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1

Anxiety in Terminally Ill Cancer Patients  

PubMed Central

Context Anxiety in terminal cancer is linked to diminished quality of life, yet overall it is poorly understood with regard to prevalence and relationship to other aspects of psychological distress. Objectives This study examines anxiety in terminally ill cancer patients, including the prevalence of anxiety symptoms, the relationship between anxiety and depression, differences in anxiety between participants receiving inpatient palliative care and those receiving outpatient care, and characteristics that distinguish highly anxious from less anxious patients. Methods Participants were 194 patients with terminal cancer. Approximately half (n = 103) were receiving inpatient care in a palliative care facility and half (n = 91) were receiving outpatient care in a tertiary care cancer center. The Hospital Anxiety and Depression Scale was used to assess anxiety and depression, and was administered along with measures of hopelessness, desire for hastened death, and social support. Results Moderately elevated anxiety symptoms were found in 18.6% of participants (n = 36) and 12.4% (n = 24) had clinically significant anxiety symptoms. Level of anxiety did not differ between the two treatment settings. However, participants receiving palliative care reported significantly higher levels of depression and desire for hastened death. A multivariate prediction model indicated that belief in an afterlife, social support, and anxiolytic and antidepressant use were unique, significant predictors of anxiety. Conclusion Severity of anxiety symptoms did not differ between the study sites, suggesting that anxiety may differ from depression and desire for hastened death in the course that it takes over the duration of terminal cancer. PMID:21565460

Kolva, Elissa; Rosenfeld, Barry; Pessin, Hayley; Breitbart, William; Brescia, Robert

2011-01-01

2

Use of TPN in terminally ill cancer patients  

Microsoft Academic Search

Total parenteral nutrition (TPN) is often used as an adjunct to cancer therapy. However, it is increasingly being used in terminally ill cancer patients without clearly defined reasons. To determine the validity of the use of TPN in terminally ill cancer patients, 26 patients with limited life expectancy due to end-stage cancer were given TPN by their physicians, and the

Giovanni F Torelli; Antonio C Campos; Michael M Meguid

1999-01-01

3

A quality of life subscale for terminally ill cancer patients  

Microsoft Academic Search

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

Anthony James Greisinger

1997-01-01

4

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

ERIC Educational Resources Information Center

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…

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

2011-01-01

5

Concept analysis of good death in terminally ill patients.  

PubMed

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

Granda-Cameron, Clara; Houldin, Arlene

2012-12-01

6

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

E-print Network

, our program provides end-of-life care to nearly 1,000 patients in Rochester and Monroe County each and Palliative Care Organization, to empower hospice professionals to meet the unique needs of dying veteransHospice is a philosophy of care that supports terminally ill patients and their loved ones through

Goldman, Steven A.

7

Islamic views on artificial nutrition and hydration in terminally ill patients.  

PubMed

Withholding and withdrawing artificial nutrition and hydration from terminally ill patients poses many ethical challenges. The literature provides little information about the Islamic beliefs, attitudes, and laws related to these challenges. Artificial nutrition and hydration may be futile and reduce quality of life. They can also harm the terminally ill patient because of complications such as aspiration pneumonia, dyspnea, nausea, diarrhea, and hypervolemia. From the perspective of Islam, rules governing the care of terminally ill patients are derived from the principle that injury and harm should be prevented or avoided. The hastening of death by the withdrawal of food and drink is forbidden, but Islamic law permits the withdrawal of futile, death-delaying treatment, including life support. Nutritional support is considered basic care and not medical treatment, and there is an obligation to provide nutrition and hydration for the dying person unless it shortens life, causes more harm than benefit, or is contrary to an advance directive that is consistent with Islamic law. The decision about withholding or withdrawing artificial nutrition and hydration from the terminally ill Muslim patient is made with informed consent, considering the clinical context of minimizing harm to the patient, with input from the patient, family members, health care providers, and religious scholars. PMID:22845721

Alsolamy, Sami

2014-02-01

8

Randomised controlled trial of effects of coordinating care for terminally ill cancer patients  

Microsoft Academic Search

OBJECTIVES--To measure effects on terminally ill cancer patients and their families of coordinating the services available within the NHS and from local authorities and the voluntary sector. DESIGN--Randomised controlled trial. SETTING--Inner London health district. PATIENTS--Cancer patients were routinely notified from 1987 to 1990. 554 patients expected to survive less than one year entered the trial and were randomly allocated to

J. M. Addington-Hall; L. D. MacDonald; H. R. Anderson; J. Chamberlain; P. Freeling; J. M. Bland; J. Raftery

1992-01-01

9

Rational Suicide Among Patients Who Are Terminally Ill  

Microsoft Academic Search

Patients' end-of-life decisions challenge nurses. Often, aggressive, life-prolonging strategies create ethical dilemmas for nurses when patients decide to stop treatment. In Oregon, assisted suicide is legal and will have a profound effect on nursing practice. When a patient considers suicide, nurses need to examine the patient's mental health, symptom management, and rational decision-making ability. Evaluation of suicide risk is a

Sharon M. Valente; Donna Trainor

1998-01-01

10

A Comparative Study of Terminally Ill Hospice and Hospital Patients.  

ERIC Educational Resources Information Center

Investigated differences between 28 hospice and 28 hospital patients who died. Comparison found that hospice patients were younger, had more people living in the home, and had shorter disease history. Age, number of people living in the home, and primary cancer site significantly discriminated between hospice and hospital patients and predicted…

Labus, Janet G.; Dambrot, Faye H.

1986-01-01

11

Attitudes of Terminally Ill Patients toward Death and Dying in Nigeria  

ERIC Educational Resources Information Center

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.…

Olokor, Christiana O.

2011-01-01

12

Differences between Terminally Ill Patients Who Know, and Those Who Do Not Know, That They are Dying.  

ERIC Educational Resources Information Center

Interview results indicated terminally ill patients with knowledge produced significantly longer transcripts than others. Groups did not differ significantly on state or trait anxiety scales. There were significant associations involving age, anxiety, and the dependent variables of the content analysis, especially among terminally ill patients

Still, Arthur; Todd, Chris

1986-01-01

13

On withholding artificial hydration and nutrition from terminally ill sedated patients. The debate continues.  

PubMed Central

The author reviews and continues the debate initiated by her recent paper in this journal. The paper was critical of certain aspects of palliative medicine, and caused Ashby and Stoffell to modify the framework they proposed in 1991. It now takes account of the need for artificial hydration to satisfy thirst, or other symptoms due to lack of fluid intake in the terminally ill. There is also a more positive attitude to the emotional needs and ethical views of the patient's family and care-givers. However, clinical concerns about the general reluctance to use artificial hydration in terminal care remain, and doubts persist about the ethical and legal arguments used by some palliative medicine specialists and others, to justify their approach. Published contributions to the debate to date, in professional journals, are reviewed. Key statements relating to the care of sedated terminally ill patients are discussed, and where necessary criticised. PMID:8798936

Craig, G M

1996-01-01

14

Open Communication Between Caregivers and Terminally Ill Cancer Patients: The Role of Caregivers' Characteristics and Situational Variables  

Microsoft Academic Search

This study assesses caregivers' perceived level of open communication about illness and death with their terminally ill relatives and examines the contribution of caregivers' characteristics and situational variables to the explanation of open communication. A total of 236 primary caregivers of terminal cancer patients participated in the study. Level of open communication was measured by 6 items clustered into 1

Yaacov G. Bachner; Sara Carmel

2009-01-01

15

Psychometric properties of the Death Anxiety Scale (DAS) among terminally ill cancer patients.  

PubMed

Research conducted with the terminally ill population in relation to death anxiety is rare and mostly outdated. The purpose of this study was to evaluate the psychometric properties of the widely used Death Anxiety Scale (DAS) on a sample of terminal cancer patients.Additionally, validation studies of the DAS have exclusively used traditional statistical methods for analysis. The current study utilized an item response theory technique (IRT), namely the Rasch Rating Scale model for data analysis. The methodology employed may be useful for other researchers conducting validation studies from an IRT perspective. PMID:21966722

Royal, Kenneth D; Elahi, Fereshte

2011-01-01

16

Stress levels of volunteer personnel working with terminally or critically ill patients in hospice, hospital, or nursing home settings  

E-print Network

with them. Some of the stressors reported by nurses working with terminally ill patients in hospitals are death of the patient (8arstow, 1980; Friel and Tehan, 1980; Gray-Toft, I980; Vachon, 1979), especially that of "younger persons. . . because... "good" death, time spent travelling as opposed to doing constructive work and exclusively working with terminally ill patients (Barstow, 1980; Fr)el and Tehan, 1980). In considering the preceding evidence hospice nurses would appear to be prime...

Aiken, Cheryl Lynn

2012-06-07

17

Factors associated with the wish to hasten death: a study of patients with terminal illness  

Microsoft Academic Search

Background. There is considerable debate regarding the clinical issues surrounding the wish to hasten death (WTHD) in the terminally ill. The clinical factors contributing to the WTHD need further investigation among the terminally ill in order to enhance understanding of the clinical assessment and treatment needs that underlie this problem. A more detailed understanding may assist with the development of

B. KELLY; P. BURNETT; D. PELUSI; S. BADGER; F. VARGHESE; M. ROBERTSON

2003-01-01

18

Reciprocal empathy and working alliance in terminal oncological illness: the crucial role of patients' attachment style.  

PubMed

Security of attachment is described as an inner resource that may also facilitate the adaptation of individuals during critical life adversity, even when facing end-stage illness and death. This study assessed the relation between attachment styles, patient-caregiver reciprocal empathy, and patient-physician working alliance, in the terminal phase of an oncological disease. We hypothesized that the attachment security of patients, as measured by the Relationship Questionnaire (RQ), is related to the reciprocal empathy with the caregiver, as measured by the Perception of Partner Empathy (PPE) questionnaire, and to the working alliance with the physician, as measured by the Working Alliance Inventory-Short Form (WAI-S). Thirty-seven end-stage cancer patients, their caregivers, and physicians participated in the study. The PPE and WAI-S were administered twice: immediately after the hospice recovery and a week later. Results showed a significant improvement in patient-caregiver empathy and in patient-physician alliance after a week at the hospice. Findings indicated that the patients' attachment style influenced their perception of reciprocal empathy with the caregiver and the working alliance with the physician. Patients with a secure attachment had a greater capacity to show empathic closeness with their caregivers and enjoyed a better working alliance with their physicians. Caregivers' attachment security, otherwise, did not show the same influence on empathy and alliance. Findings support the hypothesis that patients' attachment security plays a crucial role in the relation with their own caregiver and with the physician, even at the terminal phase. Theoretical and clinical implications of these findings are explored in the discussion. PMID:24988462

Calvo, Vincenzo; Palmieri, Arianna; Marinelli, Sara; Bianco, Francesca; Kleinbub, Johann R

2014-01-01

19

Aggravation of fatigue by steroid therapy in terminally ill patients with cancer.  

PubMed

Steroids are commonly used for fatigue relief in terminally ill cancer patients. However, steroid-induced adverse effects including depression, myopathy, and hyperglycemia may contribute to fatigue. We report our experiences with aggravation of fatigue with steroid use in three cases. Case 1 was a 65-year-old man with advanced gastric cancer. He was started on betamethasone (2 mg/d) for fatigue, but the fatigue worsened due to steroid-induced depression. Discontinuation of steroids and initiation of an antidepressant ameliorated the fatigue. Case 2 was a 68-year-old man with advanced lung cancer. He complained of fatigue. Betamethasone (1 mg/d) was started and alleviated the fatigue. However, when the betamethasone dose was increased to 2 mg/d, the fatigue, with muscle weakness and myalgia, worsened due to steroid-induced myopathy. We therefore switched from betamethasone (2 mg/d) to prednisolone (10 mg /d). The fatigue resolved and the patient returned to his previous condition. Case 3 was a 73-year-old man with recurrent bile duct cancer. He also had diabetes mellitus. He developed fatigue, anorexia and fever. We started betamethasone (1.5 mg/d) for these symptoms, but the fatigue and anorexia worsened due to steroid-induced hyperglycemia. Blood glucose rose to 532 mg/dL. Therefore, insulin therapy was started, and the dose of betamethasone was reduced to 0.5 mg/d. His glucose level decreased to less than 320 mg/dL and he recovered from the fatigue while achieving moderate oral intake. In conclusion, the possibility of steroid-induced secondary fatigue in terminally ill cancer patients should be taken into consideration. PMID:23588576

Matsuo, Naoki; Yomiya, Kinomi

2014-05-01

20

Preparing family caregivers for death and bereavement. Insights from caregivers of terminally ill patients.  

PubMed

Many family caregivers are unprepared for the death of their loved one and may suffer from worse mental health as a result. We therefore sought to determine the factors that family caregivers believe are important to preparing for death and bereavement. Focus groups and ethnographic interviews were conducted with 33 family caregivers (bereaved or current) of terminally ill patients. The interviews were audiotaped, transcribed, and analyzed using the constant comparative method. Life experiences such as the duration of caregiving/illness, advance care planning, previous experiences with caregiving or death, and medical sophistication all impacted preparedness, or the degree to which a caregiver is ready for the death and bereavement. Regardless of life experiences, however, all caregivers reported medical, practical, psychosocial, and religious/spiritual uncertainty. Because uncertainty was multidimensional, caregivers often needed more than prognostic information in order to prepare. Communication was the primary mechanism used to manage uncertainty. Good communication included clear, reliable information, combined with relationship-centered care from health care providers. Finally, preparedness had cognitive, affective, and behavioral dimensions. To prepare, some caregivers needed information tailored to their uncertainty (cognitive), others needed to "mentally" or "emotionally" prepare (affective), and still others had important tasks to complete (behavioral). In order to better prepare family caregivers for the death of a loved one, health care providers must develop a trusting relationship with caregivers, provide them with reliable information tailored to their uncertainty, and allow time for caregivers to process the information and complete important tasks. PMID:18538977

Hebert, Randy S; Schulz, Richard; Copeland, Valire C; Arnold, Robert M

2009-01-01

21

Abandonment of terminally ill patients in the Byzantine era. An ancient tradition?  

PubMed

Our research on the texts of the Byzantine historians and chroniclers revealed an apparently curious phenomenon, namely, the abandonment of terminally ill emperors by their physicians when the latter realised that they could not offer any further treatment. This attitude tallies with the mentality of the ancient Greek physicians, who even in Hippocratic times thought the treatment and care of the terminally ill to be a challenge to nature and hubris to the gods. Nevertheless, it is a very curious attitude in the light of the concepts of the Christian Byzantine physicians who, according to the doctrines of the Christian religion, should have been imbued with the spirit of philanthropy and love for their fellowmen. The meticulous analysis of three examples of abandonment of Byzantine emperors, and especially that of Alexius I Comnenus, by their physicians reveals that this custom, following ancient pagan ethics, in those times took on a ritualised form without any significant or real content. PMID:10390682

Lascaratos, J; Poulakou-Rebelakou, E; Marketos, S

1999-06-01

22

Abandonment of terminally ill patients in the Byzantine era. An ancient tradition?  

