Sample records for terminally ill patients

  1. Assessing Hopelessness in Terminally Ill Cancer Patients: Development of the Hopelessness Assessment in Illness Questionnaire

    Microsoft Academic Search

    Barry Rosenfeld; Hayley Pessin; Charles Lewis; Jennifer Abbey; Megan Olden; Emily Sachs; Lia Amakawa; Elissa Kolva; Robert Brescia; William Breitbart

    2011-01-01

    Hopelessness has become an increasingly important construct in palliative care research, yet concerns exist regarding the utility of existing measures when applied to patients with a terminal illness. This article describes a series of studies focused on the exploration, development, and analysis of a measure of hopelessness specifically intended for use with terminally ill cancer patients. The 1st stage of

  2. A quality of life subscale for terminally ill cancer patients

    Microsoft Academic Search

    Anthony James Greisinger

    1997-01-01

    A subscale was developed to assess the quality of life of cancer patients with a life expectancy of six months or less. Phase I of this study identified the major concerns of 74 terminally ill cancer patients (19 with breast cancer, 19 with lung cancer, 18 with colorectal cancer, 9 with renal cell cancer, 9 with prostate cancer), 39 family

  3. Suicidal behaviour among terminally ill cancer patients in India

    PubMed Central

    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, hopelessness and suicidal ideation, and the correlation of suicidal ideation with medical symptoms such as pain, as well as awareness of the diagnosis and understanding of the illness. Results: Most patients (79.7%) denied having suicidal thoughts or wishing for an early death; only 9.2% had severe suicidal ideation. Two patients (3.8%) with severe suicidal ideation had a past history of major depression. Factors such as the presence of pain, awareness of the diagnosis and understanding of the illness contributed to depressive mood states. Conclusion: Suicidal ideation and a desire for death appear to be linked exclusively to the presence of a mental disorder. In addition, poor pain control, and awareness of the diagnosis may also contribute to suicidal ideation. PMID:20711286

  4. Existential concerns of terminally ill cancer patients receiving specialized palliative care in Japan

    Microsoft Academic Search

    Tatsuya Morita; Masako Kawa; Yoshifumi Honke; Hiroyuki Kohara; Etsuko Maeyama; Yoshiyuki Kizawa; Tatsuo Akechi; Yosuke Uchitomi; Yasuo Kizawa

    2004-01-01

    Background Although alleviation of existential distress is important for terminally ill cancer patients, the concept of existential distress has not been fully understood. The aim of this study was to categorize existential concerns of Japanese terminally ill cancer patients and explore care strategies based on the categorizations. Methods A multicenter cross-sectional study in 88 terminally ill cancer patients receiving specialized

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

    PubMed

    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. PMID:22363039

  6. [Quick guide to communicate important news to terminally ill patients].

    PubMed

    Ghio, P; Dell'Orco, L

    2011-01-01

    The aim of this work is to be able to publish the information concerning communication with cancer patients as recommended in England. The observation and the study protocol during the stay abroad have been given the opportunity to stylize specific information on the methodology of communication of important information to terminally ill patients. It seems readily apparent as they characterized by both technical precision and sensivity to emotions and descriptions for the individual patient. How is shared by all chronic pain is predominantly complex emotion, a mix of additions and perceived physical and emotional pain - emotional. Because accurate information is beneficial to the patient and that really is not turned, so to speak, a "bullet" it is necessary that you have created, over time, a concrete "therapeutic alliance" between body physician, patient and possibly family. This arises, for sure, even at first accepted the patient during the clinical visit attentive to detail, is renewed in the definition of the common objective to be achieved, so analgesia and it is expressed in the certainty that the physician provides all the resources realistically available. It is then up to the sensitivity of the operator, doctor and/or nurse, described in the "take charge" find, from time to time, the words and manners, verbal and nonverbal, to respond fully to questions of the patient same. PMID:21533322

  7. Association between hydration volume and symptoms in terminally ill cancer patients with abdominal malignancies

    Microsoft Academic Search

    T. Morita; I. Hyodo; T. Yoshimi; M. Ikenaga; Y. Tamura; A. Yoshizawa; A. Shimada; T. Akechi; M. Miyashita; I. Adachi

    2005-01-01

    Background: To explore the association between hydration volume and symptoms during the last 3 weeks of life in terminally ill cancer patients. Patients and methods: This was a multicenter, prospective, observational study of 226 consecutive terminally ill patients with abdominal malignancies. Primary responsible physicians and nurses eval- uated the severity of membranous dehydration (dehydration score calculated from three physical findings),

  8. Disclosure of terminal illness to patients and families: diversity of governing codes in 14 Islamic countries

    Microsoft Academic Search

    Hunida E Abdulhameed; Muhammad M Hammami; Elbushra A Hameed Mohamed

    2011-01-01

    BackgroundThe consistency of codes governing disclosure of terminal illness to patients and families in Islamic countries has not been studied until now.ObjectivesTo review available codes on disclosure of terminal illness in Islamic countries.Data source and extractionData were extracted through searches on Google and PubMed. Codes related to disclosure of terminal illness to patients or families were abstracted, and then classified

  9. Information needs in terminal illness

    Microsoft Academic Search

    Jean S Kutner; John F Steiner; Kitty K Corbett; Dennis W Jahnigen; Phoebe L Barton

    1999-01-01

    Despite evidence that doctor–patient communication affects important patient outcomes, patient expectations are often not met. Communication is especially important in terminal illness, when the appropriate course of action may depend more on patient values than on medical dogma. We sought to describe the issues important to terminally ill patients receiving palliative care and to determine whether patient characteristics influence the

  10. Attitudes of Terminally Ill Patients toward Death and Dying in Nigeria

    ERIC Educational Resources Information Center

    Olokor, Christiana O.

    2011-01-01

    The purpose of this study was to analyze the attitudes of terminally ill patients toward death and dying. Four hospitals in Nigeria were randomly selected: University College Hospital, Ibadan; University of Benin Teaching Hospital, Benin City; the Lagos University Teaching Hospital, Lagos; and Igbinedion Specialist Hospital, Okada, Benin City.…

  11. Attitudes of Italian doctors to euthanasia and assisted suicide for terminally ill patients.

    PubMed

    Grassi, L; Agostini, M; Magnani, K

    1999-11-27

    Among Italian hospital physicians and general practitioners, 17.9% endorsed euthanasia or assisted suicide for terminally ill patients and 79.4% endorsed withholding or withdrawal of treatment. Need for attention to quality of life and pain control also emerged. PMID:11657574

  12. Oral health conditions affect functional and social activities of terminally-ill cancer patients

    PubMed Central

    Fischer, D.J.; Epstein, J.B.; Yao, Y.; Wilkie, D.J.

    2013-01-01

    Purpose Oral conditions are established complications in terminally-ill cancer patients. Yet despite significant morbidity, the characteristics and impact of oral conditions in these patients are poorly documented. The study objective was to characterize oral conditions in terminally-ill cancer patients to determine the presence, severity, and the functional and social impact of these oral conditions. Methods This was an observational clinical study including terminally-ill cancer patients (2.5–3 week life expectancy). Data were obtained via the Oral Problems Scale (OPS) that measures the presence of subjective xerostomia, orofacial pain, taste change, and the functional/social impact of oral conditions and a demographic questionnaire. A standardized oral examination was used to assess objective salivary hypofunction, fungal infection, mucosal erythema, and ulceration. Regression analysis and t test investigated the associations between measures. Results Of 104 participants, most were ?50 years of age, female, and high-school educated; 45% were African American, 43% Caucasian, and 37% married. Oral conditions frequencies were: salivary hypofunction (98%), mucosal erythema (50%), ulceration (20%), fungal infection (36%), and other oral problems (46%). Xerostomia, taste change, and orofacial pain all had significant functional impact; p<.001, p=.042 and p<.001, respectively. Orofacial pain also had a significant social impact (p<.001). Patients with oral ulcerations had significantly more orofacial pain with a social impact than patients without ulcers (p=.003). Erythema was significantly associated with fungal infection and with mucosal ulceration (p<.001). Conclusions Oral conditions significantly affect functional and social activities in terminally-ill cancer patients. Identification and management of oral conditions in these patients should therefore be an important clinical consideration. PMID:24232310

  13. Evaluation of the cost of home care for terminally ill cancer patients

    Microsoft Academic Search

    Marco Maltoni; Claudio Travaglini; Matteo Santi; Oriana Nanni; Emanuela Scarpi; Simonetta Benvenuti; Livia Albertazzi; Laura Amaducci; Stefania Derni; Laura Fabbri; Angelo Masi; Luigi Montanari; Giuseppe Pasini; Antonio Polselli; Umberto Tonelli; Paola Turci; Dino Amadori

    1997-01-01

    The aim of this work was to carry out a cost evaluation of the home care programme for terminally ill cancer patients run\\u000a by the Istituto Oncologico Romagnolo (I.O.R.) in the areas of Forlì, Cesena, Ravenna and Rimini (Romagna, Italy). To determine\\u000a effective home care direct costs, we first selected 1 week of care as an observation unit. We then

  14. Being in the hospital: an interpretive phenomenological study of terminally ill cancer patients' experiences.

    PubMed

    Spichiger, Elisabeth

    2009-02-01

    This article describes a study exploring terminally ill cancer patients' experiences of being in hospital and the meanings patients assigned to the hospital as their temporary residence. Ten patients and their closest family members participated in this interpretive phenomenological study during the patients' hospitalization. Data were collected in a public tertiary hospital in Switzerland. Patients' care was observed and participants were interviewed repeatedly. Data analysis included thematic analysis as well as searching for paradigm cases and exemplars. Patients described their existence in the hospital on a continuum from "prison" to "heaven." For most of their stay, patients occupied some place between these extremes and could be called "guests of necessity" who accepted the hospital as necessity but were longing for home. The quality of hospital life was not constant rather, patients' experiences were transitory and some faded away. The study revealed an aspect hitherto undescribed in the literature: patients' experiences of the hospital as a temporary residence. Its findings can heighten health care professionals' awareness of patients' experiences. Recognizing patients' perspectives regarding the hospital as their temporary living place will allow professionals to individualize patient care. PMID:19028141

  15. Does desire for hastened death change in terminally ill cancer patients?

    PubMed

    Rosenfeld, Barry; Pessin, Hayley; Marziliano, Allison; Jacobson, Colleen; Sorger, Brooke; Abbey, Jennifer; Olden, Megan; Brescia, Robert; Breitbart, William

    2014-06-01

    Understanding why some terminally ill patients may seek a hastened death (a construct referred to as "desire for hastened death" or DHD) is critical to understanding how to optimize quality of life during an individual's final weeks, months or even years of life. Although a number of predictor variables have emerged in past DHD research, there is a dearth of longitudinal research on how DHD changes over time and what factors might explain such changes. This study examined DHD over time in a sample of terminally ill cancer patients admitted to a palliative care hospital. A random sample of 128 patients completed the Schedule of Attitudes toward Hastened Death (SAHD) at two time points approximately 2-4 weeks apart participated. Patients were categorized into one of four trajectories based on their SAHD scores at both time points: low (low DHD at T1 and T2), rising (low DHD at T1 and high DHD at T2), falling (high DHD at T1 and low DHD at T2) and high (high DHD at T1 and T2). Among patients who were low at T1, several variables distinguished between those who developed DHD and those who did not: physical symptom distress, depression symptom severity, hopelessness, spiritual well-being, baseline DHD, and a history of mental health treatment. However, these same medical and clinical variables did not distinguish between the falling and high trajectories. Overall, there appears to be a relatively high frequency of change in DHD, even in the last weeks of life. Interventions designed to target patients who are exhibiting subthreshold DHD and feelings of hopelessness may reduce the occurrence of DHD emerging in this population. PMID:24747154

  16. Do Incarcerated Offenders Experience the Five Stages of Grief as Do Terminally Ill Patients?

    ERIC Educational Resources Information Center

    Pledger, Carolyn Brastow

    1985-01-01

    Examines Kubler-Ross' five stages of grief (denial, anger, bargaining, depression, acceptance) as they are experienced not by terminally ill persons, but by 20 criminal offenders and their families during incarceration. Concludes that shock of arrest and incarceration stimulates reactions similar to those of persons coping with terminal diagnosis.…

  17. Patients’ Experiences of Being a Burden on Family in Terminal Illness

    PubMed Central

    Johnson, Julia Overturf; Sulmasy, Daniel P.; Nolan, Marie T.

    2009-01-01

    Studies of persons with chronic and life-threatening illness have revealed a fear of being a burden on family. The purpose of this case study was to explore that concern in-depth in three persons with different terminal illnesses. Participants were part of a larger study of end-of-life decision making and were selected for this study because their illnesses are characterized by a steady decline in health (amyotrophic lateral sclerosis), a rapid decline (stage IV lung cancer), or an uncertain trajectory of decline (advanced heart failure). Content analysis of their interviews resulted in four themes: managing the burden, spirituality, supportive relationships, and planning for the future. Themes contained specific categories of thoughts, feelings, and actions related to fear of being a burden. These themes should be explored in greater depth in future larger studies of persons with terminal illness. PMID:19183701

  18. Recruiting terminally ill patients into non-therapeutic oncology studies: views of health professionals. | accrualnet.cancer.gov

    Cancer.gov

    Several themes emerged when interviews were conducted with clinician-researchers regarding their attitudes and concerns when recruiting terminally ill cancer patients into non-therapeutic research. The prominent themes were ethical considerations, patient-centered issues, and health professional issues. Promoting communication and autonomy and fostering familial support are important elements for overcoming patient-centered issues. Facilitating the doctor-patient relationship, using teamwork, and implementing educational programs were seen as key factors for dealing with health professional issues.

  19. Successful antidepressant treatment for five terminally ill cancer patients with major depression, suicidal ideation and a desire for death.

    PubMed

    Kugaya, A; Akechi, T; Nakano, T; Okamura, H; Shima, Y; Uchitomi, Y

    1999-11-01

    In the debate on euthanasia and physician-assisted suicide, we have to exclude terminally ill patients in whom the desire for death is caused by major depression. However, it is still not clear to what degree major depression can be treated by psychiatric intervention in this setting. We evaluated the effect of antidepressant treatment in terminally ill cancer patients. Six cancer patients with suicidal ideas thought to be due to major depression were treated with tricyclic antidepressants. Three had requested terminal sedation to relieve them from their suffering. The median survival of five of these patients was 4 weeks after diagnosis; one was lost to follow-up. The efficacy of the antidepressant treatment was assessed using the Hamilton Rating Scale for Depression (HRSD). One week after the start of treatment with antidepressants, five of the six patients showed a marked improvement in their mood and showed no further suicidal thoughts or requests for terminal sedation. The average reduction in the HRSD score was 23.4 points (14-38; SD = 9. 9). Antidepressant treatment can be effective in alleviating the desire for death due to major depression, even in terminally ill cancer patients. PMID:10541987

  20. Palliative Care Services for Indian Migrants in Australia: Experiences of the Family of Terminally Ill Patients

    PubMed Central

    Shanmugasundaram, Sujatha; O'Connor, Margaret

    2009-01-01

    Background: The way that health care systems in developing countries like India care for dying patients, has an impact on the expectations of such care for those who migrate to other countries faces. At the end of life, cultural issues may impact on the quality of life remaining and for that reason, it is important that particular cultural practices are understood. This paper describes a study that investigated the cultural issues of access to palliative care services for Indian migrants in Australia. Purpose of the Study: To investigate the experiences of the family members of terminally ill Indian migrants in Victoria, Australia. Objective of the Study: To explore the issues related to accessing palliative care services for Indian migrants; to identify the effectiveness of palliative care in supporting the patient and family and to recommend strategies for improving this care. Materials and Methods: A qualitative descriptive design was utilized. Up to 6 family members were selected for in-depth interviews in understanding cultural issues related to the palliative care services for a family member. Results: Analysis of the interviews revealed that families of Indian patients experience difficulties whilst receiving palliative care services, which fell into three main categories: Indian support systems, cultural issues, and caring experiences. Although each of these issues had a direct influence on the experience of terminal care that their family member received, cultural issues and support systems also influenced the caring experiences. Conclusion: Despite the successful implementation of palliative care services across Australia, there are still problems in accessing and receiving the services among minority and disadvantaged groups like various cultural groups. PMID:20606861

  1. Recruiting Terminally Ill Patients into Non-Therapeutic Oncology Studies: views of Health Professionals

    PubMed Central

    2012-01-01

    Background Non-therapeutic trials in which terminally ill cancer patients are asked to undergo procedures such as biopsies or venipunctures for research purposes, have become increasingly important to learn more about how cancer cells work and to realize the full potential of clinical research. Considering that implementing non-therapeutic studies is not likely to result in direct benefits for the patient, some authors are concerned that involving patients in such research may be exploitive of vulnerable patients and should not occur at all, or should be greatly restricted, while some proponents doubt whether such restrictions are appropriate. Our objective was to explore clinician-researcher attitudes and concerns when recruiting patients who are in advanced stages of cancer into non-therapeutic research. Methods We conducted a qualitative exploratory study by carrying out open-ended interviews with health professionals, including physicians, research nurses, and study coordinators. Interviews were audio-recorded and transcribed. Analysis was carried out using grounded theory. Results The analysis of the interviews unveiled three prominent themes: 1) ethical considerations; 2) patient-centered issues; 3) health professional issues. Respondents identified ethical issues surrounding autonomy, respect for persons, beneficence, non-maleficence, discrimination, and confidentiality; bringing to light that patients contribute to science because of a sense of altruism and that they want reassurance before consenting. Several patient-centered and health professional issues are having an impact on the recruitment of patients for non-therapeutic research. Facilitators were most commonly associated with patient-centered issues enhancing communication, whereas barriers in non-therapeutic research were most often professionally based, including the doctor-patient relationship, time constraints, and a lack of education and training in research. Conclusions This paper aims to contribute to debates on the overall challenges of recruiting patients to non-therapeutic research. This exploratory study identified general awareness of key ethical issues, as well as key facilitators and barriers to the recruitment of patients to non-therapeutic studies. Due to the important role played by clinicians and clinician-researchers in the recruitment of patients, it is essential to facilitate a greater understanding of the challenges faced; to promote effective communication; and to encourage educational research training programs. PMID:23216847

  2. 'To call it work somehow demeans it': the social construction of talk in the care of terminally ill patients.

    PubMed

    May, C

    1995-09-01

    The nurse has an important role in helping the terminally ill patient come to terms with the imminence of death. Such work is highly demanding and often stressful, but is work which is accorded a high moral priority by respondents in the study reported in this paper. The paper explores the ways in which nurses work to respond to patients' expressed psychosocial problems and the emphasis that they placed on providing opportunities for patients to speak about their impending death. PMID:7499624

  3. Relations between desire for early death, depressive symptoms and antidepressant prescribing in terminally ill patients with cancer

    Microsoft Academic Search

    Eoin Tiernan

    J R Soc Med 2002;95:386-390 SUMMARY Some patients with advanced cancer express the wish for an early death. This may be associated with depression. We examined the relations between depressive symptoms and desire for early death (natural or by euthanasia or physician-assisted suicide) in 142 terminally ill patients with cancer being cared for by a specialist palliative care team. They

  4. Relations between desire for early death, depressive symptoms and antidepressant prescribing in terminally ill patients with cancer

    PubMed Central

    Tiernan, E; Casey, P; O'Boyle, C; Birkbeck, G; Mangan, M; O'Siorain, L; Kearney, M

    2002-01-01

    Some patients with advanced cancer express the wish for an early death. This may be associated with depression. We examined the relations between depressive symptoms and desire for early death (natural or by euthanasia or physician-assisted suicide) in 142 terminally ill patients with cancer being cared for by a specialist palliative care team. They completed the Hospital Anxiety and Depression Scale questionnaire and answered four supplementary questions on desire for early death. Only 2 patients expressed a strong wish for death by some form of suicide or euthanasia. 120 denied that they ever wished for early release. The desire for early death correlated with depression scores. Depressive symptoms were common in the whole group but few were on antidepressant therapy. Better recognition and treatment of depression might improve the lives of people with terminal illness and so lessen desire for early death, whether natural or by suicide. PMID:12151487

  5. Coping with Loneliness among the Terminally Ill

    ERIC Educational Resources Information Center

    Rokach, Ami

    2007-01-01

    Loneliness is a universal phenomenon, and its pain is intensified by a diagnosis of a terminal illness. The present study is an investigation of the strategies used by patients with Multiple sclerosis (MS), by individuals diagnosed with cancer, and by the general population to cope with loneliness. Three hundred and twenty nine MS patients, 315…

  6. When should managed care firms terminate private benefits for chronically mentally ill patients?

    PubMed

    Gerson, S N

    1994-01-01

    Corporate America's healthcare cost crisis and the country's budget deficit are forcing limits on the resources used to finance healthcare, including mental healthcare. At the same time, the 1990 Americans with Disabilities Act bars discrimination against patients with chronic illnesses, including chronic mental illness. Therefore, corporate benefits managers need guidance on how to ethically and rationally allocate scarce clinical resources to those high-morbidity insureds who utilize disproportionate amounts of these resources. In particular, how should we define the public/private interface: When do patients who repeatedly fail to respond to treatment fall out of the private sector's responsibility? The author, medical director for a leading behavioral healthcare utilization management company, offers the following guidelines recommending reasonable and practical limitations on trials of treatment for seven common categories of difficult psychiatric patients. PMID:10141406

  7. Death Education and Attitudes toward Euthanasia and Terminal Illness.

    ERIC Educational Resources Information Center

    Nagi, Mostafa H.; Lazerine, Neil G.

    1982-01-01

    Analyzed attitudes of 614 Protestant and Catholic Cleveland clergy toward terminal illness and euthanasia. Clergy responses revealed that, although eager to prolong life, terminally ill patients feared prolonged illness more than death. The controversial nature of euthanasia became more apparent with clergy who had more training in death…

  8. Does it make clinical sense to equate terminally ill patients who require life-sustaining interventions with those who do not?

    PubMed

    Alpers, A; Lo, B

    1997-06-01

    Two US courts of appeals have ruled that competent, terminally ill patients have a constitutional right to physician-assisted suicide. The cases are now before the US Supreme Court, which is expected to issue a ruling later this year. This article analyzes the keystone of the courts' ruling: their assertion that competent, terminally ill patients who are being kept alive on life support are equivalent to competent, terminally ill patients who do not require such support. Because the former are permitted to end their lives by refusing treatment, the courts found that the latter also have a right to determine the time and manner of their death, through prescriptions for lethal doses of medication. This article analyzes whether the courts' thinking is premised on a clinically plausible view of the care of terminally ill patients. Based on a discussion of common situations involving terminal illness, we argue that the courts' reasoning is deeply flawed. The article also analyzes how the implications of the courts' reasoning might undermine the care of terminally ill patients. PMID:9169898

  9. Bioplastique medialization therapy improves the quality of life in terminally ill patients with vocal cord palsy.

    PubMed

    Alves, C B; Loughran, S; MacGregor, F B; Dey, J I R; Bowie, L J

    2002-10-01

    Unilateral vocal cord palsy can result in a weak breathy voice and an inability to communicate effectively. This study was designed to assess prospectively the efficacy of polymethylsiloxane elastomer (Bioplastique) medialization injection therapy in patients with vocal cord palsy and terminal disease with particular regard to quality of life issues. Patients with unilateral vocal cord palsy secondary to malignant disease were offered Bioplastique injection. A digital voice recording was taken preoperatively and at 1 month, 3 months and 6 months postoperatively. Maximum phonation time (MPT) was recorded at the same intervals, and patients completed two questionnaires: the voice handicap index (VHI) and SF 36 general health questionnaire. Sixteen patients were entered into the study. There was a significant improvement in voice score, MPT, VHI and in three subgroups of the SF 36 at 1 month postoperatively, and the improvement was maintained in the small number who survived to 3 and 6 months. Bioplastique injection for unilateral vocal cord palsy produces a significant improvement in quality of life in addition to measured voice quality in patients with terminal disease. It should be recommended in patients even when the life expectancy is short. PMID:12383303

  10. Survival Prediction for Terminally Ill Cancer Patients: Revision of the Palliative Prognostic Score with Incorporation of Delirium

    PubMed Central

    Maltoni, Marco; Miceli, Rosalba; Mariani, Luigi; Caraceni, Augusto; Amadori, Dino; Nanni, Oriana

    2011-01-01

    Purpose. An existing and validated palliative prognostic (PaP) score predicts survival in terminally ill cancer patients based on dyspnea, anorexia, Karnofsky performance status score, clinical prediction of survival, total WBC, and lymphocyte percentage. The PaP score assigns patients to three different risk groups according to a 30-day survival probability—group A, >70%; group B, 30%–70%; group C, <30%. The impact of delirium is known but was not incorporated into the PaP score. Materials and Methods. Our aim was to incorporate information on delirium into the PaP score based on a retrospective series of 361 terminally ill cancer patients. We followed the approach of “validation by calibration,” proposed by van Houwelingen and later adapted by Miceli for achieving score revision with inclusion of a new variable. The discriminating performance of the scores was estimated using the K statistic. Results. The prognostic contribution of delirium was confirmed as statistically significant (p < .001) and the variable was accordingly incorporated into the PaP score (D-PaP score). Following this revision, 30-day survival estimates in groups A, B, and C were 83%, 50%, and 9% for the D-PaP score and 87%, 51%, and 16% for the PaP score, respectively. The overall performance of the D-PaP score was better than that of the PaP score. Conclusion. The revision of the PaP score was carried out by modifying the cutoff values used for prognostic grouping without, however, affecting the partial scores of the original tool. The performance of the D-PaP score was better than that of the PaP score and its key feature of simplicity was maintained. PMID:22042788

  11. Dana-Farber study finds terminally ill cancer patients who discuss end-of-life care early can avoid needlessly aggressive treatment later on

    Cancer.gov

    Terminally ill cancer patients who have an early talk with their physician about care at the end-of-life are less likely to receive aggressive therapy – and more likely to enter hospice care – than patients who delay such discussions until the days and weeks before death, a new study by Dana-Farber Cancer Institute researchers suggests.

  12. Effectiveness of advance directives for the care of terminally ill patients in Chiang Mai University Hospital, Thailand.

    PubMed

    Sittisombut, Sudarat; Maxwell, Colleen; Love, Edgar J; Sitthi-Amorn, Chitr

    2008-03-01

    The key hypothesis behind advance directives (ADs) proposes that, if an intervention enhances a person's right to choose, a dying person will not opt for expensive, life-prolonging medical care and an ethically acceptable saving of resources will result. In order to assess the acceptability and effectiveness of ADs in reducing cardiopulmonary resuscitation (CPR) attempts and in-hospital death among terminally ill patients in a tertiary care hospital in northern Thailand, a non-randomized, controlled intervention study using an after-only unequivalent control group design was conducted. The majority of the subjects and the surrogates preferred to employ ADs in expressing their preferences on CPR and there was a high level of agreement between the subjects and surrogates on the decision. The use of ADs appeared to be effective in reducing futile CPR attempts and the in-hospital mortality rate among subjects during the index hospitalization. Advance directives were accepted well in this study setting. PMID:18257830

  13. Satisfaction with rehydration therapy for terminally ill cancer patients: concept construction, scale development, and identification of contributing factors.

    PubMed

    Morita, Tatsuya; Adachi, Isamu

    2002-01-01

    Comprehensive assessment is important in determination of the efficacy of rehydration therapy for terminally ill cancer patients. To validate a multidimensional satisfaction scale, a multicenter cross-sectional study was performed. The participants were requested to complete a questionnaire on their satisfaction levels with rehydration therapy, and the primary physician recorded each patient's background. A total of 173 patients were included in this study. After the development phase, the initial instrument was shortened to a 12-item scale. In the validation phase, an exploratory factor analysis revealed underlying three subscales: satisfaction with "information giving," "disturbance of daily activities," and "treatment effect." This factor structure was ascertained by a confirmatory factor analysis. The overall Cronbach's alpha coefficient was 0.73, and those for subscales ranged from 0.73 to 0.83. The total score was significantly correlated with global satisfaction score (rho=0.53), and the "treatment effect" subscale score was moderately correlated with self-perceived improvement of dehydration symptoms (rho=0.25-0.33). The test-retest examination showed fair reproductive reliability (intraclass correlation = 0.78 for total and 0.63-0.78 for subscale scores). Multivariate analyses identified that disclosure of the incurability, 15 min or more daily contact with physicians, presence of a primary responsible nurse, absence of cachexia, and absence of fluid retention symptoms were significantly associated with higher patient satisfaction. In conclusion, this scale had acceptable psychometric properties for measurement of patient satisfaction with rehydration therapy. PMID:11777188

  14. Terminally Ill Can Do without Statins, Study Finds

    MedlinePLUS

    ... Without Statins, Study Finds Reducing pill burden improves quality of life (*this news item will not be available after ... statins in terminally ill patients may improve their quality of life, a new study indicates. These findings suggest that ...

  15. Attitudes of Terminally Ill Patients Toward Euthanasia and Physician-Assisted Suicide

    Microsoft Academic Search

    Keith G. Wilson; John F. Scott; Ian D. Graham; Jean F. Kozak; Susan Chater; Raymond A. Viola; Barbara J. de Faye; Lynda A. Weaver; Dorothyann Curran

    Background: In jurisdictions that permit euthanasia or physician-assisted suicide, patients with cancer com- prise the largest group to die by these methods. We in- vestigated the personal attitudes toward these practices of patients receiving palliative care for advanced cancer. Methods: Seventy patients (32 men and 38 women; median survival, 44.5 days) took part in a survey using in-depth semistructured interviews.

  16. Are terminally ill patients dying in the ICU suitable for non-heart beating organ donation?

    Microsoft Academic Search

    Jean-Pierre Revelly; Luca Imperatori; Philippe Maravic; Marie-Denise Schaller; René Chioléro

    2006-01-01

    Objective  To evaluate the feasibility of implementing a program of controlled \\u000anon-heart beating organ donation, in patients undergoing the withdrawal of \\u000aintensive care treatment.Design and setting  Prospective observational study. Medical and Surgical ICUs in a tertiary university hospital.Patients  Consecutive patients younger than 70?years dying in the ICU after treatment \\u000awithdrawal for dire neurological prognosis.Measurements and results  We analyzed prospectively collected data from the ICU clinical information

  17. A prospective study to compare three depression screening tools in patients who are terminally ill.

    PubMed

    Lloyd-Williams, Mari; Dennis, Mick; Taylor, Fiona

    2004-01-01

    Depression is a significant symptom for approximately one in four palliative care patients. This study investigates the performance of three screening tools. Patients were asked to verbally rate their mood on a scale of 0-10; to respond "yes" or "no" to the question "Are you depressed?," and to complete the Edinburgh depression scale. They were also interviewed using a semi-structured clinical interview according to DSM-IV criteria. Complete data was available for 74 patients. For the single question, a "yes" answer had a sensitivity of 55% and specificity 74%. The Edinburgh depression scale at a cut-off point of > or =13 had a sensitivity of 70% and specificity of 80%. The verbal mood item with a cut-off point of > or =3 had a sensitivity of 80% and specificity of 43%. The Edinburgh depression scale proved to be the most reliable instrument for detecting clinical depression in palliative care patients. PMID:15474638

  18. Dana-Farber study finds most terminally ill cancer patients discuss end-of-life care with physicians, but often late in their illness

    Cancer.gov

    The vast majority of patients with incurable lung or colorectal cancer talk with a physician about their options for care at the end of life, but often not until late in the course of their illness, according to a new study by Dana-Farber Cancer Institute investigators published in the Feb. 7 issue of the Annals of Internal Medicine.

  19. Conceptualizing Alzheimer's disease as a terminal medical illness.

    PubMed

    Wolf-Klein, Gisele; Pekmezaris, Renee; Chin, Lisa; Weiner, Joseph

    2007-01-01

    Alzheimer's disease is a common illness of the elderly population, with an estimated prevalence of 4.5 million people in the United States and 24.3 million worldwide. Despite current pharmaceutic advances in delaying disease progression, there is no cure. This article reviews the evidence for conceptualizing Alzheimer's disease as a terminal medical illness. Discussed are principles of palliative care as applied to the patient with Alzheimer's disease and the patient's family. PMID:17347512

  20. Intentions in wishes to die: analysis and a typology – A report of 30 qualitative case studies of terminally ill cancer patients in palliative care

    PubMed Central

    Ohnsorge, K; Gudat, H; Rehmann-Sutter, C

    2014-01-01

    Objective To investigate the variations in and intentions of wishes to die (WTD) of palliative care cancer patients. Methods Thirty terminally ill cancer patients, their caregivers and relatives in a hospice, an oncology palliative care ward of a general hospital, and an outpatient palliative care service. 116 semistructured qualitative interviews analyzed by a combined approach using Grounded Theory and Interpretive Phenomenological Analysis. Results A WTD is dynamic and interactive. Its subjective phenomenology can be described by three aspects: intentions, motivations, and interactions. In this article, we present a typology of the possible intentions. We identified nine different (ideal) types of intentions that WTD statements might have, other than wishing to live and accepting death. Many WTD statements do not imply a desire to hasten death. The intentions of statements differ according to whether a WTD is related to as imaginary or as an action. Often WTD statements contain several partial wishes, which can be in tension with each other and form a dynamic, sometimes unstable equilibrium. Conclusions Terminally ill persons' WTD statements differ in their intention, and deeper knowledge about these differences is ethically relevant. PMID:24706488

  1. Spirituality, Religion, and Depression in the Terminally Ill

    Microsoft Academic Search

    CHRISTIAN J. NELSON; BARRY ROSENFELD; WILLIAM BREITBART; MICHELE GALIETTA

    2002-01-01

    Objective: This study examined the impact of spirituality and religiosity on depressive symptom severity in a sample of terminally ill patients with cancer and AIDS. Methods: One hundred sixty-two patients were recruited from palliative-care facilities (hospi- tals and specialized nursing facilities), all of whom had a life expectancy,6 months. The pri- mary variables used in this study were the FACIT

  2. Cautious Application of Pleural N-Terminal Pro-B-Type Natriuretic Peptide in Diagnosis of Congestive Heart Failure Pleural Effusions among Critically Ill Patients

    PubMed Central

    Yeh, Jiann-Horng; Huang, Chun-Ta; Liu, Chia-Hsiung; Ruan, Sheng-Yuan; Tsai, Yi-Ju; Chien, Ying-Chun; Yang, Ching-Yao; Huang, Chun-Kai; Hsu, Chia-Lin; Kuo, Lu-Cheng; Lee, Pei-Lin; Ku, Shih-Chi; Kuo, Ping-Hung; Yu, Chong-Jen

    2014-01-01

    Background and Objective Several studies on diagnostic accuracy of pleural N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) for effusions from congestive heart failure (CHF) conclude that pleural NT-pro-BNP is a useful biomarker with high diagnostic accuracy for distinguishing CHF effusions. However, its applicability in critical care settings remains uncertain and requires further investigations. Methods NT-proBNP was measured in pleural fluid samples of a prospective cohort of intensive care unit patients with pleural effusions. Receiver operating characteristic curve analysis was performed to determine diagnostic accuracy of pleural NT-proBNP for prediction of CHF effusions. Results One hundred forty-seven critically ill patients were evaluated, 38 (26%) with CHF effusions and 109 (74%) with non-CHF effusions of various causes. Pleural NT-proBNP levels were significantly elevated in patients with CHF effusions. Pleural NT-pro-BNP demonstrated the area under the curve of 0.87 for diagnosing effusions due to CHF. With a cutoff of 2200 pg/mL, pleural NT-proBNP displayed high sensitivity (89%) but moderate specificity (73%). Notably, 29 (27%) of 109 patients with non-CHF effusions had pleural NT-proBNP levels >2200 pg/mL and these patients were more likely to experience septic shock (18/29 vs. 10/80, P<0.001) or acute kidney injury (19/29 vs. 9/80, P<0.001). Conclusions Among critically ill patients, pleural NT-proBNP measurements remain a useful diagnostic aid in evaluation of pleural effusions. However, patients with non-CHF effusions may exhibit high pleural NT-proBNP concentrations if they suffer from septic shock or acute kidney injury. Accordingly, it is suggested that clinical context should be taken into account when interpreting pleural NT-proBNP values in critical care settings. PMID:25502236

  3. United States laws and the rights of the terminally ill.

    PubMed

    Cowan, Dale H

    2009-09-01

    United States laws that pertain to the rights of terminally ill patients include both Federal law and the laws of the individual States. These laws affect the structure and use of Advance Directives that patients prepare to provide guidance and direction as to how they wish to be treated in the event of their mental and physical incapacity. The manner by which individuals are treated when they lose decisional capacity may be subject to decisions of federal courts and ultimately the United States Supreme Court. These decisions address the balance between an individual's autonomy to direct how he or she wishes to be cared for when no longer capable of making personal decisions, the role and rights of designated decision makers for such individuals, and the role and authority of States to direct how such care can or should be provided. A separate set of decisions pertain to the issue of physician-assisted suicide. These again seek to balance the rights of individuals versus the authority and responsibility of government. As with decisions affecting care of the terminally ill, decisions arise from State law but may end up in judicial decisions of the United States Supreme Court. The decisions by the United States Supreme Court have resulted in differences among the States as to how physician-assisted suicide is managed. Finally, recent decisions have affected the access of terminally ill patients to drugs that have not been approved by the United States Food and Drug Administration (FDA) for general use. They address the rights of terminally ill patients to unapproved drugs versus the authority and responsibility of the FDA to regulate the availability of drugs. PMID:20157966

  4. Health services utilization during terminal illness in Addis Ababa, Ethiopia

    PubMed Central

    Reniers, Georges; Tesfai, Rebbeca

    2009-01-01

    Objectives We describe modern and alternative health services use in terminal illness of adults, and assess whether utilization patterns of TB/AIDS patients are distinct from those of patients suffering from other illnesses. Methods Data are from post-mortem interviews with close relatives or caretakers of the deceased. We provide descriptive statistics of health care utilization in adults and discuss their covariates in multivariate analyses. Results Over 85% of terminally sick patients visited a modern medical facility, but less than 40% spent more than 24 hours in a medical facility and only 25% died in one. Traditional healer (11%) and holy water (46%) visits offer a common treatment and healing alternative, but these visits do not co-vary in any consistent manner with the utilization of modern medical services. In terms of the cause of death, we find a higher contact rate with both modern and alternative medical service providers among TB/AIDS patients compared with those suffering from other medical conditions. The duration of illness seems to account for a good share of that variability. Other covariates of health services utilization are socio-economic status, education and age. Conclusions The contact rate of adults with modern medical facilities in terminal illness is almost universal, but their usage intensity is rather low. Alternative curative options are less commonly used, and do not exclude modern health services use. This suggests that both types of services are considered complements rather than alternatives for each other. Because the contact rate with health service providers is greatest for TB/AIDS patients, it is unlikely that HIV/AIDS-related stigma is an impediment to seeking care. We cannot exclude, however, that it delays health-seeking behaviour. PMID:19372240

  5. Chronic Illness and Patient Satisfaction

    PubMed Central

    Carlin, Caroline S; Christianson, Jon B; Keenan, Patricia; Finch, Michael

    2012-01-01

    Objective To examine how the relationship between patient characteristics, patient experience with the health care system, and overall satisfaction with care varies with illness complexity. Data Sources/Study Setting Telephone survey in 14 U.S. geographical areas. Study Design Structural equation modeling was used to examine how relationships among patient characteristics, three constructs representing patient experience with the health care system, and overall satisfaction with care vary across patients by number of chronic illnesses. Data Collection/Extraction Methods Random digital dial telephone survey of adults with one or more chronic illnesses. Principal Findings Patients with more chronic illnesses report higher overall satisfaction. The total effects of better patient–provider interaction and support for patient self-management are associated with higher satisfaction for all levels of chronic illness. The latter effect increases with illness burden. Older, female, or insured patients are more satisfied; highly educated patients are less satisfied. Conclusions Providers seeking to improve their patient satisfaction scores could do so by considering patient characteristics when accepting new patients or deciding who to refer to other providers for treatment. However, our findings suggest constructive actions that providers can take to improve their patient satisfaction scores without selection on patient characteristics. PMID:22515159

  6. Conceptualizing Alzheimer's Disease as a Terminal Medical Illness

    Microsoft Academic Search

    Gisele Wolf-Klein; Renee Pekmezaris; Lisa Chin; Joseph Weiner

    2007-01-01

    Alzheimer's disease is a common illness of the elderly population, with an estimated prevalence of 4.5 million people in the United States and 24.3 million worldwide. Despite current pharmaceutic advances in delaying disease progression, there is no cure. This article reviews the evidence for conceptualizing Alzheimer's disease as a terminal medical illness. Discussed are principles of palliative care as applied

  7. Engendering hope in the chronically and terminally ill: Nursing interventions

    Microsoft Academic Search

    Kaye Herth

    1995-01-01

    Nurses assume a primary role in the care of chronic and terminally ill individuals in their homes and are in a strategic position to foster or hinder hope. Using a descriptive survey design, home health care nurses and hospice nurses were asked to rate proposed hope interventions as to use and effectiveness in facilitating hope in their chronically ill and

  8. Death - whose decision? Euthanasia and the terminally ill

    PubMed Central

    Fraser, S.; Walters, J.

    2000-01-01

    In Australia and Oregon, USA, legislation to permit statutory sanctioned physician-assisted dying was enacted. However, opponents, many of whom held strong religious views, were successful with repeal in Australia. Similar opposition in Oregon was formidable, but ultimately lost in a 60-40% vote reaffirming physician-assisted dying. This paper examines the human dilemma which arises when technological advances in end-of-life medicine conflict with traditional and religious sanctity-of-life values. Society places high value on personal autonomy, particularly in the United States. We compare the potential for inherent contradictions and arbitrary decisions where patient autonomy is either permitted or forbidden. The broader implications for human experience resulting from new legislation in both Australia and Oregon are discussed. We conclude that allowing autonomy for the terminally ill, within circumscribed options, results in fewer ethical contradictions and greater preservation of dignity. Key Words: Physician-assisted suicide • voluntary euthanasia • patient autonomy • religious belief PMID:10786323

  9. Death--whose decision? Euthanasia and the terminally ill.

    PubMed

    Fraser, S I; Walters, J W

    2000-04-01

    In Australia and Oregon, USA, legislation to permit statutory sanctioned physician-assisted dying was enacted. However, opponents, many of whom held strong religious views, were successful with repeal in Australia. Similar opposition in Oregon was formidable, but ultimately lost in a 60-40% vote reaffirming physician-assisted dying. This paper examines the human dilemma which arises when technological advances in end-of-life medicine conflict with traditional and religious sanctity-of-life values. Society places high value on personal autonomy, particularly in the United States. We compare the potential for inherent contradictions and arbitrary decisions where patient autonomy is either permitted or forbidden. The broader implications for human experience resulting from new legislation in both Australia and Oregon are discussed. We conclude that allowing autonomy for the terminally ill, within circumscribed options, results in fewer ethical contradictions and greater preservation of dignity. PMID:10786323

  10. Contract for Living--The Terminally Ill Student.

    ERIC Educational Resources Information Center

    Gerritt, Keith S.

    1986-01-01

    Describes how a Connecticut school learned to work with a ninth-grade student who was terminally ill. The school developed a plan of action through the help of a private counselor paid from special funds approved by the superintendent. (MD)

  11. On withholding nutrition and hydration in the terminally ill: has palliative medicine gone too far?

    Microsoft Academic Search

    G M Craig

    1994-01-01

    This paper explores ethical issues relating to the management of patients who are terminally ill and unable to maintain their own nutrition and hydration. A policy of sedation without hydration or nutrition is used in palliative medicine under certain circumstances. The author argues that this policy is dangerous, medically, ethically and legally, and can be disturbing for relatives. The role

  12. Attitudes of cancer patients, family caregivers, oncologists and members of the general public toward critical interventions at the end of life of terminally ill patients

    PubMed Central

    Yun, Young Ho; Han, Kyung Hee; Park, Sohee; Park, Byeong Woo; Cho, Chi-Heum; Kim, Sung; Lee, Dae Ho; Lee, Soon Nam; Lee, Eun Sook; Kang, Jung Hun; Kim, Si-Young; Lee, Jung Lim; Heo, Dae Seog; Lee, Chang Geol; Lim, Yeun Keun; Kim, Sam Yong; Choi, Jong Soo; Jeong, Hyun Sik; Chun, Mison

    2011-01-01

    Background: Whereas most studies have focused on euthanasia and physician-assisted suicide, few have dealt comprehensively with other critical interventions administered at the end of life. We surveyed cancer patients, family caregivers, oncologists and members of the general public to determine their attitudes toward such interventions. Methods: We administered a questionnaire to four groups about their attitudes toward five end-of-life interventions — withdrawal of futile life-sustaining treatment, active pain control, withholding of life-sustaining measures, active euthanasia and physician-assisted suicide. We performed multivariable analyses to compare attitudes and to identify sociodemographic characteristics associated with the attitudes. Results: A total of 3840 individuals — 1242 cancer patients, 1289 family caregivers and 303 oncologists from 17 hospitals, as well as 1006 members of the general Korean population — participated in the survey. A large majority in each of the groups supported withdrawal of futile life-sustaining treatment (87.1%–94.0%) and use of active pain control (89.0%–98.4%). A smaller majority (60.8%–76.0%) supported withholding of life-sustaining treatment. About 50% of those in the patient and general population groups supported active euthanasia or physician-assisted suicide, as compared with less than 40% of the family caregivers and less than 10% of the oncologists. Higher income was significantly associated with approval of the withdrawal of futile life-sustaining treatment and the practice of active pain control. Older age, male sex and having no religion were significantly associated with approval of withholding of life-sustaining measures. Older age, male sex, having no religion and lower education level were significantly associated with approval of active euthanasia and physician-assisted suicide. Interpretation: Although the various participant groups shared the same attitude toward futile and ameliorative end-of-life care (the withdrawal of futile life-sustaining treatment and the use of active pain control), oncologists had a more negative attitude than those in the other groups toward the active ending of life (euthanasia and physician-assisted suicide). PMID:21624907

  13. Hyponatremia in critically ill patients

    PubMed Central

    Padhi, Rajesh; Panda, Baikuntha Nath; Jagati, Snehalata; Patra, Subhas Chandra

    2014-01-01

    Context: Hyponatremia is a common electrolyte disturbance in critically ill hence understanding its implications is important. Aims: This study was carried out to ascertain frequency, predisposing conditions and outcome in critically ill patients with hyponatremia on intensive care unit (ICU) admission. Settings and Design: This was an observational, prospective study of a series of ICU patients during a 12-month period. Materials and Methods: The patients were divided into two groups: Hyponatremic (serum sodium < 135 mmol/L) and Eunatremic groups (135-145 mmol/L). Clinical examination included volume status and drug history, biochemistries, clinical diagnosis and cause of hyponatremia. Statistical Analysis Used: Fisher's exact test, unpaired t-tests Wilcoxon ranksum tests, profile-likelihood method, log-rank test and Kaplan—Meier curves were used. P < 0.05 were considered to be statistically significant. Results: In the hyponatremic group, the frequency of hyponatremia on ICU admission was 34.3%, most were euvolumic, 58.96%. Females comprised of 36.5%. The mean age was 60.4 ± 17.2. The Syndrome of inappropriate Antidiuretic Hormone (SIADH) criteria was met in ninety-one patients (36.25%), peumonia being the leading cause of SIADH. Patients with severe sepsis, elective surgery patients, renal failure and heart failure, cirrhosis of liver and subarachnoid hemorrhage were other more likely etiologic causes (P < 0.05). The hyponatremic group spent a longer time in the ICU (P = 0.02), had longer mechanical ventilator days (P < 0.05) and had an increased mortality rate (P = 0.01). Conclusions: Hyponatremia present on admission to the ICU is independent risk factors for poor prognosis. PMID:24678150

  14. What a wish to die can mean: reasons, meanings and functions of wishes to die, reported from 30 qualitative case studies of terminally ill cancer patients in palliative care

    PubMed Central

    2014-01-01

    Background Despite research efforts over recent decades to deepen our understanding of why some terminally ill patients express a wish to die (WTD), there is broad consensus that we need more detailed knowledge about the factors that might influence such a wish. The objective of this study is to explore the different possible motivations and explanations of patients who express or experience a WTD. Methods Thirty terminally ill cancer patients, their caregivers and relatives; from a hospice, a palliative care ward in the oncology department of a general hospital, and an ambulatory palliative care service; 116 semi-structured qualitative interviews analysed using a complementary grounded theory and interpretive phenomenological analysis approach. Results Three dimensions were found to be crucial for understanding and analysing WTD statements: intentions, motivations and social interactions. This article analyses the motivations of WTD statements. Motivations can further be differentiated into (1) reasons, (2) meanings and (3) functions. Reasons are the factors that patients understand as causing them to have or accounting for having a WTD. These reasons can be ordered along the bio-psycho-socio-spiritual model. Meanings describe the broader explanatory frameworks, which explain what this wish means to a patient. Meanings are larger narratives that reflect personal values and moral understandings and cannot be reduced to reasons. Functions describe the effects of the WTD on patients themselves or on others, conscious or unconscious, that might be part of the motivation for a WTD. Nine typical ‘meanings’ were identified in the study, including “to let death put an end to severe suffering”, “to move on to another reality”, and – more frequently– “to spare others from the burden of oneself”. Conclusions The distinction between reasons, meanings and functions allows for a more detailed understanding of the motivation for the WTD statements of cancer patients in palliative care situations. Better understanding is crucial to support patients and their relatives in end-of-life care and decision making. More research is required to investigate the types of motivations for WTD statements, also among non-cancer patients. PMID:25161387

  15. Troponin in critically ill patients.

    PubMed

    Hamilton, M A; Toner, A; Cecconi, M

    2012-09-01

    Assays of cardiac troponin have become a cornerstone in the diagnosis of myocardial infarction across a broad range of clinical settings. In critically ill patients, cardiac troponin is detectable in the plasma in up to 60% of cases, and this incidence may increase further as assays become more sensitive. Troponin rises in critical care are commonly unrelated to pathology in the coronary arteries, but are frequently associated with conditions such as sepsis and respiratory failure. Such non-coronary troponin release is a significant, independent predictor of poor patient outcomes, and can be incorporated into risk scoring systems. Despite adding prognostic value, treatment for non-coronary troponin rises remains limited to management of the underlying cause, and restoration of a favourable balance between myocardial oxygen demand and supply. Conversely, troponin rises secondary to myocardial infarctions are amenable to the same interventions as in any other setting, albeit with additional diagnostic and therapeutic challenges. In this review, we will explore the utility of troponin as a biomarker in critical care, and we will outline a pragmatic management strategy for this patient population. PMID:22717463

  16. Pharmacokinetics of ranitidine in critically ill patients.

    PubMed Central

    Ilett, K F; Nation, R L; Tjokrosetio, R; Thompson, W R; Oh, T E; Cameron, P D

    1986-01-01

    The plasma pharmacokinetics of ranitidine (50 mg i.v.) have been studied in 17 critically ill patients in an intensive care unit. Measurements of gastric aspirate pH were also made in 16 of these patients. Ranitidine therapy was part of the patients' normal drug regimen. Ranitidine plasma concentration was measured by high performance liquid chromatography and appropriate polyexponential equations were fitted to concentration-time data to enable calculation of relevant pharmacokinetic parameters. Values of the volume of the initial dilution space (median = 89 ml kg-1) and volume of distribution at steady state (median = 1.54 l kg-1) were about 60% of corresponding mean literature values for healthy controls. Plasma clearance (median = 4.22 ml min-1 kg-1) and terminal half-life (median = 4.7 h) were about 2-3 fold less and 2-3 fold greater, respectively, than values for healthy controls. There was wide interpatient variation in all the pharmacokinetic parameters. Renal impairment was considered to be largely responsible for the low plasma clearance. Gastric aspirate pH was measured at 0, 1 and 7 h after ranitidine administration and 58% of samples were found to be above pH 4. Four patients had gastric pH values which were consistently below pH 4 despite average trough plasma ranitidine concentrations equal to or greater than those required for a 50% suppression of gastric acid secretion in normal volunteers. PMID:3964528

  17. End-of-Life Care for Children with Terminal Illness (For Parents)

    MedlinePLUS

    End-of-Life Care for Children With Terminal Illness KidsHealth > Parents > Doctors & Hospitals > Caring for a Seriously or Chronically Ill Child > End-of- ... families cope with terminal illness. What Is Hospice Care? Hospice care, sometimes called end-of-life palliative ...

  18. Health Care Reform and Concurrent Curative Care for Terminally Ill Children: A Policy Analysis

    PubMed Central

    Lindley, Lisa C.

    2012-01-01

    Within the Patient Protection and Affordable Care Act of 2010 or health care reform, is a relatively small provision about concurrent curative care that significantly affects terminally ill children. Effective on March 23, 2010, terminally ill children, who are enrolled in a Medicaid or state Children’s Health Insurance Plans (CHIP) hospice benefit, may concurrently receive curative care related to their terminal health condition. The purpose of this article was to conduct a policy analysis of the concurrent curative care legislation by examining the intended goals of the policy to improve access to care and enhance quality of end of life care for terminally ill children. In addition, the policy analysis explored the political feasibility of implementing concurrent curative care at the state-level. Based on this policy analysis, the federal policy of concurrent curative care for children would generally achieve its intended goals. However, important policy omissions focus attention on the need for further federal end of life care legislation for children. These findings have implications nurses. PMID:22822304

  19. Nitric oxide production in critically ill patients

    Microsoft Academic Search

    H R Wong; J A Carcillo; G Burckart; S S Kaplan

    1996-01-01

    OBJECTIVE: To measure serum nitrite and nitrate levels in critically ill children as indicators of endogenous nitric oxide (NO) production. HYPOTHESIS: Endogenous NO production is increased in children with conditions characterised by immune stimulation. DESIGN: Prospective descriptive study in a multidisciplinary paediatric intensive care unit. PATIENTS: 137 consecutive critically ill children with a variety of clinical conditions. INTERVENTIONS: Using a

  20. Relatives' Perspective on the Terminally Ill Patients Who Died after Euthanasia or Physician-Assisted Suicide: A Retrospective Cross-Sectional Interview Study in the Netherlands

    ERIC Educational Resources Information Center

    Georges, Jean-Jacques; Onwuteaka-Philipsen, Bregje D.; Muller, Martien T.; van der Wal, Gerrit; van der Heide, Agnes; van der Maas, Paul J.

    2007-01-01

    This study used retrospective interviews with 87 relatives to describe the experiences of patients who died by euthanasia or physician-assisted suicide (EAS) in the Netherlands. Most of the patients suffered from cancer (85%). The relatives were most often a partner (63%) or a child (28%) of the patient. Before explicitly requesting EAS most…

  1. Intentions to work during terminal illness: an exploratory study of antecedent conditions.

    PubMed

    Westaby, James D; Versenyi, Andrea; Hausmann, Robert C

    2005-11-01

    Facing a terminal illness is an unimaginably difficult experience, yet many individuals intend to work despite their prognosis. However, research has not systematically examined the potential antecedents underlying such intentions. Using behavioral intention theory as an underlying framework, this study hypothesized that reasons for working (intrinsic and extrinsic), the will to live, disability severity, accessibility of travel, and age would predict intentions to work during terminal illness. A representative sample of medically diagnosed amyotrophic lateral sclerosis (a.k.a. Lou Gehrig's disease) patients with a mean life expectancy of approximately 3 years participated (mean age=57.8 years). Controlling for length of diagnosis, employment status, and demographic variables, results indicated that intrinsic reasons were particularly strong predictors of intentions, followed by age, disability severity, and accessibility of travel. Exploratory findings also indicated that behavioral intentions were positively related to future employment status, consistent with past theory. ((c) 2005 APA, all rights reserved). PMID:16316283

  2. Guidelines on artificial nutrition versus hydration in terminal cancer patients

    Microsoft Academic Search

    Federico Bozzetti; Nazionale Tumori; EDUARDO BRUERA; LUCA COZZAGLIO; Zstituto Nazionale Tumori; OSCAR CORLI; Ospedale Buzzi; ANTONIO FILIBERTI; CHARLES-HENRI RAPIN; HANS NEUENSCHWANDER; MICHEL AOUN; SANTE BASSO RICCI; ROBERTO DOCI; MARIUCCIA GARRONE; Zstituto Neurologico; C. Besta; MARA GENTILINI; NICOLE LERY; MARK MANTELL; RAE SHELDON-COLLINS; GIUSEPPE TROMPINO

    1996-01-01

    Whether a terminally ill cancer patient should be actively fed or simply hydrated through subcutaneous or intravenous infusion of isotonic fluids is a matter of ongoing controversy among clinicians involved in the care of these patients.Under the auspices of the European Association for Palliative Care, a committee of experts developed guidelines to help clinicians make a reasonable decision on what

  3. The critically ill patient: nutritional implications.

    PubMed

    Forlaw, L

    1983-03-01

    The nutritional needs of critically ill patients are increased by the metabolic demands generated from injury and sepsis. Parenteral nutrition may be necessary initially to meet their nutritional requirements, with transition to enteral nutrition when their nutritional requirements can be met via the gastrointestinal tract. Meeting the nutritional needs of patients enhances their ability to tolerate the medical and surgical interventions necessary to promote resolution of their illness. PMID:6403928

  4. Physicians' attitudes and practices regarding advanced end-of-life care planning for terminally ill patients at Chiang Mai University Hospital, Thailand.

    PubMed

    Sittisombut, Sudarat; Maxwell, Colleen; Love, Edgar J; Sitthi-Amorn, Chitr

    2009-03-01

    This study examined physicians' attitudes toward advanced directives and practices for the end-of-life care at Chiang Mai University Hospital, Thailand. The data were collected from 55 physicians (24 instructors and 31 residents) using self-reported questionnaires. The majority of the participants affirmed the usefulness of the advance directive (AD) for cardiopulmonary resuscitation and respected the patients' wish for this directive, although advanced end-of-life care and resuscitation planning with the patients was limited. Mostly, the relatives were consulted regarding ADs. This study suggests that, in traditional Thai culture, physicians and families are more inclined to make decisions for the patient when they feel that it is in the patient's best interest. Further research is needed to investigate how and to what extent such attitudes can affect medical practice for end-of-life care in the context of the rapid development and consequent changes taking place in Thailand. PMID:19298305

  5. Gentamicin dosing in critically ill patients.

    PubMed

    Hansen, M; Christrup, L L; Jarløv, J O; Kampmann, J P; Bonde, J

    2001-07-01

    Gentamicin is used worldwide in the treatment of serious infections in critically ill patients. The therapeutic efficacy of gentamicin is correlated to the peak serum concentration and the adverse effects to the trough concentrations. Information concerning the pharmacodynamics in critically ill patients is scarce, but pharmacokinetic data are available. A once-daily dosage regimen has replaced multiple dosing of gentamicin in most intensive care units. No studies evaluating the superiority of either of these dosage recommendations in critically ill patients have ever been conducted. Based on 8 meta-analyses performed addressing this issue on a wide range of patients and theoretical considerations, we consider a once-daily dosage regimen feasible in critically ill patients. In septic patients the volume of distribution is significantly increased compared to normal patients, implying that the initial dose should be increased in this patient population. Additionally a general trend towards using higher loading doses (5-7 mg/kg) has been observed in USA, and the appropriateness of this dosing strategy is based on a large descriptive American study. We recommend that the initial dosage of gentamicin in critically ill hyperdynamic septic patients should be 7 mg/kg. Optimal and appropriate monitoring of the treatment with gentamicin in the critically ill patient is still an issue for further investigation. The treatment period with gentamicin should be short (3-5 days), bearing the pharmacological properties of aminoglycosides (small volume of distribution and poor tissue penetration) in mind. In patients with reduced renal function the initial dose of gentamicin should also be increased and maintenance dose reduced preferentially by prolonging the dosing intervals. However, the use of aminoglycosides in a high dose regimen in oliguric or anuric patients or patients who present with a rapidly decreasing renal function needs further consideration. PMID:11421832

  6. Perspectives of Cardiac Care Unit Nursing Staff about Developing Hospice Services in Iran for Terminally ill Cardiovascular Patients: A Qualitative Study

    PubMed Central

    Azami-Aghdash, Saber; Ghojazadeh, Morteza; Naghavi-Behzad, Mohammad; Imani, Shahin; Aghaei, Mir Hossein

    2015-01-01

    Introduction: The present study was conducted aiming to determine the points of view of cardiac care units’ nursing staff about designing and providing Hospice services in Iran for cardiovascular patients in the final stages of life. Materials and Methods: In this qualitative study, the perspectives of 16 Cardiac Care Unit (CCU) nurses selected purposefully among hospitals of Tabriz-Iran University of Medical Sciences were investigated using semi-structured interviews and were analyzed in content analysis method. Results: 33 themes were finally extracted. Some nurses were for and some were against designing and providing Hospice services in Iran. The main reasons identified for supporting this plan included: Possibility of designing and providing these services consistent with high ethical values of Iranian society; approval of authorities due to increasing the load of chronic diseases and aged population; need of families due to the problems in taking care of patients and life concerns; better pain relief and respectful death; decrease of costs as a result of lower usage of diagnostic-therapeutic services, less use of expensive facilities and drugs, and better usage of hospital beds. Conclusion: Growing load of chronic diseases has made the need for Hospice as a necessary issue in Iran. In order to provide these services, studying the viewpoints of health service providers is inevitable. Therefore using and applying the results of this study in planning and policy making about designing and providing these services in Iran for cardiovascular patients in their final stages of lives could be helpful. PMID:25709187

  7. Caregiver Grief in Terminal Illness and Bereavement: A Mixed-Methods Study

    ERIC Educational Resources Information Center

    Waldrop, Deborah P.

    2007-01-01

    Caregivers experience multiple losses during the downhill trajectory of a loved one's terminal illness. Using mixed methods, this two-stage study explored caregiver grief during a terminal illness and after the care recipient's death. Caregiver grief was a state of heightened responsiveness during end-stage care: anxiety, hostility, depression,…

  8. Adrenal Insufficiency in Critically Ill Patients

    Microsoft Academic Search

    YORAM SHENKER; JAMES B. SKATRUD

    Patients with adrenal insufficiency in the critical care setting may present with a spectrum of disease severity ranging from life-threatening adrenal crisis to mild organ dysfunction. The recognition of adrenal insufficiency is made more difficult in the critically ill patient because of the unavailability of a reli- able history, delay in reporting of diagnostic laboratory results, and the comorbidities that

  9. Palliative care for the terminally ill in America: the consideration of QALYs, costs, and ethical issues.

    PubMed

    Yang, Y Tony; Mahon, Margaret M

    2012-11-01

    The drive for cost-effective use of medical interventions has advantages, but can also be challenging in the context of end-of-life palliative treatments. A quality-adjusted life-year (QALY) provides a common currency to assess the extent of the benefits gained from a variety of interventions in terms of health-related quality of life and survival for the patient. However, since it is in the nature of end-of-life palliative care that the benefits it brings to its patients are of short duration, it fares poorly under a policy of QALY-maximization. Nevertheless, we argue that the goals of palliative care and QALY are not incompatible, and optimal integration of palliative care into the calculation of QALY may reveal a mechanism to modify considerations of how optimal quality of life can be achieved, even in the face of terminal illness. The use of QALYs in resource allocation means that palliative care will always compete with alternative uses of the same money. More research should be conducted to evaluate choices between palliative care and more aggressive therapies for the terminally ill. However, current limited data show that investing in palliative care makes more sense not only ethically, but also financially. PMID:22071573

  10. The chronically critically ill patient: pediatric considerations.

    PubMed

    Peterson-Carmichael, Stacey L; Cheifetz, Ira M

    2012-06-01

    Whether defined as chronically critically ill, long-term mechanical ventilator dependent (or otherwise chronically medically supported), or medically fragile, a population of infants and children with chronic illness clearly exists. Infants and children with chronic healthcare needs are at an increased risk for physical, developmental, behavioral, and/or emotional conditions and generally require healthcare services of a type or amount beyond that of a general pediatric or adult population. This review will focus on the specific management and psychosocial needs associated with the healthcare of this subgroup of infants and children with chronic illness. Attention will be paid to defining the population, describing trends over time, reviewing their special needs, and discussing outcomes. Increased focus and an increasing quantity of resources for this subgroup of infants and children are needed, as the number of such pediatric patients continues to grow. PMID:22663972

  11. [The existence of nursing in caring for terminally ills'life: a phenomenological study].

    PubMed

    de Almeida, Carla Simone Leite; Sales, Catarina Aparecida; Marcon, Sônia Silva

    2014-02-01

    By taking care of cancer patients in their process of end of life, nursing experience situations of suffering before the anguish of others. This study aimed to understand the meaning and significance attributed by the nurses from the palliative care cancer hospital. This is a phenomenological research, grounded in Heidegger's thinking, performed with 13 nurses, who work at Oncology hospitalward, through semi-structured interviews, which were analyzed according to the steps recommended by Josgrilberg. From understanding the statementsof the subjects, two ontological themesemerged: Feeling satisfaction and love in the care offered and Feeling anger and inabilitytowards terminally ill patients.We inferred that working in Oncology Ward is something rewarding for these professionals, but it entails physical and mental suffering, from feeling helpless before the death-dying process. Thus, we showedthat nursing professionals need to be recognized as human beings and as such, also deserving of care. PMID:24676106

  12. Considerations in the critically ill ESRD patient.

    PubMed

    Szamosfalvi, Balazs; Yee, Jerry

    2013-01-01

    ESRD patients are admitted more frequently to intensive care units (ICUs) and have higher mortality risks than the general population, and the main causes of critical illness among ESRD patients are cardiovascular events, sepsis, and bleeding. Once in the ICU, hemodynamic stabilization and fluid-electrolyte management pose major challenges in oligoanuric patients. Selection of renal replacement therapy (RRT) modality is influenced by the outpatient modality and access, as well as severity of illness, renal provider experience, and ICU logistics. Currently, most patients receive intermittent hemodialysis or continuous RRT with temporary vascular access catheters. Acute peritoneal dialysis (PD) is less frequently utilized, and utility of outpatient PD is reduced after an ICU admission. Thus, preservation of current vascular accesses, while limiting venous system damage for future access creations, is relevant. Also, dosing of small-solute clearance with urea kinetic modeling is difficult and may be supplanted by novel online clearance techniques. Medication dosing, coordinated with delivered RRT, is essential for septic patients treated with antibiotics. A comprehensive, standardized approach by a multidisciplinary team of providers, including critical care specialists, nephrologists, and pharmacists, represents a nexus of care that can reduce readmission rates, morbidity, and mortality of vulnerable ESRD patients. PMID:23265602

  13. Job Terminations Among Persons with Severe Mental Illness Participating in Supported Employment

    Microsoft Academic Search

    Deborah R. Becker; Robert E. Drake; Gary R. Bond; Haiyi Xie; Bradley J. Dain; Katherine Harrison

    1998-01-01

    For persons with psychiatric disabilities, maintaining a job is often more difficult than acquiring a job. A large proportion of jobs end unsatisfactorily. This study explored job terminations among 63 persons with severe mental illness who participated in competitive jobs through supported employment programs. More than half of the job terminations were unsatisfactory, defined as the client quitting without having

  14. Terminally ill african american elders' access to and use of hospice care.

    PubMed

    Noh, Hyunjin; Schroepfer, Tracy A

    2015-05-01

    The underuse of hospice care by terminally ill African American elders suggests they are suffering when hospice care could offer quality end of life care. Guided by the Behavioral Model for Vulnerable Populations, this study sought understanding of structural barriers faced when seeking access to hospice care and reasons for using it when access is possible. Data was collected through interviews with 28 African American hospice patients. Themes from directed content analysis provide insights into strategies used to overcome access barriers posed by income, health insurance and administrative procedure, as well as the role religion, family, information and health beliefs played in using it. Distributing educational materials and addressing spiritual/religious concerns in choosing hospice care are key in promoting African Americans' use of hospice care. PMID:24413609

  15. Optimizing antimicrobial therapy in critically ill patients

    PubMed Central

    Vitrat, Virginie; Hautefeuille, Serge; Janssen, Cécile; Bougon, David; Sirodot, Michel; Pagani, Leonardo

    2014-01-01

    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. PMID:25349478

  16. Tobacco use treatment in primary care patients with psychiatric illness

    PubMed Central

    Cerimele, Joseph M.; Halperin, Abigail C.; Saxon, Andrew J.

