled. Listing for heart transplantation or death were the outcomes used to define severity of illness. Baseline demographics, brain natriuretic peptide (BNP), standard echocardiographic and TDI-derived parameters were analyzed to determine outcome indicators. Results: Ten of the 25 patients (40%) were listed for transplantation. There were no deaths. Multivariate analysis combining age, heart rate, standard echocardiographic parameters, and BNP, resulted in shortening fraction (p=0.002) as the best indicator of listing for transplantation (R2 = 0.32). A second multivariate analysis combining age, heart rate, TDI parameters and BNP, resulted in age (p = 0.03) and septal Tei index (p = 0.03) as the best predictive model (R2 = 0.36). The area under the receiver operating characteristic (ROC) curve for septal Tei index was 0.84 (0.64-0.96, 95% confidence interval) and it was comparable to the ROC curve for shortening fraction, p=0.76. Optimal values of sensitivity (100%) and specificity (60%) were obtained with septal Tei index values > 0.51. Conclusion: The TDI septal Tei index is an indicator of disease severity in pediatric heart failure patients and offers potential advantages in comparison with standard echocardiographic measures of left ventricular ejection. PMID:24061276

  16. Illness perceptions and coping determine quality of life in COPD patients

    Directory of Open Access Journals (Sweden)

    Tiemensma J

    2016-08-01

    Full Text Available Jitske Tiemensma,1 Erin Gaab,2 Maarten Voorhaar,3,4 Guus Asijee,3,5 Adrian A Kaptein6 1Psychological Sciences, 2Health Sciences Research Institute, University of California, Merced, CA, USA; 3Department of Family Medicine, Maastricht University, Care and Public Health Research Institute School for Public Health and Primary Care, Maastricht, the Netherlands; 4Boehringer Ingelheim, Alkmaar, the Netherlands; 5Boehringer Ingelheim, Amsterdam, the Netherlands; 6Department of Medical Psychology, Leiden University Medical Centre, Leiden, the Netherlands Background: A key goal of chronic obstructive pulmonary disease (COPD care is to improve patients’ quality of life (QoL. For outcomes such as QoL, illness perceptions and coping are important determinants.Aim: The primary aim was to assess the associations between illness perceptions, coping and QoL in COPD patients. A secondary aim was to compare illness perceptions and coping of patients with reference values derived from the literature.Patients and methods: A total of 100 patients were included in the study. Patients were asked to complete the Brief Illness Perception Questionnaire (B-IPQ, the Utrecht Proactive Coping Competence scale (UPCC, and a QoL item. Correlations and linear regression models were used to analyze the data. Student’s t-tests were used to compare patients with COPD with reference values derived from the literature.Results: Patients with better understanding of COPD utilized more proactive coping strategies (P=0.04. A more intense emotional response to COPD was related to less proactive coping (P=0.02. Patients who reported using more proactive coping techniques also reported to have a better QoL (P<0.01. Illness perceptions were also related to QoL: more positive illness perceptions were related to a better QoL (all P<0.05. Patients with COPD reported more negative illness perceptions than people with a common cold or patients with asthma (all P<0.01, but reported similar

  17. Enteral nutritional therapy in septic patients in the intensive care unit: compliance with nutritional guidelines for critically ill patients

    OpenAIRE

    Pasinato, Valeska Fernandes; Berbigier, Marina Carvalho; Rubin, Bibiana de Almeida; Castro, Kamila; Moraes,Rafael Barberena; Perry, Ingrid Dalira Schweigert

    2013-01-01

    Objective Evaluate the compliance of septic patients' nutritional management with enteral nutrition guidelines for critically ill patients. Methods Prospective cohort study with 92 septic patients, age ≥18 years, hospitalized in an intensive care unit, under enteral nutrition, evaluated according to enteral nutrition guidelines for critically ill patients, compliance with caloric and protein goals, and reasons for not starting enteral nutrition early or for discontinuing it. Prognostic scores...

  18. A retrospective study of clinical profile and outcomes of critically ill patients with heat-related illness

    Directory of Open Access Journals (Sweden)

    M S Kalaiselvan

    2015-01-01

    Full Text Available Background and Aims: Heat-related illness (HRI due to high ambient temperatures is a common feature during the Indian summer. HRI often results in Intensive Care Unit (ICU admissions and are associated with significant morbidity and mortality. However, published report on the effects of HRI among the Indian population is lacking. This study was undertaken to identify the profile of patients admitted to ICU with clinical features of HRI and study their clinical outcomes. Methods: This was a retrospective case series of patients admitted with features of HRI during the summer of 2012 in our multidisciplinary ICU. Data on demographics, co-morbid illness, admission severity of illness (Acute Physiology and Chronic Health Evaluation II [APACHE II], organ failure scores (Sequential Organ Failure Assessment [SOFA] and neuroimaging studies were collected. Outcome data studied included mortality, ICU length of stay (LOS, ventilator days and hospital LOS. Statistical analysis was performed using Student′s t-test, Chi-square test and multivariate analysis. Results: Twenty-six patients met the diagnostic criteria for HRI. Fifteen were males. The mean age was 53.12 ΁ 18.6 years. Mean APACHE II score was 19.6 ΁ 7.7 and mean SOFA score was 7.5 ΁ 2.6. The common presenting symptoms were fever with neurological impairment (100% and gastrointestinal symptoms (30%. Major organ systems involvement include neurological (100%, renal (57%, hepatic (34% and coagulation abnormalities (26%. Most common metabolic abnormality noted was hyponatraemia (73%. Magnetic resonance imaging findings suggestive of heat stroke were seen in 5 of 26 patients. Mortality rate was 34%. 8 of 17 survivors had residual neurological impairment. Conclusion: HRI carries a high mortality and significant neurological morbidity.

  19. Substantial impact of illness perceptions on quality of life in patients with Crohn's disease.

    Science.gov (United States)

    van der Have, Mike; Minderhoud, Itta M; Kaptein, Adrian A; Leenders, Max; Siersema, Peter D; Fidder, Herma H; Oldenburg, Bas

    2013-09-01

    Crohn's disease (CD) negatively impact patients' health-related quality of life (HRQOL). We used the common sense model to examine the contribution of illness perceptions and coping to HRQOL, in addition to clinical and socio-demographic characteristics. This provides insight into potential targets for psychological interventions aimed at improving HRQOL. Consecutive CD patients undergoing colonoscopy were included. Disease activity was assessed by a clinical and an endoscopic index. Patients completed questionnaires assessing illness perceptions (IPQ-R), coping (Utrecht Coping List), self-perceived health, neuroticism, and HRQOL. Hierarchical multiple regression analyses were performed to assess the contribution of illness perceptions and coping to HRQOL. Illness perceptions were compared to patients with rheumatoid arthritis, myocardial infarction (MI), and head and neck cancer (HNC). Of 82 CD patients, mean age was 42±14years. Clinical and endoscopic active disease was present in 42 (52%) and 49 (60%) patients, respectively. HRQOL was strongly impaired by clinical active disease (r=-0.79), self-perceived health (r=-0.60), and perceived consequences of CD (r=-0.54), but correlated poorly with endoscopic disease activity (r=-0.29). Illness perceptions significantly contributed 3-27% to HRQOL. Coping had no contributory role. CD patients perceived similarly strong consequences of their illness as patients with MI and HNC and had the strongest thoughts about the chronic nature of their illness. CD has a similar impact on patients' daily lives as was observed in patients with MI and HNC. Illness perceptions contribute to HRQOL and should therefore be incorporated in clinical practice, thereby improving HRQOL. Copyright © 2012 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

  20. A comparison of the dental status and treatment needs of older adults with and without chronic mental illness in Sevilla, Spain

    OpenAIRE

    Velasco Ortega, Eugenio; Segura-Egea, Juan J.; Córdoba Arenas, Sara; Jiménez Guerra, Álvaro; L. Monsalve Guil; López López, José

    2013-01-01

    Objectives: To study the dental status and treatment needs of institutionalized older adults with chronic mental illness compared to a non-psychiatric control sample. Study Design: The sample size was 100, in which 50 were psychogeriatric patients (study group; SG) classified according to DSM-IV, with a mean age of 69.6 ± 6.7 years, and 50 non-psychiatric patients (control group; CG), with a mean age of 68.3 ± 6.9 years. Clinical oral health examinations were conducted and caries were recorde...

  1. Predictors of dexmedetomidine-associated hypotension in critically ill patients

    Science.gov (United States)

    Gerlach, Anthony T.; Blais, Danielle M.; Jones, G. Morgan; Burcham, Pamela K.; Stawicki, Stanislaw P.; Cook, Charles H.; Murphy, Claire V.

    2016-01-01

    Background: Dexmedetomidine is commonly used for sedation in the Intensive Care Unit (ICU), and its use may be associated with hypotension. We sought to determine predictors of dexmedetomidine-associated hypotension. Methods: Retrospective, single-center study of 283 ICU patients in four adults ICUs over a 12 month period. Univariate analyses were performed to determine factors associated with dexmedetomidine-related hypotension. Risk factors significant at the 0.20 level in the univariate analysis were considered for inclusion into a step-wise multiple logistical regression model. Results: Hypotension occurred in 121 (42.8%) patients with a median mean arterial pressure (MAP) nadir of 54 mmHg. Univariate analyses showed an association between hypotension and age (P = 0.03), Acute Physiology and Chronic Health Evaluation II (APACHE II) score (P = 0.02), baseline MAP (<0.001), admission to the cardiothoracic ICU (P = 0.05), history of coronary artery disease (P = 0.02), and postcardiac surgery (P = 0.0009). Admission to the medical ICU was associated with a decrease in development in hypotension (P = 0.03). There was a trend for hypotension with weight (P = 0.09) and history of congestive heart failure (P = 0.12) Only MAP prior to initiation (odds ratio [OR] 0.97, 95% confidence interval [95% CI] 0.95–0.99; P < 0.0001), APACHE II scores (OR 1.06, 95% CI 1.01–1.12; P = 0.017), and history of coronary artery disease (OR 0.48, 95% CI 0.26–0.90, P = 0.022) were independently associated with hypotension by multivariable analysis. Conclusions: Dexmedetomidine-associated hypotension is common. Preexisting low blood pressure, history of coronary artery disease, and higher acuity were identified as independent risk factors for dexmedetomidine-associated hypotension. PMID:27722111

  2. Psychometric evaluation of the internalized stigma of mental illness scale for patients with mental illnesses: measurement invariance across time.

    Directory of Open Access Journals (Sweden)

    Chih-Cheng Chang

    Full Text Available BACKGROUND: The current investigation examined the psychometric properties of the Internalized Stigma of Mental Illness (ISMI scale in a sample of patients with mental illness. In addition to the internal consistency, test-retest reliability, and concurrent validity that previous studies have tested for the ISMI, we extended the evaluation to its construct validity and measurement invariance using confirmatory factor analysis (CFA. METHODS: Three hundred forty-seven participants completed two questionnaires (i.e., the ISMI and the Depression and Somatic Symptoms Scale [DSSS], and 162 filled out the ISMI again after 50.23±31.18 days. RESULTS: The results of this study confirmed the frame structure of the ISMI; however, the Stigma Resistance subscale in the ISMI seemed weak. In addition, internal consistency, test-retest reliability, and concurrent validity were all satisfactory for all subscales and the total score of the ISMI, except for Stigma Resistance (α = 0.66; ICC = 0.52, and r = 0.02 to 0.06 with DSSS. Therefore, we hypothesize that Stigma Resistance is a new concept rather than a concept in internalized stigma. The acceptable fit indices supported the measurement invariance of the ISMI across time, and suggested that people with mental illness interpret the ISMI items the same at different times. CONCLUSION: The clinical implication of our finding is that clinicians, when they design interventions, may want to use the valid and reliable ISMI without the Stigma Resistance subscale to evaluate the internalized stigma of people with mental illness.