PubMed Central

Our research on the texts of the Byzantine historians and chroniclers revealed an apparently curious phenomenon, namely, the abandonment of terminally ill emperors by their physicians when the latter realised that they could not offer any further treatment. This attitude tallies with the mentality of the ancient Greek physicians, who even in Hippocratic times thought the treatment and care of the terminally ill to be a challenge to nature and hubris to the gods. Nevertheless, it is a very curious attitude in the light of the concepts of the Christian Byzantine physicians who, according to the doctrines of the Christian religion, should have been imbued with the spirit of philanthropy and love for their fellowmen. The meticulous analysis of three examples of abandonment of Byzantine emperors, and especially that of Alexius I Comnenus, by their physicians reveals that this custom, following ancient pagan ethics, in those times took on a ritualised form without any significant or real content. PMID:10390682

Lascaratos, J; Poulakou-Rebelakou, E; Marketos, S

1999-01-01

23

Coping with Loneliness among the Terminally Ill  

ERIC Educational Resources Information Center

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…

Rokach, Ami

2007-01-01

24

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

PubMed

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

Gerson, S N

1994-01-01

25

Teaching the Terminally Ill Child.  

ERIC Educational Resources Information Center

Classroom teachers of terminally ill children face potentially difficult, challenging, rewarding and professionally expanding experiences which require an understanding of the basic needs of the dying. Strategies for teaching such children include literature, writing, role playing, magic circle discussions, play therapy, art therapy, counseling,…

Ainsa, Trisha

1981-01-01

26

Death Education and Attitudes toward Euthanasia and Terminal Illness.  

ERIC Educational Resources Information Center

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…

Nagi, Mostafa H.; Lazerine, Neil G.

1982-01-01

27

Beethoven's terminal illness and death.  

PubMed

There is dispute about the cause of Beethoven's death; alcoholic cirrhosis, syphilis, infectious hepatitis, lead poisoning, sarcoidosis and Whipple's disease have all been proposed. In this article all primary source documents related to Beethoven's terminal illness and death are reviewed. The documents include his letters, the report of his physician Andreas Wawruch, his Conversation Books, the autopsy report, and a new toxicological report of his hair. His terminal illness was characterised by jaundice, ascites, ankle oedema and abdominal pain. The autopsy data indicate that Beethoven had cirrhosis of the liver, and probably also renal papillary necrosis, pancreatitis and possibly diabetes mellitus. His lifestyle for at least the final decade of his life indicated that he overindulged in alcohol in the form of wine. Alcohol was by far the most common cause of cirrhosis at that period. Toxicological analysis of his hair showed that the level of lead was elevated. During the eighteenth and early nineteenth centuries, lead was added illegally to inexpensive wines to sweeten and refresh them. These findings strongly suggest that liver failure secondary to alcoholic cirrhosis, associated with terminal spontaneous bacterial peritonitis, was the cause of death. This was complicated in the end stages by renal failure. If the presence of endogenous lead was verified by analysis of Beethoven's skeletal remains, it would suggest that the lead was derived from wine that he drank. Lead poisoning may account for some of his end-of-life symptoms. There is little clinical or autopsy evidence that Beethoven suffered from syphilis. PMID:17214130

Mai, F M M

2006-10-01

28

Confronting death: Group psychotherapy with terminally ill individuals  

Microsoft Academic Search

A model for group psychotherapy with terminally ill patients is proposed, one in which the group is homogeneous and open-ended. Cancer and HIV infection are used as examples of chronic, terminal illnesses, and the relevant literature on group psychotherapy with these conditions is reviewed. Treatment with both sets of patients has been characterized by considerable variation in the structure, composition,

Burton A. Presberg; Howard D. Kibel

1994-01-01

29

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

PubMed Central

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

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

2011-01-01

30

Timing of referral of terminally Ill patients to an outpatient hospice  

Microsoft Academic Search

Objective: Since inordinately long or short lengths of stay at hospice can create problems for patients, providers, and payers, the\\u000a author sought to identify predictors of timing of patient referral.\\u000a \\u000a \\u000a Methods: A retrospective cohort of 405 hospice outpatients was analyzed with Cox regression to evaluate the effect on length of stay\\u000a of patient age, gender, race, diagnosis, activity level, mental

Nicholas A. Christakis

1994-01-01

31

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

Microsoft Academic Search

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.

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

32

Palliative sedation to relieve psycho-existential suffering of terminally ill cancer patients  

Microsoft Academic Search

To clarify the prevalence and the characteristics of patients who received palliative sedation therapy for psycho-existential suffering, a questionnaire was sent to 105 responsible physicians at all certified palliative care units in Japan. The participants were requested to report the number of patients who received continuous deep sedation for refractory psycho-existential suffering during the past year, and to provide details

Tatsuya Morita

2004-01-01

33

Case Analyses of Terminally Ill Cancer Patients Who Refused to Sign a Living Will.  

ERIC Educational Resources Information Center

Notes that, in survey of 50 cancer patients offered living wills, 6 individuals declined to sign advance directives. Contains detailed evaluation of each of six cases. Discusses potential value of living wills in context of other, newer forms of advance directives, such as durable power of attorney for health care, and more detailed living will…

Stephens, Ronald L.; Grady, Rosemary

1992-01-01

34

Nurse views of the adequacy of decision making and nurse distress regarding artificial hydration for terminally ill cancer patients: a nationwide survey.  

PubMed

We evaluated nurse views on the adequacy of decision-making discussion among nurses and physicians regarding artificial hydration for terminally ill cancer patients and nurse distress arising from artificial hydration issues, as well as factors related to this distress. A self-administered questionnaire consisting of 4 questions about nurse views of discussions regarding artificial hydration and 6 questions about nurse distress arising from artificial hydration issues was distributed in participating institutions in October 2002 and returned by mail. A total of 3328 responses (79%) were analyzed. Almost half of the nurses felt that discussion of terminal hydration issues was insufficient. Among responses, 39% of oncology nurses and 78% of palliative care unit (PCU) nurses agreed that patients and medical practitioners discuss the issue of artificial hydration adequately, and 49% and 79%, respectively, agreed that medical practitioners discuss the issue of artificial hydration with other physicians adequately. As for distress on behalf of patients and families who refuse artificial hydration, 44% of oncology nurses and 57% of PCU nurses experienced such distress for patients, and 19% and 28% did so for families, respectively. Furthermore, 48% of oncology nurses and 47% of PCU nurses experienced distress arising from disagreements among medical practitioners about withholding artificial hydration, whereas 44% and 43% experienced distress about medical practitioners refusing artificial hydration, respectively. Discussion among care providers regarding artificial hydration is insufficient, particularly in general wards. Medical practitioners caring for terminally ill cancer patients should engage in greater discussion among patient-centered teams and facilitate individualized decision making. PMID:17601838

Miyashita, Mitsunori; Morita, Tatsuya; Shima, Yasuo; Kimura, Rieko; Takahashi, Mikako; Adachi, Isamu

35

42 CFR 418.22 - Certification of terminal illness.  

Code of Federal Regulations, 2010 CFR

42 Public Health 3 2010-10-01...Certification of terminal illness. 418.22 Section 418.22 Public Health CENTERS FOR MEDICARE...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...Certification of terminal illness. (a) Timing...

2010-10-01

36

Spirituality, Religion, and Depression in the Terminally Ill  

Microsoft Academic Search

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

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

2002-01-01

37

Bishops' response to Act on Rights of Terminally Ill.  

PubMed

In August 1985 the National Conference of Commissioners on Uniform State Laws drafted a document entitled The Uniform Rights of the Terminally Ill Act, which it recommended for enactment by all U.S. states. The act attempts to set uniform, clear guidelines for advance directives, or living wills--written declarations made by a patient that are used to guide treatment decisions should the patient become incompetent and terminally ill. The act limits the scope of an advance directive to the withdrawal or withholding of "life-sustaining treatment," which is "any medical procedure or intervention that when administered to a qualified patient will serve only to prolong the process of dying." Qualified patients are those with a terminal condition, which is "an incurable or irreversible condition that without the administration of life-sustaining treatment will, in the opinion of the attending physician, result in death within a relatively short time." The National Conference of Catholic Bishops (NCCB) Committee for Pro-Life Activities responded to the act in July 1986. The NCCB wishes to narrow the act's scope to apply only to patients in the "final stage of a terminal condition." Other specific concerns are the withdrawal of artificial nutrition and hydration, the need for communication with the family in making decisions, and the protection of an unborn child's life when the mother fulfills the conditions of the act and her living will stipulates a desire for withdrawal of life-sustaining treatment.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:10280352

Brodeur, D

1987-01-01

38

Impact of triiodothyronine and N-terminal pro-B-type natriuretic peptide on the long-term survival of critically ill patients with acute heart failure.  

PubMed

We assessed the prognostic implications of low triiodothyronine (T3) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in critically ill patients with acute heart failure. We acquired data for 144 critical care patients with acute decompensated heart failure, of which 106 were included in this study. Plasma thyroid hormones and NT-proBNP levels were determined within 48 hours of admission. We assessed these measures for predicting all-cause and cardiac mortalities. At a mean follow-up period of 25 ± 31 months, the all-cause mortality rate was 51% (54 of 106) and the cardiac mortality rate was 70% (38 of 54). A multivariate Cox regression model showed that log-transformed NT-proBNP levels (log NT-proBNP; hazard ratio [HR] 2.90, 95% confidence interval [CI] 1.38 to 6.08, p = 0.005) and T3 levels (HR 0.98, 95% CI 0.96 to 0.99, p = 0.008) were associated with all-cause mortality, and log NT-proBNP (HR 3.70, 95% CI 1.28 to 10.71, p = 0.02) and T3 (HR 0.98, 95% CI 0.96 to 0.99, p = 0.01) were associated with cardiac mortality. Based on cut-off values for NT-proBNP (10,685 pg/ml) and T3 (52.3 ng/dl), Kaplan-Meier analyses provided significant prognostic information with the highest risk for all-cause mortality in the low T3 (?52.3 ng/dl)/high NT-proBNP (>10,685 pg/ml) group (HR 8.54, 95% CI 4.19 to 17.40, p <0.0001). In conclusion, T3 levels appear to be independent predictors for both all-cause and cardiac mortalities among critical ill patients with heart failure, and high NT-proBNP and low T3 levels predict a worse long-term outcome. PMID:24406111

Chuang, Chun-Pin; Jong, Yuh-Shiun; Wu, Chang-Yu; Lo, Huey-Ming

2014-03-01

39

Chronic Illness and Patient Satisfaction  

PubMed Central

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

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

2012-01-01

40

Antibiotics Often Prescribed Needlessly for Terminally Ill, Study Finds  

MedlinePLUS

... sharing features on this page, please enable JavaScript. Antibiotics Often Prescribed Needlessly for Terminally Ill, Study Finds ... Preidt Wednesday, July 16, 2014 Related MedlinePlus Pages Antibiotics Hospice Care WEDNESDAY, July 16, 2014 (HealthDay News) -- ...

41

Critically Ill Cancer Patients: Indications  

E-print Network

Critically Ill Cancer Patients: Indications for Concurrent Palliative Care Although significant in the need for supportive services such as palliative care concomitantly with life-prolonging treatments), the approach of palliative care is to promote quality of life for patients and their families during life

von der Heydt, Rüdiger

42

General practitioners' strategies and tactics of communication with the terminally ill.  

PubMed

Interviews with 22 randomly selected general practitioners (GPs) investigated their communication with terminally ill patients. In interview analysis a conceptual distinction was drawn between objectives, strategies and tactics. When treating terminal patients, GPs expressed the objectives of keeping the patient comfortable, painfree, happy and maintaining dignity. A strategy is a plan and mode of approaching patients existing over an extended time period. Three strategies were described by GPs for use when interacting with terminally ill patients. These are characterized as 'try to disclose', 'let the patient decide' and 'avoid disclosing'. Tactics refer to behaviours used within a single consultation, as part of a strategy. Six tactics are described: evasion, denial, uncertainty, hints and prompts, euphemism and reassurance. Different strategies imply quite different forms of consultation. Thus to understand a consultation we must place it into the context of the series. PMID:7506681

Todd, C; Still, A

1993-09-01

43

The effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial  

PubMed Central

Objectives Dignity Therapy is a unique, individualized, brief psychotherapy, developed for patients (and their families) living with life threatening or life limiting illness. The purpose of this study was to determine if Dignity Therapy could mitigate distress and/or bolster end-of-life experience for patients nearing death. Trial Design Multi-site randomized controlled trial, with patients assigned to Dignity Therapy, Client Centred Care or Standard Palliative Care. Study arm assignment was based on a computer-generated table of random numbers. Blinding was achieved using opaque sealed envelopes, containing allocations that were only opened once consent had been obtained. Participants Patients receiving hospital or community (hospice or home) based palliative care, in Winnipeg, New York, or Perth, randomly assigned to, Dignity Therapy [n=108], Client Centered Care [n=107] and Standard Palliative Care (n=111). Main Outcome Measures The primary outcome measures included the FACIT Spiritual Well-Being Scale, the Patient Dignity Inventory, the Hospital Anxiety and Depression Scale; items from the Structured Interview for Symptoms and Concerns, the Quality of Life Scale and a modified Edmonton Symptom Assessment Scale. Mean changes between baseline and end of intervention ratings were determined. Secondary outcomes, examining self-report end-of-life experience, consisted of a post-study survey administered across all study arms. Intervention Dignity Therapy, a novel, brief psychotherapy, provides patients with life threatening and life limiting illnesses an opportunity to speak about things that matter most to them. These recorded conversations form the basis of a generativity document, which patients can bequeath to individuals of their choosing. Client Centred Care is a supportive psychotherapeutic approach, in which research nurse/therapists guide patients through discussions focusing on here and now issues. Findings No significant differences across study arms, between the primary study outcome measures of pre and post distress, were found. However, on the secondary outcomes, comprised of the post study survey, patients reported that Dignity Therapy was significantly more likely to be experienced as helpful (?2=35.501; p<0.001), improve quality of life (?2 =14.520; p<0.001), sense of dignity (?2 =12.655; p=0.002); change how their family sees and appreciates them (?2 =33.811; p<0.001) and be helpful to their family (?2=33.864; p<0.001). Interpretation Despite the beneficial effects of Dignity Therapy, its ability to mitigate outright distress, such as depression, desire for death or suicidality, has yet to be proven. However, there is currently ample evidence supporting its clinical application for patients nearing death, as a means of enhancing their end-of-life experience. PMID:21741309

Chochinov, Harvey Max; Kristjanson, Linda J.; Breitbart, William; McClement, Susan; Hack, Thomas F; Hassard, Tom; Harlos, Mike

2011-01-01

44

Experience with a Hospice-care Program for the Terminally Ill  

PubMed Central

A hospice-care program offers an opportunity to provide effective palliative care for patients terminally ill with malignant disease and to develop improved methods for coping with the problems of the dying patient. All patients for whom antitumor therapy does not offer a reasonable possibility of cure are eligible for Church Hospital's multidisciplinary program, the focus of which is on both the patient and his family. Acceptance by medical staff, patients and families has been enthusiastic. Both conventional and unconventional methods can be helpful in making terminally ill patients more comfortable. Much has been learned about the control of pain in such patients. Intestinal obstruction can often be managed non-operatively without the use of nasogastric tube. Other common symptoms such as weakness, anorexia, depression, dyspnea, etc. can be relieved with varying degrees of success. An objective of the program is to allow the patient to be at home for most of his terminal illness and to die there if possible. By utilizing patient and family instruction, visiting nurses and home health aides, approximately two-thirds of the patients in the program at any given time are at home. Basing the program in an acute care hospital has allowed coordination with the curative treatment of malignant disease and effective use of radiation and chemotherapy for palliative purposes. The organizational structure, financing, facilities and clinical experience with 100 consecutive patients of the Church Hospital hospice-care program are described. PMID:88209

Zimmerman, J. M.