    2014-01-01

    The prevalence of smoking is higher in patients with psychiatric illness compared to the general population. Smoking causes chronic illnesses which lead to premature mortality in those with psychiatric illness, is associated with greater burden of psychiatric symptoms, and contributes to the social isolation experienced by individuals with psychiatric disorders. Most patients with psychiatric illness present initially to primary care rather than specialty care settings, and some patients receive care exclusively in the primary care setting. Therefore, family physicians and other primary care clinicians have an important role in the recognition and treatment of tobacco use disorders in patients with psychiatric illnesses. In this article we review common myths associated with smoking and psychiatric illness, techniques in implementing evidence-based tobacco use treatments, the evidence base for tobacco use treatment for patients with specific psychiatric diagnoses, and factors to consider in treating tobacco use disorders in patients with psychiatric illness. PMID:24808119

  17. Demoralization in Patients with Medical Illness

    PubMed Central

    Sansone, Lori A.

    2010-01-01

    Demoralization is a dysphoric state encountered in both psychiatric and medical populations, and is characterized by the individual's sense of disempowerment and futility. While depression may coexist with demoralization, they appear to be distinct clinical entities, with the former being characterized by anhedonia and the latter being characterized by helplessness. Assessment measures for demoralization are available, such as the Diagnostic Criteria for Psychosomatic Research and the Demoralization Scale of the Minnesota Multiphasic Personality Inventory version 2 restructured clinical scales. However, the administration requirements of these measures tend to limit them to research environments. As for prevalence, demoralization is commonplace in medical populations, perhaps even normative. However, up to one-third of physically ill patients experience clinically meaningful demoralization. Identification by the clinician is important as there are several proposed interventions that may be helpful in alleviating demoralization in medically compromised patients. PMID:20877533

  18. Suboptimal aminoglycoside dosing in critically ill patients.

    PubMed

    Rea, Rhonda S; Capitano, Blair; Bies, Robert; Bigos, Kristin L; Smith, Randall; Lee, Howard

    2008-12-01

    Maximal aminoglycoside (AG) killing requires that the ratio of peak serum concentrations (Cmax) to the minimum inhibitory concentration (MIC) of the pathogen exceeds by > or =10. This has been shown to hasten resolution of infection in the general patient population. It was postulated that critically ill patients, likely to have larger intravascular volumes, are underdosed. The primary aim was to determine Cmax to MIC target attainment rate in medical intensive care unit (MICU) patients. A retrospective review of MICU patients who received at least 1 intravenous dose and serum concentration of either gentamicin or tobramycin was performed. A population pharmacokinetic model was developed, and MIC distributions for AG were used in determining the Cmax/MIC and in calculating the probability of attaining the pharmacodynamic (PD) target. One hundred two unique patients with 211 AG concentrations were analyzed to determine population pharmacokinetic parameters. Mean maximum clearance (CL) was 3.14L/h (95% confidence interval: 1.26-4.54 L/h), and mean volume of distribution (V) was 53 L (95% confidence interval: 38-66.8 L/h). Glomerular filtration rate and standardized body weight were identified as significant covariates for clearance in the final model. Standardized body weight also significantly affected V. There was only a 20% and 40% probability that patients receiving 7 mg/kg of gentamicin and tobramycin, respectively, will achieve PD target over the range of MIC distributions. Based on these data, the majority of critically ill patients would not be predicted to achieve the PD target under current dosing regimens. This may be a result of intensive care unit patients having a larger volume of distribution than reported in the literature. Future recommendations for treating gram-negative infections in the MICU population include using initial doses of 7 mg/kg of either gentamicin or tobramycin, measuring Cmax after the first dose, and determining MIC for the pathogen(s) with adjustment of subsequent doses to achieve the PD target. PMID:19057371

  19. Methylphenidate for Treatment of Depressive Symptoms, Apathy, and Fatigue in Medically Ill Older Adults and Terminally Ill Adults

    PubMed Central

    Hardy, Susan E.

    2009-01-01

    Background Depressive symptoms, apathy, and fatigue are common symptoms among medically ill older adults and patients with advanced disease, and are associated with morbidity and mortality. Methylphenidate has been used to treat these symptoms because of its rapid effect. Objective To review the literature regarding the efficacy and safety of methylphenidate to treat depressive symptoms, apathy, and fatigue in medically ill older adults and in palliative care. Methods English-language articles presenting systematic reviews, clinical trials, or case series describing use of methylphenidate to treat depressive symptoms, fatigue, or apathy in medically ill older adults or in palliative care were identified. The keywords “methylphenidate” and either “depressive”, “depression”, “fatigue”, or “apathy” were used to search the Cochrane Database, MEDLINE, PsycINFO, and International Pharmaceutical Abstracts. Included articles addressed depressive symptoms, apathy, or fatigue in 1) older adults (generally age 65 years or older), particularly those with comorbid medical illness; 2) adult patients receiving palliative care; and 3) adults with other chronic illnesses. We excluded articles regarding 1) treatment of depression in healthy young adults; 2) treatment of bipolar disorder or attention-deficit hyperactivity disorder; and 3) treatment of narcolepsy, chronic fatigue syndrome and related disorders. Results 19 controlled trials of methylphenidate in medically ill older adults or in palliative care were identified. Unfortunately, their conflicting results, small size, and poor methodologic quality limit our ability to draw inferences regarding the efficacy of methylphenidate, although the evidence of its safety is stronger. The available evidence suggests possible effectiveness of methylphenidate for depressive symptoms, fatigue, apathy, and cognitive slowing in various medically ill populations. Conclusions In the absence of definitive evidence of effectiveness, trials of low-dose methylphenidate in medically ill adults suffering from depression, apathy, or fatigue with monitoring for response and adverse effects are appropriate. PMID:19281939

  20. Dignity in the terminally ill: a developing empirical model

    Microsoft Academic Search

    Harvey Max Chochinov; Thomas Hack; Susan McClement; Linda Kristjanson; Mike Harlos

    2002-01-01

    Despite use of the term dignity in arguments for and against a patient's self-governance in matters pertaining to death, there is little empirical research on how this term has been used by patients who are nearing death. The objective of this study was to determine how dying patients understand and define the term dignity, in order to develop a model

  1. Use of the Internet by Patients with Chronic Illness

    Microsoft Academic Search

    Richard W. Millard; Patricia A. Fintak

    2002-01-01

    Objective: To understand how patients with chronic illness use the Internet to manage their health. Design and Participants: An online survey was conducted among 10 069 patients with chronic illnesses. Survey results were obtained from patients with 35 separate chronic conditions, with at least 50 respondents for each condition. The survey was administered online at a dedicated, password-protected web site.

  2. 42 CFR 418.22 - Certification of terminal illness.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...the start of the subsequent benefit period. (4) Face-to-face encounter. As of January 1, 2011, a hospice physician or hospice nurse practitioner must have a face-to-face encounter with each hospice patient...

  3. 42 CFR 418.22 - Certification of terminal illness.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...the start of the subsequent benefit period. (4) Face-to-face encounter. As of January 1, 2011, a hospice physician or hospice nurse practitioner must have a face-to-face encounter with each hospice patient...

  4. 42 CFR 418.22 - Certification of terminal illness.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...the start of the subsequent benefit period. (4) Face-to-face encounter. As of January 1, 2011, a hospice physician or hospice nurse practitioner must have a face-to-face encounter with each hospice patient...

  5. 42 CFR 418.22 - Certification of terminal illness.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...the start of the subsequent benefit period. (4) Face-to-face encounter. As of January 1, 2011, a hospice physician or hospice nurse practitioner must have a face-to-face encounter with each hospice patient...

  6. Remifentanil in critically ill cardiac patients.

    PubMed

    Ruggeri, Laura; Landoni, Giovanni; Guarracino, Fabio; Scolletta, Sabino; Bignami, Elena; Zangrillo, Alberto

    2011-01-01

    Remifentanil has a unique pharmacokinetic profile, with a rapid onset and offset of action and a plasmatic metabolism. Its use can be recommended even in patients with renal impairment, hepatic dysfunction or poor cardiovascular function. A potential protective cardiac preconditioning effect has been suggested. Drug-related adverse effects seem to be comparable with other opioids. In cardiac surgery, many randomized controlled trials demonstrated that the potential benefits of the use of remifentanil not only include a profound protection against intraoperative stressful stimuli, but also rapid postoperative recovery, early weaning from mechanical ventilation, and extubation. Remifentanil shows ideal properties of sedative agents being often employed for minimally invasive cardiologic techniques, such as transcatheter aortic valve implantation and radio frequency treatment of atrial flutter, or diagnostic procedures such as transesophageal echocardiography. In intensive care units remifentanil is associated with a reduction in the time to tracheal extubation after cessation of the continuous infusion; other advantages could be more evident in patients with organ dysfunction. Effective and safe analgesia can be provided in case of short and painful procedures (i.e. chest drain removal). In conclusion, thanks to its peculiar properties, remifentanil will probably play a major role in critically ill cardiac patients. PMID:21196668

  7. Opioid prescription for terminally ill outpatients in a district of northern Italy: a retrospective survey

    Microsoft Academic Search

    Chiara Salvato; Gianfranco Aretini; Donatella Serraglia; Gianni Terrazzani; Patrizia Debetto; Pietro Giusti; Alessandro Chinellato

    2003-01-01

    A retrospective survey of the opioid prescriptions issued for cancer outpatients (2125) of the Treviso district (Veneto Region, northern Italy) during the time period 1993–2000 was carried out with the specific aims to establish the rate of opioid prescription and verify whether terminally ill outpatients (1697) who had died by the end of December 2000 received adequate opioid prescription, as

  8. The terminally ill Muslim: Death and dying from the Muslim perspective

    Microsoft Academic Search

    Nabeel Sarhill; Susan LeGrand; Ramez Islambouli; Mellar P. Davis; Declan Walsh

    2001-01-01

    Islam holds life as sacred and belonging to God and that all creatures will die one day. Suicide is forbidden. Muslims believe death is only a transition between two different lives. The terminally ill Muslim desires to perform five ritual requirements. Do not resuscitate (DNR) orders are acceptable. A deceased Muslim must always be buried after being ritually washed and

  9. Ethical Guidelines for Counselors when Working with Clients with Terminal Illness Requesting Physician Aid in Dying

    ERIC Educational Resources Information Center

    Kurt, Layla J.; Piazza, Nick J.

    2012-01-01

    In 2005, the American Counseling Association (ACA) introduced a new ethical standard for counselors working with clients with terminal illness who are considering hastened death options. The authors' purpose is to inform counselors of the Death With Dignity Act and explore relevant ethical guidelines in the "ACA Code of Ethics" (ACA, 2005).

  10. Psychologists' Involvement with Terminally Ill Individuals Who are Making End-of-Life Decisions

    Microsoft Academic Search

    James L. Werth Jr; Mary M. Lewis; Jessica M. Richmond

    2009-01-01

    Psychologists and other mental health professionals have much to offer when terminally ill individuals are considering and making choices near the end of life. This article highlights ways in which psychologists can assist dying people and their loved ones, with an emphasis on facilitating end-of-life decision making through psychological assessment and intervention. In addition, the authors discuss the importance of

  11. The Medicare Hospice Benefit: Ten Years of Federal Policy for the Terminally Ill.

    ERIC Educational Resources Information Center

    Miller, Pamela J.; Mike, Paula B.

    1995-01-01

    The political and social development of the Medicare Hospice Benefit combines humanitarian and cost-saving strategies. Although it mainstreamed care of the terminally ill and provided multiple services, four major constraints of the benefit package are identified and explored. It is important that we analyze this policy before we devise new ways…

  12. Fear of Death, Mortality Communication, and Psychological Distress among Secular and Religiously Observant Family Caregivers of Terminal Cancer Patients

    ERIC Educational Resources Information Center

    Bachner, Yaacov G.; O'Rourke, Norm; Carmel, Sara

    2011-01-01

    Previous research suggests that caregivers and terminally ill patients face substantial difficulties discussing illness and death. Existing research, however, has focused primarily on the experience of patients. The current study compared responses as well as the relative strength of association between mortality communication, fear of death, and…

  13. Metoclopramide improves gastric motility in critically ill patients

    Microsoft Academic Search

    C. A. Jooste; J. Mustoe; G. Collee

    1999-01-01

    Objective: To assess the effect of metoclopramide on gastric motility in critically ill patients. Design: Prospective, controlled, single-blind cross-over trial. Setting: A 10-bed general intensive care unit. Patients: Ten critically ill, enterally fed adult patients without renal failure. Interventions: Each patient received enteral feeding with Enrich via a nasogastric tube at 50 ml\\/h throughout the 5-h study period on two

  14. Psychotic illness in patients with epilepsy

    PubMed Central

    Tadokoro, Yukari; Oshima, Tomohiro

    2012-01-01

    Apart from the rather rare ictal psychotic events, such as non-convulsive status epilepticus, modern epileptic psychoses have been categorized into three main types; chronic and acute interictal psychoses (IIPs) and postictal psychosis (PIP). Together, they comprise 95% of psychoses in patients with epilepsy (PWE). Four major questions, that is, “Is psychosis in PWE a direct consequence of epilepsy or schizophrenia induced by epilepsy?”, “Is psychosis in PWE homogeneous or heterogeneous?”, “Does psychosis in PWE have symptomatological differences from schizophrenia and related disorders?”, “Is psychosis in PWE uniquely associated with temporal lobe epilepsy (TLE)?” are tried to be answered in this review with relevant case presentations. In the final section, we propose a tentative classification of psychotic illness in PWE, with special attention to those who have undergone epilepsy surgery. Psychotic disorders in PWE are often overlooked, mistreated, and consequently lingering on needlessly. While early diagnosis is unanimously supported as a first step to avoid this delay, necessity of switching from antiepileptic drugs with supposedly adverse psychotopic effects. to others is more controversial. To elucidate the riddle of alternative psychosis, we need badly further reliable data. PMID:23139703

  15. Crafting medical history: revisiting the "definitive" account of Franklin D. Roosevelt's terminal illness.

    PubMed

    Lerner, Barron H

    2007-01-01

    While revisionist historians have challenged many standard interpretations of events in the presidency of Franklin D. Roosevelt, one account has remained virtually unscathed: an article about Roosevelt's terminal illness and death written by one of his physicians, Howard G. Bruenn. Yet this article, like all historical documents, was not "objective" but rather a reflection of social and political forces--both from the 1940s, when Roosevelt became ill, and from 1970, when Bruenn's piece was published. This essay argues that Bruenn, the Roosevelt family, and the historian James MacGregor Burns worked together to craft a document that told the story of Roosevelt's decline with a predictable trajectory. PMID:17844721

  16. Detection of substance use disorders in severely mentally ill patients

    Microsoft Academic Search

    Robert E. Drake; Arthur I. Alterman; Stanley R. Rosenberg

    1993-01-01

    Severe mental illness is frequently complicated by substance use disorder. Approximately half of the severely mentally ill patients treated in acute care psychiatric settings have abused one or more of these substances. Despite the high rate of comorbidity, substance use disorders are generally not detected in acute care psychiatric settings, leading to incorrect diagnoses and ineffective treatments. The reasons for

  17. [Spiritual care model for terminal cancer patients].

    PubMed

    Cheng, Ju-Fen; Lin, Ya-Ching; Huang, Pai-Ho; Wei, Chih-Hsin; Sun, Jia-Ling

    2014-12-01

    Providing spiritual care to patients with advanced cancer may improve the quality of life of these patients and help them experience a good death. Cancer patients are eager for additional spiritual care and for a sense of peace at the end of their life. However, spirituality is an abstract concept. The literature on spiritual care focuses primarily on elaborations of spirituality theory. Thus, first-line medical care professionals lack clear guidelines for managing the spiritual needs of terminal cancer patients. The purposes of this article were to: 1) introduce a spiritual care model based on the concept of repair and recovery of relationships that addresses the relationship between the self and God, others, id, and objects and 2) set out a four-step strategy for this model that consists of understanding, empathizing, guiding, and growing. This article provides operational guidelines for the spiritual care of terminal cancer patients. PMID:25464961

  18. The pharmacologic approach to the critically ill patient

    SciTech Connect

    Chernow, B. (Harvard Medical School, Massachusetts General Hospital, Boston, MA (US))

    1988-01-01

    This book contains papers addressing the pharmacologic approach to the critically ill patient. Chapter topics include: Radiation injury; Red cell substitutes: a current appraisal; and Psychopharmacology in the ICU.

  19. Dancing Around Death: Hospitalist-Patient Communication About Serious Illness

    PubMed Central

    Anderson, Wendy G.; Kools, Susan; Lyndon, Audrey

    2012-01-01

    Hospital physicians care for most seriously ill patients in the United States. We employed dimensional analysis to describe communication about death and dying in audio-recorded admission encounters between seriously ill patients and hospitalists. Acknowledging or not acknowledging the possibility of dying emerged as a key process. Acknowledgment was rare, and depended on synergistic communication behaviors between patient and physician. Facilitators included patients cuing for information and disclosing emotional distress, and physicians exploring the patient’s understanding of his or her illness and emotional distress. When hospitalists focused on acute issues, stated that they were awaiting test results, and deferred to other physicians, discussion moved away from acknowledgment. Meaningful discussion of end-of-life issues, including goals and values, fears about death and dying, prognosis, and options for palliative care followed open acknowledgment. This acknowledgment process can serve as a guide for providers to sensitively and honestly discuss essential end-of-life issues. PMID:23034778

  20. Connecting with chronically ill patients to improve treatment adherence.

    PubMed

    Silva, Giovana G; Swartz, Martha K; Molony, Sheila L

    2014-09-18

    This study presents an integrative review of the literature assessing the relationships among a patient's style in coping with a long-term health condition, the patient-practitioner therapeutic alliance, and treatment adherence among chronically ill adults. Evidence-based recommendations to improve nurse practitioner-patient therapeutic alliance and treatment adherence are suggested. PMID:25140851

  1. Compliance with medication regimens among chronically ill, inner city patients

    Microsoft Academic Search

    James Y. Greene; Morris Weinberger; Michael J. Jerin; Joseph J. Mamlin

    1982-01-01

    Patient adherence to medication regimens is explored as a function of (1) patient beliefs, perceptions, and knowledge of the illness, (2) extent of social support for health actions, (3) complexity of and specific knowledge about the regimen, and (4) satisfaction with clinical encounters and the health care facility. One hundred and ninety patients receiving care on an outpatient basis at

  2. Primary care issues in patients with mental illness.

    PubMed

    Kiraly, Bernadette; Gunning, Karen; Leiser, Jennifer

    2008-08-01

    Family physicians commonly care for patients with serious mental illness. Patients with psychotic and bipolar disorders have more comorbid medical conditions and higher mortality rates than patients without serious mental illness. Many medications prescribed for serious mental illness have significant metabolic and cardiovascular adverse effects. Patients treated with second-generation antipsychotics should receive preventive counseling and treatment for obesity, hyperglycemia, diabetes, and hyperlipidemia. First- and second-generation antipsychotics have been associated with QT prolongation. Many common medications can interact with antipsychotics, increasing the risk of cardiac arrhythmias and sudden death. Drug interactions can also lead to increased adverse effects, increased or decreased drug levels, toxicity, or treatment failure. Physicians should carefully consider the risks and benefits of second-generation antipsychotic medications, and patient care should be coordinated between primary care physicians and mental health professionals to prevent serious adverse effects. PMID:18711951

  3. Disparities in appendicitis rupture rate among mentally ill patients

    PubMed Central

    Tsay, Jen-Huoy; Lee, Cheng-Hua; Hsu, Yea-Jen; Wang, Pen-Jen; Bai, Ya-Mei; Chou, Yiing-Jenq; Huang, Nicole

    2007-01-01

    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. PMID:18005406

  4. Clinical Correlates of Insomnia in Patients With Chronic Illness

    Microsoft Academic Search

    David A. Katz; Colleen A. McHorney

    1998-01-01

    Background: Patients with chronic insomnia are more likely to develop affective disorders, cardiac morbidity, and other adverse health outcomes, yet many clinicians tend to trivialize the complaint of insomnia or to at- tribute it only to psychiatric causes. Objectives: To estimate the prevalence and longitudi- nal course of insomnia in patients with documented chronic medical illness and\\/or depression and to

  5. The support needs of terminally ill people living alone at home: a narrative review

    PubMed Central

    Aoun, Samar M.; Breen, Lauren J.; Howting, Denise

    2014-01-01

    Context: The number of terminally ill people who live alone at home and without a caregiver is growing and exerting pressure on the stretched resources of home-based palliative care services. Objectives: We aimed to highlight the unmet support needs of terminally ill people who live alone at home and have no primary caregiver and identify specific models of care that have been used to address these gaps. Methods: We conducted a narrative review of empirical research published in peer-reviewed journals in English using a systematic approach, searching databases 2002–2013. This review identified 547 abstracts as being potentially relevant. Of these, 95 were retrieved and assessed, with 37 studies finally reviewed. Results: Majority of the studies highlighted the reduced likelihood of this group to be cared for and die at home and the experiences of more psychosocial distress and more hospital admissions than people with a primary caregiver. Few studies reported on the development of models of care but showed that the challenges faced by this group may be mitigated by interventions tailored to meet their specific needs. Conclusion: This is the first review to highlight the growing challenges facing community palliative care services in supporting the increasing number of people living alone who require care. There is a need for more studies to examine the effectiveness of informal support networks and suitable models of care and to provide directions that will inform service planning for this growing and challenging group.

  6. Cytomegalovirus infection in critically ill patients: a systematic review

    PubMed Central

    Osawa, Ryosuke; Singh, Nina

    2009-01-01

    Introduction The precise role of cytomegalovirus (CMV) infection in contributing to outcomes in critically ill immunocompetent patients has not been fully defined. Methods Studies in which critically ill immunocompetent adults were monitored for CMV infection in the intensive care unit (ICU) were reviewed. Results CMV infection occurs in 0 to 36% of critically ill patients, mostly between 4 and 12 days after ICU admission. Potential risk factors for CMV infection include sepsis, requirement of mechanical ventilation, and transfusions. Prolonged mechanical ventilation (21 to 39 days vs. 13 to 24 days) and duration of ICU stay (33 to 69 days vs. 22 to 48 days) correlated significantly with a higher risk of CMV infection. Mortality rates in patients with CMV infection were higher in some but not all studies. Whether CMV produces febrile syndrome or end-organ disease directly in these patients is not known. Conclusions CMV infection frequently occurs in critically ill immunocompetent patients and may be associated with poor outcomes. Further studies are warranted to identify subsets of patients who are likely to develop CMV infection and to determine the impact of antiviral agents on clinically meaningful outcomes in these patients. PMID:19442306

  7. Care of the Terminally Ill from Religious Perspectives: Role of Palliative and Hospice Care

    PubMed Central

    Mir, Tanveer

    2012-01-01

    Health care should make an attempt to understand the different religious principles that affect end-of-life decisions in patient care. With advanced illness, defining an ethical framework is essential to understanding sensitive issues. Compassionate care is crucial in all end-of-life care settings. Physician awareness is a key principle in inculcating the religious values of patients. Cultural and religious awareness on the part of the health-care team is needed to provide patients with effective end-of-life palliative and hospice care. PMID:23610503

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

    PubMed

    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. PMID:24620462

  9. Cytomegalovirus (CMV) in critically-ill patients: pathogen or bystander?

    PubMed Central

    Limaye, Ajit P.; Boeckh, Michael

    2010-01-01

    Summary Despite broad variability in study populations, methodologies for CMV detection, and analytic methods used, multiple studies have documented frequent CMV infection in non-immunocompromised adults with critical illness due to a variety of causes. Higher rates of CMV infection in studies of seropositive patients suggest that reactivation of latent infection rather than primary infection is the main mechanism in this setting. Risk factors for CMV reactivation (other than seropositivity) have not been clearly defined and there does not appear to be a consistent association with severity of illness. Furthermore, CMV reactivation in this setting has been associated with important adverse clinical outcomes, including increased duration of mechanical ventilation, longer length of stay, and all-cause mortality. There are several biologically plausible mechanisms that could link CMV reactivation with adverse outcomes, including: direct lung injury (CMV pneumonia), amplification of inflammation systemically and within the lung, or predisposition to other nosocomial infections, but clinical data in the ICU setting are limited. Further observational studies are unlikely to significantly advance our understanding of the role of CMV in critically-ill patients. Given the significant impact of critical illness, limited current therapeutic options, the availability of generally well-tolerated antiviral options for CMV, and the clinical data supporting a possible pathogenic role for CMV, there is a strong rationale for a randomized controlled trial of CMV prevention as a novel means of improving the outcomes of critically-ill patients. PMID:20931610

  10. Spiritual Care For Jewish Patients Facing A Life Threatening Illness

    PubMed Central

    Bluman, Rabbi Olga F.; Klein, Linda; Thomas, Jay; Ferrell, Betty

    2013-01-01

    Providing biopsychosocial/spiritual care for patients facing a life threatening illness can be complex, and this complexity can be amplified when a patient identifies as Jewish. A common but incorrect assumption is that a person who identifies him or herself as Jewish abides by the tenets of the Jewish religion. However, many Jews consider themselves Jewish in an ethnic or cultural sense rather than connected to a religion or belief in God. This case report presents an ethnic/cultural Jew with a life threatening illness of advanced lung cancer. Despite evidence of spiritual/existential suffering, this patient declined spiritual care. From an analysis of this case and clinical experience, we suggest exploratory questions that clinicians can use in response to common questions or statements made by such patients. This exploration may lead to a chaplain referral and we highlight interventions that chaplains and clinicians may find helpful as they come alongside Jewish patients. PMID:23614173

  11. Hyponatremia in Critically Ill Neurological Patients

    Microsoft Academic Search

    Alejandro A. Rabinstein; Eelco F. M. Wijdicks

    2003-01-01

    Background: Hyponatremia is the most common and important electrolyte disorder encountered in the neurologic intensive care unit (NICU). Advances in our knowledge of the pathophysiological mechanisms at play in patients with acute neurologic disease have improved our understanding of this derangement. Review Summary: Evaluation of hyponatremia requires a struc- tured approach beginning with the measurement of serum and urine osmolalities.

  12. The Liver and Kidney in Critically Ill Patients

    Microsoft Academic Search

    Andrew J. Slack; Julia Wendon

    2009-01-01

    Both liver and kidney dysfunction are associated with adverse outcomes in critical illness. Advanced liver disease can be complicated by the hepatorenal syndrome (HRS) with liver transplantation offering the best long-term outcome. However, until recently, HRS was associated with such a poor prognosis that this group of patients rarely survived long enough for transplantation to be considered. The use of

  13. CARING FOR THE CRITICALLY ILL PATIENT

    E-print Network

    Cooper, Robin L.

    as PaO2 of 300 mm Hg or greater; hypoxia, PaO2 of less than 60 mm Hg (or ratio of PaO2 to fraction of inspired oxygen 300); and normoxia, not classified as hyperoxia or hypoxia. Main Outcome Measure In-hospital mortality. Results Of 6326 patients, 1156 had hyperoxia (18%), 3999 had hypoxia (63%), and 1171 had normoxia

  14. Parenteral Nutrition in the Critically Ill Patient

    PubMed Central

    Ziegler, Thomas R.

    2011-01-01

    A 67-year-old woman with type 2 diabetes mellitus undergoes extensive resection of the small bowel and right colon with a jejunostomy and colostomy because of mesenteric ischemia. In the surgical intensive care unit, severe systemic inflammatory response syndrome with possible sepsis develops. The patient is treated with volume resuscitation, vasopressor support, mechanical ventilation, broad-spectrum antibiotics, and intravenous insulin infusion. Low-dose tube feedings are initiated postoperatively through a nasogastric tube. However, these feedings are discontinued after the development of escalating vasopressor requirements, worsening abdominal distention, and increased gastric residual volume, along with an episode of emesis. The hospital nutritional-support service is consulted for feeding recommendations. A discussion with the patient's family reveals that during the previous 6 months, she lost approximately 15% of her usual body weight and decreased her food intake because of abdominal pain associated with eating. Her preoperative body weight was 51 kg (112 lb), or 90% of her ideal body weight. The physical examination reveals mild wasting of skeletal muscle and fat. Blood tests show hypomagnesemia, hypophosphatemia, and normal hepatic and renal function. Central venous parenteral nutrition is recommended. PMID:19741230

  15. Inflammation biomarkers and delirium in critically ill patients

    PubMed Central

    2014-01-01

    Introduction Delirium is a common occurrence in critically ill patients and is associated with an increase in morbidity and mortality. Septic patients with delirium may differ from a general critically ill population. The aim of this investigation was to study the relationship between systemic inflammation and the development of delirium in septic and non-septic critically ill patients. Methods We performed a prospective cohort study in a 20-bed mixed intensive care unit (ICU) including 78 (delirium?=?31; non-delirium?=?47) consecutive patients admitted for more than 24 hours. At enrollment, patients were allocated to septic or non-septic groups according to internationally agreed criteria. Delirium was diagnosed using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) during the first 72 hours of ICU admission. Blood samples were collected within 12 hours of enrollment for determination of tumor necrosis factor (TNF)-?, soluble TNF Receptor (STNFR)-1 and -2, interleukin (IL)-1?, IL-6, IL-10 and adiponectin. Results Out of all analyzed biomarkers, only STNFR1 (P?=?0.003), STNFR2 (P?=?0.005), adiponectin (P?=?0.005) and IL-1? (P?patients. Adjusting for sepsis and sedation, these biomarkers were also independently associated with delirium occurrence. However, none of them were significant influenced by sepsis. Conclusions STNFR1, STNFR2, adiponectin and IL-1? were associated with delirium. Sepsis did not modify the relationship between the biomarkers and delirium occurrence. PMID:24886875

  16. Critical Illness Polyneuropathy in Patients With Major Burn Injuries

    PubMed Central

    Chan, Queenie; Ng, Karl; Vandervord, John

    2010-01-01

    Objective: Critical illness polyneuropathy in burn patients is an underreported condition. It is associated with high mortality rates and prolonged hospital stay and rehabilitation. This study aims to further define the cause and outcome of critical illness polyneuropathy following major burn injuries. Methods: A retrospective review of all burn patients with neuropathy that presented to Royal North Shore Hospital, Sydney, between the period of 2004 and 2009 was performed. The neurological findings, diagnostic processes, and outcomes were examined. End points such as duration on the ventilator, length of intensive care, and hospital stay were recorded. Results: There were 7 patients in total that exhibited abnormal neurological findings. Ages ranged from 17 to 43 years with all injuries sustained in flame burns. Mean total burnt surface area is 46%. There was no mortality in this series but all 7 had evidence of sepsis and multiorgan failure with an average 42 days spent on the ventilator. Clinical findings varied greatly. Five had involvement of nerves away from the site of burns. Upper-limb weakness tended to have a slower recovery. Examination and neurophysiologic studies were often hampered by pain and bandaging over burnt skin. Conclusions: Neurological manifestations of critical illness polyneuropathy are varied and cannot always be explained by direct thermal or compression injury. This study confirms a strong link to sepsis, multiple organ failure, and slow ventilatory wean. The requirement for a precise neurophysiological diagnosis of critical illness polyneuropathy needs to be balanced with technical considerations and the likelihood of alternative diagnoses. PMID:21119768

  17. "Feelings are facts": illness perceptions in patients with lung cancer.

    PubMed

    Hoogerwerf, M A; Ninaber, M K; Willems, L N A; Kaptein, A A

    2012-08-01

    Given the high degree of psychosocial problems in patients with lung cancer, quality medical care would benefit from exploring and addressing and providing potential solutions for these problems. Patients with recently diagnosed non-small-cell lung cancer filled out a questionnaire that assessed illness perceptions and made a drawing of how they perceived their diseased lungs look. They also participated in an interview about the impact of lung cancer in their lives. Scores on the Brief Illness Perception Questionnaire indicated that patients score low on 'concern', 'emotional response' and 'timeline', indicating they hope to be cured from lung cancer. Patients drew the tumor larger than it is on the chest radiograph. The drawings are moderately accurate representations of the patients' lungs. In the interviews patients often expressed their hopes of being cured and how thinking positively would help. Patients who made a more accurate drawing of their lungs had less optimistic views about their prognosis. These views are more in line with the prognosis their physician would give them. However, few patients made an accurate drawing. This study contributes to a better insight into what patients believe and feel about their disease. Suggestions for taking patient perceptions into account are provided. PMID:22579109

  18. Acinetobacter infections: a growing threat for critically ill patients

    PubMed Central

    FALAGAS, M. E.; KARVELI, E. A.; SIEMPOS, I. I.; VARDAKAS, K. Z.

    2008-01-01

    SUMMARY There has been increasing concern regarding the rise of Acinetobacter infections in critically ill patients. We extracted information regarding the relative frequency of Acinetobacter pneumonia and bacteraemia in intensive-care-unit (ICU) patients and the antimicrobial resistance of Acinetobacter isolates from studies identified in electronic databases. Acinetobacter infections most frequently involve the respiratory tract of intubated patients and Acinetobacter pneumonia has been more common in critically ill patients in Asian (range 4–44%) and European (0–35%) hospitals than in United States hospitals (6–11%). There is also a gradient in Europe regarding the proportion of ICU-acquired pneumonias caused by Acinetobacter with low numbers in Scandinavia, and gradually rising in Central and Southern Europe. A higher proportion of Acinetobacter isolates were resistant to aminoglycosides and piperacillin/tazobactam in Asian and European countries than in the United States. The data suggest that Acinetobacter infections are a growing threat affecting a considerable proportion of critically ill patients, especially in Asia and Europe. PMID:17892629

  19. Limited-sampling strategies for anidulafungin in critically ill patients.

    PubMed

    van Wanrooy, Marjolijn J P; Proost, Johannes H; Rodgers, Michael G G; Zijlstra, Jan G; Uges, Donald R A; Kosterink, Jos G W; van der Werf, Tjip S; Alffenaar, Jan-Willem C

    2015-02-01

    Efficacy of anidulafungin is driven by the area under the concentration-time curve (AUC)/MIC ratio. Determination of the anidulafungin AUC along with MIC values can therefore be useful. Since obtaining a full concentration-time curve to determine an AUC is not always feasible or appropriate, limited-sampling strategies may be useful in adequately estimating exposure. The objective of this study was to develop a model to predict the individual anidulafungin exposure in critically ill patients using limited-sampling strategies. Pharmacokinetic data were derived from 20 critically ill patients with invasive candidiasis treated with anidulafungin. These data were used to develop a two-compartment model in MW\\Pharm using an iterative 2-stage Bayesian procedure. Limited-sampling strategies were subsequently investigated using two methods, a Bayesian analysis and a linear regression analysis. The best possible strategies for these two methods were evaluated by a Bland-Altman analysis for correlation of the predicted and observed AUC from 0 to 24 h (AUC0-24) values. Anidulafungin exposure can be adequately estimated with the concentration from a single sample drawn 12 h after the start of the infusion either by linear regression (R(2) = 0.99; bias, 0.05%; root mean square error [RMSE], 3%) or using a population pharmacokinetic model (R(2) = 0.89; bias, -0.1%; RMSE, 9%) in critically ill patients and also in less severely ill patients, as reflected by healthy volunteers. Limited sampling can be advantageous for future studies evaluating the pharmacokinetics and pharmacodynamics of anidulafungin and for therapeutic drug monitoring in selected patients. (This study has been registered at ClinicalTrials.gov under registration no. NCT01047267.). PMID:25487797

  20. Dissimilarity in patients' and spouses' representations of chronic illness: Exploration of relations to patient adaptation

    Microsoft Academic Search

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

    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 on time-line. control\\/cure. and consequences of the illness. The effects of such dissimilarity in

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

    PubMed

    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 < .01). Russian-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. PMID:24492913

  2. Central neurological complications in critically ill patients with malignancies

    Microsoft Academic Search

    Stéphane Legriel; Hélène Marijon; Michael Darmon; Virginie Lemiale; Jean-Pierre Bedos; Benoît Schlemmer; Elie Azoulay

    2010-01-01

    Objective  To determine outcomes in critically ill patients hospitalized in the ICU for central neurological complications of cancer.\\u000a \\u000a \\u000a \\u000a Design and setting  A 7-year retrospective study.\\u000a \\u000a \\u000a \\u000a Subject and intervention  Observational study in 100 critically ill cancer patients with central neurological complications managed using standardized\\u000a diagnostic and therapeutic strategies.\\u000a \\u000a \\u000a \\u000a Measurements and results  There were 52 men and 48 women, aged 55 years (IQR, 40–65). Presenting manifestations were

  3. Management of Atrial Fibrillation in Critically Ill Patients

    PubMed Central

    Arrigo, Mattia

    2014-01-01

    Atrial fibrillation (AF) is common in ICU patients and is associated with a two- to fivefold increase in mortality. This paper provides a reappraisal of the management of AF with a special focus on critically ill patients with haemodynamic instability. AF can cause hypotension and heart failure with subsequent organ dysfunction. The underlying mechanisms are the loss of atrial contraction and the high ventricular rate. In unstable patients, sinus rhythm must be rapidly restored by synchronised electrical cardioversion (ECV). If pharmacological treatment is indicated, clinicians can choose between the rate control and the rhythm control strategy. The optimal substance should be selected depending on its potential adverse effects. A beta-1 antagonist with a very short half-life (e.g., esmolol) is an advantage for ICU patients because the effect of beta-blockade on cardiovascular stability is unpredictable in those patients. Amiodarone is commonly used in the ICU setting but has potentially severe cardiac and noncardiac side effects. Digoxin controls the ventricular response at rest, but its benefit decreases in the presence of adrenergic stress. Vernakalant converts new-onset AF to sinus rhythm in approximately 50% of patients, but data on its efficacy and safety in critically ill patients are lacking. PMID:24527212

  4. Improving Primary Care for Patients With Chronic Illness

    Microsoft Academic Search

    Thomas Bodenheimer; Edward H. Wagner; Kevin Grumbach

    2002-01-01

    The chronic care model is a guide to higher-quality chronic illness manage- ment within primary care. The model predicts that improvement in its 6 in- terrelated components—self-management support, clinical information sys- tems, delivery system redesign, decision support, health care organization, and community resources—can produce system reform in which informed, activated patients interact with prepared, proactive practice teams. Case stud- ies

  5. Equipment review: Intrahospital transport of critically ill patients

    Microsoft Academic Search

    Christian Waydhas

    1999-01-01

    BACKGROUND: This review on the current literature of the intrahospital\\u0009\\u0009\\u0009\\u0009transport of critically ill patients addresses type and incidence of adverse\\u0009\\u0009\\u0009\\u0009effects, risk factors and risk assessment, and the available information on\\u0009\\u0009\\u0009\\u0009efficiency and cost-effectiveness of transferring such patients for diagnostic\\u0009\\u0009\\u0009\\u0009or therapeutic interventions within hospital. Methods and guidelines to prevent\\u0009\\u0009\\u0009\\u0009or reduce potential hazards and complications are provided. METHODS:

  6. Off-trial access to experimental cancer agents for the terminally ill: balancing the needs of individuals and society

    Microsoft Academic Search

    Manik Chahal

    2010-01-01

    The development of cancer therapies is a long and arduous process. Because it can take several years for a cancer agent to pass clinical testing and be approved for use, terminal cancer patients rarely have the time to see these experimental therapies become widely available. For most terminal cancer patients the only opportunity they have to access an experimental drug

  7. IGF-I concentration and changes in critically ill patients

    PubMed Central

    Hajsadeghi, Shokoufeh; Khamseh, Mohammad Ebrahim; Gholami, Saeid; Kerman, Scott Reza Jafarian; Gohardehi, Golnar; Moghadam, Negar Seifi; Sabet, Azade Shafiee; Moradi, Masoud; Mollahoseini, Reza; Najafi, Mehri; Keramati, Mohammad Reza

    2011-01-01

    BACKGROUND: Insulin-like growth factor 1 (IGF-I) is an anabolic growth factor that affects nitrogen balance and its changing trend is not clearly understood in critically ill patients. This study was carried out to evaluate the association between serum IGF-I levels and its changing trend in critically ill patients. METHODS: In this nested case-control study, all consecutive patients admitted to the medical ICU of Rasoul-e-Akram and Firuzgar hospital (Tehran, Iran) from January through October 2008 were included. IGF1 concentration was measured within the first 24h of ICU admission and the fourth, seventh and tenth day since admission. Patients were followed until discharge from ICU or expiration. RESULTS: The study population consisted of 90 patients (mean age: 58.01 ± 22.56), 31 (34.4%) of who died and 59 (65.6%) were discharged. On admission, 43 patients (47.7%) had low IGF-I levels, whereas 47 (52.3%) had normal or high levels. The concentration of IGF-I was not significantly different in every 4 measurements between expired and discharged patients. Significant decrease was seen between first to fourth day IGF-I concentration (p = 0.005). Changing trend was not statistically different in two groups of patients. CONCLUSIONS: There was no relation between low IGF-I concentration on admission day and increased adverse outcome, but overall these patients had lower IGF1. No clear association was found between changing trend of IGF1 and mortality. Stress on admission time may cause decreasing pattern of IGF-I in the first 4 days of admission. PMID:22091227

  8. Low but Sufficient Anidulafungin Exposure in Critically Ill Patients

    PubMed Central

    van Wanrooy, Marjolijn J. P.; Rodgers, Michael G. G.; Uges, Donald R. A.; Arends, Jan P.; Zijlstra, Jan G.; van der Werf, Tjip S.; Kosterink, Jos G. W.

    2014-01-01

    The efficacy of anidulafungin is driven by the area under the concentration-time curve (AUC)/MIC ratio. Patients in intensive care may be at risk for underexposure. In critically ill patients with an invasive Candida infection, the anidulafungin exposure and a possible correlation with disease severity or plasma protein levels were explored. Concentration-time curves were therefore obtained at steady state. Anidulafungin concentrations were measured with a validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. The MIC values of the Candida species were determined with the Etest. The target AUC/MIC ratio was based on European Committee on Antimicrobial Susceptibility Testing (EUCAST) data. Twenty patients were included. The patients received a maintenance dose of 100 mg once daily after a loading dose of 200 mg on the first day. The mean (±standard deviation) AUC, maximum concentration of drug in plasma (Cmax), and minimum concentration of drug in plasma (Cmin) were 69.8 ± 24.1 mg · h/liter, 4.7 ± 1.4 mg/liter, and 2.2 ± 0.8 mg/liter, respectively. The MIC values of all cultured Candida species were below the EUCAST MIC breakpoints. The exposure to anidulafungin in relation to the MIC that was determined appeared sufficient in all patients. The anidulafungin exposure was low in our critically ill patients. However, combined with the low MICs of the isolated Candida strains, the lower exposure observed in comparison to the exposure in the general patient population resulted in favorable AUC/MIC ratios, based on EUCAST data. No correlation was observed between anidulafungin exposure and disease severity or plasma protein concentrations. In patients with less-susceptible Candida albicans or glabrata strains, we recommend considering determining the anidulafungin exposure to ensure adequate exposure. (This trial has been registered at ClinicalTrials.gov under registration no. NCT01047267.) PMID:24165173

  9. Patient and spouse illness beliefs and quality of life in prostate cancer patients

    PubMed Central

    Wu, Lisa M.; Mohamed, Nihal E.; Winkel, Gary; Diefenbach, Michael A.

    2015-01-01

    Objective Among married prostate cancer (PC) patients, the spouse is often the primary provider of emotional support and personal care. However, few studies have investigated spouses’ illness beliefs (i.e., about disease duration and treatment control) and their impact on patients’ quality of life (QOL). Spouses’ beliefs about disease duration (timeline) were hypothesised to mediate relationships between spouses’ treatment control beliefs and patients’ QOL six months later. Methods Fifty-three patients, who underwent localised treatment for PC, and their spouses, completed an illness beliefs measure (the revised Illness Perception Questionnaire). Patients completed a QOL measure (the Functional Assessment of Cancer Therapy – General) six months later. Results Spouse timeline beliefs mediated the association between spouse treatment control beliefs and patient QOL six months later (total indirect effect = ?0.71, 95% CI 0.02-2.03). That is, spouse beliefs that the treatment would control their loved one's illness led to beliefs that the disease would be of shorter duration, which in turn led to improved patient QOL six months later. This relationship did not occur with patients’ beliefs. Conclusions Results highlight the important influence of spouse illness beliefs over time on patient QOL with implications for clinical care and dyadic research. PMID:22971045

  10. Focus on peripherally inserted central catheters in critically ill patients.

    PubMed

    Cotogni, Paolo; Pittiruti, Mauro

    2014-11-01

    Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings (emergency, intensive care, surgery) and for different purposes (fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device (CVAD) (mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters (PICCs) and centrally inserted central catheters (CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe -due to their placement into peripheral veins of the arm- and the advantage of a central location of catheter tip suitable for all osmolarity and pH solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as well as the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs (i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD (CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care. PMID:25374804

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

    PubMed

    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. PMID:24084429

  12. Acupuncture in Critically Ill Patients Improves Delayed Gastric Emptying: A Randomized

    E-print Network

    Napadow, Vitaly

    Acupuncture in Critically Ill Patients Improves Delayed Gastric Emptying: A Randomized Controlled complicated by delayed gastric emptying and gastroesophageal reflux. Acupuncture has been successfully used acupuncture can improve gastric emptying in comparison with standard promotility drugs in critically ill

  13. The impact of ED boarding time, severity of illness, and discharge destination on outcomes of critically ill ED patients.

    PubMed

    Intas, George; Stergiannis, Pantelis; Chalari, Eleftheria; Tsoumakas, Kostas; Fildissis, George

    2012-01-01

    This aim of this study was to determine the association between emergency department (ED) boarding time, severity of illness, and outcomes for critically ill patients. This was a prospective cohort study of ED patients who met criteria for admission to the intensive care unit (ICU). Patients were divided into 2 groups: those who spent less than 6 hr in the ED prior to transfer, and those who spent 6 hr or more. The groups were compared on the basis of severity of illness, Glasgow Coma Scale score, presence of fever, admission time, and hospital survival. Factors associated with increased mortality included patients who spent 6 hr or longer in the ED, had a fever, were admitted in the evening or night, or were indirect ICU admissions. Length of time spent in the ED prior to transfer to inpatient care is one of several factors associated with increased mortality in critical care patients who were intubated in the ED. PMID:22561226

  14. Communication with patients suffering from serious physical illness.

    PubMed

    Grassi, Luigi; Caruso, Rosangela; Costantini, Anna

    2015-01-01

    Communication is the corner stone of the relationship with the patient in all medical settings with the main aims of creating a good inter-personal relationship, exchanging information, and making treatment-related decisions. In a rapidly changing cultural and social context, the paternalistic approach of doctors knowing the best and deciding what should be done for a patient has been replaced by a shared decision-making approach, with patients being advised to educate themselves, ask questions and influence the course of the discussion with their doctors. Thus, a need for an improvement in the communication skills of physicians is extremely important for patients affected by serious physical illness (e.g. cancer, HIV infection, multiple sclerosis, amyotrophic lateral sclerosis). Certain attitudes, behaviour and skills (e.g. capacity to impart confidence, being empathetic, providing a 'human touch', relating on a personal level, being forthright, being respectful, and being thorough) are part of effective communication. However, some specific aspects influencing doctor-patient communication and relationships, such as personality variables, coping and attachment styles, as well as cultural factors, should also be taken in to account. The development of training curricula to help doctors acquire proper skills in communication is mandatory, since research has shown that training in communication may facilitate the effectiveness of a doctor-patient relationship and the patient's satisfaction with care and give a general sense of humanity, which is easily lost in a biotechnologically oriented medicine. © 2015 S. Karger AG, Basel. PMID:25832510

  15. The pharmacokinetics of aztreonam and penetration into the bronchial secretions of critically ill patients.

    PubMed

    Boccazzi, A; Langer, M; Mandelli, M; Ranzi, A M; Urso, R

    1989-03-01

    The pharmacokinetics of aztreonam were studied in ten critically ill intubated patients with lower respiratory tract infections. Serum and urinary concentrations of the drug and its penetration into bronchial secretions after a 2-g intravenous bolus were measured. Using a two-compartment linear model a terminal half-life of 1.87 + 0.46 h was determined. No interpatient differences were found for half-life values, AUC or volume of distribution, except in the case of one obese patient. The greatest variability was observed in the clearance values, and in particular the extrarenal clearance which ranged from 0.3 to 9.6 1/h. Maximum concentrations in bronchial secretions were reached very quickly in the 2 h after drug administration, with a range of 4.8-18.7 mg/l. No accumulation of aztreonam after repeated doses was detected. PMID:2732121

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

    Microsoft Academic Search

    Mark D. Hanson; Samantha Johnson; Anne Niec; Anna Marie Pietrantonio; B. High; H. MacMillan; K. W. Eva

    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 pro- vide a stigma-reduction strategy. This article reports an investi- gation of this hypothetical association between simulation dis- comfort and mental illness stigma. Methods: ASPs were randomly assigned to one of two simu- lation

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

    Microsoft Academic Search

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

    2009-01-01

    Older patients with medical illnesses are at risk of institutionalization. The purpose of this study is to investigate the factors leading to institutionalization in older patients after recovery from medical illnesses. We studied 535 older patients in two convalescence hospitals in Hong Kong. Of them, 116 patients (21.7%) needed to move to nursing homes upon discharge. Univariate analysis showed that

  18. Evolving concepts of hemodynamic monitoring for critically ill patients

    PubMed Central

    Hamzaoui, Olfa; Monnet, Xavier; Teboul, Jean-Louis

    2015-01-01

    The last decades have been characterized by a continuous evolution of hemodynamic monitoring techniques from intermittent toward continuous and real-time measurements and from an invasive towards a less invasive approach. The latter approach uses ultrasounds and pulse contour analysis techniques that have been developed over the last 15 years. During the same period, the concept of prediction of fluid responsiveness has also been developed and dynamic indices such as pulse pressure variation, stroke volume variation, and the real-time response of cardiac output to passive leg raising or to end-expiration occlusion, can be easily obtained and displayed with the minimally invasive techniques. In this article, we review the main hemodynamic monitoring devices currently available with their respective advantages and drawbacks. We also present the current viewpoint on how to choose a hemodynamic monitoring device in the most severely ill patients and especially in patients with circulatory shock. PMID:25878430

  19. Cytomegalovirus Reactivation in Critically-Ill Immunocompetent Patients

    PubMed Central

    Limaye, Ajit P.; Kirby, Katharine A.; Rubenfeld, Gordon D.; Leisenring, Wendy M.; Bulger, Eileen M.; Neff, Margaret J.; Gibran, Nicole S.; Huang, Meei-Li; Santo, Tracy K.; Corey, Lawrence; Boeckh, Michael

    2009-01-01

    Context Cytomegalovirus (CMV) infection is associated with adverse clinical outcomes in immunosuppressed persons, but the incidence and association of CMV reactivation with adverse outcomes in persons lacking evidence of immunosuppression (“immunocompetent”) with critical illness have not been well-defined. Objective To determine the association of CMV reactivation with intensive care unit (ICU) and hospital length of stay in critically-ill immunocompetent persons. Methods We prospectively assessed CMV plasma DNAemia by real-time PCR twice weekly and clinical outcomes in a cohort of CMV seropositive, immunocompetent adults admitted to an ICU. Clinical parameters were assessed by personnel blinded to CMV PCR results. Risk factors for CMV reactivation and association with hospital and ICU length of stay (LOS) were assessed by multivariable logistic regression and proportional odds models. Setting Six ICU’s at two separate hospitals at a large tertiary care academic medical center between 2004–2006. Participants A total of 120 critically-ill, CMV seropositive adults lacking evidence of immunosuppression. Main Outcome Measures Association of CMV reactivation with prolonged hospital length of stay or death. Results The primary composite endpoint of continued hospitalization (n=35) or death (n=10) at 30 days occurred in 45 (35%) of the 120 patients. CMV viremia at any level or > 1,000 copies/ml occurred in 33% (39 of 120, 95% confidence interval [CI] 24%–41%) and 20% (24 of 120, 95% CI 13%–28%), at a median of 12 days (range 3–57) and 26 days (range 9–56), respectively. By logistic regression, CMV infection at any level (adjusted OR: 4.3 [1.6–11.9], p = 0.005), >1,000 copies/ml (adjusted OR 13.9 [3.2–60], p < 0.001), or average CMV area under the curve [AUC] (adjusted OR 2.1 [1.3–3.2], p < 0.001), was independently associated with hospitalization or death by 30 days. In multivariable partial proportional odds models, both CMV seven-day moving average (OR 5.1 (2.9–9.1) p < 0.0001) and CMV AUC (OR 3.2 (2.1–4.7), p < 0.0001) were independently associated with a hospital LOS ?14 days. Conclusions These preliminary findings suggest that reactivation of CMV occurs frequently in critically-ill immunocompetent patients and is associated with prolonged hospitalization or death. A controlled trial of CMV prophylaxis in this setting is warranted. PMID:18647984

  20. Adaptation to different noninvasive ventilation masks in critically ill patients*

    PubMed Central

    da Silva, Renata Matos; Timenetsky, Karina Tavares; Neves, Renata Cristina Miranda; Shigemichi, Liane Hirano; Kanda, Sandra Sayuri; Maekawa, Carla; Silva, Eliezer; Eid, Raquel Afonso Caserta

    2013-01-01

    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. PMID:24068269

  1. Heparin-induced thrombocytopenia in critically ill patients.

    PubMed

    Warkentin, Theodore E

    2015-02-01

    Many critically ill patients receive heparin, either before intensive care unit (ICU) admission (e.g., postcardiac surgery), for prophylaxis/treatment of thrombosis, for hemodialysis/filtration, or even incidentally (e.g., flushing of intravascular catheters), and are therefore at risk for developing immune heparin-induced thrombocytopenia (HIT), a prothrombotic drug reaction caused by platelet-activating antiplatelet factor 4 (PF4)/heparin antibodies. However, HIT explains at most 1 in 100 thrombocytopenic ICU patients (HIT frequency 0.3-0.5% vs. 30-50% background frequency of ICU-associated thrombocytopenia), and most patients who form anti-PF4/heparin antibodies do not develop HIT; hence, HIT overdiagnosis often occurs. This review discusses HIT-related issues relevant to ICU patients, including how to (1) distinguish HIT both clinically and serologically from non-HIT-related thrombocytopenia; (2) recognize HIT-mimicking disorders, such as the acute disseminated intravascular coagulation (DIC)/liver necrosis-limb necrosis syndrome; (3) prevent HIT in the ICU through use of low-molecular-weight heparin; and (4) treat HIT, including awareness of "PTT confounding" when anticoagulating patients with DIC. PMID:25590528

  2. [Central nervous system involvement in patients with decompression illness].

    PubMed

    Kohshi, Kiyotaka; Katoh, Takahiko; Abe, Haruhiko; Wong, Robert M

    2003-05-01

    Dysbarism or decompression illness (DCI), a general term applied to all pathological changes secondary to altered environmental pressure, has two forms decompression sickness (DCS) and arterial gas embolism (AGE) after pulmonary barotrauma. Cerebral and spinal disorders have been symptomatically categorized as AGE and DCS, respectively. Magnetic resonance images (MRIs) of divers with DCI showed multiple cerebral infarction in the terminal and border zones of the brain arteries. In addition, there were no differences between MRI findings for compressed air and breath-hold divers. Although the pathogenesis of the brain is not well understood, we propose that arterialized bubbles passing through the lungs and heart involved the brain. From the mechanisms of bubble formation, however, this disorder has been classified as DCS. We propose that there is a difference between clinical and mechanical diagnoses in the criteria of brain DCI. In contrast to brain injury, the spinal cord is involved only in compressed air divers, and is caused by disturbed venous circulation due to bubbles in the epidural space. The best approach to prevent diving accidents is to make known the problems for professional and amateur divers. PMID:12833851

  3. Current Legislation on Admission of Mentally Ill Patients in China

    PubMed Central

    Shao, Yang; Xie, Bin; Good, Mary-Jo DelVecchio; Good, Byron J.

    2009-01-01

    Objective To date, there is no systematic analysis of mental health laws and their implementation across the People’s Republic of China. This article aims to describe and analyze current legal frameworks for voluntary and involuntary admissions of mentally ill patients in the five cities of China that currently have municipal mental health regulations. Methods Information on the legislation and practice of involuntary admission in the five cities was gathered and assessed using the “WHO Checklist on Mental Health Legislation.” The checklist was completed for each city by a group of psychiatrists trained in mental health legislation. Results Although the mental health regulations in these five cities cover the basic principles needed to meet international standards of mental health legislation, some defects in the legislation remain. In particular, these regulations lack detail in specifying procedures for dealing with admission and treatment and lack oversight and review mechanisms and procedures for appeal of involuntary admission and treatment. Conclusions A more comprehensive and enforceable national mental health act is needed in order to ensure the rights of persons suffering mental illness in terms of admission and treatment procedures. In addition, more research is needed to understand how the current municipal regulations of mental health services in these cities are implemented in routine practice. PMID:19913300

  4. Renal replacement therapy for critically ill patients: an intermittent continuity

    PubMed Central

    2014-01-01

    Choice of the right renal replacement therapy for severe acute kidney injury in critically ill patients has been investigated many times in the last two decades. Although some questions have been answered, in current practice many different approaches are still used in the ICU. One basic and important issue is the frequency of renal replacement delivery: apart from pathophysiological speculations, in terms of hard outcomes (namely mortality and length of hospital stay) should dialysis be delivered continuously or intermittently? The authors of the CONVINT study provided a (last) response to this debate: in expert hands, the two treatments provide similar outcomes. This study confirms previous studies and is also important for other aspects, such as the possibility that the two modalities are complementary and may be indicated for different purposes. PMID:24670363

  5. Candida glabrata candidemia: An emerging threat in critically ill patients

    PubMed Central

    Gupta, Ashish; Gupta, Anu; Varma, Amit

    2015-01-01

    Background: Candidemia is an important nosocomial blood stream infection in critically ill patients. Although several studies have addressed candidemia, very few have reviewed the impact of Candida glabrata candidemia in Intensive Care Unit (ICU) patients. Materials and Methods: The medical records of ICU patients between 2006 and 2010 were reviewed retrospectively. The epidemiology, clinical features and mortality related risk factors among our adult ICU patients were seen. Results: Among 144 episodes of candidemia, C. glabrata (n = 26; 18.05%) was the third most common species isolated. The incidence of C. glabrata candidemia was 0.21/1000 ICU admissions. The most common risk factors were prior exposure to broad spectrum antibiotics (100%), central venous catheter (100%), mechanical ventilation (76.9%), diabetes mellitus (50%), age >65 years (46.15%). Urine (23%) was the most common source of C. glabrata candidemia. Overall in hospital 30 days mortality rate due to C. glabrata fungemia was 53.8%. Patients who were treated with fluconazole showed better outcome than patients treated with amphotericin B. Renal failure requiring hemodialysis was the significantly associated with mortality in our study. Conclusion: Candida glabrata was the 3rd most common Candida causing candidemia in our ICUs with a incidence of 0.21/1000 ICU admissions. The outcome of ICU acquired C. glabrata candidemia was poor with 30 days mortality rate of 53.8%. Renal failure requiring hemodialysis was the only risk factor associated with mortality. Further studies are required to identify the other risk factors associated with mortality in C. glabrata candidemia.

  6. Withdrawal from Dialysis and Palliative Care for Severely Ill Dialysis Patients in terms of Patient-Centered Medicine.

    PubMed

    Ishikawa, Hideaki; Ogihara, Nao; Tsukushi, Saori; Sakamoto, Junichi

    2013-01-01

    We treated a dementia patient with end stage chronic kidney disease (CKD). The patient also had severe chronic heart disease and suffered from untreatable respiratory distress during the clinical course of his illness. We therefore initiated peritoneal dialysis therapy (PD) as renal replacement therapy, although we had difficulties continuing stable PD for many reasons, including a burden on caregivers and complications associated with PD therapy itself. Under these circumstances we considered that palliative care prior to intensive care may have been an optional treatment. This was a distressing decision regarding end-of-life care for this patient. We were unable to confirm the patient's preference for end-of-life care due to his dementia. Following sufficiently informed consent the patient's family accepted withdrawal from dialysis (WD). We simultaneously initiated nonabandonment and continuation of careful follow-up including palliative care. We concluded that the end-of-life care we provided would contribute to a peaceful and dignified death of the patient. Although intensive care based on assessment of disease is important, there is a limitation to care, and therefore we consider that WD and palliative care are acceptable options for care of our patients in the terminal phase of their lives. PMID:24558626

  7. Physical activity patterns of patients with cardiopulmonary illnesses

    PubMed Central

    Nguyen, Huong Q.; Steele, Bonnie G.; Dougherty, Cynthia M.; Burr, Robert

    2012-01-01

    OBJECTIVES The aims of this paper are to: 1) describe objectively-confirmed physical activity patterns across three chronic cardiopulmonary conditions, and 2) examine the relationship between selected physical activity dimensions with disease severity, self-reported physical and emotional functioning, and exercise performance. INTERVENTIONS Not applicable. DESIGN Cross-sectional study. SETTING Participant’s home environment. PARTICIPANTS Patients with cardiopulmonary illnesses: chronic obstructive pulmonary disease (COPD, n=63), heart failure (HF, n=60), and patients with implantable cardioverter defibrillator (ICD, n=60). MAIN OUTCOME MEASURES Seven ambulatory physical activity dimensions (total steps, percent time active, percent time ambulating at low, medium, and high intensity, maximum cadence for 30 continuous minutes, and peak performance) were measured with an accelerometer. RESULTS Subjects with COPD had the lowest amount of ambulatory physical activity compared to subjects with heart failure and cardiac dysrhythmias (all seven activity dimensions, p<.05); total step counts were: 5319 vs. 7464 vs. 9570, respectively. Six minute walk distance were correlated (r=.44 to .65, p<.01) with all physical activity dimensions in the COPD sample, the strongest correlations being with total steps and peak performance. In subjects with cardiac impairment, maximal oxygen consumption had only small to moderate correlations with five of the physical activity dimensions (r=.22 to .40, p<.05). In contrast, correlations between six minute walk test distance and physical activity were higher (r=.48 to .61, p<.01) albeit in a smaller sample of only patients with heart failure. For all three samples, self-reported physical and mental health functioning, age, body mass index, airflow obstruction, and ejection fraction had either relatively small or non-significant correlations with physical activity. CONCLUSIONS All seven dimensions of ambulatory physical activity discriminated between subjects with COPD, heart failure, and cardiac dysrhythmias. Depending on the research or clinical goal, use of one dimension such as total steps may be sufficient. Although physical activity had high correlations with performance on a six minute walk test relative to other variables, accelerometry-based physical activity monitoring provides unique, important information about real-world behavior in patients with cardiopulmonary illness not already captured with existing measures. PMID:22772084

  8. USING COMPUTATIONAL PATIENTS TO EVALUATE ILLNESS MECHANISMS IN SCHIZOPHRENIA

    PubMed Central

    Hoffman, Ralph E.; Grasemann, Uli; Gueorguieva, Ralitza; Quinlan, Donald; Lane, Douglas; Miikkulainen, Risto

    2011-01-01

    Background Various malfunctions involving working memory, semantics, prediction error, and dopamine neuromodulation have been hypothesized to cause disorganized speech and delusions in schizophrenia. Computational models may provide insights into why some mechanisms are unlikely, suggest alternative mechanisms, and tie together explanations of seemingly disparate symptoms and experimental findings. Methods Eight corresponding illness mechanisms were simulated in DISCERN, an artificial neural network model of narrative understanding and recall. For this study, DISCERN learned sets of “autobiographical” and “impersonal” crime stories with associated emotion-coding. In addition, 20 healthy controls and 37 patients with schizophrenia or schizoaffective disorder matched for age, gender and parental education were studied using a delayed story-recall task. A goodness-of-fit analysis was performed to determine the mechanism best reproducing narrative breakdown profiles generated by healthy controls and patients with schizophrenia. Evidence of delusion-like narratives was sought in simulations best matching the narrative breakdown profile of patients. Results All mechanisms were equivalent in matching the narrative breakdown profile of healthy controls. However, exaggerated prediction-error signaling during consolidation of episodic memories, termed hyperlearning, was statistically superior to other mechanisms in matching the narrative breakdown profile of patients. These simulations also systematically confused “autobiographical” agents with “impersonal” crime story agents to model fixed, self-referential delusions. Conclusions Findings suggest that exaggerated prediction-error signaling in schizophrenia intermingles and corrupts narrative memories when incorporated into long-term storage, thereby disrupting narrative language and producing fixed delusional narratives. If further validated by clinical studies, these computational patients could provide a platform for developing and testing novel treatments. PMID:21397213

  9. [Visiting nurse for a terminal ALS patient].