  3. Factors influencing antibiotic treatment cost and outcome in critically ill patients: A “real-life” study

    Directory of Open Access Journals (Sweden)

    Perić Aneta

    2014-01-01

    Full Text Available Background/Aim. Critically ill patients are at very high risk of developing severe infections in intensive care units (ICUs. Procalcitonin (PCT levels are eleveted in the circulation in patients with bacterial sepsis and PCT might be useful in guiding antibiotic treatment. The aim of this study was to estimate factors influencing patients survival and treatment cost in ICU with special emphasis on the impact of PCT serum levels use in guiding antimicrobial therapy. Methods. The study was conducted from August 2010 to May 2012 in the Intensive Therapy Unit, Clinic of Anesthesiology and Intensive Therapy, Military Medical Academy (MMA, Belgrade, Serbia. All adult critically ill patients with sepsis and/or trauma admitted in the ICU were included in the study. This study included only the cost of antimicrobial therapy in the ICU and the cost for PCT analysis. We used prices valid in the MMA for the year 2012. PCT in serum was measured by homogeneous immunoassay on a Brahms Kryptor analyzer. Results. A total of 102 patients were enrolled. The mean patients age was 55 ± 19 years and 61.8% of patients were male. The mean length of stay (LOS in the ICU was 12 ± 21 days. There was a statistically significant difference (p < 0.001 between the sepsis and trauma group regarding outcome (higher mortality rate was in the sepsis group, particularly in the patients with peritonitis who were mostly women. The patients younger than 70 years had better chance of survival. LOS, the use of carbapenems and PCT-measurement influenced the cost of therapy in the ICU. Conclusions. The obtained results show that age, the diagnosis and gender were the main predictors of survival of critically ill patients in the ICU. The cost of ICU stay was dependent on LOS, use of carbapenems and PCT measurement although the influence of these three factors on the outcome in the patients did not reach a statistical significance.

  4. Attitudes of Malaysian general hospital staff towards patients with mental illness and diabetes

    Directory of Open Access Journals (Sweden)

    Midin Marhani

    2011-05-01

    Full Text Available Abstract Background The context of the study is the increased assessment and treatment of persons with mental illness in general hospital settings by general health staff, as the move away from mental hospitals gathers pace in low and middle income countries. The purpose of the study was to examine whether general attitudes of hospital staff towards persons with mental illness, and extent of mental health training and clinical experience, are associated with different attitudes and behaviours towards a patient with mental illness than towards a patients with a general health problem - diabetes. Methods General hospital health professionals in Malaysia were randomly allocated one of two vignettes, one describing a patient with mental illness and the other a patient with diabetes, and invited to complete a questionnaire examining attitudes and health care practices in relation to the case. The questionnaires completed by respondents included questions on demographics, training in mental health, exposure in clinical practice to people with mental illness, attitudes and expected health care behaviour towards the patient in the vignette, and a general questionnaire exploring negative attitudes towards people with mental illness. Questionnaires with complete responses were received from 654 study participants. Results Stigmatising attitudes towards persons with mental illness were common. Those responding to the mental illness vignette (N = 356 gave significantly lower ratings on care and support and higher ratings on avoidance and negative stereotype expectations compared with those responding the diabetes vignette (N = 298. Conclusions Results support the view that, in the Malaysian setting, patients with mental illness may receive differential care from general hospital staff and that general stigmatising attitudes among professionals may influence their care practices. More direct measurement of clinician behaviours than able to be implemented

  5. Effect of a Probiotic Preparation (VSL#3 on Cardiovascular Risk Parameters in Critically-Ill Patients

    Directory of Open Access Journals (Sweden)

    Sarvin Sanaie

    2013-07-01

    Conclusion: Administration of probiotics in critically ill patients reduced the levels of TG and hs-CRP and increased HDL-C levels. However, no significant change was detected in levels of total cholesterol or LDL-C.

  6. The potential of antimicrobials to induce thrombocytopenia in critically ill patients

    DEFF Research Database (Denmark)

    Johansen, Maria Egede; Jensen, Jens Ulrik Stæhr; Bestle, Morten Heiberg

    2013-01-01

    Antimicrobial-induced thrombocytopenia is frequently described in the literature among critically ill patients. Several antimicrobials have been implicated, although experimental evidence to demonstrate causality is limited. We report, using a randomized trial, the potential of antimicrobials to ...

  7. Hyperproteic hypocaloric enteral nutrition in the critically ill patient: A randomized controlled clinical trial

    National Research Council Canada - National Science Library

    Rugeles, Saúl-Javier; Rueda, Juan-David; Díaz, Carlos-Eduardo; Rosselli, Diego

    2013-01-01

    Our aim was to evaluate the impact of hyperproteic hypocaloric enteral feeding on clinical outcomes in critically ill patients, particularly on severity of organic failure measured with the Sequential...

  8. Beta-lactam dosing in critically ill patients with septic shock and continuous renal replacement therapy

    National Research Council Canada - National Science Library

    Ulldemolins, Marta; Vaquer, Sergi; Llauradó-Serra, Mireia; Pontes, Caridad; Calvo, Gonzalo; Soy, Dolors; Martín-Loeches, Ignacio

    2014-01-01

    .... This article aims to describe the current clinical scenario for beta-lactam dosing in critically ill patients with septic shock and CRRT, to highlight the sources of variability among the different...

  9. Clinical versus Actuarial Predictions of Violence in Patients with Mental Illness.

    Science.gov (United States)

    Gardner, William; And Others

    1996-01-01

    Compared accuracy of an actuarial procedure for the prediction of community violence by patients with mental illnesses to accuracy of clinicians' concern ratings of patient violence. Data came from a study of 357 pairs of patients seen in a psychiatric emergency room. Actuarial predictions based only on patients' histories of violence were more…

  10. Perceived autonomy in renal patients: the importance of illness/treatment perceptions.

    NARCIS (Netherlands)

    Jansen, D.; Heijmans, M.; Boeschoten, E.; Rijken, M.

    2007-01-01

    Research Question : To what extend do illness and treatment perceptions of dialysis patients predict perceived autonomy? Method: Prospective cohort study among dialysis patients. A total of 166 dialysis patients participated in the first wave of data collection. Patients completed questionnaires at

  11. [Mental health of children, adolescents and young adults--part 2: burden of illness, deficits of the German health care system and efficacy and effectiveness of early intervention services].

    Science.gov (United States)

    Karow, A; Bock, T; Naber, D; Löwe, B; Schulte-Markwort, M; Schäfer, I; Gumz, A; Degkwitz, P; Schulte, B; König, H H; Konnopka, A; Bauer, M; Bechdolf, A; Correll, C; Juckel, G; Klosterkötter, J; Leopold, K; Pfennig, A; Lambert, M

    2013-11-01

    Numerous birth-control studies, epidemiological studies, and observational studies investigated mental health and health care in childhood, adolescence and early adulthood, including prevalence, age at onset, adversities, illness persistence, service use, treatment delay and course of illness. Moreover, the impact of the burden of illness, of deficits of present health care systems, and the efficacy and effectiveness of early intervention services on mental health were evaluated. According to these data, most mental disorders start during childhood, adolescence and early adulthood. Many children, adolescents and young adults are exposed to single or multiple adversities, which increase the risk for (early) manifestations of mental diseases as well as for their chronicity. Early-onset mental disorders often persist into adulthood. Service use of children, adolescents and young adults is low, even lower than in adult patients. Moreover, there is often a long delay between onset of illness and first adequate treatment with a variety of linked consequences for poorer psychosocial prognosis. This leads to a large burden of illness with respect to disability and costs. As a consequence several countries have implemented so-called "early intervention services" at the border of child and adolescent and adult psychiatry. Emerging studies show that these health care structures are effective and efficient. Part 2 of the present review focuses on illness burden including disability and costs, deficits of the present health care system in Germany, and efficacy and efficiency of early intervention services. © Georg Thieme Verlag KG Stuttgart · New York.

  12. Early maladaptive schemas in adult patients with attention deficit hyperactivity disorder.

    Science.gov (United States)

    Philipsen, Alexandra; Lam, Alexandra P; Breit, Sigrid; Lücke, Caroline; Müller, Helge H; Matthies, Swantje

    2017-06-01

    The main purpose of this study was to examine whether adult patients with attention deficit hyperactivity disorder (ADHD) demonstrate sets of dysfunctional cognitive beliefs and behavioural tendencies according to Jeffrey Young's schema-focused therapy model. Sets of dysfunctional beliefs (maladaptive schemas) were assessed with the Young Schema Questionnaire (YSQ-S2) in 78 adult ADHD patients and 80 control subjects. Patients with ADHD scored significantly higher than the control group on almost all maladaptive schemas. The 'Failure', 'Defectiveness/Shame', 'Subjugation' and 'Emotional Deprivation' schemas were most pronounced in adult ADHD patients, while only 'Vulnerability to Harm or Illness' did not differ between the two groups. The schemas which were most pronounced in adult patients with ADHD correspond well with their learning histories and core symptoms. By demonstrating the existence of early maladaptive schemas in adults suffering from ADHD, this study suggests that schema theory may usefully be applied to adult ADHD therapy.

  13. Exploring quality of life in Italian patients with rare disease: a computer-aided content analysis of illness stories.

    Science.gov (United States)

    Caputo, Andrea

    2014-01-01

    The present study used a narrative-based approach to identify common themes that characterized the illness experience and quality of life of patients affected by rare disease (RD). Textual data were comprised of illness stories written by 32 adult Italian patients (eight men and 24 women), with the following RD diagnoses: amyotrophic lateral sclerosis (n = 12), anorectal atresia (n = 4), Poland syndrome (n = 4), and idiopathic pulmonary hypertension (n = 12). Computer-aided content analysis was performed to detect the main themes (cluster analysis) and latent factors (correspondence analysis) emerging in patients' narratives, and to test their association with gender and diagnosis. Four thematic domains were detected in the textual corpus, which are respectively referred to as: hopelessness (12.74%), need for autonomy (38.43%), search for normalcy (11.89%), and expectations of recovery (36.94%). Three latent factors explained the overall data variance: the relationship with social and medical healthcare providers (F1), adjustment processes to disease and social limitations (F2), and self-beliefs and coping (F3). Some differences were revealed with respect to patient gender and diagnosis. Illness stories highlight the significant relationship of RD patients with healthcare services and their need for a holistic approach because of the lack of effective treatment. Physical limitation and emotional distress do not necessarily seem to overlap for adjustment and quality of life (QoL). Overall, the perception of illness chronicity is likely to affect patients' self-beliefs and coping with more than their feeling of abnormalcy, that is the less salient theme.

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

    Science.gov (United States)

    Kale, Minal S; Federman, Alex D; Krauskopf, Katherine; Wolf, Michael; O'Conor, Rachel; Martynenko, Melissa; Leventhal, Howard; Wisnivesky, Juan P

    2015-01-01

    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 (pillness ((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 prevalent, and associated with illness beliefs that predict decreased adherence. Our results suggest that targeted strategies to address low health literacy and related illness and medications beliefs might improve COPD medication adherence and other self-management behaviors.

  15. Daily stress and cortisol patterns in parents of adult children with a serious mental illness.

    Science.gov (United States)

    Barker, Erin T; Greenberg, Jan S; Seltzer, Marsha Mailick; Almeida, David M

    2012-01-01

    The goal of the current study was to examine whether parenting an adult child with a serious mental illness (SMI) has a physiological impact on parents. Multiple samples of saliva were collected on 4 days from 61 parents (mean age = 60.07 years, SD = 10.01) of individuals with a SMI (bipolar disorder, schizophrenia, and major depression; mean age = 32.46 years, SD = 10.57) and a comparison group of 321 parents (mean age = 58.09 years, SD = 12.88) of individuals without a SMI (mean age = 32.36; SD = 13.87). Saliva samples were assayed for the hormone cortisol and group differences in diurnal cortisol patterns and their association with daily stress severity were explored. On days after elevated stress, a hypoactivation pattern of diurnal cortisol suggestive of chronic stress was evident for parents of individuals with a SMI. After more stressful days, cortisol levels increased less from waking to 30 min after waking and declined less from 30 min after waking to bedtime for parents of individuals with a SMI. The results of the current study add to a growing body of evidence that the long-term effects of parenting an adult with a disability has a biological impact on aging parents and support the need for family interventions across adulthood and into old age for parents of individuals with SMI.

  16. Sepsis prediction in critically ill patients by platelet activation markers on ICU admission: a prospective pilot study.