1979-01-01

45

Nurses' Identification of Important yet Under-Utilized End-of-Life Care Skills for Patients with Life-Limiting or Terminal Illnesses  

PubMed Central

Abstract Rationale This study was designed to identify nurses' perspectives on nursing skills that are important yet under-utilized in end-of-life care. Methods A 45-item survey was administered to nurses (n?=?717) in four U.S. states with a response rate of 79%. We identified skills that were endorsed by more than 60% of nurses as extremely important and also endorsed as not currently practiced by more than 25% of nurses. We used Chi square statistics to examine professional characteristics associated with ratings of end-of-life care skills including practice settings, years of experience, and end-of-life care education. Content analysis was used to examine nurses' responses to open-ended questions. Results Nineteen items were endorsed as extremely important and also ranked as under-utilized. These end-of-life care skills included communication skills, symptom management competencies especially those concerning anxiety and depression, and issues related to patient-centered care systems. Four complementary themes emerged from qualitative analysis of nurses' comments, which supported the quantitative findings. Conclusions This study provides a summary of skills nurses feel are important and under-utilized in their care of patients with life-limiting illnesses. The findings support the need to target both nursing education and healthcare system interventions to improve the use of practical end-of-life care skills by nurses with a focus on communication and symptom management skills. PMID:20597709

Shannon, Sarah E.; Engelberg, Ruth; Dotolo, Danae; Silvestri, Gerard A.; Curtis, J. Randall

2010-01-01

46

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

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…

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

47

Creating the final conversations scale: a measure of end-of-life relational communication with terminally ill individuals.  

PubMed

Final conversations (FCs) are defined as the communicative interactions, both verbal and nonverbal, that occur between terminally ill patients and relational partners. In this study, the "Final Conversations Scale" was developed and tested. A total of 152 participants that had engaged in final conversations with individuals that were terminally ill completed the newly developed instrument. Factor analysis produced a five-factor structure, including: messages of spirituality/religion; expressions of love; proactive difficult relationship talk; everyday communication; and talk about illness/death. Participants' perceptions of the relational closeness and difficulty with the deceased significantly influenced the individuals' recalled frequency of FCs messages. Practical and scholarly implications focus on the needs of the family members regarding their communication with terminally ill individuals, as well as directions for future research with the FCs Scale. PMID:25148453

Generous, Mark Alan; Keeley, Maureen P

2014-01-01

48

Finding Boundaries Inside Prison Walls: Case Study of a Terminally Ill Inmate  

ERIC Educational Resources Information Center

The number of terminally ill prison inmates rises each year. Mental health professionals are uniquely prepared to provide therapy during the end-of-life process with their assessment, training, empathy, and communication skills. This case study examines the six-month therapy of one terminally ill inmate, using a client-centered approach. Drawing…

O'Connor, Mary-Frances

2004-01-01

49

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

ERIC Educational Resources Information Center

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,…

Waldrop, Deborah P.

2007-01-01

50

Preparation for Counseling Adults with Terminal Illness: Personal and Professional Parallels  

ERIC Educational Resources Information Center

This article presents a review of the literature on counseling adults with terminal illness, particularly the literature on the nature of preparation that counselors and other professionals who attend to the needs of adults with a terminal illness require. The authors review information and findings from philosophical, psychological, practical,…

Manis, Amie A.; Bodenhorn, Nancy

2006-01-01

51

End-of-Life Decision Making: A Preliminary Outline for Preparing Counselors to Work with Terminally Ill Individuals  

ERIC Educational Resources Information Center

End-of-life care is continuously becoming an issue of paramount importance given an increase in medical advances, the aging of the population, and the movement toward contributing toward a quality of life among terminally ill patients. However, there is a dearth in literature related to this topic specifically in terms of preparing counselors to…

Duba, Jill D.; Magenta, Mary

2008-01-01

52

Perceived illness intrusion among patients on hemodialysis.  

PubMed

Dialysis therapy is extremely stressful as it interferes with all spheres of daily activities of the patients. This study is aimed at understanding the perceived illness intrusion among pa-tients on hemodialysis (HD) and to find the association between illness intrusion and patient demographics as well as duration of dialysis. A cross sectional study involving 90 patients with chronic kidney disease (CKD) stage V, on HD was performed during the period from 2005 to 2006. The subjects included were above 18 years of age, willing, stable and on dialysis for at least two months. Patients with psychiatric co-morbidity were excluded. A semi-structured interview schedule covering socio-demographics and a 13 item illness intrusion checklist covering the various aspects of life was carried out. The study patients were asked to rate the illness intrusion and the extent. The data were analyzed statistically. The mean age of the subjects was 50.28 +/- 13.69 years, males were predominant (85%), 73% were married, 50% belonged to Hindu religion, 25% had pre-degree education, 25% were employed and 22% were housewives. About 40% and 38% of the study patients belonged to middle and upper socio-economic strata respectively; 86% had urban background and lived in nuclear families. The mean duration on dialysis was 24 +/- 29.6 months. All the subjects reported illness intrusion to a lesser or greater extent in various areas including: health (44%), work (70%) finance (55%), diet (50%) sexual life (38%) and psychological status (25%). Illness had not intruded in areas of relationship with spouse (67%), friends (76%), family (79%), social (40%) and religious functions (72%). Statistically significant association was noted between illness intrusion and occupation (P= 0.02). PMID:19414939

Bapat, Usha; Kedlaya, Prashanth G

2009-05-01

53

Delirium management in critically ill patients  

PubMed Central

Delirium among critically ill patients is common. Presence of delirium imparts a poorer prognosis to patients, including longer ICU and hospital length of stay, increased risk of institutionalization, higher health related costs, and elevated mortality. Even with such grave consequences, the rates of delirium diagnosis are dire. The importance of early recognition through validated tools and appropriate management of this life-threatening condition cannot be over emphasized. This article provides an overview of delirium pathophysiology, diagnosis, and management with a focus on critically ill patients. PMID:25383387

Calvo-Ayala, Enrique; Khan, Babar

2013-01-01

54

Adrenal Insufficiency in Critically Ill Patients  

Microsoft Academic Search

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

YORAM SHENKER; JAMES B. SKATRUD

55

Insulin therapy in critically ill patients  

PubMed Central

Hyperglycemia frequently occurs with acute medical illness, especially among patients with cardiovascular disease, and has been linked to increased morbidity and mortality in critically ill patients. Even patients who are normoglycemic can develop hyperglycemia in response to acute metabolic stress. An expanding body of literature describes the benefits of normalizing hyperglycemia with insulin therapy in hospitalized patients. As a result, both the American Diabetes Association and the American College of Endocrinology have developed guidelines for optimal control of hyperglycemia, specifically targeting critically ill, hospitalized patients. Conventional blood glucose values of 140–180 mg/dL are considered desirable and safely achievable in most patients. More aggressive control to <110 mg/dL remains controversial, but has shown benefits in certain patients, such as those in surgical intensive care. Intravenous infusion is often used for initial insulin administration, which can then be transitioned to subcutaneous insulin therapy in those patients who require continued insulin maintenance. This article reviews the data establishing the link between hyperglycemia and its risks of morbidity and mortality, and describes strategies that have proven effective in maintaining glycemic control in high-risk hospitalized patients. PMID:21191429

Ellahham, Samer

2010-01-01

56

Patients’ perception of their depressive illness  

Microsoft Academic Search

Perception of illness has been described as an important predictor in the medical health psychology literature, but has been given little attention in the domain of mental disorders. The patient's Perception of Depression Questionnaire (PDIQ) is a newly developed measure whose factor structure and psychometric properties were evaluated on a sample of 174 outpatients meeting criteria for major depressive disorder.

Rachel Manber; Andrea S Chambers; Sabrina K Hitt; Cynthia McGahuey; Pedro Delgado; John J. B Allen

2003-01-01

57

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

PubMed

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

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

2014-02-01

58

A psychological profile of middle-age cancer patients' terminal experience in hospice home care  

Microsoft Academic Search

Cancer patients facing terminal illness have the most complex psychological and reluctant feeling, especially for middle age adults. This paper aims at exploring the middle-age cancer patients' terminal experience from the psychological profile in hospice home care. The research adopted the purposive sampling method and collected data though participatory observation and in-depth interviews. The data were analyzed by the phenomenology

H T Lee; W Y Wu; S C Hu

2011-01-01

59

Termination and Verification for Ill-Posed Semidefinite Programming ...  

E-print Network

Jun 17, 2005 ... error bounds for the true optimal value, where all rounding errors due to floating ... relates violations of primal and dual feasibility to intrinsic properties of the optimization ... code of semidefinite solvers for the purpose of termination. ... using MATLAB [16], the interval toolbox INTLAB [30], and the semidefinite ...

2005-06-17

60

Job termination among individuals with severe mental illness participating in a supported employment program.  

PubMed

This study, which explored job terminations among 60 individuals with severe mental illness participating in a supported employment program in Hong Kong, used the Chinese Job Termination Interview that was validated and translated from the Job Termination Interview (JTI; Becker, Drake, Bond et al., 1988). More than half of the job terminations (53%) were unsatisfactory which included dissatisfaction with job (44%) and lack of interest (22%). Modification of work schedules and provision of adequate supervision and coaching at the workplace were identified as necessary job accommodations. Similarities and differences of findings were compared with overseas studies. Possible improvement of current supported employment program was discussed. PMID:17040175

Mak, Donald C S; Tsang, Hector W H; Cheung, Leo C C

2006-01-01

61

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

PubMed Central

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

Hardy, Susan E.

2009-01-01

62

Cytomegalovirus infection in critically ill patients: a systematic review  

Microsoft Academic Search

ABSTRACT: 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

Ryosuke Osawa; Nina Singh

2009-01-01

63

Optimizing antimicrobial therapy in critically ill patients  

PubMed Central

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

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

2014-01-01

64

Lingering terminal illness and family: insights from literature.  

PubMed

Literature invites us to enter into the human dilemma in a manner that is different from but no less penetrating than clinical observation. The writer's craft uncovers realities other than the statistically measurable and objective. In languages far from the strictly literal and closer to indirection, symbolism, and aesthetics, the literary artist probes imagination and consciousness. He presents us with transcripts of conversations replete with intonations, and we thereby become privy to motivations and inner thoughts. The artistry of a piece of fiction, autobiographical essay, poem, or drama propels us into empathetic relationships. We feel with the emotions of the involved dramatis personae; we witness their interactions; we experience their points of view. And by such participation, we, the readers, come to perceive and even refine our own. Themes of chronic illness, dying, and bereavement are certainly not alien to literature. This paper explores several literary moments that may help the professional who is working with these issues to have a broader appreciation of the subtleties of these human experiences. PMID:7274401

Bertman, S L

1980-12-01

65

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

ERIC Educational Resources Information Center

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).

Kurt, Layla J.; Piazza, Nick J.

2012-01-01

66

A Developmentally Sensitive Approach to Clinical Hypnosis for Chronically and Terminally Ill Adolescents  

Microsoft Academic Search

Adolescents who suffer from terminal and\\/or chronic medical illnesses must face difficult developmental issues coupled with increased burdens of physical discomfort and uncertainty about survival. Clinical hypnosis is one technique that can be used to help these individuals gain a sense of comfort and control over their lives. I describe the use of a developmentally sensitive hypnotherapeutic intervention for chronically

Gary W. Harper

1999-01-01

67

Storytelling by Adults Diagnosed with Terminal Illness: Narrative Identifying through Dialogical Research  

ERIC Educational Resources Information Center

The purpose of this dialogical qualitative research study was to gain insight into the process of storytelling with adults diagnosed with terminal illness as a way of making meaning of their experiences and lives. The study was informed by the conceptual frameworks of story, storytelling, and story listening which are grounded in the theory of…

Sauer, Michael Paul

2012-01-01

68

Intentions to Work During Terminal Illness: An Exploratory Study of Antecedent Conditions  

Microsoft Academic Search

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

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

2005-01-01

69

Peace, Equanimity, and Acceptance in the Cancer Experience (PEACE): Validation of a scale to assess acceptance and struggle with terminal illness  

PubMed Central

Objectives The role of emotional acceptance of a terminal illness in end-of-life (EOL) care is not known. We developed a measure of peaceful acceptance at the EOL, and evaluated the role of peaceful acceptance in EOL decision-making and care. Methods We developed the Peace, Equanimity, and Acceptance in the Cancer Experience (PEACE) questionnaire to measure the extent to which patients with advanced cancer feel a sense of peaceful acceptance of their terminal illness. The scale was administered to 160 advanced cancer patients along with measures of other attributes hypothesized to be related to acceptance, including cognitive acceptance of terminal illness. EOL outcomes in 56 patients who died during the study were also examined. Results The 12-item PEACE questionnaire had two subscales: a 7-item Struggle with Illness (Cronbach's ? =.81) and a 5-item Peaceful Acceptance (? = .78) subscale. Both subscales were associated with patients’ self-reported peacefulness (r=.66 for acceptance, P<.0001; r=?.37 for struggle, P<.0001.) Struggle with Illness scores were associated with cognitive terminal illness acknowledgement (mean scores 14.9 versus 12.4, P=.001) and some aspects of advance care planning (living will or health care proxy, mean scores 13.9 versus 11.5, P=.02). In addition, among patients who had died, use of a feeding tube at the EOL was inversely associated with Peaceful Acceptance (P=.015). Conclusion The PEACE questionnaire is a valid and reliable measure of Peaceful Acceptance and Struggle with Illness. Scores are associated with some choices for EOL care among patients with advanced cancer. PMID:18429006

Mack, Jennifer W.; Nilsson, Matthew; Balboni, Tracy; Friedlander, Robert J.; Block, Susan D.; Trice, Elizabeth; Prigerson, Holly G.

2013-01-01

70

Does compassion include euthanasia? Physicians' roles in caring for the terminally ill preclude the use of euthanasia.  