    PubMed

    Kitamikado, H; Sugihara, S; Enomoto, K; Sueda, M; Tanaka, T; Mori, H; Fukuyama, Y

    1999-12-01

    The authors' hospital is a 585-bed hospital under the direct management of the National Health Insurance System. The hospital has been providing visiting nurses for the past 8 years, who work from local medical centers and the Visiting Nurses Department. Thirty-seven patients have received such home care, among whom 8 had intractable disease. Patient S was a 46-year-old woman who suffered from amyotrophic lateral sclerosis (ALS). The onset of the disease was in April, 1993, when the patient experienced muscular atrophy in both legs and deteriorating muscular strength. The diagnosis was definitive in 1995. On March 1, 1998, the patient received emergency hospitalization for breathing difficulties and aspiration pneumonia, and on March 5 underwent tracheotomy. A cannula had to be inserted for tubal feeding, and the physician in charge explained to her family that her prognosis was 3 months. Both the patient and her family desired home care, and the patient returned home on April 11. Respecting the wishes of the patient, the visiting nurse provided support so that home treatment could be continued. In the end, the patient lived at home while receiving home treatment for 7 months. Through the support provided by the visiting nurse, efforts were made to keep the patient's condition stable, and she was able to continue home treatment and living at home for a higher quality of life. PMID:10630215

  10. Terminal (Mis)diagnosis and the Physician–Patient Relationship in LM Montgomery’s The Blue Castle

    PubMed Central

    2010-01-01

    LM Montgomery’s The Blue Castle was first published in 1926, yet contains many insights into medical practice that remain relevant today. The protagonist, Valancy, mistakenly receives a terminal diagnosis in a letter from her physician, who has sent her a note intended for another patient. Her interactions with the physician raise issues that are still relevant in contemporary medical education and practice, primarily the importance of effective communication in the physician–patient relationship, especially in the context of diagnosing terminal illness and handling a diagnostic error. The Blue Castle offers a useful starting point for debate and discussion in medical education about these topics. PMID:20473640

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

    ERIC Educational Resources Information Center

    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…

  12. Dignity amidst liminality: healing within suffering among Chinese terminal cancer patients.

    PubMed

    Ho, Andy H Y; Leung, Pamela P Y; Tse, Doris M W; Pang, Samantha M C; Chochinov, Harvey M; Neimeyer, Robert A; Chan, Cecilia L W

    2013-01-01

    This study critically examines the concepts of dignity and liminality at the end-of life, in an effort to better understand the processes of healing within suffering among Chinese terminal cancer patients receiving palliative care services in Hong Kong. Meaning-oriented interviews were conducted with 18 Chinese terminal patients, aged 44 to 98, to elicit the narratives and stories of their illness experience. All interviews were analyzed using grounded theory and supplemented by ethnographic observations and field notes. Two major themes and eight subprocesses of healing adopted by patients to achieve and maintain dignity were identified: (a) personal autonomy, which encompasses the need to (i) regain control over living environments, (ii) maintain self-sufficiency despite institutional care, (ii) make informed care decisions to reduce sense of burden, and (iv) engage in future planning to create a lasting legacy; and (b) family connectedness, which encompasses the need to (i) maintain close ties with family members to express appreciation, (ii) achieve reconciliation, (iii) fulfill family obligations, and (iv) establish a continuing bond that transcends generations. Implications of these themes for advanced care planning and life review interventions were discussed with the goal of enhancing patient autonomy and family connectedness, and thereby providing structure and meaning for Chinese terminal patients and their families at the end of life. PMID:24517523

  13. Volume replacement in critically ill patients with acute renal failure.

    PubMed

    Ragaller, M J; Theilen, H; Koch, T

    2001-02-01

    Maintenance and restoration of intravascular volume are essential tasks of critical care management to achieve sufficient organ function and to avoid multiple organ failure in critically ill patients. Inadequate intravascular volume followed by impaired renal perfusion is the predominate cause of acute renal failure. Crystalloid solutions are the first choice to correct fluid and electrolyte deficits in these patients. However, in case of major hypovolemia, particularly in situations of increased capillary permeability, colloid solutions are indicated to achieve sufficient tissue perfusion. Whereas albumin should be avoided for correction of intravascular hypovolemia, synthetic colloids can restore intravascular volume and stabilize hemodynamic conditions. In addition to a faster, more effective and prolonged restoration of intravascular volume, colloid solutions are able to improve microcirculation. Of the synthetic colloids, hydroxyethyl starch (HES) solutions with a low in vivo molecular weight, such as HES 200/0.5, offer the best risk/benefit ratio. These solutions are safe with respect to effects on coagulation, platelets, reticuloendothelial system, and renal function, if used below their upper dosage limits. For patients with acute renal dysfunction, daily monitoring of renal function is necessary if colloids are required to stabilize hemodynamic conditions. In these patients, measurement of the colloidal osmotic pressure and adequate amounts of crystalloid solutions will reduce the risk of hyperoncotic renal failure. Of all colloids, gelatin and HES solutions with low in vivo molecular weight are preferred in these cases. In the very specific situation of kidney transplantation, colloid solutions should be administered in a restricted manner to organ donors and kidney recipients. PMID:11251029

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

    Microsoft Academic Search

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

    2007-01-01

    INTRODUCTION: Various cohort studies have shown that acute (short-term) mortality rates in unselected critically ill patients may have improved during the past 15 years. Whether these benefits also affect acute and long-term prognosis in chronically critically ill patients is unclear, as are determinants relevant to prognosis. METHODS: We conducted a retrospective analysis of data collected from March 1993 to February

  15. MPCS: Mobile-phone based patient compliance system for chronic illness care

    Microsoft Academic Search

    Guanling Chen; Bo Yan; Minho Shin; David Kotz; Ethan Berkel

    2009-01-01

    More than 100 million Americans are currently living with at least one chronic health condition and expenditures on chronic diseases account for more than 75 percent of the $2.3 trillion cost of our healthcare system. To improve chronic illness care, patients must be empowered and engaged in health self-management. However, only half of all patients with chronic illness comply with

  16. Patient Assessment of Chronic Illness Care (PACIC) and Improved Patient-centered Outcomes for Chronic Conditions

    Microsoft Academic Search

    Julie Schmittdiel; David M. Mosen; Russell E. Glasgow; Judith Hibbard; Carol Remmers; Jim Bellows

    2008-01-01

    Background  The Patient Assessment of Chronic Illness Care (PACIC) has potential for use as a patient-centered measure of the implementation\\u000a of the Chronic Care Model (CCM), but there is little research on the relationship between the PACIC and important behavioral\\u000a and quality measures for patients with chronic conditions.\\u000a \\u000a \\u000a \\u000a Objective  To examine the relationship between PACIC scores and self-management behaviors, patient rating of

  17. Pharmacokinetic Changes and Dosing Modification of Aminoglycosides in Critically Ill Obese Patients: A Literature Review

    PubMed Central

    Velissaris, Dimitrios; Karamouzos, Vasilios; Marangos, Markos; Pierrakos, Charalampos; Karanikolas, Menelaos

    2014-01-01

    The objective of the paper is to review the literature and provide recommendations for use of aminoglycoside antibiotics in critically ill obese patients. Literature search in PubMed for all articles on the use of aminoglycosides in critically ill obese patients was conducted, and all articles related to pharmacokinetics in obesity were reviewed. Bibliographies of all searched manuscripts were also reviewed in an attempt to find additional references. Although aminoglycoside pharmacokinetics have been described in detail, data on aminoglycoside use and appropriate dose modification in critically ill obese patients are very limited. Knowledge on aminoglycoside pharmacokinetics and use in critically ill obese patients is incomplete. Pathophysiologic changes in obesity can result in sub- or supra-therapeutic aminoglycoside plasma concentrations, especially in the presence of sepsis. Rigorous clinical studies are needed to establish aminoglycoside dosing guidelines in critically ill obese patients with sepsis. PMID:24883145

  18. Pharmacokinetic changes and dosing modification of aminoglycosides in critically ill obese patients: a literature review.

    PubMed

    Velissaris, Dimitrios; Karamouzos, Vasilios; Marangos, Markos; Pierrakos, Charalampos; Karanikolas, Menelaos

    2014-08-01

    The objective of the paper is to review the literature and provide recommendations for use of aminoglycoside antibiotics in critically ill obese patients. Literature search in PubMed for all articles on the use of aminoglycosides in critically ill obese patients was conducted, and all articles related to pharmacokinetics in obesity were reviewed. Bibliographies of all searched manuscripts were also reviewed in an attempt to find additional references. Although aminoglycoside pharmacokinetics have been described in detail, data on aminoglycoside use and appropriate dose modification in critically ill obese patients are very limited. Knowledge on aminoglycoside pharmacokinetics and use in critically ill obese patients is incomplete. Pathophysiologic changes in obesity can result in sub- or supra-therapeutic aminoglycoside plasma concentrations, especially in the presence of sepsis. Rigorous clinical studies are needed to establish aminoglycoside dosing guidelines in critically ill obese patients with sepsis. PMID:24883145

  19. Consent for dental therapy in severely ill patients.

    PubMed

    Friedlander, A H; Mills, M J; Cummings, J L

    1988-02-01

    Delirium, dementia, or depression is frequently seen in association with severe medical illness. Usually transient, it is precipitated by the stress of systemic illness and the medications used to treat the underlying disease. Unrecognized, it may invalidate the informed consent required for the provision of emergency dental care services. PMID:3278265

  20. Illness representation of patients with systolic heart failure.

    PubMed

    Cherrington, Candace C; Lawson, Thomas N; Clark, Karen B

    2006-01-01

    Studies have shown that individuals influence their health outcomes, both positively and negatively, through their illness representation. To date, no studies describe the illness representation of persons with systolic heart failure, a significant contributor of morbidity and mortality in older adults. The purpose of this study was to describe illness representation in heart failure. Twenty-two subjects with New York Heart Association class II or III systolic heart failure were recruited at a university-based heart failure clinic. Illness representation was measured using the revised Illness Perception Questionnaire. The means on each of the 9 subscales were found to be significantly different from the neutral point of 3. The results suggest that participants believed that their heart failure was a chronic, cyclic disease with serious consequences that they could control through treatment. In addition, participants believed that they understood their heart failure and did not have a negative affective response to their heart failure. PMID:17170594

  1. Causal Attribution and Illness Perception: A Cross-Sectional Study in Mexican Patients with Psychosis

    PubMed Central

    Gómez-de-Regil, Lizzette

    2014-01-01

    Health psychology researchers have begun to focus greater attention on people's beliefs about health/illness since these beliefs can clearly affect behavior. This cross-sectional study aimed at (1) identifying the most common factors psychotic patients attribute their illness to and (2) assessing the association between causal attribution and illness perception (cognitive, emotional, and comprehensibility dimensions). Sixty-two patients (56.5% females) who had been treated for psychosis at a public psychiatric hospital in Mexico answered the Angermeyer and Klusmann Illness Attribution Scale and the Brief Illness Perception Questionnaire. Results showed that most patients attributed psychosis onset to social factors and that attribution to their personality might have an overwhelmingly negative effect on their lives. Acknowledging psychotic patient attributional beliefs and considering them in clinical practice could improve treatment efficacy and overall recovery success. This is particularly important in psychosis, since symptoms are often severe and/or persistent and require long-term treatment. PMID:25525628

  2. Saccharomyces boulardii prevents diarrhea in critically ill tube-fed patients

    Microsoft Academic Search

    G. Bleichner H. Bléhaut; H. Bléhaut; H. Mentec; D. Moyse

    1997-01-01

    Objective: To assess the preventive effect of Saccharomyces boulardii on diarrhea in critically ill tube-fed patients and to evaluate risk factors for diarrhea. Design: Prospective, multicenter, randomized, double-blind placebo-controlled study. Setting: Eleven intensive care units in teaching and general hospitals. Patients: Critically ill patients whose need for enteral nutrition was expected to exceed 6 days. Intervention: S. boulardii 500 mg

  3. Catheter culture as a guide in the management of infection in the critically ill surgical patient.

    PubMed

    Kholoussy, A M; Sufian, S; Pavlides, C; Matsumoto, T

    1980-05-01

    Results of a bacteriologic study of 194 intravascular catheters inserted in 56 critically ill surgical patients showed that with strict adherence to aseptic insertion techniques and proper care, catheter contamination could be reduced to a minimum, and catheter-induced septicemia could be avoided. Our findings in septic patients showed that in the critically ill surgical patients, routine bacteriologic studies of intravascular catheters helped in anticipation and diagnosis of sepsis as well as selection of appropriate antiobiotic therapy. PMID:7386997

  4. Psychometric Evaluation of the Internalized Stigma of Mental Illness Scale for Patients with Mental Illnesses: Measurement Invariance across Time

    PubMed Central

    Chang, Chih-Cheng; Wu, Tsung-Hsien; Chen, Chih-Yin; Wang, Jung-Der; Lin, Chung-Ying

    2014-01-01

    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 (??=?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. PMID:24887440

  5. Interpretation of C-Reactive Protein Concentrations in Critically Ill Patients

    PubMed Central

    Anselin, Sophie; Zouaoui Boudjeltia, Karim; Biston, Patrick; Piagnerelli, Michaël

    2013-01-01

    Infection is often difficult to recognize in critically ill patients because of the marked coexisting inflammatory process. Lack of early recognition prevents timely resuscitation and effective antimicrobial therapy, resulting in increased morbidity and mortality. Measurement of a biomarker, such as C-reactive protein (CRP) concentration, in addition to history and physical signs, could facilitate diagnosis. Although frequently measured in clinical practice, few studies have reported on the pathophysiological role of this biomarker and its predictive value in critically ill patients. In this review, we discuss the pathophysiological role of CRP and its potential interpretation in the inflammatory processes observed in critically ill patients. PMID:24286072

  6. Sexually transmitted disease prevention services for female chronically mentally ill patients

    Microsoft Academic Search

    John H. Coverdale; Timothy L. Bayer; Laurence B. McCullough; Frank A. Chervenak

    1995-01-01

    Chronically and variably impaired autonomy makes women with chronic mental illness particularly vulnerable to contracting sexually transmitted diseases (STDs) including AIDS. A lack of female controlled protective devices also adds to the vulnerability of these patients. In this context, the authors make recommendations for the design of clinically comprehensive and ethically justified programs to minimize the risk of mentally ill

  7. Assessing Patient Management Plans of Doctors and Medical Students: An Illness Script Perspective

    ERIC Educational Resources Information Center

    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…

  8. Cost of Illness and Disease Severity in a Cohort of French Patients with Parkinson's Disease

    Microsoft Academic Search

    Claude Le Pen; Suzanne Wait; Max Dujardin; Marc Ziegler

    1999-01-01

    Objective: To assess the relationship between severity and progression of illness in Parkinson's disease and the use of healthcare resources. Design and setting: This was a prospective cost-of-illness study conducted in France based on clinical observation over a 6-month period of patients with Parkinson's disease treated in the hospital or community setting. Regression analyses were performed to construct the model

  9. Patients understanding of depression associated with chronic physical illness: a qualitative study

    PubMed Central

    2014-01-01

    Background Detection of depression can be difficult in primary care, particularly when associated with chronic illness. Patient beliefs may affect detection and subsequent engagement with management. We explored patient beliefs about the nature of depression associated with physical illness. Methods A qualitative interview study of patients registered with general practices in Leeds, UK. We invited patients with coronary heart disease or diabetes from primary care to participate in semi-structured interviews exploring their beliefs and experiences. We analysed transcripts using a thematic approach, extended to consider narratives as important contextual elements. Results We interviewed 26 patients, including 17 with personal experience of depression. We developed six themes: recognising a problem, complex causality, the role of the primary care, responsibility, resilience, and the role of their life story. Participants did not consistently talk about depression as an illness-like disorder. They described a change in their sense of self against the background of their life stories. Participants were unsure about seeking help from general practitioners (GPs) and felt a personal responsibility to overcome depression themselves. Chronic illness, as opposed to other life pressures, was seen as a justifiable cause of depression. Conclusions People with chronic illness do not necessarily regard depression as an easily defined illness, especially outside of the context of their life stories. Efforts to engage patients with chronic illness in the detection and management of depression may need further tailoring to accommodate beliefs about how people view themselves, responsibility and negative views of treatment. PMID:24555886

  10. Severity of illness and outcome of treatment in alcoholic patients in the intensive care unit

    Microsoft Academic Search

    N.-H. Jensen; L. Dragsted; J. K. Christensen; J. C. Jørgensen; J. Qvist

    1988-01-01

    To study whether critically ill alcoholics were more sick and had a worse outcome than other patients treated in the intensive care unit, data were collected during the initial 24 h on 216 consecutive patients admitted to an intensive care unit. Twentysix patients (12%) met the criteria for alcohol abuse. The patients' chronic health 6 months prior to admission and

  11. ENFERMEDAD TERMINAL Y PSICOLOGÍA DE LA SALUD

    Microsoft Academic Search

    Gregorio Escalante; Karen Lorena Escalante

    2002-01-01

    Terminal illness and health psychology The terminal phase of human life begins when the physician judges that the patient's conditions are worsening and nothing can be done to stop or reverse the progress of the illness. At this point the treatment becomes basically palliative and mainly focused on reducing pain. In such a conditions a number of controversial dilemmas appear,

  12. Outcome of critically ill patients with acute kidney injury using the akin criteria

    E-print Network

    Mandelbaum, Tal

    Objective: Acute kidney injury affects 5% to 7% of all hospitalized patients with a much higher incidence in the critically ill. The Acute Kidney Injury Network proposed a definition in which serum creatinine rises (>0.3 ...

  13. Immunoinflammatory Response in Critically Ill Patients: Severe Sepsis and/or Trauma

    PubMed Central

    Popovic, Nada; Djordjevic, Dragan

    2013-01-01

    Immunoinflammatory response in critically ill patients is very complex. This review explores some of the new elements of immunoinflammatory response in severe sepsis, tumor necrosis factor-alpha in severe acute pancreatitis as a clinical example of immune response in sepsis, immune response in severe trauma with or without secondary sepsis, and genetic aspects of host immuno-inflammatory response to various insults in critically ill patients. PMID:24371374

  14. Population Pharmacokinetics of Ceftizoxime Administered by Continuous Infusion in Clinically Ill Adult Patients

    Microsoft Academic Search

    BRYAN FACCA; BILL FRAME; STEVE TRIESENBERG

    1998-01-01

    Ceftizoxime is a widely used beta-lactam antimicrobial agent, but pharmacokinetic data for use with clin- ically ill patients are lacking. We studied the population pharmacokinetics of ceftizoxime in 72 clinically ill patients at a community-based, university-affiliated hospital. A population pharmacokinetic model for cefti- zoxime was created by using a prospective observational design. Ceftizoxime was administered by continuous infusion to treat

  15. Pharmacokinetics of Caspofungin in Critically Ill Patients on Continuous Renal Replacement Therapy

    PubMed Central

    Weiler, Stefan; Seger, Christoph; Pfisterer, Hartwig; Stienecke, Eva; Stippler, Florian; Welte, René; Joannidis, Michael; Griesmacher, Andrea

    2013-01-01

    Caspofungin pharmacokinetics was assessed in 27 critically ill patients, including 7 on continuous venovenous hemofiltration (CVVH), 8 on continuous venovenous hemodialysis (CVVHD), and 13 not requiring continuous renal replacement therapy (CRRT). Caspofungin exposure during CRRT was very similar to that of the control group and comparable to that in healthy volunteers. Caspofungin clearance by CRRT was very low. Therefore, the standard dosage of caspofungin is probably adequate for critically ill patients undergoing CVVH or CVVHD. PMID:23733471

  16. Treatment of substance abuse in severely mentally ill patients

    Microsoft Academic Search

    Robert E. Drake; Stephen J. Bartels; Gregory B. Teague; Douglas L. Noordsy; Robin E. Clark

    1993-01-01

    Substance abuse is the most common comorbid complication of severe mental illness. Current clinical research converges on several emerging principles of treatment that address the scope, pace, intensity, and structure of dual-diagnosis programs. They include a) assertive outreach to facilitate engagement and participation in substance abuse treatment, b) close monitoring to provide structure and social reinforcement, c) integrating substance abuse

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

    PubMed Central

    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

  18. Use and Perceived Credibility of Medication Information Sources for Patients with a Rare Illness: Differences by Gender

    Microsoft Academic Search

    Delesha M. Carpenter; Robert F. DeVellis; Susan L. Hogan; Edwin B. Fisher; Brenda M. DeVellis; Joanne M. Jordan

    2011-01-01

    Patients with rare illnesses may use medication information sources that are appreciably different from those used by patients with more common illnesses. This article's purpose is to describe vasculitis patients' most frequently used medication information sources, determine which sources patients perceive as credible, and explore gender differences in source use and perceived credibility. Using an online questionnaire, patients (n = 232) indicated

  19. Supporting Cancer Patients in Illness Management: Usability Evaluation of a Mobile App

    PubMed Central

    Kaufman, David R; Ruland, Cornelia M

    2014-01-01

    Background Mobile phones and tablets currently represent a significant presence in people’s everyday lives. They enable access to different information and services independent of current place and time. Such widespread connectivity offers significant potential in different app areas including health care. Objective Our goal was to evaluate the usability of the Connect Mobile app. The mobile app enables mobile access to the Connect system, an online system that supports cancer patients in managing health-related issues. Along with symptom management, the system promotes better patient-provider communication, collaboration, and shared decision making. The Connect Mobile app enables access to the Connect system over both mobile phones and tablets. Methods The study consisted of usability tests of a high fidelity prototype with 7 cancer patients where the objectives were to identify existing design and functionality issues and to provide patients with a real look-and-feel of the mobile system. In addition, we conducted semistructured interviews to obtain participants’ feedback about app usefulness, identify the need for new system features and design requirements, and measure the acceptance of the mobile app and its features within everyday health management. Results The study revealed a total of 27 design issues (13 for mobile apps and 14 for tablet apps), which were mapped to source events (ie, errors, requests for help, participants' concurrent feedback, and moderator observation). We also applied usability heuristics to identify violations of usability principles. The majority of violations were related to enabling ease of input, screen readability, and glanceability (15 issues), as well as supporting an appropriate match between systems and the real world (7 issues) and consistent mapping of system functions and interactions (4 issues). Feedback from participants also showed the cancer patients’ requirements for support systems and how these needs are influenced by different context-related factors, such as type of access terminal (eg, desktop computer, tablet, mobile phone) and phases of illness. Based on the observed results, we proposed design and functionality recommendations that can be used for the development of mobile apps for cancer patients to support their health management process. Conclusions Understanding and addressing users’ requirements is one of the main prerequisites for developing useful and effective technology-based health interventions. The results of this study outline different user requirements related to the design of the mobile patient support app for cancer patients. The results will be used in the iterative development of the Connect Mobile app and can also inform other developers and researchers in development, integration, and evaluation of mobile health apps and services that support cancer patients in managing their health-related issues. PMID:25119490

  20. Rehabilitation of Critical Illness Polyneuropathy and Myopathy Patients: An Observational Study

    ERIC Educational Resources Information Center

    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…

  1. Preliminary Evidence for a Medical Nutrition Therapy Protocol: Enteral Feedings for Critically Ill Patients

    Microsoft Academic Search

    Kendra K. Kattelmann; Mary Hise; Mary Russell; Pam Charney; Milton Stokes; Charlene Compher

    2006-01-01

    The objective of this study was to evaluate the evidence behind specific but common patient care decisions in support of enteral feedings for patients admitted to intensive care units. Six specific questions were developed and refined to address clinical outcomes specific to clinical practice decisions pertinent to enteral feeding of critically ill patients. The data sources consisted of an intensive

  2. Understanding the suffering of a patient with an illness: signs, context and strategies.

    PubMed

    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. PMID:22991127

  3. Correlations Between Awareness of Illness (Insight) and History of Addiction in Heroin-Addicted Patients

    PubMed Central

    Maremmani, Angelo Giovanni Icro; Rovai, Luca; Rugani, Fabio; Pacini, Matteo; Lamanna, Francesco; Bacciardi, Silvia; Perugi, Giulio; Deltito, Joseph; Dell’Osso, Liliana; Maremmani, Icro

    2012-01-01

    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 behavior. 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. PMID:22787450

  4. Energy requirements and the use of predictive equations versus indirect calorimetry in critically ill patients.

    PubMed

    Wichansawakun, Sanit; Meddings, Liisa; Alberda, Cathy; Robbins, Sarah; Gramlich, Leah

    2015-02-01

    Nutrition support has been shown to have a positive impact on critically ill patients who meet their defined goals of nutrition therapy. However, inappropriate energy assessment can contribute to under- or overfeeding resulting in deleterious effects. Thus, assessment of energy expenditure in critically ill patients is crucial to prevent negative impacts from inappropriate feeding. Currently, the optimal energy requirement and appropriate energy assessment in these patients is controversial. Indirect calorimetry or predictive equations have been suggested to evaluate energy expenditure in critically ill patients. Indirect calorimetry is a gold standard for evaluating energy expenditure, but it is not always available and has some limitations. Many predictive equations, therefore, have been developed to predict energy expenditure in critically ill patients. However, these equations cannot be used generally in these patients since they were developed in a unique patient population. Many studies compared measured energy expenditure with predictive energy expenditure, but the data regarding accuracy is not robust. Therefore, clinicians should consider using these equations carefully based on the current supporting data. Indirect calorimetry is recommended for use in evaluating energy expenditure in critically ill patients if it is available. PMID:25610953

  5. Personality Change Pre- to Post- Loss in Spousal Caregivers of Patients with Terminal Lung Cancer

    PubMed Central

    Hoerger, Michael; Chapman, Benjamin P.; Prigerson, Holly G.; Fagerlin, Angela; Mohile, Supriya G.; Epstein, Ronald M.; Lyness, Jeffrey M.; Duberstein, Paul R.

    2015-01-01

    Personality is relatively stable in adulthood but could change in response to life transitions, such as caring for a spouse with a terminal illness. Using a case-control design, spousal caregivers (n=31) of patients with terminal lung cancer completed the NEO-FFI twice, 1.5 years apart, before and after the patient’s death. A demographically-matched sample of community controls (n=93) completed the NEO-FFI on a similar timeframe. Based on research and theory, we hypothesized that bereaved caregivers would experience greater changes than controls in interpersonal facets of extraversion (sociability), agreeableness (prosocial, nonantagonistic), and conscientiousness (dependability). Consistent with hypotheses, bereaved caregivers experienced an increase in interpersonal orientation, becoming more sociable, prosocial, and dependable (Cohen’s d = .48?.67), though there were no changes in nonantagonism. Changes were not observed in controls (ds ? .11). These initial findings underscore the need for more research on the effect of life transitions on personality. PMID:25614779

  6. Quality of life in couples living with Huntington’s disease: the role of patients’ and partners’ illness perceptions

    PubMed Central

    Scharloo, M.; Helder, D. I.; Snoei, L.; van Kempen, G. M. J.; Weinman, J.; van Houwelingen, J. C.; Roos, R. A. C.

    2007-01-01

    Research suggests that chronically ill patients and their partners perceive illness differently, and that these differences have a negative impact on patients’ quality of life (QoL). This study assessed whether illness perceptions of patients with Huntington’s disease (HD) differ from those of their partners, and examined whether spousal illness perceptions are important for the QoL of the couples (n = 51 couples). Partners reported that their HD-patient spouses suffered more symptoms and experienced less control than the patients themselves reported. Illness perceptions of patients and partners correlated significantly with patient QoL. Partners’ beliefs in a long duration of the patientsillness and less belief in cure, were associated with patient vitality scores. Suggestions for future research emphasize the importance of qualitative research approaches in combination with cognitive-behavioural approaches. PMID:17375373

  7. A meta-ethnographic synthesis on phenomenographic studies of patients’ experiences of chronic illness

    PubMed Central

    Röing, Marta

    2015-01-01

    Phenomenography is a qualitative research approach developed within an educational framework, focusing on the qualitative experience of learning. It is also being used, to a lesser degree, in healthcare research. In the present study, we conducted a meta-ethnographic synthesis of phenomenographic studies on chronic illness, in order to give a broader perspective of how chronic illness can be experienced. Our aim was not to describe patients’ various individual experiences of illness, but instead to identify the different ways chronic illness can be experienced by patients. Our synthesis and phenomenographic interpretation of 12 selected articles found that patients’ experiences of chronic illness can be described in terms of a different lived body, a struggle with threat to identity and self-esteem, a diminished lifeworld, and a challenging reality. These experiences relate to each other in a process of recurring loops, where the different ways of experiencing continue to influence each other over time. According to these findings, the use of phenomenography as a research approach has the potential to add to the understanding of how chronic illness can be experienced. Patients may benefit from seeing that their illness can be experienced in many different ways and that it has many aspects, which then can lead to a better understanding and coping with their illness. We suggest that it may be worthwhile to expand the scope of phenomenography outside pedagogics. This presupposes a revision of the application to include a wider and more comprehensive description, for instance, of the different ways illness and healthcare phenomena can be experienced, and how these different ways are related to each other, with less focus on hierarchical relations. PMID:25690674

  8. A meta-ethnographic synthesis on phenomenographic studies of patients' experiences of chronic illness.

    PubMed

    Röing, Marta; Sanner, Margareta

    2015-01-01

    Phenomenography is a qualitative research approach developed within an educational framework, focusing on the qualitative experience of learning. It is also being used, to a lesser degree, in healthcare research. In the present study, we conducted a meta-ethnographic synthesis of phenomenographic studies on chronic illness, in order to give a broader perspective of how chronic illness can be experienced. Our aim was not to describe patients' various individual experiences of illness, but instead to identify the different ways chronic illness can be experienced by patients. Our synthesis and phenomenographic interpretation of 12 selected articles found that patients' experiences of chronic illness can be described in terms of a different lived body, a struggle with threat to identity and self-esteem, a diminished lifeworld, and a challenging reality. These experiences relate to each other in a process of recurring loops, where the different ways of experiencing continue to influence each other over time. According to these findings, the use of phenomenography as a research approach has the potential to add to the understanding of how chronic illness can be experienced. Patients may benefit from seeing that their illness can be experienced in many different ways and that it has many aspects, which then can lead to a better understanding and coping with their illness. We suggest that it may be worthwhile to expand the scope of phenomenography outside pedagogics. This presupposes a revision of the application to include a wider and more comprehensive description, for instance, of the different ways illness and healthcare phenomena can be experienced, and how these different ways are related to each other, with less focus on hierarchical relations. PMID:25690674

  9. Transplant in a patient with comorbid psychiatric illness: an ethical dilemma.

    PubMed

    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. PMID:25509229

  10. How does illness severity influence depression, health satisfaction and life satisfaction in patients with cardiovascular disease? The mediating role of illness perception and self-efficacy beliefs.

    PubMed

    Steca, P; Greco, A; Monzani, D; Politi, A; Gestra, R; Ferrari, G; Malfatto, G; Parati, G

    2013-01-01

    Numerous empirical studies have investigated the relationships between cardiovascular diseases (CVD) and patients' psychological well-being, with a focus almost exclusively on its dark side. Very little is known on the impact of illness severity on both negative and positive indicators of patients' well-being, as well as on the psychosocial variables that may mediate this association. Aim of the study was to investigate the impact of illness severity on depression as well as on health satisfaction and life satisfaction of patients undergoing a cardiovascular rehabilitation. It also aimed at testing the mediation of illness perception and self-efficacy beliefs in managing cardiac risk factors. The study involved 172 patients (mean age?=?66.43?years; SD?=?9.99?years; 76.2% men). Illness severity was measured in terms of left ventricular ejection fraction at discharge from the cardiology department, whereas all psychological dimensions were assessed one week later. Results showed significant relationships among illness severity, depression and health satisfaction that were fully mediated by illness perception and self-efficacy beliefs, but not significant relation between disease severity and life satisfaction (?2 (1)?=?2.30, p?=?n.s.). Overall, findings underline the importance of working on illness perception and self-efficacy beliefs to contrast depression and to improve health and life satisfaction in patients with CVD. PMID:23343116

  11. Computerised cognitive behavioural therapy for psychological distress in patients with physical illnesses: a systematic review.

    PubMed

    McCombie, Andrew; Gearry, Richard; Andrews, Jane; Mikocka-Walus, Antonina; Mulder, Roger

    2015-03-01

    Whilst cognitive behaviour therapy (CBT) has been shown to improve outcomes in patients with chronic physical illnesses, there are barriers to its implementation which computerised CBT (CCBT) may overcome. We reviewed all studies of CCBT for treating psychological distress (PD) in chronic physical illness populations. Systematic searches were undertaken in July, 2013. All articles about CCBT for PD secondary to physical illness were included. Twenty-nine studies (thirty papers) were included. Overall, the quality of evidence was poor. Studies about irritable bowel syndrome demonstrated the best evidence. The evidence for CCBT in the treatment of PD in physical illness patients is modest, perhaps due to the seldom use of PD screening. More robust research designs including longer follow up periods are required. Nevertheless, no studies reported a negative effect of CCBT on any outcome measures. PMID:25666485

  12. STIGMA OF MENTAL ILLNESS: COMPARISON OF PATIENTS’ AND STUDENTS’ ATTITUDES IN SLOVENIA

    Microsoft Academic Search

    Mateja Strbad; Igor Švab; Bojan Zalar; Vesna Švab

    Abstract Background,It is known that the consequences of stigmatization towards people with severe mental illness reflect themselves in a lack of self-esteem and consequently,in low level of initiatives toimprove,one’s status in the community.,The burden,of stigma may,cause denial of partici- pation in the stigmatized group. So far, there were few studies to compare the mentally ill patients’ perception,of the »other« mentally

  13. Significance of pathologic oxygen supply dependency in critically ill patients: Comparison between measured and calculated methods

    Microsoft Academic Search

    G. Hanique; T. Dugernier; P. F. Laterre; A. Dougnac; J. Roeseler; M. S. Reynaert

    1994-01-01

    Objective  Oxygen supply dependency at normal or high oxygen delivery rate has been increasingly proposed as a hallmark and a risk factor\\u000a in critical illnesses. We hypothesized that as fas as an adequate oxygen delivery is provided, oxygen consumption, when determined\\u000a by indirect calorimetry, is not dependent on oxygen delivery in critically ill patients whereas calculated oxygen consumption\\u000a is associated with

  14. Acceptance of illness and satisfaction with life among malaria patients in rivers state, Nigeria

    PubMed Central

    2014-01-01

    Background 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. Methods 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. Results 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?illness acceptance with p?patients did not accept their illness, while the level of 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. PMID:24885562

  15. Causes of death and determinants of outcome in critically ill patients

    Microsoft Academic Search

    Viktoria D Mayr; Martin W Dünser; Veronika Greil; Stefan Jochberger; Günter Luckner; Hanno Ulmer; Barbara E Friesenecker; Jukka Takala; Walter R Hasibeder; NA Halpern; SM Pastores; RJ Greenstein; E Azoulay; C Adrie; A De Lassence; F Pochard; D Moreau; G Thiery; C Cheval; P Moine; M Garrouste-Orgeas; C Alberti; WA Knaus; DP Wagner; JE Zimmerman; EA Draper; DD Benoit; KH Vandewoude; JM Decruyenaere; EA Hoste; FA Colardyn; B Afessa; IJ Morales; PD Scanlon; SG Peters; Y Arabi; QA Ahmed; S Haddad; A Aljumah; A Al-Shimemeri; B Bernieh; M Al Hakim; Y Boobes; E Siemkovics; H El Jack; E Estenssoro; A Dubin; E Laffaire; H Canales; G Saenz; M Moseinco; M Pozo; A Gomez; N Baredes; G Jannello; H Khouli; A Afrasiabi; M Shibli; R Hajal; CR Barrett; P Homel; L Chang; CF Horng; YC Huang; YY Hsieh; DJ Bentrem; JJ Yeh; MF Brennan; R Kiran; DP Jaques; Y Fong; RN Pugh; IM Murray-Lyon; JL Dawson; MC Pietroni; R Williams; A de Rijk; W Schaufeli; JR Le Gall; S Lemeshow; F Saulnier; GR Bramer; KM Flegal; CL Ogden; CL Johnson; JT Crosson; MM Levy; MP Fink; JC Marshall; E Abraham; D Angus; D Cook; J Cohen; SM Opal; JL Vincent; G Ramsay; JE Nelson; DE Meier; A Litke; DA Natale; RE Siegel; RS Morrison; F Konrad; T Marx; H Wiedeck; J Kilian; G Rocher; P Sjokvist; P Dodek; L Griffith; A Freitag; J Varon; C Bradley; G Van den Berghe; P Wouters; F Weekers; C Verwaest; F Bruyninckx; M Schetz; D Vlasselaers; P Ferdinande; P Lauwers; R Bouillon; CM Martin; AD Hill; K Burns; LM Chen; SP Keenan; KD Busche; L McCarthy; KJ Inman; WJ Sibbald; RJ Hall; GM Rocker; E Rivers; B Nguyen; S Havstad; J Ressler; A Muzzin; B Knoblich; E Peterson; M Tomlanovich; D De Backer; M Varpula; M Tallgren; K Saukkonen; LM Voipio-Pulkki; V Pettila; G Bernardin; C Pardier; F Tiger; P Deloffre; M Mattei; PGH Metnitz; CG Krenn; H Steltzer; T Lang; J Ploder; K Lenz; W Druml; S Uchino; JA Kellum; R Bellomo; GS Doig; H Morimatsu; S Morgera; I Tan; C Bouman; E Macedo; Goldhill; A Sumner; J Latour; V Lopez-Camps; M Rodriguez-Serra; JS Giner; A Nolasco; C Alvarez-Dardet; M Trivedi; SA Ridley; MM Treggiari; JA Romand; CB Wallis; HT Dvaies; AJ Shearer; EE Alvarez-Leon; R Elosua; A Zamora; E Aldasoro; J Galcera; H Vanaclocha; A Segura; M Fiol; J Turumbay; G Perez; SH Wanzer; DD Federman; SJ Adelstein; CK Cassel; EH Cassem; RE Cranford; EW Hook; B Lo; CG Moertel; P Safar; J Purdie; J Trofe; TM Beebe; JF Buell; MJ Hanaway; RR Alloway; TG Gross; ES Woodle; F Fieux; B Jordan; R Moreno; AL Rosenberg; C Watts; HJ Freyberger; M Albus; A De Maio; MB Torres; RH Reeves; RJA Goris; TPA te Boekhorst; JKS Nuytinck; JS Gimbrere

    1985-01-01

    INTRODUCTION: Whereas most studies focus on laboratory and clinical research, little is known about the causes of death and risk factors for death in critically ill patients. METHODS: Three thousand seven hundred patients admitted to an adult intensive care unit (ICU) were prospectively evaluated. Study endpoints were to evaluate causes of death and risk factors for death in the ICU,

  16. Severity-of-illness markers as predictors of nosocomial infection in adult intensive care unit patients

    Microsoft Academic Search

    Margaret E. McCusker; André R. S. Périssé; Mary-Claire Roghmann

    2002-01-01

    Background: Patients admitted to intensive care units (ICUs) are at high risk for acquiring nosocomial infections. We examined the association between markers of severity of illness at ICU admission and the development of ICU-attributable nosocomial infections. Methods: Retrospective cohort study of 851 patients admitted to the medical or surgical ICU in an urban teaching hospital from January 1997 to January

  17. RESEARCH Open Access Burden of illness and quality of life in patients

    E-print Network

    Paris-Sud XI, Université de

    RESEARCH Open Access Burden of illness and quality of life in patients being treated for seasonal-free days (SFD) and Quality of Life (QoL)) in patients with Seasonal Allergic Rhinitis (SAR) being treated questions on symptoms and completed questionnaires on QoL (mini-rhinoconjunctivitis Quality of Life

  18. Percutaneous transhepatic cholecystostomy and delayed laparoscopic cholecystectomy in critically ill patients with acute calculus cholecystitis

    Microsoft Academic Search

    Ram M Spira; Aviran Nissan; Oded Zamir; Tzeela Cohen; Scott I Fields; Herbert R Freund

    2002-01-01

    Background: The ultimate therapy for acute cholecystitis is cholecystectomy. However, in critically ill elderly patients the mortality of emergency cholecystectomy may reach up to 30%. Open cholecystostomy performed under local anesthesia was considered to be the procedure of choice for treatment of acute cholecystitis in high-risk patients. In recent years, ultrasound- or computed tomography (CT)-guided percutaneous transhepatic cholecystostomy (PTHC) replaced

  19. Patients' beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness

    Microsoft Academic Search

    Robert Horne; John Weinman

    1999-01-01

    The aim of this cross-sectional study was to quantify patients' personal beliefs about the necessity of their prescribed medication and their concerns about taking it and to assess relations between beliefs and reported adherence among 324 patients from four chronic illness groups (asthma, renal, cardiac, and oncology). The findings revealed considerable variation in reported adherence and beliefs about medicines within

  20. Anxiety is not manifested by elevated heart rate and blood pressure in acutely ill cardiac patients

    Microsoft Academic Search

    Marla J. De Jong; Debra K. Moser; Kyungeh An; Misook L. Chung

    2004-01-01

    Background: Accurate assessment of anxiety in cardiac patients is important because anxiety is associated with adverse outcomes. Clinicians often use heart rate and blood pressure as indicators of anxiety; however, little is known about whether these measures accurately reflect anxiety in acutely ill patients. Aims: The purpose of this study was to determine whether heart rate and blood pressure were

  1. Prevention and diagnosis of venous thromboembolism in critically ill patients: a Canadian survey

    Microsoft Academic Search

    Deborah Cook; Joseph McMullin; Richard Hodder; Mark Heule; Jaime Pinilla; Peter Dodek; Thomas Stewart

    2001-01-01

    BACKGROUND: Venous thromboembolism (VTE) confers considerable morbidity and mortality in hospitalized patients, although few studies have focused on the critically ill population. The objective of this study was to understand current approaches to the prevention and diagnosis of deep venous thrombosis (DVT) and pulmonary embolism (PE) among patients in the intensive care unit (ICU). DESIGN: Mailed self-administered survey of ICU

  2. Intensive Insulin Treatment in Critically Ill Trauma Patients Normalizes Glucose by Reducing Endogenous Glucose Production

    Microsoft Academic Search

    ANDERS THORELL; OLAV ROOYACKERS; PETER MYRENFORS; MATTIAS SOOP; JONAS NYGREN

    Critical illness is associated with insulin resistance and hy- perglycemia. Intensive insulin treatment to normalize blood glucose during feeding has been shown to improve morbidity and mortality in patients in intensive care. The mechanisms behind the glucose-controlling effects of insulin in stress are not well understood. Six previously healthy, severely traumatized patients (in- jury severity score > 15) were studied

  3. Identifying illness perception schemata and their association with depression and quality of life in cardiac patients

    Microsoft Academic Search

    Michael R. Le Grande; Peter C. Elliott; Marian U. C. Worcester; Barbara M. Murphy; Alan J. Goble; Vanessa Kugathasan; Karan Sinha

    2012-01-01

    The purpose of this paper is to identify groups of cardiac patients who share similar perceptions about their illness and to examine the relationships between these schemata and psychosocial outcomes such as quality of life and depression. A total of 190 cardiac patients with diagnoses of myocardial infarction, stable angina pectoris or chronic heart failure, completed a battery of psychosocial

  4. The Long-term Psychological Effects of Daily Sedative Interruption on Critically Ill Patients

    Microsoft Academic Search

    John P. Kress; Brian Gehlbach; Maureen Lacy; Neil Pliskin; Anne S. Pohlman; Jesse B. Hall

    2003-01-01

    Critically ill patients often receive sedatives, which may delay libera- tion from mechanical ventilation and intensive care unit discharge. Daily interruption of sedatives alleviates these problems, but the impact of this practice on long-term psychological outcomes is un- known. We compared psychological outcomes of intensive care unit patients undergoing daily sedative interruption (intervention) with those without this protocol (control). Assessments

  5. Serum cystatin C concentration as a marker of acute renal dysfunction in critically ill patients

    Microsoft Academic Search

    Patricia Villa; Manuel Jiménez; Maria-Cruz Soriano; Jesus Manzanares; Pilar Casasnovas

    2005-01-01

    INTRODUCTION: In critically ill patients sudden changes in glomerular filtration rate (GFR) are not instantly followed by parallel changes in serum creatinine. The aim of the present study was to analyze the utility of serum cystatin C as a marker of renal function in these patients. METHODS: Serum creatinine, serum cystatin C and 24-hour creatinine clearance (CCr) were determined in

  6. Physicians' Nonverbal Rapport Building and Patients' Talk About the Subjective Component of Illness.

    ERIC Educational Resources Information Center

    Duggan, Ashley P.; Parrott, Roxanne L.

    2001-01-01

    Considers how physicians' nonverbal communication is sometimes associated with patients' affective satisfaction. Examines the relationship between physicians' nonverbal rapport building and patients' disclosure of information related to the subjective component of illness. Considers implications for understanding the role of physicians' nonverbal…

  7. The Stigma of Mental Illness: Patients’ Anticipations and Experiences

    Microsoft Academic Search

    Matthias C. Angermeyer; Michael Beck; Sandra Dietrich; Anita Holzinger

    2004-01-01

    Background: There are studies that either deal with the stigmatization patients anticipate or with patients’ concrete stigmatization experiences. Up until now, however, research is short of studies that investigate both aspects of subjective stigmatization simultaneously.Aims: This study aims at investigating to what extent patients with schizophrenia or depression anticipate and experience stigmatization and how this is influenced by the type

  8. Illness perceptions in patients receiving rheumatology rehabilitation: association with health and outcomes at 12 months

    PubMed Central

    2013-01-01

    Background Illness perceptions have been found to change over time and following health care. Hence, addressing illness perceptions alongside existing health care interventions may be important for the sustainment of health gains following rehabilitation. The aim of this study was to measure the illness perceptions of patients receiving inpatient rheumatology rehabilitation and assess the association with aspects of health and outcomes at baseline, discharge and 12 months. Methods Patients with a rehabilitation stay of one week or more at three institutions in Norway in 2009 were invited to participate in the study. At baseline, discharge and 12 months, patients completed The Rheumatic Disease Illness Perception Questionnaire (RD-IPQ) which includes aspects of illness perceptions important to patients with rheumatic diseases. Stepwise regression analysis was used to assess associations between RD-IPQ scores and different aspects of health at baseline and follow-up after controlling for other aspects of health and sociodemographic variables. Results For the 134 patients included in the study, baseline RD-IPQ scores had a mean of 58.2 (SD 14.9) on a 0–100 scale, where 100 is the worst possible. Scores showed improvement after the rehabilitation stay which were maintained at 12 months. RD-IPQ scores were positively associated with health and outcomes. At baseline RD-IPQ scores were statistically significant in explaining variation in pain, physical function and SF-36 mental health scores. Baseline RD-IPQ scores were significant in explaining fatigue, pain, SF-36 role limitations and social function scores following rehabilitation and at 12 months. Conclusion Illness perceptions as measured by the RD-IPQ were associated with health and outcomes as measured by rheumatology-specific and generic instruments. The consideration of illness perceptions as a component of rehabilitation may be important in achieving desired outcomes. PMID:23324450

  9. Measuring Hospital Inefficiency: The Effects of Controlling for Quality and Patient Burden of Illness

    PubMed Central

    Mutter, Ryan L; Rosko, Michael D; Wong, Herbert S

    2008-01-01

    Objective To assess the impact of employing a variety of controls for hospital quality and patient burden of illness on the mean estimated inefficiency and relative ranking of hospitals generated by stochastic frontier analysis (SFA). Study Setting This study included urban U.S. hospitals in 20 states operating in 2001. Data Design/Data Collection We took hospital data for 1,290 hospitals from the American Hospital Association Annual Survey and the Medicare Cost Reports. We employed a variety of controls for hospital quality and patient burden of illness. Among the variables we used were a subset of the quality indicators generated from the application of the Patient Safety Indicator and Inpatient Quality Indicator modules of the Agency for Healthcare Research and Quality, Quality Indicator software to the Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases. Measures of a component of patient burden of illness came from the application of the Comorbidity Software to HCUP data. Data Analysis We used SFA to estimate hospital cost-inefficiency. We tested key assumptions of the SFA model with likelihood ratio tests. Principal Findings The measures produced by the Comorbidity Software appear to account for variations in patient burden of illness that had previously been masquerading as inefficiency. Outcome measures of quality can provide useful insight into a hospital's operations but may have little impact on estimated inefficiency once controls for structural quality and patient burden of illness have been employed. Conclusions Choices about controlling for quality and patient burden of illness can have a nontrivial impact on mean estimated hospital inefficiency and the relative ranking of hospitals generated by SFA. PMID:18783458

  10. Illness acceptance degree versus intensity of psychopathological symptoms in patients with psoriasis

    PubMed Central

    Taba?a, Klaudia; Kocur, Józef

    2013-01-01

    Introduction Chronic inflammatory skin diseases such as psoriasis have undoubtedly a negative impact on the patients’ quality of life. Many of them may face various limitations in their psychosocial lives because of symptoms indicating the presence of psychopathological phenomena. Mental disorders in patients with skin diseases occur much more frequently than in the general population. Studies show that a considerable percentage (30-60%) of dermatological patients suffers from mental disorders (depressive and anxiety disorders being the most common). A person's attitude towards illness, its acceptance, and also the recognition of its limitations may be of a great importance in the process of the disease control. Aim To evaluate of the relationship between the illness acceptance degree, and the presence and intensity of psychopathological symptoms in patients with psoriasis. Material and methods The research was conducted on a group of 54 people (23 men and 31 women), who were treated for psoriasis in the Department of Dermatology and Venereology, Medical University of Lodz and in the Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Lodz. The following research methods were used: a questionnaire prepared for the purpose of the research, Acceptance of Illness Scale (AIS) and Symptom Checklist (SCL-90). Results It was found that there was a relationship between the skin illness acceptance degree and intensity of psychopathological symptoms in patients with psoriasis (negative correlations). Conclusions The higher the degree of illness acceptance is, the better mental condition of patients with psoriasis is. The intensity of psychopathological symptoms is also affected by the duration of illness, other people's attitude to the skin disease, age and education level of the patients examined. PMID:24278064

  11. Hypothermia predicts mortality in critically ill elderly patients with sepsis

    PubMed Central

    2010-01-01

    Background Advanced age is one of the factors that increase mortality in intensive care. Sepsis and multi-organ failure are likely to further increase mortality in elderly patients. We compared the characteristics and outcomes of septic elderly patients (> 65 years) with younger patients (? 65 years) and identified factors during the first 24 hours of presentation that could predict mortality in elderly patients. Methods This study was conducted in a Level III intensive care unit with a case mix of medical and surgical patients excluding cardiac and neurosurgical patients. We performed a retrospective review of all septic patients admitted to our ICU between July 2004 and May 2007. In addition to demographics and co-morbidities, physiological and laboratory variables were analysed to identify early predictors of mortality in elderly patients with sepsis. Results Of 175 patients admitted with sepsis, 108 were older than 65 years. Elderly patients differed from younger patients with regard to sex, temperature (37.2°C VS 37.8°C p < 0.01), heart rate, systolic blood pressure, pH, HCO3, potassium, urea, creatinine, APACHE III and SAPS II. The ICU and hospital mortality was significantly higher in elderly patients (10.6% Vs 23.14% (p = 0.04) and 19.4 Vs 35.1 (p = 0.02) respectively). Elderly patients who died in hospital had a significant difference in pH, HCO3, mean blood pressure, potassium, albumin, organs failed, lactate, APACHE III and SAPS II compared to the elderly patients who survived while the mean age and co-morbidities were comparable. Logistic regression analysis identified temperature (OR [per degree centigrade decrease] 0.51; 95% CI 0.306- 0.854; p = 0.010) and SAPS II (OR [per point increase]: 1.12; 95% CI 1.016-1.235; p = 0.02) during the first 24 hours of admission to independently predict increased hospital mortality in elderly patients. Conclusions The mortality in elderly patients with sepsis is higher than the younger patients. Temperature (hypothermia) and SAPS II scores during the first 24 hours of presentation independently predict hospital mortality. PMID:20875107

  12. Illness representations in patients with chronic kidney disease on maintenance hemodialysis.

    PubMed

    Fowler, Christopher; Baas, Linda S

    2006-01-01

    A sample of patients with chronic kidney disease on maintenance hemodialysis participated in a study to explore the relationship between illness perception and quality of life. Illness perception was examined based on the Common-Sense Model of Illness as described by Leventhal. Forty-two participants completed the Revised Illness Perception Questionnaire (IPQ-R), the Index of Well-being (IWB) and a brief demographic form. All of the subscales of the IPQ-R and the IWB demonstrated adequate reliability (alpha levels > or = .70) except for the treatment control subscale (alpha = .46). More perceived consequences of kidney disease and higher scores on the emotional representation scale were negatively correlated with scores on the IWB. Future research is needed to assess the influence of factors such as coping strategies on illness representations and on well-being. Nephrology nurses are in an optimal position to identify the illness perceptions of patients on chronic hemodialysis and can introduce specific coping mechanisms to enhance overall well-being. As well nephrology nurses can function as part of the overall health care team to identify the resources available to minimize the perceived consequences of chronic kidney disease. PMID:16613412

  13. Hsp72 Is a Novel Biomarker to Predict Acute Kidney Injury in Critically Ill Patients

    PubMed Central

    Morales-Buenrostro, Luis E.; Salas-Nolasco, Omar I.; Barrera-Chimal, Jonatan; Casas-Aparicio, Gustavo; Irizar-Santana, Sergio; Pérez-Villalva, Rosalba; Bobadilla, Norma A.

    2014-01-01

    Background and Objectives Acute kidney injury (AKI) complicates the course of disease in critically ill patients. Efforts to change its clinical course have failed because of the fail in the early detection. This study was designed to assess whether heat shock protein (Hsp72) is an early and sensitive biomarker of acute kidney injury (AKI) compared with kidney injury molecule (Kim-1), neutrophil gelatinase-associated lipocalin (NGAL), and interleukin-18 (IL-18) biomarkers. Methods A total of 56 critically ill patients fulfilled the inclusion criteria. From these patients, 17 developed AKI and 20 were selected as controls. In AKI patients, Kim-1, IL-18, NGAL, and Hsp72 were measured from 3 days before and until 2 days after the AKI diagnosis and in no-AKI patients at 1, 5 and 10 days after admission. Biomarker sensitivity and specificity were determined. To validate the results obtained with ROC curves for Hsp72, a new set of critically ill patients was included, 10 with AKI and 12 with no-AKI patients. Results Urinary Hsp72 levels rose since 3 days before the AKI diagnosis in critically ill patients; this early increase was not seen with any other tested biomarkers. Kim-1, IL-18, NGAL, and Hsp72 significantly increased from 2 days before AKI and remained elevated during the AKI diagnosis. The best sensitivity/specificity was observed in Kim-1 and Hsp72: 83/95% and 100/90%, respectively, whereas 1 day before the AKI diagnosis, the values were 100/100% and 100/90%, respectively. The sensibility, specificity and accuracy in the validation test for Hsp72 were 100%, 83.3% and 90.9%, respectively. Conclusions The biomarker Hsp72 is enough sensitive and specific to predict AKI in critically ill patients up to 3 days before the diagnosis. PMID:25313566

  14. Effectiveness of long-term acute care hospitalization in elderly patients with chronic critical illness

    PubMed Central

    Kahn, Jeremy M.; Werner, Rachel M.; David, Guy; Have, Thomas R. Ten; Benson, Nicole M.; Asch, David A.

    2012-01-01

    Background For patients recovering from severe acute illness, admission to a long-term acute care hospital (LTAC) is an increasingly common alternative to continued management in an intensive care unit. Objective To examine the effectiveness of LTAC transfer in patients with chronic critical illness. Research Design Retrospective cohort study in United States hospitals from 2002 to 2006. Subjects Medicare beneficiaries with chronic critical illness, defined as mechanical ventilation and at least 14 days of intensive care. Measures Survival, costs and hospital readmissions. We used multivariate analyses and instrumental variables to account for differences in patient characteristics, the timing of LTAC transfer and selection bias. Results A total of 234,799 patients met our definition of chronic critical illness. Of these, 48,416 (20.6%) were transferred to an LTAC. In the instrumental variable analysis, patients transferred to an LTAC experienced similar survival compared to patients who remained in an intensive care unit (adjusted hazard ratio = 0.99, 95% CI: 0.96 to 1.01, p=0.27). Total hospital-related costs in the 180 days following admission were lower among patients transferred to LTACs (adjusted cost difference = -$13,422, 95% CI: -26,662 to -223, p=0.046). This difference was attributable to a reduction in skilled nursing facility admissions (adjusted admission rate difference = -0.591 (95% CI: -0.728 to -0.454, p <0.001). Total Medicare payments were higher (adjusted cost difference = $15,592, 95% CI: 6,343 to 24,842, p=0.001). Conclusions Patients with chronic critical illness transferred to LTACs experience similar survival compared with patients who remain in intensive care units, incur fewer health care costs driven by a reduction in post-acute care utilization, but invoke higher overall Medicare payments. PMID:22874500

  15. Psychosocial predictors of suicidal ideation in patients diagnosed with chronic illnesses in Jordan.

    PubMed

    Amer, Nuha Remon Yacoub; Hamdan-Mansour, Ayman M

    2014-11-01

    Suicide ideation (SI) is considered a major psychiatric emergency in patients diagnosed with chronic illnesses. Suicide ideation is a multifaceted issue that involves bio- psychosocial and cultural factors that interfere with patients' abilities. The purpose of this study is to investigate the psychosocial predictors of SI among Jordanian patients with chronic illnesses. A cross-sectional design using self-administered questionnaires was used to collect data from 480 patients diagnosed with diabetes mellitus, cardiovascular diseases, and cancer. The mean score of suicide ideation was 4.07 (SD  =  1.7) and almost 20% (n  =  85) of the participants found to be suicidal, the majority were suffering from moderate to severe depressive symptoms and low levels of life satisfaction. Also, the analysis showed that the patients had a high level of optimism and moderate perception of social support from family, friends, and significant other. Type of illness has a significant relation to the 'seriousness' component of SI (p  =  0.023). Depression (?  =  0.345, p<0.001) was a significant risk factor for 'thought' component of SI, and optimism (?  =  -0.008, p<0.05) a significant protective factor against the thought component of SI. Patients with chronic illnesses suffer serious psychological disturbances and are in need of psychological care, and periodic psychological screening to maintain their psychological wellbeing. PMID:25353299

  16. Ketoconazole hepatotoxicity in a patient treated for environmental illness and systemic candidiasis

    SciTech Connect

    Brusko, C.S.; Marten, J.T. (Purdue University School of Pharmacy and Pharmacal Sciences, Lafayette, IN (United States))

    1991-12-01

    Environmental illness, a hypothesized disease caused by exposure to substances such as combustion products, pesticides, food additives, and Candida albicans, is discussed. The case of a patient with environmental illness and systemic candidiasis for six weeks with ketoconazole, liver enzyme concentrations increased. One month after discontinuation of ketoconazole, the liver enzyme concentrations decreased; however, over the next five months, liver enzymes and bilirubin increased. The patient developed encephalopathy and eventually was transferred to a medical center for possible liver transplant. A review of the literature pertaining to ketoconazole hepatotoxicity is also presented.16 references.

  17. A prospective, randomized study in critically ill patients using the Oligon Vantex ® catheter

    Microsoft Academic Search

    L Corral; M Nolla-Salas; J Ibañez-Nolla; M. A León; R. M D??az; M Cruz Mart??n; R Iglesia; R Catalan

    2003-01-01

    Microbial colonization and the incidence of catheter-related bloodstream infections (CR-BSI) associated with Oligon Vantex® silver central venous catheters (CVC) in critically ill patients were determined. A prospective, randomized, controlled 17-month trial was carried out in an intensive care unit (ICU). All patients requiring a triple-lumen CVC for four days or longer were enrolled. Patients were randomized to receive a standard

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

    PubMed Central

    Aji, Budi; Yamamoto, Shelby Suzanne; Sauerborn, Rainer

    2014-01-01

    Background Little research has focused on the economic hardship among the insured with severe illnesses and high treatment costs, in particular, the consequence of poorer insurance coverage for high-cost illnesses. Therefore, we presented the case for identifying the experiences of insured patients with severe chronic and acute illnesses. This study identified a qualitative understanding of the economic impact of severe chronic and acute illnesses and household strategies to deal with high treatment costs. Design Interviews were conducted with 19 insured households of three different health insurance programs with a family member that had been hospitalized for severe chronic or acute illnesses in either Banyumas or Margono Sukarjo hospitals in Banyumas, Central Java, Indonesia. A thematic analysis was applied to guide the interpretation of the data. Results Insured households with a family member that had been hospitalized for severe chronic and acute illnesses were greatly affected by the high treatment costs. Four major issues emerged from this qualitative study: insured patients are still burdened with high out-of-pocket payments, households adopt various strategies to cope with the high cost of treatments, households experience financial hardships, and positive and negative perceptions of the insured regarding their health insurance coverage for acute and chronic illnesses. Conclusions Askes and Jamsostek patients faced financial burdens from high cost sharing for hospital amenities, non-covered drugs, and treatments and other indirect costs. Meanwhile, Jamkesmas beneficiaries faced no financial burden for related medical services but were rather burdened with indirect costs for the carers. Households relied on internal resources to cover hospital bills as the first strategy, which included the mobilization of savings, sale of assets, and borrowing of money. External support was tapped secondarily and included financial support from extended family members, donations from neighbors and the community, and additional benefits from employers. However, insured households overall had positive perceptions of insurance. PMID:25308817

  19. The influence of illness severity on health satisfaction in patients with cardiovascular disease: the mediating role of illness perception and self-efficacy beliefs.

    PubMed

    Greco, Andrea; Steca, Patrizia; Pozzi, Roberta; Monzani, Dario; Malfatto, Gabriella; Parati, Gianfranco

    2015-01-01

    The importance of psychological factors in improving conditions of cardiovascular disease (CVD) patients is stressed by the guidelines for their prevention and rehabilitation, but little is known about the impact of illness severity on patients' well-being, and on the psychosocial variables that may mediate this association. The aim of this study was to investigate the role of illness perception and self-efficacy beliefs on the relationship between illness severity and health satisfaction in 75 CVD patients undergoing rehabilitation (80% men; mean age = 65.44) at the St. Luca Hospital, Istituto Auxologico Italiano, Milan, Italy. Illness severity was measured in terms of left ventricular ejection fraction; psychological factors were assessed at the beginning and end of rehabilitation. Results from path analyses showed that the relationships among CVD severity and health satisfaction were mediated by illness perception and self-efficacy beliefs. Findings underscored the importance of considering illness representations and self-efficacy beliefs to improve well-being in CVD patients. PMID:24965513

  20. Deteriorated executive functions in patients with successful surgery for pituitary adenomas compared with other chronically ill patients.

    PubMed

    Müssig, Karsten; Besemer, Britta; Saur, Ralf; Klingberg, Stefan; Häring, Hans-Ulrich; Gallwitz, Baptist; Leyhe, Thomas

    2011-03-01

    Pituitary adenomas, even after successful treatment, are associated with cognitive impairments. It is unclear whether these deficits are a consequence of unspecific factors associated with having a chronic illness and whether the cognitive dysfunctions exceed those of other chronically ill patients. Thirty-eight patients with transsphenoidal surgery for pituitary adenomas and 38 patients undergoing L-thyroxine replacement therapy after thyroid surgery were studied neuropsychologically with established tests. Executive function was examined with the Trail-Making Test A and B, working memory with the digit span test, attention with the digit symbol test, verbal memory with the German version of the Auditory Verbal Learning and Memory Test, and general verbal intelligence by a vocabulary test. Attention (p = .007), attentional speed (p = .0004), executive control (p = .04), and working memory (p = .01), were significantly reduced in patients with pituitary adenomas compared with other chronically ill patients. In contrast, no differences were found between the groups for verbal memory (all subtests: p ? .06). Patients with successful surgery for pituitary adenomas show also in comparison with other chronically ill patients an increased risk for deficits in certain aspects of cognitive function, including attention and working memory, supporting the relevance of the brain lesion and its treatment for these dysfunctions. PMID:21205414

  1. Ketamine and Propofol Combination (“Ketofol”) for Endotracheal Intubations in Critically Ill Patients: A Case Series

    PubMed Central

    de Moraes, Alice Gallo; Racedo Africano, Carlos J.; Hoskote, Sumedh S.; Reddy, Dereddi Raja S.; Tedja, Rudy; Thakur, Lokendra; Pannu, Jasleen K.; Hassebroek, Elizabeth C.; Smischney, Nathan J.

    2015-01-01

    Case series Patient: Male, 77 • Male, 25 • Male, 63 • Male, 70 • Male, 70 • Female, 61 Final Diagnosis: — Symptoms: Hypotension • respiratory failure Medication: Ketamine • Propofol • Etomidate Clinical Procedure: Endotracheal intubation Specialty: Critical Care Medicine Objective: Educational Purpose (only if useful for a systematic review or synthesis) Background: Endotracheal intubation is a common procedure performed for critically ill patients that can have immediate life-threatening complications. Induction medications are routinely given to facilitate the procedure, but most of these medications are associated with hypotension. While etomidate is known for its neutral hemodynamic profile, it has been linked with increased mortality in septic patients and increased morbidity in trauma patients. Ketamine and propofol are effective anesthetics with counteracting cardiovascular profiles. No data are available about the use of this combination in critically ill patients undergoing endotracheal intubation. Case Series: We describe 6 cases in which the combination of ketamine and propofol (“ketofol”) was used as an induction agent for endotracheal intubation in critically ill patients with a focus on hemodynamic outcomes. All patients received a neuromuscular blocker and fentanyl, while 5 patients received midazolam. We recorded mean arterial pressure (MAP) 1 minute before induction and 15 minutes after intubation with the combination. Of the 6 patients, 5 maintained a MAP ?65 mmHg 15 minutes after intubation. One patient was on norepinephrine infusion with a MAP of 64 mmHg, and did not require an increase in the dose of the vasopressor 15 minutes after intubation. No hemodynamic complications were reported after any of the intubations. Conclusions: This case series describes the use of the “ketofol” combination as an induction agent for intubation in critically ill patients when hemodynamic stability is desired. Further research is needed to establish the safety of this combination and how it compares to other induction medications. PMID:25676819

  2. Equivalent mismatch negativity deficits across deviant types in early illness schizophrenia-spectrum patients.

    PubMed

    Hay, Rachel A; Roach, Brian J; Srihari, Vinod H; Woods, Scott W; Ford, Judith M; Mathalon, Daniel H

    2015-02-01

    Neurophysiological abnormalities in auditory deviance processing, as reflected by the mismatch negativity (MMN), have been observed across the course of schizophrenia. Studies in early schizophrenia patients have typically shown varying degrees of MMN amplitude reduction for different deviant types, suggesting that different auditory deviants are uniquely processed and may be differentially affected by duration of illness. To explore this further, we examined the MMN response to 4 auditory deviants (duration, frequency, duration+frequency "double deviant", and intensity) in 24 schizophrenia-spectrum patients early in the illness (ESZ) and 21 healthy controls. ESZ showed significantly reduced MMN relative to healthy controls for all deviant types (p<0.05), with no significant interaction with deviant type. No correlations with clinical symptoms were present (all ps>0.05). These findings support the conclusion that neurophysiological mechanisms underlying processing of auditory deviants are compromised early in illness, and these deficiencies are not specific to the type of deviant presented. PMID:25603283

  3. Toxic Bradycardias in the Critically Ill Poisoned Patient

    PubMed Central

    Givens, Melissa L.