    Science.gov (United States)

    Layios, Nathalie; Delierneux, Céline; Hego, Alexandre; Huart, Justine; Gosset, Christian; Lecut, Christelle; Maes, Nathalie; Geurts, Pierre; Joly, Arnaud; Lancellotti, Patrizio; Albert, Adelin; Damas, Pierre; Gothot, André; Oury, Cécile

    2017-12-01

    Platelets have been involved in both immune surveillance and host defense against severe infection. To date, whether platelet phenotype or other hemostasis components could be associated with predisposition to sepsis in critical illness remains unknown. The aim of this work was to identify platelet markers that could predict sepsis occurrence in critically ill injured patients. This single-center, prospective, observational, 7-month study was based on a cohort of 99 non-infected adult patients admitted to ICUs for elective cardiac surgery, trauma, acute brain injury, and post-operative prolonged ventilation and followed up during ICU stay. Clinical characteristics and severity score (SOFA) were recorded on admission. Platelet activation markers, including fibrinogen binding to platelets, platelet membrane P-selectin expression, plasma soluble CD40L, and platelet-leukocytes aggregates were assayed by flow cytometry at admission and 48 h later, and then at the time of sepsis diagnosis (Sepsis-3 criteria) and 7 days later for sepsis patients. Hospitalization data and outcomes were also recorded. Of the 99 patients, 19 developed sepsis after a median time of 5 days. These patients had a higher SOFA score at admission; levels of fibrinogen binding to platelets (platelet-Fg) and of D-dimers were also significantly increased compared to the other patients. Levels 48 h after ICU admission no longer differed between the two patient groups. Platelet-Fg % was an independent predictor of sepsis (P = 0.0031). By ROC curve analysis, cutoff point for Platelet-Fg (AUC = 0.75) was 50%. In patients with a SOFA cutoff of 8, the risk of sepsis reached 87% when Platelet-Fg levels were above 50%. Patients with sepsis had longer ICU and hospital stays and higher death rate. Platelet-bound fibrinogen levels assayed by flow cytometry within 24 h of ICU admission help identifying critically ill patients at risk of developing sepsis.

  17. The Sonoma Water Evaluation Trial (SWET): A randomized drinking water intervention trial to reduce gastrointestinal illness in older adults

    Science.gov (United States)

    Objectives. We estimate the risk of highly credible gastrointestinal illness (HCGI) among adults 55 and older in a community drinking tap water meeting current U.S. standards. Methods. We conducted a randomized, triple-blinded, crossover trial in 714 households (988 indiv...

  18. A comparison of the dental status and treatment needs of older adults with and without chronic mental illness in Sevilla, Spain

    Science.gov (United States)

    Segura-Egea, Juan J.; Córdoba-Arenas, Sara; Jiménez-Guerra, Alvaro; Monsalve-Guil, Loreto; López-López, José

    2013-01-01

    Objectives: To study the dental status and treatment needs of institutionalized older adults with chronic mental illness compared to a non-psychiatric control sample. Study Design: The sample size was 100, in which 50 were psychogeriatric patients (study group; SG) classified according to DSM-IV, with a mean age of 69.6 ± 6.7 years, and 50 non-psychiatric patients (control group; CG), with a mean age of 68.3 ± 6.9 years. Clinical oral health examinations were conducted and caries were recorded clinically using the Decayed, Missing and Filled Teeth Index (DMFT). Results were analyzed statistically using the Student’s t-test or analysis of variance. Results: Caries prevalence was 58% and 62% in SG and CG, respectively. DMFT index was 28.3 ± 6.6 in SG and 21.4 ± 6.07 in CG (p Gerodontology, oral health, older adult, psychiatric patients, schizophrenia. PMID:23229258

  19. Secondary bacteraemia in adult patients with prolonged dengue fever.

    Science.gov (United States)

    Premaratna, R; Dissanayake, D; Silva, F H D S; Dassanayake, M; de Silva, H J

    2015-03-01

    Although dengue management guidelines do not advice on use of antibiotics in dengue shock syndrome, unrecognised bactraemia is likely to contribute to morbidity and mortality. To assess the occurance of secondary bacteraemia in adult patients with prolonged dengue fever. A prospective study was conducted recruiting patients with confirmed acute dengue infection who had prolonged fever (>5 days). Two sets of blood cultures were taken in such patients prior to institution of antibiotic therapy. Demographic, clinical, haematological and biochemical parameters were recorded. Development of ascites and pleural effusions were detected using ultrasonography. Fourty patients (52.5% males) with a mean age of 29.8 years (SD 13.6) were studied. The average duration of fever was 7.9 days (SD 1.8). Ten patients (25%) had bacterial isolates in their blood cultures; Staphylococcus aureus (n=2), coliforms (n=3), pseudomonas (n=1) and 4 had mixed growths. The culture positive group had severe body aches at admission and higher fever, third space fluid accumulation, a significant drop in platelets and a higher CRP. A quarter of dengue patients with prolonged fever had a bacterial isolate. Culture positive patients appeared more ill with body aches and had higher degrees of fever during the latter part of the illness. Increased vascular permeability may predispose to bacterial seepage into blood. Although white cell count is not helpful in detecting bacteraemia, low platelet count and elevation of CRP seem to be helpful.

  20. The Effect of an Extended Wilderness Education Experience on Ill-Structured Problem-Solving Skill Development in Emerging Adult Students

    Science.gov (United States)

    Collins, Rachel H.

    2014-01-01

    In a society that is becoming more dynamic, complex, and diverse, the ability to solve ill-structured problems has become an increasingly critical skill. Emerging adults are at a critical life stage that is an ideal time to develop the skills needed to solve ill-structured problems (ISPs) as they are transitioning to adult roles and starting to…

  1. Ceftolozane/Tazobactam Pharmacokinetics in a Critically Ill Adult Receiving Continuous Renal Replacement Therapy.

    Science.gov (United States)

    Bremmer, Derek N; Nicolau, David P; Burcham, Pam; Chunduri, Anil; Shidham, Ganesh; Bauer, Karri A

    2016-05-01

    Limited data are available on ceftolozane/tazobactam dosing in patients receiving continuous renal replacement therapy (CRRT). Thus we performed a pharmacokinetic analysis of intravenous ceftolozane/tazobactam in a critically ill patient receiving CRRT at our medical center. A 47-year-old critically ill man with multidrug-resistant Pseudomonas aeruginosa pneumonia, bacteremia, and osteomyelitis was receiving ceftolozane/tazobactam 3 g (ceftolozane 2 g/tazobactam 1 g) every 8 hours while receiving continuous venovenous hemodiafiltration (CVVHDF). After the fifth dose of ceftolozane/tazobactam, plasma samples were obtained at 1-, 2-, 4-, 6-, and 8-hour time points. Two additional post-hemodialysis filter plasma samples were obtained to assess CVVHDF clearance. The maximum and minimum plasma concentrations for ceftolozane were 163.9 μg/ml and 79.4 μg/ml, respectively. The area under the plasma concentration-time curve from 0-8 hours (AUC0-8 ) was 689 μg hour/ml; the plasma half-life was 13.3 hours. The ceftolozane CVVHDF clearance and total clearance were 2.4 L/hour and 2.9 L/hour, respectively. Compared with a patient with normal renal function, this patient receiving CVVHDF had decreased ceftolozane clearance. A ceftolozane/tazobactam dosage of 1.5 g every 8 hours should adequately achieve a desired drug concentration above the minimum inhibitory concentration of 8 μg/ml for the treatment of pneumonia. Additional pharmacokinetic data are needed to confirm our results and for alternative forms of CRRT. © 2016 Pharmacotherapy Publications, Inc.

  2. CORRELATIONS BETWEEN AWARENESS OF ILLNESS (INSIGHT AND HISTORY OF ADDICTION IN HEROIN-ADDICTED PATIENTS

    Directory of Open Access Journals (Sweden)

    Angelo Giovanni Icro eMaremmani

    2012-07-01

    Full Text Available In a group of 1066 heroin addicts, who were seeking treatment for opioid agonist treatment, we looked for differences in historical, demographic and clinical characteristics, between patients with different levels of awareness of illness (insight. The results showed that, in the cohort studied, a majority of subjects lacked insight into their heroin-use behaviour. Compared with the impaired-insight group, those who possessed insight into their illness showed significantly greater awareness of past social, somatic and psychopathological impairments, and had a greater number of past treatment-seeking events for heroin addiction. In contrast with other psychiatric illnesses, the presence of awareness appears to be related to the passing of time and to the worsening of the illness. Methodologies to improve the insight of patients should, therefore, be targeted more directly on patients early in their history of heroin dependence, because the risk of lack of insight is greatest during this period.

  3. Understanding the suffering of a patient with an illness: signs, context and strategies.

    Science.gov (United States)

    Hueso Montoro, César; Siles González, José; Amezcua, Manuel; Bonill de Las Nieves, Candela; Pastor Montero, Sonia; Celdrán Mañas, Miriam

    2012-01-01

    The aim of this study is to understand the suffering of a patient with an illness, by using a secondary research method, that is, a qualitative meta-study. The primary data source of the meta-study includes "biographical reports". This project is based on a case study, in which the first-hand experiences of a patient with an illness were collected. The findings of the reports were compiled using the Archivos de la Memoria collection of the Index Foundation (Granada, Spain) and journals specialized in editing these materials. A selection of 20 biographical reports was targeted. The results of the meta-study show that suffering is a multidimensional process within a framework of ambiguous feelings. The suffering involves family and social network participation. Patients develop a range of strategies to overcome the illness. One of the effects is the fear of illness relapse or worsening.

  4. The effects of motivation feedback in patients with severe mental illness: a cluster randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Jochems EC

    2015-12-01

    Full Text Available Eline C Jochems,1,2 Christina M van der Feltz-Cornelis,1–3 Arno van Dam,3,4 Hugo J Duivenvoorden,5 Cornelis L Mulder1,6 1Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Center, Rotterdam, the Netherlands; 2GGz Breburg, Top Clinical Center for Body, Mind and Health, Tilburg, the Netherlands; 3Tilburg University, Faculty of Social Sciences, Tranzo Department, Tilburg, the Netherlands; 4GGZ Westelijk Noord Brabant, Bergen op Zoom, the Netherlands; 5Erasmus MC University Medical Center, Rotterdam, the Netherlands; 6BavoEuropoort, Parnassia Psychiatric Institute, Rotterdam, the Netherlands Objective: To evaluate the effectiveness of providing clinicians with regular feedback on the patient’s motivation for treatment in increasing treatment engagement in patients with severe mental illness.Methods: Design: cluster randomized controlled trial (Dutch Trials Registry NTR2968. Participants: adult outpatients with a primary diagnosis of a psychotic disorder or a personality disorder and their clinicians, treated in 12 community mental health teams (the clusters of two mental health institutions in the Netherlands. Interventions: monthly motivation feedback (MF generated by clinicians additional to treatment as usual (TAU and TAU by the community mental health teams. Primary outcome: treatment engagement at patient level, assessed at 12 months by clinicians. Randomization: teams were allocated to MF or TAU by a computerized randomization program that randomized each team to a single treatment by blocks of varying size. All participants within these teams received similar treatment. Clinicians and patients were not blind to treatment allocation at the 12-month assessment.Results: The 294 randomized patients (148 MF, 146 TAU and 57 clinicians (29 MF, 28 TAU of 12 teams (6 MF, 6 TAU were analyzed according to the intention-to-treat principle. No statistically significant differences

  5. Adaptation to illness in relation to pain perceived by patients after surgery

    Science.gov (United States)

    Chabowski, Mariusz; Junke, Michał; Juzwiszyn, Jan; Milan, Magdalena; Malinowski, Maciej; Janczak, Dariusz

    2017-01-01

    Background Pain is one of the factors that decrease quality of life. Undergoing surgery is inevitably associated with the sensation of pain, which can affect a patient’s level of acceptance of an illness. The aim of the study was to evaluate the level of acceptance of illness in patients undergoing surgical treatment with relation to the pain perceived by them during surgical treatment and to determine other factors that affect adaptation to illness among patients subjected to invasive treatment. Material and methods The study was conducted on a group of 100 patients with mean age of 51.27 (SD=18.98) hospitalized in surgery departments in the Provincial Specialist Hospital in Wrocław, Poland, in April 2016. The Acceptance of Illness Scale (AIS) and the Visual Analog Scale (VAS) for pain were used. Results The mean score of VAS was 3.86 (SD =2.02). The mean score of AIS was 24.42 (SD =7.35). The level of acceptance of illness was significantly negatively correlated with the intensity of pain (p<0.001; r=−0.498), the number of coexisting diseases (p=0.002; r=−0.31), age (p<0.001; r=−0.391), and the period of time since the operation (p=0.007; r=−0.266). Patients taking analgesics showed a significantly lower acceptance of illness than those who did not (p=0.009). A patient’s place of living, education, and sex had no significant impact on their acceptance of illness. Conclusion A higher level of pain translates into a lower adaptation to illness despite the use of analgesics, which may indicate that inadequate pain control leads to a decrease in the acceptance of illness. Further research on monitoring postoperative pain, as well as the development of postoperative prevention programs, is required. PMID:28721086

  6. Adapting a Psychosocial Intervention for Smartphone Delivery to Middle-Aged and Older Adults with Serious Mental Illness.