PubMed

As technological advances continue to allow physicians to prolong dying patients' lives, healthcare providers face many issues surrounding physician-assisted suicide and euthanasia. When a physician performs euthanasia or assists in suicide, he or she is killing the patient. The action can in no way be interpreted as allowing an eventually inevitable death to occur earlier rather than later. The physician is culpable. Physicians play three important roles when caring for terminally ill patients: adviser, friend, and priest. The risks inherent in each of these could create an illusion that performing euthanasia and assisting in suicide are humane and logical options. Finally, physicians should not miss opportunities for grace when caring for dying patients. When physicians convey the diagnosis, when patients express the desire to control the timing of the death, and when patients are feeling sadness and anger, physicians must rise to the occasion to act as friend and minister and to introduce grace and healing to the dying. PMID:10124304

Hooyman, N W

1993-03-01

71

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

PubMed

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

Lerner, Barron H

2007-01-01

72

Mechanical ventilation in critically ill cancer patients: outcome and utilisation of resources  

Microsoft Academic Search

Intensive care is increasingly being used in the management of cancer patients. It is important that a disproportionate share\\u000a of special care resources is not expended on futile care of terminally ill patients. A requirement for mechanical ventilation\\u000a has been stated to affect survival in cancer patients. The objectives of this study were to determine our hospital utilisation\\u000a of ICU

Ulf E. Kongsgaard; Nina K. Meidell

1999-01-01

73

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

Microsoft Academic Search

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 psychological distress (i.e., depressive symptomatology, emotional exhaustion) among secular and religiously observant family

Yaacov G. Bachner; Norm ORourke; Sara Carmel

2011-01-01

74

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

ERIC Educational Resources Information Center

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…

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

2011-01-01

75

Illness Representation and Change in Dietary Habits in Hypercholesterolemic Patients  

Microsoft Academic Search

The association between a patient's illness representation and long-term changes in treatment adherence still needs to be clarified. AIM: to evaluate the association between the representation of hypercholesterolemia and dietary modifications over 1-year, controlling for biopsychosocial factors. METHODS: 208 hypercholesterolemic Caucasian patients. Measures of dietary intake, illness representation, and biopsychosocial factors were collected at baseline, 3, 6, and 12 months.

Marie-France Coutu; Gilles Dupuis; Bianca D'Antono; Lysanne Rochon-Goyer

2003-01-01

76

Multiple Organ System Failure in Critically Ill Cirrhotic Patients  

Microsoft Academic Search

Objectives: The prognosis for critically ill cirrhotic patients depends on the extent of hepatic and extrahepatic organ dysfunction\\/failure. We hypothesize that a graded multiple organ dysfunction score, sequential organ failure assessment (SOFA), would provide more descriptive and discriminative power for predicting the hospital mortality for critically ill cirrhotic patients than the classical organ system failure (OSF) score, which defines organ

Ming-Hung Tsai; Yun-Shing Peng; Jau-Min Lien; Hsu-Huei Weng; Yu-Pin Ho; Chun Yang; Yin-Yi Chu; Yung-Chang Chen; Ji-Tseng Fang; Cheng-Tang Chiu; Pang-Chi Chen

2004-01-01

77

[Home care for terminal patients and information technology].  

PubMed

An electronic medical record sharing system, which supports management of terminally ill patients at home, was developed in Matsudo City as a trial project. The system interconnects several facilities including four general practitioners (GPs), a visiting nurse center and a supporting municipal hospital. It provides the latest patients' information from GPs to the municipal hospital in case of the acute change of the patients' condition and their transfer. Using this system the discussion between GPs and visiting nurses became much more fruitful than we had expected, while some doctors did not use the system because of their computer literacy. Problems in the system security and privacy protection as well as clarification of users' responsibility remain to be solved. A more expanded system is now being developed as a new enterprise of Matsudo Medical Association following this system. PMID:12536825

Hasegawa, Keiko; Gokita, Tomoko; Fujimoto, Yoshie; Souma, Mariko; Yamazaki, Shunji; Ooshima, Hitoshi; Takabayashi, Katsuhiko

2002-12-01

78

Detection of substance use disorders in severely mentally ill patients  

Microsoft Academic Search

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

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

1993-01-01

79

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

PubMed

Thrombo-prophylaxis has been shown to reduce the incidence of pulmonary embolism (PE) and mortality in surgical patients. The purpose of this review is to find out the evidence-based clinical practice criteria of deep vein thrombosis (DVT) prophylaxis in acutely ill medical and critically ill patients. English-language randomized controlled trials, systematic reviews, and meta-analysis were included if they provided clinical outcomes and evaluated therapy with low-dose heparin or related agents compared with placebo, no treatment, or other active prophylaxis in the critically ill and medically ill population. For the same, we searched MEDLINE, PUBMED, Cochrane Library, and Google Scholar. In acutely ill medical patients on the basis of meta-analysis by Lederle et al. (40 trials) and LIFENOX study, heparin prophylaxis had no significant effect on mortality. The prophylaxis may have reduced PE in acutely ill medical patients, but led to more bleeding events, thus resulting in no net benefit. In critically ill patients, results of meta-analysis by Alhazzani et al. and PROTECT Trial indicate that any heparin prophylaxis compared with placebo reduces the rate of DVT and PE, but not symptomatic DVT. Major bleeding risk and mortality rates were similar. On the basis of MAGELLAN trial and EINSTEIN program, rivaroxaban offers a single-drug approach to the short-term and continued treatment of venous thrombosis. Aspirin has been used as antiplatelet agent, but when the data from two trials the ASPIRE and WARFASA study were pooled, there was a 32% reduction in the rate of recurrence of venous thrombo-embolism and a 34% reduction in the rate of major vascular events. PMID:24987238

Saigal, Saurabh; Sharma, Jai Prakash; Joshi, Rajnish; Singh, Dinesh Kumar

2014-06-01

80

[Helping a terminal cancer patient establish hope].  

PubMed

Cancer patients who feel a sense of hopelessness concerning the prospects of long-term treatment success may defeat all efforts to stop their diseases. The authors present a case study of a breast cancer patient, a former nursing instructor, who suffered from passiveness, depression, resistance to communication, blunted affect, lack of participation in self-care, and refusal to eat--all resulting from a lack of treatment-related progress. One of the authors established a continuing and active care relationship with the patient. As part of her nursing care plan, she enacted encouraging social interactions, provided medical treatment information, assisted with self-care procedures, and attempted to maintain a constant level of psychological calm. Outcomes included an improved positive attitude toward treatment, enhanced self-control, active participation in self-care, and improved social interaction. The patient was also better able to adapt to her illness and to face an uncertain future. PMID:15045901

Juang, Chuen-Mih; Chang, Yu-Ping

2004-02-01

81

Type D personality and illness perceptions in myocardial infarction patients  

Microsoft Academic Search

ObjectivesTo determine the relationship between Type D personality (the tendency to experience negative emotions and to be socially inhibited) and illness beliefs in postmyocardial infarction (MI) patients.

Lynn Williams; Rory C. O'Connor; Neil R. Grubb; Ronan E. O'Carroll

2011-01-01

82

Brain dysfunction in patients with chronic critical illness.  

PubMed

Critically ill patients frequently experience acute brain dysfunction in the form of coma or delirium, both of which are common during acute and chronic critical illness (CCI). These manifestations of brain dysfunction are associated with numerous adverse outcomes during acute critical illness, including prolonged hospitalization, increased healthcare costs, and increased mortality. The prognosis of CCI patients with coma or delirium has not yet been thoroughly studied, but preliminary studies suggest this population is at high risk for detrimental outcomes associated with acute brain dysfunction. Additionally, a high percentage of patients who survive acute or CCI suffer from long-term brain dysfunction, which manifests primarily as memory deficits and executive dysfunction and is predicted by brain dysfunction in the ICU. Interventions directed at reducing the burden of brain dysfunction during critical illness have shown promise in studies of patients with acute critical illness, but these therapies have yet to be studied during CCI. Thus, multicenter randomized trials are needed to determine which interventions are most effective for such patients. Until these data are available, management strategies that have been proven beneficial during acute critical illness-such as reduction of sedative exposure, especially to benzodiazepines, and early use of physical and occupational therapy-should be employed during the treatment of patients with CCI. PMID:22663969

Girard, Timothy D

2012-06-01

83

Gentamicin volume of distribution in critically ill septic patients  

Microsoft Academic Search

Gentamicin intrapatient pharmacokinetics variations were studied in 40 critically ill medical patients, suffering gram-negative sepsis. These patients were studied in two phases throughout gentamicin treatment: firstly, on the second day of treatment, when aggressive fluid therapy was required, and secondly, five days later, when patients had achieved a more stable clinical condition. Pharmacokinetic parameters were determined using least squares linear

C. Triginer; I. Izquierdo; R. Fernfindez; J. Rello; J. Torrent; S. Benito; A. Net

1990-01-01

84

Acute gastro-intestinal bleeding in the critically ill patient  

Microsoft Academic Search

Summary Endoscopic studies have shown that all critically ill patients are liable to a degree of stress ulceration. Diffuse erosions appear first in the fundus and then spread to the corpus and antrum within 48 h. Duodenal disease is particuarly common in burns patients. Discrete ulceration occurs in most severely injured patients. Mucosal damage is probably initiated by ischaemia but

J. R. Croker

1979-01-01

85

Dancing around death: hospitalist-patient communication about serious illness.  

PubMed

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

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

2013-01-01

86

Posterior reversible encephalopathy syndrome (PRES) in critically ill obstetric patients  

Microsoft Academic Search

ObjectiveTo describe clinical, neuroradiological and evolutionary findings in obstetric patients with posterior reversible encephalopathy syndrome (PRES).DesignRetrospective case series.SettingUniversity intensive care unit (ICU).PatientsFour critically ill patients. Two patients experienced PRES in late postpartum without the classical pre-eclamptic signs. All patients showed impairment of consciousness and epileptic seizures; two of them presented cortical blindness and headache, too. True status epilepticus (SE) occurred

Giuseppe Servillo; Pasquale Striano; Salvatore Striano; Fabio Tortora; Patrizia Boccella; Edoardo De Robertis; Flavia Rossano; Francesco Briganti; Rosalba Tufano

2003-01-01

87

Significance of serum magnesium levels in critically ill-patients  

PubMed Central

Background: Magnesium is one of the major electrolytes, deficiency of which is frequently overlooked in critical illness, leading to an adverse clinical outcome if not monitored regularly. Settings and Design: Single center prospective observational study of 2 years duration. Materials and Methods: The subjects studied were monitored for serum magnesium levels 2 times: Day 1 and day 4 of intensive care unit (ICU) admission. Patients were divided into normomagnesemic and hypomagnesemic groups and compared for various parameters. Results: Out of 70 critically ill-patients, 50 patients (71.43%) were normomagnesemic, 17 patients (24.29%) were hypomagnesemic and three patients were hypermagnesemic. The stay of the patients in ICU (P > 0.05), Acute Physiology and Chronic Health Evaluation-II (APACHE-II) scoring (P = 0.34) and co-morbidity (P = 0.360) showed an insignificant variation between the two groups. Associated electrolyte abnormalities in hypomagnesemic patients were hypokalemia (58.82%), hyponatremia (47.05%), hypocalcemia (70.58%) and hypophosphatemia (29.41%). About 76.47% of hypomagnesemic population was on magnesium lowering drugs while as 46% of normomagnesemic population was on magnesium lowering drugs (P = 0.030). Mortality of hypomagnesemic group was 74.47% while that of normomagnesemic group was 36% (P = 0.004). Conclusion: Hypomagnesemia is a significant electrolyte abnormality in critically ill-patients. Critically ill hypomagnesemic patients have higher mortality than the normomagnesemic patients. PMID:24600576

Zafar, Mir Sadaqat Hassan; Wani, Javaid Iqbal; Karim, Raiesa; Mir, Mohammad Muzaffer; Koul, Parvaiz Ahmad

2014-01-01

88

Ethical dilemma: offering short-term extracorporeal membrane oxygenation support for terminally ill children who are not candidates for long-term mechanical circulatory support or heart transplantation.  

PubMed

The use of extracorporeal membrane oxygenation (ECMO) in terminally ill pediatric patients who are not candidates for long-term mechanical circulatory support or heart transplantation requires careful deliberation. We present the case of a 16-year-old female with a relapse of acute lymphoid leukemia and acute-on-chronic cardiomyopathy who received short-term ECMO therapy. In addition, we highlight several ethical considerations that were crucial to this patient's family-centered care and demonstrate that this therapy can be accomplished in a manner that respects patient autonomy and family wishes. PMID:24668981

Shankar, Venkat; Costello, John P; Peer, Syed M; Klugman, Darren; Nath, Dilip S

2014-04-01

89

Wellbeing, illness perception and coping strategies in Italian Celiac patients.  

PubMed

The clinical features of Celiac Disease (CD) are heterogeneous and both severity and extent of villous atrophy do not correlate with clinical presentation. This study aims to evaluate the psychological wellbeing of CD patients with a similar clinical pattern and to explore whether patients with different levels of wellbeing differed in illness perception and coping strategies. CD outpatients with proven diagnosis filled in validated questionnaires to investigate wellbeing (PGWBI), illness perception (IPQ-R) and coping style (COPE). One hundred and four patients underwent data analysis. Compared to Italian reference sample, CD patients reported a significantly reduced PGWBI total score (p<0.001), self-control (p<0.001), general health (p=0.002) and vitality (p<0.001) and increased anxiety (p=0.009). 7.7% of patients reported a positive wellbeing, 40.4% distress absence, 28.8% a moderate distress and 23.1% a severe distress. Patients with distress showed a different illness perception and reported more frequently two dysfunctional strategies: focus on and venting emotions (p= 0.009) and substance abuse (p= 0.01) compared to those having a positive wellbeing. A high percentage of CD patients experience distress and differ from those who reach wellbeing in illness perception and use of coping strategies. Assessing subjective viewpoint with standardized methods can provide useful information for a better management of CD patients. PMID:23298509

Baiardini, I; Braido, F; Menoni, S; Bellandi, G; Savi, E; Canonica, G W; Macchia, D

2012-01-01

90

Progressive cellular dehydration and proteolysis in critically ill patients  

Microsoft Academic Search

SummaryBackground According to a recent hypothesis, the profound loss of body protein that occurs in critically ill patients is triggered and maintained by cell shrinkage secondary to cellular dehydration. We tested this hypothesis by studying sequential changes in intracellular water, total body protein, total body potassium, and intracellular potassium in patients receiving intensive care for blunt trauma or sepsis.Methods Nine

P. J Finn; L. D Plank; M. A Clark; A. B Connolly; G. L Hill

1996-01-01

91

Control of blood glucose during nutritional support in Ill patients  

Microsoft Academic Search

The traditional “Sliding Scale” is an inefficient and unreliable way of controlling blood glucose levels in ill patients receiving nutritional support in the Intensive Care Unit. In these patients, it is necessary to reassess insulin requirements frequently in the light of changing clinical circumstances. A significant improvement in control can be achieved by using a dynamic scale of instructions for

A. M. J. Woolfson

1980-01-01

92

Clinical Correlates of Insomnia in Patients With Chronic Illness  

Microsoft Academic Search

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

David A. Katz; Colleen A. McHorney

1998-01-01

93

Perceived illness intrusions among continuous ambulatory peritoneal dialysis patients.  