    2012-01-01

    Cardiovascular drugs are a common cause of poisoning, and toxic bradycardias can be refractory to standard ACLS protocols. It is important to consider appropriate antidotes and adjunctive therapies in the care of the poisoned patient in order to maximize outcomes. While rigorous studies are lacking in regards to treatment of toxic bradycardias, there are small studies and case reports to help guide clinicians' choices in caring for the poisoned patient. Antidotes, pressor support, and extracorporeal therapy are some of the treatment options for the care of these patients. It is important to make informed therapeutic decisions with an understanding of the available evidence, and consultation with a toxicologist and/or regional Poison Control Center should be considered early in the course of treatment. PMID:22545217

  4. Variability of linezolid concentrations after standard dosing in critically ill patients: a prospective observational study

    PubMed Central

    2014-01-01

    Introduction Severe infections in intensive care patients show high morbidity and mortality rates. Linezolid is an antimicrobial drug frequently used in critically ill patients. Recent data indicates that there might be high variability of linezolid serum concentrations in intensive care patients receiving standard doses. This study was aimed to evaluate whether standard dosing of linezolid leads to therapeutic serum concentrations in critically ill patients. Methods In this prospective observational study, 30 critically ill adult patients with suspected infections received standard dosing of 600 mg linezolid intravenously twice a day. Over 4 days, multiple serum samples were obtained from each patient, in order to determine the linezolid concentrations by liquid chromatography tandem mass spectrometry. Results A high variability of serum linezolid concentrations was observed (range of area under the linezolid concentration time curve over 24 hours (AUC24) 50.1 to 453.9 mg/L, median 143.3 mg*h/L; range of trough concentrations (Cmin)?patients, respectively. Finally, potentially toxic levels (defined as AUC24?>?400 mg*h/L and Cmin?>?10 mg/L) were observed for 7 of the patients. Conclusions A high variability of linezolid serum concentrations with a substantial percentage of potentially subtherapeutic levels was observed in intensive care patients. The findings suggest that therapeutic drug monitoring of linezolid might be helpful for adequate dosing of linezolid in critically ill patients. Trial registration Clinicaltrials.gov NCT01793012. Registered 24 January 2013. PMID:25011656

  5. Family functioning in families of first-episode psychosis patients as compared to chronic mentally ill patients and healthy controls.

    PubMed

    Koutra, Katerina; Triliva, Sofia; Roumeliotaki, Theano; Stefanakis, Zacharias; Basta, Maria; Lionis, Christos; Vgontzas, Alexandros N

    2014-11-30

    The present study aimed to investigate possible differences in family environment among patients experiencing their First Episode of Psychosis (FEP), chronic patients and controls. Family cohesion and flexibility (FACES-IV) and psychological distress (GHQ-28) were evaluated in families of 50 FEP and 50 chronic patients, as well as 50 controls, whereas expressed emotion (FQ) and family burden (FBS) were assessed in families of FEP and chronic patients. Multivariable linear regression analysis, adjusted for confounders, indicated impaired cohesion and flexibility for families of FEP patients compared to controls, and lower scores for families of chronic patients compared to those of FEP patients. Caregivers of chronic patients scored significantly higher in criticism, and reported higher burden and psychological distress than those of FEP patients. Our findings suggest that unbalanced levels of cohesion and flexibility, high criticism and burden appeared to be the outcome of psychosis and not risk factors triggering the onset of the illness. Furthermore, emotional over-involvement both in terms of positive (i.e. concern) and negative behaviors (i.e. overprotection) is prevalent in Greek families. Psychoeducational interventions from the early stages of the illness should be considered to promote caregivers' awareness regarding the patients' illness, which in turn, may ameliorate dysfunctional family interactions. PMID:25024058

  6. Individualization of Piperacillin Dosing for Critically Ill Patients: Dosing Software To Optimize Antimicrobial Therapy

    PubMed Central

    Felton, T. W.; Roberts, J. A.; Lodise, T. P.; Van Guilder, M.; Boselli, E.; Neely, M. N.

    2014-01-01

    Piperacillin-tazobactam is frequently used for empirical and targeted therapy of infections in critically ill patients. Considerable pharmacokinetic (PK) variability is observed in critically ill patients. By estimating an individual's PK, dosage optimization Bayesian estimation techniques can be used to calculate the appropriate piperacillin regimen to achieve desired drug exposure targets. The aim of this study was to establish a population PK model for piperacillin in critically ill patients and then analyze the performance of the model in the dose optimization software program BestDose. Linear, with estimated creatinine clearance and weight as covariates, Michaelis-Menten (MM) and parallel linear/MM structural models were fitted to the data from 146 critically ill patients with nosocomial infection. Piperacillin concentrations measured in the first dosing interval, from each of 8 additional individuals, combined with the population model were embedded into the dose optimization software. The impact of the number of observations was assessed. Precision was assessed by (i) the predicted piperacillin dosage and by (ii) linear regression of the observed-versus-predicted piperacillin concentrations from the second 24 h of treatment. We found that a linear clearance model with creatinine clearance and weight as covariates for drug clearance and volume of distribution, respectively, best described the observed data. When there were at least two observed piperacillin concentrations, the dose optimization software predicted a mean piperacillin dosage of 4.02 g in the 8 patients administered piperacillin doses of 4.00 g. Linear regression of the observed-versus-predicted piperacillin concentrations for 8 individuals after 24 h of piperacillin dosing demonstrated an r2 of >0.89. In conclusion, for most critically ill patients, individualized piperacillin regimens delivering a target serum piperacillin concentration is achievable. Further validation of the dosage optimization software in a clinical trial is required. PMID:24798288

  7. Individualization of piperacillin dosing for critically ill patients: dosing software to optimize antimicrobial therapy.

    PubMed

    Felton, T W; Roberts, J A; Lodise, T P; Van Guilder, M; Boselli, E; Neely, M N; Hope, W W

    2014-07-01

    Piperacillin-tazobactam is frequently used for empirical and targeted therapy of infections in critically ill patients. Considerable pharmacokinetic (PK) variability is observed in critically ill patients. By estimating an individual's PK, dosage optimization Bayesian estimation techniques can be used to calculate the appropriate piperacillin regimen to achieve desired drug exposure targets. The aim of this study was to establish a population PK model for piperacillin in critically ill patients and then analyze the performance of the model in the dose optimization software program BestDose. Linear, with estimated creatinine clearance and weight as covariates, Michaelis-Menten (MM) and parallel linear/MM structural models were fitted to the data from 146 critically ill patients with nosocomial infection. Piperacillin concentrations measured in the first dosing interval, from each of 8 additional individuals, combined with the population model were embedded into the dose optimization software. The impact of the number of observations was assessed. Precision was assessed by (i) the predicted piperacillin dosage and by (ii) linear regression of the observed-versus-predicted piperacillin concentrations from the second 24 h of treatment. We found that a linear clearance model with creatinine clearance and weight as covariates for drug clearance and volume of distribution, respectively, best described the observed data. When there were at least two observed piperacillin concentrations, the dose optimization software predicted a mean piperacillin dosage of 4.02 g in the 8 patients administered piperacillin doses of 4.00 g. Linear regression of the observed-versus-predicted piperacillin concentrations for 8 individuals after 24 h of piperacillin dosing demonstrated an r(2) of >0.89. In conclusion, for most critically ill patients, individualized piperacillin regimens delivering a target serum piperacillin concentration is achievable. Further validation of the dosage optimization software in a clinical trial is required. PMID:24798288

  8. Assertive Community Treatment for People with Severe Mental Illness: Critical Ingredients and Impact on Patients

    Microsoft Academic Search

    Gary R. Bond; Robert E. Drake; Kim T. Mueser; Eric Latimer

    2001-01-01

    This article describes the critical ingredients of the assertive community treatment (ACT) model for people with severe mental illness and then reviews the evidence regarding its effectiveness and cost effectiveness. ACT is an intensive mental health program model in which a multidisciplinary team of professionals serves patients who do not readily use clinic-based services, but who are often at high

  9. Highly Sensitive Detection of Dengue Virus Nucleic Acid in Samples from Clinically Ill Patients

    Microsoft Academic Search

    Jorge L. Munoz-Jordan; Cynthia S. Collins; Edgardo Vergne; Gilberto A. Santiago; Lyle Petersen; Wellington Sun; Jeffrey M. Linnen

    Dengue virus (DENV) is a major cause of febrile illness and hemorrhagic fever in tropical and subtropical regions. Typically, patients presenting with acute dengue disease are viremic but may not have yet developed detectable titers of antibody. Therefore, early diagnosis depends mostly on detection of viral components, such as the RNA. To define the potential use of transcription-mediated amplification (TMA)

  10. Blood Glucose Measurements in Critically Ill Patients Tom Van Herpe, Ph.D.,1,2

    E-print Network

    and scientific interest in the dysregulation of the normal glucose homeostasis has emerged only recently. Before22 Blood Glucose Measurements in Critically Ill Patients Tom Van Herpe, Ph.D.,1,2 and Dieter) blood glucose, (Hct) hematocrit, (ICU) intensive care unit, (ISO) International Organization

  11. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial

    Microsoft Academic Search

    William D Schweickert; Mark C Pohlman; Anne S Pohlman; Celerina Nigos; Amy J Pawlik; Cheryl L Esbrook; Linda Spears; Megan Miller; Mietka Franczyk; Deanna Deprizio; Gregory A Schmidt; Amy Bowman; Rhonda Barr; Kathryn E McCallister; Jesse B Hall; John P Kress

    2009-01-01

    Summary Background Long-term complications of critical illness include intensive care unit (ICU)-acquired weakness and neuropsychiatric disease. Immobilisation secondary to sedation might potentiate these problems. We assessed the effi cacy of combining daily interruption of sedation with physical and occupational therapy on functional outcomes in patients receiving mechanical ventilation in intensive care. Methods Sedated adults (?18 years of age) in the

  12. Patient empowerment and feedback did not decrease pain in seriously ill hospitalized adults

    Microsoft Academic Search

    Norman A Desbiens; Albert W Wu; Yutaka Yasui; Joanne Lynn; Carlos Alzola; Neil S Wenger; Alfred F Connors; Russell S Phillips; William Fulkerson

    1998-01-01

    We tested a nurse clinician-mediated intervention to relieve pain in a group of seriously ill hospitalized adults using a randomized controlled trial at five tertiary care academic centers in the US. The study included 4804 patients admitted between January 1992 and January 1994 with one or more of nine high mortality diagnoses; 2652 were allocated to the intervention and 2152

  13. Hospice Comics: Representations of Patient and Family Experience of Illness and Death in Graphic Novels.

    PubMed

    Czerwiec, Mk; Huang, Michelle N

    2014-08-20

    Non-fiction graphic novels about illness and death created by patients and their loved ones have much to teach all readers. However, the bond of empathy made possible in the comic form may have special lessons for healthcare providers who read these texts and are open to the insights they provide. PMID:25138207

  14. Recent Clinical Advances in the Management of Critically Ill Patients with Acute Renal Failure

    Microsoft Academic Search

    William R. Clark; Jeffrey J. Letteri; Shigehiko Uchino; Rinaldo Bellomo; Claudio Ronco

    2006-01-01

    Background: Significant progress has been made in the field of renal replacement therapy for critically ill patients with acute renal failure (ARF) over the past few years. This review highlights these developments. Methods: Recent studies assessing the clinical utility of the RIFLE classification system for the diagnosis of ARF were reviewed. Clinical outcome studies evaluating the effect of continuous renal

  15. Illness representations, psychological distress and non-cardiac chest pain in patients attending an emergency department

    PubMed Central

    Webster, R.; Norman, P.; Goodacre, S.; Thompson, A.R.; McEachan, R.R.C.

    2014-01-01

    Objective: Many patients who attend an emergency department (ED) with chest pain receive a diagnosis of non-cardiac chest pain (NCCP), and often suffer poor psychological outcomes and continued pain. This study assessed the role of illness representations in explaining psychological distress and continued chest pain in patients attending an ED. Methods: ED NCCP patients (N?=?138) completed measures assessing illness representations, anxiety, depression and quality of life (QoL) at baseline, and chest pain at one month. Results: Illness representations explained significant amounts of the variance in anxiety (Adj. R²?=?.38), depression (Adj. R²?=?.18) and mental QoL (Adj. R²?=?.36). A belief in psychological causes had the strongest associations with outcomes. At one month, 28.7% of participants reported experiencing frequent pain, 13.2% infrequent pain and 58.1% no pain. Anxiety, depression and poor QoL, but not illness representations, were associated with continued chest pain. Conclusions: The findings suggest that (i) continued chest pain is related to psychological distress and poor QoL, (ii) interventions should be aimed at reducing psychological distress and improving QoL and (iii) given the associations between perceived psychological causes and psychological distress/QoL, NCCP patients in the ED might benefit from psychological therapies to manage their chest pain. PMID:24831735

  16. Pharmacokinetics of intravenous omeprazole in critically ill paediatric patients

    Microsoft Academic Search

    Maria Jose Solana; Jesús López-Herce

    2010-01-01

    The proton pump inhibitors are first-line drugs for the treatment of a number of gastrointestinal diseases. These drugs have\\u000a a good safety profile, making it possible to use them in paediatric patients. Although their pharmacokinetics in children\\u000a has not been extensively studied, research performed suggests that the dose used should be varied as a function of age, as\\u000a this factor

  17. [Reliability of family reports of illness anamnesis of schizophrenic patients].

    PubMed

    Hambrecht, M; Häfner, H

    1997-04-01

    Because a valid psychiatric history is difficult to obtain from an acute psychotic patient, particularly upon first admission, information given by important others is necessary for diagnostic classification, but the validity of this data must be examined. Within the ABC Schizophrenia Study, the onset and early course of schizophrenia was assessed from 171 post-psychotic first admissions and their close relatives. High agreement was found for substance abuse, self-destructive behaviour, paranoid delusion and social role deficits. Agreement was low for unspecific symptoms like depression, anxiety, problems with concentration or sleep. Due to a lack of sensitivity of the relatives' reports, agreement was also low for formal thought and perceptual disorders and derealization. A second study with 30 patients with schizophrenia and with 2 or more relatives for each case (n = 69) demonstrated that the quality of relatives' reports depends primarily on the relative's image of the patient (e.g., perceived dominance) and on the relative's attributions about the cause of the disease. Close and long contact tends to impair the quality of reports. Again, the observation of different symptoms is influenced differently by these factors. PMID:9235307

  18. Retrospective review on obstetric cases of critically ill and dead patients in Dongguan.

    PubMed

    Shen, Li-Han; Fang, Yun-Yong; Zheng, Yan-Bing; Xiao, Li-Juan; Huang, Su-Ran; Liu, Xi-Zhen; Cai, Li-Hua

    2015-03-01

    This retrospective analysis was set to understand the epidemiological status of the critically ill obstetric patients in Dongguan city, Guangdong, China. Understanding the risk factors for the death cases can provide scientific evidences for future preventive strategies to decrease the maternal mortality rate. This retrospective included the statistical data and clinical data on the cases of critically ill and dead obstetric patients admitted to Dongguan People's Hospital and Dongguan Maternal & Child Health Hospital from September 1st, 2009 to August 31st, 2013. Data included numbers of the critically ill maternal and obstetric women, common obstetric and maternal comorbidities and complications in the critically ill patients, the basic characteristics of maternal and obstetric deaths, records of regular prenatal examinations, the time intervals between onset of acute symptoms and ICU admission, blood purification, and the acute physiology and chronic health evaluation II (APACHE II) score. During the 5-year period, there were increasing trend of critically ill pregnant and obstetric patients, and the prevalence rate of critically ill obstetric patients was 8.99-9.28 %. The most common obstetric causes of admission were massive postpartum hemorrhage (63.54 %), followed by pregnancy-associated hypertension (15.85 %) and placenta previa (8.92 %). The most common non-obstetric causes of admission were acute heart failure (1.98 %). In the observed period, 20 critically ill obstetric patients died in these two hospitals (mortality rate 0.24 %, 20/8,129). The mean age of dead women was (30.3 ± 6.6) years old and mean gestational age was (30.1 ± 9.3) weeks. 75 % of the patient had more than two pregnancies. Over 90 % of the patients received education below junior high school level. 85 % of the patients were non-Dongguan natives and regular prenatal care rate was only 15 % on dead cases. The most common causes of death were pregnancy-associated hypertension, acute heart failure, and massive postpartum hemorrhage. The dead patients experienced longer interval between onset of acute symptoms and ICU admission (media = 62.5 h), higher APACHE II score (25.4 ± 5.4), and lower blood purification treatment rate (10 %). The incidence of critically ill pregnant and obstetric patients is high in Dongguan city. The group of dead obstetric patients, the majority of which were non-Dongguan natives, usually experienced above-average pregnancies, lower educational level, lower regular prenatal care rate, and longer interval between onset of acute symptoms and ICU admission. Critically ill obstetric patients may benefit from publicized informed relevant education, government-supported health care, preventative interventions of critical obstetric and medical complications, timely ICU admission after onset of acute symptoms, and the enhanced support of organ functions within the ICU. PMID:25315638

  19. Venous Thromboembolism in Critically Ill Cirrhotic Patients: Practices of Prophylaxis and Incidence

    PubMed Central

    Al-Dorzi, Hasan M.; Tamim, Hani M.; Aldawood, Abdulaziz S.; Arabi, Yaseen M.

    2013-01-01

    Objectives. We compared venous thromboembolism (VTE) prophylaxis practices and incidence in critically ill cirrhotic versus noncirrhotic patients and evaluated cirrhosis as a VTE risk factor. Methods. A cohort of 798 critically ill patients followed for the development of clinically detected VTE were categorized according to the diagnosis of cirrhosis. VTE prophylaxis practices and incidence were compared. Results. Seventy-five (9.4%) patients had cirrhosis with significantly higher INR (2.2 ± 0.9 versus 1.3 ± 0.6, P < 0.0001), lower platelet counts (115,000 ± 90,000 versus 258,000 ± 155,000/?L, P < 0.0001), and higher creatinine compared to noncirrhotic patients. Among cirrhotics, 31 patients received only mechanical prophylaxis, 24 received pharmacologic prophylaxis, and 20 did not have any prophylaxis. Cirrhotic patients were less likely to receive pharmacologic prophylaxis (odds ratio, 0.08; 95% confidence interval (CI), 0.04–0.14). VTE occurred in only two (2.7%) cirrhotic patients compared to 7.6% in noncirrhotic patients (P = 0.11). The incidence rate was 2.2 events per 1000 patient-ICU days for cirrhotic patients and 3.6 events per 1000 patient-ICU days for noncirrhotics (incidence rate ratio, 0.61; 95% CI, 0.15–2.52). On multivariate Cox regression analysis, cirrhosis was not associated with VTE risk (hazard ratio, 0.40; 95% CI, 0.10–1.67). Conclusions. In critically ill cirrhotic patients, VTE incidence did not statistically differ from that in noncirrhotic patients. PMID:24386564

  20. Assessing Capacity in Psychiatric Patients With Acute Medical Illness Who Refuse Care

    PubMed Central

    Spike, Jeffrey P.

    2014-01-01

    Three cases are presented that demonstrate the difficulty of assessing medical decision-making capacity in patients with psychiatric illness who are refusing care. Health professionals often assess capacity differently in practice. Provided their patients have some understanding of their illness and have some plans for meeting basic needs, psychiatrists are often inclined to give patients the freedom to refuse care even if they do not exhibit a full understanding of the medical facts of their case and why they are refusing it. Adult medicine physicians, in contrast, are inclined to require patients to state a more complete understanding of the benefits and burdens of evaluation and treatment before allowing them to refuse care when their refusals might result in adverse medical outcomes. The 3 cases exemplify the tension between these approaches and highlight the role of hospital ethics consultation in addressing this conflict.

  1. Organ dysfunction in critically ill cancer patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

    PubMed Central

    ÑAMENDYS-SILVA, SILVIO A.; CORREA-GARCÍA, PAULINA; GARCÍA-GUILLÉN, FRANCISCO J.; LÓPEZ-BASAVE, HORACIO N.; MONTALVO-ESQUIVEL, GONZALO; TEXCOCANO-BECERRA, JULIA; HERRERA-GÓMEZ, ÁNGEL; MENESES-GARCÍA, ABELARDO

    2015-01-01

    The aim of the present study was to observe the incidence of organ dysfunction and the intensive care unit (ICU) outcomes of critically ill cancer patients during the cytoreductive surgery with hyperthermic intraperitoneal chemotherapy post-operative period. The present study included 25 critically ill cancer patients admitted to the ICU of the National Cancer Institute (Mexico City, Mexico) between January 2007 and February 2013. The incidence of organ dysfunction was 68% and patients exhibiting ?1 organ system dysfunction during ICU admittance remained in hospital for a significantly shorter period compared with patients who exhibited ?2 organ system dysfunctions (12.4±10.7 vs. 24.1±12.8 days; P=0.025). Therefore, the present study demonstrated that a high incidence of organ dysfunction was associated with a longer ICU hospital stay. PMID:25789059

  2. Failure of lorazepam to treat alprazolam withdrawal in a critically ill patient

    PubMed Central

    Sachdev, Gaurav; Gesin, Gail; Christmas, A Britton; Sing, Ronald F

    2014-01-01

    Management of sedation in the critical care unit is an ongoing challenge. Benzodiazepines have been commonly used as sedatives in critically ill patients. The pharmacokinetic and pharmacodynamic properties that make benzodiazepines effective and safe in critical care sedation include rapid onset of action and decreased respiratory depression. Alprazolam is a commonly used benzodiazepine that is prescribed for anxiety and panic disorders. It is frequently prescribed in the outpatient setting. Its use has been reported to result in a relatively high rate of dependence and subsequent withdrawal symptoms. Symptoms of alprazolam withdrawal can be difficult to recognize and treat in the critical care setting. In addition, other benzodiazepines may also be ineffective in treating alprazolam withdrawal. We present a case of alprazolam withdrawal in a critically ill trauma patient who failed treatment with lorazepam and haloperidol. Subsequent replacement with alprazolam resulted in significant improvement in the patient’s medication use and clinical status. PMID:24834401

  3. Modulation of asymmetric dimethylarginine in critically ill patients receiving intensive insulin treatment: a possible explanation of reduced morbidity and mortality?

    Microsoft Academic Search

    Michiel P. C. Siroen; Leeuwsen van P. A. M; Robert J. Nijveldt; Tom Teerlink; Pieter J. Wouters; Greet Van den Berghe

    2005-01-01

    OBJECTIVE: Asymmetric dimethylarginine, which inhibits production of nitric oxide, has been shown to be a strong and independent predictor of mortality in critically ill patients with clinical evidence of organ dysfunction. Interestingly, intensive insulin therapy in critically ill patients improved morbidity and mortality, but the exact mechanisms by which these beneficial effects are brought about remain unknown. Therefore, we aimed

  4. Percutaneous dilatational tracheostomy versus surgical tracheostomy in critically ill patients: a systematic review and meta-analysis

    Microsoft Academic Search

    Anthony Delaney; Sean M Bagshaw; Marek Nalos

    2006-01-01

    INTRODUCTION: Tracheostomy is one of the more commonly performed procedures in critically ill patients yet the optimal method of performing tracheostomies in this population remains to be established. The aim of this study was to systematically review and quantitatively synthesize all randomized clinical trials (RCTs), comparing elective percutaneous dilatational tracheostomy (PDT) and surgical tracheostomy (ST) in adult critically ill patients

  5. Long term follow up of severely ill patients who underwent urgent cardiac transplantation

    Microsoft Academic Search

    D Mulcahy; M Fitzgerald; C Wright; J Sparrow; J Pepper; M Yacoub; K M Fox

    1993-01-01

    OBJECTIVE--To assess long term survival (> 5 years) and quality of life in severely ill patients referred for urgent cardiac transplantation. SETTING--Tertiary referral centres: before transplantation at the National Heart Hospital (late 1984 to end 1986); after transplantation at Harefield Hospital. SUBJECTS--Eighteen patients (15 men; three women) who had required intensive support in hospital before cardiac transplantation and were alive

  6. Short-term effects of prone position in critically ill patients with acute respiratory distress syndrome

    Microsoft Academic Search

    L. Blanch; J. Mancebo; M. Perez; M. Martinez; A. Mas; A. J. Betbese; D. Joseph; J. Ballús; U. Lucangelo; E. Bak

    1997-01-01

    .  \\u000a \\u000a Objective: Changing the position from supine to prone is an emerging strategy to improve gas exchange in patients with the acute respiratory\\u000a distress syndrome (ARDS). The aim of this study was to evaluate the acute effects on gas exchange, hemodynamics, and respiratory\\u000a system mechanics of turning critically ill patients with ARDS from supine to prone. Design: Open, prospective study.

  7. Comparative health status of patients with 11 common illnesses in Wales

    Microsoft Academic Search

    R A Lyons; S V Lo; B N Littlepage

    1994-01-01

    OBJECTIVE--To assess the health status of patients with 11 common illnesses--asthma, diabetes, arthritis, back pain, sciatica, hypertension, angina, anxiety, depression, and heart attack and stroke. DESIGN--Face to face interview using a structured questionnaire which contained the Short Form 36 questionnaire (SF-36) and questions on lifestyle, health service utilisation, and self reported conditions treated by physicians. SETTING--Patients' homes, in West Glamorgan,

  8. Penetration of ceftazidime into bronchial secretions in critically ill patients.

    PubMed

    Langer, M; Cantoni, P; Bellosta, C; Boccazzi, A

    1991-12-01

    Five adult patients admitted to ICU, with respiratory failure, required endotracheal intubation and respiratory support. They were treated with ceftazidime because of lower respiratory tract infections. All patients were given ceftazidime at 1, 2 and 3 g dosages in a randomized sequence and timed serum and bronchial secretion samples collected. Mean peak serum concentrations of 60.3, 148.7 and 224.8 mg/L were found in the three treatment groups and mean trough levels of 1.02, 1.85 and 1.63 mg/L respectively. Ceftazidime appeared rapidly in bronchial secretions reaching mean maximal concentrations of 2.2, 4.81 and 5.69 mg/L in the first sampling period (0-2 h). Serum and bronchial secretions AUCs have been calculated showing that both almost doubled their values between 1 and 2 g dosing, while between 2 and 3 g doses only a moderate and non-significant increase were found. On the basis of these results, the existence of a saturable transport mechanism for ceftazidime from serum to bronchial secretions can be postulated. PMID:1816189

  9. Pharmacokinetics of Ganciclovir during Continuous Venovenous Hemodiafiltration in Critically Ill Patients

    PubMed Central

    Kitzberger, Reinhard; Drolz, Andreas; Zauner, Christian; Jäger, Walter; Böhmdorfer, Michaela; Kraff, Stefanie; Fritsch, Achim; Thalhammer, Florian; Fuhrmann, Valentin; Schenk, Peter

    2014-01-01

    Ganciclovir is an antiviral agent that is frequently used in critically ill patients with cytomegalovirus (CMV) infections. Continuous venovenous hemodiafiltration (CVVHDF) is a common extracorporeal renal replacement therapy in intensive care unit patients. The aim of this study was to investigate the pharmacokinetics of ganciclovir in anuric patients undergoing CVVHDF. Population pharmacokinetic analysis was performed for nine critically ill patients with proven or suspected CMV infection who were undergoing CVVHDF. All patients received a single dose of ganciclovir at 5 mg/kg of body weight intravenously. Serum and ultradiafiltrate concentrations were assessed by high-performance liquid chromatography, and these data were used for pharmacokinetic analysis. Mean peak and trough prefilter ganciclovir concentrations were 11.8 ± 3.5 mg/liter and 2.4 ± 0.7 mg/liter, respectively. The pharmacokinetic parameters elimination half-life (24.2 ± 7.6 h), volume of distribution (81.2 ± 38.3 liters), sieving coefficient (0.76 ± 0.1), total clearance (2.7 ± 1.2 liters/h), and clearance of CVVHDF (1.5 ± 0.2 liters/h) were determined. Based on population pharmacokinetic simulations with respect to a target area under the curve (AUC) of 50 mg · h/liter and a trough level of 2 mg/liter, a ganciclovir dose of 2.5 mg/kg once daily seems to be adequate for anuric critically ill patients during CVVHDF. PMID:24145543

  10. Monte Carlo simulations: maximizing antibiotic pharmacokinetic data to optimize clinical practice for critically ill patients.

    PubMed

    Roberts, Jason A; Kirkpatrick, Carl M J; Lipman, Jeffrey

    2011-02-01

    Infections in critically ill patients continue to result in unacceptably high morbidity and mortality. Although few data exist for correlating antibiotic exposure with outcome, antibiotic dosing is likely to be highly important for maximizing resolution of infection in many patients. The practical and financial difficulties of performing pharmacokinetic (PK) studies in critically ill patients mean that analyses to maximize data such as Monte Carlo simulation (MCS) are highly valuable. MCS uses computer software to perform virtual clinical trials. The building blocks for MCS are: firstly, a robust population PK model from the patient population of interest; secondly, descriptors of the effect of covariates that influence the PK parameters; thirdly, description of the susceptibility of bacteria to the antibiotic and finally a PK/pharmacodynamic (PD) target associated with antibiotic efficacy. Probability of target attainment (PTA) outputs can then be generated that describe the proportion of patients that will achieve a pre-specified PD target for an MIC distribution. Such analyses can then inform dosing requirements, which can be used to have a high likelihood of achieving PK/PD targets for organisms with different MICs. In this issue of JAC, Zelenitsky et al. provide a very useful example of MCS for interpreting the optimal methods for dosing meropenem, piperacillin/tazobactam, cefepime and ceftobiprole in critically ill patients. PMID:21118912

  11. Low dose adrenocorticotropic hormone test and adrenal insufficiency in critically ill acquired immunodeficiency syndrome patients

    PubMed Central

    Shashidhar, P. K.; Shashikala, G. V.

    2012-01-01

    Context: Prevalence of adrenal insufficiency (AI) is not uncommon in HIV infected population. However, AI is rarely diagnosed in clinical practice because many patients have non-specific symptoms and signs. Critical illness in such patients further complicates the evaluation of adrenal function. A 1?gm ACTH test can be used for diagnosis, since it results in more physiological levels of ACTH. A serum cortisol of <18 ?g/dL, 30 or 60-minutes after ACTH test has been accepted as indicative of AI, but many experts advocate the normal cortisol response should exceed 25 ?g/dL, in critically ill patients. Aim: To determine the prevalence of AI in critically ill AIDS patients, by using 1 ?g ACTH test and also, to compare the diagnostic criteria for adrenal insufficiency between cortisol response of <18 ?g/dL and <25 ?g/dL. Settings and Design: This prospective study was done in the Department of Medicine. Materials and Methods: After taking blood for basal plasma cortisol from AIDS affected fifty adult men and women aged over 18 yrs, 1 ?g ACTH was given intravenously, and blood samples were again collected at 30 and 60 minutes for plasma cortisol estimation. Statistical analysis: It was done by Mann-Whitney test. Results: Prevalence of AI was 74% (37 patients) and 92% (46 patients), when the peak stimulated cortisol level of <18 ?g/dL and <25 ?g/dL, respectively, was used. Conclusion: AI is more prevalent in critically ill AIDS patients. Hence, this test can be performed for early intervention and better management. PMID:22629505

  12. Surviving Critical Illness: The Acute Respiratory Distress Syndrome as Experienced by Patients and Their Caregivers

    PubMed Central

    Cox, Christopher E.; Docherty, Sharron L.; Brandon, Debra H.; Whaley, Christie; Attix, Deborah K.; Clay, Alison S.; Dore, Daniel V.; Hough, Catherine L.; White, Douglas B.; Tulsky, James A.

    2009-01-01

    Objective Survivors of the acute respiratory distress syndrome (ARDS), a systemic critical illness, often report poor quality of life based on responses to standardized questionnaires. However, the experiences of ARDS survivors have not been reported. Our objective was to characterize the effects of critical illness in the daily lives and functioning of ARDS survivors. Design, Setting, and Patients We recruited consecutively 31 ARDS survivors and their informal caregivers from medical and surgical intensive care units of an academic medical center and a community hospital. Eight patients died before completing interviews. We conducted semi-structured interviews with 23 ARDS survivors and 24 caregivers three to nine months after ICU admission, stopping enrollment after thematic saturation was reached. Transcripts were analyzed using Colaizzi’s qualitative methodology to identify significant ways in which survivors’ critical illness experience impacted their lives. Measurements and Main Results Participants related five key elements of experience as survivors of ARDS: pervasive memories of critical care, day to day impact of new disability, critical illness defining the sense of self, relationship strain and change, and ability to cope with disability. Survivors described remarkable disability that persisted for months. Caregivers’ interviews revealed substantial strain from caregiving responsibilities, as well as frequent symptom minimization by patients. Conclusions The diverse and unique experiences of ARDS survivors reflect the global impact of severe critical illness. We have identified symptom domains important to ARDS patients that are not well represented in existing health outcomes measures. These insights may aid the development of targeted interventions to enhance recovery and return of function after ARDS. PMID:19865004

  13. Assessment of body cell mass at bedside in critically ill patients.

    PubMed

    Savalle, Magali; Gillaizeau, Florence; Maruani, Gérard; Puymirat, Etienne; Bellenfant, Florence; Houillier, Pascal; Fagon, Jean-Yves; Faisy, Christophe

    2012-08-01

    Critical illness affects body composition profoundly, especially body cell mass (BCM). BCM loss reflects lean tissue wasting and could be a nutritional marker in critically ill patients. However, BCM assessment with usual isotopic or tracer methods is impractical in intensive care units (ICUs). We aimed to modelize the BCM of critically ill patients using variables available at bedside. Fat-free mass (FFM), bone mineral (Mo), and extracellular water (ECW) of 49 critically ill patients were measured prospectively by dual-energy X-ray absorptiometry and multifrequency bioimpedance. BCM was estimated according to the four-compartment cellular level: BCM = FFM - (ECW/0.98) - (0.73 × Mo). Variables that might influence the BCM were assessed, and multivariable analysis using fractional polynomials was conducted to determine the relations between BCM and these data. Bootstrap resampling was then used to estimate the most stable model predicting BCM. BCM was 22.7 ± 5.4 kg. The most frequent model included height (cm), leg circumference (cm), weight shift (?) between ICU admission and body composition assessment (kg), and trunk length (cm) as a linear function: BCM (kg) = 0.266 × height + 0.287 × leg circumference + 0.305 × ?weight - 0.406 × trunk length - 13.52. The fraction of variance explained by this model (adjusted r(2)) was 46%. Including bioelectrical impedance analysis variables in the model did not improve BCM prediction. In summary, our results suggest that BCM can be estimated at bedside, with an error lower than ±20% in 90% subjects, on the basis of static (height, trunk length), less stable (leg circumference), and dynamic biometric variables (?weight) for critically ill patients. PMID:22649067

  14. Management of acute cholecystitis in critically ill patients: contemporary role for cholecystostomy and subsequent cholecystectomy.

    PubMed

    Morse, Bryan C; Smith, J Brandon; Lawdahl, Richard B; Roettger, Richard H

    2010-07-01

    The diagnosis of acute cholecystitis in critically ill patients carries a high mortality rate. Although decompression and drainage of the gallbladder through a cholecystostomy tube may be used as a temporary treatment of acute cholecystitis in this population, there is still some debate about the management of the tube and the subsequent need for a cholecystectomy. This series evaluates the clinical course and outcomes of critically ill patients who underwent the insertion of cholecystostomy tubes for the initial treatment of acute cholecystitis. This is a retrospective review of critically ill patients admitted to the hospital intensive care unit who were diagnosed with acute cholecystitis and underwent a cholecystostomy tube as a temporary treatment for the disease. Patients were identified through the Greenville Hospital System electronic medical records coding database. Medical records were reviewed for demographic data, diagnoses, imaging, complications, and outcomes. From January 2002 through June 2008, 50 patients were identified for the study. The mean age was 72 +/- 11 years, and the majority (66%) were men. The following comorbidities were found: severe cardiovascular disease (40 patients), respiratory failure (30 patients), and multisystem organ dysfunction (30 patients). The mean intensive care unit length of stay (LOS) was 16 +/- 9 days, and the mean hospital LOS was 28 +/- 27 days. At 30 days, the morbidity associated with the cholecystostomy tube itself was 4 per cent, but overall in-hospital morbidity and mortality rates were 62 and 50 per cent, respectively. Of the 25 patients who survived longer than 30 days, 12 retained their cholecystostomy tubes until they underwent cholecystectomy (four open, seven laparoscopic). All of the remaining 13 patients had their cholecystostomy tubes removed, and eight developed recurrent cholecystitis. Of these patients with recurrent of cholecystitis, five had cholecystectomy or repeat cholecystostomy, but the remaining three patients died. Although this is a small patient population, these data suggest that, in critically ill patients, cholecystostomy tubes should remain in place until the patient is deemed medically suitable to undergo cholecystectomy. Removal of the cholecystostomy tube without subsequent cholecystectomy is associated with a high incidence of recurrent cholecystitis and devastating consequences. PMID:20698375

  15. Point-of-care testing in critically ill patients.

    PubMed

    Fries, Dietmar; Streif, Werner

    2015-02-01

    Point-of-care (POC) testing in hemostasis has experienced a significant increase in the spectrum of available tests and the number of tests performed. Short turn-around time and observation of rapid changes in test results are facilitated. The quality control process in POC testing must encompass a preanalytic (collection), analytic (measurement), and postanalytic (clinical response) phase. Erroneous interpretation of findings and difficult quality controls can outweigh the advantages of POC testing.Only a limited number of hemostatic POC tests have proven useful so far: prothrombin time POC-monitoring of oral vitamin K antagonists; activated clotting time POC-monitoring of high-dose heparin therapy; platelet function analyzer (PFA; Siemens, Marburg, Germany) closure time (CT)-detection of von Willebrand disease and severe platelet function defects; whole blood aggregometry (WBA) Multiplate (Roche Diagnostics, Rotkreuz, Switzerland), and the VerifyNow system (Accumetrics, San Diego, CA)-detection of platelet dysfunction due to antiplatelet drugs; thromboelastography-continuous observation of clot formation and fibrinolysis. The use of various agonists in WBA and thromboelastography (TEG) requires some expertise. In experienced hands the PFA CT and WBA and TEG are recommended combinations.Application of POC testing depends strictly on whether it improves medical care and patient outcome. More POC test systems are in the research pipeline, but only a few will resist the ravages of time. PMID:25611850

  16. Failure of lorazepam to treat alprazolam withdrawal in a critically ill patient.

    PubMed

    Sachdev, Gaurav; Gesin, Gail; Christmas, A Britton; Sing, Ronald F

    2014-02-01

    Management of sedation in the critical care unit is an ongoing challenge. Benzodiazepines have been commonly used as sedatives in critically ill patients. The pharmacokinetic and pharmacodynamic properties that make benzodiazepines effective and safe in critical care sedation include rapid onset of action and decreased respiratory depression. Alprazolam is a commonly used benzodiazepine that is prescribed for anxiety and panic disorders. It is frequently prescribed in the outpatient setting. Its use has been reported to result in a relatively high rate of dependence and subsequent withdrawal symptoms. Symptoms of alprazolam withdrawal can be difficult to recognize and treat in the critical care setting. In addition, other benzodiazepines may also be ineffective in treating alprazolam withdrawal. We present a case of alprazolam withdrawal in a critically ill trauma patient who failed treatment with lorazepam and haloperidol. Subsequent replacement with alprazolam resulted in significant improvement in the patient's medication use and clinical status. PMID:24834401

  17. The Effect of Telephone-Facilitated Depression Care on Older, Medically Ill Patients

    PubMed Central

    Pickett, Yolonda R.; Kennedy, Gary J.; Freeman, Katherine; Cummings, Johnine; Woolis, William

    2013-01-01

    The objective of this study was to determine the effectiveness of a telephone-facilitated depression care protocol in older, medically ill adults compared to routine care. A 12-week double blind randomized controlled trial was conducted in recently discharged primary care patients (N=124). Depression was assessed with the Patient Health Questionnaire-9. Primary care providers were notified of the level of depression severity and indications for treatment but neither they nor the patients were contacted by a psychiatrist or other mental health professional. The primary outcome was initiation of treatment. Secondary outcomes were symptoms reduction and depression remission rates. There were no significant outcome differences between the facilitated and routine care groups. This study showed that older, medically ill adults may require a level of depression care that goes beyond a telephone-facilitated protocol. PMID:23572444

  18. Psychosocial experiences in the context of life-threatening illness: The cardiac rehabilitation patient.

    PubMed

    Holder, Gerard N; Young, William C; Nadarajah, Sheeba R; Berger, Ann M

    2014-06-01

    Objective: One of the most prevalent life-threatening illnesses is heart disease. The initial trauma of being diagnosed with a life-threatening illness or having a cardiac event can begin a psychosocial chain reaction that results in a transformation of the lives of these patients. The goal of our study was to investigate the lived experiences of psychosocial healing in rehabilitation of cardiac patients using a qualitative written interview. Method: A purposive sample of 14 cardiac event survivors was recruited. Participants were interviewed after informed consent and screening. We used a qualitative analysis and model-revision approach similar to the procedure outlined by Charmaz (2006). Results: Participants consistently mentioned that a heightened awareness of mortality was a motivating factor that led to participants focusing more on their family and relationships, having an enhanced outlook on life, and making healthy lifestyle changes. Significance of results: If clinicians are able to employ a measure to better understand the nature of a patient's progression from cardiac event to successful recovery, interventions such as cardiac rehabilitation can be implemented earlier and more effectively during the course of the illness and recovery phases of treatment. Theoretically, this early detection of a patient's progression could reduce the time spent recovering from a cardiac event, and it would allow treatments for these conditions to better alleviate the psychosocial concerns faced by patients. PMID:24892820

  19. Assessment of pharmacokinetic changes of meropenem during therapy in septic critically ill patients

    PubMed Central

    2014-01-01

    Background Meropenem is a carbapenem antibiotic commonly used in critically ill patients to treat severe infections. The available pharmacokinetic (PK) data has been mostly obtained from healthy volunteers as well as from clinical studies addressing selected populations, often excluding the elderly and also patients with renal failure. Our aim was to study PK of meropenem in a broader population of septic critically ill patients. Methods We characterized the PK of meropenem in 15 critically ill patients during the first 36 hrs of therapy. Aditionally, whenever possible, we collected a second set of late plasma samples after 5 days of therapy to evaluate PK intra-patient variability and its correlation with clinical course. Patients received meropenem (1 g every 8 hrs IV). Drug plasma profiles were determined by high-performance liquid chromatography. The PK of meropenem was characterized and compared with clinical parameters. Results Fifteen septic critically ill patients (8 male, median age 73 yrs) were included. The geometric mean of the volume of distribution at the steady state (Vss)/weight was 0.20 (0.15-0.27) L/kg. No correlation of Vss/weight with severity or comorbidity scores was found. However the Sequential Organ Failure Assessment score correlated with the Vss/weight of the peripheral compartment (r2?=?0.55, p?=?0.021). The median meropenem clearance (Cl) was 73.3 (45–120) mL/min correlated with the creatinine (Cr) Cl (r2?=?0.35, p?=?0.033). After 5 days (N?=?7) although Vss remained stable, a decrease in the proportion of the peripheral compartment (Vss2) was found, from 61.3 (42.5-88.5)% to 51.7 (36.6-73.1)%. No drug accumulation was noted. Conclusions In this cohort of septic, unselected, critically ill patients, large meropenem PK heterogeneity was noted, although neither underdosing nor accumulation was found. However, Cr Cl correlated to meropenem Cl and the Vss2 decreased with patient’s improvement. PMID:24731745

  20. Hepatitis C Treatment Eligibility and Comorbid Medical Illness in Methadone Maintenance (MMT) and Non-MMT Patients: A Case-Control Study

    Microsoft Academic Search

    Steven L. Batki; Kelly M. Canfield; Emily Smyth; Robert Ploutz-Snyder; Robert A. Levine

    2010-01-01

    Comorbid medical illness is common in patients with chronic hepatitis C (HCV) infection and in methadone treatment (MMT) patients, yet little is known about the impact of medical illness on HCV treatment eligibility. Medical illness and HCV treatment eligibility were compared in a case-control study of 80 MMT patients entering an HCV treatment trial and 80 matched non-MMT patients entering

  1. Systemic varicella-zoster virus infection in two critically ill patients in an intensive care unit

    PubMed Central

    2013-01-01

    Varicella-zoster virus (VZV) usually causes localized zoster in adults. However, in immunocompromised patients, it can cause systemic infection accompanied by complications such as pneumonia, encephalitis, and hepatitis. Although most of critically ill patients in intensive care unit (ICU) are immunologically compromised, they are usually not considered to be at risk for systemic VZV infection. We report two cases of systemic VZV infection occurring in critically ill patients in an ICU. One patient was a 69-year-old man with Streptococcus pneumoniae-induced purpurafulminans, and the other was a 75-year-old woman with severe acute pancreatitis. During the clinical course in the ICU, characteristic vesicles with umbilical fossa appeared diffusely and bilaterally on their face, trunk, and extremities. VZV-specific IgG levels were confirmed to be elevated compared to that of the pre-onset, and a diagnosis of recurrent VZV infection was made in both patients. The patients were treated at the same ICU but did not coincide with each other; therefore a cross-infection was unlikely. They were treated with intravenous acyclovir, but the latter patient eventually died of respiratory failure. VZV infection can cause a number of serious complications, and can lead to death in some patients. Early detection and proper treatment are needed to prevent the infection from spreading out and save the patients. It might be necessary to consider antiviral prophylaxis against VZV infection for a part of critically ill patients in ICU, although the effectiveness of this approach is yet to be established. PMID:23829348

  2. The significance of tubular and glomerular proteinuria in critically ill patients with severe acute kidney injury

    PubMed Central

    Lim, Christopher Thiam Seong; Tan, Han Khim; Lau, Yeow Kok

    2014-01-01

    Objective: Critically ill patients with acute kidney injury (AKI) frequently need acute renal replacement therapy (aRRT). We evaluated an inexpensive, rapid quantitative and qualitative analysis of proteinuria on the course of AKI patients requiring aRRT in intensive care. Method: This was a prospective, observational study of critically ill patients with severe established AKI or Acute on Chronic Kidney Injury (AoCKI) requiring aRRT. Urine samples were analyzed using Sodium-Dodecyl-Sulphate-Polyacryamide Gel Electrophoresis (SDS-PAGE). Results: A total of 30 critically ill patients were studied. Those who died have higher APACHE II (29 ± 6 vs. 20 ± 5, p<0.001), multi-organ failure (0.7 ± 0.5 vs. 0.2 ± 0.4, p < 0.02) and Tubular/Glomerular ratio (114 ± 60 vs. 75± 37, p < 0.05).The renal non-recoverers have higher baseline creatinine (415 ± 328 vs. 125± 19 umol/l, p < 0.01), urinary Dipstick value (1.8±0.8 vs. 0.5±0, p <0.05) and Glomerular score (3.0 ± 1.8 vs. 0.6 ± 0.2, p < 0.02).Heavy tubular proteinuria also predicts a longer duration of interim dialysis support and mortality whereas glomerular proteinuria correlates with development of chronicity and End Stage Renal Disease (ESRD). Conclusions: The dominant presence of tubular proteinuria is associated with poor survival in patients who have high APACHE II score and multi-organ failure. It also correlates with a longer duration of dialysis support in survivals. Renal Non-recoverers had heavy dominant presence of glomerular proteinuria. SDS-PAGE proteinuria analysis offers a reliable and inexpensive method to prognosticate proteinuria in this group of critically ill patients. PMID:25674105

  3. Acute Kidney Injury in Critically Ill Vascular Surgery Patients is Common and Associated with Increased Mortality

    PubMed Central

    Harris, Donald G.; Koo, Grace; McCrone, Michelle P.; Weltz, Adam S.; Chiu, William C.; Sarkar, Rajabrata; Scalea, Thomas M.; Diaz, Jose J.; Lissauer, Matthew E.; Crawford, Robert S.

    2015-01-01

    Introduction: Vascular surgery patients have multiple risk factors for renal dysfunction, but acute kidney injury (AKI) is poorly studied in this group. The purpose of this study was to define the incidence, risk factors, and outcomes of AKI in high-risk vascular patients. Methods: Critically ill vascular surgery patients admitted during January–December 2012 were retrospectively analyzed with 1-year follow-up. The endpoint was AKI by established RIFLE creatinine criteria. The primary analysis was between patients with or without AKI, with secondary analysis of post-operative AKI. Outcomes were inpatient and 1-year mortality, inpatient lengths of stay, and discharge renal function. Results: One-hundred and thirty six vascular surgery patients were included, representing 27% of all vascular surgery admissions during the study period. Sixty-five (48%) developed AKI. Independent global risk factors for AKI were diabetes, increasing critical illness severity, and sepsis. While intraoperative blood loss and hypotension were associated with subsequent renal dysfunction, post-operative AKI rates were similar for patients undergoing aortic, carotid, endovascular, or peripheral vascular procedures. All RIFLE grades of AKI were associated with worse outcomes. Overall, patients with AKI had significantly increased short- and long-term mortality, longer inpatient lengths of stay, and worse discharge renal function. Conclusion: AKI is common among critically ill vascular surgery patients. Importantly, the type of surgical procedure appears to be less important than intra- and perioperative management in determining renal dysfunction. Regardless of its severity, AKI is a clinically significant complication that is associated with substantially worse patient outcomes.

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

    PubMed Central

    Mat Nor, Mohd Basri; Md Ralib, Azrina

    2014-01-01

    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. PMID:24719759

  5. Aspergillus sp. isolated in critically ill patients with extracorporeal membrane oxygenation support.

    PubMed

    Aubron, Cecile; Pilcher, David; Leong, Tim; Cooper, D James; Scheinkestel, Carlos; Pellegrino, Vince; Cheng, Allen C

    2013-09-01

    This study reports Aspergillus isolation in critically ill patients who underwent extracorporeal membrane oxygenation (ECMO) and highlights the difficulty in establishing a diagnosis of aspergillosis in this population. The diagnosis of Aspergillus infection or colonization was retrospectively performed using the proposed modified criteria of the European Organization for Research and Treatment of Cancer and the Mycoses Study Group (EORTC/MSG) adapted to critically ill patients. Between 2005 and 2011, 11 of 151 patients (7.2%) who underwent ECMO had Aspergillus sp. isolates, 10 in a pulmonary sample and 1 in a mediastinal wound sample. Five patients did not have any classical risk factors for aspergillosis. One patient had a proven invasive pulmonary aspergillosis (IPA), 2 had a putative IPA, and 1 patient had a possible Aspergillus mediastinitis, whilst in 7 patients this was considered colonization. However, the clinical relevance of Aspergillus isolation was based on an algorithm not validated in patients undergoing ECMO. Our data support the need to implement non-invasive diagnostic procedures for aspergillosis in this population. PMID:23746344

  6. Predicting red blood cell transfusion in hospitalized patients: role of hemoglobin level, comorbidities, and illness severity

    PubMed Central

    2014-01-01

    Background Randomized controlled trial evidence supports a restrictive strategy of red blood cell (RBC) transfusion, but significant variation in clinical transfusion practice persists. Patient characteristics other than hemoglobin levels may influence the decision to transfuse RBCs and explain some of this variation. Our objective was to evaluate the role of patient comorbidities and severity of illness in predicting inpatient red blood cell transfusion events. Methods We developed a predictive model of inpatient RBC transfusion using comprehensive electronic medical record (EMR) data from 21 hospitals over a four year period (2008-2011). Using a retrospective cohort study design, we modeled predictors of transfusion events within 24 hours of hospital admission and throughout the entire hospitalization. Model predictors included administrative data (age, sex, comorbid conditions, admission type, and admission diagnosis), admission hemoglobin, severity of illness, prior inpatient RBC transfusion, admission ward, and hospital. Results The study cohort included 275,874 patients who experienced 444,969 hospitalizations. The 24 hour and overall inpatient RBC transfusion rates were 7.2% and 13.9%, respectively. A predictive model for transfusion within 24 hours of hospital admission had a C-statistic of 0.928 and pseudo-R2 of 0.542; corresponding values for the model examining transfusion through the entire hospitalization were 0.872 and 0.437. Inclusion of the admission hemoglobin resulted in the greatest improvement in model performance relative to patient comorbidities and severity of illness. Conclusions Data from electronic medical records at the time of admission predicts with very high likelihood the incidence of red blood transfusion events in the first 24 hours and throughout hospitalization. Patient comorbidities and severity of illness on admission play a small role in predicting the likelihood of RBC transfusion relative to the admission hemoglobin. PMID:24884605

  7. Personal Prayer in Patients Dealing with Chronic Illness: A Review of the Research Literature

    PubMed Central

    Jors, Karin; Baumann, Klaus

    2015-01-01

    Background. Prayer is commonly used among patients for health purposes. Therefore, this review focused on three main questions: (1) why do people turn to prayer in times of illness?, (2) what are the main topics of their prayers?, and (3) how do they pray? Method. We undertook a systematic review of the literature by searching the databases PubMed, Medline, and PsycINFO. The following inclusion criteria were used: (1) participants in the study were patients dealing with an illness, (2) the study examined the use of private rather than intercessory prayer, and (3) the content and purpose of prayer rather than its effects were investigated. Results. 16 articles were included in the final review. Participants suffered from a variety of chronic diseases, mostly cancer. Five main categories for the reasons and topics of prayer were found: (1) disease-centered prayer, (2) assurance-centered prayer, (3) God-centered prayer, (4) others-centered prayer, and (5) lamentations. Among these, disease-centered prayer was most common. Conclusions. Although most patients with chronic diseases do pray for relief from their physical and mental suffering, the intention of their prayers is not only for healing. Rather, prayer can be a resource that allows patients to positively transform the experience of their illness.

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

    PubMed Central

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

    2007-01-01

    Introduction Various cohort studies have shown that acute (short-term) mortality rates in unselected critically ill patients may have improved during the past 15 years. Whether these benefits also affect acute and long-term prognosis in chronically critically ill patients is unclear, as are determinants relevant to prognosis. Methods We conducted a retrospective analysis of data collected from March 1993 to February 2005. A cohort of 390 consecutive surgical patients requiring intensive care therapy for more than 28 days was analyzed. Results The intensive care unit (ICU) survival rate was 53.6%. Survival rates at one, three and five years were 61.8%, 44.7% and 37.0% among ICU survivors. After adjustment for relevant covariates, acute and long-term survival rates did not differ significantly between 1993 to 1999 and 1999 to 2005 intervals. Acute prognosis was determined by disease severity during ICU stay and by primary diagnosis. However, only the latter was independently associated with long-term prognosis. Advanced age was an independent prognostic determinant of poor short-term and long-term survival. Conclusion Acute and long-term prognosis in chronically critically ill surgical patients has remained unchanged throughout the past 12 years. After successful surgical intervention and intensive care, long-term outcome is reasonably good and is mainly determined by age and underlying disease. PMID:17504535

  9. A regressional analysis of maladaptive rumination, illness perception and negative emotional outcomes in Asian patients suffering from depressive disorder.

    PubMed

    Lu, Yanxia; Tang, Catherine; Liow, Chiew Shan; Ng, Winnie Wei Ni; Ho, Cyrus Su Hui; Ho, Roger Chun Mun

    2014-12-01

    Although illness perception has been shown to be associated with illness outcomes in various chronic physical diseases, the association of illness perception and rumination are not well elucidated in mental disorders. This study aims to investigate the mediational effects of adaptive and maladaptive rumination in the relationship between illness perception and negative emotions (depression, anxiety and stress) in male and female patients (N=110) suffering from depressive disorders. The results showed that maladaptive rumination mediated the relationship between illness perception and negative emotions in both male and female depressive patients. However, no mediating effects of adaptive rumination were found in the relationship between illness perception and negative emotion. Maladaptive rumination mediated the relationship between perceived identity, chronicity of illness, consequences of illness and emotional representation of illness and negative emotions in males. It also mediated the relationship between perceived identity and emotional representation of illness and negative emotions in females. The results, possible clinical implications and limitations of this study are also discussed. PMID:25440564

  10. Manipulations of the metabolic response for management of patients with severe surgical illness: review.

    PubMed

    Connolly, A B; Vernon, D R

    2000-06-01

    The metabolic response to severe surgical illness is complex and varied. Much recent laboratory and clinical research has focused on increasing our understanding of the metabolic response and the development of new therapies designed to modify this response. Antiinflammatory agents can target harmful aspects of the metabolic response; the immune system can be stimulated; and anabolic factors can be used in an attempt to enhance recovery. The nutritional support of the surgical patient remains crucial, but the effects of new additives are being studied in a variety of surgical conditions. As yet, few of these "novel" agents have found an established role in the management of surgical patients. This review focuses on many "novel" agents or those that do not yet have a clearly defined role in surgical illness. Clinical trials in the areas of severe sepsis, major surgical trauma, and major elective surgery have been emphasized. PMID:10773122

  11. Which Domains of Spirituality are Associated with Anxiety and Depression in Patients with Advanced Illness?

    Microsoft Academic Search

    Kimberly S. Johnson; James A. Tulsky; Judith C. Hays; Robert M. Arnold; Maren K. Olsen; Jennifer H. Lindquist; Karen E. Steinhauser

    2011-01-01

    Background  Anxiety and depression are common in seriously ill patients and may be associated with spiritual concerns. Little research\\u000a has examined how concerns in different domains of spirituality are related to anxiety and depression.\\u000a \\u000a \\u000a \\u000a \\u000a Objective  To examine the association of spiritual history and current spiritual well-being with symptoms of anxiety and depression in\\u000a patients with advanced illness.\\u000a \\u000a \\u000a \\u000a \\u000a Design  Cross-sectional cohort study\\u000a \\u000a \\u000a \\u000a Participants  Two hundred

  12. Stigma of mental illness, religious change, and explanatory models of mental illness among Jewish patients at a mental-health clinic in North Jerusalem

    Microsoft Academic Search

    Daniel D. Rosen; David Greenberg; James Schmeidler; Gaby Shefler

    2008-01-01

    During 3 months in 2004, 38 recent referrals to a Community Mental Health Clinic in North Jerusalem, a substantially Ultra-Orthodox Jewish neighborhood, were evaluated by the Explanatory Model Interview Catalogue. This questionnaire, which includes a 13-item scale measuring stigma towards mental illness, was adapted and translated into Hebrew. Patients with a more religious upbringing expressed a greater sense of stigma

  13. Recommendations for the intra-hospital transport of critically ill patients

    Microsoft Academic Search

    Benoît Fanara; Cyril Manzon; Olivier Barbot; Thibaut Desmettre; Gilles Capellier

    2010-01-01

    INTRODUCTION: This study was conducted to provide Intensive Care Units and Emergency Departments with a set of practical procedures (check-lists) for managing critically-ill adult patients in order to avoid complications during intra-hospital transport (IHT). METHODS: Digital research was carried out via the MEDLINE, EMBASE, CINAHL and HEALTHSTAR databases using the following key words: transferring, transport, intrahospital or intra-hospital, and critically

  14. Clinical application of artificial neural network (ANN) modeling to predict pharmacokinetic parameters of severely ill patients.

    PubMed

    Yamamura, Shigeo

    2003-09-12

    Artificial neural network (ANN) modeling was used to evaluate the pharmacokinetics of aminoglycosides (arbekacin sulfate and amikacin sulfate) in severely ill patients. The plasma level was predicted by ANN modeling using parameters related to the severity of the patient's condition and the predictive performance was shown to be better than could be achieved using multiple regression analysis. These results indicate that there is a non-linear relationship between the pharmacokinetics of aminoglycosides and the severity of the patient's condition, and this should be taken into account when determining the dose for severely ill patients. Patients whose plasma levels are likely to fall below the effective level can be identified by ANN modeling with a predictive sensitivity and specificity superior to multivariate logistic regression analysis. The predictable range should be inferred from the data structure before the modeling in order to improve the predictive performance. The volume of distribution (Vd) in the normal range was weakly predicted by ANN modeling from the patients' data. Prediction of clearance by ANN modeling was poorer than that obtained from serum creatinine concentration by linear regression analysis. These results suggest that the input-output relationship (linear or non-linear) should be taken into account in selecting the modeling method. Linear modeling can give better predictive performance for linear systems and non-linear modeling can give better predictive performance for non-linear systems. In general, the performance of ANN modeling was superior to linear modeling for PK/PD prediction. For accurate modeling, a predictable range should be inferred from the data structure before the analysis. Restriction of the predictable region, as determined from the data structure, produced an increase in prediction performance. When applying ANN modeling in clinical settings, the predictive performance and predictable region should be investigated in detail to avoid the risk of harm to severely ill patients. PMID:12954201

  15. Patients’ Perspectives on Stigma of Mental Illness (an Egyptian Study in a Private Hospital)

    PubMed Central

    Sidhom, Emad; Abdelfattah, Ahmed; Carter, Julie M.; El-Dosoky, Ahmed; El-Islam, Mohamed Fakhr

    2014-01-01

    The present study is concerned with the stigma of mental illness. It examines the subjective element of the experience of stigma among a sample of in-patients with different mental disorders. The sample was taken from consecutive admissions of in-patients meeting International Classification of Diseases, 10th revision (ICD-10) criteria for mental disorders who had capacity to decide on participation in the study and were willing to respond to the structured interview. The study was undertaken in an Egyptian private psychiatric hospital. The structured clinical interview included aspects of the emotional, behavioral, and cognitive effects of having a psychiatric diagnosis on in-patients with various diagnostic labels in an Egyptian psychiatric hospital. It also studied whether this effect changes with specific disorders, total duration of illness, or sociodemographic variables as gender, age, or educational level. The study illustrated the core items of stigmatization attached to the diagnosis of mental illness (1), which more than half of the participants responded affirmatively. The study aimed to explore the most prevailing aspects of stigma or social disadvantage; hoping that this may offer a preliminary guide for clinicians to address these issues in their practice. PMID:25505426

  16. Optimal care and design of the tracheal cuff in the critically ill patient

    PubMed Central

    2014-01-01

    Despite the increasing use of non-invasive ventilation and high-flow nasal-oxygen therapy, intubation is still performed in a large proportion of critically ill patients. The aim of this narrative review is to discuss recent data on long-term intubation-related complications, such as microaspiration, and tracheal ischemic lesions. These complications are common in critically ill patients, and are associated with substantial morbidity and mortality. Recent data suggest beneficial effects of tapered cuffed tracheal tubes in reducing aspiration. However, clinical data are needed in critically ill patients to confirm this hypothesis. Polyurethane-cuffed tracheal tubes and continuous control of cuff pressure could be beneficial in preventing microaspiration and ventilator-associated pneumonia (VAP). However, large multicenter studies are needed before recommending their routine use. Cuff pressure should be maintained between 20 and 30 cmH2O to prevent intubation-related complications. Tracheal ischemia could be prevented by manual or continuous control of cuff pressure. PMID:24572178

  17. El psicólogo ante el enfermo en situación terminal

    Microsoft Academic Search

    M. Pilar Barreto

    Title: The Psychologist in front of the patient in the terminal situation. Abstract: Many old people are victims of incurable illnesses who suffer greatly in the weeks preceeding death. Palliative care is an alternative approach that is really useful for terminal patients. The main aim in palliative care is to ensure the patient's comfort or wellbeing. Psychologists, work- ing in

  18. A qualitative study of decision-making by breast cancer patients about telling their children about their illness

    Microsoft Academic Search

    Saran Yoshida; Hiroyuki Otani; Kei Hirai; Akiko Ogata; Asuka Mera; Shiho Okada; Akira Oshima

    2010-01-01

    Objective  Many breast cancer patients are troubled about telling their school-age children about their illness. However, little attention\\u000a has been paid to the factors that encourage or discourage them from revealing the illness. This study explored decision-making\\u000a by breast cancer patients about telling their children about their illness.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Participants were 30 breast cancer patients recruited from a regional cancer institution in

  19. Use of an Electronic Patient Portal Among the Chronically Ill: An Observational Study

    PubMed Central

    Linna, Miika; Rönkkö, Ilona; Kröger, Virpi

    2014-01-01

    Background Electronic patient portals may enhance effective interaction between the patient and the health care provider. To grasp the full potential of patient portals, health care providers need more knowledge on which patient groups prefer electronic services and how patients should be served through this channel. Objective The objective of this study was to assess how chronically ill patients’ state of health, comorbidities, and previous care are associated with their adoption and use of a patient portal. Methods A total of 222 chronically ill patients, who were offered access to a patient portal with their health records and secure messaging with care professionals, were included in the study. Differences in the characteristics of non-users, viewers, and interactive users of the patient portal were analyzed before access to the portal. Patients’ age, gender, diagnoses, levels of the relevant physiological measurements, health care contacts, and received physiological measurements were collected from the care provider’s electronic health record. In addition, patient-reported health and patient activation were assessed by a survey. Results Despite the broad range of measures used to indicate the patients’ state of health, the portal user groups differed only in their recorded diagnosis for hypertension, which was most common in the non-user group. However, there were significant differences in the amount of care received during the year before access to the portal. The non-user group had more nurse visits and more measurements of relevant physiological outcomes than viewers and interactive users. They also had fewer referrals to specialized care during the year before access to the portal than the two other groups. The viewers and the interactive users differed from each other significantly in the number of nurse calls received, the interactive users having more calls than the viewers. No significant differences in age, gender, or patient activation were detected between the user groups. Conclusions Previous care received by the patient is an important predictor for the use of a patient portal. In a group of patients with a similar disease burden, demand for different types of health services and preferences related to the service channel seem to contribute to the choice to use the patient portal. Further research on patient portal functionalities and their potential to meet patient needs by complementing or substituting for traditional health care services is suggested. PMID:25488754

  20. [Representations on patient illness and cure at the Chemical Dependency Center of the Central Navy Hospital].