    Science.gov (United States)

    Whiteman, Karen L; Lohman, Matthew C; Gill, Lydia E; Bruce, Martha L; Bartels, Stephen J

    2017-08-01

    To describe the process of adapting an integrated medical and psychiatric self-management intervention to a smartphone application for middle-aged and older adults with serious mental illness using an adaptive systems engineering framework and user-centered design. First, we determined the technical abilities and needs of middle-aged and older adults with serious mental illnesses using smartphones. Then, we developed smartphone content through principles of user-centered design and modified an existing smartphone platform. Finally, we conducted a usability test using "think aloud" and verbal probing. We adapted a psychosocial self-management intervention to a smartphone application and tested its usability. Ten participants (mean age: 55.3 years, SD: 6.2 years) with serious mental illness and comorbid chronic health conditions reported a high level of usability and satisfaction with the smartphone application. Middle-aged and older adults with serious mental illness and limited technical abilities were able to participate in a process involving user-centered design and adaptation of a self-management intervention to be delivered by a smartphone. High usability ratings suggest that middle-aged and older adults with serious mental illness have the potential to use tailored smartphone interventions. Future research is indicated to establish effectiveness and to determine the type and intensity of clinical support needed to successfully implement smartphone applications as a component of community-based services for older adults with psychiatric and medical conditions. Copyright © 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  7. Noninvasive ventilation during the weaning process in chronically critically ill patients

    Science.gov (United States)

    Servera, Emilio; Barrot, Emilia; Sanchez-Oro-Gómez, Raquel; Gómez de Terreros, F. Javier; Martín-Vicente, M. Jesús; Utrabo, Isabel; Núñez, M. Belen; Binimelis, Alicia; Sala, Ernest; Zamora, Enrique; Segrelles, Gonzalo; Ortega-Gonzalez, Angel; Masa, Fernando

    2016-01-01

    Chronically critically ill patients often undergo prolonged mechanical ventilation. The role of noninvasive ventilation (NIV) during weaning of these patients remains unclear. The aim of this study was to determine the value of NIV and whether a parameter can predict the need for NIV in chronically critically ill patients during the weaning process. We conducted a prospective study that included chronically critically ill patients admitted to Spanish respiratory care units. The weaning method used consisted of progressive periods of spontaneous breathing trials. Patients were transferred to NIV when it proved impossible to increase the duration of spontaneous breathing trials beyond 18 h. 231 chronically critically ill patients were included in the study. 198 (85.71%) patients achieved weaning success (mean weaning time 25.45±16.71 days), of whom 40 (21.4%) needed NIV during the weaning process. The variable which predicted the need for NIV was arterial carbon dioxide tension at respiratory care unit admission (OR 1.08 (95% CI 1.01–1.15), p=0.013), with a cut-off point of 45.5 mmHg (sensitivity 0.76, specificity 0.67, positive predictive value 0.76, negative predictive value 0.97). NIV is a useful tool during weaning in chronically critically ill patients. Hypercapnia despite mechanical ventilation at respiratory care unit admission is the main predictor of the need for NIV during weaning. PMID:28053973

  8. Noninvasive ventilation during the weaning process in chronically critically ill patients

    Directory of Open Access Journals (Sweden)

    Jesus Sancho

    2016-10-01

    Full Text Available Chronically critically ill patients often undergo prolonged mechanical ventilation. The role of noninvasive ventilation (NIV during weaning of these patients remains unclear. The aim of this study was to determine the value of NIV and whether a parameter can predict the need for NIV in chronically critically ill patients during the weaning process. We conducted a prospective study that included chronically critically ill patients admitted to Spanish respiratory care units. The weaning method used consisted of progressive periods of spontaneous breathing trials. Patients were transferred to NIV when it proved impossible to increase the duration of spontaneous breathing trials beyond 18 h. 231 chronically critically ill patients were included in the study. 198 (85.71% patients achieved weaning success (mean weaning time 25.45±16.71 days, of whom 40 (21.4% needed NIV during the weaning process. The variable which predicted the need for NIV was arterial carbon dioxide tension at respiratory care unit admission (OR 1.08 (95% CI 1.01–1.15, p=0.013, with a cut-off point of 45.5 mmHg (sensitivity 0.76, specificity 0.67, positive predictive value 0.76, negative predictive value 0.97. NIV is a useful tool during weaning in chronically critically ill patients. Hypercapnia despite mechanical ventilation at respiratory care unit admission is the main predictor of the need for NIV during weaning.

  9. Rehabilitation of Critical Illness Polyneuropathy and Myopathy Patients: An Observational Study

    Science.gov (United States)

    Novak, Primoz; Vidmar, Gaj; Kuret, Zala; Bizovicar, Natasa

    2011-01-01

    Critical illness polyneuropathy and myopathy (CIPNM) frequently develops in patients hospitalized in intensive care units. The number of patients with CIPNM admitted to inpatient rehabilitation is increasing. The aim of this study was to comprehensively evaluate the outcome of their rehabilitation. Twenty-seven patients with CIPNM were included in…

  10. Internalized Stigma of Mental Illness among Schizophrenic Patients and Their Families (Comparative Study)

    Science.gov (United States)

    Mahmoud, Sahar; Zaki, Rania A.

    2015-01-01

    This study was a comparative study aiming to assess the extent of internalized stigma of mental illness among patients with schizophrenia & identify stigma as perceived by family members caring schizophrenic patients. The study was conducted in two settings 1st clinic was outpatient clinic for psychiatric patient affiliated to Abbasia…

  11. Trauma Exposure and Posttraumatic Stress Disorder in Adults with Severe Mental Illness: A Critical Review

    Science.gov (United States)

    Grubaugh, Anouk L.; Zinzow, Heidi M.; Paul, Lisa; Egede, Leonard E.; Frueh, B. Christopher

    2011-01-01

    There is a great deal of research on the prevalence, correlates, and treatment of PTSD in the general population. However, we know very little about the manifestation and consequences of PTSD in more complicated patient populations. The purpose of the current paper is to provide a comprehensive review of PTSD within the context of severe mental illness (SMI; i.e., schizophrenia spectrum disorders, mood disorders). Extant data suggest that trauma and PTSD are highly prevalent among individuals with SMI relative to the general population, and both are associated with adverse clinical functioning and increased healthcare burden. However, trauma and PTSD remain overlooked in this population, with low recognition rates in public-sector settings. Additionally, there are few data on the clinical course and treatment of PTSD among individuals with SMI. Particularly lacking are longitudinal studies, randomized controlled treatment trials, and studies using ethno-racially diverse samples. Furthermore, there is a need to better understand the interplay between trauma, PTSD, and severe forms of mental illness and to further develop and disseminate evidence-based PTSD treatments in this population. The current state of the literature and future directions for practice are discussed. PMID:21596012

  12. Resident Dyads Providing Transition Care to Adolescents and Young Adults With Chronic Illnesses and Neurodevelopmental Disabilities.

    Science.gov (United States)

    Chung, Richard J; Jasien, Joan; Maslow, Gary R

    2017-04-01

    Youth with special health care needs often experience difficulty transitioning from pediatric to adult care. These difficulties may derive in part from lack of physician training in transition care and the challenges health care providers experience establishing interdisciplinary partnerships to support these patients. This educational innovation sought to improve pediatrics and adult medicine residents' interdisciplinary communication and collaboration. Residents from pediatrics, medicine-pediatrics, and internal medicine training programs participated in a transitions clinic for patients with chronic health conditions aged 16 to 26 years. Residents attended 1 to 4 half-day clinic sessions during 1-month ambulatory rotations. Pediatrics/adult medicine resident dyads collaboratively performed psychosocial and medical transition consultations that addressed health care navigation, self-care, and education and vocation topics. Two to 3 attending physicians supervised each clinic session (4 hours) while concurrently seeing patients. Residents completed a preclinic survey about baseline attitudes and experiences, and a postclinic survey about their transitions clinic experiences, changes in attitudes, and transition care preparedness. A total of 46 residents (100% of those eligible) participated in the clinic and completed the preclinic survey, and 25 (54%) completed the postclinic survey. A majority of respondents to the postclinic survey reported positive experiences. Residents in both pediatrics and internal medicine programs reported improved preparedness for providing transition care to patients with chronic health conditions and communicating effectively with colleagues in other disciplines. A dyadic model of collaborative transition care training was positively received and yielded improvements in immediate self-assessed transition care preparedness.

  13. A clinical diagnostic model for predicting influenza among young adult military personnel with febrile respiratory illness in Singapore.

    Directory of Open Access Journals (Sweden)

    Vernon J Lee

    Full Text Available INTRODUCTION: Influenza infections present with wide-ranging clinical features. We aim to compare the differences in presentation between influenza and non-influenza cases among those with febrile respiratory illness (FRI to determine predictors of influenza infection. METHODS: Personnel with FRI (defined as fever ≥ 37.5 °C, with cough or sore throat were recruited from the sentinel surveillance system in the Singapore military. Nasal washes were collected, and tested using the Resplex II and additional PCR assays for etiological determination. Interviewer-administered questionnaires collected information on patient demographics and clinical features. Univariate comparison of the various parameters was conducted, with statistically significant parameters entered into a multivariate logistic regression model. The final multivariate model for influenza versus non-influenza cases was used to build a predictive probability clinical diagnostic model. RESULTS: 821 out of 2858 subjects recruited from 11 May 2009 to 25 Jun 2010 had influenza, of which 434 (52.9% had 2009 influenza A (H1N1, 58 (7.1% seasonal influenza A (H3N2 and 269 (32.8% influenza B. Influenza-positive cases were significantly more likely to present with running nose, chills and rigors, ocular symptoms and higher temperature, and less likely with sore throat, photophobia, injected pharynx, and nausea/vomiting. Our clinical diagnostic model had a sensitivity of 65% (95% CI: 58%, 72%, specificity of 69% (95% CI: 62%, 75%, and overall accuracy of 68% (95% CI: 64%, 71%, performing significantly better than conventional influenza-like illness (ILI criteria. CONCLUSIONS: Use of a clinical diagnostic model may help predict influenza better than the conventional ILI definition among young adults with FRI.

  14. Influenza virus infection among pediatric patients reporting diarrhea and influenza-like illness

    Directory of Open Access Journals (Sweden)

    Uyeki Timothy M

    2010-01-01

    Full Text Available Abstract Background Influenza is a major cause of morbidity and hospitalization among children. While less often reported in adults, gastrointestinal symptoms have been associated with influenza in children, including abdominal pain, nausea, vomiting, and diarrhea. Methods From September 2005 and April 2008, pediatric patients in Indonesia presenting with concurrent diarrhea and influenza-like illness were enrolled in a study to determine the frequency of influenza virus infection in young patients presenting with symptoms less commonly associated with an upper respiratory tract infection (URTI. Stool specimens and upper respiratory swabs were assayed for the presence of influenza virus. Results Seasonal influenza A or influenza B viral RNA was detected in 85 (11.6% upper respiratory specimens and 21 (2.9% of stool specimens. Viable influenza B virus was isolated from the stool specimen of one case. During the time of this study, human infections with highly pathogenic avian influenza A (H5N1 virus were common in the survey area. However, among 733 enrolled subjects, none had evidence of H5N1 virus infection. Conclusions The detection of influenza viral RNA and viable influenza virus from stool suggests that influenza virus may be localized in the gastrointestinal tract of children, may be associated with pediatric diarrhea and may serve as a potential mode of transmission during seasonal and epidemic influenza outbreaks.

  15. Electroconvulsive therapy in a terminally ill patient: when every day of improvement counts.

    Science.gov (United States)

    Mulder, Marlies E; Verwey, Bastiaan; van Waarde, Jeroen A

    2012-03-01

    Electroconvulsive therapy (ECT) is seldom used in a palliative setting. Although literature on the application of ECT in terminally ill patients is sparse, ECT may be useful to rapidly improve the quality of life in these patients. We present the case of a 71-year-old man with metastasized pancreas carcinoma complicated by severe depression. After 3 ECT sessions, the communication between the patient and his family in the last moments of his life improved. We conclude that ECT should be considered to treat mood disorders in terminally ill patients when every day of improvement counts.