PubMed

To study the perceived illness intrusion of continuous ambulatory peritoneal dialysis (CAPD) patients, to examine their demographics, and to find out the association among demographics, duration of illness as well as illness intrusion, 40 chronic kidney disease stage V patients on CAPD during 2006-2007 were studied. Inclusion criteria were patients' above 18 years, willing, stable, and completed at least two months of dialysis. Those with psychiatric co-morbidity were excluded. Sociodemographics were collected using a semi-structured interview schedule. A 14-item illness intrusion checklist covering various aspects of life was administered. The subjects had to rate the illness intrusion in their daily life and the extent of intrusion. The data was analyzed using descriptive statistics and chi square test of association. The mean age of the subjects was 56.05 ± 10.05 years. There was near equal distribution of gender. 82.5% were married, 70.0% belonged to Hindu religion, 45.0% were pre-degree, 25.0% were employed, 37.5% were housewives and 30.0% had retired. 77.5% belonged to the upper socioeconomic strata, 95.0% were from an urban background and 65.0% were from nuclear families. The mean duration of dialysis was 19.0 ± 16.49 months. Fifty-eight percent of the respondents were performing the dialysis exchanges by themselves. More than 95.0%were on three or four exchanges per day. All the 40 subjects reported illness intrusion in their daily life. Intrusion was perceived to some extent in the following areas: health 47.5%, work 25.0%, finance 37.5%, diet 40.0%, and psychological 50.0%. Illness had not intruded in the areas of relationship with spouse 52.5%, sexual life 30.0%, with friends 92.5%, with family 85.5%, social functions 52.5%, and religious functions 75.0%. Statistically significant association was not noted between illness intrusion and other variables. CAPD patients perceived illness intrusion to some extent in their daily life. Elderly, educated married subjects were predominant. There was no statistically significant association between illness intrusion and other variables. PMID:22982907

Bapat, Usha; Kedlya, Prashanth G

2012-09-01

94

Measuring Illness Behavior in Patients with Systemic Sclerosis  

PubMed Central

Objective Illness behaviors (cognitive, affective, and behavioral reactions) among individuals with systemic sclerosis (SSc) are of clinical concern due to relationships between these behaviors and physical and mental-health quality of life such as pain and symptoms of depression. Self-report measures with good psychometric properties can aid in the accurate assessment of illness behavior. The Illness Behavior Questionnaire (IBQ) was designed to measure abnormal illness behaviors; however, despite its long-standing use, there is disagreement regarding its subscales. The goal of the present study was to evaluate the validity of the IBQ in a cohort of patients with SSc. Methods Patients with SSc (N = 278) completed the IBQ at enrollment to the Genetics versus ENvironment In Scleroderma Outcome Study (GENISOS). Structural validity of previously derived factor solutions was investigated using confirmatory factor analysis. Exploratory factor analysis was utilized to derive SSc-specific subscales. Results None of the previously derived structural models were supported for SSc patients. Exploratory factor analysis supported a SSc-specific factor structure with 5 subscales. Validity analyses suggested that the subscales were generally independent of disease severity, but were correlated with other health outcomes (i.e., fatigue, pain, disability, social support, mental health). Conclusion The proposed subscales are recommended for use in SSc, and can be utilized to capture illness behavior that may be of clinical concern. PMID:23097280

Merz, Erin L.; Malcarne, Vanessa L.; Roesch, Scott C.; Sharif, Roozbeh; Harper, Brock E.; Draeger, Hilda T.; Gonzalez, Emilio B.; Nair, Deepthi K.; McNearney, Terry A.; Assassi, Shervin; Mayes, Maureen D.

2012-01-01

95

Pulmonary penetration of piperacillin and tazobactam in critically ill patients.  

PubMed

Pulmonary infections in critically ill patients are common and are associated with high morbidity and mortality. Piperacillin-tazobactam is a frequently used therapy in critically ill patients with pulmonary infection. Antibiotic concentrations in the lung reflect target-site antibiotic concentrations in patients with pneumonia. The aim of this study was to assess the plasma and intrapulmonary pharmacokinetics (PK) of piperacillin-tazobactam in critically ill patients administered standard piperacillin-tazobactam regimens. A population PK model was developed to describe plasma and intrapulmonary piperacillin and tazobactam concentrations. The probability of piperacillin exposures reaching pharmacodynamic end points and the impact of pulmonary permeability on piperacillin and tazobactam pulmonary penetration was explored. The median piperacillin and tazobactam pulmonary penetration ratios were 49.3 and 121.2%, respectively. Pulmonary piperacillin and tazobactam concentrations were unpredictable and negatively correlated with pulmonary permeability. Current piperacillin-tazobactam regimens may be insufficient to treat pneumonia caused by piperacillin-tazobactam-susceptible organisms in some critically ill patients. PMID:24926779

Felton, T W; McCalman, K; Malagon, I; Isalska, B; Whalley, S; Goodwin, J; Bentley, A M; Hope, W W

2014-10-01

96

Terminal (Mis)diagnosis and the Physician-Patient Relationship in LM Montgomery's The Blue Castle  

PubMed Central

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

2010-01-01

97

Spiritual Care For Jewish Patients Facing A Life Threatening Illness  

PubMed Central

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

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

2013-01-01

98

The Balance Between Providing Support, Prolonging Suffering, and Promoting Death: Ethical Issues Surrounding Psychological Treatment of a Terminally Ill Client  

Microsoft Academic Search

A psychologist with a client who is terminally ill and wishes to discuss end-of-life options, specifically the option of hastening death, is faced with an ethical dilemma as to how to proceed with treatment. Specifically, he or she is bound by the American Psychological Association's (2002) potentially conflicting Principles A and E, which advise a psychologist to “do no harm”

Rachel Winograd

2012-01-01

99

Amicus Curiae Brief for the United States Supreme Court on Mental Health, Terminal Illness, and Assisted Death  

Microsoft Academic Search

The Supreme Court will hear the case of Gonzales v. Oregon in the fall of2005 to determine if prescriptions written under Oregon's Death with Dignity law violate the Controlled Substances Act. The Attorney General of the United States also believes that hastening death is a public health danger because of the vulnerability of people with terminal illness, primarily because of

Pamela J. Miller; James L. Werth Jr

2006-01-01

100

Care Coordination for the Chronically Ill: Understanding the Patient's Perspective  

PubMed Central

Objective To identify factors associated with perception of care coordination problems among chronically ill patients. Methods Patient-level data were obtained from a random-digit dial telephone survey of adults with chronic conditions. The survey measured respondents' self-report of care coordination problems and level of patient activation, using the Patient Activation Measure (PAM-13). Logistic regression was used to assess association between respondents' self-report of care coordination problems and a set of patient characteristics. Results Respondents in the highest activation stage had roughly 30–40 percent lower odds of reporting care coordination problems compared to those in the lowest stage (p < .01). Respondents with multiple chronic conditions were significantly more likely to report coordination problems than those with hypertension only. Respondents' race/ethnicity, employment, insurance status, income, and length of illness were not significantly associated with self-reported care coordination problems. Conclusion We conclude that patient activation and complexity of chronic illness are strongly associated with patients' self-report of care coordination problems. Developing targeted strategies to improve care coordination around these patient characteristics may be an effective way to address the issue. PMID:22985032

Maeng, Daniel D; Martsolf, Grant R; Scanlon, Dennis P; Christianson, Jon B

2012-01-01

101

Precipitating Factors of Acute Illness in Patients with Chronic Disease  

PubMed Central

The precipitating causes of acute illness in patients with chronic organic disease can often be prevented, reversed or controlled. The various kinds of precipitating factors are described, and their anticipation and the prompt institution of remedial measures are emphasized. PMID:5843867

Munroe, D. S.

1965-01-01

102

Parenteral Nutrition in the Critically Ill Patient  

PubMed Central

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

Ziegler, Thomas R.

2011-01-01

103

Inflammation biomarkers and delirium in critically ill patients  

PubMed Central

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

2014-01-01

104

Depression in older patients with neurologic illness: causes, recognition, management.  

PubMed

Depression is common in the elderly, particularly in older persons with neurologic illness. Its etiology in this population is incompletely understood and likely to be multifactorial. Identifying depression in elderly patients with neurologic illness can be a challenge, as many of its features resemble symptoms of the underlying neurologic disease or of the aging process itself. Nevertheless, recognition and effective management of depression in this population is vital, since depression is a major source of excess morbidity and since treatment often results in improved quality of life for patients and their caregivers. Assessing for suidicality is a key diagnostic consideration in this population. Antidepressant medications, psychotherapy, and electroconvulsive therapy all can be effective in treating depression in elderly neurologic patients. PMID:16265943

Carson, Alan; Margolin, Richard

2005-10-01

105

Clinical use of lactate monitoring in critically ill patients  

PubMed Central

Increased blood lactate levels (hyperlactataemia) are common in critically ill patients. Although frequently used to diagnose inadequate tissue oxygenation, other processes not related to tissue oxygenation may increase lactate levels. Especially in critically ill patients, increased glycolysis may be an important cause of hyperlactataemia. Nevertheless, the presence of increased lactate levels has important implications for the morbidity and mortality of the hyperlactataemic patients. Although the term lactic acidosis is frequently used, a significant relationship between lactate and pH only exists at higher lactate levels. The term lactate associated acidosis is therefore more appropriate. Two recent studies have underscored the importance of monitoring lactate levels and adjust treatment to the change in lactate levels in early resuscitation. As lactate levels can be measured rapidly at the bedside from various sources, structured lactate measurements should be incorporated in resuscitation protocols. PMID:23663301

2013-01-01

106

Thirst in Critically Ill Patients: From Physiology to Sensation  

PubMed Central

Critically ill patients often have distressful episodes of severe thirst, but the underlying complex biochemical, neurohormonal regulatory controls that regulate this primal sensation have rarely been addressed by clinicians. Subtle changes in plasma osmolality are the most potent stimulus for thirst. In response to increases in osmolality, osmoreceptors activate release of the neurohormone vasopressin (also known as antidiuretic hormone). The released vasopressin acts on the kidneys to conserve water to correct the hyperosmolar state. If this compensatory mechanism is unsuccessful, thirst arises to promote drinking. Thirst induced by marked volume loss, in contrast, is more closely related to the volemic and pressure changes regulated by the renin-angiotensin aldosterone system. Understanding the physiological mechanisms of thirst will help in understanding the pathophysiological consequences of underlying thirst-related disease and treatments in critically ill patients. Further clinical research is needed to elucidate the multiple inhibitory and excitatory neurohormonal stimuli that motivate patients’ intense desire for water. PMID:23817822

Arai, Shoshana; Stotts, Nancy; Puntillo, Kathleen

2013-01-01

107

Clinical and critical care concerns in severely ill obese patient  

PubMed Central

The incidence of obesity has acquired an epidemic proportion throughout the globe. As a result, increasing number of obese patients is being presented to critical care units for various indications. The attending intensivist has to face numerous challenges during management of such patients. Almost all the organ systems are affected by the impact of obesity either directly or indirectly. The degree of obesity and its prolong duration are the main factors which determine the harmful effect of obesity on human body. The present article reviews few of the important clinical and critical care concerns in critically ill obese patients. PMID:23087857

Bajwa, Sukhminder Jit Singh; Sehgal, Vishal; Bajwa, Sukhwinder Kaur

2012-01-01

108

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

PubMed

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

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

2014-03-01

109

'Immunonutrition' Ill-Advised for ICU Patients on Feeding Tube, Study Says  

MedlinePLUS

... features on this page, please enable JavaScript. 'Immunonutrition' Ill-Advised for ICU Patients on Feeding Tube, Study ... should discourage routine prescription of immunonutrition for critically ill patients outside the scope of well-designed randomized ...

110

Glycemic control in non-diabetic critically ill patients  

PubMed Central

Hyperglycemia is a common and costly health care problem in hospitalized patients. In hospital hyperglycemia is defined as any glucose value >7.8 mmol/l (140 mg/dl). Hyperglycemia is present in 40% of critically ill patients and in up to 80% of patients after cardiac surgery, with ~ 80% of ICU patients with hyperglycemia having no history of diabetes prior to admission. The risk of hospital complications relates to the severity of hyperglycemia, with a higher risk observed in patients without a history of diabetes compared to those with known diabetes. Improvement in glycemic control reduces hospital complications and mortality; however, the ideal glycemic target has not been determined. A target glucose level between 7.8 and 10.0 mmol/l (140 and 180 mg/dl) is recommended for the majority of ICU patients. This review aims to present updated recommendations for the inpatient management of hyperglycemia in critically ill patients with and without a history of diabetes. PMID:21925080

Farrokhi, Farnoosh; Smiley, Dawn; Umpierrez, Guillermo E.

2013-01-01

111

Management of Atrial Fibrillation in Critically Ill Patients  

PubMed Central

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

Arrigo, Mattia

2014-01-01

112

Amicus Curiae brief for the United States Supreme Court on mental health, terminal illness, and assisted death.  

PubMed

The Supreme Court will hear the case of Gonzales v. Oregon in the fall of 2005 to determine if prescriptions written under Oregon's Death with Dignity law violate the Controlled Substances Act. The Attorney General of the United States also believes that hastening death is a public health danger because of the vulnerability of people with terminal illness, primarily because of the possibility of depression. PMID:17387073

Miller, Pamela J; Werth, James L

2005-01-01

113

Equipment review: Intrahospital transport of critically ill patients  

Microsoft Academic Search

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:

Christian Waydhas

1999-01-01

114

Jail hospitalization of prearraignment patient arrestees with mental illness.  

PubMed

A growing number of individuals with mental illness are receiving psychiatric treatment in the criminal justice system. However, mental health problems facing individuals immediately after arrest and before arraignment have not been adequately studied. In New York City, prearraignment arrestees who require psychiatric hospitalization are temporarily transferred from police custody to correctional custody and admitted to the Bellevue Jail Psychiatry Service (BJPS) for treatment. The purpose of this study was to gain a better understanding of the impact of this jail hospitalization on the legal disposition of this vulnerable population. A retrospective chart review was conducted of 204 consecutively admitted male patient-arrestees on the BJPS. Results showed that admission to the BJPS delayed arraignment by an average of 8.03 days, with longer delays for individuals arrested outside of Manhattan. Although these delays are considered acceptable under legal precedent, concerns arise about the therapeutic impact of this practice on newly arrested individuals with severe mental illness. PMID:24618522

Gray, Susan M; Racine, Christopher W; Smith, Christopher W; Ford, Elizabeth B

2014-01-01

115

Prescribing of psychoactive drugs for chronically ill elderly patients.  