    PubMed

    Halpern, Elizabeth Espindola; Leite, Ligia Maria Costa

    2012-04-01

    This article presents one of the segments of ethnographic research which was conducted over a two-year period, by means of participant observation, at the Chemical Dependency Center of the Brazilian Navy. Patients of 2 treatment groups were observed during 24 sessions of group therapy. Among the 22 existing patients of the two groups, 13 patients were randomly selected for individual interviews. Their illness and healing representations related to mental and behavioral disorders caused by drugs were examined, and also the influence of the work environment on patient involvement with drugs was investigated. Results show that patients believe that they are responsible for their illness and for their alcoholic sobriety and they also believe they will never be cured. Furthermore, they do not usually accept the on-going medical discourse or the Alcoholics Anonymous belief that they are recovering alcoholics; they build their own views about their diagnoses, prognoses, and treatments. There are cultural traits particular to the naval life that indicate that the categories analyzed are mainly social, and that certain work-related conditions lead to the emergence of alcoholism in many patients, despite the fact that drugs are commonly tackled from the administrative perspective. PMID:22534861

  1. Host factors and clinical outcomes of Candida colonization in critically ill patients.

    PubMed

    Jacobs, David M; Beyda, Nicholas D; Asuphon, Orarik; Jahangir Alam, M; Garey, Kevin W

    2015-02-01

    This study aimed to describe factors and outcomes associated with Candida colonization of critically ill patients. This was a cross-sectional study conducted over 2 weeks in the intensive care unit (ICU) of a tertiary care hospital at the Texas Medical Center, Houston, TX. All Candida samples were prospectively collected with demographic and clinical data collected retrospectively. We examined 48 patients, 32 (67 %) were colonized with Candida spp; 25 (52.1 %) patients were isolated with Candida albicans and 18 (37.5 %) were isolated with a non-albicans species, mostly commonly Candida glabrata. A multivariate analysis identified proton pump inhibitor administration at admission to ICU [odds ratio 5.66; 95 % confidence interval 1.12-28.5] as associated with colonization. Patients colonized with Candida had a significantly longer length of ICU and hospital stays (7.6 ± 6.6 vs. 4.2 ± 2.6 days, P = 0.01 and 14.9 ± 12.9 vs. 7.5 ± 6.7 days, P = 0.02, respectively). Clonality testing between C. albicans and C. glabrata strains identified indistinguishable strains among the patient cohort. These data provide additional information on Candida colonization in critically ill patients. PMID:25173925

  2. Adverse Hospital Events for Mentally Ill Patients Undergoing Coronary Artery Bypass Surgery

    PubMed Central

    Li, Yue; Glance, Laurent G; Cai, Xueya; Mukamel, Dana B

    2008-01-01

    Context Patients with mental disorders show higher burden of coronary heart disease, and may face special safety issues during in-hospital cardiac care. Objectives To compare the postoperative complication rate between patients with and without mental disorders undergoing isolated coronary artery bypass graft (CABG) surgery. Design, Setting, and Patients Retrospective analyses of New York state hospital claims between 1997 and 2004 (N=135,701). Complications were defined using the Agency for Healthcare Research and Quality Patient Safety Indicators (AHRQ PSI). Principal Findings Mental disorders were significantly associated with higher anesthesia complications (adjusted odds ratio [AOR]=6.44, p<.001), decubitus ulcer (AOR=1.42, p=.006), postoperative hip fracture (AOR=3.29, p<.001), and overall complication rate representing nine PSIs (AOR=1.27, p<.001). Conclusions Mentally ill patients undergoing CABG surgery are more likely to experience potentially preventable complications and injuries. The mechanism underlying this observation warrants further study. PMID:18665856

  3. Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients

    PubMed Central

    2014-01-01

    Introduction Higher body mass index (BMI) is associated with lower mortality in mechanically ventilated critically ill patients. However, it is yet unclear which body component is responsible for this relationship. Methods This retrospective analysis in 240 mechanically ventilated critically ill patients included adult patients in whom a computed tomography (CT) scan of the abdomen was made on clinical indication between 1 day before and 4 days after admission to the intensive care unit. CT scans were analyzed at the L3 level for skeletal muscle area, expressed as square centimeters. Cutoff values were defined by receiver operating characteristic (ROC) curve analysis: 110 cm2 for females and 170 cm2 for males. Backward stepwise regression analysis was used to evaluate low-muscle area in relation to hospital mortality, with low-muscle area, sex, BMI, Acute Physiologic and Chronic Health Evaluation (APACHE) II score, and diagnosis category as independent variables. Results This study included 240 patients, 94 female and 146 male patients. Mean age was 57 years; mean BMI, 25.6 kg/m2. Muscle area for females was significantly lower than that for males (102?±?23 cm2 versus 158?±?33 cm2; P?patients for both females and males. Mortality was 29%, significantly higher in females than in males (37% versus 23%; P?=?0.028). Low-muscle area was associated with higher mortality compared with normal-muscle area in females (47.5% versus 20%; P?=?0.008) and in males (32.3% versus 7.5%; P?patients, muscle mass appeared as primary predictor, not sex. Conclusions Low skeletal muscle area, as assessed by CT scan during the early stage of critical illness, is a risk factor for mortality in mechanically ventilated critically ill patients, independent of sex and APACHE II score. Further analysis suggests muscle mass as primary predictor, not sex. BMI is not an independent predictor of mortality when muscle area is accounted for. PMID:24410863

  4. Effectiveness of antibiotic prophylaxis in critically ill adult patients: systematic review of randomised controlled trials

    PubMed Central

    D’Amico, Roberto; Pifferi, Silvia; Leonetti, Cinzia; Torri, Valter; Tinazzi, Angelo; Liberati, Alessandro

    1998-01-01

    Objective: To determine whether antibiotic prophylaxis reduces respiratory tract infections and overall mortality in unselected critically ill adult patients. Design: Meta-analysis of randomised controlled trials from 1984 and 1996 that compared different forms of antibiotic prophylaxis used to reduce respiratory tract infections and mortality with aggregate data and, in a subset of trials, data from individual patients. Subjects: Unselected critically ill adult patients; 5727 patients for aggregate data meta-analysis, 4343 for confirmatory meta-analysis with data from individual patients. Main outcome measures: Respiratory tract infections and total mortality. Results: Two categories of eligible trials were defined: topical plus systemic antibiotics versus no treatment and topical preparation with or without a systemic antibiotic versus a systemic agent or placebo. Estimates from aggregate data meta-analysis of 16 trials (3361 patients) that tested combined treatment indicated a strong significant reduction in infection (odds ratio 0.35; 95% confidence interval 0.29 to 0.41) and total mortality (0.80; 0.69 to 0.93). With this treatment five and 23 patients would need to be treated to prevent one infection and one death, respectively. Similar analysis of 17 trials (2366 patients) that tested only topical antibiotics indicated a clear reduction in infection (0.56; 0.46 to 0.68) without a significant effect on total mortality (1.01; 0.84 to 1.22). Analysis of data from individual patients yielded similar results. No significant differences in treatment effect by major subgroups of patients emerged from the analyses. Conclusions: This meta-analysis of 15 years of clinical research suggests that antibiotic prophylaxis with a combination of topical and systemic drugs can reduce respiratory tract infections and overall mortality in critically ill patients. This effect is significant and worth while, and it should be considered when practice guidelines are defined. Key messages Over 40% of patients who need ventilation in intensive care develop respiratory tract infections and about 30% may die in the units If the most effective antibiotic prophylaxis (that is, a protocol combining topical and systemic antibiotics) is used the incidence of respiratory tract infections can be reduced by 65% and total mortality by 20% A regimen of topical antibiotics alone reduces respiratory tract infections but does not influence survival The concern that widespread antibiotic use may lead to resistance cannot be confirmed or ruled out by this review. Trials with different design are probably warranted to handle this question This important effect of antibiotic prophylaxis with a combination of topical and systemic antibiotics on survival should be considered by intensivists when treatment policies are designed PMID:9554897

  5. Patient Assessment of Chronic Illness Care, Glycemic Control and the Utilization of Community Health Care among the Patients with Type 2 Diabetes in Shanghai, China

    PubMed Central

    Liu, Li-Juan; Li, Yun; Sha, Kun; Wang, Yue; He, Xiang

    2013-01-01

    Objectives To evaluate the relationship between Patient Assessment of Chronic Illness Care in community health centers and self-management behaviors and glycemic control and to examine the relationship between Patient Assessment of Chronic Illness Care in community health centers and the utilization of community health centers for monitoring and treating diabetes among the patients with type 2 diabetes. Methods A questionnaire including self-management behaviors, glycemic control, Patient Assessment of Chronic Illness Care in community health centers and the most often utilized medical institutions for monitoring and treating diabetes (community health centers vs. hospitals) was administered to 960 patients with type 2 diabetes in Shanghai, China. The relationships between Patient Assessment of Chronic Illness Care and self-management behaviors, self-management behaviors and glycemic control, Patient Assessment of Chronic Illness Care and glycemic control, Patient Assessment of Chronic Illness Care and the most often utilized medical institutions for monitoring and treating diabetes were examined. Results Wilcoxon rank sum tests showed that the high scores of total Patient Assessment of Chronic Illness Care and five subscales in community health centers were positively related to almost all the proper self-management behaviors and good glycemic control (p<0.05). Almost all of the proper self-management behaviors were positively related to good glycemic control (p<0.01). High summary score of the Patient Assessment of Chronic Illness Care was positively associated with the utilization of community health centers for monitoring and treating diabetes (p<0.001). Conclusions Patient Assessment of Chronic Illness Care (implementation of the Chronic Care Model) in community health centers was associated with patients' self-management behaviors and glycemic control, and finally was associated with the utilization of community health centers for monitoring and treating diabetes. PMID:24039847

  6. Clergy-laity support and patients’ mood during serious illness: A cross-sectional epidemiologic study

    PubMed Central

    Hays, Judith C.; Wood, Laura; Steinhauser, Karen; Olson, Maren K.; Lindquist, Jennifer H.; Tulsky, James

    2013-01-01

    Objectives Religious participation is positively associated with mental health, but attendance at worship services declines during serious illness. This study assessed whether home visits by clergy or laity provide benefits to seriously ill patients who may have difficulty attending religious services. Design and sample A cross-sectional study design nested in an observational epidemiologic cohort study. The regionally-representative sample of patients had metastatic lung, colorectal, breast, and prostate cancer (n=70), Class III and IV congestive heart failure (n=70), or chronic obstructive pulmonary disease with hypercapnea (n=70) and observed regarding clergy-laity support in their naturalistic environments. Measures Dependent variable: 10-item Center for Epidemiologic Studies – Depression scale. Independent variable: A one-item question measuring how much helpful support patients received from clergy or other persons from church, temple, synagogue, or mosque Covariates: demographic, health, social support, religiousness. Analysis Descriptive, bivariate, and general linear models Results Depressed mood was negatively associated with clergy-laity support in a non-linear pattern. Depressed mood was also positively associated with functional deficits and a lifetime history of difficulties related to religious involvement. Conclusions In lieu of worship attendance when people are sick, home visits by members of a patient’s religious community may bolster mood by providing continuity of instrumental, emotional, and spiritual support. PMID:21838948

  7. Internalized stigma and its psychosocial correlates in Korean patients with serious mental illness.

    PubMed

    Kim, Woo Jung; Song, Youn Joo; Ryu, Hyun-Sook; Ryu, Vin; Kim, Jae Min; Ha, Ra Yeon; Lee, Su Jin; Namkoong, Kee; Ha, Kyooseob; Cho, Hyun-Sang

    2015-02-28

    We aimed to examine internalized stigma of patients with mental illness in Korea and identify the contributing factors to internalized stigma among socio-demographic, clinical, and psychosocial variables using a cross-sectional study design. A total of 160 patients were recruited from a university mental hospital. We collected socio-demographic data, clinical variables and administered self-report scales to measure internalized stigma and levels of self-esteem, hopelessness, social support, and social conflict. Internalized stigma was identified in 8.1% of patients in our sample. High internalized stigma was independently predicted by low self-esteem, high hopelessness, and high social conflict among the psychosocial variables. Our finding suggests that simple psychoeducation only for insight gaining cannot improve internalized stigma. To manage internalized stigma in mentally ill patients, it is needed to promote hope and self-esteem. We also suggest that a relevant psychosocial intervention, such as developing coping skills for social conflict with family, can help patients overcome their internalized stigma. PMID:25554354

  8. Levosimendan versus dobutamine in critically ill patients: a meta-analysis of randomized controlled trials

    PubMed Central

    Huang, Xuan; Lei, Shu; Zhu, Mei-fei; Jiang, Rong-lin; Huang, Li-quan; Xia, Guo-lian; Zhi, Yi-hui

    2013-01-01

    Objective: To evaluate the clinical efficacy of levosimendan versus dobutamine in critically ill patients requiring inotropic support. Methods: Clinical trials were searched in PubMed, EMBASE, and the Cochrane Central Registry of Clinical Trials, as well as Web of Science. Studies were included if they compared levosimendan with dobutamine in critically ill patients requiring inotropic support, and provided at least one outcome of interest. Outcomes of interest included mortality, incidence of hypotension, supraventricular arrhythmias, and ventricular arrhythmias. Results: Data from a total of 3 052 patients from 22 randomized controlled trials (RCTs) were included in the analysis. Overall analysis showed that the use of levosimendan was associated with a significant reduction in mortality (269 of 1 373 [19.6%] in the levosimendan group, versus 328 of 1 278 [25.7%] in the dobutamine group, risk ratio (RR)=0.81, 95% confidence interval (CI) 0.70–0.92, P for effect=0.002). Subgroup analysis indicated that the benefit from levosimendan could be found in the subpopulations of cardiac surgery, ischemic heart failure, and concomitant ?-blocker therapy in comparison with dobutamine. There was no significant difference in the incidence of hypotension, supraventricular arrhythmias, or ventricular arrhythmias between the two drugs. Conclusions: In contrast with dobutamine, levosimendan is associated with a significant improvement in mortality in critically ill patients requiring inotropic support. Patients having cardiac surgery, with ischemic heart failure, and receiving concomitant ?-blocker therapy may benefit from levosimendan. More RCTs are required to address the questions about no positive outcomes in the subpopulation in a cardiology setting, and to confirm the advantages in long-term prognosis. PMID:23645177

  9. Predicting In-Hospital Mortality among Critically-Ill Patients with End-Stage Liver Disease

    PubMed Central

    Balekian, Alex A.; Gould, Michael K.

    2012-01-01

    Purpose Critically-ill patients with end-stage liver disease (ESLD) are at high risk for death during intensive care unit (ICU) hospitalization, and currently available prognostic models have limited accuracy in this population. We aimed to identify variables associated with in-hospital mortality among critically-ill ESLD patients, and to develop and validate a simple, parsimonious model for bedside use. Materials and Methods We performed a retrospective chart review of 653 ICU admissions for ESLD patients; modeled in-hospital mortality using multivariable logistic regression; and compared the predictive ability of several different models using the area under receiver operating characteristic (AU-ROC) curves. Results Multivariable predictors of in-hospital mortality included Model for End-stage Liver Disease (MELD) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score, mechanical ventilation, and gender; there was also an interaction between MELD score and gender (p<0.02). MELD alone had better discrimination (AU-ROC 0.83) than APACHE II alone (AU-ROC 0.76), and adding mechanical ventilation to MELD achieved the single largest increase in model discrimination (AU-ROC 0.85; p<0.01). In a parsimonious, two-predictor model, higher MELD scores (OR 1.14 per 1-point increase; 95% CI 1.11 – 1.16), and mechanical ventilation (OR 6.20; 95% CI 3.05 – 12.58) were associated with increased odds of death. Model discrimination was also excellent in the validation cohort (AU-ROC 0.90). Conclusions In critically-ill ESLD patients, a parsimonious model including only MELD and mechanical ventilation is more accurate than APACHE II alone for predicting in-hospital mortality. This simple bedside model can provide clinicians and patients with valuable prognostic information for medical decision-making. PMID:23059012

  10. Endogenous glutamine production in critically ill patients: the effect of exogenous glutamine supplementation

    PubMed Central

    2014-01-01

    Introduction Glutamine rate of appearance (Ra) may be used as an estimate of endogenous glutamine production. Recently a technique employing a bolus injection of isotopically labeled glutamine was introduced, with the potential to allow for multiple assessments of the glutamine Ra over time in critically ill patients, who may not be as metabolically stable as healthy individuals. Here the technique was used to evaluate the endogenous glutamine production in critically ill patients in the fed state with and without exogenous glutamine supplementation intravenously. Methods Mechanically ventilated patients (n?=?11) in the intensive care unit (ICU) were studied on two consecutive days during continuous parenteral feeding. To allow the patients to be used as their own controls, they were randomized for the reference measurement during basal feeding without supplementation, before or after the supplementation period. Glutamine Ra was determined by a bolus injection of 13C-glutamine followed by a period of frequent sampling to establish the decay-curve for the glutamine tracer. Exogenous glutamine supplementation was given by intravenous infusion of a glutamine containing dipeptide, L-alanyl-L-glutamine, 0.28 g/kg during 20 hours. Results A 14% increase of endogenous glutamine Ra was seen at the end of the intravenous supplementation period as compared to the basal measurements (P?=?0.009). Conclusions The bolus injection technique to measure glutamine Ra to estimate the endogenous production of glutamine in critically ill patients was demonstrated to be useful for repetitive measurements. The hypothesized attenuation of endogenous glutamine production during L-alanyl-L-glutamine infusion given as a part of full nutrition was not seen. PMID:24731231

  11. Effects of paracentesis on hemodynamic parameters and respiratory function in critically ill patients

    PubMed Central

    2014-01-01

    Background Ascites is a major and common complication of liver cirrhosis. Large or refractory ascites frequently necessitates paracentesis. The aim of our study was to investigate the effects of paracentesis on hemodynamic and respiratory parameters in critically ill patients. Methods Observational study comparing hemodynamic and respiratory parameters before and after paracentesis in 50 critically ill patients with advanced hemodynamic monitoring. 28/50 (56%) required mechanical ventilation. Descriptive statistics are presented as mean?±?standard deviation for normally distributed data and median, range, and interquartile range (IQR) for non-normally distributed data. Comparisons of hemodynamic and respiratory parameters before and after paracentesis were performed by Wilcoxon signed-rank tests. Bivariate relations were assessed by Spearman’s correlation coefficient and univariate regression analyses. Results Median amount of ascites removed was 5.99 L (IQR, 3.33-7.68 L). There were no statistically significant changes in hemodynamic parameters except a decrease in mean arterial pressure (-7 mm Hg; p?=?0.041) and in systemic vascular resistance index (-116 dyne·sec/cm5/m2; p?=?0.016) when measured 2 hours after paracentesis. In all patients, oxygenation ratio (PaO2/FiO2; median, 220 mmHg; IQR, 161–329 mmHg) increased significantly when measured immediately (+58 mmHg; p?=?0.001), 2 hours (+9 mmHg; p?=?0.004), and 6 hours (+6 mmHg); p?=?0.050) after paracentesis. In mechanically ventilated patients, lung injury score (cumulative points without x-ray; median, 6; IQR, 4–7) significantly improved immediately (5; IQR, 4–6; p?ill patients is safe regarding circulatory function and is related to immediate and sustained improvement of respiratory function. PMID:24467993

  12. Technology-based interventions for psychiatric illnesses: improving care, one patient at a time.

    PubMed

    Ben-Zeev, D

    2014-12-01

    Worldwide, individuals with severe psychiatric illnesses struggle to receive evidence-based care. While science has made remarkably slow progress in the development and implementation of effective psychiatric treatments, we have witnessed enormous progress in the emergence and global penetration of personal computing technology. The present paper examines how digital resources that are already widespread (e.g., smartphones, laptop computers), can be leveraged to support psychiatric care. These instruments and implementation strategies can increase patient access to evidenced-based care, help individuals overcome the barriers associated with the stigma of mental illness, and facilitate new treatment paradigms that harness wireless communication, sensors and the Internet, to enhance treatment potency. Innovative digital treatment programmes that have been used successfully with a range of conditions (i.e., schizophrenia, posttraumatic stress disorder and borderline personality disorder) are presented in the paper to demonstrate the utility and potential impact of technology-based interventions in the years ahead. PMID:25046343

  13. [Ill due to amalgam? 10 rules for managing the symptomatic patient].

    PubMed

    Bailer, J; Staehle, H J; Rist, F

    2003-08-21

    Over the past two decades, mercury released by amalgam fillings has been held responsible for a number of mental and somatic health complaints. However, a systematic relation between increased mercury levels and the severity of the reported symptoms has never been demonstrated in any of the present well-controlled multidisciplinary studies. These studies, however, have found a high prevalence of mental disorders, especially somatization syndromes, among patients with self-diagnosed "amalgam illness". Additionally, our own studies indicate that amalgam anxiety is often merely one aspect of a general environmental anxiety. Overall, the present findings suggest a psychological etiology for amalgam-related complaints. Our psychosomatic model of "amalgam illness" integrates external factors, individual predispositions and specific processes of perception, awareness, evaluation and attribution. Practical management strategies for primary care physicians can be derived from this model. PMID:14526572

  14. Birthdates of patients affected by mental illness and solar activity: A study from Italy

    NASA Astrophysics Data System (ADS)

    Ventriglio, Antonio; Borelli, Albacenzina; Bellomo, Antonello; Lepore, Alberto

    2011-04-01

    PurposeThis epidemiologic study tested an hypothesized association between the year of birth of persons with major mental illnesses and solar activity over the past century. MethodsWe collected data on diagnoses and birthdates of psychiatric patients born between 1926 and 1975 (N = 1954) in south Italy for comparison to yearly solar activity as registered by the International Observatories. ResultsWe found a strong inverse correlation between high solar activity (HSA) and incidence of schizophrenia and bipolar disorder in a 20-year period whereas the incidence of non-affective/non-psychotic disorders was moderately associated with HSA in the same period. ConclusionsInterpretation of the observed correlations between HSA during years of birth and the incidence of mental illnesses remains unclear, but the findings encourage further study.

  15. Newly identified psychiatric illness in one general practice: 12-month outcome and the influence of patients' personality.

    PubMed Central

    Wright, A F; Anderson, A J

    1995-01-01

    BACKGROUND. Relatively little is known about the natural history and outcome of psychological problems in patients who present to general practitioners. Only a small proportion of such patients are seen by specialists. Clinical experience suggests that patient personality is one of the factors influencing outcome in patients diagnosed as having psychiatric illness. AIM. This study set out to examine prospectively the progress and 12-month outcome of patients with newly identified psychiatric illness, and the association of patients' personality with outcome. METHOD. One hundred and seventy one patients with clinically significant psychiatric illness attending one practice in a Scottish new town were followed up prospectively (96 presented with psychological symptoms and 75 with somatic symptoms), and were compared with a group of 127 patients with chronic physical illness. Patients were assessed in terms of psychiatric state, social problems and personality using both computer-based and pencil and paper tests in addition to clinical assessments at each consultation during the follow-up year and structured interview one year after recruitment. RESULTS. Most of the improvement in psychiatric state scores on the 28-item general health questionnaire occurred in the first six months of the illness. Of the 171 patients with psychiatric illness 34% improved quickly and remained well, 54% had an intermittent course but had improved at 12-month follow up while 12% pursued a chronic course without improvement. The mean number of consultations in the follow-up year was 8.4 for patients presenting with psychological symptoms, 7.2 for those presenting with somatic symptoms and 6.6 for patients with chronic physical illness. The Eysenck N score proved a strong predictor of the outcome of new psychiatric illness. CONCLUSION. Only one in three patients with newly identified psychiatric illness improved quickly and and remained well, reflecting the importance of continuing care of patients with psychological problems. This study has confirmed the feasibility of simple personality testing in everyday practice and shown a link between Eysenck N score and the outcome of new psychiatric illness. The predictive value of the Eysenck N score in general practice requires further research. PMID:7702888

  16. Autonomic activity, pain, and perceived health in patients on sick leave due to stress-related illnesses

    Microsoft Academic Search

    Marina Heiden; Margareta Barnekow-Bergkvist; Minori Nakata; Eugene Lyskov

    2005-01-01

    Objective: The aim of the present study was to compare autonomic activity, pressure-pain thresholds, and subjective assessments of\\u000a health and behavior between patients with stress-related illnesses and healthy control subjects.Methods: Twenty sick-listed patients with stress-related illnesses and 20 age- and gender-matched healthy subjects performed tests\\u000a of autonomic regulation and algometric tests, and completed questionnaires about physical and mental health and

  17. Respiratory muscle dysfunction: a multicausal entity in the critically ill patient undergoing mechanical ventilation.

    PubMed

    Díaz, Magda C; Ospina-Tascón, Gustavo A; Salazar C, Blanca C

    2014-02-01

    Respiratory muscle dysfunction, particularly of the diaphragm, may play a key role in the pathophysiological mechanisms that lead to difficulty in weaning patients from mechanical ventilation. The limited mobility of critically ill patients, and of the diaphragm in particular when prolonged mechanical ventilation support is required, promotes the early onset of respiratory muscle dysfunction, but this can also be caused or exacerbated by other factors that are common in these patients, such as sepsis, malnutrition, advanced age, duration and type of ventilation, and use of certain medications, such as steroids and neuromuscular blocking agents. In this review we will study in depth this multicausal origin, in which a common mechanism is altered protein metabolism, according to the findings reported in various models. The understanding of this multicausality produced by the same pathophysiological mechanism could facilitate the management and monitoring of patients undergoing mechanical ventilation. PMID:23669061

  18. Assessment of candidemia-attributable mortality in critically ill patients using propensity score matching analysis

    PubMed Central

    2012-01-01

    Introduction Candidemia in critically ill patients is usually a severe and life-threatening condition with a high crude mortality. Very few studies have focused on the impact of candidemia on ICU patient outcome and attributable mortality still remains controversial. This study was carried out to determine the attributable mortality of ICU-acquired candidemia in critically ill patients using propensity score matching analysis. Methods A prospective observational study was conducted of all consecutive non-neutropenic adult patients admitted for at least seven days to 36 ICUs in Spain, France, and Argentina between April 2006 and June 2007. The probability of developing candidemia was estimated using a multivariate logistic regression model. Each patient with ICU-acquired candidemia was matched with two control patients with the nearest available Mahalanobis metric matching within the calipers defined by the propensity score. Standardized differences tests (SDT) for each variable before and after matching were calculated. Attributable mortality was determined by a modified Poisson regression model adjusted by those variables that still presented certain misalignments defined as a SDT > 10%. Results Thirty-eight candidemias were diagnosed in 1,107 patients (34.3 episodes/1,000 ICU patients). Patients with and without candidemia had an ICU crude mortality of 52.6% versus 20.6% (P < 0.001) and a crude hospital mortality of 55.3% versus 29.6% (P = 0.01), respectively. In the propensity matched analysis, the corresponding figures were 51.4% versus 37.1% (P = 0.222) and 54.3% versus 50% (P = 0.680). After controlling residual confusion by the Poisson regression model, the relative risk (RR) of ICU- and hospital-attributable mortality from candidemia was RR 1.298 (95% confidence interval (CI) 0.88 to 1.98) and RR 1.096 (95% CI 0.68 to 1.69), respectively. Conclusions ICU-acquired candidemia in critically ill patients is not associated with an increase in either ICU or hospital mortality. PMID:22698004

  19. Care for patients with severe mental illness: the general practitioner's role perspective

    PubMed Central

    Oud, Marian JT; Schuling, Jan; Slooff, Cees J; Groenier, Klaas H; Dekker, Janny H; Meyboom-de Jong, Betty

    2009-01-01

    Background Patients with severe mental illness (SMI) experience distress and disabilities in several aspects of life, and they have a higher risk of somatic co-morbidity. Both patients and their family members need the support of an easily accessible primary care system. The willingness of general practitioners and the impeding factors for them to participate in providing care for patients with severe mental illness in the acute and the chronic or residual phase were explored. Methods A questionnaire survey of a sample of Dutch general practitioners spread over the Netherlands was carried out. This comprised 20 questions on the GP's 'Opinion and Task Perspective', 19 questions on 'Treatment and Experiences', and 27 questions on 'Characteristics of the General Practitioner and the Practice Organisation'. Results 186 general practitioners distributed over urban areas (49%), urbanised rural areas (38%) and rural areas (15%) of the Netherlands participated. The findings were as follows: GPs currently considered themselves as the first contact in the acute psychotic phase. In the chronic or residual phase GPs saw their core task as to diagnose and treat somatic co-morbidity. A majority would be willing to monitor the general health of these patients as well. It appeared that GP trainers and GPs with a smaller practice setting made follow-up appointments and were willing to monitor the self-care of patients with SMI more often than GPs with larger practices. GPs also saw their role as giving support and information to the patient's family. However, they felt a need for recognition of their competencies when working with mental health care specialists. Conclusion GPs were willing to participate in providing care for patients with SMI. They considered themselves responsible for psychotic emergency cases, for monitoring physical health in the chronic phase, and for supporting the relatives of psychotic patients. PMID:19419547

  20. The Pursuit of Preventive Care for Chronic Illness: Turning Healthy People into Chronic Patients

    PubMed Central

    Kreiner, Meta J.; Hunt, Linda M.

    2013-01-01

    Preventive health care has become prominent in clinical medicine in the United States, emphasizing risk assessment and control, rather than addressing the signs and symptoms of pathology. Current clinical guidelines, reinforced by evidence-based decision aids and quality of care assessment, encourage clinicians to focus on maintaining rigid test thresholds which are based on population norms. While achieving these goals may benefit the total population, this may be of no benefit or even harmful to individual patients. In order to explore how this phenomenon is manifest in clinical care, and consider some factors that promote and sustain this trend, we analyze observations of over 100 clinical consultations, and open-ended interviews with 58 primary care clinicians and 70 of their patients. Both clinicians and patients equated at-risk states with illness, and viewed the associated interventions not as prevention, but as treatment. This conflation of risk and disease redefines clinical success such that reducing the threat of anticipated future illness requires acceptance of aggressive treatments and any associated adverse effects in the present. While the expanding emphasis on preventive medicine may improve the health profile of the total population, the implications of these innovations for the well-being of individual patients merits careful reconsideration. PMID:24372285

  1. Comparing illness presentation, treatment and functioning between patients with adolescent- and adult-onset psychosis.

    PubMed

    Hui, Christy Lai-Ming; Li, Adrienne Wing-Yee; Leung, Chung-Ming; Chang, Wing-Chung; Chan, Sherry Kit-Wa; Lee, Edwin Ho-Ming; Chen, Eric Yu-Hai

    2014-12-30

    Studies have shown that early- and adult-onset schizophrenia patients differ in pre-morbid traits, illness presentation, psychopathology, and prognosis. We aimed to compare adult-onset patients (age range 26-55 years) with an adolescent-onset cohort (15-25 years) in demographics, illness presentation and functioning at baseline. Participants were from two territory-wide early intervention services for adolescent-onset (n=671) and adult-onset psychosis patients (n=360) in Hong Kong. The adolescent-onset cohort had their initial psychotic episode from 2001-2003; retrospective data collection was done through systematic case note review. The adult-onset cohort was recruited for a larger interventional study from 2009-2011; information was collected via face-to-face interviews. Adult-onset psychosis was significantly associated with more females, more smokers, more non-local birth, more full-time employment, better functioning, poorer medication adherence, more psychiatric hospitalization and fewer with schizophrenia than adolescent-onset psychosis (mean age: 20.4). The effect sizes were small, except for medication adherence where a robust effect was found. No group difference in DUP was found. The finding that adult-onset patients had better functioning challenges the view that adolescent- and adult-onset psychoses share a similar prognostic trajectory. Implications for adapting intervention processes for adolescent- and adult-onset psychosis are discussed. PMID:25238985

  2. Aspergillus tracheobronchitis in critically ill patients with chronic obstructive pulmonary diseases.

    PubMed

    He, Hangyong; Jiang, Shan; Zhang, Li; Sun, Bing; Li, Fang; Zhan, Qingyuan; Wang, Chen

    2014-08-01

    Aspergillus tracheobronchitis (ATB) is considered as an unusual form of invasive aspergillosis and has a fatal outcome. There is little current information on several aspects of chronic obstructive pulmonary diseases (COPD) complicated by ATB, the frequency of which is expected to increase in the coming years. In a prospective study of invasive bronchial-pulmonary aspergillosis (IBPA) in a critically ill COPD population, three proven cases of ATB were identified. The three new cases, combined with eight previously reported cases of COPD with ATB over a 30-year period (1983-2013), were analysed. Among 153 critically ill COPD patients admitted to the ICU, eight cases were complicated by ATB [23.5% of IBPA (8 of 34); and 5.2% of COPD (8 of 153)], and three cases were finally diagnosed as proven ATB by histopathological findings. Among the three new cases reported and the eight published cases, the overall mortality rate was 72.7% (8 of 11 cases), with a median of 11.5 days (range, 7-27 days) between admission to death. The mortality rate was significantly higher in patients with invasive pulmonary aspergillosis (IPA) [100% (8 of 8 patients)] than in patients without parenchyma invasion [0% (0 of 3 patient), P = 0.006]. Seven patients (77.8%) received systemic corticosteroid therapy and three patients (33.3%) inhaled corticosteroids before diagnosis with ATB. Dyspnoea resistant to corticosteroids (77.8%) was the most frequent symptom. The radiological manifestations progressed rapidly in three patients (75%) who had normal chest X-rays (CXRs) at admission. Pseudomembranous lesions were the most frequent form (54.5%) observed by bronchoscopy. Aspergillus fumigatus was the most frequently isolated pathogen (40%). ATB is an uncommon cause of exacerbation in approximately 5% of critically ill COPD patients admitted to the ICU, and may progress rapidly to IPA with a high mortality rate. Dyspnoea resistant to corticosteroids and appropriate antibiotics with a negative CXR should raise the suspicion of ATB. Early diagnosis of ATB is based on bronchoscopic examination and proven diagnosis maybe safely established with a bronchial mucous biopsy. PMID:24673772

  3. Mobile teleradiology with smartphone terminals as a part of a multimedia electronic patient record

    Microsoft Academic Search

    J. Reponen; J. Niinimäki; T. Kumpulainen; E. Ilkko; A. Karttunen; P. Jartti

    2005-01-01

    Electronic patient record (EPR) and picture archiving and communication systems (PACS) can be connected to wireless terminals which deliver information to the point of care. We present our experiences with mobile teleradiology using special type mobile phones: smartphones and personal digital assistants (PDA) with phone functions. According to the results, these terminals are feasible for emergency situations and mainly for

  4. Can Transthoracic Echocardiography Be Used to Predict Fluid Responsiveness in the Critically Ill Patient? A Systematic Review

    PubMed Central

    Mandeville, Justin C.; Colebourn, Claire L.

    2012-01-01

    Introduction. We systematically evaluated the use of transthoracic echocardiography in the assessment of dynamic markers of preload to predict fluid responsiveness in the critically ill adult patient. Methods. Studies in the critically ill using transthoracic echocardiography (TTE) to predict a response in stroke volume or cardiac output to a fluid load were selected. Selection was limited to English language and adult patients. Studies on patients with an open thorax or abdomen were excluded. Results. The predictive power of diagnostic accuracy of inferior vena cava diameter and transaortic Doppler signal changes with the respiratory cycle or passive leg raising in mechanically ventilated patients was strong throughout the articles reviewed. Limitations of the technique relate to patient tolerance of the procedure, adequacy of acoustic windows, and operator skill. Conclusions. Transthoracic echocardiographic techniques accurately predict fluid responsiveness in critically ill patients. Discriminative power is not affected by the technique selected. PMID:22400109

  5. Broad-spectrum ?-lactams in obese non-critically ill patients

    PubMed Central

    Hites, M; Taccone, F S; Wolff, F; Maillart, E; Beumier, M; Surin, R; Cotton, F; Jacobs, F

    2014-01-01

    Objectives: Obesity may alter the pharmacokinetics of ?-lactams. The goal of this study was to evaluate if and why serum concentrations are inadequate when standard ?-lactam regimens are administered to obese, non-critically ill patients. Subjects and methods: During first year, we consecutively included infected, obese patients (body mass index (BMI) ?30?kg?m?2) who received meropenem (MEM), piperacillin-tazobactam (TZP) or cefepime/ceftazidime (CEF). Patients with severe sepsis or septic shock, or those hospitalized in the intensive care unit were excluded. Serum drug concentrations were measured twice during the elimination phase by high-performance liquid chromatography. We evaluated whether free or total drug concentrations were >1 time (fT>minimal inhibition concentration (MIC)) or >4 times (T>4MIC) the clinical breakpoints for Pseudomonas aeruginosa during optimal periods of time: ?40% for MEM, ?50% for TZP and ?70% for CEF. Results: We included 56 patients (median BMI: 36?kg?m?2): 14 received MEM, 31 TZP and 11 CEF. The percentage of patients who attained target fT>MIC and T>4MIC were 93% and 21% for MEM, 68% and 19% for TZP, and 73% and 18% for CEF, respectively. High creatinine clearance (107 (range: 6–398) ml?min?1) was the only risk factor in univariate and multivariate analyses to predict insufficient serum concentrations. Conclusions: In obese, non-critically ill patients, standard drug regimens of TZP and CEF resulted in insufficient drug concentrations to treat infections due to less susceptible bacteria. Augmented renal clearance was responsible for these low serum concentrations. New dosage regimens need to be explored in this patient population (EUDRA-CT: 2011-004239-29). PMID:24956136

  6. A case of masked toxic adenoma in a patient with non-thyroidal illness

    PubMed Central

    2014-01-01

    Background Non-thyroidal illness (NTI) refers to changes in thyroid hormone levels in critically ill patients in the absence of primary hypothalamic-pituitary-thyroid dysfunction, and these abnormalities usually resolve after clinical recovery. However, NTI can be accompanied by primary thyroid dysfunction. We report herein a case of a woman with NTI accompanied by primary hyperthyroidism. Case presentation A 52-year-old female was admitted to the intensive care unit with heart failure and atrial fibrillation. She had a longstanding thyroid nodule, and a thyroid function test revealed low levels of triiodothyronine and free thyroxine as well as undetectable thyroid stimulating hormone (TSH). She was diagnosed with NTI, and her TSH level began to recover but not completely at discharge. The thyroid function test was repeated after 42 months to reveal primary hyperthyroidism, and a thyroid scan confirmed a toxic nodule. Conclusion This case suggests that although NTI was diagnosed, primary hyperthyroidism should be considered as another possible diagnosis if TSH is undetectable. Thyroid function tests should be repeated after clinical recovery from acute illness. PMID:24383500

  7. New colistin population pharmacokinetic data in critically ill patients suggesting an alternative loading dose rationale.

    PubMed

    Grégoire, N; Mimoz, O; Mégarbane, B; Comets, E; Chatelier, D; Lasocki, S; Gauzit, R; Balayn, D; Gobin, P; Marchand, S; Couet, W

    2014-12-01

    Colistin is an old antibiotic that has recently gained a considerable renewal of interest as the last-line defense therapy against multidrug-resistant Gram-negative bacteria. It is administered as colistin methanesulfonate (CMS), an inactive prodrug, and it was shown that due to slow CMS conversion, colistin plasma concentrations increase very slowly after treatment initiation, which constitutes the rationale for a loading dose in critically ill patients. However, faster CMS conversion was observed in healthy volunteers but using a different CMS brand, which may also have a major impact on colistin pharmacokinetics. Seventy-three critically ill patients not undergoing dialysis received multiple doses of CMS. The CMS concentrations were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS), and a pharmacokinetic analysis was conducted using a population approach. We confirmed that CMS renal clearance and colistin concentrations at steady state are mostly governed by creatinine clearance, but we predict a typical maximum concentration of drug in serum (Cmax) of colistin close to 2 mg/liter, occurring 3 h after an initial dose of 2 million international units (MIU) of CMS. Accordingly, the estimated colistin half-life (t1/2) was relatively short (3.1 h), with rapid attainment of steady state. Our results are only partially consistent with other recently published results. We confirm that the CMS maintenance dose should be adjusted according to renal function in critically ill patients. However, much higher than expected colistin concentrations were observed after the initial CMS dose, with rapid steady-state achievement. These discrepancies challenge the pharmacokinetic rationale for a loading dose, which may still be appropriate for rapid bacterial eradication and an improved clinical cure rate. PMID:25267662

  8. Utility of flexible fiberoptic bronchoscopy for critically ill pediatric patients: A systematic review

    PubMed Central

    Field-Ridley, Aida; Sethi, Viyeka; Murthi, Shweta; Nandalike, Kiran; Li, Su-Ting T

    2015-01-01

    AIM: To investigate the diagnostic yield, therapeutic efficacy, and rate of adverse events related to flexible fiberoptic bronchoscopy (FFB) in critically ill children. METHODS: We searched PubMed, SCOPUS, OVID, and EMBASE databases through July 2014 for English language publications studying FFB performed in the intensive care unit in children < 18 years old. We identified 666 studies, of which 89 full-text studies were screened for further review. Two reviewers independently determined that 27 of these studies met inclusion criteria and extracted data. We examined the diagnostic yield of FFB among upper and lower airway evaluations, as well as the utility of bronchoalveolar lavage (BAL). RESULTS: We found that FFB led to a change in medical management in 28.9% (range 21.9%-69.2%) of critically ill children. The diagnostic yield of FFB was 82% (range 45.2%-100%). Infectious organisms were identified in 25.7% (17.6%-75%) of BALs performed, resulting in a change of antimicrobial management in 19.1% (range: 12.2%-75%). FFB successfully re-expanded atelectasis or removed mucus plugs in 60.3% (range: 23.8%-100%) of patients with atelectasis. Adverse events were reported in 12.9% (range: 0.5%-71.4%) of patients. The most common adverse effects of FFB were transient hypotension, hypoxia and/or bradycardia that resolved with minimal intervention, such as oxygen supplementation or removal of the bronchoscope. Serious adverse events were uncommon; 2.1% of adverse events required intervention such as bag-mask ventilation or intubation and atropine for hypoxia and bradycardia, normal saline boluses for hypotension, or lavage and suctioning for hemorrhage. CONCLUSION: FFB is safe and effective for diagnostic and therapeutic use in critically ill pediatric patients. PMID:25685726

  9. Validation of a prognostic score in critically ill patients undergoing transport.

    PubMed Central

    Bion, J F; Edlin, S A; Ramsay, G; McCabe, S; Ledingham, I M

    1985-01-01

    Fifty consecutive critically ill patients transported between hospitals by a mobile intensive care team were assessed prospectively using a modification of the acute physiology and chronic health evaluation (APACHE II) sickness scoring system. Assessments were made before and after resuscitation, on return to base, and after 24 hours of intensive care. No patient died during transport. Twenty two patients died subsequently in hospital and 28 survived to return home. The mean score for the non-survivors before resuscitation was 21.7 and for the survivors 12.2 (p less than 0.0005). Among the non-survivors there was a significant fall in score with resuscitation but this did not alter their subsequent outcome. Neither group deteriorated during transport. The sickness score is a powerful method for determining prognosis, and employed longitudinally it may be useful in the assessment of treatment. It has important implications for the administration and organisation of regional intensive care services. PMID:3926230

  10. [Dysphagia management of acute and long-term critically ill intensive care patients].

    PubMed

    Zielske, J; Bohne, S; Axer, H; Brunkhorst, F M; Guntinas-Lichius, O

    2014-10-01

    Dysphagia is a severe complication in critically ill patients and affects more than half the patients in an intensive care unit. Dysphagia also has a strong impact on morbidity and mortality. Risk factors for the development of dysphagia are neurological diseases, age >55-70 years, intubation >7 days and sepsis. With increasing numbers of long-term survivors chronic dysphagia is becoming an increasing problem. There is not much knowledge on the influence of specific diseases, including the direct impact of sepsis on the development of dysphagia. Fiberoptic evaluation of swallowing is a standardized tool for bedside evaluation, helping to plan swallowing training during the acute phase and to decrease the rate of chronic dysphagia. For evaluation of chronic dysphagia even more extensive diagnostic tools as well as several options of stepwise rehabilitation using restitution, compensation and adaption strategies for swallowing exist. Currently it seems that these options are not being sufficiently utilized. In general, there is a need for controlled clinical trials analyzing specific swallowing rehabilitation concepts for former critically ill patients and long-term survivors. PMID:23430119

  11. Clinical Conundrums in Management of Hypothyroidism in Critically Ill Geriatric Patients

    PubMed Central

    Sehgal, Vishal; Bajwa, Sukhminder Jit Singh; Sehgal, Rinku; Bajaj, Anurag

    2014-01-01

    Context: Articles in various international and national bibliographic indices were extensively searched with an emphasis on thyroid and hypothyroid disorders, hypothyroidism in elderly hospitalized patients, hypothyroidism in critically ill geriatric population, thyroxine in elderly hypothyroid, drug interactions and thyroid hormones, and thyroid functions in elderly. Evidence acquisition: Entrez (including PubMed), NIH.gov, Medscape.com, WebMD.com, MedHelp.org, Search Medica, MD consult, yahoo.com, and google.com were searched. Manual search was performed on various textbooks of medicine, critical care, pharmacology, and endocrinology. Results: Thyroid function tests in elderly hospitalized patients must be interpreted with circumspection. The elderly are often exposed to high iodide content and critical care settings. This may occur because of either decreased iodine excretion or very high intake of iodine. This is especially true for elderly population with underlying acute or chronic kidney diseases or both. Amiodarone, with a very high iodine content, is also often used in this set of population. Moreover, other medications including iodinated contrast are often used in the critical care settings. These may affect different steps of thyroid hormone metabolism, and thereby complicate the interpretation of thyroid function tests. Conclusions: The current review is aimed at analyzing and managing various clinical aspects of hypothyroidism in hospitalized elderly, and critically ill geriatric patients. PMID:24719636

  12. Pharmacokinetics of ertapenem in critically ill patients receiving continuous venovenous hemodialysis or hemodiafiltration.

    PubMed

    Eyler, Rachel F; Vilay, A Mary; Nader, Ahmed M; Heung, Michael; Pleva, Melissa; Sowinski, Kevin M; DePestel, Daryl D; Sörgel, Fritz; Kinzig, Martina; Mueller, Bruce A

    2014-01-01

    This study characterizes the pharmacokinetics of ertapenem, a carbapenem antibiotic, in critically ill adult subjects receiving continuous renal replacement therapy (CRRT). Eight critically ill patients with suspected/known Gram-negative infections receiving continuous venovenous hemodialysis (CVVHD) or continuous venovenous hemodiafiltration (CVVHDF) and ertapenem were enrolled. One gram of ertapenem was infused over 30 min. Predialyzer blood samples were drawn with the first dose of ertapenem from the hemodialysis tubing at time zero, 30 min, and 1, 2, 4, 8, 12, 18, and 24 h after the start of the ertapenem infusion. Effluent was collected at the same time points. Ertapenem total serum, unbound serum, and effluent concentrations from all eight subjects were used simultaneously to perform a population compartmental pharmacokinetic modeling procedure using NONMEM. Monte Carlo simulations were performed to evaluate the ability of several ertapenem dosing regimens (500 mg once daily, 750 mg once daily, 500 mg twice daily, and 1,000 mg once daily) to obtain effective unbound serum concentrations above 0.5, 1, and 2 ?g/ml. For our simulated patients, all regimens produced unbound ertapenem concentrations above 2 ?g/ml for 40% of the dosing interval for at least 96% of simulated patients. (This study has been registered at ClinicalTrials.gov under registration no. NCT00877370.). PMID:24323468

  13. Undergraduate training in the care of the acutely ill patient: a literature review

    Microsoft Academic Search

    Christopher M. Smith; Gavin D. Perkins; Ian Bullock; Julian F. Bion

    2007-01-01

    Objective  To characterise the problem of teaching acute care skills to undergraduates and to look for potential solutions.\\u000a \\u000a \\u000a \\u000a Design  Systematic literature review including Medline, EMBASE, CINAHL. Eligible studies described education and training issues focusing\\u000a on caring for acutely ill patients. Articles were excluded if they did not address either educational or clinical aspects\\u000a of acute care and resuscitation.\\u000a \\u000a \\u000a \\u000a Measurement and results  We identified

  14. Dyspnea in the thoracic trauma patient: a human response to illness.

    PubMed

    Legare, Carol; Sawatzky, Jo-Ann V

    2010-01-01

    Dyspnea is one of the most common presenting symptoms in thoracic trauma patients; therefore, trauma nurses require extensive knowledge of this symptom. The Human Response to Illness model provides an organizing framework to establish a comprehensive understanding of the human response of dyspnea following thoracic trauma. The model is used to describe the physiological, pathophysiological, behavioral, and experiential perspectives of dyspnea in thoracic trauma, while considering personal and environmental factors. This comprehensive overview will provide the trauma nurse with appropriate evidence-based rationale for interventions in the management of acute dyspnea in the thoracic trauma population. PMID:20234237

  15. Superficial Temporal Artery Pseudoaneurysm: A Conservative Approach in a Critically Ill Patient

    SciTech Connect

    Grasso, Rosario Francesco, E-mail: r.grasso@unicampus.it; Quattrocchi, Carlo Cosimo [University Campus Bio-Medico of Rome, Department of Radiology, Interdisciplinary Center for Biomedical Research (Italy); Crucitti, Pierfilippo [University Campus Bio-Medico of Rome, Department of Surgery, Interdisciplinary Center for Biomedical Research (Italy); Carboni, Giampiero [University Campus Bio-Medico of Rome, Department of Cardiology, Interdisciplinary Center for Biomedical Research (Italy); Coppola, Roberto [University Campus Bio-Medico of Rome, Department of Surgery, Interdisciplinary Center for Biomedical Research (Italy); Zobel, Bruno Beomonte [University Campus Bio-Medico of Rome, Department of Radiology, Interdisciplinary Center for Biomedical Research (Italy)

    2007-04-15

    A 71-year-old man affected by cardio- and cerebrovascular disease experienced an accidental fall and trauma to the fronto-temporal area of the head. A few weeks later a growing mass appeared on his scalp. A diagnosis of superficial temporal artery pseudoaneurysm was made following CT and color Doppler ultrasound. His clinical condition favoured a conservative approach by ultrasound-guided compression and subsequent surgical resection. A conservative approach should be considered the treatment of choice in critically ill patients affected by superficial temporal artery pseudoaneurysm.

  16. Acute appendicitis in acute leukemia and the potential role of decitabine in the critically ill patient

    PubMed Central

    Warad, Deepti; Kohorst, Mira A.; Altaf, Sadaf; Ishitani, Michael B.; Khan, Shakila; Rodriguez, Vilmarie; Nageswara Rao, Amulya A.

    2015-01-01

    Acute appendicitis in children with acute leukemia is uncommon and often recognized late. Immunocompromised host state coupled with the importance of avoiding treatment delays makes management additionally challenging. Leukemic infiltration of the appendix though rare must also be considered. Although successful conservative management has been reported, surgical intervention is required in most cases. We present our experience with acute appendicitis in children with acute leukemia and a case of complete remission of acute myeloid leukemia with a short course of decitabine. Decitabine may serve as bridging therapy in critically ill patients who are unable to undergo intensive chemotherapy.

  17. Plasma tryptophan and tyrosine levels are independent risk factors for delirium in critically ill patients

    Microsoft Academic Search

    P. P. Pandharipande; A. Morandi; J. R. Adams; T. D. Girard; J. L. Thompson; A. K. Shintani; E. Wesley Ely

    2009-01-01

    Aim  The pathophysiology of delirium remains elusive though neurotransmitters and their precursor large neutral amino acids (LNAAs)\\u000a may play a role. This pilot study investigated whether alterations of tryptophan (Trp), phenylalanine (Phe), and tyrosine\\u000a (Tyr) plasma levels were associated with a higher risk of transitioning to delirium in critically ill patients.\\u000a \\u000a \\u000a \\u000a Methods  Plasma LNAA concentrations were determined on days 1 and 3

  18. Digital art and quality living for elderly people and terminal cancer patients

    Microsoft Academic Search

    Yu-Huei Su; Mei-Ju Su; Yen-Ting Chen; Han-Wei Zhang; Robert Chen; Serina Lai; Yen-Shan Lin; Sao-Jie Chen; Heng-Shuen Chen

    2009-01-01

    In order to counter the barriers of care for mobility-impaired person, like ageing citizens and terminal cancer patient, we plan a platform, u-care system that integrates wireless telecommunication, sensor network, and information technology to take care of the mobility impaired person, elderly and terminal cancer patient. Through the u-care system, the digital art contents were streaming through broadband Internet and

  19. A well-being support program for patients with severe mental illness: a service evaluation

    PubMed Central

    2011-01-01

    Background The risk of cardiovascular disease is increased in patients with severe mental illness (SMI) dramatically reducing life expectancy. Method A real world pragmatic service evaluation of a Well-Being Support Program (WSP) was conducted. This was a four-session package delivered over a one-year period by mental health practitioners that had received additional training in providing physical health assessment and intervention. Patients' physical health was screened and appropriate one-to-one and group intervention was offered. Results 212 mental health practitioners were trained in the WSP and 782 patients were enrolled on the program. The majority of our sample was overweight or obese; 66% had a Body Mass Index (BMI) >25. Lifestyle risk factors for cardiovascular disease (CVD) were common and the patients had low self esteem. The average number of formally recorded well-being sessions attended was 2.10. Just under a quarter of those patients enrolled in the program completed. The only cardiovascular risk factor that significantly altered in patients that completed the program was BMI. The qualitative feedback about the program was largely positive. Conclusions The need to intervene to enhance the physical health of people with SMI is beyond doubt. Maintaining patient engagement in a physical health improvement program is challenging. Regular comprehensive physical health monitoring is necessary to establish the benefit of intervention and increase life expectancy and well-being in this population. PMID:21418627

  20. Co-enrollment of critically ill patients into multiple studies: patterns, predictors and consequences

    PubMed Central

    2013-01-01

    Introduction Research on co-enrollment practices and their impact are limited in the ICU setting. The objectives of this study were: 1) to describe patterns and predictors of co-enrollment of patients in a thromboprophylaxis trial, and 2) to examine the consequences of co-enrollment on clinical and trial outcomes. Methods In an observational analysis of an international thromboprophylaxis trial in 67 ICUs, we examined the co-enrollment of critically ill medical-surgical patients into more than one study, and examined the clinical and trial outcomes among co-enrolled and non-co-enrolled patients. Results Among 3,746 patients enrolled in PROTECT (Prophylaxis for ThromboEmbolism in Critical Care Trial), 713 (19.0%) were co-enrolled in at least one other study (53.6% in a randomized trial, 37.0% in an observational study and 9.4% in both). Six factors independently associated with co-enrollment (all P < 0.001) were illness severity (odds ratio (OR) 1.35, 95% confidence interval (CI) 1.19 to 1.53 for each 10-point Acute Physiology and Chronic Health Evaluation (APACHE) II score increase), substitute decision-makers providing consent, rather than patients (OR 3.31, 2.03 to 5.41), experience of persons inviting consent (OR 2.67, 1.74 to 4.11 for persons with > 10 years' experience compared to persons with none), center size (all ORs > 10 for ICUs with > 15 beds), affiliation with trials groups (OR 5.59, 3.49 to 8.95), and main trial rather than pilot phase (all ORs > 8 for recruitment year beyond the pilot). Co-enrollment did not influence clinical or trial outcomes or risk of adverse events. Conclusions Co-enrollment was strongly associated with features of the patients, research personnel, setting and study. Co-enrollment had no impact on trial results, and appeared safe, acceptable and feasible. Transparent reporting, scholarly discourse, ethical analysis and further research are needed on the complex topic of co-enrollment during critical illness. PMID:23298553

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

    PubMed Central

    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 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. Methods 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. Results 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%. Conclusions A program of algorithms-guided care is effective for nurse case management of patients requesting same day consultation for minor illnesses in primary care. PMID:23679821

  2. Alterations of mismatch negativity (MMN) in schizophrenia patients with auditory hallucinations experiencing acute exacerbation of illness.

    PubMed

    Fisher, Derek J; Labelle, Alain; Knott, Verner J

    2012-08-01

    Auditory verbal hallucinations (AHs), or hearing 'voices', are one of the hallmark symptoms of patients with schizophrenia. The primary objective of this study was to compare hallucinating schizophrenia patients with respect to differences in deviance detection, as indexed by the auditory mismatch negativity (MMN). Patients were recruited during an acute psychotic episode requiring hospitalization, during which time symptoms of psychosis, including auditory hallucinations, are likely to be at their most severe. MMNs to duration, frequency, gap, intensity and location deviants (as elicited by the 'optimal' multi-feature paradigm) were recorded in 12 acutely ill schizophrenia patients (SZ) with persistent AHs and 15 matched healthy controls (HC). Electrical activity was recorded from 32 scalp electrodes. MMN amplitudes and latencies for each deviant were compared between groups and were correlated with trait (PSYRATS) and state measures of AH severity and Positive and Negative Syndrome Scale (PANSS) ratings in SZs. There were significant group differences for duration, gap, intensity and location MMN amplitudes, such that SZs exhibited reduced MMNs compared to HCs. Additionally, gap MMN amplitudes were correlated with measures of hallucinatory state and frequency of AHs, while location MMN was correlated with perceived location of AHs. In summary, this study corroborates previous research reporting a robust duration MMN deficit in schizophrenia, as well as reporting gap, intensity and location MMN deficits in acutely ill schizophrenia patients with persistent AHs. Additionally, MMN amplitudes were correlated with state and trait measures of AHs. These findings offer further support to previous work suggesting that the presence of auditory hallucinations may make a significant contribution to the widely reported MMN deficits in schizophrenia. PMID:22727705

  3. How to communicate with patients about future illness progression and end of life: a systematic review

    PubMed Central

    Parry, Ruth; Land, Victoria; Seymour, Jane

    2014-01-01

    Background Conversation and discourse analytic research has yielded important evidence about skills needed for effective, sensitive communication with patients about illness progression and end of life. Objectives To: ??Locate and synthesise observational evidence about how people communicate about sensitive future matters; ??Inform practice and policy on how to provide opportunities for talk about these matters; ??Identify evidence gaps. Design Systematic review of conversation/discourse analytic studies of recorded interactions in English, using a bespoke appraisal approach and aggregative synthesis. Results 19 publications met the inclusion criteria. We summarised findings in terms of eight practices: ‘fishing questions’—open questions seeking patients’ perspectives (5/19); indirect references to difficult topics (6/19); linking to what a patient has already said—or noticeably not said (7/19); hypothetical questions (12/19); framing difficult matters as universal or general (4/19); conveying sensitivity via means other than words, for example, hesitancy, touch (4/19); encouraging further talk using means other than words, for example, long silences (2/19); and steering talk from difficult/negative to more optimistic aspects (3/19). Conclusions Practices vary in how strongly they encourage patients to engage in talk about matters such as illness progression and dying. Fishing questions and indirect talk make it particularly easy to avoid engaging—this may be appropriate in some circumstances. Hypothetical questions are more effective in encouraging on-topic talk, as is linking questions to patients’ cues. Shifting towards more ‘optimistic’ aspects helps maintain hope but closes off further talk about difficulties: practitioners may want to delay doing so. There are substantial gaps in evidence. PMID:25344494

  4. Central and peripheral venous lines-associated blood stream infections in the critically ill surgical patients

    PubMed Central

    2012-01-01

    Critically ill surgical patients are always at increased risk of actual or potentially life-threatening health complications. Central/peripheral venous lines form a key part of their care. We review the current evidence on incidence of central and peripheral venous catheter-related bloodstream infections in critically ill surgical patients, and outline pathways for prevention and intervention. An extensive systematic electronic search was carried out on the relevant databases. Articles were considered suitable for inclusion if they investigated catheter colonisation and catheter-related bloodstream infection. Two independent reviewers engaged in selecting the appropriate articles in line with our protocol retrieved 8 articles published from 1999 to 2011. Outcomes on CVC colonisation and infections were investigated in six studies; four of which were prospective cohort studies, one prospective longitudinal study and one retrospective cohort study. Outcomes relating only to PICCs were reported in one prospective randomised trial. We identified only one study that compared CVC- and PICC-related complications in surgical intensive care units. Although our search protocol may not have yielded an exhaustive list we have identified a key deficiency in the literature, namely a paucity of studies investigating the incidence of CVC- and PICC-related bloodstream infection in exclusively critically ill surgical populations. In summary, the diverse definitions for the diagnosis of central and peripheral venous catheter-related bloodstream infections along with the vastly different sample size and extremely small PICC population size has, predictably, yielded inconsistent findings. Our current understanding is still limited; the studies we have identified do point us towards some tentative understanding that the CVC/PICC performance remains inconclusive. PMID:22947496

  5. Identification and Treatment of Symptoms Associated with Inflammation in Medically Ill Patients

    PubMed Central

    Dantzer, Robert; Capuron, Lucile; Irwin, Michael R.; Miller, Andrew H.; Ollat, Helene; Perry, Victor Hugh; Rousey, Sarah; Yirmiya, Raz

    2008-01-01

    Medically ill patients present with a high prevalence of non-specific comorbid symptoms including pain, sleep disorders, fatigue and cognitive and mood alterations that is a leading cause of disability. However, despite major advances in the understanding of the immune-to-brain communication pathways that underlie the pathophysiology of these symptoms in inflammatory conditions, little has been done to translate this newly acquired knowledge to the clinics and to identify appropriate therapies. In a multidisciplinary effort to address this problem, clinicians and basic scientists with expertise in areas of inflammation, psychiatry, neurosciences and psychoneuroimmunology were brought together in a specialized meeting organized in Bordeaux, France, on May 28–29, 2007. These experts considered key questions in the field, in particular those related to identification and quantification of the predominant symptoms associated with inflammation, definition of systemic and central markers of inflammation, possible domains of intervention for controlling inflammation associated symptoms, and relevance of animal models of inflammation associated symptoms. This resulted in a number of recommendations that should improve the recognition and management of inflammation-associated symptoms in medically ill patients. PMID:18061362

  6. Systematic review: The relation between nutrition and nosocomial pneumonia: randomized trials in critically ill patients

    PubMed Central

    1997-01-01

    Objective To review the effect of enteral nutrition on nosocomial pneumonia in critically ill patients as summarized in randomized clinical trials. Study identification and selection Studies were identified through MEDLINE, SCISEARCH, EMBASE, the Cochrane Library, bibliographies of primary and review articles, and personal files. Through duplicate independent review, we selected randomized trials evaluating approaches to nutrition and their relation to nosocomial pneumonia. Data abstraction In duplicate, independently, we abstracted key data on the design features, population, intervention and outcomes of the studies. Results We identified four trials of enteral vs total parenteral nutrition, one trial of early enteral nutrition vs delayed enteral nutrition, one trial of gastric vs jejunal tube feeding, one trial of intermittent vs continuous enteral feeding, and three trials evaluating different enteral feeding formulae. Sample sizes were small, pneumonia definitions were variable and blinded outcome assessment was infrequent. Randomized trial evidence is insufficient to draw conclusions about the relation between enteral nutrition and nosocomial pneumonia. Conclusions Nutritional interventions in critically ill patients appear to have a modest and inconsistent effect on nosocomial pneumonia. This body of evidence neither supports nor refutes the gastropulmonary route of infection. PMID:11094461

  7. Hospice is a philosophy of care that supports terminally ill patients and their loved ones through

    E-print Network

    Goldman, Steven A.

    at www.VNSnet.com The incredible support my family received from Visiting Nurse Hospice will stay with me forever. My biggest frustration was feeling helpless to do anything to help my mother, but our hospice of my family. The nurse also helped communicate our questions and concerns to the physician." tom ru

  8. Use of Opiates to Manage Pain in the Seriously and Terminally Ill Patient

    MedlinePLUS

    ... 4) • Hydrocodone/Acetaminophen combinations (e.g., Vicodin) • Hydrocodone/Ibuprofen combinations (e.g., Vicoprofen) • Oxycodone/Acetaminophen combinations (e. ... hearing damage, or kidney damage), arthritis medicines like ibuprofen (Motrin, Advil) or naproxen (Naprosyn) (which can cause ...

  9. Assessment of pain in less severely ill and injured aeromedical evacuation patients: a prospective field study.

    PubMed

    Bridges, Elizabeth; Dukes, Susan; Serres, Jennifer

    2015-03-01

    Pain management is vitally important to injured patients being evacuated from the warzone. A prospective assessment of real-time ratings of pain acceptability, intensity, and satisfaction of a convenience sample of 114 less severely ill and injured U.S. military patients being evacuated on Aeromedical Evacuation (AE) missions from Ramstein Air Field, Germany, to Andrews Air Force Base, Maryland, was conducted. Data were collected before and during 12 AE flights in December 2012 and May 2013. Acceptable pain intensity was a median of 6/10 (range 2-9), with 76% of patients indicating an acceptable pain intensity greater than 4. During AE transport, 75% of patients reported at least one pain score ?4. Despite these high pain ratings, there was documentation of administration for only 58% of routine and 48% for as-needed analgesics/adjuvants. Over 47% of patients experienced pain that exceeded their acceptable intensity level, but of those patients with pain that was more severe than acceptable, only 10% rated their satisfaction with their pain management as poor or fair. This is the first study to provide real-time concurrent assessment of pain and pain management during en route care. The worst pain was reported for the hospital to aircraft arrival, suggesting the need for interventions to safely optimize pain management during this handoff period. PMID:25747630

  10. Reading chest radiographs in the critically ill (Part II): Radiography of lung pathologies common in the ICU patient

    PubMed Central

    Khan, Ali Nawaz; Al-Jahdali, Hamdan; AL-Ghanem, Sarah; Gouda, Alaa

    2009-01-01

    This is part II of two series review of reading chest radiographs in the critically ill. Conventional chest radiography remains the cornerstone of day to day management of the critically ill occasionally supplemented by computed tomography or ultrasound for specific indications. In this second review we discuss radiographic findings of cardiopulmonary disorders common in the intensive care patient and suggest guidelines for interpretation based not only on imaging but also on the pathophysiology and clinical grounds. PMID:19641649

  11. Benefits of Teaching Medical Students How to Communicate with Patients Having Serious Illness

    PubMed Central

    Ellman, Matthew S.; Fortin, Auguste H.