  16. Continuity in care of older people chronically ill patients in a battlefield of competing rationales

    DEFF Research Database (Denmark)

    Kjerholt, Mette; Wagner, Lis; Delmar, Charlotte;

    2014-01-01

    perspective in older, chronically ill patients' care as reflected in nursing staff's communication about the patients. DESIGN: Explorative Participatory Action Research (PAR). SETTING: An acute, general medical ward at a Danish university hospital. PARTICIPANTS: Hospital and municipality nurses (n = 29......BACKGROUND: Continuity is crucial when caring for older chronically ill patients. Research has shown that the integration of patients' own perspectives on their situation is of utmost importance for continuity and quality of care. Studies have, however, demonstrated a number of problems with health...

  17. A comparative study of varying doses of enoxaparin for thromboprophylaxis in critically ill patients

    DEFF Research Database (Denmark)

    Robinson, Sian; Zincuk, Aleksander; Larsen, Ulla Lei

    2013-01-01

    INTRODUCTION: Critically ill patients are predisposed to venous thromboembolism. We hypothesized that higher doses of enoxaparin would improve thromboprophylaxis without increasing the risk of bleeding. Peak anti-factor Xa (anti-Xa) levels of 0.1- 0.4 IU/ml, reflect adequate thromboprophylaxis...... for general ward patients. Studies conducted in orthopaedic patients demonstrated a statistically significant relationship between anti-Xa levels and wound haematoma and thrombosis. Corresponding levels for critically ill patients may well be higher, but have never been validated in large studies. METHODS: 80...

  18. Transplant in a patient with comorbid psychiatric illness: an ethical dilemma.

    Science.gov (United States)

    Boyum, Eric N; Brown, Douglas; Zihni, Ahmed M; Keune, Jason D; Hong, Barry A; Kodner, Ira J; Ray, Shuddhadeb

    2014-11-01

    This article addresses a difficult ethical dilemma that transplant surgeons may potentially encounter: whether a patient with a psychiatric illness is a good candidate for a liver transplant. This case study illustrates the challenges involved when considering the ethical principles of patient self-determination, distributive justice of scarce medical resources, "social worth," and protection of vulnerable patient populations. Are patients with psychiatric illness able to provide consent for transplantation? Is it possible to avoid misallocating valuable donor organs and, at the same time, fairly allocate these resources? This article seeks to answer these questions and provide insight into this ethical dilemma.

  19. A Research Agenda for Communication Between Health Care Professionals and Patients Living With Serious Illness.

    Science.gov (United States)

    Tulsky, James A; Beach, Mary Catherine; Butow, Phyllis N; Hickman, Susan E; Mack, Jennifer W; Morrison, R Sean; Street, Richard L; Sudore, Rebecca L; White, Douglas B; Pollak, Kathryn I

    2017-09-01

    Poor communication by health care professionals contributes to physical and psychological suffering in patients living with serious illness. Patients may not fully understand their illness, prognosis, and treatment options or may not receive medical care consistent with their goals. Despite considerable research exploring the role of communication in this setting, many questions remain, and a clear agenda for communication research is lacking. Through a consensus conference and subsequent activities, we reviewed the state of the science, identified key evidence gaps in understanding the impact of communication on patient outcomes, and created an agenda for future research. We considered 7 broad topics: shared decision making, advance care planning, communication training, measuring communication, communication about prognosis, emotion and serious illness communication, and cultural issues. We identified 5 areas in which further research could substantially move the field forward and help enhance patient care: measurement and methodology, including how to determine communication quality; mechanisms of communication, such as identifying the specific clinician behaviors that patients experience as both honest and compassionate, or the role of bias in the clinical encounter; alternative approaches to advance care planning that focus on the quality of serious illness communication and not simply completion of forms; teaching and disseminating communication skills; and approaches, such as economic incentives and other clinician motivators, to change communication behavior. Our findings highlight the urgent need to improve quality of communication between health care professionals and patients living with serious illness through a broad range of research that covers communication skills, tools, patient education, and models of care.

  20. Vasopressin use in critically ill cirrhosis patients with catecholamine-resistant septic shock: The CVICU cohort

    Science.gov (United States)

    Myc, Lukasz A; Stine, Jonathan G; Chakrapani, Rinita; Kadl, Alexandra; Argo, Curtis K

    2017-01-01

    AIM To examine patient-centered outcomes with vasopressin (AVP) use in patients with cirrhosis with catecholamine-refractory septic shock. METHODS We conducted a single center, retrospective cohort study enrolling adult patients with cirrhosis treated for catecholamine-resistant septic shock in the intensive care unit (ICU) from March 2011 through December 2013. Other etiologies of shock were excluded. Multivariable regression models were constructed for seven and 28-d mortality comparing AVP as a second-line therapy to a group of all other vasoactive agents. RESULTS Forty-five consecutive patients with cirrhosis were treated for catecholamine-resistant septic shock; 21 received AVP while the remaining 24 received another agent [phenylephrine (10), dopamine (6), norepinephrine (4), dobutamine (2), milrinone (2)]. In general, no significant differences in baseline demographics, etiology of cirrhosis, laboratory values, vital signs or ICU mortality/severity of illness scores were observed with the exception of higher MELD scores in the AVP group (32.4, 95%CI: 28.6-36.2 vs 27.1, 95%CI: 23.6-30.6, P = 0.041). No statistically significant difference was observed in unadjusted 7-d (52.4% AVP vs 58.3% and P = 0.408) or 28-d mortality (81.0% AVP vs 87.5% non-AVP, P = 0.371). Corticosteroid administration was associated with lower 28-d mortality (HR = 0.37, 95%CI: 0.16-0.86, P = 0.021) independent of AVP use. CONCLUSION AVP is similar in terms of patient centered outcomes of seven and 28-d mortality, in comparison to all other vasopressors when used as a second line vasoactive agent in catecholamine resistant septic shock. Large-scale prospective study would help to refine current consensus standards and provide further support to our findings. PMID:28144392

  1. Simple motor tasks independently predict extubation failure in critically ill neurological patients.

    Science.gov (United States)

    Kutchak, Fernanda Machado; Rieder, Marcelo de Mello; Victorino, Josué Almeida; Meneguzzi, Carla; Poersch, Karla; Forgiarini, Luiz Alberto; Bianchin, Marino Muxfeldt

    2017-01-01

    To evaluate the usefulness of simple motor tasks such as hand grasping and tongue protrusion as predictors of extubation failure in critically ill neurological patients. This was a prospective cohort study conducted in the neurological ICU of a tertiary care hospital in the city of Porto Alegre, Brazil. Adult patients who had been intubated for neurological reasons and were eligible for weaning were included in the study. The ability of patients to perform simple motor tasks such as hand grasping and tongue protrusion was evaluated as a predictor of extubation failure. Data regarding duration of mechanical ventilation, length of ICU stay, length of hospital stay, mortality, and incidence of ventilator-associated pneumonia were collected. A total of 132 intubated patients who had been receiving mechanical ventilation for at least 24 h and who passed a spontaneous breathing trial were included in the analysis. Logistic regression showed that patient inability to grasp the hand of the examiner (relative risk = 1.57; 95% CI: 1.01-2.44; p Glasgow Coma Scale scores at extubation (p Escala de Coma de Glasgow no momento da extubação (p < 0,001), abertura dos olhos em resposta ao comando (p = 0,001), PImáx (p < 0,001), PEmáx (p = 0,006) e índice de respiração rápida e superficial (p = 0,03). A incapacidade de obedecer a comandos motores simples é preditora de extubação malsucedida em pacientes neurológicos críticos. Preensão de mão e protrusão da língua em resposta ao comando podem ser testes rápidos e fáceis realizados à beira do leito para identificar pacientes neurológicos críticos que sejam candidatos à extubação.

  2. Accuracy of five-level adult emergency triage system on critically ill patients: a retrospective observation study in real world%五级成人急诊分诊标准对急危重症患者分诊的准确性:一项真实界的回顾性研究

    Institute of Scientific and Technical Information of China (English)

    冒山林; 曹隽; 龚黎琳; 邵江炜; 夏志洁

    2016-01-01

    .37%、97.42%、89.58%)均显著高于对照组(分别为97.51%、92.54%、80.16%,均P<0.01).结论 采用FLAETS分诊急危重症患者客观可靠,能使预检护士更好地处理病情急与缓、重与轻、先与后的关系,使得急危重症患者得到及时有效的救治.%Objective To observe the accuracy of the five-level adult emergency triage system (FLAETS) in determining the severity of critically ill patients,and to analyze the factors that influenced the accuracy of the triage.Methods The triage information of patients admitted to Huashan North Hospital Affiliated to Fudan University between 1 year before and 1 year (started in July 2014) after the implementation of the FLAETS were retrospective analyzed.The patients who triaged by FLAETS (from September 2014 to August 2015) were served as observational group,and those manual triaged by modified early warning score (MEWS,from July 2013 to June 2014) were set as control group.The patients with triage of Ⅰ,Ⅱ,and Ⅲ levels were enrolled (fatal,critical,urgent),and the triage results of emergency physicians-in-chief on duty were set as "gold standard".The gender,age,triage level,the proportion of over-triage,the proportion of under-triage,and mortality were compared between two groups.The reasons for the overtriage and under-triage were analyzed.The accuracy of FLAETS in determining severity of critically ill patients was calculated.Results 18449 patients were enrolled in observational group,and 720,1641 and 16088 patients were triaged as level Ⅰ,level ⅡⅡ,level Ⅲ respectively;17 378 patients were triaged as critically ill patients according to "gold standard",and level Ⅰ,level Ⅱ,level Ⅲ were 637,1476 and 15 265 patients respectively.6 352 patients were enrolled in control group,and level Ⅰ,level Ⅱ,level Ⅲ were 204,771 and 5 377 patients respectively;6002 patients were triaged as critically ill patients according to "gold standard",and level Ⅰ,level Ⅱ,level

  3. [Chronic illness from the perspective of patients and health professionals: a qualitative study in Mexico].

    Science.gov (United States)

    Mercado-Martínez, Francisco J; Hernández-Ibarra, Eduardo

    2007-09-01

    Chronic diseases are leading causes of morbidity, mortality, and increasing expenditures in numerous countries. However, little is known about how chronic diseases are perceived and managed by social actors. This article aims to compare the perspectives of health professionals and patients towards chronic diseases, besides analyzing the relationship between these two groups. A qualitative, multi-center study was conducted in three Mexican cities: Guadalajara, San Luis Potosí, and Mexico City. Participants included chronically ill individuals, physicians, and other health professionals from primary and secondary health care centers. Data collection used focus groups and interviews. The data were analyzed using discourse analysis. Participants' perceptions varied, from the medicalized view of physicians to that of patients focused on illness and the lifeworld. The participants agreed that there are unequal relationships between health professionals, families, and the chronically ill, but that relationships are more equal among the chronically ill themselves. The article includes by discussing various implications of the findings.

  4. Illness perceptions mediate the relationship between depression and quality of life in patients with epilepsy.

    Science.gov (United States)

    Shallcross, Amanda J; Becker, Danielle A; Singh, Anuradha; Friedman, Daniel; Montesdeoca, Jacqueline; French, Jacqueline; Devinsky, Orrin; Spruill, Tanya M

    2015-11-01

    The current study examined whether negative illness perceptions help explain the link between depression and quality of life. Seventy patients with epilepsy completed standardized self-report questionnaires measuring depression, illness perception, and quality of life (QOL). Illness perception statistically mediated the relationship between depression and QOL (Indirect effect (CI; confidence interval) = -.72, lower limit = -1.7, upper limit = -.22, p < .05). Results held with and without adjusting for potential confounding variables (age, sex, ethnicity, income, and seizure frequency) and when operationalizing depression as a continuous variable that indexed severity of symptoms or as a dichotomous variable that indexed criteria consistent with a diagnosis of major depressive disorder. This study is the first to suggest that illness perceptions may be a useful target in screening and intervention approaches in order to improve QOL among low-income, racially/ethnically diverse patients with epilepsy.

  5. Insurance Coverage and Health Outcomes in Young Adults With Mental Illness Following the Affordable Care Act Dependent Coverage Expansion.