PubMed Central

The prescribing of psychoactive drugs for 1431 chronically ill elderly patients being assessed for long-term institutional or community care was surveyed. Psychoactive drugs had been prescribed for about one quarter of the patients; benzodiazepines were the most frequently prescribed group. Judging from the extensive prescribing of flurazepam and chloral hydrate, commonly used hypnotics, the main reason psychoactive drugs were prescribed was to provide night-time sedation. Antidepressants and drugs promoted as useful in improving cognitive function were infrequently prescribed. Commendable prescribing practices included the infrequent use of "cerebral vasodilators" and barbiturates. Questionable prescribing practices included the infrequent use of tricyclic antidepressants in severely depressed patients and the use of tranquilizers in patients described by their attending physician as markedly or extremely withdrawn. Images p1506-a PMID:26459

Achong, M. R.; Bayne, J. R.; Gerson, L. W.; Golshani, S.

1978-01-01

116

Focus on peripherally inserted central catheters in critically ill patients.  

PubMed

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

Cotogni, Paolo; Pittiruti, Mauro

2014-11-01

117

Focus on peripherally inserted central catheters in critically ill patients  

PubMed Central

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

Cotogni, Paolo; Pittiruti, Mauro

2014-01-01

118

Energy estimation and measurement in critically ill patients.  

PubMed

The estimation of caloric needs of critically ill patients is usually based on energy expenditure (EE), while current recommendations for caloric intake most often rely on a fixed amount of calories. In fact, during the early phase of critical illness, caloric needs are probably lower than EE, as a substantial proportion of EE is covered by the non-inhibitable endogenous glucose production. Hence, the risk of overfeeding is higher during the early phase than the late phase, while the risk of underfeeding is higher during the late phase of critical illness. Therefore, an accurate measurement of EE can be helpful to prevent early overfeeding and late underfeeding. Available techniques to assess EE include predictive equations, calorimetry, and doubly labeled water, the reference method. The available predictive equations are often inaccurate, while indirect calorimetry is difficult to perform for several reasons, including a shortage of reliable devices and technical limitations. In this review, the authors intend to discuss the different techniques and the influence of the method used on the interpretation of the results of clinical studies. PMID:24113283

Fraipont, Vincent; Preiser, Jean-Charles

2013-11-01

119

Echocardiographic Hemodynamic Monitoring in the Critically Ill Patient  

PubMed Central

Echocardiography has shown to be an essential diagnostic tool in the critically ill patient's assessment. In this scenario the initial fluid therapy, such as it is recommended in the actual clinical guidelines, not always provides the desired results and maintains a considerable incidence of cardiorrespiratory insufficiency. Echocardiography can council us on these patients' clinical handling, not only the initial fluid therapy but also on the best-suited election of the vasoactive/inotropic treatment and the early detection of complications. It contributes as well to improving the etiological diagnosis, allowing one to know the heart performance with more precision. The objective of this manuscript is to review the more important parameters that can assist the intensivist in theragnosis of hemodynamically unstable patients. PMID:22758613

Romero-Bermejo, Francisco J; Ruiz-Bailen, Manuel; Guerrero-De-Mier, Manuel; Lopez-Alvaro, Julian

2011-01-01

120

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

E-print Network

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

Napadow, Vitaly

121

76 FR 56505 - Agency Information Collection (Application by Insured Terminally Ill Person for Accelerated...  

Federal Register 2010, 2011, 2012, 2013

...Ill Person for Accelerated Benefit (38 CFR 9.14(e)) Activity...OMB Review AGENCY: Veterans Benefits Administration, Department...announces that the Veterans Benefits Administration (VBA), Department...PRA submission describes the nature of the information...

2011-09-13

122

Relating illness complexity to reimbursement in CKD patients  

PubMed Central

Background: Despite significant investments of federal and state dollars to transition patient medical records to an all-electronic system, a chasm still exists between health care quality and payment for it. A major reason for this gap is the difficulty in evaluating health care outcomes based on claims data. Since both payers and patients may not appreciate how illness complexity impacts treatment outcomes, it is difficult to determine fair provider compensation. Objectives: Chronic kidney disease (CKD) typifies these problems and is often associated with comorbidities that impact cost, health, and work productivity. Thus, the objective of this study was to evaluate an illness complexity score (ICS) based on a linear regression of select blood values that might assist in predicting average monthly reimbursements in CKD patients. A second objective was to compare the results of this ICS prediction to results obtained by prediction of average monthly reimbursement using CKD stage. A third objective was to analyze the relationship between the change in ICS, estimated glomerular filtration rate (eGFR), and CKD stage over time to average monthly reimbursement. Methods: We calculated parsimonious values for select variables associated with CKD patients and compared the ICS to ordinal staging of renal disease. Data from 177 de-identified patients over 13 months was collected, which included 15 blood chemistry observations along with complete claims data for all medical expenses. To test for the relationship between average blood chemistry values, stages of CKD, age, and average monthly reimbursement, we modeled an association through a linear regression function of age, eGFR, and the Z-scores calculated from average monthly values of phosphorus, parathyroid hormone, glucose, hemoglobin, bicarbonate, albumin, creatinine, blood urea nitrogen, potassium, calcium, sodium, alkaline phosphatase, alanine aminotransferase, and white blood cells. Results: The results of our study demonstrated that the association between average ICS values throughout the entire study period predicted average monthly reimbursements with an R2 value of 0.41. Comparing that value to the association between the average CKD stage and average monthly reimbursement demonstrated an R2 value of 0.08. Thus, ICS offers five times greater sensitivity over CKD staging as a measure of illness complexity. Conclusion: Sorting the patient population by changes in CKD stage or ICS over the entire study period revealed significant differences between the two scoring methods. Groups scored by ICS demonstrated greater sensitivity by capturing dysfunction in other organ systems and had a better association with reimbursement than groups scored by CKD staging. PMID:22114513

Bessette, Russell W; Carter, Randy L

2011-01-01

123

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

PubMed

This study investigated the illness perceptions of patients with systemic lupus erythematosus (SLE) and whether perceptions are influenced by type of treatment for proliferative lupus nephritis. In addition, the illness perceptions of SLE patients were compared with those of patients with other chronic illnesses. Thirty-two patients who had experienced at least one episode of proliferative lupus nephritis were included. Patients were treated with either a high or low-dose cyclophosphamide (CYC) regimen (National Institutes of Health [NIH] vs. Euro-Lupus protocol). Illness perceptions were measured with the Brief Illness Perception Questionnaire (B-IPQ) and a drawing assignment. The low-dose CYC group perceived their treatment as more helpful than the high-dose CYC group. In comparison with patients with asthma, SLE patients showed more negative illness perceptions on five of the eight illness perception domains. Drawings of the kidney provided additional information about perceptions of treatment effectiveness, kidney function and patients' understanding of their illness. Drawing characteristics showed associations with perceptions of consequences, identity, concern and personal control. These findings suggest that the type of treatment SLE patients with proliferative lupus nephritis receive may influence perceptions of treatment effectiveness. In addition, patients' drawings reveal perceptions of damage caused by lupus nephritis to the kidneys and the extent of relief provided by treatment. The finding that SLE is experienced as a more severe illness than other chronic illnesses supports the need to more frequently assess and aim to improve psychological functioning in SLE patients. PMID:21362752

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

2011-03-01

124

Use of inotropes and vasopressor agents in critically ill patients  

PubMed Central

Inotropes and vasopressors are biologically and clinically important compounds that originate from different pharmacological groups and act at some of the most fundamental receptor and signal transduction systems in the body. More than 20 such agents are in common clinical use, yet few reviews of their pharmacology exist outside of physiology and pharmacology textbooks. Despite widespread use in critically ill patients, understanding of the clinical effects of these drugs in pathological states is poor. The purpose of this article is to describe the pharmacology and clinical applications of inotropic and vasopressor agents in critically ill patients. LINKED ARTICLES This article is commented on by Bracht et al., pp. 2009–2011 and De Backer and Scolletta, pp. 2012–2014 of this issue. To view Bracht et al. visit http://dx.doi.org/10.1111/j.1476-5381.2011.01776.x and to view De Backer and Scolletta visit http://dx.doi.org/10.1111/j.1476-5381.2011.01746.x PMID:21740415

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

2012-01-01

125

Delirium in critically ill patients: epidemiology, pathophysiology, diagnosis and management.  

PubMed

Delirium is commonly observed in critically ill patients and is associated with negative outcomes. The pathophysiology of delirium is not completely understood. However, alterations to neurotransmitters, especially acetylcholine and dopamine, inflammatory pathways and an aberrant stress response are proposed mechanisms leading to intensive care unit (ICU) delirium. Detection of delirium using a validated delirium assessment tool makes early treatment possible, which may improve prognosis. Patients at high risk of delirium, especially those with cognitive decline and advanced age, should be identified in the first 24 hours of admission to the ICU. Whether these high-risk patients benefit from haloperidol prophylaxis deserves further study. The effectiveness of a multicomponent, non-pharmacological approach is shown in non-ICU patients, which provides proof of concept for use in the ICU. The few studies on this approach in ICU patients suggest that the burden of ICU delirium may be reduced by early mobility, increased daylight exposure and the use of earplugs. In addition, the combined use of sedation, ventilation, delirium and physical therapy protocols can reduce the frequency and severity of adverse outcomes and should become part of routine practice in the ICU, as should avoidance of deliriogenic medication such as anticholinergic drugs and benzodiazepines. Once delirium develops, symptomatic treatment with antipsychotics is recommended, with haloperidol being the drug of first choice. However, there is limited evidence on the safety and effectiveness of antipsychotics in ICU delirium. PMID:22804788

Zaal, Irene J; Slooter, Arjen J C

2012-07-30

126

Graphic Representation of Illness: A Novel Method of Measuring Patients’ Perceptions of the Impact of Illness  

Microsoft Academic Search

Background: Health outcome is multi-faceted, and for both research and clinical practice, greater knowledge of its facets is required. The Pictorial Representation of Illness and Self Measure (PRISM) was developed as a simple, rapid measure of the current impact of illness and symptoms on the individual. Methods: The PRISM task was completed by 26 outpatients with rheumatoid arthritis participating in

Stefan Büchi; Tom Sensky; Louis Sharpe; Natalie Timberlake

1998-01-01

127

Current Legislation on Admission of Mentally Ill Patients in China  

PubMed Central

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

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

2009-01-01

128

Effect of Ventilator Mode on Sleep Quality in Critically Ill Patients  

Microsoft Academic Search

To determine whether sleep quality is influenced by the mode of free of critical illness, arousals can result from a derangement mechanical ventilation, we performed polysomnography on 11 criti- of arterial blood gases or an increase in respiratory effort cally ill patients. Because pressure support predisposes to central (11-13), and both are common occurrences in critically ill apneas in healthy

Sairam Parthasarathy; Martin J. Tobin

129

Psychological States in Terminal Cancer Patients as Measured Over Time.  

ERIC Educational Resources Information Center

Determined the level and change in denial, death anxiety, anxiety, depression, hostility, love, being, and self-esteem over time in terminal cancer patients. Cancer patients had significantly lower death anxiety than the control subjects and a relative increase in the being variable over time. The clinical opinion that denial protects against…

Dougherty, Kimberly; And Others

1986-01-01

130

Illness perceptions and coping explain well-being in patients with Huntington's disease  

Microsoft Academic Search

This study sought to investigate the contribution of illness perceptions and coping mechanisms to the explanation of well-being of patients with Huntington's disease (HD). We investigated the Leventhal et al. assumption of the Self-regulation Model that coping mediates the relationship between illness perceptions and patients’ well-being. Illness perceptions, coping, and well-being in 77 HD patients were assessed with validated questionnaires;

Adrian A. Kaptein; Desiree I. Helder; Margreet Scharloo; Godfried M. J. Van Kempen; John Weinman; Hans J. C. Van Houwelingen; Raymund A. C. Roos

2006-01-01

131

C5a Mediates Peripheral Blood Neutrophil Dysfunction in Critically Ill Patients  

Microsoft Academic Search

Rationale: Critically ill patients are highly susceptible to hospital- acquired infection. Neutrophil function in critical illness remains poorly understood. Objectives: To characterize and define mechanisms of peripheral blood neutrophil (PBN) dysfunction in critically ill patients. To determinewhethertheinflamedlungcontributesadditionalphago- cytic impairment. Methods:Prospectivecollectionofbloodandbronchoalveolarlavage fluid from patients with suspected ventilator-associated pneumonia and from age- and sex-matched volunteers; laboratory analysis of neutrophil functions. Measurements and

Andrew Conway Morris; Kallirroi Kefala; Thomas S. Wilkinson; Kevin Dhaliwal; Lesley Farrell; Tim Walsh; Simon J. Mackenzie; Hamish Reid; Donald J. Davidson; Chris Haslett; Adriano G. Rossi; Jean-Michel Sallenave; A. John Simpson

2009-01-01

132

A randomised, controlled trial of the pulmonary artery catheter in critically ill patients  

Microsoft Academic Search

Objective: To compare the survival and clinical outcomes of critically ill patients treated with the use of a pulmonary artery catheter (PAC) to those treated without the use of a PAC. Design: Prospective, randomised, controlled, clinical trial from October 1997 to February 1999. Setting: Adult intensive care unit at a large teaching hospital. Patients: Two hundred one critically ill patients

Andrew Rhodes; Rebecca J. Cusack; Philip J. Newman; Michael R. Grounds; David E. Bennett

2002-01-01

133

Long-term treatment for patients with severe mental illness and substance abuse  

Microsoft Academic Search

Summary Drug and alcohol addiction is common among patients with severe mental illness. Those patients often fall between different treatment systems. Since 1994 a long-term treatment for patients with this kind of \\

Olof Blix; Ulf Eek

134

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

PubMed

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

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

135

USING COMPUTATIONAL PATIENTS TO EVALUATE ILLNESS MECHANISMS IN SCHIZOPHRENIA  

PubMed Central

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

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

2011-01-01

136

Senescent birds redouble reproductive effort when ill: confirmation of the terminal investment hypothesis  

Microsoft Academic Search

This study reports an experimental confirmation of the terminal investment hypothesis, a longstanding theoretical idea that animals should increase their reproductive effort as they age and their prospects for survival and reproduction decline. Previous correlational and experimental attempts to test this hypothesis have yielded contradictory results. In the blue-footed booby, Sula nebouxii, a long-lived bird, after initial increase, male reproductive

Alberto Velando; Hugh Drummond; Roxana Torres

2006-01-01

137

Public attitudes toward euthanasia and suicide for terminally ill persons: 1977 and 1996  

Microsoft Academic Search

This study replicates Singh's (1979) “classic” examination of correlates of euthanasia and suicide attitudes. The purposes of the current study were to assess (1) changes in public attitudes toward these voluntary termination of life practices, and (2) changes in the effects on attitudes of selected independent variables. I found Americans’ approval of both euthanasia and suicide in 1996 to be

Michael A. DeCesare

2000-01-01

138

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

ERIC Educational Resources Information Center

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…

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

2008-01-01

139

Ultrasonography of the optic nerve in neurocritically ill patients.  