    2012-01-01

    Innovative approaches are needed to teach medical students effective and compassionate communication with seriously ill patients. We describe two such educational experiences in the Yale Medical School curriculum for third-year medical students: 1) Communicating Difficult News Workshop and 2) Ward-Based End-of-Life Care Assignment. These two programs address educational needs to teach important clinical communication and assessment skills to medical students that previously were not consistently or explicitly addressed in the curriculum. The two learning programs share a number of educational approaches driven by the learning objectives, the students’ development, and clinical realities. Common educational features include: experiential learning, the Biopsychosocial Model, patient-centered communication, integration into clinical clerkships, structured skill-based learning, self-reflection, and self-care. These shared features ? as well as some differences ? are explored in this paper in order to illustrate key issues in designing and implementing medical student education in these areas. PMID:22737055

  12. Addressing the Access Problem for Patients with Serious Mental Illness who Require Tertiary Medical Care.

    PubMed

    Hensel, Jennifer M; Flint, Alastair J

    2015-01-01

    There is evidence to suggest that people with serious mental illness (SMI) have lower access to tertiary care than patients without SMI, particularly when care is complex. Barriers are present at the level of the individual, providers, and the health care system. High levels of co-morbidity and the associated health care costs, along with a growing focus on facilitating equal access to quality care for all, urges health care systems to address existing gaps. Some interventions have been successful at improving access to primary care for patients with SMI, but relatively little research has focused on access to complex interventions. This paper summarizes the scope of the problem regarding access to complex tertiary medical care among people with SMI. Barriers are discussed and potential solutions are proposed. Policies and programs must be developed, implemented, and evaluated to determine cost-effectiveness and impact on outcomes. PMID:25702725

  13. Internists' attitudes towards terminal sedation in end of life care

    PubMed Central

    Kaldjian, L; Jekel, J; Bernene, J; Rosenthal, G; Vaughan-Sarrazin, M; Duffy, T

    2004-01-01

    Objective: To describe the frequency of support for terminal sedation among internists, determine whether support for terminal sedation is accompanied by support for physician assisted suicide (PAS), and explore characteristics of internists who support terminal sedation but not assisted suicide. Design: A statewide, anonymous postal survey. Setting: Connecticut, USA. Participants: 677 Connecticut members of the American College of Physicians. Measurements: Attitudes toward terminal sedation and assisted suicide; experience providing primary care to terminally ill patients; demographic and religious characteristics. Results: 78% of respondents believed that if a terminally ill patient has intractable pain despite aggressive analgesia, it is ethically appropriate to provide terminal sedation (diminish consciousness to halt the experience of pain). Of those who favoured terminal sedation, 38% also agreed that PAS is ethically appropriate in some circumstances. Along a three point spectrum of aggressiveness in end of life care, the plurality of respondents (47%) were in the middle, agreeing with terminal sedation but not with PAS. Compared with respondents who were less aggressive or more aggressive, physicians in this middle group were more likely to report having more experience providing primary care to terminally ill patients (p = 0.02) and attending religious services more frequently (p<0.001). Conclusions: Support for terminal sedation was widespread in this population of physicians, and most who agreed with terminal sedation did not support PAS. Most internists who support aggressive palliation appear likely to draw an ethical line between terminal sedation and assisted suicide. PMID:15467087

  14. Meanings of Being Critically Ill in a Sound-Intensive ICU Patient Room - A Phenomenological Hermeneutical Study

    PubMed Central

    Johansson, Lotta; Bergbom, Ingegerd; Lindahl, Berit

    2012-01-01

    The aim of this study was to illuminate the meanings of being critically ill in a sound-intensive ICU patient room, as disclosed through patients’ narratives. Patient rooms in ICUs are filled with loud activity and studies have revealed sound levels comparable to those of a busy road above the patient’s head. There is a risk that the sound or noise is disturbing and at worst a major problem for the patient, but there is a lack of knowledge concerning the patients’ own experiences. Thirteen patients were asked to narrate their experiences of the sound environment in ICU patient rooms. The interviews were analyzed using a phenomenological- hermeneutical method inspired by the philosophy of Ricoeur. Six themes emerged from the analysis. Conclusion: The meanings of being a patient in a sound- intensive environment were interpreted as never knowing what to expect next regarding noise, but also of being situated in the middle of an uncontrollable barrage of noise, unable to take cover or disappear. This condition is not to be seen as static; for some patients there is movement and change over time. The meanings indicate that the unpredictable shifts between silence and disturbing sounds stress the critically ill patient and impede sleep and recovery. Our findings indicate the need to reduce disturbing and unexpected sounds and noise around critically ill patients in high-tech environments in order to facilitate wellbeing, sleep and recovery. Nurses have a vital role in developing such an environment. PMID:22977654

  15. Mental illness and the late Victorians: a study of patients admitted to three asylums in York, 1880-1884.

    PubMed

    Renvoize, E B; Beveridge, A W

    1989-02-01

    The case histories of the patients newly admitted to the Retreat Asylum in York between 1880-1884 were examined. Most patients were aged under 50 years, single and non-Quaker, and a majority satisfied the Research Diagnostic Criteria for a diagnosis of schizophrenia or affective disorder. It was found that 72.9% of the patients were deluded, the most common delusions being of persecution, grandeur and guilt; in 34.9% of the deluded patients, the delusion had a religious content. Suicidal ideation was recorded in the case records of 31.4% of the patients. Drug therapy was commonly prescribed, a history of assault on other patients or asylum staff was recorded in 38.1% of the patients, and 11% of patients were force fed at some stage during their illness. Within a year of admission 49.1% of the patients were discharged, the prognosis being better for patients with an affective illness than for schizophrenia, but 31.4% remained in the asylum for five or more years. The characteristics, alleged causes of mental illness, and treatment and outcome of the Retreat patients were compared with those of patients admitted during the same period to the two other York asylums which served different socio-economic groups of the population. Mortality rates were higher in the asylum admitting mainly pauper patients, and possible reasons for this are explored. PMID:2657829

  16. Place of death among patients with terminal heart failure in a continuous inotropic infusion program.

    PubMed

    Taitel, Michael; Meaux, Nita; Pegus, Cheryl; Valerian, Christopher; Kirkham, Heather

    2012-06-01

    Although most patients with terminal heart failure (HF) prefer to die at home, the majority die in hospitals. To determine the impact of home inotropic support in the place of death among patients with terminal HF, this retrospective study compared the place of death in patients with terminal HF enrolled in an inotropic infusion program to place of death in a national sample of patients with HF. The rate of home death among program participants (64.5%; n = 217) was significantly higher (P < .001) than an age- and sex-adjusted rate of home death in a national sample (35.9%; n = 56 596). Patients with HF participating in home inotropic support can remain at home during the final stage of life and are less likely to die in hospitals. PMID:21840872

  17. Candidemia in non-neutropenic critically ill patients: analysis of prognostic factors and assessment of systemic antifungal therapy

    Microsoft Academic Search

    J. Nolla-Salas; A. Sitges-Serra; C. León-Gil; J. Martínez-González; M. A. León-Regidor; J. M. Torres-Rodríguez

    1997-01-01

    Objective: To determine the incidence and prognosis of candidemia in non-neutropenic critically ill patients, to define mortality-related\\u000a factors, and to evaluate the results of systemic antifungal therapy.\\u000a \\u000a \\u000a \\u000a Design: A prospective multicenter survey in which medical and\\/or surgical intensive care units (ICUs) in 28 hospitals in Spain participated.\\u000a \\u000a \\u000a \\u000a \\u000a \\u000a Patients: All critically ill patients with positive blood cultures for Candida species admitted

  18. Genetic polymorphisms of innate and adaptive immunity as predictors of outcome in critically ill patients.

    PubMed

    Kompoti, Maria; Michopoulos, Alexandros; Michalia, Martha; Clouva-Molyvdas, Phyllis-Maria; Germenis, Anastasios E; Speletas, Matthaios

    2015-03-01

    Sepsis and septic shock frequently cause the admission or complicate the clinical course of critically ill patients admitted in the intensive care units (ICU). Genetic variations disrupting the immune sensing of infectious organisms, could affect the ability of the immune system to respond to infection, and may influence both the genetic predisposition to infection and the diversity of the clinical presentation of sepsis. The aim of this study was to uncover possible associations between common functional immune gene polymorphisms (of both innate and adaptive immunity) and ICU-acquired sepsis and mortality. The TLR4-D299G (rs4986790), TLR4-T399I (rs4986791), C2-c.841_849+19del28 (rs9332736), TACI-C104R (rs34557412), BAFFR-P21R (rs77874543), and BAFFR-H159Y (rs61756766) polymorphisms were detected in a cohort of 215 critically ill patients, admitted in an 8-bed medical/surgical ICU. Interestingly, TLR4-D299G, TLR4-T399I and BAFFR-P21R carriage was associated with a lower risk of ICU-acquired sepsis. This association applied particularly in medical patients, while in trauma and surgical patients no significant associations were observed. Moreover, carriers of TACI-C104R displayed an undiagnosed mild to moderate hypogammaglobulinemia along with a significantly lower survival rate in the ICU, although lethal events were not attributed to sepsis. These findings further elucidate the role that host immune genetic variations may play in the susceptibility to ICU-acquired sepsis and ICU mortality. PMID:25454804

  19. Compliance to treatment in patients with chronic illness: A concept exploration

    PubMed Central

    Rafii, Forough; Fatemi, Naima Seyed; Danielson, Ella; Johansson, Christina Melin; Modanloo, Mahnaz

    2014-01-01

    Background: 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. Materials and Methods: 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. Results: 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. Conclusions: 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. PMID:24834085

  20. Venous thromboembolism risk and prophylaxis in hospitalised medically ill patients. The ENDORSE Global Survey.

    PubMed

    Bergmann, Jean-Francois; Cohen, Alexander T; Tapson, Victor F; Goldhaber, Samuel Z; Kakkar, Ajay K; Deslandes, Bruno; Huang, Wei; Anderson, Frederick A

    2010-04-01

    Limited data are available regarding the risk for venous thromboembolism (VTE) and VTE prophylaxis use in hospitalised medically ill patients. We analysed data from the global ENDORSE survey to evaluate VTE risk and prophylaxis use in this population according to diagnosis, baseline characteristics, and country. Data on patient characteristics, VTE risk, and prophylaxis use were abstracted from hospital charts. VTE risk and prophylaxis use were evaluated according to the 2004 American College of Chest Physicians (ACCP) guidelines. Multivariable analysis was performed to identify factors associated with use of ACCP-recommended prophylaxis. Data were evaluated for 37,356 hospitalised medical patients across 32 countries. VTE risk varied according to medical diagnosis, from 31.2% of patients with gastrointestinal/hepatobiliary diseases to 100% of patients with acute heart failure, active non-infectious respiratory disease, or pulmonary infection (global rate, 41.5%). Among those at risk for VTE, ACCP-recommended prophylaxis was used in 24.4% haemorrhagic stroke patients and 40-45% of cardiopulmonary disease patients (global rate, 39.5%). Large differences in prophylaxis use were observed among countries. Markers of disease severity, including central venous catheters, mechanical ventilation, and admission to intensive care units, were strongly associated with use of ACCP-recommended prophylaxis. In conclusion, VTE risk varies according to medical diagnosis. Less than 40% of at-risk hospitalised medical patients receive ACCP-recommended prophylaxis. Prophylaxis use appears to be associated with disease severity rather than medical diagnosis. These data support the necessity to improve implementation of available guidelines for evaluating VTE risk and providing prophylaxis to hospitalised medical patients. PMID:20135072

  1. Analysis of patients with decompression illness transported via physician-staffed emergency helicopters

    PubMed Central

    Oode, Yasumasa; Yanagawa, Youichi; Omori, Kazuhiko; Osaka, Hiromichi; Ishikawa, Kouhei; Tanaka, Hiroshi

    2015-01-01

    Context: There have been few reports investigating the effects of air transportation on patients with decompression illness (DCI). Aims: To investigate the influence of air transportation on patients with DCI transported via physician-staffed emergency helicopters (HEMS: Emergency medical system of physician-staffed emergency helicopters). Settings and Design: A retrospective medical chart review in a single hospital. Materials and Methods: A medical chart review was retrospectively performed in all patients with DCI transported via HEMS between July 2009 and June 2013. The exclusion criteria included cardiopulmonary arrest on surfacing. Statistical analysis used: The paired Student's t-test. Results: A total of 28 patients were treated as subjects. Male and middle-aged subjects were predominant. The number of patients who suddenly surfaced was 15/28. All patients underwent oxygen therapy during flight, and all but one patient received the administration of lactate Ringer fluid. The subjective symptoms of eight of 28 subjects improved after the flight. The range of all flights under 300 m above sea level. There were no significant differences between the values obtained before and after the flight for Glasgow coma scale, blood pressure, and heart rate. Concerning the SpO2, statistically significant improvements were noted after the flight (96.2 ± 0.9% versus 97.3 ± 0.7%). There were no relationships between an improvement in subjective symptoms and the SpO2. Conclusion: Improvements in the subjective symptoms and/or SpO2 of patients with DCI may be observed when the patient is transported via HEMS under flights less than 300 m in height with the administration of oxygen and fluids. PMID:25709249

  2. Alignment of patient and primary care practice member perspectives of chronic illness care: a cross-sectional analysis

    PubMed Central

    2014-01-01

    Background Little is known as to whether primary care teams’ perceptions of how well they have implemented the Chronic Care Model (CCM) corresponds with their patients’ own experience of chronic illness care. We examined the extent to which practice members’ perceptions of how well they organized to deliver care consistent with the CCM were associated with their patients’ perceptions of the chronic illness care they have received. Methods Analysis of baseline measures from a cluster randomized controlled trial testing a practice facilitation intervention to implement the CCM in small, community-based primary care practices. All practice “members” (i.e., physician providers, non-physician providers, and staff) completed the Assessment of Chronic Illness Care (ACIC) survey and adult patients with 1 or more chronic illnesses completed the Patient Assessment of Chronic Illness Care (PACIC) questionnaire. Results Two sets of hierarchical linear regression models accounting for nesting of practice members (N?=?283) and patients (N?=?1,769) within 39 practices assessed the association between practice member perspectives of CCM implementation (ACIC scores) and patients’ perspectives of CCM (PACIC). ACIC summary score was not significantly associated with PACIC summary score or most of PACIC subscale scores, but four of the ACIC subscales [Self-management Support (p?patient characteristics. The magnitude of the coefficients, however, indicates that the level of association is weak. Conclusions The ACIC and PACIC scales appear to provide complementary and relatively unique assessments of how well clinical services are aligned with the CCM. Our findings underscore the importance of assessing both patient and practice member perspectives when evaluating quality of chronic illness care. Trial registration NCT00482768 PMID:24678983

  3. EVALUATION OF COGNITIVE BEHAVIOURAL TRAINING AND PHYSICAL ACTIVITY FOR PATIENTS WITH STRESS-RELATED ILLNESSES: A RANDOMIZED CONTROLLED STUDY

    Microsoft Academic Search

    Marina Heiden; Eugene Lyskov; Minori Nakata; Tore Sahlin; Margareta Barnekow-Bergkvist

    2007-01-01

    Objective: To evaluate the effects of a cognitive behavioural training programme and a physical activity programme for patients with stress-related illnesses. Design: In a randomized controlled study, patients were al- located randomly to 1 of 3 groups, where group 1 partici- pated in a cognitive behavioural training programme, group 2 participated in a physical activity programme, and group 3, the

  4. Fluid resuscitation with colloid or crystalloid solutions in critically ill patients: a systematic review of randomised trials

    Microsoft Academic Search

    Gill Schierhout; Ian Roberts

    Objective: To determine the effect on mortality of resuscitation with colloid solutions compared with resuscitation with crystalloids. Design: Systematic review of randomised controlled trials of resuscitation with colloids compared with crystalloids for volume replacement of critically ill patients; analysis stratified according to patient type and quality of allocation concealment. Subjects: 37 randomised controlled trials were eligible, of which 26 unconfounded

  5. Effect of fiber supplementation on the microbiota in critically ill patients

    PubMed Central

    O’Keefe, Stephen JD; Ou, Junhai; DeLany, James P; Curry, Scott; Zoetendal, Erwin; Gaskins, H Rex; Gunn, Scott

    2011-01-01

    AIM: To determine tolerance to fiber supplementation of semi-elemental tube feeds in critically ill patients and measure its effect on colonic microbiota and fermentation. METHODS: Thirteen intensive care unit patients receiving jejunal feeding with a semi-elemental diet for predominantly necrotizing pancreatitis were studied. The study was divided into 2 parts: first, short-term (3-9 d) clinical tolerance and colonic fermentation as assessed by fecal short chain fatty acid (SCFA) concentrations and breath hydrogen and methane was measured in response to progressive fiber supplementation increasing from 4 g tid up to normal requirement levels of 8 g tid; second, 4 patients with diarrhea were studied for 2-5 wk with maximal supplementation to additionally assess its influence on fecal microbiota quantitated by quantitative polymerase chain reaction (qPCR) of microbial 16S rRNA genes and Human Intestinal Tract Chip (HITChip) microarray analysis. Nearly all patients were receiving antibiotics (10/13) and acid suppressants (11/13) at some stage during the studies. RESULTS: In group 1, tolerance to progressive fiber supplementation was good with breath hydrogen and methane evidence (P = 0.008 and P < 0.0001, respectively) of increased fermentation with no exacerbation of abdominal symptoms and resolution of diarrhea in 2 of 4 patients. In group 2 before supplementation, fecal microbiota mass and their metabolites, SCFA, were dramatically lower in patients compared to healthy volunteers. From qPCR and HITChip analyses we calculated that there was a 97% reduction in the predominant potential butyrate producers and starch degraders. Following 2-5 wk of fiber supplementation there was a significant increase in fecal SCFA (acetate 28.4 ± 4.1 ?mol/g to 42.5 ± 3.1 ?mol/g dry weight, P = 0.01; propionate 1.6 ± 0.5 vs 6.22 ± 1.1, P = 0.006 and butyrate 2.5 ± 0.6 vs 5.9 ± 1.1, P = 0.04) and microbial counts of specific butyrate producers, with resolution of diarrhea in 3 of 4 patients. CONCLUSION: Conventional management of critically ill patients, which includes the use of elemental diets and broad-spectrum antibiotics, was associated with gross suppression of the colonic microbiota and their production of essential colonic fuels, i.e., SCFA. Our investigations show that fiber supplementation of the feeds has the potential to improve microbiota mass and function, thereby reducing the risks of diarrhea due to dysbiosis. PMID:22180847

  6. Ethical considerations in consenting critically ill patients for bedside clinical care and research.

    PubMed

    Rincon, Fred; Lee, Kiwon

    2015-03-01

    Care of critically ill patients, as in any other field, demands the exercise of ethical principles related to respect of patient's autonomy, beneficence, nonmaleficence, and distributive justice. Professional duty and the common law require doctors to obtain consent before giving treatment or for requesting participation in clinical research. A procedure or research study must be adequately explained, and the patient must have the capacity to consent. If a patient does not have decision-making capacity, treatment must be given using alternative forms of consent or using principles of implied consent in emergency or life-threatening situations. In the case of clinical research, informed consent must always be sought. Exemptions to this rule are morally justified in circumstances related to research in life-threatening conditions or life-saving interventions in which the investigator departs from sound principles of equipoise. This usually implies the imposition of safeguards such as consultation with the community in which the study were to take place, oversight in patient screening and recruitment process by institutional review boards, special study designs, retrospective and prospective consent processes, and independent safety monitoring. PMID:24019298

  7. Clinical relevance of multiple respiratory virus detection in adult patients with acute respiratory illness.

    PubMed

    Choi, Seong-Ho; Chung, Jin-Won; Kim, Hye Ryoun

    2015-04-01

    Because increasing numbers of nasopharyngeal swab specimens from adult patients with acute respiratory illness (ARI) are being tested by respiratory virus (RV) multiplex reverse transcriptase PCR (RVM-RT-PCR), multiple RV detection (MRVD) is being encountered more frequently. However, the clinical relevance of MRVD in adult patients has rarely been evaluated. The clinical characteristics of hospitalized adult patients with ARI and MRVD by RVM-RT-PCR tests were compared to those of patients with single RV detection (SRVD) during a single year at a tertiary care center. MRVD was observed in 26 of the 190 adult patients (13.7%). The patients with MRVD had a higher incidence of chronic lung disease than the patients with SRVD (34.6% versus 15.9%, crude odds ratio [OR] = 2.81, 95% confidence interval [CI] = 1.13 to 6.98, P = 0.03). Although the former were more likely than the latter to receive mechanical ventilation (19.2% versus 6.7%, crude OR = 3.31, 95% CI = 1.05 to 10.47, P = 0.049), the length of hospital stay (median, 7 versus 6.5 days; P = 0.66), and the in-hospital mortality rate (7.7% versus 4.3%, crude OR = 1.87, 95% CI = 0.37 to 9.53, P = 0.35) were not different between the two groups. In multivariate analysis, chronic lung disease was associated with MRVD (adjusted OR = 3.08, 95% CI = 1.12 to 8.46, P = 0.03). In summary, it was not uncommon to encounter adult patients with ARI and MRVD by RVM-RT-PCR tests of nasopharyngeal swab specimens. MRVD was associated with chronic lung disease rather than the severity of the ARI. PMID:25631799

  8. Adaptation and validation of the patient assessment of chronic illness care in the French context

    PubMed Central

    2014-01-01

    Background Chronic diseases are major causes of disability worldwide with rising prevalence. Most patients suffering from chronic conditions do not always receive optimal care. The Chronic Care Model (CCM) has been developed to help general practitioners making quality improvements. The Patient Assessment of Chronic Illness Care (PACIC) questionnaire was increasingly used in several countries to appraise the implementation of the CCM from the patients’ perspective. The objective of this study was to adapt the PACIC questionnaire in the French context and to test the validity of this adaptation in a sample of patients with multiple chronic conditions. Methods The PACIC was translated into French language using a forward/backward procedure. The French version was validated using a sample of 150 patients treated for obstructive sleep apnea syndrome (OSAS) and having multiple chronic co-morbidities. Several forms of validity were analysed: content; face; construct; and internal consistency. The construct validity was investigated with an exploratory factorial analysis. Results The French-version of the PACIC consisted in 18 items, after merging two pairs of items due to redundancy. The high number of items exhibiting floor/ceiling effects and the non-normality of the ratings suggested that a 5-points rating scale was somewhat inappropriate to assess the patients’ experience of care. The construct validity of the French-PACIC was verified and resulted in a bi-dimensional structure. Overall this structure showed a high level of internal consistency. The PACIC score appeared to be significantly related to the age and self-reported health of the patients. Conclusions A French-version of the PACIC questionnaire is now available to evaluate the patients’ experience of care and to monitor the quality improvements realised by the medical structures. This study also pointed out some methodological issues about the PACIC questionnaire, related to the format of the rating scale and to the structure of the questionnaire. PMID:24947538

  9. Erythropoietin-receptor agonists in critically ill patients: a meta-analysis of randomized controlled trials

    PubMed Central

    Zarychanski, Ryan; Turgeon, Alexis F.; McIntyre, Lauralyn; Fergusson, Dean A.

    2007-01-01

    Introduction Anemia and the need for red blood cell transfusions are common among patients admitted to intensive care units. Erythropoietin has been used to decrease the need for transfusions; however, its ability to improve clinical outcomes is unknown. We evaluated the effect of erythropoietin-receptor agonists on clinically important outcomes, including mortality, length of stay in hospital or intensive care unit, ventilator use, transfusion requirements and major adverse events. Methods To identify relevant studies, we searched electronic databases covering 1950 to 2007 (MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the Scopus database). We also searched conference proceedings and grey literature sources. We selected all randomized controlled trials involving critically ill patients that compared an erythropoietin-receptor agonist with a placebo or no intervention. No language restrictions were considered. Data were extracted using a standardized extraction template. We used a fixed effects model to calculate all summary measures of treatment effects. Results Of 673 identified records, 9 studies that investigated erythropoietin alpha met the eligibility criteria and were included in our analysis. Erythropoietin, compared with placebo or no intervention, had no statistically significant effect on overall mortality (odds ratio [OR] 0.86, 95% confidence interval [CI] 0.71–1.05, I2 = 0%). The treatment and control groups did not differ in the length of stay in hospital or intensive care unit, or in the duration of mechanical ventilation, in the 3 studies that reported these outcomes. Erythropoietin, compared with placebo, significantly reduced the odds of a patient receiving at least 1 transfusion (OR 0.73, 95% CI 0.64–0.84, I2 = 54.7%). The mean number of units of blood transfused per patient was decreased by 0.41 units in the erythropoietin group (95% CI 0.10–0.74, I2 = 79.2%). Most of the included studies were performed before the widespread adoption of a restrictive transfusion strategy. Only 1 study provided detailed reports of adverse events, and none of the studies systematically evaluated all patients for venous thromboembolism. Interpretation At this time, we do not recommend the routine use of erythropoietin-receptor agonists in critically ill patients. The reduction in red blood cell transfusions per patient was very small, and there is insufficient evidence to determine whether this intervention results in clinically important benefits with acceptable risks. PMID:17823140

  10. Sources of Stress in Nursing Terminal Patients in a Hospice.

    ERIC Educational Resources Information Center

    Gray-Toft, Pamela; Anderson, James G.

    1987-01-01

    Investigated sources of stress experienced by hospice nurses. Stress sources included: physical characteristics of the unit as well as staffing policies designed to improve the quality of care; procedures followed in admitting patients; policies related to the preparation of meals and open visitation; and greater involvement with the patient and…

  11. Neuromuscular electrical stimulation prevents muscle wasting in critically ill comatose patients.

    PubMed

    Dirks, Marlou L; Hansen, Dominique; Van Assche, Aimé; Dendale, Paul; Van Loon, Luc J C

    2015-03-01

    Fully sedated patients, being treated in the intensive care unit (ICU), experience substantial skeletal muscle loss. Consequently, survival rate is reduced and full recovery after awakening is compromised. Neuromuscular electrical stimulation (NMES) represents an effective method to stimulate muscle protein synthesis and alleviate muscle disuse atrophy in healthy subjects. We investigated the efficacy of twice-daily NMES to alleviate muscle loss in six fully sedated ICU patients admitted for acute critical illness [n=3 males, n=3 females; age 63 ± 6 y; APACHE II (Acute Physiology and Chronic Health Evaluation II) disease-severity-score: 29 ± 2]. One leg was subjected to twice-daily NMES of the quadriceps muscle for a period of 7 ± 1 day whereas the other leg acted as a non-stimulated control (CON). Directly before the first and on the morning after the final NMES session, quadriceps muscle biopsies were collected from both legs to assess muscle fibre-type-specific cross-sectional area (CSA). Furthermore, phosphorylation status of the key proteins involved in the regulation of muscle protein synthesis was assessed and mRNA expression of selected genes was measured. In the CON leg, type 1 and type 2 muscle-fibre-CSA decreased by 16 ± 9% and 24 ± 7% respectively (P<0.05). No muscle atrophy was observed in the stimulated leg. NMES increased mammalian target of rapamycin (mTOR) phosphorylation by 19 ± 5% when compared with baseline (P<0.05), with no changes in the CON leg. Furthermore, mRNA expression of key genes involved in muscle protein breakdown either declined [forkhead box protein O1 (FOXO1); P<0.05] or remained unchanged [muscle atrophy F-box (MAFBx) and muscle RING-finger protein-1 (MuRF1)], with no differences between the legs. In conclusion, NMES represents an effective and feasible interventional strategy to prevent skeletal muscle atrophy in critically ill comatose patients. PMID:25296344

  12. First-dose pharmacokinetics of aminoglycosides in critically ill haematological malignancy patients.

    PubMed

    Blackburn, Laura M; Tverdek, Frank P; Hernandez, Mike; Bruno, Jeffrey J

    2015-01-01

    The primary objective of this study was to determine the volume of distribution (Vd) (L/kg) of intravenous aminoglycosides (AGs) in critically ill haematological malignancy patients. Secondary objectives were to determine the body weight (actual, ideal, adjusted or lean) that yields the most precise estimate of Vd when normalised in L/kg as well as the frequency that current first-dose strategies result in post-distributional peak concentrations (C(peak)) within the target range (tobramycin 16-24 mg/L; amikacin 32-48 mg/L). In total, 58 AG doses were included (tobramycin, n = 34; amikacin, n = 24). Median Vd was 0.38 L/kg normalised per the most precise dose weight, which was actual body weight (ABW). The median dose was 445 mg (5.8 mg/kg ABW) for tobramycin and 1200 mg (13.8 mg/kg ABW) for amikacin. Target C(peak) (tobramycin 20mg/L; amikacin 40 mg/L) was achieved in only 25% of all AG episodes, with 4% exceeding the target and 71% falling below the target. Twenty-four organisms were isolated in the study sample; target C(peak) achievement (tobramycin 20 mg/L; amikacin 40 mg/L) would yield a peak:minimum inhibitory concentration of 10 in 75% and 52% of organisms, respectively. In conclusion, an increased Vd of AGs was identified in this critically ill haematological malignancy patient sample, and current dosing yielded a suboptimal C(peak) in the majority of patients. PMID:25455848

  13. Timing of Tracheostomy in Critically Ill Patients: A Meta-Analysis

    PubMed Central

    Huang, Huibin; Li, Ying; Ariani, Felinda; Chen, Xiaoli; Lin, Jiandong

    2014-01-01

    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. PMID:24667875

  14. Timing of (supplemental) parenteral nutrition in critically ill patients: a systematic review

    PubMed Central

    2014-01-01

    Supplemental parenteral nutrition (SPN) is used in a step-up approach when full enteral support is contraindicated or fails to reach caloric targets. Recent nutrition guidelines present divergent advices regarding timing of SPN in critically ill patients ranging from early SPN (<48 h after admission; EPN) to postponing initiation of SPN until day 8 after Intensive Care Unit (ICU) admission (LPN). This systematic review summarizes results of prospective studies among adult ICU patients addressing the best timing of (supplemental) parenteral nutrition (S)PN. A structured PubMed search was conducted to identify eligible articles. Articles were screened and selected using predetermined criteria and appraised for relevance and validity. After critical appraisal, four randomized controlled trials (RCTs) and two prospective observational studies remained. One RCT found a higher percentage of alive discharge from the ICU at day 8 in the LPN group compared to EPN group (p?=?0.007) but no differences in ICU and in-hospital mortality. None of the other RCTs found differences in ICU or in-hospital mortality rates. Contradicting or divergent results on other secondary outcomes were found for ICU length of stay, hospital length of stay, infection rates, nutrition targets, duration of mechanical ventilation, glucose control, duration of renal replacement therapy, muscle wasting and fat loss. Although the heterogeneity in quality and design of relevant studies precludes firm conclusions, it is reasonable to assume that in adult critically ill patients, there are no clinically relevant benefits of EPN compared with LPN with respect to morbidity or mortality end points, when full enteral support is contraindicated or fails to reach caloric targets. However, considering that infectious morbidity and resolution of organ failure may be negatively affected through mechanisms not yet clearly understood and acquisition costs of parenteral nutrition are higher, the early administration of parenteral nutrition cannot be recommended. PMID:25593747

  15. A patient-centred approach to health service delivery: improving health outcomes for people with chronic illness

    PubMed Central

    2013-01-01

    Background The Wagner Model provides a framework that can help to facilitate health system transition towards a chronic care oriented model. Drawing on elements of this framework as well as health policy related to patient centred care, we describe the health needs of patients with chronic illness and compare these with services which should ideally be provided by a patient-centred health system. This paper aims to increase understanding of the challenges faced by chronically ill patients and family carers in relation to their experiences with the health care system and health service providers. Method We interviewed patients, carers and health care professionals (HCPs) about the challenges faced by people living with complicated diabetes, chronic heart failure or chronic obstructive pulmonary disease. Results Patients indicated that they had a range of concerns related to the quality of health care encounters with health care professionals (HCPs), with these concerns being expressed as needs or wants. These included: 1) the need for improved communication and information delivery on the part of HCPs; 2) well organised health services and reduced waiting times to see HCPs; 3) help with self care; 4) greater recognition among professionals of the need for holistic and continuing care; and 5) inclusion of patients and carers in the decision making processes. Conclusions In order to address the challenges faced by people with chronic illness, health policy must be more closely aligned with the identified needs and wants of people affected by chronic illness than is currently the case. PMID:23819721

  16. Internalized Stigma and Stigma Resistance Among Patients with Mental Illness in Han Chinese Population.

    PubMed

    Lien, Yin-Ju; Kao, Yu-Chen; Liu, Yia-Ping; Chang, Hsin-An; Tzeng, Nian-Sheng; Lu, Chien-Wen; Loh, Ching-Hui

    2014-08-23

    Research suggests that accurate measurement is essential in evaluating internalized stigma and abilities to combat with stigma for treatment compliances and outcomes in individuals with mental illness. The purpose of this study was to assess the reliability and validity of the Chinese version of the Internalized Stigma of Mental Illness Scale (ISMIS-C), which is one of the few tools available to measure internalized stigma and stigma resistance (SR) simultaneously. A total of 160 outpatients with (n = 103) and without (n = 57) psychotic disorders were administrated with the ISMIS-C, and measures of self-esteem, self-efficacy, depression, and hopelessness. Overall, the 29-item ISMIS-C was presented to be internal reliable (Cronbach's alpha = 0.90), and reliable over time (intraclass correlation coefficients = 0.36-0.73). The construct validity of the ISMIS-C derived from the factor analysis was nearly identical to the original version. ISMIS-C dimension scores were well correlated with each other and measures of self-esteem, self-efficacy, depression, and hopelessness. Our data also demonstrated that psychotic patients experienced higher internalized stigma scores than those without psychotic diagnoses, but endorsed indifferently on SR scores. This scale can be used as an informative device when investigating "internalized stigma" and "SR" among individuals with or without psychotic disorders. PMID:25150055

  17. Caring for critically ill patients with ebola virus disease. Perspectives from West Africa.

    PubMed

    Fowler, Robert A; Fletcher, Thomas; Fischer, William A; Lamontagne, Francois; Jacob, Shevin; Brett-Major, David; Lawler, James V; Jacquerioz, Frederique A; Houlihan, Catherine; O'Dempsey, Tim; Ferri, Mauricio; Adachi, Takuya; Lamah, Marie-Claire; Bah, Elhadj Ibrahima; Mayet, Thierry; Schieffelin, John; McLellan, Susan L; Senga, Mikiko; Kato, Yasuyuki; Clement, Christophe; Mardel, Simon; Vallenas Bejar De Villar, Rosa Constanza; Shindo, Nahoko; Bausch, Daniel

    2014-10-01

    The largest ever Ebola virus disease outbreak is ravaging West Africa. The constellation of little public health infrastructure, low levels of health literacy, limited acute care and infection prevention and control resources, densely populated areas, and a highly transmissible and lethal viral infection have led to thousands of confirmed, probable, or suspected cases thus far. Ebola virus disease is characterized by a febrile severe illness with profound gastrointestinal manifestations and is complicated by intravascular volume depletion, shock, profound electrolyte abnormalities, and organ dysfunction. Despite no proven Ebola virus-specific medical therapies, the potential effect of supportive care is great for a condition with high baseline mortality and one usually occurring in resource-constrained settings. With more personnel, basic monitoring, and supportive treatment, many of the sickest patients with Ebola virus disease do not need to die. Ebola virus disease represents an illness ready for a paradigm shift in care delivery and outcomes, and the profession of critical care medicine can and should be instrumental in helping this happen. PMID:25166884

  18. Treatment of post-traumatic stress disorder in patients with severe mental illness: a review.

    PubMed

    Mabey, Linda; van Servellen, Gwen

    2014-02-01

    Although the prevalence of post-traumatic stress disorder (PTSD) is high among those with severe mental illness, little is known about the use of interventions to lessen the burden of PTSD in this population. Currently, there are limited data about safe and effective interventions to treat these individuals. This systematic published work review presents the scientific published work reporting studies of psychological treatment approaches for individuals with comorbid PTSD and severe mental illness. A secondary aim of this study was to identify the specific models implemented and tested, and their impact upon patient outcomes. A review of the published work from January 2001 through January 2012 of English-language publications retrieved from the Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE, and the American Psychological Association generated abstracts (PsycINFO) databases was conducted. Six studies met the inclusion criteria for the review. The treatment programs described were cognitive-behavioural therapy, psychoeducation, exposure-based cognitive-behavioural therapy, and eye movement desensitization and reprocessing. Evidence of the effectiveness of these programs is examined. Data to support the use of these interventions are limited, indicating the need for further research and efficacy trials. Future areas of research and implications for nursing are discussed. PMID:23363327

  19. Health Care Providers and Dying Patients: Critical Issues in Terminal Care.

    ERIC Educational Resources Information Center

    Benoliel, Jeanne Quint

    1988-01-01

    Identifies three major areas of concern in relationship between health care providers and dying patients: (1) nature of difficulties and stresses associated with terminal care; (2) education of providers for work; and (3) influence of organizational structure and institutionalized values on services for dying patients and families. Reviews…

  20. Elevated Plasma Homocysteine Concentration in Elderly Patients with Mental Illness Is Mainly Related to the Presence of Vascular Disease and Not the Diagnosis

    Microsoft Academic Search

    Karin Nilsson; Lars Gustafson; Björn Hultberg

    2007-01-01

    Background: Plasma total homocysteine (tHcy) is often elevated in patients with mental illness. Since patients with mental illness and vascular disease exhibit a higher plasma tHcy concentration than patients without vascular disease, it is possible that elevated plasma tHcy in mental illness is mainly due to concomitant vascular disease. Methods: We have investigated plasma tHcy, cobalamin\\/folate status, renal function and

  1. Reduced Serum Butyrylcholinesterase Activity Indicates Severe Systemic Inflammation in Critically Ill Patients

    PubMed Central

    Zivkovic, Aleksandar R.; Schmidt, Karsten; Sigl, Annette; Decker, Sebastian O.; Brenner, Thorsten; Hofer, Stefan

    2015-01-01

    Systemic inflammation is an immune response to a nonspecific insult of either infectious or noninfectious origin and remains a challenge in the intensive care units with high mortality rate. Cholinergic neurotransmission plays an important role in the regulation of the immune response during inflammation. We hypothesized that the activity of butyrylcholinesterase (BChE) might serve as a marker to identify and prognose systemic inflammation. By using a point-of-care-testing (POCT) approach we measured BChE activity in patients with severe systemic inflammation and healthy volunteers. We observed a decreased BChE activity in patients with systemic inflammation, as compared to that of healthy individuals. Furthermore, BChE activity showed an inverse correlation with the severity of the disease. Although hepatic function has previously been found essential for BChE production, we show here that the reduced BChE activity associated with systemic inflammation occurs independently of and is thus not caused by any deficit in liver function in these patients. A POCT approach, used to assess butyrylcholinesterase activity, might further improve the therapy of the critically ill patients by minimizing time delays between the clinical assessment and treatment of the inflammatory process. Hence, assessing butyrylcholinesterase activity might help in early detection of inflammation. PMID:25762852

  2. Goal-Oriented Respiratory Management for Critically Ill Patients with Acute Respiratory Distress Syndrome

    PubMed Central

    Barbas, Carmen Sílvia Valente; Matos, Gustavo Faissol Janot; Amato, Marcelo Britto Passos; Carvalho, Carlos Roberto Ribeiro

    2012-01-01

    This paper, based on relevant literature articles and the authors' clinical experience, presents a goal-oriented respiratory management for critically ill patients with acute respiratory distress syndrome (ARDS) that can help improve clinicians' ability to care for these patients. Early recognition of ARDS modified risk factors and avoidance of aggravating factors during hospital stay such as nonprotective mechanical ventilation, multiple blood products transfusions, positive fluid balance, ventilator-associated pneumonia, and gastric aspiration can help decrease its incidence. An early extensive clinical, laboratory, and imaging evaluation of “at risk patients” allows a correct diagnosis of ARDS, assessment of comorbidities, and calculation of prognostic indices, so that a careful treatment can be planned. Rapid administration of antibiotics and resuscitative measures in case of sepsis and septic shock associated with protective ventilatory strategies and early short-term paralysis associated with differential ventilatory techniques (recruitment maneuvers with adequate positive end-expiratory pressure titration, prone position, and new extracorporeal membrane oxygenation techniques) in severe ARDS can help improve its prognosis. Revaluation of ARDS patients on the third day of evolution (Sequential Organ Failure Assessment (SOFA), biomarkers and response to infection therapy) allows changes in the initial treatment plans and can help decrease ARDS mortality. PMID:22957224

  3. The attributable mortality of delirium in critically ill patients: prospective cohort study

    PubMed Central

    Zaal, Irene J; Spitoni, Cristian; Ong, David S Y; van der Kooi, Arendina W; Bonten, Marc J M; Slooter, Arjen J C; Cremer, Olaf L

    2014-01-01

    Objective To determine the attributable mortality caused by delirium in critically ill patients. Design Prospective cohort study. Setting 32 mixed bed intensive care unit in the Netherlands, January 2011 to July 2013. Participants 1112 consecutive adults admitted to an intensive care unit for a minimum of 24 hours. Exposures Trained observers evaluated delirium daily using a validated protocol. Logistic regression and competing risks survival analyses were used to adjust for baseline variables and a marginal structural model analysis to adjust for confounding by evolution of disease severity before the onset of delirium. Main outcome measure Mortality during admission to an intensive care unit. Results Among 1112 evaluated patients, 558 (50.2%) developed at least one episode of delirium, with a median duration of 3 days (interquartile range 2-7 days). Crude mortality was 94/558 (17%) in patients with delirium compared with 40/554 (7%) in patients without delirium (P<0.001). Delirium was significantly associated with mortality in the multivariable logistic regression analysis (odds ratio 1.77, 95% confidence interval 1.15 to 2.72) and survival analysis (subdistribution hazard ratio 2.08, 95% confidence interval 1.40 to 3.09). However, the association disappeared after adjustment for time varying confounders in the marginal structural model (subdistribution hazard ratio 1.19, 95% confidence interval 0.75 to 1.89). Using this approach, only 7.2% (95% confidence interval ?7.5% to 19.5%) of deaths in the intensive care unit were attributable to delirium, with an absolute mortality excess in patients with delirium of 0.9% (95% confidence interval ?0.9% to 2.3%) by day 30. In post hoc analyses, however, delirium that persisted for two days or more remained associated with a 2.0% (95% confidence interval 1.2% to 2.8%) absolute mortality increase. Furthermore, competing risk analysis showed that delirium of any duration was associated with a significantly reduced rate of discharge from the intensive care unit (cause specific hazard ratio 0.65, 95% confidence interval 0.55 to 0.76). Conclusions Overall, delirium prolongs admission in the intensive care unit but does not cause death in critically ill patients. Future studies should focus on episodes of persistent delirium and its long term sequelae rather than on acute mortality. Trial registration Clinicaltrials.gov NCT01905033. PMID:25422275

  4. Termination of Twin Pregnancies with Hydatidiform Moles: a Case Series of Four Patients

    PubMed Central

    PENG, Mei; LI, Li; ZHENG, Jingjie; DING, Yiling; YU, Ling; HUANG, Jian

    2014-01-01

    Abstract P A twin pregnancy with a complete hydatidiform mole with a coexistent foetus (CHMF) is a rare condition that typically results in poor pregnancy outcomes. For patients with refractory vaginal bleeding, termination of pregnancy is more appropriate. However, unified methods for termination remain to be explored. In the present study, we reviewed the termination measures in four cases of twin pregnancy with CHMF. Additional understanding of this condition will aid in the treatment of women with this condition and improve their pregnancy outcomes.

  5. The Effect of a Patient Portal With Electronic Messaging on Patient Activation Among Chronically Ill Patients: Controlled Before-and-After Study

    PubMed Central

    Linna, Miika; Rönkkö, Ilona

    2014-01-01

    Background It has been suggested that providing patients with access to their medical records and secure messaging with health care professionals improves health outcomes in chronic care by encouraging and activating patients to manage their own condition. Objectives The aim was to evaluate the effect of access to a patient portal on patient activation among chronically ill patients. Further, the relationship between temporal proximity of a severe diagnosis and patient activation were assessed. Methods A total of 876 chronically ill patients from public primary care were allocated to either an intervention group receiving immediate access to a patient portal that included their medical records, care plan, and secure messaging with a care team, or to a control group receiving usual care. Patient Activation Measure (PAM) at baseline and at 6-month follow-up was obtained from 80 patients in the intervention group and 57 patients in the control group; thus, a total of 137 patients were included in the final analysis. Results No significant effect of access to patient portal on patient activation was detected in this study (F 1,133=1.87, P=.17, ?2=0.01). Patients starting at a lower level of activation demonstrated greater positive change in activation compared to patients starting at higher levels of activation in both the intervention and control groups. Further, patients diagnosed with a severe diagnosis during the intervention showed greater positive change in patient activation compared to patients whose last severe diagnosis was made more than 2 years ago. The results also suggest that the intervention had greatest effect on patients starting at the highest level of patient activation (difference in change of patient activation=4.82, P=.13), and among patients diagnosed within a year of the intervention (difference in change of patient activation=7.65, P=.12). Conclusions Time since last severe diagnosis and patient activation at baseline may affect changes in patient activation, suggesting that these should be considered in evaluation of activating chronic care interventions and in the specification of possible target groups for these interventions. This may be relevant in designing services for a heterogeneous group of patients with a distinct medical history and level of activation. PMID:25413368

  6. Prevention of venous thromboembolism in hospitalized acutely ill medical patients: focus on the clinical utility of (low-dose) fondaparinux

    PubMed Central

    Di Nisio, Marcello; Porreca, Ettore

    2013-01-01

    Venous thromboembolism (VTE) is a frequent complication among acutely ill medical patients hospitalized for congestive heart failure, acute respiratory insufficiency, rheumatologic disorders, and acute infectious and/or inflammatory diseases. Based on robust data from randomized controlled studies and meta-analyses showing a reduced incidence of VTE by 40% to about 60% with pharmacologic thromboprophylaxis, prevention of VTE with low molecular weight heparin (LMWH), unfractionated heparin (UFH), or fondaparinux is currently recommended in all at-risk hospitalized acutely ill medical patients. In patients who are bleeding or are at high risk for major bleeding, mechanical prophylaxis with graduated compression stockings or intermittent pneumatic compression may be suggested. Thromboprophylaxis is generally continued for 6 to 14 days or for the duration of hospitalization. Selected cases could benefit from extended thromboprophylaxis beyond this period, although the risk of major bleeding remains a concern, and additional studies are needed to identify patients who may benefit from prolonged prophylaxis. For hospitalized acutely ill medical patients with renal insufficiency, a low dose (1.5 mg once daily) of fondaparinux or prophylactic LMWH subcutaneously appears to have a safe profile, although proper evaluation in randomized studies is lacking. The evidence on the use of prophylaxis for VTE in this latter group of patients, as well as in those at higher risk of bleeding complications, such as patients with thrombocytopenia, remains scarce. For critically ill patients hospitalized in intensive care units with no contraindications, LMWH or UFH are recommended, with frequent and careful assessment of the risk of bleeding. In this review, we discuss the evidence for use of thromboprophylaxis for VTE in acutely ill hospitalized medical patients, with a focus on (low-dose) fondaparinux. PMID:24068866

  7. Thromboprophylaxis patterns and determinants in critically ill patients: a multicenter audit

    PubMed Central

    2014-01-01

    Introduction Heparin is safe and prevents venous thromboembolism in critical illness. We aimed to determine the guideline concordance for thromboprophylaxis in critically ill patients and its predictors, and to analyze factors associated with the use of low molecular weight heparin (LMWH), as it may be associated with a lower risk of pulmonary embolism and heparin-induced thrombocytopenia without increasing the bleeding risk. Methods We performed a retrospective audit in 28 North American intensive care units (ICUs), including all consecutive medical-surgical patients admitted in November 2011. We documented ICU thromboprophylaxis and reasons for omission. Guideline concordance was determined by adding days in which patients without contraindications received thromboprophylaxis to days in which patients with contraindications did not receive it, divided by the total number of patient-days. We used multilevel logistic regression including time-varying, center and patient-level covariates to determine the predictors of guideline concordance and use of LMWH. Results We enrolled 1,935 patients (62.3?±?16.7 years, Acute Physiology and Chronic Health Evaluation [APACHE] II score 19.1?±?8.3). Patients received thromboprophylaxis with unfractionated heparin (UFH) (54.0%) or LMWH (27.6%). Guideline concordance occurred for 95.5% patient-days and was more likely in patients who were sicker (odds ratio (OR) 1.49, 95% confidence interval (CI) 1.17, 1.75 per 10-point increase in APACHE II), heavier (OR 1.32, 95% CI 1.05, 1.65 per 10-m/kg2 increase in body mass index), had cancer (OR 3.22, 95% CI 1.81, 5.72), previous venous thromboembolism (OR 3.94, 95% CI 1.46,10.66), and received mechanical ventilation (OR 1.83, 95% CI 1.32,2.52). Reasons for not receiving thromboprophylaxis were high risk of bleeding (44.5%), current bleeding (16.3%), no reason (12.9%), recent or upcoming invasive procedure (10.2%), nighttime admission or discharge (9.7%), and life-support limitation (6.9%). LMWH was less often administered to sicker patients (OR 0.65, 95% CI 0.48, 0.89 per 10-point increase in APACHE II), surgical patients (OR 0.41, 95% CI 0.24, 0.72), those receiving vasoactive drugs (OR 0.47, 95% CI 0.35, 0.64) or renal replacement therapy (OR 0.10, 95% CI 0.05, 0.23). Conclusions Guideline concordance for thromboprophylaxis was high, but LMWH was less commonly used, especially in patients who were sicker, had surgery, or received vasopressors or renal replacement therapy, representing a potential quality improvement target. PMID:24766968

  8. Metabolic and nutritional support of critically ill patients: consensus and controversies.

    PubMed

    Preiser, Jean-Charles; van Zanten, Arthur Rh; Berger, Mette M; Biolo, Gianni; Casaer, Michael P; Doig, Gordon S; Griffiths, Richard D; Heyland, Daren K; Hiesmayr, Michael; Iapichino, Gaetano; Laviano, Alessandro; Pichard, Claude; Singer, Pierre; Van den Berghe, Greet; Wernerman, Jan; Wischmeyer, Paul; Vincent, Jean-Louis

    2015-12-01

    The results of recent large-scale clinical trials have led us to review our understanding of the metabolic response to stress and the most appropriate means of managing nutrition in critically ill patients. This review presents an update in this field, identifying and discussing a number of areas for which consensus has been reached and others where controversy remains and presenting areas for future research. We discuss optimal calorie and protein intake, the incidence and management of re-feeding syndrome, the role of gastric residual volume monitoring, the place of supplemental parenteral nutrition when enteral feeding is deemed insufficient, the role of indirect calorimetry, and potential indications for several pharmaconutrients. PMID:25777846

  9. Evaluation of the pressure ulcers risk scales with critically ill patients: a prospective cohort study 1

    PubMed Central

    Borghardt, Andressa Tomazini; do Prado, Thiago Nascimento; de Araújo, Thiago Moura; Rogenski, Noemi Marisa Brunet; Bringuente, Maria Edla de Oliveira

    2015-01-01

    AIMS: to evaluate the accuracy of the Braden and Waterlow risk assessment scales in critically ill inpatients. METHOD: this prospective cohort study, with 55 patients in intensive care units, was performed through evaluation of sociodemographic and clinical variables, through the application of the scales (Braden and Waterlow) upon admission and every 48 hours; and through the evaluation and classification of the ulcers into categories. RESULTS: the pressure ulcer incidence was 30.9%, with the Braden and Waterlow scales presenting high sensitivity (41% and 71%) and low specificity (21% and 47%) respectively in the three evaluations. The cut off scores found in the first, second and third evaluations were 12, 12 and 11 in the Braden scale, and 16, 15 and 14 in the Waterlow scale. CONCLUSION: the Braden scale was shown to be a good screening instrument, and the Waterlow scale proved to have better predictive power. PMID:25806628

  10. Stratification of the severity of critically ill patients with classification trees

    PubMed Central

    2009-01-01

    Background Development of three classification trees (CT) based on the CART (Classification and Regression Trees), CHAID (Chi-Square Automatic Interaction Detection) and C4.5 methodologies for the calculation of probability of hospital mortality; the comparison of the results with the APACHE II, SAPS II and MPM II-24 scores, and with a model based on multiple logistic regression (LR). Methods Retrospective study of 2864 patients. Random partition (70:30) into a Development Set (DS) n = 1808 and Validation Set (VS) n = 808. Their properties of discrimination are compared with the ROC curve (AUC CI 95%), Percent of correct classification (PCC CI 95%); and the calibration with the Calibration Curve and the Standardized Mortality Ratio (SMR CI 95%). Results CTs are produced with a different selection of variables and decision rules: CART (5 variables and 8 decision rules), CHAID (7 variables and 15 rules) and C4.5 (6 variables and 10 rules). The common variables were: inotropic therapy, Glasgow, age, (A-a)O2 gradient and antecedent of chronic illness. In VS: all the models achieved acceptable discrimination with AUC above 0.7. CT: CART (0.75(0.71-0.81)), CHAID (0.76(0.72-0.79)) and C4.5 (0.76(0.73-0.80)). PCC: CART (72(69-75)), CHAID (72(69-75)) and C4.5 (76(73-79)). Calibration (SMR) better in the CT: CART (1.04(0.95-1.31)), CHAID (1.06(0.97-1.15) and C4.5 (1.08(0.98-1.16)). Conclusion With different methodologies of CTs, trees are generated with different selection of variables and decision rules. The CTs are easy to interpret, and they stratify the risk of hospital mortality. The CTs should be taken into account for the classification of the prognosis of critically ill patients. PMID:20003229

  11. Use of acid suppressive therapy in hospitalized non-critically ill patients

    PubMed Central

    Sheikh-Taha, Marwan; Alaeddine, Sarah; Nassif, Julie

    2012-01-01

    AIM: To assess the appropriateness of prescribing acid suppressive therapy (AST) in a general medicine service in a tertiary care hospital. METHODS: In this retrospective observational study, we reviewed the inpatient records of all patients admitted to the general medical service in a tertiary care hospital in Beirut, Lebanon, from April 1 to May 31, 2011. Treatment with AST was considered appropriate if the patient had a specific indication or appropriate treatment purpose [e.g., gastro-esophageal reflux disease (GERD), peptic ulcer disease, dyspepsia, acute or suspected gastrointestinal (GI) bleeding]. Appropriate administration of stress ulcer prophylaxis (SUP) was derived from an internal guideline that is based on the American Society of Health System Pharmacists guidelines. Prophylaxis was considered appropriate if a patient had 1 absolute indication (coagulopathy or requiring mechanical ventilation), or 2 or more relative indications (sepsis, occult bleeding, use of high dose corticosteroids, recent use of non-steroidal anti-inflammatory drugs for more than 3 mo, renal or liver failure, enteral feeding and anticoagulant use). RESULTS: Of the 153 patient admissions during the study period, 130 patients (85%) were started on AST, out of which 11 (8.5%) had a diagnosis that supports the use of this therapy (GI bleed, gastritis and GERD), 16 (12.3%) had an absolute indication for SUP, 59 (45.4%) had 2 or more relative indications for SUP, and 44 (33.8%) received AST without an appropriate indication. In addition, one patient with an absolute indication for SUP and four with two or more relative indications did not receive AST. Rabeprazole was the most frequently used AST (59.2%), followed by omeprazole (24.6%), esomeprazole (11.6%) and ranitidine (4.6%). The dose of AST was appropriate in 126 patients (96.9%) and the route of administration was appropriate in 123 patients (94.6%). Fifteen of the admitted patients (10%) were discharged on AST, 7 of which (47%) did not have an appropriate indication. CONCLUSION: AST is overused in hospitalized non-critically ill patients and many patients are discharged on unnecessary AST which can increase cost, drug interactions and adverse events. Potential interventions include implementation of institutional protocols and prescriber education. PMID:23494814

  12. Increased liver stiffness denotes hepatic dysfunction and mortality risk in critically ill non-cirrhotic patients at a medical ICU

    PubMed Central

    2011-01-01

    Introduction Hepatic dysfunction is a common finding in critically ill patients on the ICU and directly influences survival. Liver stiffness can be measured by the novel method of transient elastography (fibroscan) and is closely associated with hepatic fibrosis in patients with chronic liver disease, but also is increased in patients with acute hepatitis, acute liver failure and cholestasis. We investigated liver stiffness as a potentially useful tool for early detection of patients with hepatic deterioration and risk stratification with respect to short- and long-term mortality. Methods We prospectively evaluated 108 consecutive critically ill patients at our medical intensive care unit (ICU) with subsequent longitudinal liver stiffness measurements (admission, Day 3, Day 7 and weekly thereafter) during the course of ICU treatment. Outcome was followed after discharge (median observation time 237 days). Results Liver stiffness could be reliably measured in 71% of ICU patients at admission (65% at Day 3, 63% at Day 7). Critically ill patients (n = 108) had significantly increased liver stiffness compared to sex- and age-matched standard care patients (n = 25). ICU patients with decompensated cirrhosis showed highest liver stiffness, whereas other critical diseases (for example, sepsis) and comorbidities (for example, diabetes, obesity) did not impact stiffness values. At admission to the ICU, liver stiffness is closely related to hepatic damage (liver synthesis, cholestasis, fibrosis markers). During the course of ICU treatment, fluid overload (renal failure, volume therapy) and increased central venous pressure (mechanical ventilation, heart failure) were major factors determining liver stiffness. Liver stiffness values > 18 kilopascal (kPa) at ICU admission were associated with increased ICU and long-term mortality, even in non-cirrhotic patients. Conclusions Considering that liver stiffness cannot be validly measured in about 30% of ICU patients, transient elastography performed at ICU admission might be a useful tool to early identify liver dysfunction and predict mortality in critically ill patients at a medical ICU. PMID:22082207

  13. Role of patients' view of their illness in predicting return to work and functioning after myocardial infarction: longitudinal study

    Microsoft Academic Search

    Keith J Petrie; John Weinman; Norman Sharpe; Judith Buckley

    1996-01-01

    AbstractObjective: To examine whether patients' initial perceptions of their myocardial infarction predict subsequent attendance at a cardiac rehabilitation course, return to work, disability, and sexual dysfunction.Design: Patients' perceptions of their illness were measured at admission with their first myocardial infarction and at follow up three and six months later.Setting: Two large teaching hospitals in Auckland, New Zealand.Subjects: 143 consecutive patients

  14. Efficacy of argatroban in critically ill patients with heparin resistance: a retrospective analysis.

    PubMed

    Treichl, Benjamin; Bachler, Mirjam; Lorenz, Ingo; Friesenecker, Barbara; Oswald, Elgar; Schlimp, Christoph J; Pedross, Florian; Fries, Dietmar

    2015-02-01

    The patients who do not respond even to very high dosages of heparin are assumed to suffer from heparin resistance. The aim of this study was to investigate whether critically ill patients suffering from heparin resistance generally have low antithrombin III (AT) levels, and if the direct thrombin inhibitor argatroban in that case can be an effective option to achieve prophylactic anticoagulation. The study was conducted at the Department for General and Surgical Intensive Care Medicine at the University Hospital Innsbruck. We retrospectively included all patients between 2008 and 2012, who received argatroban because of poor response to high-dosage heparin prophylaxis. The period under observation lasted in total for 9 days, 2 days of anticoagulation with unfractionated heparin (UFH) and 7 days with argatroban. The primary objective was to investigate if after 7 (±?1) hours of switching to argatroban the activated partial thromboplastin time (aPTT) levels were in a prophylactic range of 45 to 55 seconds. Further objectives were to assess the AT level, side effects such as bleeding or thromboembolism, platelet count, correlation between organ function and argatroban dose as well as any need for allogeneic blood products. The study population, consisting of 5 women and 15 men with a mean (±?standard deviation, SD) age of 54.6?±?16.3 years, differed in many clinical aspects. A median (interquartile range) heparin dose of 1,000, 819 to 1,125 IU/h was administered for 2 days and failed in providing a prophylactic anticoagulation measured by the aPTT. The mean aPTT level with heparin treatment was 38.5?seconds (±?4.7) its change within that period was not significant. After switching to argatroban, the mean increase of the aPTT levels in all study patients amounted from 38.5 to 48.3?seconds (p?ill patients, to achieve prophylactic anticoagulation when heparin resistance occurs. PMID:25594496

  15. Waiting times in the ambulatory sector - the case of chronically Ill patients

    PubMed Central

    2013-01-01

    Aims First, the influence of determinants on the waiting times of chronically ill patients in the ambulatory sector is investigated. The determinants are subdivided into four groups: (1) need, (2) socio-economic factors, (3) health system and (4) patient time pressures. Next, the influence of waiting times on the annual number of consultations is examined to assess whether the existing variation in waiting times influences the frequency of medical examinations. The waiting times of chronically ill patients are analysed since regular ambulatory care for this patient group could both improve treatment outcomes and lower costs. Data sources Individual data from the 2010 Representative Survey conducted by the National Association of Statutory Health Insurance Physicians (KBV) together with regional data from the Federal Office of Construction and Regional Planning. Study design This is a retrospective observational study. The dependent variables are waiting times in the ambulatory sector and the number of consultations of General Practitioners (GPs) and specialist physicians in the year 2010. The explanatory variables of interest are ‘need’ and ‘health system’ in the first model and ‘length of waiting times’ in the second. Negative binomial models with random effects are used to estimate the incidence rate ratios of increased waiting times and number of consultations. Subsequently, the models are stratified by urban and rural areas. Results In the pooled regression the factor ‘privately insured’ shortens the waiting time for treatment by a specialist by approximately 28% (about 3 days) in comparison with members of the statutory health insurance system. The category of insurance has no influence on the number of consultations of GPs. In addition, the regression results stratified by urban and rural areas show that in urban areas the factor ‘privately insured’ reduces the waiting time for specialists by approximately 35% (about 3.3 days) while in rural areas there is no evidence of statistical influence. In neither of the models, however, does the waiting time have a documentable effect on the number of consultations in the ambulatory sector. Conclusions In our random sample, characteristics of the health care system have an influence on the waiting time for specialists, but the waiting time has no documentable effect on the number of consultations in the ambulatory sector. In the present analysis this applies to consultations of both GPs and specialists. Nevertheless, it does not rule out the possibility that the length of waiting times might influence the treatment outcomes of certain patient populations. PMID:24020453

  16. Hypomagnesemia in critically ill cancer patients: a prospective study of predictive factors.

    PubMed

    Deheinzelin, D; Negri, E M; Tucci, M R; Salem, M Z; da Cruz, V M; Oliveira, R M; Nishimoto, I N; Hoelz, C

    2000-12-01

    Hypomagnesemia is the most common electrolyte disturbance seen upon admission to the intensive care unit (ICU). Reliable predictors of its occurrence are not described. The objective of this prospective study was to determine factors predictive of hypomagnesemia upon admission to the ICU. In a single tertiary cancer center, 226 patients with different diagnoses upon entering were studied. Hypomagnesemia was defined by serum levels <1.5 mg/dl. Demographic data, type of cancer, cause of admission, previous history of arrhythmia, cardiovascular disease, renal failure, drug administration (particularly diuretics, antiarrhythmics, chemotherapy and platinum compounds), previous nutrition intake and presence of hypovolemia were recorded for each patient. Blood was collected for determination of serum magnesium, potassium, sodium, calcium, phosphorus, blood urea nitrogen and creatinine levels. Upon admission, 103 (45.6%) patients had hypomagnesemia and 123 (54.4%) had normomagnesemia. A normal dietary habit prior to ICU admission was associated with normal Mg levels (P = 0.007) and higher average levels of serum Mg (P = 0.002). Postoperative patients (N = 182) had lower levels of serum Mg (0.60 +/- 0.14 mmol/l compared with 0.66 +/- 0.17 mmol/l, P = 0.006). A stepwise multiple linear regression disclosed that only normal dietary habits (OR = 0.45; CI = 0.26-0.79) and the fact of being a postoperative patient (OR = 2.42; CI = 1. 17-4.98) were significantly correlated with serum Mg levels (overall model probability = 0.001). These findings should be used to identify patients at risk for such disturbance, even in other critically ill populations. PMID:11105096

  17. Rethinking the patient: using Burden of Treatment Theory to understand the changing dynamics of illness

    PubMed Central

    2014-01-01

    Background In this article we outline Burden of Treatment Theory, a new model of the relationship between sick people, their social networks, and healthcare services. Health services face the challenge of growing populations with long-term and life-limiting conditions, they have responded to this by delegating to sick people and their networks routine work aimed at managing symptoms, and at retarding – and sometimes preventing – disease progression. This is the new proactive work of patient-hood for which patients are increasingly accountable: founded on ideas about self-care, self-empowerment, and self-actualization, and on new technologies and treatment modalities which can be shifted from the clinic into the community. These place new demands on sick people, which they may experience as burdens of treatment. Discussion As the burdens accumulate some patients are overwhelmed, and the consequences are likely to be poor healthcare outcomes for individual patients, increasing strain on caregivers, and rising demand and costs of healthcare services. In the face of these challenges we need to better understand the resources that patients draw upon as they respond to the demands of both burdens of illness and burdens of treatment, and the ways that resources interact with healthcare utilization. Summary Burden of Treatment Theory is oriented to understanding how capacity for action interacts with the work that stems from healthcare. Burden of Treatment Theory is a structural model that focuses on the work that patients and their networks do. It thus helps us understand variations in healthcare utilization and adherence in different healthcare settings and clinical contexts. PMID:24969758

  18. Plasma exposure of free linezolid and its ratio to minimum inhibitory concentration varies in critically ill patients.

    PubMed

    Yagi, Tatsuya; Naito, Takafumi; Doi, Matsuyuki; Nagura, Osanori; Yamada, Takahiro; Maekawa, Masato; Sato, Shigehito; Kawakami, Junichi

    2013-10-01

    The clinical implications of free linezolid monitoring have not been fully clarified in critically ill patients. The aim of this study was to evaluate the variability in pharmacokinetics of free linezolid and its relationship with susceptibility to meticillin-resistant Staphylococcus aureus (MRSA) in critically ill patients. Twenty critically ill MRSA-infected patients receiving intravenous linezolid were enrolled. Blood specimens were collected by 12-h sampling after dosing at Day 7. The medians (interquartile range) of the minimum free concentration, area under the concentration-time curve of total and free linezolid from 0 to 24 h (AUC(0-24) and fAUC(0-24), respectively) and percentage bound were 9.9 ?g/mL (5.2-15 ?g/mL), 495 ?gh/mL (291-695 ?gh/mL), 385 ?gh/mL (242-528 ?gh/mL) and 23% (15-28%), respectively. The medians of the AUC(0-24) and fAUC(0-24) to minimum inhibitory concentration ratios (AUC/MIC and fAUC/MIC) were 248 (144-347) and 192 (109-264), respectively. Two patients failed to achieve adequate levels of AUC/MIC and fAUC/MIC for linezolid. The percentage bound of linezolid in hypoalbuminaemic patients was significantly lower than in non-hypoalbuminaemic patients. A significant correlation was observed between fAUC(0-24) and creatinine clearance. In addition, the fAUC(0-24) was correlated with the minimum free concentration. In conclusion, the plasma level of free linezolid was variable in critically ill patients with renal dysfunction and hypoalbuminaemia. This finding suggests that the monitoring of free linezolid is necessary in critically ill patients. PMID:23988716

  19. Soft Set-Based Decision Making for Patients Suspected Influenza-Like Illness

    NASA Astrophysics Data System (ADS)

    Herawan, Tutut

    In previous work, we presented an applicability of soft set theory for decision making of patients suspected influenza. The proposed technique is based on maximal supported objects by parameters. At this stage of the research, results are presented and discussed from a qualitative point of view against recent soft decision making techniques through an artificial dataset. In this paper, we present an extended application of our soft set-based decision making through a Boolean valued information system from a dataset of patients suspected ILI (Influenza-Like Illness). Using soft set theory and maximal symptoms co-occurences in patients, we explore how soft set-based decision making technique can be used to reduce the number of dispensable symptoms and further make a correct and fast decision. The result of this work can be used for recommendation of decision making based on the clusters decision captured. Finally, this technique may potentially contribute to lowering the complexity of medical decision making without loss of original information.