    Science.gov (United States)

    Kozloff, Nicole; Sommers, Benjamin D

    2017-07-01

    As a provision of the Affordable Care Act, young adults were able to remain on their parents' health insurance plans until age 26. We examined the impact of the 2010 dependent coverage expansion on insurance coverage and health outcomes among young adults with mental illness. Data are from the 2008-2013 National Survey on Drug Use and Health, an annual population-based survey of noninstitutionalized US individuals aged 12 and older. We used a difference-in-differences approach to compare young adults with mental illness subject to the provision (aged 19-25 years, n = 19,051) with an older comparison group (aged 26-34 years, n = 7,958) before (2008-2009) and after (2011-2013) the dependent coverage expansion in their insurance coverage, use of health services, and self-reported health. In adjusted analyses, following the dependent coverage expansion, private insurance coverage increased by 11.7 percentage points (95% CI, 8.4-15.1, P health treatment at least monthly on average (+2.0% [95% CI, 0.1% to 4.0%, P = .04]) and a modest decrease in those reporting their overall health as fair or poor (-2.3% [95% CI, -4.6% to -0.0%, P = .05]). Unmet mental health needs due to cost decreased significantly among those with moderate-to-serious mental illness (-12.3% [95% CI, -22.7% to -2.0%, P = .02]), but did not change among those with mild illness. The 2010 dependent coverage expansion was associated with an increase in insurance coverage, several indicators of mental health treatment, and improved self-reported health among young adults with mental illness.

  6. Illness perception and adherence to healthy behaviour in Jordanian coronary heart disease patients.

    Science.gov (United States)

    Mosleh, Sultan M; Almalik, Mona Ma

    2016-06-01

    Patients diagnosed with coronary heart disease are strongly recommended to adopt healthier behaviours and adhere to prescribed medication. Previous research on patients with a wide range of health conditions has explored the role of patients' illness perceptions in explaining coping and health outcomes. However, among coronary heart disease patients, this has not been well examined. The purpose of this study was to explore coronary heart disease patients' illness perception beliefs and investigate whether these beliefs could predict adherence to healthy behaviours. A multi-centre cross-sectional study was conducted at four tertiary hospitals in Jordan. A convenience sample of 254 patients (73% response rate), who visited the cardiac clinic for routine review, participated in the study. Participants completed a self-reported questionnaire, which included the Brief Illness Perception Questionnaire, the Godin Leisure Time Activity questionnaire and the Morisky Medication Adherence Scale. Patients reported high levels of disease understanding (coherence) and they were convinced that they were able to control their condition by themselves and/or with appropriate treatment. Male patients perceived lower consequences (padherence was predicted by both a strong perception in personal control (β 2.66, 95% confidence interval 1.28-4.04), timeline (β -1.85, 95% confidence interval 0. 8-2.88) and illness coherence (β 2.12, 95% confidence interval 0.35-3.90). Medication adherence was predicted by perception of personal control and treatment control. Adherence to a low-fat diet regimen was predicted by perception of illness coherence only (odds ratio 12, 95% confidence interval 1.04-1.33). Finally, the majority of patients thought that the cause of their heart problem was related to coronary heart disease risk factors such as obesity and high-fat meals. Patients' illness beliefs are candidates for a psycho-educational intervention that should be targeted at improved disease

  7. Editorial on the original article entitled "Permissive underfeeding of standard enteral feeding in critically ill adults" published in the New England Journal of Medicine on June 18, 2015.

    Science.gov (United States)

    Casaer, Michael P; Van den Berghe, Greet

    2015-09-01

    On June 18, 2015, the New England Journal of Medicine published an article entitled "Permissive underfeeding of standard enteral feeding in critically ill adults", which reports the results of a study that examined the impact of prolonged nutritional energy restriction for critically ill patients. The study design was unique in the sense that patients in both groups received similar doses of protein during the intervention, while the non-protein energy intake was reduced in the intervention group. The study showed no differences in outcome between the two study groups. These results add to a growing body of high quality evidence against the dogmatic belief that full enteral or parenteral feeding should be given as early as possible during critical illness to prevent complications. Further research is now needed to address the question of the optimal timing to provide more nutritional support for the benefit of the patients, possibly guided by improved biomarkers that need to be developed and validated, and to investigate underlying mechanisms.

  8. Anakinra for the treatment of acute severe gout in critically ill patients.

    Science.gov (United States)

    Thueringer, Jessica T; Doll, Natalie K; Gertner, Elie

    2015-08-01

    To report on the efficacy and safety of anakinra for treatment of acute gouty arthritis in medically complex, critically ill patients. Retrospective chart review of 13 critically ill hospitalized patients treated with anakinra for 20 episodes of acute gouty arthritis between 2009 and 2014 at a single health plan and institution (HealthPartners Medical Group and Regions Hospital) in Saint Paul, Minnesota. Data was obtained on baseline characteristics, medical comorbidities, reason for hospitalization, prior gout treatment, reason for choosing anakinra over standard therapy, anakinra dosing, response to treatment, and adverse outcomes. A total of 10 patients were in the Intensive Care Unit, 1 was in the Burn Unit for extensive 3rd degree burns, 1 was critically ill with a new diagnosis of hemophagocytic lymphohistiocytosis, and 1 was critically ill in isolation with active disseminated multidrug-resistant tuberculosis. Of these patients, 85% had active infections and 92% had renal insufficiency. All patients had a significant response to anakinra treatment: 50% (10/20 episodes) within 24h, an additional 40% (8/20 episodes) by 48h, and the remaining 10% (2/20 episodes) by 72h. Anakinra was well tolerated with only 1 case of leukopenia and 1 possible infectious complication. Anakinra is a safe and efficacious treatment for acute gouty arthritis in medically complex, critically ill patients when standard treatment modalities cannot be used. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Giving meaning to illness: An investigation of self-defining memories in patients with relapsing-remitting multiple sclerosis patients.

    Science.gov (United States)

    Voltzenlogel, Virginie; Ernst, Alexandra; de Sèze, Jérôme; Brassat, David; Manning, Liliann; Berna, Fabrice

    2016-10-01

    Multiple sclerosis (MS) patients are often unable to adequately fulfill their established roles due to physical disabilities and cognitive changes, making this chronic illness particularly threatening to personal identity. Twenty-five MS patients and 25 healthy controls were asked to recall five self-defining memories (SDM). Overall characteristics of SDM did not differ between patients and controls; MS patients displayed preserved capacity to draw meaning upon past events. Moreover, almost two-thirds of MS patients mentioned at least one illness related SDM and about 25% of patients' SDM referred to MS. These memories were experienced as more negative and associated with more tension than other SDM but led toward more positive emotion and less negative emotion over time; they were also more central and more integrated to the personal identity. We concluded that self-challenging events due to MS may trigger both cognitive and emotional processes enabling the integration of illness in patients' self-representations.

  10. Cystic fibrosis lung disease in adult patients.

    Science.gov (United States)

    Vender, Robert L

    2008-04-01

    As the longevity of all patients with cystic fibrosis (CF) continues to increase (median 2005 survival=36.8 years), more adult patients will be receiving their medical care from nonpediatric adult-care providers. Cystic fibrosis remains a fatal disease, with more than 80% of patients dying after the age of 18 years, and most deaths resulting from pulmonary disease. The changing epidemiology requires adult-care providers to become knowledgeable and competent in the clinical management of adults with CF. Physicians must understand the influence of specific genotype on phenotypic disease presentation and severity, the pathogenic factors determining lung disease onset and progression, the impact of comorbid disease factors such as CF-related diabetes and malnutrition upon lung disease severity, and the currently approved or standard accepted therapies used for chronic management of CF lung disease. This knowledge is critical to help alleviate morbidity and improve mortality for the rapidly expanding population of adults with CF.

  11. Protective connections and educational attainment among young adults with childhood-onset chronic illness.

    Science.gov (United States)

    Maslow, Gary; Haydon, Abigail A; McRee, Annie-Laurie; Halpern, Carolyn T

    2012-08-01

    Youth with childhood-onset chronic illness (COCI) are at risk of poor educational attainment. Specific protective factors that promote college graduation in this population have not been studied previously. In this study, we examine the role protective factors during adolescence play in promoting college graduation among young adults with COCI. Data were collected from 10,925 participants in the National Longitudinal Study of Adolescent Health (Add Health). Protective factors present before 18 years of age included mentoring, parent relationship quality, school connectedness, and religious attendance. College graduation was the outcome of interest assessed when participants had a mean age of 28 years. Analysis was stratified by presence of COCI. About 2% of participants (N = 230) had 1 of 4 COCIs (cancer, diabetes, epilepsy, or heart disease). All 4 protective factors were associated with college graduation for youth without COCI. In the final multivariate model, only school connectedness was associated with college graduation for youth with COCI. School connectedness is of particular importance in promoting educational attainment for youth with COCI. © 2012, American School Health Association.

  12. Quantification of free-living activity patterns using accelerometry in adults with mental illness

    Science.gov (United States)

    Chapman, Justin J.; Roberts, James A.; Nguyen, Vinh T.; Breakspear, Michael

    2017-01-01

    Physical activity is disrupted in many psychiatric disorders. Advances in everyday technologies – such as accelerometers in smart phones – opens exciting possibilities for non-intrusive acquisition of activity data. Successful exploitation of this opportunity requires the validation of analytical methods that can capture the full movement spectrum. The study aim was to demonstrate an analytical approach to characterise accelerometer-derived activity patterns. Here, we use statistical methods to characterize accelerometer-derived activity patterns from a heterogeneous sample of 99 community-based adults with mental illnesses. Diagnoses were screened using the Mini International Neuropsychiatric Interview, and participants wore accelerometers for one week. We studied the relative ability of simple (exponential), complex (heavy-tailed), and composite models to explain patterns of activity and inactivity. Activity during wakefulness was a composite of brief random (exponential) movements and complex (heavy-tailed) processes, whereas movement during sleep lacked the heavy-tailed component. In contrast, inactivity followed a heavy-tailed process, lacking the random component. Activity patterns differed in nature between those with a diagnosis of bipolar disorder and a primary psychotic disorder. These results show the potential of complex models to quantify the rich nature of human movement captured by accelerometry during wake and sleep, and the interaction with diagnosis and health. PMID:28266563

  13. Cultural diversity in physical diseases among patients with mental illnesses

    DEFF Research Database (Denmark)

    Larsen, Jens I; Andersen, Ulla A; Becker, Thomas

    2012-01-01

    in accordance with ICD-10 were also registered. Psychiatric and physical comorbidity were calculated and standardized rate ratio incidences of background populations were our primary measures.Results:Incidence rate ratios were increased for both CVD, DM and overweight in both F2 and F3 in all cultures (Western...... in background populations was seen and was most marked in overweight.Conclusions:Overweight, CVD and DM were increased in schizophrenia spectrum disorders and affective disorders in all three cultures investigated (Western Europe, Nigeria and Japan). Lifestyle diseases were also seen in Nigeria and Japan....... The results from this study indicate that cultural background might be seen as an important factor in dealing with lifestyle diseases among people with a severe mental illness, as it is in the general population....

  14. Risk factors for early invasive fungal disease in critically ill patients

    Science.gov (United States)

    Singh, Gurmeet; Pitoyo, Ceva Wicaksono; Aditianingsih, Dita; Rumende, Cleopas Martin

    2016-01-01

    Background: The incidence of invasive fungal disease (IFD) is increasing worldwide in the past two to three decades. Critically ill patients in Intensive Care Units are more vulnerable to fungal infection. Early detection and treatment are important to decrease morbidity and mortality in critically ill patients. Objective: Our study aimed to assess factors associated with early IFD in critically ill patients. Materials and Methods: This prospective cohort study was conducted in critically ill patients, from March to September 2015. Total number of patients (74) in this study was drawn based on one of the risk factors (human immunodeficiency virus). Specimens were collected on day 5–7 of hospitalization. Multivariate analysis with logistic regression was performed for factors, with P < 0.25 in bivariate analysis. Results: Two hundred and six patients were enrolled in this study. Seventy-four patients were with IFD, majority were males (52.7%), mean age was 58 years (range 18–79), mean Leon's score was 3 (score range 2–5), majority group was nonsurgical/nontrauma (72.9%), and mean fungal isolation was positive on day 5. Candida sp. (92.2%) is the most frquently isolated fungal infection. Urine culture yielded the highest number of fungal isolates (70.1%). Mortality rate in this study was 50%. In multivariate analysis, diabetes mellitus (DM) (P = 0.018, odds ratio 2.078, 95% confidence interval 1.135–3.803) was found as an independent factor associated with early IFD critically ill patients. Conclusion: DM is a significant factor for the incidence of early IFD in critically ill patients. PMID:27994377

  15. Risk factors for early invasive fungal disease in critically ill patients

    Directory of Open Access Journals (Sweden)

    Gurmeet Singh

    2016-01-01

    Full Text Available Background: The incidence of invasive fungal disease (IFD is increasing worldwide in the past two to three decades. Critically ill patients in Intensive Care Units are more vulnerable to fungal infection. Early detection and treatment are important to decrease morbidity and mortality in critically ill patients. Objective: Our study aimed to assess factors associated with early IFD in critically ill patients. Materials and Methods: This prospective cohort study was conducted in critically ill patients, from March to September 2015. Total number of patients (74 in this study was drawn based on one of the risk factors (human immunodeficiency virus. Specimens were collected on day 5–7 of hospitalization. Multivariate analysis with logistic regression was performed for factors, with P< 0.25 in bivariate analysis. Results: Two hundred and six patients were enrolled in this study. Seventy-four patients were with IFD, majority were males (52.7%, mean age was 58 years (range 18–79, mean Leon's score was 3 (score range 2–5, majority group was nonsurgical/nontrauma (72.9%, and mean fungal isolation was positive on day 5. Candida sp. (92.2% is the most frquently isolated fungal infection. Urine culture yielded the highest number of fungal isolates (70.1%. Mortality rate in this study was 50%. In multivariate analysis, diabetes mellitus (DM (P = 0.018, odds ratio 2.078, 95% confidence interval 1.135–3.803 was found as an independent factor associated with early IFD critically ill patients. Conclusion: DM is a significant factor for the incidence of early IFD in critically ill patients.