PubMed

The rapid diagnosis of intracranial hypertension is urgently needed for therapeutic reasons in various clinical settings. This can rarely be achieved without invasive procedures such as intracranial pressure (ICP) monitoring or neuroimaging. The optic nerve is surrounded by cerebrospinal fluid (CSF) and dura mater, which forms the optic nerve sheath (ONS). Because of the connection with the intracranial subarachnoid space, ONS diameter (ONSD) is influenced by CSF pressure variations. Bedside ultrasonographic measurement of ONSD has been proposed as a non-invasive and reliable means to detect raised ICP in neurocritically ill patients. In several studies, it proves to have a good correlation with the direct measurement of ICP and a low interobserver variability. However, no general consensus exists over the upper normal ONSD limit. We performed a review of the literature on the use of the ultrasonography of the optic nerve in the evaluation of patients with suspected intracranial hypertension. The aim of this review is to describe the technique and to assess the validity of this diagnostic method. PMID:21463263

Moretti, R; Pizzi, B

2011-07-01

140

Technical efficiency in the clinical management of critically ill patients.  

PubMed

The purpose of this paper is to obtain empirical measures of performance in the management of critical patients treated in intensive care units (ICUs) and to evaluate the factors associated with performance, in a two stage approach. In the first stage, this paper uses an extended version of Data Envelopment Analysis (non-discretionary and categorical variables, and weight constraints under consideration) to obtain measures of technical efficiency in the treatment of 993 critical care patients in intensive care units in Catalonia (Spain) in 1991-92. The model incorporates accurate individual measures of illness severity from Mortality Probability Models (MPM II0) and quality outcome measures in the input-output set to obtain non-biased efficiency measures. In the second stage, a loglinear regression model is applied to test a number of hypothesis about the role of different environmental factors--such as ownership, market structure, dimension, internal organization, diagnostic, mortality risk, etc.--to explain differences in the efficiency scores. PMID:9639338

Puig-Junoy, J

1998-05-01

141

Would more mental illness services help general practitioners manage their difficult patients?  

PubMed Central

It is argued that the type of local specialist services and the extent of their use are largely the outcome of negotiations between general practitioners and their patients. A study was carried out on behalf of a health care planning team for the mentally ill to discover whether more mental illness services would help general practitioners manage their difficult patients. The findings led to some developments in problem-oriented services but not mental illness services in general. PMID:7310761

Broome, Annabel K.; Kat, Bernard J. B.

1981-01-01

142

Predictive value of an abnormal hepatobiliary scan in patients with severe intercurrent illness  

SciTech Connect

Ten patients had severe intercurrent illness and the gallbladder could not be seen on a hepatobiliary scan. In 4, surgery and pathological examination showed that the gallbladder was normal; 1 had chronic cholecystitis and 5 had acute acalculous cholecystitis. This study indicates that a positive hepatobiliary scan may not be indicative of acute gallbladder disease in the seriously ill patient.

Kalff, V.; Froelich, J.W.; Lloyd, R.; Thrall, J.H.

1983-01-01

143

Evaluation of multifrequency bioimpedance spectroscopy for measurement of the extracellular water space in critically ill patients  

Microsoft Academic Search

The purpose of this study was to compare multifrequency bioimpedance spectroscopy (BIS) estimates of extracellular water volume (ECW) in critically ill patients with measurements by bromide dilution. Stable bromide dilution and BIS were performed in 37 critically ill patients as soon as haemodynamic stability was achieved (day 0) and again 10 days later. While BIS underestimated the dilution results on

L. D. Plank; D. N. Monk; G. A. Woollard; G. L. Hill

1998-01-01

144

Doctors, patients and influenza-like illness: clinicians or patients at risk?  

Microsoft Academic Search

Background: Healthcare providers can transmit influenza and influenza-like illness (ILI) to patients and vice versa. However, the magnitude of this problem in the healthcare system as a whole is unknown. Using population-based administrative health data, we tested the hypothesis of a temporal association of ILI diagnosis among clinicians and their patients.Methods: Healthcare providers under study included physicians (85%) and a

N. Yiannakoulias; M. L. Russell; L. W. Svenson; D. P. Schopflocher

2004-01-01

145

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

PubMed

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

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

2014-08-01

146

Sleep disturbances in critically ill patients in ICU: how much do we know?  

PubMed

Sleep disturbances in the intensive care unit (ICU) seem to lead to development of delirium, prolonged ICU stay, and increased mortality. That is why sufficient sleep is important for good outcome and recovery in critically ill patients. A variety of small studies reveal pathological sleep patterns in critically ill patients including abnormal circadian rhythm, high arousal and awakening index, reduced Slow Wave Sleep, and Rapid Eye Movement sleep. The purpose of this study is to summarise different aspects of sleep-awake disturbances, causes and handling methods in critically ill patients by reviewing the underlying literature. There are no studies of level 1 evidence proving the positive impact of the tested interventions on the critically ill patients' sleep pattern. Thus, disturbed sleep in critically ill patients with all the severe consequences remains an unresolved problem and needs further investigation. PMID:22404330

Boyko, Y; Ording, H; Jennum, P

2012-09-01

147

Evaluation of Prescribing Medications for Terminal Cancer Patients near Death: Essential or Futile  

PubMed Central

Purpose The purpose of this study is to evaluate the prescription of essential or futile medications for terminal cancer patients during their final admission. Materials and Methods We conducted a retrospective review of the medical charts of terminally ill cancer patients admitted to the Hemato-oncology Department of two teaching hospitals from March 1, 2007 to December 31, 2009. Essential medications were based on the drugs listed by the International Association for Hospice and Palliative Care, while futile medications were defined when short-term benefit to patients with respect to survival, quality of life, or symptom control was not anticipated. Results A total of 196 patients were included. Among essential medications, strong opioids were the most frequently prescribed drugs during the last admission (62.2% fentanyl, 44.3% morphine), followed by megestrol (46.0%), and metoclopramide (37.2%); 51% of gastric protectors were prescribed with potential futility. Anti-hypertensive and antiglycemic agents were administered to those who experienced arterial blood pressure below 90 mm Hg (47.3%) or presented with a single measurement of fasting glucose below 50 mg/dL (10.7%), respectively. Statins were prescribed to 6.1% (12/196) of patients, and 75% of those prescriptions were regarded as futile. Conclusion Our data suggest that effective prescription of essential medications and withdrawal from futile medications should be actively reconciled for improvement of a patient's end-of-life care. PMID:24155681

Lee, Hye Ran; Yi, Seong Yoon

2013-01-01

148

[Work disability in long-term illness--Part 2: Termination of employment].  

PubMed

If the employment has terminated and the performance capacity of the employee is no longer up to demands made by his last job, the second consideration in respect of his disablement concerns the following points: similar work to be performed within the narrow framework of his former in case of compensation payment because of unemployment: activities within the framework of jobs he can be judged to perform, as laid down by German labour legislation in respect of compensation payments to the unemployed. The compulsory sickness body will have to clarify by expertising which activities can be considered as yardsticks from a medical point of view. PMID:8268702

Hennies, G

1993-10-01

149

[Using the illness representation model to provide care for a patient with diabetic nephropathy].  

PubMed

Patients interpret illness through personal knowledge and experience, while illness representation guides patient attitudes with regard to seeing a doctor, accepting treatment and adopting healthy behavior. Nurses who understand the illness representation of patients may be better able to provide intervention in order to enhance patient self-care skills and ultimately improve patient health. This article describes a nurse's experience providing care to a patient with diabetic nephropathy. He suffered from decreasing urine output, lower limb edema and shortness of breath. He also underwent a role transformation from a healthy individual to hemodialysis patient. He interpreted hemodialysis to be the end of meaning in his life and as preventing his continuing to work and earn money. He thus rejected hemodialysis treatment. The authors applied the illness presentation model to understand the patient's perception of his illness, then helped the patient to correct his misconceptions about the hemodialysis treatment in order to change his illness representation of hemodialysis and guide him to accept his new role. After one month of care, the patient accepted arterio-venous shunt surgery and accepted that hemodialysis both mitigated his illness and improved life quality. The authors would like to share their report on this case to provide nursing professionals with a reference on one approach to improving healthcare quality. PMID:20535685

Yang, Lin-Chi; Lin, Chiu-Chu

2010-06-01

150

Illness beliefs of leprosy patients: use of medical anthropology in clinical practice.  

PubMed

Illness beliefs of 61 patients identified as having leprosy were assessed by Kleinman's Explanatory Model Format. Our patients used a wide variety of etiologic theories which were grouped in categories such as venereal disease, heredity, dangerous food, sin, karma, and humoral disorders. Despite efforts at patient education, very few patients adopted the concept of bacterial infection to explain their illness. The patients identified their illness with a variety of different labels, some of which had associations with particular symptoms. Leprosy was perceived and experienced more as a series of acute disorders not necessarily related to one another. The various theories of illness were instrumental in directing treatment choices which included a number of indigenous healing practices. Such information may be useful in improving patient care and compliance by providing practitioners with interpretive strategies for communicating with their patients. PMID:3411165

Neylan, T C; Nelson, K E; Schauf, V; Scollard, D M

1988-06-01

151

Senescent birds redouble reproductive effort when ill: confirmation of the terminal investment hypothesis  

PubMed Central

This study reports an experimental confirmation of the terminal investment hypothesis, a longstanding theoretical idea that animals should increase their reproductive effort as they age and their prospects for survival and reproduction decline. Previous correlational and experimental attempts to test this hypothesis have yielded contradictory results. In the blue-footed booby, Sula nebouxii, a long-lived bird, after initial increase, male reproductive success declines progressively with age. Before laying, males of two age classes were challenged with lipopolysaccharide to elicit an immune response, which induced symptoms of declining survival prospects. Reproductive success of immune-challenged mature males fell, while that of immune-challenged old males showed a 98% increase. These results demonstrate that senescent males with poor reproductive prospects increase their effort when those prospects are threatened, whereas younger males with good reproductive prospects do not. PMID:16777735

Velando, Alberto; Drummond, Hugh; Torres, Roxana

2006-01-01

152

Senescent birds redouble reproductive effort when ill: confirmation of the terminal investment hypothesis.  

PubMed

This study reports an experimental confirmation of the terminal investment hypothesis, a longstanding theoretical idea that animals should increase their reproductive effort as they age and their prospects for survival and reproduction decline. Previous correlational and experimental attempts to test this hypothesis have yielded contradictory results. In the blue-footed booby, Sula nebouxii, a long-lived bird, after initial increase, male reproductive success declines progressively with age. Before laying, males of two age classes were challenged with lipopolysaccharide to elicit an immune response, which induced symptoms of declining survival prospects. Reproductive success of immune-challenged mature males fell, while that of immune-challenged old males showed a 98% increase. These results demonstrate that senescent males with poor reproductive prospects increase their effort when those prospects are threatened, whereas younger males with good reproductive prospects do not. PMID:16777735

Velando, Alberto; Drummond, Hugh; Torres, Roxana

2006-06-22

153

Voices of the terminally ill: uncovering the meaning of desire for euthanasia.  

PubMed

This study aimed to better understand the meaning of desire for euthanasia. An hermeneutic approach was undertaken using a purposively selected sample of advanced cancer patients who desired euthanasia while receiving palliative care. Unstructured interviews were conducted with six participants, which were audiotaped, transcribed and analysed. This approach allowed in-depth exploration and interpretation of the patients' lived experience. The findings illustrated a timeline from previous wellness to approaching death with five major themes: (1) reality, (2) perception, (3) anticipation, (4) desire and (5) holding environment. The desire for euthanasia is not confined to physical or psychosocial concerns relating to advanced cancer, but incorporates hidden existential yearnings for connectedness, care and respect, understood within the context of the patients' lived experience. Euthanasia requests cannot be taken at face value but require in-depth exploration of their covert meaning, in order to ensure that the patients' needs are being addressed adequately. PMID:15984507

Mak, Yvonne Yi Wood; Elwyn, Glyn

2005-06-01

154

Patients' narratives of chronic illnesses and the notion of biographical disruption.  

PubMed

Bury's (1982) argument that the onset of a chronic illness represents a biographical disruption has become paradigmatic in the sociology of illness studies. More recently Bury (1991, 1997) himself Williams (2000) and other medical sociologists have argued that the notion of illness as biographical disruption needs re-examination. Following a phenomenological approach, in this paper the author draws on different narrative models (Labov and Waletzky 1967 and Ricoeur 1980) to analyze how patients orient to the onset of chronic illness as the complicating action. The data comprise eight narratives collected in South America: three correspond to patients with renal failure, and five to patients with HIV/AIDS disease. It is observed that in some cases, patients' complicating actions are rather oriented to experiences of poverty, drug addiction, and criminality that took place prior to their onset of their illnesses. These experiences, instead of the onset of their illnesses, occupy the place of the complicating action in these patients' narratives. The author discusses that in the studies of illness narratives, it is difficult to operate from a different paradigm, but argues that conflating the onset of chronic illness with a biographical disruption may confuse the episodic dimension of narrative with the configurational dimension. PMID:22616353

Delbene, Roxana

2011-01-01

155

Feigning terminal illness to get narcotics: a cautionary tale for hospices.  

PubMed

We present the case of a woman who enrolled in the hospice benefit in order to obtain narcotics. We believe this is a cautionary tale for hospices because of our propensity to enroll patients with minimal corroborating information, in order not to delay symptom management. Also we are philosophically predisposed to believe a patient's self-report of pain and other distressing symptoms. PMID:21868431

Gonzalez, Faustino; Galante, Mirta

2012-08-01

156

ENFERMEDAD TERMINAL Y PSICOLOGÍA DE LA SALUD  

Microsoft Academic Search

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,

Gregorio Escalante; Karen Lorena Escalante

2002-01-01

157

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

PubMed Central

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

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

2014-01-01

158

Quality Nursing Care for Hospitalized Patients with Advanced Illness: Concept Development  

PubMed Central

The quality of nursing care as perceived by hospitalized patients with advanced illness has not been examined. A concept of quality nursing care for this population was developed by integrating the literature on constructs defining quality nursing care with empirical findings from interviews of 16 patients with advanced illness. Quality nursing care was characterized as competence and personal caring supported by professionalism and delivered with an appropriate demeanor. Although the attributes of competence, caring, professionalism, and demeanor were identified as common components of quality care across various patient populations, the caring domain increased in importance when patients with advanced illness perceived themselves as vulnerable. Assessment of quality nursing care for patients with advanced illness needs to include measures of patient perceptions of vulnerability. PMID:20572095

Izumi, Shigeko; Baggs, Judith G.; Knafl, Kathleen A.