  20. Vitamin D status in adult critically ill patients in Eastern India: An observational retrospective study

    PubMed Central

    Padhi, Rajesh; Panda, Baikunthanath; Jagati, Snehalata; Patra, Subhas Chandra

    2014-01-01

    Background: The prevalence of vitamin D deficiency in critically ill patients has been reported to be as high as 80%. There is insufficient data regarding the relationship between 25-hydroxyvitamin D [25(OH) D] levels and outcomes in medical intensive care unit (MICU). The goal of this study was to evaluate the prevalence of 25(OH) D deficiency in MICU and its relationship with outcomes. Subjects and Methods: This was a retrospective study in a MICU of a teaching medical college hospital of Eastern India. All patients admitted to MICU, who had levels of 25(OH) D available, were included in the study. The discriminative powers of admission and lowest 25(OH) D values regarding day-30 mortality were evaluated by producing receiver operating curves (ROC). Binary end points were analyzed by means of a Fisher's exact test. Continuous variables were compared by using unpaired t-tests, Welch's tests, or Wilcoxon ranksum tests. All odds ratios and their corresponding 95% confidence intervals were calculated according to the profile-likelihood method. The time from inclusion to death in the two groups was compared with the use of the log-rank test, and the results are presented as Kaplan–Meier curves. Hazard ratios for death from hypo 25(OH) D were calculated by logistic regression model. All P values were 2-tailed and P < 0.05 was considered statistically significant. Results: Of the 300 patients admitted during the study period, 25(OH) D levels were available in 152 patients (50.6%). Of these 152 patients, 15 patients (9.8%) had 25(OH) D insufficiency (20-29.9 ng/dL), 79 (51.9%) had 25(OH) D deficiency (0-19.9 ng/dL), and the levels were normal (>30 ng/dl) in 58 (38.2%) patients. Most of the patients with deficient 25(OH) D levels were females (P < 0.05). Higher mortality (P = 0.01), increased length of MICU stay, and prolonged ventilation were observed in patients with 25(OH) D deficiency. Conclusions: Patients with 25(OH) D deficiency in MICU have increased hospital mortality, longer mechanical ventilation, and longer MICU stay. PMID:25125805

  1. Opioid rotation for toxicity reduction in terminal cancer patients

    Microsoft Academic Search

    Noe´mi D. de Stoutz; Eduardo Bruera; Maria Suarez-Almazor

    1995-01-01

    Accumulation of active (toxic) metabolites of opioids might explain cases of opioid toxicity when high doses are used for long periods of time. Other mechanisms of late toxicity of opioids may be found at the receptor level. Whatever the cause, a change of opioids using equianalgesic doses can be expected to improve symptoms of toxicity in some patients, while maintaining

  2. What really matters in end-of-life discussions? Perspectives of patients in hospital with serious illness and their families

    PubMed Central

    You, John J.; Dodek, Peter; Lamontagne, Francois; Downar, James; Sinuff, Tasnim; Jiang, Xuran; Day, Andrew G.; Heyland, Daren K.

    2014-01-01

    Background: The guideline-recommended elements to include in discussions about goals of care with patients with serious illness are mostly based on expert opinion. We sought to identify which elements are most important to patients and their families. Methods: We used a cross-sectional study design involving patients from 9 Canadian hospitals. We asked older adult patients with serious illness and their family members about the occurrence and importance of 11 guideline-recommended elements of goals-of-care discussions. In addition, we assessed concordance between prescribed goals of care and patient preferences, and we measured patient satisfaction with goals-of-care discussions using the Canadian Health Care Evaluation Project (CANHELP) questionnaire. Results: Our study participants included 233 patients (mean age 81.2 yr) and 205 family members (mean age 60.2 yr). Participants reported that clinical teams had addressed individual elements of goals-of-care discussions infrequently (range 1.4%–31.7%). Patients and family members identified the same 5 elements as being the most important to address: preferences for care in the event of life-threatening illness, values, prognosis, fears or concerns, and questions about goals of care. Addressing more elements was associated with both greater concordance between patients’ preferences and prescribed goals of care, and greater patient satisfaction. Interpretation: We identified elements of goals-of-care discussions that are most important to older adult patients in hospital with serious illness and their family members. We found that guideline-recommended elements of goals-of-care discussions are not often addressed by health care providers. Our results can inform interventions to improve the determination of goals of care in the hospital setting. PMID:25367427

  3. Cisapride improves gastric emptying in mechanically ventilated, critically ill patients. A randomized, double-blind trial.

    PubMed

    Heyland, D K; Tougas, G; Cook, D J; Guyatt, G H

    1996-12-01

    We conducted a randomized, double-blind, placebo-controlled trial in mechanically ventilated intensive care unit (ICU) patients to evaluate the effect of cisapride on gastric emptying using an acetaminophen absorption model. We enrolled 72 patients expected to remain in the ICU for more than 48 h; 39% were female; the average age was 54.0 +/- 19.1 yr; 47% were postoperative, 83% were receiving narcotics, and the mean simplified acute physiology score (SAPS) was 9.5 +/- 3.0. Within 72 h of admission to ICU, 1.6 g of acetaminophen suspension was administered via a nasogastric tube into the stomach (Day 1). Blood samples were drawn at baseline, 30, 60, 90, 120, and 180 min for measurement of plasma acetaminophen levels. The following morning (Day 2), patients were randomized to receive 20 mg of cisapride or placebo and gastric emptying was again assessed. The difference (Day 2-Day 1) in the maximal plasma concentration was 49.1 mumol/L in the cisapride groups compared with 12.3 mumol/L in the placebo group (p = 0.005) and the time to reach maximal concentration was significantly shorter in the cisapride group (-40.8 min versus -4.2 min, p = 0.02). The difference in area under the time-acetaminophen concentration curve was also greater in the patients receiving cisapride (5,534 versus 2,832, p = 0.09). We conclude that cisapride enhances gastric emptying in critically ill patients. Studies to examine the effect of cisapride on tolerance to enteral nutrition, infectious morbidity, and other clinically important outcomes are warranted. PMID:8970354

  4. Clinical review: Helmet and non-invasive mechanical ventilation in critically ill patients.

    PubMed

    Esquinas Rodriguez, Antonio M; Papadakos, Peter J; Carron, Michele; Cosentini, Roberto; Chiumello, Davide

    2013-01-01

    Non-invasive mechanical ventilation (NIV) has proved to be an excellent technique in selected critically ill patients with different forms of acute respiratory failure. However, NIV can fail on account of the severity of the disease and technical problems, particularly at the interface. The helmet could be an alternative interface compared to face mask to improve NIV success. We performed a clinical review to investigate the main physiological and clinical studies assessing the efficacy and related issues of NIV delivered with a helmet. A computerized search strategy of MEDLINE/PubMed (January 2000 to May 2012) and EMBASE (January 2000 to May 2012) was conducted limiting the search to retrospective, prospective, nonrandomized and randomized trials. We analyzed 152 studies from which 33 were selected, 12 physiological and 21 clinical (879 patients). The physiological studies showed that NIV with helmet could predispose to CO? rebreathing and increase the patients' ventilator asynchrony. The main indications for NIV were acute cardiogenic pulmonary edema, hypoxemic acute respiratory failure (community-acquired pneumonia, postoperative and immunocompromised patients) and hypercapnic acute respiratory failure. In 9 of the 21 studies the helmet was compared to a face mask during either continous positive airway pressure or pressure support ventilation. In eight studies oxygenation was similar in the two groups, while the intubation rate was similar in four and lower in three studies for the helmet group compared to face mask group. The outcome was similar in six studies. The tolerance was better with the helmet in six of the studies. Although these data are limited, NIV delivered by helmet could be a safe alternative to the face mask in patients with acute respiratory failure. PMID:23680299

  5. Clinical review: Helmet and non-invasive mechanical ventilation in critically ill patients

    PubMed Central

    2013-01-01

    Non-invasive mechanical ventilation (NIV) has proved to be an excellent technique in selected critically ill patients with different forms of acute respiratory failure. However, NIV can fail on account of the severity of the disease and technical problems, particularly at the interface. The helmet could be an alternative interface compared to face mask to improve NIV success. We performed a clinical review to investigate the main physiological and clinical studies assessing the efficacy and related issues of NIV delivered with a helmet. A computerized search strategy of MEDLINE/PubMed (January 2000 to May 2012) and EMBASE (January 2000 to May 2012) was conducted limiting the search to retrospective, prospective, nonrandomized and randomized trials. We analyzed 152 studies from which 33 were selected, 12 physiological and 21 clinical (879 patients). The physiological studies showed that NIV with helmet could predispose to CO2 rebreathing and increase the patients' ventilator asynchrony. The main indications for NIV were acute cardiogenic pulmonary edema, hypoxemic acute respiratory failure (community-acquired pneumonia, postoperative and immunocompromised patients) and hypercapnic acute respiratory failure. In 9 of the 21 studies the helmet was compared to a face mask during either continous positive airway pressure or pressure support ventilation. In eight studies oxygenation was similar in the two groups, while the intubation rate was similar in four and lower in three studies for the helmet group compared to face mask group. The outcome was similar in six studies. The tolerance was better with the helmet in six of the studies. Although these data are limited, NIV delivered by helmet could be a safe alternative to the face mask in patients with acute respiratory failure. PMID:23680299

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

    PubMed Central

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

    2013-01-01

    Background In Ontario, Canada, the patient-centred medical home is a model of primary care delivery that includes 3 model types of interest for this study: enhanced fee-for-service, blended capitation, and team-based blended capitation. All 3 models involve rostering of patients and have similar practice requirements but differ in method of physician reimbursement, with the blended capitation models incorporating adjustments for age and sex, but not case mix, of rostered patients. We evaluated the extent to which persons with mental illness were included in physicians’ total practices (as rostered and non-rostered patients) and were included on physicians’ rosters across types of medical homes in Ontario. Methods Using population-based administrative data, we considered 3 groups of patients: those with psychotic or bipolar diagnoses, those with other mental health diagnoses, and those with no mental health diagnoses. We modelled the prevalence of mental health diagnoses and the proportion of patients with such diagnoses who were rostered across the 3 medical home model types, controlling for demographic characteristics and case mix. Results Compared with enhanced fee-for-service practices, and relative to patients without mental illness, the proportions of patients with psychosis or bipolar disorders were not different in blended capitation and team-based blended capitation practices (rate ratio [RR] 0.91, 95% confidence interval [CI] 0.82–1.01; RR 1.06, 95% CI 0.96–1.17, respectively). However, there were fewer patients with other mental illnesses (RR 0.94, 95% CI 0.90–0.99; RR 0.89, 95% CI 0.85–0.94, respectively). Compared with expected proportions, practices based on both capitation models were significantly less likely than enhanced fee-for-service practices to roster patients with psychosis or bipolar disorders (for blended capitation, RR 0.92, 95% CI 0.90–0.93; for team-based capitation, RR 0.92, 95% CI 0.88–0.93) and also patients with other mental illnesses (for blended capitation, RR 0.94, 95% CI 0.92–0.95; for team-based capitation, RR 0.93, 95% CI 0.92–0.94). Interpretation Persons with mental illness were under-represented in the rosters of Ontario’s capitation-based medical homes. These findings suggest a need to direct attention to the incentive structure for including patients with mental illness. PMID:23687535

  7. Combined Intravenous and Intraventricular Administration of Colistin Methanesulfonate in Critically Ill Patients with Central Nervous System Infection

    PubMed Central

    Ziaka, Mairi; Markantonis, Sophia L.; Fousteri, Marizoza; Zygoulis, Paris; Panidis, Dimitris; Karvouniaris, Marios; Zakynthinos, Epaminondas

    2013-01-01

    Colistin pharmacokinetics were prospectively studied after intravenous administration of colistin methanesulphonate in critically ill patients without central nervous system infection (controls, n = 5) and in patients with external ventricular drain-associated ventriculitis after intravenous administration (EVDViv, n = 3) or combined intravenous/intraventricular administration (EVDVcomb, n = 4). Cerebrospinal fluid (CSF)/serum colistin concentration ratios were higher in EVDViv than in control patients (11% versus 7%, P ? 0.05) and in EVDVcomb compared to all other patients (P < 0.0001). CSF colistin concentrations above the MIC of 0.5 ?g/ml were achieved only in EVDVcomb patients. PMID:23335739

  8. Depression and Chronic Illness

    MedlinePLUS

    ... and one-fifth with terminal cancer experience a depressive disorder. Sadly, less than half of those receive treatment for depression. Facing a chronic illness naturally leads to feelings of uncertainty, grief, sadness, anger or fear. But when these feelings ...

  9. Impact of a specialized multidisciplinary tracheostomy team on tracheostomy care in critically ill patients

    PubMed Central

    de Mestral, Charles; Iqbal, Sameena; Fong, Nancy; LeBlanc, Joanne; Fata, Paola; Razek, Tarek; Khwaja, Kosar

    2011-01-01

    Background A multidisciplinary tracheostomy team was created in 2005 to follow critically ill patients who had undergone a tracheostomy until their discharge from hospital. Composed of a surgeon, surgical resident, respiratory therapist, speech-language pathologist and clinical nurse specialist, this team has been meeting twice a week for rounds involving patients who transitioned from the intensive care unit (ICU) to the medical and surgical wards. Our objective was to assess the impact of this multidisciplinary team on downsizing and decannulation times, on the incidence of speaking valve placement and on the incidence of tracheostomy-related complications on the ward. Methods This study was conducted at a tertiary care, level-1 trauma centre and teaching hospital and involved all patients who had received a tracheostomy during admission to the ICU from Jan. 1 to Dec. 31, 2004 (preservice group), and from Jan. 1 to Dec. 31, 2006 (postservice group). We compared the outcomes of patients who required tracheostomies in a 12-month period after the team was created with those of patients from a similar time frame before the establishment of the team. Results There were 32 patients in the preservice group and 54 patients in the post-service group. Under the new tracheostomy service, there was a decrease in incidence of tube blockage (5.5% v. 25.0%, p = 0.016) and calls for respiratory distress (16.7% v. 37.5%, p = 0.039) on the wards. A significantly larger proportion of patients also received speaking valves (67.4% v. 19.4%, p < 0.001) after creation of the team. Furthermore, there appeared to be a decreased time to first tube downsizing (26.0 to 9.4 d) and decreased time to decannulation (50.4 to 28.4 d), although this did not reach statistical significance owing to our small sample size. Conclusion Standardized care provided by a specialized multidisciplinary tracheostomy team was associated with fewer tracheostomy-related complications and an increase in the use of a speaking valve. PMID:21443833

  10. A prospective determination of the incidence of perceived inappropriate care in critically ill patients

    PubMed Central

    Singal, Rohit K; Sibbald, Robert; Morgan, Brenda; Quinlan, Mel; Parry, Neil; Radford, Michael; Martin, Claudio M

    2014-01-01

    BACKGROUND: Health care providers’ perceptions regarding appropriateness in end-of-life treatments have been widely studied. While nurses and physicians believe that rationing and other cost-related practices sometimes occur in the intensive care unit (ICU), they allege that treatment is often excessive. OBJECTIVE: To prospectively determine the incidence and causes of health care providers’ perceptions regarding appropriateness of end-of-life treatments. METHODS: The present prospective study collected data from patients admitted to the medical-surgical trauma ICU of a 30-bed, Canadian teaching hospital over a three-month period. Daily surveys were completed independently by bedside nurses, charge nurses and attending physician. RESULTS: In total, 5224 of 6558 expected surveys (representing 294 patients) were analyzed, yielding a response rate of 79.7%. The incidence of perceived inappropriate care in the present study was 6.5% (19 of 294 patients), with ongoing treatment for >2 days after this determination occurring in 1% (three of 294 patients). However, at least one caregiver perceived inappropriate care at some point in 110 of 294 (37.5%) patients. In these cases, in which processes to address care were not already underway, respondents believed that important issues resulting in provision of inappropriate treatments included patient-family issues and communication before or in the ICU. Caregivers did not know their patients’ wishes 22% (1129 of 5224) of the time. CONCLUSIONS: Although ongoing inappropriate care appeared to be a rare occurrence, the issue was a concern to at least one caregiver in one-third of cases. Public awareness for end-of-life issues, adequate communication, and up-to-date knowledge and practice in determining the wishes of critically ill patients are potential target areas to improve end-of-life care and reduce inappropriate care in the ICU. A daily, prospective survey of multidisciplinary caregivers, such as the survey used in the present study, is a viable and valuable means of determining the scope and causes of inappropriate care in the ICU. PMID:24367791

  11. Facility based cross-sectional study of self stigma among people with mental illness: towards patient empowerment approach

    PubMed Central

    2013-01-01

    Background Self stigma among people with mental illness results from multiple cognitive and environmental factors and processes. It can negatively affect adherence to psychiatric services, self esteem, hope, social integration and quality of life of people with mental illness. The purpose of this study was to measure the level of self stigma and its correlates among people with mental illness at Jimma University Specialized Hospital, Psychiatry clinic in southwest Ethiopia. Methods Facility based cross-sectional study was conducted on 422 consecutive samples of people with mental illness using interviewer administered and pretested internalized stigma of mental illness (ISMI) scale. Data was entered using EPI-DATA and analysis was done using STATA software. Bivariate and multivariate linear regressions were done to identify correlates of self stigma. Results On a scale ranging from 1 to 4, the mean self stigma score was 2.32 (SD?=?0.30). Females had higher self stigma (std. ??=?0.11, P?Patients with a history of traditional treatment had higher self stigma (std. ??=?0.11, P?illness (std. ??=?0.16, P?illness were associated with higher self stigma. Drug side effects and perceived signs of mental illness were correlated with increased self stigma while education and self esteem decreased self stigma among people with mental illness. Patient empowerment psychosocial interventions and strategies to reduce drug side effects can be helpful in reducing self stigma among people with mental illnesses. PMID:24004512

  12. Outcome and Attributable Mortality in Critically Ill Patients With Bacteremia Involving Methicillin-Susceptible and Methicillin-Resistant Staphylococcus aureus

    Microsoft Academic Search

    Stijn I. Blot; Koenraad H. Vandewoude; Eric A. Hoste; Francis A. Colardyn

    2002-01-01

    Background: Staphylococcus aureus bacteremia car- ries high mortality rates. The clinical impact of methi- cillin resistance remains controversial: outcome com- parisons between patients with bacteremia involving methicillin-susceptible (MSSA) and methicillin- resistant (MRSA) S aureus are difficult to perform be- cause of important differences in severity of illness. Methods: A retrospective cohort analysis and 2 inde- pendent case-control analyses were performed

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

    Microsoft Academic Search

    Marcus J Schultz; Robin E Harmsen; Peter E Spronk

    2010-01-01

    ABSTRACT: 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 reporting an unexpected higher mortality. Consequently, enthusiasm for the implementation of SGC has declined, hampering translation of

  14. High Seroprevalence of Antibodies against Spotted Fever and Scrub Typhus Bacteria in Patients with Febrile Illness, Kenya

    PubMed Central

    Thiga, Jacqueline W.; Mutai, Beth K.; Eyako, Wurapa K.; Ng’ang’a, Zipporah; Jiang, Ju; Richards, Allen L.

    2015-01-01

    Serum samples from patients in Kenya with febrile illnesses were screened for antibodies against bacteria that cause spotted fever, typhus, and scrub typhus. Seroprevalence was 10% for spotted fever group, <1% for typhus group, and 5% for scrub typhus group. Results should help clinicians expand their list of differential diagnoses for undifferentiated fevers. PMID:25811219

  15. A new patient focused index for measuring quality of life in persons with severe and persistent mental illness

    Microsoft Academic Search

    M. Becker; R. Diamond; F. Sainfort

    1993-01-01

    The quality of life in persons with severe and persistent mental illness is often poor. Most treatment programmes have the goal of increasing quality of life. Unfortunately, existing methods to assess qualtiy of life are cumbersome and oriented towards research rather than clinical settings. This study describes preliminary steps in the development, testing and application of a new patient focused

  16. Diagnostic utility of B-type natriuretic peptide in critically ill patients with pulmonary edema: a prospective cohort study

    Microsoft Academic Search

    Joseph E Levitt; Ajeet G Vinayak; Brian K Gehlbach; Anne Pohlman; William Van Cleve; Jesse B Hall; John P Kress

    2008-01-01

    ABSTRACT: INTRODUCTION: Distinguishing pulmonary edema due to acute lung injury (ALI) or the acute respiratory distress syndrome (ARDS) from hydrostatic or cardiogenic edema is challenging in critically ill patients. B-type natriuretic peptide (BNP) can effectively identify congestive heart failure in the emergency room setting but, despite increasing use, its diagnostic utility has not been validated in the intensive care unit

  17. The fundamentals of mold-related illness: when to suspect the environment is making a patient sick.

    PubMed

    Fung, Frederick; Hughson, William G

    2008-04-01

    Disorders related to indoor air quality have become a major concern for primary care physicians, who often are asked to evaluate patients whose symptoms may be caused or aggravated by indoor exposure to mold. In this article, we review the common types of indoor mold and discuss the management of mold exposure and related illnesses. PMID:18467813

  18. Prediction scores do not correlate with clinically adjudicated categories of pulmonary embolism in critically ill patients

    PubMed Central

    Katsios, CM; Donadini, M; Meade, M; Mehta, S; Hall, R; Granton, J; Kutsiogiannis, J; Dodek, P; Heels-Ansdell, D; McIntyre, L; Vlahakis, N; Muscedere, J; Friedrich, J; Fowler, R; Skrobik, Y; Albert, M; Cox, M; Klinger, J; Nates, J; Bersten, A; Doig, C; Zytaruk, N; Crowther, M; Cook, DJ

    2014-01-01

    BACKGROUND: Prediction scores for pretest probability of pulmonary embolism (PE) validated in outpatient settings are occasionally used in the intensive care unit (ICU). OBJECTIVE: To evaluate the correlation of Geneva and Wells scores with adjudicated categories of PE in ICU patients. METHODS: In a randomized trial of thromboprophylaxis, patients with suspected PE were adjudicated as possible, probable or definite PE. Data were then retrospectively abstracted for the Geneva Diagnostic PE score, Wells, Modified Wells and Simplified Wells Diagnostic scores. The chance-corrected agreement between adjudicated categories and each score was calculated. ANOVA was used to compare values across the three adjudicated PE categories. RESULTS: Among 70 patients with suspected PE, agreement was poor between adjudicated categories and Geneva pretest probabilities (kappa 0.01 [95% CI ?0.0643 to 0.0941]) or Wells pretest probabilities (kappa ?0.03 [95% CI ?0.1462 to 0.0914]). Among four possible, 16 probable and 50 definite PEs, there were no significant differences in Geneva scores (possible = 4.0, probable = 4.7, definite = 4.5; P=0.90), Wells scores (possible = 2.8, probable = 4.9, definite = 4.1; P=0.37), Modified Wells (possible = 2.0, probable = 3.4, definite = 2.9; P=0.34) or Simplified Wells (possible = 1.8, probable = 2.8, definite = 2.4; P=0.30). CONCLUSIONS: Pretest probability scores developed outside the ICU do not correlate with adjudicated PE categories in critically ill patients. Research is needed to develop prediction scores for this population. PMID:24083302

  19. Accuracy of point-of-care blood glucose measurements in critically ill patients in shock.

    PubMed

    Garingarao, Carlo Jan Pati-An; Buenaluz-Sedurante, Myrna; Jimeno, Cecilia Alegado

    2014-09-01

    A widely used method in monitoring glycemic status of ICU patients is point-of-care (POC) monitoring devices. A possible limitation to this method is altered peripheral blood flow in patients in shock, which may result in over/underestimations of their true glycemic status. This study aims to determine the accuracy of blood glucose measurements with a POC meter compared to laboratory methods in critically ill patients in shock. POC blood glucose was measured with a glucose-1-dehydrogenase-based reflectometric meter. The reference method was venous plasma glucose measured by a clinical chemistry analyzer (glucose oxidase-based). Outcomes assessed were concordance to ISO 15197:2003 minimum accuracy criteria for glucose meters, bias in glucose measurements obtained by the 2 methods using Bland-Altman analysis, and clinical accuracy through modified error grid analysis. A total of 186 paired glucose measurements were obtained. ISO 2003 accuracy criteria were met in 95.7% and 79.8% of POC glucose values in the normotensive and hypotensive group, respectively. Mean bias for the normotensive group was -12.4 mg/dL, while mean bias in the hypotensive group was -34.9 mg/dL. POC glucose measurements within the target zone for clinical accuracy were 90.2% and 79.8% for the normotensive and hypotensive group, respectively. POC blood glucose measurements were significantly less accurate in the hypotensive subgroup of ICU patients compared to the normotensive group. We recommend a lower threshold in confirming POC blood glucose with a central laboratory method if clinically incompatible. In light of recently updated accuracy standards, we also recommend alternative methods of glucose monitoring for the ICU population as a whole regardless of blood pressure status. PMID:25172876

  20. Serum uric acid levels and different phases of illness in bipolar I patients treated with lithium.

    PubMed

    Muti, Matteo; Del Grande, Claudia; Musetti, Laura; Marazziti, Donatella; Turri, Milo; Cirronis, Marco; Pergentini, Irene; Corsi, Martina; Dell'Osso, Liliana; Corsini, Giovanni Umberto

    2015-02-28

    Recent findings support the role of purinergic system dysfunction in the pathophysiology of bipolar disorder (BD). The present study aimed to evaluate the pattern of serum uric acid levels in a sample of 98 BD I patients followed-up prospectively in a naturalistic study and treated with lithium monotherapy or in association with other mood stabilizers (valproate or carbamazepine), in relation to different phases of illness and to pharmacological treatment. The results showed that uric acid levels were significantly higher in patients suffering from a manic/mixed episode, than in those euthymic or during a depressive phase. Further, these levels were related to the Clinical Global Impression-Bipolar Version (CGI-BP) scale score for the severity of manic symptoms. A positive correlation was found also with male sex and with serum lithium levels. These findings suggest that a dysregulation of the purinergic system may occur during manic/mixed episodes, and they support a possible role of serum uric acid levels as a state-dependent marker of BD manic phases. PMID:25547850

  1. Adherence to Universal (barrier) Precautions during interventions on critically ill and injured emergency department patients.

    PubMed

    Kelen, G D; DiGiovanna, T A; Celentano, D D; Kalainov, D; Bisson, L; Junkins, E; Stein, A; Lofy, L; Scott, C R; Sivertson, K T

    1990-01-01

    In a study undertaken to determine compliance with Universal Precautions, we observed 129 personnel performing 1,274 interventions on 151 consecutive critically ill and injured patients in an emergency department setting in July 1988. Barrier precautions were fully adhered to 44.0% of the time. During interventions in patients with profuse bleeding, adherence was only 19.5% in contrast to 44.7% for those who were not bleeding. Adherence was 56.4% during minor interventions but only 16.7% during major procedures. Adherence rates varied among health care providers: residents, 58%; emergency staff physicians, 38%; consultant physicians, 43%; emergency nursing staff, 44%; paramedics, 8%; radiology technicians, 14%; and housekeeping, 91%. In a follow up questionnaire that ascertained reasons for lack of compliance, 47% of providers indicated that there was not always sufficient time to put on protective material, 33% felt that precautions interfered with skillful performance of procedures, and 23% stated that materials were uncomfortable. Only 2.7% felt that Universal Precautions did not work. Since there is no proven postexposure prophylaxis for human immunodeficiency virus, Universal Precautions must be rigorously followed until such time as they are shown not to be effective or an alternate approach is developed. Strategies to improve compliance and improvements in barrier technology need to be developed. PMID:2398462

  2. Fecal incontinence in acutely and critically ill patients: options in management.

    PubMed

    Beitz, Janice M

    2006-12-01

    Fecal incontinence presents a major challenge in the comprehensive nursing care of acutely and critically ill patients. When manifested as diarrhea, the effects of fecal incontinence can range from mild (superficial skin irritation) to profound (severe perineal dermatitis, dehydration, electrolyte imbalance, and sepsis). Fecal incontinence has many etiologies and risk factors. These include damage to the anal sphincter or pelvic floor, liquid stool consistency, abnormal colonic transport, and decreased intestinal capacity. To avoid or minimize complications, the cause of diarrhea should be addressed, fecal leakage prevented, stool contained, and skin integrity preserved. Management options addressing these goals include diet, pharmacological therapy, and the use of containment products. Management options and their respective advantages and disadvantages are presented with a special focus on safety issues. Diverse approaches are safe only if they are knowledgeably selected, carefully instituted, and constantly monitored for their effects on patient outcomes. Research to identify which options work best in selected clinical situations and which combinations of therapies are most effective is needed. PMID:17204827

  3. The experience of communication difficulties in critically ill patients in and beyond intensive care: Findings from a larger phenomenological study.

    PubMed

    Tembo, Agness C; Higgins, Isabel; Parker, Vicki

    2014-12-01

    Communication difficulties in intensive care units (ICU) with critically ill patients have been well documented for more than three decades. However, there is only a paucity of literature that has explored communication difficulties beyond the ICU environment. This paper discusses the experience of communication difficulties in critically ill patients in ICU and beyond as part of findings from a larger study that explored the lived experiences of critically ill patients in ICU in the context of daily sedation interruption (DSI). The aim of the study was to describe the lived experience of people who experienced critical illness in ICU using a hermeneutic phenomenological approach in the DSI context. Twelve participants aged between 20 and 76 years with an ICU stay ranging from 3 to 36 days were recruited from a 16 bed ICU in a large regional referral hospital in New South Wales (NSW), Australia. Participants were intubated, mechanically ventilated and subjected to (DSI) during their critical illness in ICU. In-depth face to face interviews with participants were conducted at two weeks after discharge from ICU and at six to eleven months later. Interviews were audio taped and transcribed. Thematic analysis using van Manen's (1990) method was completed. The overarching theme; 'Being in limbo' and subthemes 'Being disrupted'; 'Being imprisoned' and 'Being trapped' depict the main elements of the experience. This paper discusses communication difficulties in critically ill patients as one of the main findings relating to the theme 'Being trapped'. Participants' reports of communication difficulties in ICU are similar to those reported by patients in other studies where DSI was not used. However, not many studies have reported ongoing communication difficulties after ICU hospitalisation. Recommendations are made for new models of care and support to mitigate critically ill patients' communication concerns in ICU and for further research into the causes and treatment to benefit this group of patients. Most importantly, extra care is recommended not to damage vocal cords during intubation and cuff inflation in the course of mechanical ventilation. PMID:25486970

  4. Telephone-based health coaching for chronically ill patients: study protocol for a randomized controlled trial

    PubMed Central

    2013-01-01

    Background The rising prevalence of chronic conditions constitutes a major burden for patients and healthcare systems and is predicted to increase in the upcoming decades. Improving the self-management skills of patients is a strategy to steer against this burden. This could lead to better outcomes and lower healthcare costs. Health coaching is one method for enhancing the self-management of patients and can be delivered by phone. The effects of telephone-based health coaching are promising, but still inconclusive. Economic evaluations and studies examining the transferability of effects to different healthcare systems are still rare. Aim of this study is to evaluate telephone-based health coaching for chronically ill patients in Germany. Methods/Design The study is a prospective randomized controlled trial comparing the effects of telephone-based health coaching with usual care during a 4-year time period. Data are collected at baseline and after 12, 24 and 36 months. Patients are selected based on one of the following chronic conditions: diabetes, coronary artery disease, asthma, hypertension, heart failure, COPD, chronic depression or schizophrenia. The health coaching intervention is carried out by trained nurses employed by a German statutory health insurance. The frequency and the topics of the health coaching are manual-based but tailored to the patients’ needs and medical condition, following the concepts of motivational interviewing, shared decision-making and evidence-based-medicine. Approximately 12,000 insurants will be enrolled and randomized into intervention and control groups. Primary outcome is the time until hospital readmission within two years after enrolling in the health coaching, assessed by routine data. Secondary outcomes are patient-reported outcomes like changes in quality of life, depression and anxiety and clinical values assessed with questionnaires. Additional secondary outcomes are further economic evaluations like health service use as well as costs and hospital readmission rates. The statistical analyses includes intention-to-treat and as-treated principles. The recruitment will be completed in September 2014. Discussion This study will provide evidence regarding economic and clinical effects of telephone-delivered health coaching. Additionally, this study will show whether health coaching is an adequate option for the German healthcare system to address the growing burden of chronic diseases. Trial registration German Clinical Trials Register (Deutsches Register Klinischer Studien; DRKS) DRKS00000584. PMID:24135027

  5. The stigma of mental illness in Southern Ghana: attitudes of the urban population and patients’ views

    Microsoft Academic Search

    Antonia Barke; Seth Nyarko; Dorothee Klecha

    Purpose  Stigma is a frequent accompaniment of mental illness leading to a number of detrimental consequences. Most research into the\\u000a stigma connected to mental illness was conducted in the developed world. So far, few data exist on countries in sub-Saharan\\u000a Africa and no data have been published on population attitudes towards mental illness in Ghana. Even less is known about the

  6. The Adolescent with a Life-Threatening Illness: Cultural Myths and Social Realities.

    ERIC Educational Resources Information Center

    Nannis, Ellen D.; And Others

    This paper discusses the attitudes of terminally ill adolescent patients towards their illness and their behaviors during their treatment. Preliminary results are reported on an ongoing study of 12 boys and six girls (age 8-21) with metastatic pediatric solid tumors and lymphomas that failed to respond to conventional treatment. Interviews of…

  7. The role of social support in dialysis patients' feelings of autonomy and self-esteem: is support more beneficial for patients with specific illness perceptions?

    PubMed

    Jansen, Daphne L; Rijken, Mieke; Kaptein, Ad A; Boeschoten, Elisabeth W; Dekker, Friedo W; Groenewegen, Peter P

    2014-09-01

    The purpose of this study was to investigate whether effects of various types of support on dialysis patients' perceived autonomy and self-esteem depend on patients' perceived concerns and personal control regarding their illness. One hundred sixty-six patients completed written questionnaires. Main and interaction effects of support, concern, and personal control on autonomy and self-esteem were examined using linear regression analyses. General emotional support was positively related to autonomy in highly concerned patients (p < .05). Overprotection was negatively associated with autonomy (p < .05), and this association was stronger in patients with high perceived personal control (p < .01). A positive main effect of general emotional support (p < .05) and a negative main effect of overprotection (p < .01) on self-esteem were observed. The role of support in dialysis patients' autonomy appears to depend on patients' illness perceptions, whereas the role of support in patients' self-esteem does not. These findings suggest that dialysis patients' personal views about their illness can provide insight into whether patients could benefit from support, and that the provision of support should be tailored to patients' individual needs. PMID:24933040

  8. Detection of co-occurring mental illness among adult patients in the New Jersey substance abuse treatment system

    Microsoft Academic Search

    Hsou Mei Hu; Anna Kline; Frederick Y. Huang; Douglas M. Ziedonis

    2006-01-01

    OBJECTIVES: We assessed the detection of mental illness in an adult population of substance abuse patients and the rate of referral for mental health treatment.\\u000aMETHODS: We obtained combined administrative records from 1994 to 1997 provided by the New Jersey substance abuse and mental health systems and estimated detection and referral rates of patients with co-occurring disorders (n = 47,379).

  9. Impact of emergency intubation on central venous oxygen saturation in critically ill patients: a multicenter observational study

    Microsoft Academic Search

    Glenn Hernandez; Hector Peña; Rodrigo Cornejo; Maximiliano Rovegno; Jaime Retamal; Jose Luis Navarro; Ignacio Aranguiz; Ricardo Castro; Alejandro Bruhn

    2009-01-01

    INTRODUCTION: Central venous oxygen saturation (ScvO2) has emerged as an important resuscitation goal for critically ill patients. Nevertheless, growing concerns about its limitations as a perfusion parameter have been expressed recently, including the uncommon finding of low ScvO2 values in patients in the intensive care unit (ICU). Emergency intubation may induce strong and eventually divergent effects on the physiologic determinants

  10. Predicting Premature Termination within a Randomized Controlled Trial for Binge-Eating Patients

    ERIC Educational Resources Information Center

    Fluckiger, Christoph; Meyer, Andrea; Wampold, Bruce E.; Gassmann, Daniel; Messerli-Burgy, Nadine; Munsch, Simone

    2011-01-01

    Understanding the dropout rates of efficacious forms of psychotherapy for patients with binge eating disorder (BED) is an unsolved problem within this increasing population. Up until now the role of psychotherapy process characteristics as predictors of premature termination has not been investigated in the BED literature. Within a randomized…

  11. Continuous Infusion of Piperacillin/Tazobactam in Septic Critically Ill Patients—A Multicenter Propensity Matched Analysis

    PubMed Central

    Gonçalves-Pereira, João; Oliveira, Bruno Serra; Janeiro, Sérgio; Estilita, Joana; Monteiro, Catarina; Salgueiro, Andrea; Vieira, Alfredo; Gouveia, Joao; Paulino, Carolina; Bento, Luis; Póvoa, Pedro

    2012-01-01

    The clinical efficacy of continuous infusion of piperacillin/tazobactam in critically ill patients with microbiologically documented infections is currently unknown. We conducted a retrospective multicenter cohort study in 7 Portuguese intensive care units (ICU). We included 569 critically ill adult patients with a documented infection and treated with piperacillin/tazobactam admitted to one of the participating ICU between 2006 and 2010. We successfully matched 173 pairs of patients according to whether they received continuous or conventional intermittent dosing of piperacillin/tazobactam, using a propensity score to adjust for confounding variables. The majority of patients received 16g/day of piperacillin plus 2g/day of tazobactam. The 28-day mortality rate was 28.3% in both groups (p?=?1.0). The ICU and in-hospital mortality were also similar either in those receiving continuous infusion or intermittent dosing (23.7% vs. 20.2%, p?=?0.512 and 41.6% vs. 40.5%, p?=?0.913, respectively). In the subgroup of patients with a Simplified Acute Physiology Score (SAPS) II>42, the 28-day mortality rate was lower in the continuous infusion group (31.4% vs. 35.2%) although not reaching significance (p?=?0.66). We concluded that the clinical efficacy of piperacillin/tazobactam in this heterogeneous group of critically ill patients infected with susceptible bacteria was independent of its mode of administration, either continuous infusion or intermittent dosing. PMID:23185458

  12. Predictors of survival in terminal-cancer patients with irreversible bowel obstruction receiving home parenteral nutrition

    Microsoft Academic Search

    Fabrizio Pasanisi; Andrea Orban; Luca Scalfi; Lucia Alfonsi; Lidia Santarpia; Enzo Zurlo; Angela Celona; Adelaide Potenza; Franco Contaldo

    2001-01-01

    Clinical, anthropometric, hematologic, and biochemical variables, evaluated immediately before starting nutritional treatment, were related to survival in 76 terminal-cancer patients with irreversible bowel obstruction receiving home parenteral nutrition. At baseline, abnormally low values were observed in the following percentages of patients: 40.8% for body mass index, 59.2% for serum albumin, 84.2% for hemoglobin, 48.7% for lymphocyte count, and 60% for

  13. The influence of patient gender on medical and psychology students' illness attributions: experiences with a narrative technique.

    PubMed

    Csörsz, Ilona; Kakuk, Péter; Mills, Eszter M; Molnár, Péter; Máth, János; Csabai, Márta

    2014-05-01

    We attempted to identify whether and how the gender of the patient influences interpretations of an illness narrative. We investigated how medical and psychology undergraduates' (n = 313) views change according to the patient's gender, students' gender, and field of study. A short story about a female patient was chosen as stimulus material, and a gender-modified version with a male protagonist was created for comparison. Responses were content analyzed by qualitative and quantitative methods. The female patient elicited more detailed descriptions and somatizing attributions. The gender of students had a stronger impact on responses than their field of study. PMID:23479307

  14. Illness Perception and Cardiovascular Risk Factors in Patients with Type 2 Diabetes: Cross-sectional Questionnaire Study

    PubMed Central

    Petri?ek, Goranka; Vrci?-Keglevi?, Mladenka; Vuleti?, Gorka; Cerove?ki, Venija; Ožva?i?, Zlata; Murgi?, Lucija

    2009-01-01

    Aim To investigate illness perception in patients with type 2 diabetes mellitus and its association with the degree of control over relevant cardiovascular risk factors. Methods A cross-sectional questionnaire-based study was performed from June 2007 to March 2008. A stratified random sample of 46 Croatian general practitioners was asked to select, using systematic sampling, the first 6 patients with type 2 diabetes mellitus aged ?18 years who visited them for consultation during the study period. Data on 250 patients included patient illness perception assessment (Brief Illness Perception Questionnaire, IPQ), cardiovascular risk factors, and socio-demographic data. Results The patients’ mean age was 63.0?±?10.9 years and mean duration of diabetes was 9.3?±?7.8 years. The patientsillness perception assessment on an 11-point (0 to 10) scale showed the highest median scores (interquartile range): 10 (8 to 10) for “timeline” and 8 (7 to 9) for “treatment control,” followed by 7 (5 to 8) for “personal control,” 7 (5 to 9) for “understanding,” 5 (3 to 7) for “consequences,” 6 (4 to 7) for “concern,” and 5 (2 to 7) for “emotional response.” The lowest score was 3 (1 to 5) for “identity.” Multivariate logistic regression showed that the Brief IPQ item “concern” (P?patients' beliefs seem to be associated with the degree of control over cardiovascular risk factors, they should be included in routine clinical assessments. PMID:20017227

  15. Advocating for Persons Who Are Mentally Ill: A History of Mutual Empowerment of Patients and Profession

    Microsoft Academic Search

    Edward F. Foulks

    2000-01-01

    The author reviews the history of advocacy for mentally ill individuals. Through organizations such as the National Mental Health Association and the National Alliance for the Mentally Ill, collaboration among professionals, consumers, and concerned citizens is enhanced. The common causes and differences among organizations are discussed within the context of how psychiatrists can realize leadership strategies to further advance advocacy

  16. Enteral nutrition in the critically ill patient: A critical review of the evidence

    Microsoft Academic Search

    D. K. Heyland; D. J. Cook; G. H. Guyatt

    1993-01-01

    Objective: To examine the relationship between enteral nutrition (EN) and infection in the critically ill. Setting: Computerized search of published research and review of relevant reference lists. Study selection: 151 citations were reviewed and 39 arti- cles met selection criteria. Primary studies were included if they evaluated EN in critically ill humans and its effect on infectious morbidity and mortality.

  17. Learned illness behavior in patients with irritable bowel syndrome and peptic ulcer

    Microsoft Academic Search

    William E. Whitehead; Carolyn Winget; Al S. Fedoravicius; Susan Wooley; Barry Blackwell

    1982-01-01

    Chronic illness behavior is defined by frequent visits to physicians, multiple somatic complaints, and disability disproportionate to physical findings. The prevalence of chronic illness behavior in people with irritable bowel syndrome and peptic ulcer was studied in a telephone survey of 832 people from metropolitan Cincinnati. People with irritable bowel syndrome (8% of the sample) were more likely than people

  18. Mixing t?rttam and tablets. A healing proposal for mentally ill patients in Gunaseelam (South India).

    PubMed

    Saglio-Yatzimirsky, Marie Caroline; Sébastia, Brigitte

    2014-10-30

    Well known for its powerful deity who heals the mentally ill, the village of Gunaseelam illustrates an interesting example of mental healthcare combining rituals (t?rttam) and medication (tablets). After the Ervadi tragedy, the government forbade the confinement and chaining of the mentally ill in unlicensed places such as in religious institutions as contrary to human rights, so a clinic was established to treat patients. How is the intrusion of psychiatry into the temple and its association with the rituals perceived by priests and psychiatrists, and by patients and caregivers? What are the implications that this therapeutic combination has for the quality of life of patients and caregivers and for the life of the village and the temple? This article attempts to explore these questions through the particular case of Gunaseelam and offers some ways to develop mental healthcare practices that are more acceptable to the people, notably those people from lower social backgrounds. PMID:25355285

  19. Seriously Ill Hospitalized Patients’ Perspectives on the Benefits and Harms of Two Models of Hospital CPR Discussions

    PubMed Central

    Anderson, Wendy G.; Cimino, Jenica W.; Lo, Bernard

    2013-01-01

    Objective To describe seriously ill patients’ perspectives on expert-endorsed approaches for hospital cardiopulmonary resuscitation (CPR) discussions. Methods We created two videos depicting a hospital doctor discussing CPR with a seriously ill patient. One depicted a values-based approach with a doctor's recommendation, and one an information-focused approach without a recommendation. During semi-structured interviews, 20 seriously ill hospitalized patients viewed and commented on both videos. We conducted a thematic analysis to describe benefits and harms of specific discussion components. Results Half of participants reported no preference between the videos; 35% preferred the information-focused, and 15% the values-based. Participants’ reactions to the discussion components varied. They identified both benefits and harms with components in both videos,though most felt comfortable with all components (range, 60-65%) except for the doctor's recommendation in the values-based video. Only 40% would feel comfortable receiving a recommendation, while 65% would feel comfortable with the doctor eliciting their CPR preference as in the information-focused video, p=0.03. Conclusion Participants’ reactions to expert-endorsed discussion components varied. Most would feel uncomfortable receiving a doctor's recommendation about CPR. Practice Implications Participants’ varied reactions suggest the need to tailor CPR discussions to individual patients. Many patients may find doctor's recommendations to be problematic. PMID:24005002

  20. Early treatment with IgM-enriched intravenous immunoglobulin does not mitigate critical illness polyneuropathy and/or myopathy in patients with multiple organ failure and SIRS/sepsis: a prospective, randomized, placebo-controlled, double-blinded trial

    PubMed Central

    2013-01-01

    Introduction Critical illness polyneuropathy and/or myopathy (CIPNM) is a severe complication of critical illness. Retrospective data suggest that early application of IgM-enriched intravenous immunoglobulin (IVIG) may prevent or mitigate CIPNM. Therefore, the primary objective was to assess the effect of early IgM-enriched IVIG versus placebo to mitigate CIPNM in a prospective setting. Methods In this prospective, randomized, double-blinded and placebo-controlled trial, 38 critically ill patients with multiple organ failure (MOF), systemic inflammatory response syndrome (SIRS)/sepsis, and early clinical signs of CIPNM were included. Patients were randomly assigned to be treated either with IgM-enriched IVIG or placebo over a period of three days. CIPNM was measured by the CIPNM severity sum score based on electrophysiological stimulation of the median, ulnar, and tibial nerves on days 0, 4, 7, 14 and on the histological evaluation of muscle biopsies on days 0 and 14 and ranged from 0 (no CIPNM) to 8 (very severe CIPNM). Results A total of 38 critically ill patients were included and randomized to receive either IgM-enriched IVIG (n = 19) or placebo (n = 19). Baseline characteristics were similar between the two groups. CIPNM could not be improved by IVIG treatment, represented by similar CIPNM severity sum scores on day 14 (IVIG vs. placebo: 4.8 ± 2.0 vs. 4.5 ± 1.8; P = 0.70). CIPNM severity sum score significantly increased from baseline to day 14 (3.5 ± 1.6 vs. 4.6 ± 1.9; P = 0.002). After an interim analysis the study was terminated early due to futility in reaching the primary endpoint. Conclusions Early treatment with IVIG did not mitigate CIPNM in critically ill patients with MOF and SIRS/sepsis. Trial registration Clinicaltrials.gov: NCT01867645 PMID:24088271

  1. Do they hear what we speak? Assessing the effectiveness of communication to families of critically ill neurosurgical patients

    PubMed Central

    Mathew, Jacob Eapen; Azariah, Jayraj; George, Smitha Elizabeth; Grewal, Sarvpreet Singh

    2015-01-01

    Background and Aims: Clinician-family communication must be effective for medical decision making in any Intensive Care Unit (ICU) setting. We performed a prospective study to assess the effectiveness of communication to families of critically ill neurosurgical patients based on the two criteria of comprehension and satisfaction. Materials and Methods: The study was conducted on 75 patients in a 15 bedded neurosurgical ICU. An independent investigator assessed the comprehension and satisfaction of families between the 3rd and the 5th day of admission in ICU. Comprehension was tested using three components, that is, comprehension of diagnosis, prognosis and treatment. The satisfaction was measured using a modified version of the Critical Care Family Needs Inventory (CCFNI) (score of 56-extreme dissatisfaction and 14-extreme satisfaction). Results: Poor comprehension was noted in 52 representatives (71.2%). The mean satisfaction score as measured by the CCFNI score was 28. Factors associated with poor comprehension included increasing age of patient representative (P = 0.024), higher simplified acute physiology score (P = 0.26), nonoperated patients (P = 0.0087) and clinician estimation of poor prognosis (P = 0.01). Operated patients had significantly better satisfaction score (P = 0.04). Conclusion: Families of patients were reasonably satisfied, but had poor comprehension levels of the patient's illness. The severity of the patient's illness, poor prognosis as estimated by the physician and nonoperated patients were independent predictors of poor comprehension. Extra effort to communicate with patient representatives at risk of poor comprehension and provision of a family information leaflet could possibly remedy this situation.

  2. Granulocytic Myeloid-Derived Suppressor Cells inversely correlate with plasma arginine and overall survival in critically ill patients.

    PubMed

    Gey, Alain; Tadie, Jean-Marc; Caumont-Prim, Aurore; Hauw-Berlemont, Caroline; Cynober, Luc; Fagon, Jean-Yves; Terme, M; Diehl, Jean-Luc; Delclaux, Christophe; Tartour, Eric

    2014-12-01

    Critically ill patients display a state of immunosuppression that has been attributed in part to decreased plasma arginine concentrations. However, we and other authors have failed to demonstrate a clinical benefit of L-arginine supplementation. We hypothesize that, in these critically ill patients, these low plasma arginine levels may be secondary to the presence of granulocytic myeloid-derived suppressor cells (gMDSC), which express arginase known to convert arginine into NO and citrulline. Indeed, in a series of 28 nonsurgical critically ill patients, we showed a dramatic increase in gMDSC compared to healthy subjects (p = 0.0002). A significant inverse correlation was observed between arginine levels and gMDSC (p = 0.01). As expected, gMDSC preferentially expressed arginase in these patients. Patients with high gMDSC levels on admission to the Medical Intensive Care Unit (MICU) presented an increased risk of death at day 7 after admission (p = 0.02). In contrast, neither plasma arginine levels nor monocytic MDSC levels, nor neutrophil levels were associated with overall survival at day 7. No relationship was found between BMI or SAPS score, SOFA score or gMDSC levels, eliminating a possible bias concerning the direct prognostic role of these cells. As gMDSC exert their immunosuppressive activity via multiple mechanisms (production of PGE2, IL-10, arginase, etc.), it may be more relevant to target these cells rather than simply supplementing with L-arginine to improve immunosuppression and its clinical consequences observed in critically ill patients. PMID:25476957

  3. Study Design of the Microcirculatory Shock Occurrence in Acutely Ill Patients (microSOAP): an International Multicenter Observational Study of Sublingual Microcirculatory Alterations in Intensive Care Patients.

    PubMed

    Vellinga, Namkje A R; Boerma, E Christiaan; Koopmans, Matty; Donati, Abele; Dubin, Arnaldo; Shapiro, Nathan I; Pearse, Rupert M; Bakker, Jan; Ince, Can

    2012-01-01

    Objective. Sublingual microcirculatory alterations are associated with an adverse prognosis in several critical illness subgroups. Up to now, single-center studies have reported on sublingual microcirculatory alterations in ICU patient subgroups, but an extensive evaluation of the prevalence of these alterations is lacking. We present the study design of an international multicenter observational study to investigate the prevalence of microcirculatory alterations in critically ill: the Microcirculatory Shock Occurrence in Acutely ill Patients (microSOAP). Methods. 36 ICU's worldwide have participated in this study aiming for inclusion of over 500 evaluable patients. To enable communication and data collection, a website, an Open Clinica 3.0 database, and image uploading software have been designed. A one-session assessment of the sublingual microcirculation using Sidestream Dark Field imaging and data collection on patient characteristics has been performed in every ICU patient >18 years, regardless of underlying disease. Statistical analysis will provide insight in the prevalence and severity of sublingual alterations, its relation to systemic hemodynamic variables, disease, therapy, and outcome. Conclusion. This study will be the largest microcirculation study ever performed. It is expected that this study will also establish a basis for future studies related to the microcirculation in critically ill. PMID:22666566

  4. Responding to Intractable Terminal Suffering: The Role of Terminal Sedation and Voluntary Refusal of Food and Fluids

    Microsoft Academic Search

    Timothy E. Quill; Ira R. Byock

    2000-01-01

    When provided by a skilled, multidisciplinary team, pallia- tive care is highly effective at addressing the physical, psychological, social, and spiritual needs of dying patients and their families. However, some patients who have wit- nessed harsh death want reassurance that they can escape if their suffering becomes intolerable. In addition, a small percentage of terminally ill patients receiving comprehen- sive

  5. Colistin therapy in critically ill patients with chronic renal failure and its effect on development of renal dysfunction.

    PubMed

    Turkoglu, Melda; Dizbay, Murat; Ciftçi, Arzu; Aksakal, F Nur; Aygencel, Gülbin

    2012-02-01

    Recently, colistin has become a salvage therapy in the treatment of serious Intensive Care Unit infections owing to the emergence of extensively drug-resistant (XDR) bacterial isolates. This study aimed to show the effectiveness of colistin in critically ill patients with renal failure. A prospective case-control study of 94 patients admitted to medical intensive care units of a university hospital from December 2008 to June 2010 was conducted. All patients had infections with XDR Acinetobacter baumannii or Pseudomonas aeruginosa and received colistin. Cases comprised 39 patients with chronic renal failure (CRF) and controls were other patients without CRF. Apart from the male dominancy in the CRF group, there was no statistical difference between the two groups regarding demographic characteristics, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and site and type of infection. In patients who completed colistin therapy, bacteriological cure was seen in 87% of patients with CRF and 95% of patients without CRF (P=0.890). Mortality in patients with CRF was similar to that in patients without CRF (44% and 42%, respectively) (P=0.999). Nephrotoxicity developed in 23.6% of patients in the control group. Concomitant nephrotoxic agents and total defined daily dose of colistin did not affect the development of nephrotoxicity. The mortality rate was 38% in patients with nephrotoxicity, similar to the mortality rate in patients without nephrotoxicity (36%) (P=0.999). In conclusion, in critically ill patients with CRF, colistin therapy, although used at a reduced dosage, was as effective as in patients without CRF. PMID:22115538

  6. Microsoft Word - illness_representations.doc

    Cancer.gov

    Illness Representations Michael A. Diefenbach, Ph.D. General Description and Theoretical Background Illness representations are patients’ beliefs and expectations about an illness or somatic symptom. Illness representations are central to Leventhal’s

  7. Circulating MicroRNA-223 Serum Levels Do Not Predict Sepsis or Survival in Patients with Critical Illness

    PubMed Central

    Benz, Fabian; Tacke, Frank; Luedde, Mark; Trautwein, Christian; Luedde, Tom; Koch, Alexander; Roderburg, Christoph

    2015-01-01

    Background and Aims. Dysregulation of miR-223 was recently linked to various diseases associated with systemic inflammatory responses such as type 2 diabetes, cancer, and bacterial infections. However, contradictory results are available on potential alterations of miR-223 serum levels during sepsis. We thus aimed to evaluate the diagnostic and prognostic value of miR-223 serum concentrations in patients with critical illness and sepsis. Methods. We used i.v. injection of lipopolysaccharide (LPS) as well as cecal pole ligation and puncture (CLP) for induction of polymicrobial sepsis in mice and measured alterations in serum levels of miR-223. These results from mice were translated into a large and well-characterized cohort of critically ill patients admitted to the medical intensive care unit (ICU). Finally, results from analysis in patients were correlated with clinical data and extensive sets of routine and experimental biomarkers. Results. Although LPS injection induced moderately elevated serum miR-223 levels in mice, no significant alterations in miR-223 serum levels were found in mice after CLP-induced sepsis. In accordance with these results from animal models, serum miR-223 levels did not differ between critically ill patients and healthy controls. However, ICU patients with more severe disease (APACHE-II score) showed moderately reduced circulating miR-223. Strikingly, no differences in miR-223 levels were found in critically ill patients with or without sepsis, and serum levels of miR-223 did not correlate with classical markers of inflammation or bacterial infection. Finally, low miR-223 serum levels were moderately associated with an unfavorable prognosis of patients during the ICU treatment but did not predict long-term mortality. Conclusion. Recent reports on alterations in miR-223 serum levels during sepsis revealed contradictory results, preventing a potential use of this miRNA in clinical routine. We clearly show that miR-223 serum levels do not reflect the presence of sepsis neither in mouse models nor in a large cohort of ICU patients and do not indicate clinical outcome of critically ill patients. Thus miR-223 serum levels should not be used as a biomarker in this setting.

  8. Quality of life as medicine: a pilot study of patients with chronic illness and pain.

    PubMed

    Ventegodt, Søren; Merrick, Joav; Anderson, Niels Jørgen

    2003-06-16

    An intensive 5-day quality-of-life (QoL) session was constructed based on a psychosomatic model. The session was comprised of teaching on philosophy of life, psychotherapy, and body therapy. The three elements were put together in such a way that they mutually supported each other. The synergy attained was considerable. The pilot study demonstrated that in the course of only 1 week, patients had time to revise essential life-denying views and to integrate important, unfinished life events involving negative feelings. Consequently, the patients became more present in the body's blocked-off areas and subjectively healthier. Nineteen persons with chronic illness and pain (fibromyalgia, chronic tiredness, whiplash, mild depression, and problems involving pain in arms and legs including osteoarthritis), and unemployed for 5-7 years attended the course. In the week before and after the 5-day course, the participants completed the validated SEQOL (Self-Evaluation of Quality of Life Questionnaire) including questions on self-evaluated health and the unvalidated "Self-Evaluation of Working-Life Quality Questionnaire" (SEQWL). This pilot study was without a control group or clinical control. As far as diagnoses were concerned, the group was inhomogeneous. Common for the group was a low QoL, poor quality of working life QWL, and numerous health problems. The study showed an 11.2% improvement in QoL (p < 0.05), a 6.3% improvement in QWL (p < 0.05), and a 12.0% improvement in self-perceived physical health (p = 0.08). There was a 17.3% improvement in self-perceived psychological health (p < 0.05) and satisfaction with health in general improved by 21.4% (p < 0.05). Symptoms like pain were almost halved and several of the participants were free of pain for the first time in years. In conclusion it seemed that the combination of training in philosophy of life, psychotherapy, and body therapy can give patients a large, fast, and efficient improvement in QoL, QWL, and health. It is not known if these changes will be permanent and if all kinds of patients with different health problems will gain from this cure. Further research should be conducted. PMID:12847301

  9. Pharmacokinetics of gentamicin in critically ill patients: pilot study evaluating the first dose.

    PubMed

    Gonçalves-Pereira, J; Martins, A; Póvoa, P

    2010-08-01

    Gentamicin is extensively used in the treatment of severe Gram-negative bacterial infections. A loading dose of 7 mg/kg is recommended to achieve a maximum concentration (C(max)) above 16 mg/L. We studied gentamicin pharmacokinetic data from patients treated between January 2006 and June 2008 in two intensive-care units. The Sawchuk and Zaske one-compartment pharmacokinetic model was used to estimate the gentamicin volume of distribution (the 32 patients had a median age of 68 years (23 men)). The median volume of distibution (V(d)) per kilogram of body weight (V(d)/kg) was 0.41 L/kg (interquartile range of 0.36-0.46 L/kg), with no correlations with age, Charlson comorbidity score, sequential organ failure assessment (SOFA) score and creatinine serum level (r(2) = 0.016, 0.058, 0.037, and 0.067, respectively). Women had a significantly higher median V(d)/kg (0.50 vs. 0.40 L/kg, p 0.002) and lower C(max) (15.2 vs. 18.5 mg/L, p 0.016), despite similar dose/kg. In a logistic regression model, only sex (female: OR 0.032; 95% CI 0.03-0.387) and dose/kg (per mg/kg: OR 3.21; 95% CI 1.17-8.79) were significantly associated with the achievement of C(max) above 16 mg/L. Gentamicin clearance was 57 mL/min (interquartile range of 44.7-78 mL/min) and decreased with age (r(2) = 0.178, p 0.016), SOFA score (r(2) = 0.199, p 0.011) and creatinine clearance (r(2) = 0.258, p 0.003). Gentamicin V(d) was increased in critically ill patients, particularly in women. Therefore, high gentamicin loading doses should be given to all patients, especially women, independently of organ failure. Gentamicin clearance decreases with age, SOFA score, and renal failure. PMID:19832713

  10. Economics of dialysis dependence following renal replacement therapy for critically ill acute kidney injury patients

    PubMed Central

    Ethgen, Olivier; Schneider, Antoine G.; Bagshaw, Sean M.; Bellomo, Rinaldo; Kellum, John A.

    2015-01-01

    Background The obective of this study was to perform a cost-effectiveness analysis comparing intermittent with continuous renal replacement therapy (IRRT versus CRRT) as initial therapy for acute kidney injury (AKI) in the intensive care unit (ICU). Methods Assuming some patients would potentially be eligible for either modality, we modeled life year gained, the quality-adjusted life years (QALYs) and healthcare costs for a cohort of 1000 IRRT patients and a cohort of 1000 CRRT patients. We used a 1-year, 5-year and a lifetime horizon. A Markov model with two health states for AKI survivors was designed: dialysis dependence and dialysis independence. We applied Weibull regression from published estimates to fit survival curves for CRRT and IRRT patients and to fit the proportion of dialysis dependence among CRRT and IRRT survivors. We then applied a risk ratio reported in a large retrospective cohort study to the fitted CRRT estimates in order to determine the proportion of dialysis dependence for IRRT survivors. We conducted sensitivity analyses based on a range of differences for daily implementation cost between CRRT and IRRT (base case: CRRT day $632 more expensive than IRRT day; range from $200 to $1000) and a range of risk ratios for dialysis dependence for CRRT as compared with IRRT (from 0.65 to 0.95; base case: 0.80). Results Continuous renal replacement therapy was associated with a marginally greater gain in QALY as compared with IRRT (1.093 versus 1.078). Despite higher upfront costs for CRRT in the ICU ($4046 for CRRT versus $1423 for IRRT in average), the 5-year total cost including the cost of dialysis dependence was lower for CRRT ($37 780 for CRRT versus $39 448 for IRRT on average). The base case incremental cost-effectiveness analysis showed that CRRT dominated IRRT. This dominance was confirmed by extensive sensitivity analysis. Conclusions Initial CRRT is cost-effective compared with initial IRRT by reducing the rate of long-term dialysis dependence among critically ill AKI survivors. PMID:25326472

  11. Emotional control, styles of coping with stress and acceptance of illness among patients suffering from chronic somatic diseases.

    PubMed

    Janowski, Konrad; Kurpas, Donata; Kusz, Joanna; Mroczek, Bo?ena; Jedynak, Tomasz

    2014-02-01

    The purpose of this study was to analyse the associations of emotional control with sociodemographic and clinical variables in a sample of patients with a range of chronic somatic diseases. The relationships between emotional control, coping styles and adjustment to the disease were investigated. The sample consisted of 300 patients with the mean age of 54.60?±?17.57 years. Courtauld Emotional Control Scale was used to measure the patients' tendency to suppress negative emotions, Coping Inventory for Stressful Situations was used to measure coping styles and Acceptance of Illness Scale was applied to determine adjustment to the disease. Patients with neurological conditions showed significantly lower suppression of anger. Levels of emotional control were found to be related to gender, age and educational level but not to the place of residence. Task-oriented style of coping with stress correlated positively with suppression of depression and anxiety, whereas acceptance of illness correlated negatively with suppression of anger. Levels of emotional control are only weakly related to the type of diagnosis; however, some clinical samples may show lower suppression of anger. Suppression of negative emotions is weakly related to adjustment indicators such as certain coping styles and acceptance of illness. PMID:23653433

  12. Population pharmacodynamic modelling of lorazepam- and midazolam-induced sedation upon long-term continuous infusion in critically ill patients

    Microsoft Academic Search

    Eleonora L. Swart; Klaas P. Zuideveld; Joost de Jongh; Meindert Danhof; Lambertus G. Thijs; Robert M. J. Strack van Schijndel

    2006-01-01

    Objective  The objective of the present investigation was to develop a population pharmacodynamic model for midazolam- and lorazepam-induced\\u000a sedation upon long-term continuous infusion in critically ill patients.\\u000a \\u000a \\u000a \\u000a Methods  The study was conducted in 59 patients receiving lorazepam and 54 patients receiving midazolam by continuous infusion for\\u000a at least 24 h. Repeated blood samples were obtained for determination of the concentrations of lorazepam and

  13. Mortality amongst Patients with Influenza-Associated Severe Acute Respiratory Illness, South Africa, 2009-2013

    PubMed Central

    Cohen, Cheryl; Moyes, Jocelyn; Tempia, Stefano; Groome, Michelle; Walaza, Sibongile; Pretorius, Marthi; Dawood, Halima; Chhagan, Meera; Haffejee, Summaya; Variava, Ebrahim; Kahn, Kathleen; von Gottberg, Anne; Wolter, Nicole; Cohen, Adam L.; Malope-Kgokong, Babatyi; Venter, Marietjie; Madhi, Shabir A.

    2015-01-01

    Introduction Data on the burden and risk groups for influenza-associated mortality from Africa are limited. We aimed to estimate the incidence and risk-factors for in-hospital influenza-associated severe acute respiratory illness (SARI) deaths. Methods Hospitalised patients with SARI were enrolled prospectively in four provinces of South Africa from 2009–2013. Using polymerase chain reaction, respiratory samples were tested for ten respiratory viruses and blood for pneumococcal DNA. The incidence of influenza-associated SARI deaths was estimated at one urban hospital with a defined catchment population. Results We enrolled 1376 patients with influenza-associated SARI and 3% (41 of 1358 with available outcome data) died. In patients with available HIV-status, the case-fatality proportion (CFP) was higher in HIV-infected (5%, 22/419) than HIV-uninfected individuals (2%, 13/620; p = 0.006). CFPs varied by age group, and generally increased with increasing age amongst individuals >5 years (p<0.001). On multivariable analysis, factors associated with death were age-group 45–64 years (odds ratio (OR) 4.0, 95% confidence interval (CI) 1.01–16.3) and ?65 years (OR 6.5, 95%CI 1.2–34.3) compared to 1–4 year age-group who had the lowest CFP, HIV-infection (OR 2.9, 95%CI 1.1–7.8), underlying medical conditions other than HIV (OR 2.9, 95%CI 1.2–7.3) and pneumococcal co-infection (OR 4.1, 95%CI 1.5–11.2). The estimated incidence of influenza-associated SARI deaths per 100,000 population was highest in children <1 year (20.1, 95%CI 12.1–31.3) and adults aged 45–64 years (10.4, 95%CI 8.4–12.9). Adjusting for age, the rate of death was 20-fold (95%CI 15.0–27.8) higher in HIV-infected individuals than HIV-uninfected individuals. Conclusion Influenza causes substantial mortality in urban South Africa, particularly in infants aged <1 year and HIV-infected individuals. More widespread access to antiretroviral treatment and influenza vaccination may reduce this burden. PMID:25786103

  14. [Assistance provided with home nursing care for a terminal cancer patient].