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

    Science.gov (United States)

    Kale, Minal S.; Federman, Alex D.; Krauskopf, Katherine; Wolf, Michael; O’Conor, Rachel; Martynenko, Melissa; Leventhal, Howard; Wisnivesky, Juan P.

    2015-01-01

    Background 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. Methods 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. Results 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). Conclusions In this cohort of urban

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

    Directory of Open Access Journals (Sweden)

    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

  18. Illness Perception in Primary Cutaneous T-cell Lymphomas: What Patients Believe About Their Disease.

    Science.gov (United States)

    Eder, Johanna; Kammerstätter, Martina; Erhart, Friedrich; Mairhofer-Muri, Daniela; Trautinger, Franz

    2016-03-01

    There is currently no information available on illness perception in primary cutaneous T-cell lymphomas (CTCL). The aim of this study was therefore to gather initial information on disease understanding and interpretation in patients with CTCL. Consecutive patients from a hospital-based primary cutaneous lymphoma ward completed the Revised Illness Perception Questionnaire (IPQ-R) on 2 consecutive visits. A total of 24 patients with different variants of CTCL were included in the study. Patients experienced their condition as being long-lasting, but not fundamentally affecting their lives. Patients had poor belief in personal control, but strong belief in treatment control. They did not show a good understanding of their disease, and had a moderately negative emotional response to their illness. In conclusion, the IPQ-R provides a feasible and reproducible tool for measurement and better understanding of illness perception in patients with CTCL. Knowledge of patients' attitudes towards their disease should enable optimization of the patient-physician relationship and patient care.

  19. History of foster care among homeless adults with mental illness in Vancouver, British Columbia: a precursor to trajectories of risk.

    Science.gov (United States)

    Patterson, Michelle L; Moniruzzaman, Akm; Somers, Julian M

    2015-02-26

    It is well documented that a disproportionate number of homeless adults have childhood histories of foster care placement(s). This study examines the relationship between foster care placement as a predictor of adult substance use disorders (including frequency, severity and type), mental illness, vocational functioning, service use and duration of homelessness among a sample of homeless adults with mental illness. We hypothesize that a history of foster care predicts earlier, more severe and more frequent substance use, multiple mental disorder diagnoses, discontinuous work history, and longer durations of homelessness. This study was conducted using baseline data from two randomized controlled trials in Vancouver, British Columbia for participants who responded to a series of questions pertaining to out-of-home care at 12 months follow-up (n = 442). Primary outcomes included current mental disorders; substance use including type, frequency and severity; physical health; duration of homelessness; vocational functioning; and service use. In multivariable regression models, a history of foster care placement independently predicted incomplete high school, duration of homelessness, discontinuous work history, less severe types of mental illness, multiple mental disorders, early initiation of drug and/or alcohol use, and daily drug use. This is the first Canadian study to investigate the relationship between a history of foster care and current substance use among homeless adults with mental illness, controlling for several other potential confounding factors. It is important to screen homeless youth who exit foster care for substance use, and to provide integrated treatment for concurrent disorders to homeless youth and adults who have both psychiatric and substance use problems. Both trials are registered with the International Standard Randomized Control Trial Number Register and were assigned ISRCTN57595077 (Vancouver At Home Study: Housing First plus

  20. Rough Set Theory based prognostication of life expectancy for terminally ill patients.

    Science.gov (United States)

    Gil-Herrera, Eleazar; Yalcin, Ali; Tsalatsanis, Athanasios; Barnes, Laura E; Djulbegovic, Benjamin

    2011-01-01

    We present a novel knowledge discovery methodology that relies on Rough Set Theory to predict the life expectancy of terminally ill patients in an effort to improve the hospice referral process. Life expectancy prognostication is particularly valuable for terminally ill patients since it enables them and their families to initiate end-of-life discussions and choose the most desired management strategy for the remainder of their lives. We utilize retrospective data from 9105 patients to demonstrate the design and implementation details of a series of classifiers developed to identify potential hospice candidates. Preliminary results confirm the efficacy of the proposed methodology. We envision our work as a part of a comprehensive decision support system designed to assist terminally ill patients in making end-of-life care decisions.

  1. Do Aspirin and Other Antiplatelet Drugs Reduce the Mortality in Critically Ill Patients?

    Directory of Open Access Journals (Sweden)

    Wolfgang Lösche

    2012-01-01

    Full Text Available Platelet activation has been implicated in microvascular thrombosis and organ failure in critically ill patients. In the first part the present paper summarises important data on the role of platelets in systemic inflammation and sepsis as well as on the beneficial effects of antiplatelet drugs in animal models of sepsis. In the second part the data of retrospective and prospective observational clinical studies on the effect of aspirin and other antiplatelet drugs in critically ill patients are reviewed. All of these studies have shown that aspirin and other antiplatelet drugs may reduce organ failure and mortality in these patients, even in case of high bleeding risk. From the data reviewed here interventional prospective trials are needed to test whether aspirin and other antiplatelet drugs might offer a novel therapeutic option to prevent organ failure in critically ill patients.

  2. Low levels of physical activity in patients with severe mental illness

    DEFF Research Database (Denmark)

    Nyboe, Lene; Lund, H

    2013-01-01

    Background: Physical inactivity is an independent risk factor for cardiovascular diseases and Type 2 diabetes, both being highly prevalent in patients with severe mental illness. Though physical activity has become an important issue in psychiatric treatment and rehabilitation in the past decade......, systematic evaluations of physical activity level in psychiatric populations could be more disseminated. Aim: The primary aim of the study was to investigate the physical activity level of psychiatric patients in comparison with healthy controls. Methods: Patients with severe mental illness (n =47...

  3. Hypertensive patients perception of their illness: A qualitative study ...

    African Journals Online (AJOL)

    Although the patients recognised the need for treatment of hypertension, they are not ... in decision making on the commencement of antihypertensive drugs. ... The patients did not have adequate knowledge of non drug management of ...

  4. Acceptance of illness and satisfaction with life among malaria patients in rivers state, Nigeria.

    Science.gov (United States)

    Van Damme-Ostapowicz, Katarzyna; Krajewska-Kułak, Elżbieta; Nwosu, Paul J C; Kułak, Wojciech; Sobolewski, Marek; Olszański, Romuald

    2014-05-03

    Health condition is one of the basic factors affecting satisfaction with life, and the level of illness acceptance. The purpose of the study was to analyse the level of illness acceptance, the level of satisfaction with life among malaria patients, and the level of trust placed in the physician and the nurse. The study employs the method of diagnostic survey based on standardised AIS and SWLS scales, as well as Anderson and Dedrick's PPTS and PNTS scales. The average AIS level was 12 points, while the average level of SwL at the SWLS scale was 16.5 points. The average level of trust in the physician and the nurse amounted to 50.6 points and 51.4 points, respectively. The correlation between the level of illness acceptance and self-evaluated satisfaction with life was statistically significant, with R = 0.56. The marital status influenced the level of illness acceptance with p satisfaction with life with p satisfaction with life with p satisfaction with life was low. The majority of respondents trusted their physician and nurse. There is a statistically significant correlation between the level of illness acceptance and the self-evaluated satisfaction with life. The marital status had a statistically significant effect on the acceptance of illness and the satisfaction with life. The individuals who had a job demonstrated higher levels of quality of life and illness acceptance.

  5. Patient education for adults with rheumatoid arthritis

    NARCIS (Netherlands)

    Riemsma, R.P.; Kirwan, J.R.; Taal, E.; Rasker, H.J.J.

    2009-01-01

    Patient education shows short-term benefits for adults with rheumatoid arthritis. The purpose was to examine the effectiveness of patient education interventions on health status (pain, functional disability, psychological well-being and disease activity) in patients with rheumatoid arthritis (RA).

  6. Critically ill patients with acute cholecystitis are at increased risk for extensive gallbladder inflammation.

    Science.gov (United States)

    Papadakis, Marios; Ambe, Peter C; Zirngibl, Hubert

    2015-01-01

    Acute cholecystitis is a common diagnosis and surgery is the standard of care for young and fit patients. However, due to high risk of postoperative morbidity and mortality, surgical management of critically ill patients remains a controversy. It is not clear, whether the increased risk of perioperative complications associated with the management of critically ill patients with acute cholecystitis is secondary to reduced physiologic reserve per se or to the severity of gallbladder inflammation. A retrospective analysis of prospectively collected data of patients undergoing laparoscopic cholecystectomy for acute cholecystitis in a university hospital over a three-year-period was performed. The ASA scores at the time of presentation were used to categorize patients into two groups. The study group consisted of critically ill patients with ASA 3 and 4, while the control group was made up of fit patients with ASA 1 and 2. Both groups were compared with regard to perioperative data, postoperative outcome and extent of gallbladder inflammation on histopathology. Two hundred and seventeen cases of acute cholecystitis with complete charts were available for analysis. The study group included 67 critically ill patients with ASA 3 and 4, while the control group included 150 fit patients with ASA 1 and 2. Both groups were comparable with regard to perioperative data. Histopathology confirmed severe cholecystitis in a significant number of cases in the study group compared to the control group (37 % vs. 18 %, p = 0.03). Significantly higher rates of morbidity and mortality were recorded in the study group (p < 0.05). Equally, significantly more patients from the study group were managed in the ICU (40 % vs. 8 %, p = 0.001). Critically ill patients presenting with acute cholecystitis are at increased risk for extensive gallbladder inflammation. The increased risk of morbidity and mortality seen in such patients might partly be secondary to severe acute

  7. Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers

    Directory of Open Access Journals (Sweden)

    Barbara Gomes

    Full Text Available BACKGROUND: Extensive evidence shows that well over 50% of people prefer to be cared for and to die at home provided circumstances allow choice. Despite best efforts and policies, one-third or less of all deaths take place at home in many countries of the world. OBJECTIVES: 1. to quantify the effect of home palliative care services for adult patients with advanced illness and their family caregivers on patients' odds of dying at home; 2. to examine the clinical effectiveness of home palliative care services on other outcomes for patients and their caregivers such as symptom control, quality of life, caregiver distress and satisfaction with care; 3. to compare the resource use and costs associated with these services; 4. to critically appraise and summarize the current evidence on cost-effectiveness. METHODS: Search methods: We searched 12 electronic databases up to November 2012. We checked the reference lists of all included studies, 49 relevant systematic reviews, four key textbooks and recent conference abstracts. We contacted 17 experts and researchers for unpublished data. Selection criteria: We included randomised controlled trials (RCTs, controlled clinical trials (CCTs, controlled before and after studies (CBAs and interrupted time series (ITSs evaluating the impact of home palliative care services on outcomes for adults with advanced illness or their family caregivers, or both. Data collection and analysis: One review author assessed the identified titles and abstracts. Two independent reviewers performed assessment of all potentially relevant studies, data extraction and assessment of methodological quality. We carried out meta-analysis where appropriate and calculated numbers needed to treat to benefit (NNTBs for the primary outcome (death at home. MAIN RESULTS: We identified 23 studies (16 RCTs, 6 of high quality, including 37,561 participants and 4042 family caregivers, largely with advanced cancer but also congestive heart failure

  8. Fungal Peritonitis: Underestimated Disease in Critically Ill Patients with Liver Cirrhosis and Spontaneous Peritonitis.