    PubMed

    Saito, Mayumi; Yamada, Mai; Kitamikado, Hatsue; Sugihara, Sachiko; Sueda, Mieko; Yagishita, Toshiyuki; Oka, Yoichi

    2008-12-01

    A visiting nursing service was provided for a 90-year-old male patient with terminal stage of pancreatic cancer whose prognosis was to live for two to three months. We provided nursing service not only for the patient's pain control but also for the member of the family by giving specific nursing tips as well as mental support. After the patient passed away, the eldest daughter was quoted saying "we could do everything we wanted to from home nursing care." It appeared that she was totally satisfied with our nursing service. We concluded the following caregiver roles based on this clinical example: 1) Try to alleviate a terminal patient's pain as much as possible so that the patient and the family will be at ease. 2) Arrange the care giver's anxiety individually. 3) Guide the care giver a specific know-how that can be accomplished and let the patient and the care giver choose which one they want. 4) Teach the process of the withholding and with drawing of life and try to consolidate the purpose of nursing intentions among the care givers. 5) Respect the patient and caregiver and make the best out of the situation by being flexible. PMID:20443306

  15. Patient and prisoner experiences : major mental illness and masculinity in the context of violent offending behaviour 

    E-print Network

    Haddow, Christine

    2013-11-26

    Traditional understandings of violence by the mentally disordered largely look to mental illness to explain such behaviour. More recently, research has begun to examine the role of alternative factors in driving violent ...

  16. Attitudes of Malaysian general hospital staff towards patients with mental illness and diabetes

    Microsoft Academic Search

    Harry Minas; Ruzanna Zamzam; Marhani Midin; Alex Cohen

    2011-01-01

    Background  The context of the study is the increased assessment and treatment of persons with mental illness in general hospital settings\\u000a by general health staff, as the move away from mental hospitals gathers pace in low and middle income countries. The purpose\\u000a of the study was to examine whether general attitudes of hospital staff towards persons with mental illness, and extent

  17. Illness perceptions, coping and functioning in patients with rheumatoid arthritis, chronic obstructive pulmonary disease and psoriasis

    Microsoft Academic Search

    M Scharloo; A. A Kaptein; J Weinman; J. M Hazes; L. N. A Willems; W Bergman; H. G. M Rooijmans

    1998-01-01

    The present cross-sectional study analyzed the extent to which illness perceptions and coping strategies (as measured by the Illness Perception Questionnaire and the Utrecht Coping List, respectively) are associated with levels of daily functioning, as indicated by the Medical Outcomes Study SF-20, and disease-specific measures in 244 adults: 84 with rheumatoid arthritis (RA); 80 with chronic obstructive lung disease (COPD);

  18. Performance of two measures of general health-related quality of life, the EQ-5D and the RAND36 among critically ill patients

    Microsoft Academic Search

    Anne Kaarlola; Ville Pettilä; Pertti Kekki

    2004-01-01

    Objective: To compare two health-related quality of life mea- sures, the preference-based EQ-5D with five questions and the profile- based RAND-36 with 36 questions, in previous critically ill patients. Design: Prospective observational study. Setting: A ten-bed medical- surgical intensive care unit (ICU) in a tertiary care university hospital. Patients: Of the 2,709 critically ill patients, treated during the years 1995-2000,

  19. Saccharomyces boulardii prevents diarrhea in critically ill tube-fed patients* A multicenter, randomized, double-blind placebo-controlled trial

    Microsoft Academic Search

    G. Bleichner; H. Mentec; D. Moyse

    Objective: To assess the preventive effect of Saccharomyces boulardii on diarrhea in critically ill tube-fed patients and to evaluate risk factors for diarrhea. Design: Prospective, multicenter, randomized, double-blind placebo-controlled study. Setting: Eleven intensive care units in teaching and general hospitals. Patients: Critically ill patients whose need for enteral nutrition was expected to exceed 6 days. Intervention: S. boulardii 500 mg

  20. Protection of hepatocyte mitochondrial ultrastructure and function by strict blood glucose control with insulin in critically ill patients

    Microsoft Academic Search

    D Mesotten; P J Wouters; Ilse Vanhorebeek; Rita De Vos; Christiane De Wolf-Peeters; Greet Van den Berghe

    2005-01-01

    Summary Background Maintenance of normoglycaemia by use of insulin reduces morbidity and mortality of patients in surgical intensive care. Studies on mitochondrial function in critical illness or diabetes suggest that effects of intensive insulin therapy on mitochondrial integrity contribute to the clinical benefits. Methods Enzyme activities of the respiratory-chain complexes and oxidative-stress-sensitive glyceraldehyde-3- phosphate dehydrogenase (GAPDH) were measured by spectrophotometry

  1. End-of-Life Care for Critically Ill Patients with Heart Failure: A Multidisciplinary Viewpoint from the Intensive Care Unit

    Microsoft Academic Search

    Thomas Fassier; Elie Azoulay

    Care near the end of life (EOL) for critically ill patients is emerging as an essential task in cardiology and heart failure\\u000a (HF) management. Professional recommendations were recently published on this topic and a consensus exists that research and\\u000a debate in this area need further progress. In the field of critical care medicine, development of research about EOL care\\u000a was

  2. HAART receipt and viral suppression among HIV-infected patients with co-occurring mental illness and illicit drug use

    Microsoft Academic Search

    Geetanjali Chander; Seth Himelhoch; John A. Fleishman; James Hellinger; Paul Gaist; Richard D. Moore; Kelly A. Gebo

    2009-01-01

    Mental illness (MI) and illicit drug use (DU) frequently co-occur. We sought to determine the individual and combined effects of MI and DU on highly active antiretroviral therapy (HAART) receipt and HIV-RNA suppression among individuals engaged in HIV care. Using 2004 data from the HIV Research Network (HIVRN), we performed a cross-sectional study of HIV-infected patients followed at seven primary

  3. Use of health care services by patients with co-occurring severe mental illness and substance use disorders

    Microsoft Academic Search

    Marius N. Kêdoté; Astrid Brousselle; François Champagne

    2008-01-01

    Background: To better respond to the health care needs of people with co-occurring mental illness and substance use disorders, it is vital to understand their itinerary through the health care system.Aim: To describe the characteristics of service utilization among patients with co-occurring disorders in a large urban area.Method: We used a sample (n = 5467) constituted from administrative and clinical databases. Those

  4. Urinary L-FABP predicts poor outcomes in critically ill patients with early acute kidney injury.

    PubMed

    Parr, Sharidan K; Clark, Amanda J; Bian, Aihua; Shintani, Ayumi K; Wickersham, Nancy E; Ware, Lorraine B; Ikizler, T Alp; Siew, Edward D

    2015-03-01

    Biomarker studies for early detection of acute kidney injury (AKI) have been limited by nonselective testing and uncertainties in using small changes in serum creatinine as a reference standard. Here we examine the ability of urine L-type fatty acid-binding protein (L-FABP), neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), and kidney injury molecule-1 (KIM-1) to predict injury progression, dialysis, or death within 7 days in critically ill adults with early AKI. Of 152 patients with known baseline creatinine examined, 36 experienced the composite outcome. Urine L-FABP demonstrated an area under the receiver-operating characteristic curve (AUC-ROC) of 0.79 (95% confidence interval 0.70-0.86), which improved to 0.82 (95% confidence interval 0.75-0.90) when added to the clinical model (AUC-ROC of 0.74). Urine NGAL, IL-18, and KIM-1 had AUC-ROCs of 0.65, 0.64, and 0.62, respectively, but did not significantly improve discrimination of the clinical model. The category-free net reclassification index improved with urine L-FABP (total net reclassification index for nonevents 31.0%) and urine NGAL (total net reclassification index for events 33.3%). However, only urine L-FABP significantly improved the integrated discrimination index. Thus, modest early changes in serum creatinine can help target biomarker measurement for determining prognosis with urine L-FABP, providing independent and additive prognostic information when combined with clinical predictors. PMID:25229339

  5. The Role of Illness Beliefs, Treatment Beliefs, and Perceived Severity of Symptoms in Explaining Distress in Cancer Patients During Chemotherapy Treatment

    Microsoft Academic Search

    Ingela C. V. Thuné-Boyle; Lynn B. Myers; Stanton P. Newman

    2006-01-01

    The authors investigated cancer patients' interpretations of their physical symptoms and their illness beliefs with the objective of establishing the importance of these variables in predicting distress during chemotherapy treatment. Past researchers have suggested that causal attributions of physical symptoms and beliefs about illness progression and its consequences may serve as important mediators between number and perceived severity of symptoms

  6. Communication Practices in Physician Decision-Making for an Unstable Critically Ill Patient with End-Stage Cancer

    PubMed Central

    Mohan, Deepika; Alexander, Stewart C.; Garrigues, Sarah K.; Arnold, Robert M.

    2010-01-01

    Abstract Background Shared decision-making has become the standard of care for most medical treatments. However, little is known about physician communication practices in the decision making for unstable critically ill patients with known end-stage disease. Objective To describe communication practices of physicians making treatment decisions for unstable critically ill patients with end-stage cancer, using the framework of shared decision-making. Design Analysis of audiotaped encounters between physicians and a standardized patient, in a high-fidelity simulation scenario, to identify best practice communication behaviors. The simulation depicted a 78-year-old man with metastatic gastric cancer, life-threatening hypoxia, and stable preferences to avoid intensive care unit (ICU) admission and intubation. Blinded coders assessed the encounters for verbal communication behaviors associated with handling emotions and discussion of end-of-life goals. We calculated a score for skill at handling emotions (0–6) and at discussing end of life goals (0–16). Subjects Twenty-seven hospital-based physicians. Results Independent variables included physician demographics and communication behaviors. We used treatment decisions (ICU admission and initiation of palliation) as a proxy for accurate identification of patient preferences. Eight physicians admitted the patient to the ICU, and 16 initiated palliation. Physicians varied, but on average demonstrated low skill at handling emotions (mean, 0.7) and moderate skill at discussing end-of-life goals (mean, 7.4). We found that skill at discussing end-of-life goals was associated with initiation of palliation (p?=?0.04). Conclusions It is possible to analyze the decision making of physicians managing unstable critically ill patients with end-stage cancer using the framework of shared decision-making. PMID:20642362

  7. Very Early Passive Cycling Exercise in Mechanically Ventilated Critically Ill Patients: Physiological and Safety Aspects - A Case Series

    PubMed Central

    Camargo Pires-Neto, Ruy; Fogaça Kawaguchi, Yurika Maria; Sayuri Hirota, Adriana; Fu, Carolina; Tanaka, Clarice; Caruso, Pedro; Park, Marcelo; Ribeiro Carvalho, Carlos Roberto

    2013-01-01

    Introduction Early mobilization can be performed in critically ill patients and improves outcomes. A daily cycling exercise started from day 5 after ICU admission is feasible and can enhance functional capacity after hospital discharge. In the present study we verified the physiological changes and safety of an earlier cycling intervention (< 72 hrs of mechanical ventilation) in critical ill patients. Methods Nineteen hemodynamically stable and deeply sedated patients within the first 72 hrs of mechanical ventilation were enrolled in a single 20 minute passive leg cycling exercise using an electric cycle ergometer. A minute-by-minute evaluation of hemodynamic, respiratory and metabolic variables was undertaken before, during and after the exercise. Analyzed variables included the following: cardiac output, systemic vascular resistance, central venous blood oxygen saturation, respiratory rate and tidal volume, oxygen consumption, carbon dioxide production and blood lactate levels. Results We enrolled 19 patients (42% male, age 55±17 years, SOFA = 6 ± 3, SAPS3 score = 58 ± 13, PaO2/FIO2 = 223±75). The median time of mechanical ventilation was 1 day (02), and 68% (n=13) of our patients required norepinephrine (maximum concentration = 0.47 µg.kg-1.min-1). There were no clinically relevant changes in any of the analyzed variables during the exercise, and two minor adverse events unrelated to hemodynamic instability were observed. Conclusions In our study, this very early passive cycling exercise in sedated, critically ill, mechanically ventilated patients was considered safe and was not associated with significant alterations in hemodynamic, respiratory or metabolic variables even in those requiring vasoactive agents. PMID:24040200

  8. Continuous extraovular prostaglandin F2 alpha instillation for late pregnancy termination in patients with previous cesarean section delivery.

    PubMed

    Atad, J; Lissak, A; Calderon, I; Sorokin, T; Abramovici, H

    1986-08-01

    Late pregnancy termination by continuous extraovular instillation of prostaglandin F2 alpha (PGF2 alpha) was successfully performed in 13 patients with previous cesarean section (CS) delivery. The indications for pregnancy termination were intrauterine fetal demise in nine patients, social indications in two patients. Down's Syndrome in one patient and quadruplets pregnancy in one patient. One patient had a previous classical vertical cesarean section, two had two previous and one three previous low segment transverse (LST) cesarean sections. The other nine patients had one previous low segment transverse cesarean section. The instillation of prostaglandin solution was obtained by using a new double balloon catheter designed for extraovular pregnancy terminations. All patients aborted following the procedure with no complications. The instillation abortion time ranged from 5 1/2 to 20 h (mean 13.3 h). PMID:2878842

  9. [Assistance for improving QOL of patients with terminal disease cared at home].

    PubMed

    Kitamikado, Hatsue; Kanetsu, Hiroko; Sugihara, Sachiko; Kikukawa, Fumie; Sueda, Mieko; Yanagisawa, Shinji; Tanaka, Toshikazu; Mori, Hiromichi; Sato, Koichiro

    2002-12-01

    A visiting nursing service was provided for a female patient with the terminal stage of transverse colon cancer. The patient, who strongly wanted to stay at home, was discharged from hospital under continuous subcutaneous injection of morphine hydrochloride in late April 2001. The visiting nurse supported her life including the procedures for the continuous subcutaneous injection for attenuating pain as the main symptom. As a result, her fear of pain was reduced and she became able to control pain by oral medication. She became able to walk to the rest room and take a shower and have increased ADL while regaining the strength of will. Family members were concerned with the potential sudden change in her conditions or intensification of pain at home but the worry was contained by understanding the procedures to follow in such cases. QOL can be improved even at the terminal stage if: 1. the patient understand the pathological condition; 2. the patient discloses his/her worry; 3. the patient can choose the way of living; 4. caregiver can cope with the change; 5. caregiver can maintain the nursing capability; 6. the medical provider's assistance system is established. PMID:12536835

  10. [Nursing care in terminality: compliance with principles of bioethics ].

    PubMed

    Felix, Zirleide Carlos; Batista, Patricia Serpa de Souza; da Costa, Solange Fátima Geraldo; Lopes, Maria Emília Limeira; de Oliveira, Regina Célia; Abrão, Fátima Maria da Silva

    2014-09-01

    The aim of the study was to investigate the principles of bioethics reported by nurses when caring for terminally ill patients. Exploratory research with qualitative approach, developed with fifteen nurses from an intensive care unit of a university hospital, in northeastern Brazil. Data collection was conducted between March and July 2013, through a form. Data were analyzed using the technique of content analysis, emerging the following thematic category: respect to the principles of autonomy, beneficence, non-maleficence and justice to take care of the terminally ill patients. The participating nurses valued these principles when caring for terminally ill patients, which reflect the ethical commitment of these professionals in the practice of nursing care. It is noteworthy that bioethical principles should guide the nursing care of human beings throughout their life cycle. PMID:25474847

  11. The challenges of multiple organ dysfunction syndrome and extra-corporeal circuits for drug delivery in critically ill patients.

    PubMed

    Hites, Maya; Dell'Anna, Antonio Maria; Scolletta, Sabino; Taccone, Fabio Silvio

    2014-11-20

    The multiple organ dysfunction syndrome (MODS) is characterized by more than one organ system failing, especially during critical illness. MODS is the leading cause of morbidity and mortality in current ICU practice; moreover, multiple organ dysfunction, especially liver and kidneys, may significantly affect the pharmacokinetics (PKs) of different drugs that are currently administered in critically ill patients. These PK alterations may either result in insufficient drug concentrations to achieve the desired effects or in blood and tissue accumulation, with the development of serious adverse events. The use of extra-corporeal circuits, such as extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT), may further contribute to PKs changes in this patients' population. In this review, we have described the main PK changes occurring in all these conditions and how drug concentrations may potentially be affected. The lack of prospective studies on large cohorts of patients makes impossible any specific recommendation on drug regimen adjustment in ICU patients. Nevertheless, the clinicians should be aware of these abnormalities in order to better understand some unexpected therapeutic issues occurring in such patients. PMID:24842474

  12. “Because Somebody Cared about Me. That's How It Changed Things”: Homeless, Chronically Ill Patients’ Perspectives on Case Management

    PubMed Central

    Davis, Elizabeth; Tamayo, Aracely; Fernandez, Alicia

    2012-01-01

    Background Case management programs for chronically ill, homeless people improve health and resource utilization by linking patients with case managers focused on improving management of medical and psychosocial problems. Little is known about participants’ perspectives on case management interventions. Methods This qualitative study used in-depth, one-on-one interviews to understand the impact of a case management program from the perspective of participants. A standardized interview guide with open-ended questions explored experiences with the case management program and feelings about readiness to leave the program. Results Four recurrent themes emerged: (1) Participants described profound social isolation prior to case management program enrollment; (2) Participants perceived that caring personal relationships with case managers were key to the program; (3) Participants valued assistance with navigating medical and social systems; and (4) Participants perceived that their health improved through both the interpersonal and the practical aspects of case management. Conclusions Chronically ill, homeless people enrolled in a case management program perceived that social support from case managers resulted in improved health. Programs for this population should consider explicitly including comprehensive social support interventions. Further research on case management should explore the impact of different types of social support on outcomes for homeless chronically ill patients. PMID:23029350

  13. Effects of Chronic Illness on the Quality of Life in Psychiatric out patients of the Iraq – Iran War

    PubMed Central

    Shahidi, Shahriar; Nejati, Vahid; Karami, Gholamreza; Masoomi, Mehdi

    2013-01-01

    Objective Quality of life measures can provide an important source of medical information for promoting the health status of chronically ill patients. The purpose of the present study was to evaluate health related quality of life in psychiatric veterans of the Iraq- Iran war of the 1980s. Methods They were out patients diagnosed with various psychiatric symptoms. The present study used a cross sectional design, in which 971 psychiatric veterans were selected by Systematic-randomized sampling and evaluated using the SF36 questionnaire. Results Findings revealed that veterans who suffered from one or more chronic conditions/illnesses reported significantly more bodily pain and significantly less vitality, mental and general health compared to those veterans without chronic conditions. Moreover, specific aspects of poor quality of life were more salient in specific chronic conditions/illnesses than others. Conclusion Based on these findings, chronic conditions, especially respiratory problems, can have a detrimental effect on the quality of life in psychiatric war veterans. PMID:23682246

  14. Does Beta-lactam Pharmacokinetic Variability in Critically Ill Patients Justify Therapeutic Drug Monitoring? A Systematic Review

    PubMed Central

    2012-01-01

    The pharmacokinetics of beta-lactam antibiotics in intensive care patients may be profoundly altered due to the dynamic, unpredictable pathophysiological changes that occur in critical illness. For many drugs, significant increases in the volume of distribution and/or variability in drug clearance are common. When “standard” beta-lactam doses are used, such pharmacokinetic changes can result in subtherapeutic plasma concentrations, treatment failure, and the development of antibiotic resistance. Emerging data support the use of beta-lactam therapeutic drug monitoring (TDM) and individualized dosing to ensure the achievement of pharmacodynamic targets associated with rapid bacterial killing and optimal clinical outcomes. The purpose of this work was to describe the pharmacokinetic variability of beta-lactams in the critically ill and to discuss the potential utility of TDM to optimize antibiotic therapy through a structured literature review of all relevant publications between 1946 and October 2011. Only a few studies have reported the utility of TDM as a tool to improve beta-lactam dosing in critically ill patients. Moreover, there is little agreement between studies on the pharmacodynamic targets required to optimize antibiotic therapy. The impact of TDM on important clinical outcomes also remains to be established. Whereas TDM may be theoretically rational, clinical studies to assess utility in the clinical setting are urgently required. PMID:22839761

  15. Health related quality of life in Critically ill Patients A study of health related quality of life in critically ill patients admitted on the Intensive Care

    Microsoft Academic Search

    J. G. M. Hofhuis

    2008-01-01

    Health related quality of life (HRQOL) is a relevant outcome measure for patients admitted to the\\u000aintensive care unit (ICU). Long term outcome for physical and psychological factors, functional\\u000astatus and social interactions are becoming more and more important both for doctors and nurses\\u000aas well as for patients and their relatives (1;2). Therefore doctors and nurses want to know

  16. Pharmacokinetics of fluconazole in critically ill patients with acute kidney injury receiving sustained low-efficiency diafiltration.

    PubMed

    Sinnollareddy, Mahipal G; Roberts, Michael S; Lipman, Jeffrey; Robertson, Thomas A; Peake, Sandra L; Roberts, Jason A

    2015-02-01

    Fluconazole is a widely used antifungal agent in critically ill patients. It is predominantly (60-80%) excreted unchanged in urine. Sustained low-efficiency diafiltration (SLED-f) is increasingly being utilised in critically ill patients because of its practical advantages over continuous renal replacement therapy. To date, the effect of SLED-f on fluconazole pharmacokinetics and dosing has not been studied. The objective of this study was to describe the pharmacokinetics of fluconazole in critically ill patients with acute kidney injury receiving SLED-f and to compare this with other forms of renal replacement therapy. Serial blood samples were collected at pre- and post-filter ports within the SLED-f circuit during SLED-f and from an arterial catheter before and after SLED-f from three patients during one session. Fluconazole concentrations were measured using a validated chromatography method. Median clearance (CL) and 24-h area under the concentration-time curve (AUC0-24) were 2.1L/h and 152 mg·h/L, respectively, whilst receiving SLED-f. Moreover, 72% of fluconazole was cleared by a single SLED-f session (6h) compared with previous reports of 33-38% clearance by a 4-h intermittent haemodialysis session. CL and AUC0-24 were comparable with previous observations in a pre-dilution mode of continuous venovenous haemodiafiltration. The observed rebound concentration of fluconazole post SLED-f was <2%. Although a definitive dosing recommendation is not possible due to the small patient number, it is clear that doses >200mg daily are likely to be required to achieve the PK/PD target for common pathogens because of significant fluconazole clearance by SLED-f. PMID:25455854

  17. An increase in mean platelet volume after admission is associated with higher mortality in critically ill patients

    PubMed Central

    2014-01-01

    Background Platelet activation and consumption are common in critically ill patients and are associated with poorer prognosis. Mean platelet volume is a simple surrogate for platelet activation, with higher MPV being associated with worse clinical condition on a large array of clinical diagnoses. We therefore aimed to investigate associations between changes in platelet count and mean platelet volume (MPV) with prognosis and inflammatory cytokine values in critically ill patients. Methods This study prospectively included 84 critically ill patients. Patients were stratified into four groups according to proportional changes in MPV (?MPV24h) and platelet count (?Plat24h) in the first 24 hours after admission. Mortality between groups was compared using the ?2 test. Logistic regression was performed using hospital mortality as outcome and Simplified Acute Physiology Score (SAPS 3), ?Plat24h and ?MPV24h as covariates. Concentrations of the following inflammatory mediators were measured using Miliplex® technology: IL1?, IL6, IL8, IL10, epidermal growth factor, vascular endothelial growth factor, TNF? and IFN?. Cytokine concentrations were compared between groups using the Kruskal-Wallis test with Bonferroni correction. Results Patients in whom MPV increased and platelet count decreased had higher mortality rates (46%). According to logistic regression, ?MPV24h was independently associated with increased mortality (OR 1.28 per 1% increase; 95% CI 1.08 to 1.48). No strong associations between inflammatory mediators and changes in MPV and platelet count were found. Conclusion An increase in MPV after admission to an ICU is independently associated with higher hospital mortality. PMID:25520853

  18. Usefulness of N-terminal pro-B-type natriuretic peptide in patients admitted to the intensive care unit: a multicenter prospective observational study

    PubMed Central

    2014-01-01

    Background The role of N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) as a prognostic factor in patients admitted to the intensive care unit (ICU) is not yet fully established. We aimed to determine whether NT-pro-BNP is predictive of ICU mortality in a multicenter cohort of critically ill patients. Methods A total of 1440 patients admitted to 22 ICUs (medical, 14; surgical, six; multidisciplinary, two) in 15 tertiary or university-affiliated hospitals between July 2010 and January 2011 were assessed. Patient data, including NT-pro-BNP levels and Simplified Acute Physiology Score (SAPS) 3 scores, were recorded prospectively in a web-based database. Results The median age was 64 years (range, 53–73 years), and 906 (62.9%) patients were male. The median NT-pro-BNP level was 341 pg/mL (104–1,637 pg/mL), and the median SAPS 3 score was 57 (range, 47–69). The ICU mortality rate was 18.9%, and hospital mortality was 24.5%. Hospital survivors showed significantly lower NT-pro-BNP values than nonsurvivors (245 pg/mL [range, 82–1,053 pg/mL] vs. 875 pg/mL [241–5,000 pg/mL], respectively; p?ill patients. However, there was little additional prognostic power when adding NT-pro-BNP to SAPS 3 score. PMID:24612820

  19. Vulnerability and access to care for South Asian Sikh and Muslim patients with life limiting illness in Scotland: prospective longitudinal qualitative study 

    E-print Network

    Bhopal, Raj; Worth, A; Irshad, T; Brown, D; Lawton, J; Grant, E; Murray, S; Kendall, M; Adam, J; Gardee, R; Sheikh, A

    2009-02-03

    Objectives To examine the care experiences of South Asian Sikh and Muslim patients in Scotland with life limiting illness and their families and to understand the reasons for any difficulties with access to services and how these might be overcome...

  20. Has Stewart approach improved our ability to diagnose acid-base disorders in critically ill patients?

    PubMed

    Masevicius, Fabio D; Dubin, Arnaldo

    2015-02-01

    The Stewart approach-the application of basic physical-chemical principles of aqueous solutions to blood-is an appealing method for analyzing acid-base disorders. These principles mainly dictate that pH is determined by three independent variables, which change primarily and independently of one other. In blood plasma in vivo these variables are: (1) the PCO2; (2) the strong ion difference (SID)-the difference between the sums of all the strong (i.e., fully dissociated, chemically nonreacting) cations and all the strong anions; and (3) the nonvolatile weak acids (Atot). Accordingly, the pH and the bicarbonate levels (dependent variables) are only altered when one or more of the independent variables change. Moreover, the source of H(+) is the dissociation of water to maintain electroneutrality when the independent variables are modified. The basic principles of the Stewart approach in blood, however, have been challenged in different ways. First, the presumed independent variables are actually interdependent as occurs in situations such as: (1) the Hamburger effect (a chloride shift when CO2 is added to venous blood from the tissues); (2) the loss of Donnan equilibrium (a chloride shift from the interstitium to the intravascular compartment to balance the decrease of Atot secondary to capillary leak; and (3) the compensatory response to a primary disturbance in either independent variable. Second, the concept of water dissociation in response to changes in SID is controversial and lacks experimental evidence. In addition, the Stewart approach is not better than the conventional method for understanding acid-base disorders such as hyperchloremic metabolic acidosis secondary to a chloride-rich-fluid load. Finally, several attempts were performed to demonstrate the clinical superiority of the Stewart approach. These studies, however, have severe methodological drawbacks. In contrast, the largest study on this issue indicated the interchangeability of the Stewart and conventional methods. Although the introduction of the Stewart approach was a new insight into acid-base physiology, the method has not significantly improved our ability to understand, diagnose, and treat acid-base alterations in critically ill patients. PMID:25685724

  1. Has Stewart approach improved our ability to diagnose acid-base disorders in critically ill patients?

    PubMed Central

    Masevicius, Fabio D; Dubin, Arnaldo

    2015-01-01

    The Stewart approach-the application of basic physical-chemical principles of aqueous solutions to blood-is an appealing method for analyzing acid-base disorders. These principles mainly dictate that pH is determined by three independent variables, which change primarily and independently of one other. In blood plasma in vivo these variables are: (1) the PCO2; (2) the strong ion difference (SID)-the difference between the sums of all the strong (i.e., fully dissociated, chemically nonreacting) cations and all the strong anions; and (3) the nonvolatile weak acids (Atot). Accordingly, the pH and the bicarbonate levels (dependent variables) are only altered when one or more of the independent variables change. Moreover, the source of H+ is the dissociation of water to maintain electroneutrality when the independent variables are modified. The basic principles of the Stewart approach in blood, however, have been challenged in different ways. First, the presumed independent variables are actually interdependent as occurs in situations such as: (1) the Hamburger effect (a chloride shift when CO2 is added to venous blood from the tissues); (2) the loss of Donnan equilibrium (a chloride shift from the interstitium to the intravascular compartment to balance the decrease of Atot secondary to capillary leak; and (3) the compensatory response to a primary disturbance in either independent variable. Second, the concept of water dissociation in response to changes in SID is controversial and lacks experimental evidence. In addition, the Stewart approach is not better than the conventional method for understanding acid-base disorders such as hyperchloremic metabolic acidosis secondary to a chloride-rich-fluid load. Finally, several attempts were performed to demonstrate the clinical superiority of the Stewart approach. These studies, however, have severe methodological drawbacks. In contrast, the largest study on this issue indicated the interchangeability of the Stewart and conventional methods. Although the introduction of the Stewart approach was a new insight into acid-base physiology, the method has not significantly improved our ability to understand, diagnose, and treat acid-base alterations in critically ill patients. PMID:25685724

  2. Understanding the problems developing a healthy living programme in patients with serious mental illness: a qualitative study

    PubMed Central

    2014-01-01

    Background People with serious mental illness are at an increased risk of physical ill health. Mortality rates are around twice those of the general population with higher levels of cardiovascular disease, metabolic disease, diabetes, and respiratory illness. Although genetics may have a role in the physical health problems of these patients, lifestyle and environmental factors such as smoking, obesity, poor diet, and low levels of physical activity play a prominent part. Methods A qualitative grounded theory approach was used to understand the problems experienced by these individuals when asked to attend a healthy living programme. Three main areas were explored: the influence of potential barriers, health problems, and general attitudes towards healthy living. Results Thirteen patients were interviewed during the study. Many did not recall receiving an initial invitation letter to the programme. Several believed that there was no necessity to attend as they had already had recent routine health checks by their general practitioner. The patients’ current level of mental and physical health was important with symptoms such as depression, anxiety or arthritis affecting interest in the programme. Patients described that they found smoking enjoyable or calming in its effect. Dietary intake was determined by taste or gaining pleasure in eating certain types of food. Several lessons were learnt during this research that may aid future research and practice. Participation seemed to be better if the approach was first made by the patient’s own community keyworker. This contact may have provided a greater opportunity to explain the purpose and importance of the programme. Alternative appointments should be considered when certain patients are in better physical and mental health. Healthy living programmes need to be flexible and adaptive to individual patient needs. Assistance from their community worker may help engagement. Simple measures may improve participation and reduce potential barriers. Conclusion These findings highlighted some of the problems encountered by patients when attempting to participate in a healthy living programme. These results may be useful when implementing future healthy living interventions for patients with serious mental disorders. PMID:24524248

  3. Genetic Variations of PIP4K2A Confer Vulnerability to Poor Antipsychotic Response in Severely Ill Schizophrenia Patients

    PubMed Central

    Kaur, Harpreet; Jajodia, Ajay; Grover, Sandeep; Baghel, Ruchi; Gupta, Meenal; Jain, Sanjeev; Kukreti, Ritushree

    2014-01-01

    Literature suggests that disease severity and neurotransmitter signaling pathway genes can accurately identify antipsychotic response in schizophrenia patients. However, putative role of signaling molecules has not been tested in schizophrenia patients based on severity of illness, despite its biological plausibility. In the present study we investigated the possible association of polymorphisms from five candidate genes RGS4, SLC6A3, PIP4K2A, BDNF, PI4KA with response to antipsychotic in variably ill schizophrenia patients. Thus in present study, a total 53 SNPs on the basis of previous reports and functional grounds were examined for their association with antipsychotic response in 423 schizophrenia patients segregated into low and high severity groups. Additionally, haplotype, diplotype, multivariate logistic regression and multifactor-dimensionality reduction (MDR) analyses were performed. Furthermore, observed associations were investigated in atypical monotherapy (n?=?355) and risperidone (n?=?260) treated subgroups. All associations were estimated as odds ratio (OR) and 95% confidence interval (CI) and test for multiple corrections was applied. Single locus analysis showed significant association of nine variants from SLC6A3, PIP4K2A and BDNF genes with incomplete antipsychotic response in schizophrenia patients with high severity. We identified significant association of six marker diplotype ATTGCT/ATTGCT (rs746203-rs10828317-rs7094131-rs2296624-rs11013052-rs1409396) of PIP4K2A gene in incomplete responders (corrected p-value?=?0.001; adjusted-OR?=?3.19, 95%-CI?=?1.46–6.98) with high severity. These associations were further observed in atypical monotherapy and risperidone sub-groups. MDR approach identified gene-gene interaction among BDNF_rs7103411-BDNF_rs1491851-SLC6A3_rs40184 in severely ill incomplete responders (OR?=?7.91, 95%-CI?=?4.08–15.36). While RGS4_rs2842026-SLC6A3_rs2975226 interacted synergistically in incomplete responders with low severity (OR?=?4.09, 95%-CI?=?2.09–8.02). Our findings provide strong evidence that diplotype ATTGCT/ATTGCT of PIP4K2A gene conferred approximately three-times higher incomplete responsiveness towards antipsychotics in severely ill patients. These results are consistent with the known role of phosphatidyl-inositol-signaling elements in antipsychotic action and outcome. Findings have implication for future molecular genetic studies as well as personalized medicine. However more work is warranted to elucidate underlying causal biological pathway. PMID:25025909

  4. A Minimal Psychological Intervention in Chronically Ill Elderly Patients with Depression: A Randomized Trial

    Microsoft Academic Search

    Femke Lamers; Catharina C. M. Jonkers; Hans Bosma; Gertrudis I. J. M. Kempen; Jaap A. M. J. Meijer; Brenda W. J. H. Penninx; J. André Knottnerus; Jacques T. M. van Eijk

    2010-01-01

    Background: Among older persons with chronic somatic diseases, depression often remains unrecognized and untreated in primary care. The Depression in Elderly with Long-Term Afflictions (DELTA) study aimed to evaluate the effectiveness of a nurse-led minimal psychological intervention (MPI) in chronically ill elderly persons with depression. Methods: A randomized controlled trial was conducted, comparing the MPI with usual care in 361

  5. Indian Psychiatric Society multicentric study on assessment of health-care needs of patients with severe mental illnesses

    PubMed Central

    Grover, Sandeep; Avasthi, Ajit; Shah, Sandip; Lakdawala, Bhavesh; Chakraborty, Kaustav; Nebhinani, Naresh; Kallivayalil, Roy Abraham; Dalal, Pranob K.; Sinha, Vishal; Khairkar, Praveen; Mukerjee, Divya G.; Thara, R.; Behere, Prakash; Chauhan, Nidhi; Thirunavukarasu, M.; Malhotra, Sameer

    2015-01-01

    Aim: To assess the health-care needs of the patients with severe mental disorders. Materials and Methods: Patients with the diagnosis of a severe mental disorder (schizophrenia and related psychotic disorders, bipolar disorder, recurrent depressive disorder, major depressive disorder and obsessive compulsive disorder) were assessed using Camberwell Assessment of Need-Research version (CAN-R) Scale and indigenously designed Supplementary Needs Assessment Scale (SNAS). Results: The study included 1494 patients recruited from 15 centers. The most common diagnostic group was that of affective disorders (55.3%), followed by psychotic disorders (37.6%). The mean number of total needs as perceived by the patients was 7.6 on the CAN-R. About two-third of the needs as assessed on CAN-R were met, and one-third were unmet. On CAN-R, main domains of needs as reported by patients were those of money, welfare benefits, transport, information about the illness and treatment, relief of psychological distress, company, household skills and intimate relationships. On SNAS, the mean number of total needs as perceived by the patients was 7.6 of which 4.1 were met needs. The most common domains of needs as assessed on SNAS were those of financial help, medical reimbursement, psychoeducation, free treatment, certification of mental illness, flexible work/job timings, addressing the caregiver stress and legal aid. Conclusion: About two-third of the needs, of the patients with severe mental disorders are met as assessed using CAN-R. However, higher percentages of unmet needs are identified on SNAS. In view of the commonly reported needs, a change in the orientation of services offered to people with mental disorders is very much called for. At the government level, desired policies must be formulated to support the patients with mental disorders. PMID:25657456

  6. Personality dimensions of schizophrenia patients compared to control subjects by gender and the relationship with illness severity

    PubMed Central

    2014-01-01

    Background Personality traits and schizophrenia present gender differences; however, gender has not been considered in most studies on personality and schizophrenia. This study aims to identify the different personality dimensions of schizophrenia patients and healthy control subjects by gender and to explore the relationship between personality dimensions and illness severity variables by analyzing data for males and females separately. Methods Temperament and Character Inventory-Revised dimensions were compared by gender between 161 schizophrenia patients and 214 healthy controls from a population-based sample using independent t-tests. We then investigated whether personality dimensions are related to illness severity variables using correlation analyses and bivariate logistic regression, also by gender. Results The patients had significantly higher scores for harm avoidance (HA) and self-transcendence (ST) and lower scores for reward dependence (RD), cooperativeness (C), and self-directedness (SD) than the controls. Similar results were obtained when the sample was stratified by gender, however the differences were higher and more significant for HA among males and for RD among females. The number of admissions to a psychiatric hospital positively correlated with novelty seeking (NS) in males and negatively with SD in females. In males, SD and ST negatively correlated with the number of suicide attempts. Conclusions Male and female patients present difficulties for regulating and adapting behavior to achieve goals (SD) and for identifying and accepting others (C), as well as a great sense of spirituality and universe identification (ST). However, male patients are more characterized by being fearful, doubtful and easily fatigued (HA), while female patients are characterized by presenting difficulties maintaining and pursuing associated reward behaviors (RD). Furthermore, male and female patients who are frequently admitted to psychiatric hospitals and male patients who attempt suicide should be evaluated regarding their personality dimensions. Future studies assessing the relationship between personality dimensions and the clinical features of schizophrenia should consider gender differences. PMID:24884428

  7. Anticoagulation Strategies in Venovenous Hemodialysis in Critically Ill Patients: A Five-Year Evaluation in a Surgical Intensive Care Unit

    PubMed Central

    Kabisch, Björn; Wurm, Karin; Ebert, Katharina; Bauer, Michael

    2014-01-01

    Renal failure is a common complication among critically ill patients. Timing, dosage, and mode of renal replacement (RRT) are under debate, but also anticoagulation strategies and vascular access interfere with dialysis success. We present a retrospective, five-year evaluation of patients requiring RRT on a multidisciplinary 50-bed surgical intensive care unit of a university hospital with special regard to anticoagulation strategies and vascular access. Anticoagulation was preferably performed with unfractionated heparin or regional citrate application (RAC). Bleeding and suspected HIT-II were most common causes for RAC. In CVVHD mode filter life span was significantly longer under RAC compared to heparin or other anticoagulation strategies (P = 0.001). Femoral vascular access was associated with reduced filter life span (P = 0.012), especially under heparin anticoagulation (P = 0.015). Patients on RAC had higher rates of metabolic alkalosis (P = 0.001), required more transfusions (P = 0.045), and showed higher illness severity measured by SOFA scores (P = 0.001). RRT with unfractionated heparin represented the most common anticoagulation strategy in this study population. However, patients with bleeding risk and severe organ dysfunction were more likely placed on RAC. Citrate provided longer filter life spans regardless of vascular access site. Attention has to be paid to metabolic disturbances. PMID:25548793

  8. Reliable real-time calculation of heart-rate complexity in critically ill patients using multiple noisy waveform sources.

    PubMed

    Liu, Nehemiah T; Cancio, Leopoldo C; Salinas, Jose; Batchinsky, Andriy I

    2014-04-01

    Heart-rate complexity (HRC) has been proposed as a new vital sign for critical care medicine. The purpose of this research was to develop a reliable method for determining HRC continuously in real time in critically ill patients using multiple waveform channels that also compensates for noisy and unreliable data. Using simultaneously acquired electrocardiogram (Leads I, II, V) and arterial blood pressure waveforms sampled at 360 Hz from 250 patients (over 375 h of patient data), we evaluated a new data fusion framework for computing HRC in real time. The framework employs two algorithms as well as signal quality indices. HRC was calculated (via the method of sample entropy), and equivalence tests were then performed. Bland-Altman plots and box plots of differences between mean HRC values were also obtained. Finally, HRC differences were analyzed by paired t tests. The gold standard for obtaining true means was manual verification of R waves and subsequent entropy calculations. Equivalence tests between mean HRC values derived from manually verified sequences and those derived from automatically detected peaks showed that the "Fusion" values were the least statistically different from the gold standard. Furthermore, the fusion of waveform sources produced better error density distributions than those derived from individual waveforms. The data fusion framework was shown to provide in real-time a reliable continuously streamed HRC value, derived from multiple waveforms in the presence of noise and artifacts. This approach will be validated and tested for assessment of HRC in critically ill patients. PMID:23990286

  9. Long-Term Sequelae of Severe Acute Kidney Injury in the Critically Ill Patient without Comorbidity: A Retrospective Cohort Study

    PubMed Central

    Fortrie, Gijs; Stads, Susanne; Aarnoudse, Albert-Jan H.; Zietse, Robert; Betjes, Michiel G.

    2015-01-01

    Background and Objectives Acute kidney injury (AKI) necessitating renal replacement therapy (RRT) is associated with high mortality and increased risk for end stage renal disease. However, it is unknown if this applies to patients with a preliminary unremarkable medical history. The purpose of this study was to describe overall and renal survival in critically ill patients with AKI necessitating RRT stratified by the presence of comorbidity. Design, Setting, Participants, and Measurements A retrospective cohort study was performed, between 1994 and 2010, including all adult critically ill patients with AKI necessitating RRT, stratified by the presence of comorbidity. Logistic regression, survival curve and cox proportional hazards analyses were used to evaluate overall and renal survival. Standardized mortality rate (SMR) analysis was performed to compare long-term survival to the predicted survival in the Dutch population. Results Of the 1067 patients included only 96(9.0%) had no comorbidity. Hospital mortality was 56.6% versus 43.8% in patients with and without comorbidity, respectively. In those who survived hospitalization 10-year survival was 45.0% and 86.0%, respectively. Adjusted for age, sex and year of treatment, absence of comorbidity was not associated with hospital mortality (OR=0.74, 95%-CI=0.47-1.15), while absence of comorbidity was associated with better long-term survival (adjusted HR=0.28, 95%-CI = 0.14-0.58). Compared to the Dutch population, patients without comorbidity had a similar mortality risk (SMR=1.6, 95%-CI=0.7-3.2), while this was increased in patients with comorbidity (SMR=4.8, 95%-CI=4.1-5.5). Regarding chronic dialysis dependency, 10-year renal survival rates were 76.0% and 92.9% in patients with and without comorbidity, respectively. Absence of comorbidity was associated with better renal survival (adjusted HR=0.24, 95%-CI=0.07-0.76). Conclusions While hospital mortality remains excessively high, the absence of comorbidity in critically ill patients with RRT-requiring AKI is associated with a relative good long-term prognosis in those who survive hospitalization. PMID:25799318

  10. Malnutrition at the Time of Surgery Affects Negatively the Clinical Outcome of Critically Ill Patients with Gastrointestinal Cancer

    PubMed Central

    Shpata, Vjollca; Prendushi, Xhensila; Kreka, Manika; Kola, Irena; Kurti, Floreta; Ohri, Ilir

    2014-01-01

    Introduction: Malnutrition is a frequent concomitant of surgical illness, especially in gastrointestinal cancer surgery. The aim of the study was to assess the prevalence of malnutrition in the GI cancer patients and its relation with clinical outcome. We also examined associations between the energy balance and clinical outcomes in these patients. Methods: Prospective study on 694 surgical patients treated in the ICU of the UHC of Tirana. Patients were divided into well-nourished and malnourished groups according to their nutritional status. Multiple regression analysis was used to analyze the effect of malnutrition and cumulated energy balance on clinical outcome. Results: The prevalence of pre-operative malnutrition was 65.3% for all surgical patients and 84.9% for gastrointestinal cancer patients. Malnutrition, as analyzed by a multivariate logistic regression model, is an independent risk factor for higher complications, infections, and mortality, longer stay in the ventilator and ICU. Also this model showed that cumulated energy balance correlated with infections, and mortality and was independently associated with the length ventilator and ICU stay. Conclusion: This study shows that malnutrition is a significant problem in surgical patients, especially in patients with gastrointestinal cancer. Malnutrition and cumulated energy deficit in gastro-intestinal surgery patients with malignancy is an independent risk factor on increased post-operative morbidity and mortality. PMID:25568549

  11. The process of recovery of people with mental illness: The perspectives of patients, family members and care providers: Part 1

    PubMed Central

    2010-01-01

    Background It is a qualitative design study that examines points of divergence and convergence in the perspectives on recovery of 36 participants or 12 triads. Each triad comprising a patient, a family member/friend, a care provider and documents the procedural, analytic of triangulating perspectives as a means of understanding the recovery process which is illustrated by four case studies. Variations are considered as they relate to individual characteristics, type of participant (patient, family, member/friend and care provider), and mental illness. This paper which is part of a larger study and is based on a qualitative research design documents the process of recovery of people with mental illness: Developing a Model of Recovery in Mental Health: A middle range theory. Methods Data were collected in field notes through semi-structured interviews based on three interview guides (one for patients, one for family members/friends, and one for caregivers). Cross analysis and triangulation methods were used to analyse the areas of convergence and divergence on the recovery process of all triads. Results In general, with the 36 participants united in 12 triads, two themes emerge from the cross-analysis process or triangulation of data sources (12 triads analysis in 12 cases studies). Two themes emerge from the analysis process of the content of 36 interviews with participants: (1) Revealing dynamic context, situating patients in their dynamic context; and (2) Relationship issues in a recovery process, furthering our understanding of such issues. We provide four case studies examples (among 12 cases studies) to illustrate the variations in the way recovery is perceived, interpreted and expressed in relation to the different contexts of interaction. Conclusion The perspectives of the three participants (patients, family members/friends and care providers) suggest that recovery depends on constructing meaning around mental illness experiences and that the process is based on each person's dynamic context (e.g., social network, relationship), life experiences and other social determinants (e.g., symptoms, environment). The findings of this study add to existing knowledge about the determinants of the recovery of persons suffering with a mental illness and significant other utilizing public mental health services in Montreal, Canada. PMID:20540771

  12. [Utility of prolonged incubation and terminal subcultures of blood cultures from immunocompromised patients].

    PubMed

    Soloaga, R; Procopio, A; Manganello, S; Ivanovic, V; Romay, N; Pirosanto, Y; Fernández, A; Zudiker, R; Echeverría, A; Nagel, C; del Castillo, M; López, E; Gutfraind, Z; Tokumoto, M; Guelfand, L

    2001-01-01

    The value of blind terminal subcultures (7 and 30 days) and prolonged incubation (30 days) of blood cultures from immunosuppressed patients was analyzed in the Fundación Favaloro, the Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia and the Hospital de Niños Ricardo Gutiérrez. A total of 2707 blood cultures and 369 patients were included (transplantation of solid organs 154, oncohematologic disorders 106 and solid tumors 109). Bact-Alert bottles were incubated at 35 degrees C for 30 days in the Bact-Alert System. Bottles with positive signals were routinely removed, and aliquots of the broth were Gram stained and subcultured aerobically in chocolate agar and Sabouraud agar. A total of 136 bacteremic episodes were obtained. The positivization time of blood cultures was 81.6% at 24 h, 93.3% at 48 h, 94.5% at 72 h and 97.7% within 7 days. Only 3 (2.2%) episodes were positive by blind terminal subcultures and 1 (0.75%) by prolonged incubation (14 days). The median time and range of positivization in hours were 13.8 and 2.2-168, respectively. The microorganisms isolated were coagulase negative staphylococci (n = 24), Klebsiella pneumoniae (n = 22), Staphylococcus aureus (n = 21), Escherichia coli (n = 18), Acinetobacter spp (n = 9), Candida spp (n = 8), Pseudomonas aeruginosa (n = 6), Enterobacter cloacae (n = 5), Stenotrophomonas maltophilia (n = 5), Enterococcus faecalis, Salmonella spp and Capnocytophaga sputigena (n = 2), Enterobacter aerogenes, Enterococcus faecium, Citrobacter diversus, Candida albicans, Klebsiella oxytoca, Chryseomonas luteola, Serratia marcescens, Abiotrophia spp, Campylobacter jejuni, Moraxella catarrhalis, Moraxella urethralis, Neisseria sicca, beta hemolytic group G streptococci, Rhodococcus equi, Micrococcus spp, Cryptococcus neoformans and Streptococcus mitis (n = 1). In our experience, blind terminal subcultures and prolonged incubation of blood cultures from immunosuppressed patients are unnecessary and cost expensive. PMID:11594009

  13. Real-time continuous glucose monitoring versus conventional glucose monitoring in critically ill patients: a systematic review study protocol

    PubMed Central

    Zhu, Weidong; Jiang, Libing; Jiang, Shouyin; Ma, Yuefeng; Zhang, Mao

    2015-01-01

    Introduction Stress-induced hyperglycaemia, which has been shown to be associated with an unfavourable prognosis, is common among critically ill patients. Additionally, it has been reported that hypoglycaemia and high glucose variabilities are also associated with adverse outcomes. Thus, continuous glucose monitoring (CGM) may be the optimal method to detect severe hypoglycaemia, hyperglycaemia and decrease glucose excursion. However, the overall accuracy and reliability of CGM systems and the effects of CGM systems on glucose control and prognosis in critically ill patients remain inconclusive. Therefore, we will conduct a systematic review and meta-analysis to clarify the associations between CGM systems and clinical outcome. Methods and analysis We will search PubMed, EMBASE and the Cochrane Library from inception to October 2014. Studies comparing CGM systems with any other glucose monitoring methods in critically ill patients will be eligible for our meta-analysis. The primary endpoints include the incidence of hypoglycaemia and hyperglycaemia, mean glucose level, and percentage of time within the target range. The second endpoints include intensive care unit (ICU) mortality, hospital mortality, duration of mechanical ventilation, length of ICU and hospital stay, and the Pearson correlation coefficient and the results of error grid analysis. In addition, we will record all complications (eg, acquired infections) in control and intervention groups and local adverse events in intervention groups (eg, bleeding or infections). Ethics and dissemination Ethics approval is not required as this is a protocol for a systematic review. The findings will be disseminated in a peer-reviewed journal and presented at a relevant conference. Trial registration number PROSPERO registration number: CRD42014013488. PMID:25616512

  14. Changing Diagnostic and Treatment Criteria for Chronic Illness: A Critical Consideration of their Impact on Low-Income Hispanic Patients

    PubMed Central

    Hunt, Linda M.; Kreiner, Meta; Rodriguez-Mejia, Fredy

    2015-01-01

    Low-income Hispanics are often identified as especially at risk for common chronic conditions like diabetes, and targeted for aggressive screening and treatment. Anthropologists and other social scientists have extensively explored barriers and facilitators to chronic illnesses management in minority populations, but have not yet considered the impact of recently lowered diagnostic and treatment thresholds on such groups. In this paper, we critically review recent changes in diabetes, hypertension and high cholesterol diagnostic and treatment standards which have dramatically increased the number of people being treated for these conditions. Drawing on an ethnographic study of chronic illness management in two Hispanic-serving clinics in the Midwest, we examine how these new standards are being applied, and consider the resulting health care challenges these Hispanic patients face. Our analysis leads us to question the value of promoting narrowly defined treatment goals, particularly when patients lack reliable access to the health care resources these goals require. While improving the health of low-income Hispanics is a worthwhile goal, it is important to consider whether these efforts may be promoting over-diagnosis and over-treatment, drawing them into an expensive chronic patient role with uncertain benefit.

  15. A retrospective quasi-experimental study of a transitional housing program for patients with severe and persistent mental illness.

    PubMed

    Siskind, Dan; Harris, Meredith; Kisely, Steve; Siskind, Victor; Brogan, James; Pirkis, Jane; Crompton, David; Whiteford, Harvey

    2014-07-01

    Transitional housing programs aim to improve living skills and housing stability for tenuously housed patients with mental illness. 113 consecutive Transitional Housing Team (THT) patients were matched to 139 controls on diagnosis, time of presentation, gender and prior psychiatric hospitalisation and compared using a difference-in-difference analysis for illness acuity and service use outcomes measured 1 year before and after THT entry/exit. There was a statistically significant difference-in-difference favouring THT participants for bed days (mean difference in difference -20.76 days, SE 9.59, p = 0.031) and living conditions (HoNOS Q11 mean difference in difference -0.93, SE 0.23, p < 0.001). THT cost less per participant (I$14,024) than the bed-days averted (I$17,348). The findings of reductions in bed days and improved living conditions suggest that transitional housing programs can have a significant positive impact for tenuously housed patients with high inpatient service usage, as well as saving costs for mental health services. PMID:24150440

  16. [Acute glycemic control in critically ill perioperative patients; the impact of parenteral nutrition on the effect of intensive insulin therapy].

    PubMed

    Egi, Moritoki

    2012-05-01

    Hyperglycemia is common in critically ill patients. Recently the international multicentre NICE-SUGAR study reported increased mortality with this approach and recent meta-analyses do not support adopting intensive glucose control for critically ill patients. One possible explanation of the different effect of intensive insulin therapy between Leuven study and NICE-SUGAR study is how aggressively parenteral nutrition was applied. In Leuven study, parenteral nutrition was applied aggressively (total intravenous intake of non-protein calorie; 12-18 kcal x kg(-1) day(-1)), while in NICE-SUGAR study, "permissive hypo-nutrition" (total intravenous intake of non-protein calorie; 1-1.5 kcal x kg(-1) x day(-1)) was applied. As recent meta-analysis showed that the percentage of calories given intravenously was significantly associated with a treatment effect of intensive insulin therapy, this difference might be relevant. Recently, EPaNC trial showed that aggressive parenteral nutrition may increase infection rate and worsen outcomes, even though they apply intensive insulin therapy in all participating patients. The results of the NICE-SUGAR study and EPaNIC trial have resulted in the more moderate recommendation to target a blood glucose concentration between 144 and 180 mg x dl(-1) and less aggressive parenteral nutrition. Until another level I evidence is available, clinicians would be well advised to abide by the age-old adage, "First, do no harm". PMID:22702088

  17. Religious versus Conventional Psychotherapy for Major Depression in Patients with Chronic Medical Illness: Rationale, Methods, and Preliminary Results

    PubMed Central

    Koenig, Harold G.

    2012-01-01

    This paper (1) reviews the physical and religious barriers to CBT that disabled medically ill-depressed patients face, (2) discusses research on the relationship between religion and depression-induced physiological changes, (3) describes an ongoing randomized clinical trial of religious versus secular CBT in chronically ill patients with mild-to-moderate major depression designed to (a) overcome physical and religious barriers to CBT and (b) compare the efficacy of religious versus secular CBT in relieving depression and improving immune and endocrine functions, and (4) presents preliminary results that illustrate the technical difficulties that have been encountered in implementing this trial. CBT is being delivered remotely via instant messaging, telephone, or Skype, and Christian, Jewish, Muslim, Buddhist, and Hindu versions of religious CBT are being developed. The preliminary results described here are particular to the technologies employed in this study and are not results from the CBT clinical trial whose findings will be published in the future after the study ends and data are analyzed. The ultimate goal is to determine if a psychotherapy delivered remotely that integrates patients' religious resources improves depression more quickly than a therapy that ignores them, and whether religious CBT is more effective than conventional CBT in reversing depression-induced physiological changes. PMID:22778932

  18. How do we use therapeutic drug monitoring to improve outcomes from severe infections in critically ill patients?

    PubMed

    Wong, Gloria; Sime, Fekade Bruck; Lipman, Jeffrey; Roberts, Jason A

    2014-01-01

    High mortality and morbidity rates associated with severe infections in the critically ill continue to be a significant issue for the healthcare system. In view of the diverse and unique pharmacokinetic profile of drugs in this patient population, there is increasing use of therapeutic drug monitoring (TDM) in attempt to optimize the exposure of antibiotics, improve clinical outcome and minimize the emergence of antibiotic resistance. Despite this, a beneficial clinical outcome for TDM of antibiotics has only been demonstrated for aminoglycosides in a general hospital patient population. Clinical outcome studies for other antibiotics remain elusive. Further, there is significant variability among institutions with respect to the practice of TDM including the selection of patients, sampling time for concentration monitoring, methodologies of antibiotic assay, selection of PK/PD targets as well as dose optimisation strategies. The aim of this paper is to review the available evidence relating to practices of antibiotic TDM, and describe how TDM can be applied to potentially improve outcomes from severe infections in the critically ill. PMID:25430961

  19. Heavy metal in the intensive care unit: a review of current literature on trace element supplementation in critically ill patients.

    PubMed

    Rech, Megan; To, Long; Tovbin, Alina; Smoot, Thomas; Mlynarek, Mark

    2014-02-01

    Trace elements are essential for many physiologic processes. In recent years, supplementation has been studied for a variety of indications, including glycemic control, wound healing, antioxidant effect, and anemia. Critical illness, especially states such as burns, traumas, and septic shock, is associated with inflammatory and oxidative stress, immune dysfunction, and malnutrition. In these patients, enteral and parenteral nutrition or pharmaceutical supplementation is used to provide essential macronutrients, including trace elements. The purpose of this review is to describe trace element supplementation, including iron, copper, chromium, manganese, selenium, and zinc, and highlight their mechanism, pharmacology, outcome data, and adverse effects. PMID:24336443

  20. [Home care for terminal cancer patients from the family and caregiver perspective].

    PubMed

    Ishikawa, Mitsuko; Ogiwara, Miyoko; Yamaoka, Keita; Matsumoto, Ayumi; Fujimaki, Yoko; Watanabe, Mutsuko; Kushida, Kazuki

    2014-12-01

    The progression of home care provision is associated with an increased burden on the family, as patients tend to progressively become more dependent on medicine. In the present case, a family supported a patient by performing medical activities such as taking blood sugar measurements, administering insulin injections, exchanging fluids, managing each tube, handling medical devices, conducting status observations, and attending to emergency calls. Thus, the family caregiver undertakes duties that were previously performed by a nurse and interacts with the various professionals who visit the patient's home daily. Therefore, the caregiver undergoes a considerable amount of stress. Family caregivers with no medical knowledge or nursing experience require plenty of support, in order to fulfill a patient's requirements. The first step is the establishment of trust between the medical professionals and the caregiver. In the present case, because the trust had been established, interprofessional collaboration ensured that the patient received support until the end. Thus, we reported on the perspectives of the family and caregiver on home care for terminal cancer patients. PMID:25595073

  1. Gastric vs Small Bowel Feeding in Critically Ill Neurologically Injured Patients: Results of a Multicenter Observational Study.

    PubMed

    Saran, Delara; Brody, Rebecca A; Stankorb, Susan M; Parrott, Scott J; Heyland, Daren K

    2014-06-19

    Background: To evaluate gastric compared with small bowel feeding on nutrition and clinical outcomes in critically ill, neurologically injured patients. Materials and Methods: International, prospective observational studies involving 353 intensive care units (ICUs) were included. Eligible patients were critically ill, mechanically ventilated with neurological diagnoses who remained in the ICU and received enteral nutrition (EN) exclusively for at least 3 days. Sites provided data, including patient characteristics, nutrition practices, and 60-day outcomes. Patients receiving gastric or small bowel feeding were compared. Covariates including age, sex, body mass index, and Acute Physiology and Chronic Health Evaluation II score were used in the adjusted analyses. Results: Of the 1691 patients who met our inclusion criteria, 1407 (94.1%) received gastric feeding and 88 (5.9%) received small bowel feeding. Adequacy of calories from EN was highest in the gastric group (60.2% and 52.3%, respectively, unadjusted analysis; P = .001), but this was not significant in the adjusted model (P = .428). The likelihood of EN interruptions due to gastrointestinal (GI) complications was higher for the gastric group (19.6% vs 4.7%, unadjusted model; P = .015). There were no significant differences in the rate of discontinuation of mechanical ventilation (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.66-1.12; P = .270) or the rate of being discharged alive from the ICU (HR, 0.94; 95% CI, 0.72-1.23; P = .641) and hospital (HR, 1.16; 95% CI, 0.87-1.55; P = .307) after adjusting for confounders. Conclusions: Despite a higher likelihood of EN interruptions due to GI complications, gastric feeding may be associated with better nutrition adequacy, but neither route is associated with better clinical outcomes. PMID:24947058

  2. Four hour creatinine clearance is better than plasma creatinine for monitoring renal function in critically ill patients

    PubMed Central

    2012-01-01

    Introduction Acute kidney injury (AKI) diagnosis is based on an increase in plasma creatinine, which is a slowly changing surrogate of decreased glomerular filtration rate. We investigated whether serial creatinine clearance, a direct measure of the glomerular filtration rate, provided more timely and accurate information on renal function than serial plasma creatinine in critically ill patients. Methods Serial plasma creatinine and 4-hour creatinine clearance were measured 12-hourly for 24 hours and then daily in 484 patients. AKI was defined either as > 50% increase in plasma creatinine from baseline, or > 33.3% decrease in creatinine clearance. The diagnostic and predictive performance of the two AKI definitions were compared. Results Creatinine clearance decrease diagnosed AKI in 24% of those not diagnosed by plasma creatinine increase on entry. These patients entered the ICU sooner after insult than those diagnosed with AKI by plasma creatinine elevation (P = 0.0041). Mortality and dialysis requirement increased with the change in creatinine clearance-acute kidney injury severity class (P = 0.0021). Amongst patients with plasma creatinine < 1.24 mg/dl on entry, creatinine clearance improved the prediction of AKI considerably (Net Reclassification Improvement 83%, Integrated Discrimination Improvement 0.29). On-entry, creatinine clearance associated with AKI severity and duration (P < 0.0001) predicted dialysis need (area under the curve: 0.75) and death (0.61). A > 33.3% decrease in creatinine clearance over the first 12 hours was associated with a 2.0-fold increased relative risk of dialysis or death. Conclusions Repeated 4-hour creatinine clearance measurements in critically ill patients allow earlier detection of AKI, as well as progression and recovery compared to plasma creatinine. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN012606000032550. PMID:22713519

  3. Chromosomal abnormalities and mental illness

    Microsoft Academic Search

    D J MacIntyre; D H R Blackwood; D J Porteous; B S Pickard; W J Muir

    2003-01-01

    Linkage studies of mental illness have provided suggestive evidence of susceptibility loci over many broad chromosomal regions. Pinpointing causative gene mutations by conventional linkage strategies alone is problematic. The breakpoints of chromosomal abnormalities occurring in patients with mental illness may be more direct pointers to the relevant gene locus. Publications that describe patients where chromosomal abnormalities co-exist with mental illness

  4. What Is Mental Illness: Mental Illness Facts

    MedlinePLUS

    ... 950-NAMI; info@nami.org ©2015 What is Mental Illness: Mental Illness Facts Mental illnesses are medical conditions that disrupt ... illness recovery. Here are some important facts about mental illness and recovery: Mental illnesses are serious medical illnesses. ...

  5. Predictive value of serum bicarbonate, arterial base deficit/excess and SAPS III score in critically ill patients.

    PubMed

    Surbatovic, Maja; Radakovic, Sonja; Jevtic, Miodrag; Filipovic, Nikola; Romic, Predrag; Popovic, Nada; Jevdjic, Jasna; Grujic, Krasimirka; Djordjevic, Dragan

    2009-01-01

    Arterial base deficit/excess (BD/E) is commonly used marker of metabolic acidosis in critically ill patients, but requires an arterial puncture and blood gas analysis. We hypothesized that serum bicarbonate (HCO3), which can be routinely obtained, strongly correlates with arterial BD/E and provides equivalent predictive information. In addition, we evaluated predictive value of simplified acute physiology score III (SAPS III). Total of 152 critically ill surgical patients were included in retrospective analysis. On admission to intensive care unit sets of simultaneously obtained paired laboratory data, including an arterial blood gas and serum chemistry panel with serum HCO3 were obtained. Very strong correlation between BD/E and simultaneously measured serum HCO3 levels was found (r = 0.857, R(2) = 0.732, p < 0.01). The serum HCO3 level reliably identified a significant metabolic acidosis (AUC = 0.761, p < 0.05). BD and SAPS III were good predictors of mortality (AUCs 0.70 and 0.74, respectively). Serum HCO3 may be used as substitute to detect severe metabolic acidosis. BD and SAPS III score were good predictors of mortality. PMID:19893110

  6. Screening for type 2 diabetes mellitus in patients with mental illness: application of a self-assessment score for diabetes mellitus risk.

    PubMed

    Shin, Jinah K; Shortridge-Baggett, Lillie M; Sachmechi, Issac; Barron, Charles; Chiu, Ya-Lin; Bajracharya, Bhavana; Bang, Heejung

    2014-12-30

    Various methods for diabetes risk assessment have been developed over a decade, but they were not evaluated in patients with mental illness. This study examined the feasibility and utility of a self-assessment score for type 2 diabetes mellitus (DM2) risk among patients with mental illness. DM2 risk was assessed by patients with mental illness as well as clinicians via a self-assessment questionnaire, and the resulting scores were compared to each other as well as with actual diagnosis. Of 100 patients, nine patients were newly revealed to have DM2 and 34 patients have pre-DM2. Patients tended to underreport risk factors - obesity and physical activity - so perceived to have lower risk. Sensitivity of the self-assessment score was different when used by patients and by clinicians despite correlation coefficient of 0.82. Based on positive predictive values, we may expect one out of two patients who have high scores actually have DM2 or pre-DM2. Also, the discrimination capability was reasonably high (AUC=0.79), comparable to its performance observed in general populations. The self-assessment score has potential as a simple and adjunct tool to identify a high risk group of DM2/pre-DM2 among persons with mental illness, especially, when used together with health care providers. PMID:25223258

  7. Psychological support based on positive suggestions in the treatment of a critically ill ICU patient – A case report

    PubMed Central

    Varga, Zsófia; Fritúz, Gábor

    2013-01-01

    This case report describes the way psychological support based on positive suggestions (PSBPS) was added to the traditional somatic treatment of an acute pancreatitis 36-year-old male patient. Psychological support based on positive suggestions (PSBPS) is a new adjunct therapeutic tool focused on applying suggestive techniques in medical settings. The suggestive techniques usually applied with critically ill patients are based on a number of pre-prepared scripts like future orientation, reframing, positivity, supporting autonomy, etc., and other, very unique and personalized interventions, which are exemplified with verbatim quotations. We describe the way several problems during treatment of intensive care unit (ICU) patients were solved using suggestive methods: uncooperativeness, difficulties of weaning, building up enteral nutrition, supporting recovery motivation, and so on, which permanently facilitated the patient’s medical state: the elimination of gastrointestinal bleeding, recovery of the skin on the abdomen, etc. Medical effects follow-up data at 10 months show that the patient recovered and soon returned to his original work