    Science.gov (United States)

    Lahmer, Tobias; Brandl, Andreas; Rasch, Sebastian; Schmid, Roland M; Huber, Wolfgang

    2016-01-01

    Spontaneous peritonitis, especially spontaneous fungal peritonitis (SFP), is an important and potentially fatal complication in patients with endstage liver disaese. We evaluated potential risk factors, microbiological findings, and outcome of patients with SFP compared to spontaneous bacterial peritonitis (SBP) in critically ill patients. Retrospective analyses of critically ill patients with suspected spontaneous peritonitis. Out of 205 patients, 20 (10%) had SFP, 28 (14%) had SBP, 48 (24%) had peritonitis without microbiological findings (SP) and 109 (52%) had no-peritonitis (NP). APACHE II and SOFA score were significantly higher in patients with SFP (26; 22-28; pperitonitis could be significantly more often found in patients with SFP (65%; pperitonitis was significantly more often in patients with SFP (85%; pperitonitis.

  9. Symptoms, treatment and "dying peacefully" in terminally ill cancer patients: a prospective study

    NARCIS (Netherlands)

    Georges, J.J.; Philipsen, B.D.; Heide, van der A.; Wal, van der G.; Maas, van der P.J.

    2005-01-01

    GOALS: The aims of this study were to describe the symptoms, their treatment during the final months of life of terminally ill cancer patients and to assess characteristics of the dying process. PATIENTS AND METHODS: We used a prospective study design. From a representative sample of physicians who

  10. Sodium intake, dietary knowledge, and illness perceptions of controlled and uncontrolled rural hypertensive patients.

    Science.gov (United States)

    Kamran, Aziz; Azadbakht, Leila; Sharifirad, Gholamreza; Mahaki, Behzad; Sharghi, Afshan

    2014-01-01

    Introduction and Objectives. Nutritional knowledge of the patients is important in dietary adherence. This study aimed to determine the relationship between illness perceptions and nutritional knowledge with the amounts of sodium intake among rural hypertensive patients. Methods. In a cross-sectional study, 671 hypertensive patients were selected in a multistage random sampling from the rural areas of Ardabil city, Iran, in 2013. Data were collected using a questionnaire consisting of four sections and were analyzed using Pearson correlation and multiple linear regressions by SPSS-18. Results. The mean of sodium intake in the uncontrolled hypertensive patients was 3599 ± 258 mg/day and significantly greater than controlled group (2654 ± 540 mg/day) (P < 0.001). Knowledge and illness perceptions could predict 47.2% of the variation in sodium intake of uncontrolled group. A significant negative relationship was found between knowledge and illness perceptions of uncontrolled hypertensive patients with dietary sodium intake (r = -0.66, P < 0.001 and r = -0.65, P < 0.001, resp.). Conclusion. Considering the fact that patients' nutritional knowledge and illness perceptions could highly predict their sodium intake, the importance of paying more attention to improve patients' information and perceptions about hypertension is undeniable, especially among the uncontrolled hypertensive patients.

  11. Parents' perceptions of a patient portal for managing their child's chronic illness.

    Science.gov (United States)

    Britto, Maria T; Hesse, Elizabeth A; Kamdar, Opal J; Munafo, Jennifer Knopf

    2013-07-01

    Through interviews, we sought to describe parents' perceptions of a patient portal for the management of their child's chronic illness. Parents perceive patient portals as beneficial, providing easier communication with care providers, convenience, a sense of control, reduced anxiety, and reassurance. Future research should aim to quantitate these benefits. Copyright © 2013 Mosby, Inc. All rights reserved.

  12. Illness perceptions and treatment perceptions of patients with chronic kidney disease: different phases, different perceptions?

    NARCIS (Netherlands)

    Jansen, D.L.; Heijmans, M.J.W.M.; Rijken, M.; Spreeuwenberg, P.; Grootendorst, D.C.; Dekker, F.W.; Boeschoten, E.W.; Kaptein, A.A.; Groenewegen, P.P.

    2013-01-01

    Objectives: To examine the variability of illness and treatment perceptions – that have been found to be associated with chronic kidney disease (CKD) patients' outcomes (e.g., quality of life) – across the CKD trajectory, by investigating whether there are differences in perceptions in patients: (1)

  13. Time perception and illness acceptance among remitting-relapsing multiple sclerosis patients under treatment

    Directory of Open Access Journals (Sweden)

    Joanna Król

    2015-10-01

    Avoiding contemplation of negative past and concentrating on hedonistic future constitute significant predictors of illness acceptance. These results may be of importance in terms of holistic approach to treatment of RR-MS patients. In the initial stage of the disease progression, patients might benefit from psychological support due to change in temporal orientation.

  14. A Case of Mixed Infections in a Patient Presenting with Acute Febrile Illness in the Tropics

    Directory of Open Access Journals (Sweden)

    L. S. Yong

    2013-01-01

    Full Text Available Concurrent infections with more than one etiological agent can result in an illness with overlapping symptoms, resulting in a situation where the diagnosis and management of such a patient could be challenging. We report a case of vivax malaria in a patient who was also serologically positive for leptospirosis and dengue.

  15. Individualised antibiotic dosing for patients who are critically ill: challenges and potential solutions

    NARCIS (Netherlands)

    Roberts, J.A.; Abdul-Aziz, M.H.; Lipman, J.; Mouton, J.W.; Vinks, A.A.; Felton, T.W.; Hope, W.W.; Farkas, A.; Neely, M.N.; Schentag, J.J.; Drusano, G.; Frey, O.R.; Theuretzbacher, U.; Kuti, J.L.

    2014-01-01

    Infections in critically ill patients are associated with persistently poor clinical outcomes. These patients have severely altered and variable antibiotic pharmacokinetics and are infected by less susceptible pathogens. Antibiotic dosing that does not account for these features is likely to result

  16. Individualised antibiotic dosing for patients who are critically ill: challenges and potential solutions

    NARCIS (Netherlands)

    Roberts, J.A.; Abdul-Aziz, M.H.; Lipman, J.; Mouton, J.W.; Vinks, A.A.; Felton, T.W.; Hope, W.W.; Farkas, A.; Neely, M.N.; Schentag, J.J.; Drusano, G.; Frey, O.R.; Theuretzbacher, U.; Kuti, J.L.

    2014-01-01

    Infections in critically ill patients are associated with persistently poor clinical outcomes. These patients have severely altered and variable antibiotic pharmacokinetics and are infected by less susceptible pathogens. Antibiotic dosing that does not account for these features is likely to result

  17. Illness perceptions and treatment perceptions of patients with chronic kidney disease: different phases, different perceptions?

    NARCIS (Netherlands)

    Jansen, D.L.; Heijmans, M.J.W.M.; Rijken, M.; Spreeuwenberg, P.; Grootendorst, D.C.; Dekker, F.W.; Boeschoten, E.W.; Kaptein, A.A.; Groenewegen, P.P.

    2013-01-01

    Objectives: To examine the variability of illness and treatment perceptions – that have been found to be associated with chronic kidney disease (CKD) patients' outcomes (e.g., quality of life) – across the CKD trajectory, by investigating whether there are differences in perceptions in patients: (1)

  18. Changing the obesogenic environment of severe mentally ill residential patients : ELIPS, a cluster randomised study design

    NARCIS (Netherlands)

    Looijmans, Anne; Jorg, Frederike; Schoevers, Robert A.; Bruggeman, Richard; Stolk, Ronald P.; Corpeleijn, Eva

    2014-01-01

    Background: Severe mentally ill (SMI) patients have a reduced life expectancy of 13-30 years compared to the general population, largely due to an increased risk of cardiovascular mortality. Unhealthy lifestyle behaviours in SMI patients contribute to this increased risk. The obesogenic living envir

  19. Extended-duration rivaroxaban thromboprophylaxis in acutely ill medical patients: MAGELLAN study protocol

    NARCIS (Netherlands)

    A.T. Cohen; T.E. Spiro; H.R. Büller; L. Haskell; D. Hu; R. Hull; A. Mebazaa; G. Merli; S. Schellong; A. Spyropoulos; V. Tapson

    2011-01-01

    Patients with acute medical illnesses are at increased risk of venous thromboembolism (VTE), a significant cause of morbidity and mortality. Thromboprophylaxis is recommended in these patients but questions remain regarding the optimal duration of therapy. The aim of this study is to determine wheth

  20. Illness perceptions and treatment beliefs in pulmonary rehabilitation for patients with COPD

    NARCIS (Netherlands)

    Fischer, Maarten Jan

    2011-01-01

    In spite of the well-demonstrated benefits for patients, 20-40% of the patients with COPD who are referred to a pulmonary rehabilitation programme do not complete treatment. The aim of this thesis was to investigate the association of illness perceptions and treatment beliefs with treatment adherenc

  1. Enteral nutrition therapy for critically ill adult patients: critical review and algorithm creation Terapia nutricional enteral para pacientes adultos en estado crítico: análisis crítico de la literatura y la creación de algoritmo

    Directory of Open Access Journals (Sweden)

    L. Araújo-Junqueira

    2012-08-01

    Full Text Available Introduction: Undernutrition directly affects critically ill patient's clinical outcome and mortality rates. Objective: Interdisciplinar algorithm creation aiming to optimize the enteral nutrition therapy for critically ill adult patients. Data source: Pubmed, SciELO, Scholar Google, Web of Science, Scopus, with research of these key words: protocols, enteral nutrition, nutritional support, critical care, undernutrition, fasting. Setting: Intensive Care Unit, Hospital de Clínicas, Federal University of Uberlándia, MG, Brazil. Measurements and main results: Were established in the algorithm a following sequential steps: After a clinical-surgical diagnosis, including the assessment of hemodynamic stability, were requested passage of a feeding tube in post-pyloric position and a drainage tube in gastric position. After hemodynamic stability it should be done the nutritional status diagnosis, calculated nutritional requirements, as well as chosen formulation of enteral feeding. Unless contraindicated, aiming to increase tolerance was started infusion with small volumes (15 ml/h of a semi-elemental diet, normocaloric, hypolipidic (also hyperproteic, with addition of glutamine. To ensure infusion of the diet, as well as the progressive increase of infusion rates, the patient was monitored for moderate or severe intestinal intolerance. The schedule and infusion rates were respected and diet was not routinely suspended for procedures and diagnostic tests, unless indicated by the medical team. Conclusions: For nutrition therapy success it is essential routine monitoring and extensive interaction between the professionals involved. Nutritional conducts should be reevaluated and improved, seeking complete and specialized care to the critically ill patients. Adherence to new practices is challenging, though instruments such as protocols and algorithms help making information more accessible and comprehensible.Introducción: La hiponutrición afecta

  2. Factors associated with subjective burden in siblings of adults with severe mental illness.

    Science.gov (United States)

    Greenberg, J S; Kim, H W; Greenley, J R

    1997-04-01

    Experiences of subjective burden were analyzed in a sample of 164 siblings of persons with serious mental illness. Findings indicated that the well sibling's experience of burden was consistently related to the symptomatology of the ill sibling. In addition, those who viewed the ill sibling's behavior as outside his or control exhibited lower levels of subjective burden than did those who viewed the behavior as within the sibling's control. Implications for research and clinical intervention are discussed.

  3. Long-term correlates of childhood abuse among adults with severe mental illness: adult victimization, substance abuse, and HIV sexual risk behavior.

    Science.gov (United States)

    Meade, Christina S; Kershaw, Trace S; Hansen, Nathan B; Sikkema, Kathleen J

    2009-04-01

    The prevalence of childhood sexual and physical abuse among persons with severe mental illness (SMI) is disproportionately high. Adults with SMI also engage in high rates of HIV risk behaviors. This study examined the association between childhood abuse and adult victimization, substance abuse, and lifetime HIV sexual risk in a sample of 152 adults with SMI receiving community mental health services. Structured interviews assessed psychiatric, psychosocial, and behavioral risk factors. Seventy percent reported childhood physical and/or sexual abuse, and 32% reported both types of abuse. Participants with childhood abuse were more likely to report adult victimization and greater HIV risk. A structural equation model found that childhood abuse was directly and indirectly associated with HIV risk through drug abuse and adult vicitimization. Integrated treatment a