2011-01-01

159

Current practice in transferring critically ill patients among hospitals in the west of Scotland  

Microsoft Academic Search

OBJECTIVE--To identify the requirements of an interhospital transfer service for critically ill patients. DESIGN--Retrospective survey of the current functions of a specialist interhospital transfer team from data collected at the time of transfer and from records of intensive care unit. SETTING--Mobile intensive care unit based at a tertiary referral centre, which serves the west of Scotland. PATIENTS--All critically ill patients

W G Reeve; C J Runcie; J Reidy; P G Wallace

1990-01-01

160

Six-month outcome of critically ill patients given glutamine-supplemented parenteral nutrition  

Microsoft Academic Search

An abundant amino acid in the human body, glutamine (Gln) has many important metabolic roles that may protect orpromote tissue integrity and enhance the immune system. Low plasma and tissue levels of Gln in the critically ill suggest that demand may exceed endogenous supply. A relative deficiency of Gln in such patients could compromise recovery and result in prolonged illness

Richard D. Griffiths; Christina Jones; T. E. Allan Palmer

1997-01-01

161

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

ERIC Educational Resources Information Center

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…

Monajemi, Alireza; Schmidt, Henk G.; Rikers, Remy M. J. P.

2012-01-01

162

Body consciousness, illness-related impairment, and patient adherence in hemodialysis  

Microsoft Academic Search

Recent theory and evidence suggests that bodily self-focusing tendencies (e.g., private body consciousness) may be associated with medical regimen adherence among chronically ill patients. The present study examined the joint effects of private body consciousness and degree of illness- related physical impairment on treatment regimen adherence in a sample of 52 hemodialysis pa- tients. It was predicted that the effect

Alan J. Christensen; John S. Wiebe; Dawn L. Edwards; John D. Michels; William J. Lawton

1996-01-01

163

Interpretation of C-Reactive Protein Concentrations in Critically Ill Patients  

PubMed Central

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

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

2013-01-01

164

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

PubMed Central

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

2014-01-01

165

Interval neurophysiological changes in non septic critically ill mechanically ventilated patients.  

PubMed

Peripheral nerve changes in critically ill patients are common, sepsis being the most important risk factor. The aim of our study is to investigate interval neurophysiological changes in non septic mechanically ventilated critically ill patients, a group who has not been the focus of previous studies. Consecutive non septic mechanically ventilated critically ill patients were included. Baseline nerve conduction studies (NCS) were done within 3 days of intensive care unit admission, and 48 hours after the initiation of mechanical ventilation, and were followed up 7-8 days later. Sural and ulnar sensory, and median and peroneal motor nerves were tested. Nine patients were studied, five (56%) showed significant changes in their NCS compared to baseline. The peroneal and sural nerve amplitudes significantly dropped in all of the five affected patients, with drop of those of the median motor nerves in two, and ulnar sensory nerves in three patients. In conclusion, interval changes in peripheral nerves can exist in critically ill mechanically ventilated non septic patients. The pattern is similar to critically ill patients with sepsis. Theories of possible pathophysiology of critical illness neuropathy should not merely depend on the presence of sepsis as a trigger and other mechanisms should be investigated. PMID:22854770

El-Salem, Khalid; Khassawneh, Basheer; Alrefai, Ali; Dwairy, Abdel Raheem; Rawashdeh, Sukaina

2012-08-01

166

Treatment of substance abuse in severely mentally ill patients  

Microsoft Academic Search

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

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

1993-01-01

167

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

E-print Network

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 ...

Mandelbaum, Tal

168

Immediate intralipid clearance from plasma in critically ill patients after a single-dose injection  

SciTech Connect

Plasma fractional removal rates (k2) of Intralipid injected in parallel with /sup 125/I albumin were analyzed in five healthy males and nine critically ill patients. The k2 values of critically ill patients were similar to those of healthy subjects. However, the initial plasma concentrations of Intralipid calculated by extrapolation to zero-time (y0) were markedly different. The mean y0 value in the critically ill patients was 43% that of healthy subjects. No plasma loss of /sup 125/I albumin occurred throughout the test. Intralipid to /sup 125/I albumin plasma concentration ratios during the removal phase paralleled the curves obtained from the iv fat tolerance test. This suggests that these ratios depend on Intralipid clearance rather than leakage from the circulation. The immediate loss of Intralipid suggests that the pulmonary vasculature, the first capillary bed through which the emulsion passes, could be the site where a substantial uptake of the emulsion occurs in critically ill patients.

Lindh, A.; Roessner, S.

1987-09-01

169

Gender-specific correlates of substance use in patients with serious mental illness  

Microsoft Academic Search

The aims of this study were to examine gender differences in symptoms, functioning, substance use problems and substance use correlates in patients with serious mental illness. The current study is cross-sectional, and data were collected using the Health of the Nation Outcome Scales for Severe Mental Illness (HoNOS-SMI) questionnaire. The questionnaire was completed by the patients' therapists. The study included

Turid Møller Olsø; Camilla Buch Gudde; Elin Wullum; Olav M. Linaker

2012-01-01

170

Sepsis is a major determinant of outcome in critically ill HIV\\/AIDS patients  

Microsoft Academic Search

INTRODUCTION: New challenges have arisen for the management of critically ill HIV\\/AIDS patients. Severe sepsis has emerged as a common cause of intensive care unit (ICU) admission for those living with HIV\\/AIDS. Contrastingly, HIV\\/AIDS patients have been systematically excluded from sepsis studies, limiting the understanding of the impact of sepsis in this population. We prospectively followed up critically ill HIV\\/AIDS

André M Japiassú; Rodrigo T Amâncio; Emerson C Mesquita; Denise M Medeiros; Helena B Bernal; Estevão P Nunes; Paula M Luz; Beatriz Grinsztejn; Fernando A Bozza

2010-01-01

171

Immunoinflammatory response in critically ill patients: severe sepsis and/or trauma.  

PubMed

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

Surbatovic, Maja; Veljovic, Milic; Jevdjic, Jasna; Popovic, Nada; Djordjevic, Dragan; Radakovic, Sonja

2013-01-01

172

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

PubMed Central

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

Popovic, Nada; Djordjevic, Dragan

2013-01-01

173

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

PubMed Central

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

Latalova, Klara; Kamaradova, Dana; Prasko, Jan

2014-01-01

174

Assessment of pain and other symptoms in mexican patients with advanced illness.  

PubMed

ABSTRACT Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual. During this stage, several symptoms appear and contribute to a decrement in the quality of life. We performed a retrospective study evaluating medical records of terminally ill patients who attended a specialized pain and palliative medicine service. The Edmonton Symptom Assessment Scale (ESAS) was used to document symptoms intensity. Data analysis was carried out at two times: the initial assessment and the last visit before death. We analyzed thirty-eight cases of which 58% were women (22 cases) and the mean age of the sample was 60.7 years (SD: 15.6). All cases had an oncologic disease classified as end-stage cancer and were considered as palliative patients. Symptom intensity was documented by the ESAS in two different moments: pain 3.7 (SD: 3.2) vs. 4.1 (SD: 3.4), nausea 1.4 (SD: 3.2) vs. 1.8 (SD: 3.3), depression 3.4 (SD: 3.4) vs. 4.3 (SD: 3.7), anxiety 3 (SD: 3.5) vs. 2.4 (SD: 3.6), weakness 4.8 (SD: 3.5) vs. 6.2 (SD: 3.6), dyspnea 1.1 (SD: 2.7) vs. 2.8 (SD: 3.4), anorexia 3.5 (SD: 3.7) vs. 4.7 (SD: 3.8), and somnolence 2.6 (SD: 3.5) vs. 4.9 (SD: 3.5). Statistical significance was found in weakness, dyspnea, and somnolence. We found the ESAS a useful tool for symptom assessment. In this study, we document the prevalence of symptoms at the end of life in a Spanish-speaking country. Physicians trained in pain and palliative medicine managed those symptoms, and we observed that symptoms maintained the same intensity. There is the possibility that the intervention made by those clinicians modified the symptomatic outcome in those patients. Evaluation of effective protocols for symptom management at the end of life is needed. PMID:25313923

Covarrubias-Gómez, Alfredo; Hernández-Martínez, Eva E; Ruiz-Ramírez, S; López Collada-Estrada, Maria

2014-12-01

175

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

PubMed

Respiratory syncytial virus (RSV), although not typically considered an important pathogen in adults, may cause acute exacerbation of chronic obstructive pulmonary disease (COPD). It is unclear which COPD patients are at highest risk for developing serious RSV illness. Our objective was to identify risk factors for RSV illness among adult patients with COPD. We conducted a pooled analysis of data from COPD patients in 2 previously published longitudinal studies that examined RSV infection in high risk adults for ? 2 RSV seasons. Risk factors for RSV illness studied included age, sex, race, smoking status, exposure to children, home oxygen use, inhaled or oral steroid use, instrumental activities of daily living scores, and co-morbid conditions. Outcomes studied included symptomatic and medically attended RSV illness. Logistic regression was used to identify significant risk factors for RSV illness among older adults with COPD. Among 379 patients with COPD, the rate of symptomatic RSV illness was 11.1% (42/379); almost half (20/42) of whom required medical attention. In multivariable analyses, congestive heart failure (odds ratio [OR] = 4.18; 95% CI: 1.38, 12.69) and exposure to children (OR = 2.38; 95% CI: 1.03, 5.51) were risk factors for symptomatic RSV illness. Congestive heart failure (OR = 4.16; 95% CI: 1.02, 17.01) was the only significant risk factor for developing medically attended RSV illness. Exposure to children and congestive heart failure are risk factors for RSV illness among adult patients with COPD. Future prospective, well-designed studies are needed to corroborate these findings and examine other risk factors, including history of exacerbations. PMID:23536980

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

2013-06-01

176

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

PubMed Central

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

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

177

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

PubMed Central

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

Kaufman, David R; Ruland, Cornelia M

2014-01-01

178

Care of long-term mentally ill patients by British general practitioners.  

PubMed

In the United Kingdom, patients gain access to psychiatric care through general practitioners (GPs). The first of three studies conducted to assess the role of GPs in managing patients with long-term mental illness found that such patients were unevenly distributed in general practices and that GPs preferred to care for them in collaboration with psychiatric specialists. A more detailed study of 16 general practices yielded information on characteristics and care of long-term mentally ill patients, including a high rate of GP consultations for them. A third, controlled study examined the impact of teaching GPs to provide a structured assessment of long-term mentally ill patients every six months; after the intervention, only a small number of patients actually received such assessments. PMID:9406270

Burns, T; Kendrick, T

1997-12-01

179

Duration of Illness and Treatment Effects on Hippocampal Volume in Male Patients with Schizophrenia  

E-print Network

of the hippocampus is one of the most consistently described structural abnormalities in patients with schizophrenia patients with schizophrenia or schizophreniform disorder. Method Quantitative 1.5 Tesla MRI examinations1 Duration of Illness and Treatment Effects on Hippocampal Volume in Male Patients

180

Reliability of anion gap as an indicator of blood lactate in critically ill patients  

Microsoft Academic Search

Objective: To evaluate the sensitivity, specificity, and predictive values of an elevated anion gap as an indicator of hyperlactatemia\\u000a and to assess the contribution of blood lactate to the serum anion gap in critically ill patients. Design: Prospective study. Setting: General intensive care unit of a university hospital. Patients: 498 patients, none with ketonuria, severe renal failure or aspirin, glycol,

J. Levraut; T. Bounatirou; C. Ichai; J.-F. Ciais; P. Jambou; R. Hechema; D. Grimaud

1997-01-01

181

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

Microsoft Academic Search

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

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

2006-01-01

182

Psychiatric morbidity among cancer patients and awareness of illness  

Microsoft Academic Search

A significant proportion of cancer patients experience psychiatric morbidity. Potential predictors of psychiatric morbidity include patient disease-related factors and factors relating to the patient’s environment. The aim of this study was to investigate the prevalence of psychiatric morbidity and the relationship between the clinical or personal factors, especially psychiatric morbidity, and awareness of cancer diagnosis among a group of Turkish

FigenCulha Atesci; Bahar Baltalarli; NalanKalkan Oguzhanoglu; Filiz Karadag; Osman Ozdel; Nursel Karagoz

2004-01-01

183

[Chronic illness from the perspective of patients and health professionals: a qualitative study in Mexico].  

PubMed

Chronic diseases are leading causes of morbidity, mortality, and increasing expenditures in numerous countries. However, little is known about how chronic diseases are perceived and managed by social actors. This article aims to compare the perspectives of health professionals and patients towards chronic diseases, besides analyzing the relationship between these two groups. A qualitative, multi-center study was conducted in three Mexican cities: Guadalajara, San Luis Potosí, and Mexico City. Participants included chronically ill individuals, physicians, and other health professionals from primary and secondary health care centers. Data collection used focus groups and interviews. The data were analyzed using discourse analysis. Participants' perceptions varied, from the medicalized view of physicians to that of patients focused on illness and the lifeworld. The participants agreed that there are unequal relationships between health professionals, families, and the chronically ill, but that relationships are more equal among the chronically ill themselves. The article includes by discussing various implications of the findings. PMID:17700952

Mercado-Martínez, Francisco J; Hernández-Ibarra, Eduardo

2007-09-01

184

The balance between providing support, prolonging suffering, and promoting death: Ethical issues surrounding psychological treatment of a terminally-ill client  

Microsoft Academic Search

A psychologist with a client who is terminally ill and wishes to discuss end-of-life options, specifically the option of hastening death, is faced with an ethical dilemma as to how to proceed with treatment. Specifically, he or she is bound by the American Psychological Association's potentially-conflicting Principles A and E, which advise a psychologist to “do no harm” as well

Rachel Winograd

2012-01-01

185

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

Microsoft Academic Search

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

Mateja Strbad; Igor Švab; Bojan Zalar; Vesna Švab

186

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

PubMed Central

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

2014-01-01

187

The Stigma of Mental Illness: Patients’ Anticipations and Experiences  

Microsoft Academic Search

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

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

2004-01-01

188

Hypothermia predicts mortality in critically ill elderly patients with sepsis  

Microsoft Academic Search

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

Ravindranath Tiruvoipati; Kevin Ong; Himangsu Gangopadhyay; Subhash Arora; Ian Carney; John Botha

2010-01-01

189

Ventilator Associated Pneumonia in Critically Ill Patients: Prevention and Treatment  

Microsoft Academic Search

Ventilator associated pneumonia (VAP) represents a major threat to the recovery of patients receiving mechanical ventilation, and is a difficult diagnostic and therapeutic challenge for critical care physicians. VAP occurs in 5-25% of all patients with different varieties of respiratory failure, and its incidence exceeds 70% in patients who die of adult respiratory distress syndrome (ARDS). The microaspiration of bacteria

Argyris MICHALOPOULOS; Stefanos GEROULANOS

190

Demoralization, anhedonia and grief in patients with severe physical illness  

PubMed Central

Within the physically ill population, demoralization has been a valuable concept with which to consider dysphoric states. Moreover, it can be distinguished from other mood states. In this study we replicate previous research and show that demoralization can be distinguished from anhedonic depression and grief. All three correlate more or less equally with measures of depression (e.g., the Beck Depression Inventory), although they are differentiated on styles of coping, and social, family and physical functioning. These results confirm that distinguishing depression with demoralization from depression with anhedonia is both useful and scientifically valid. It sharpens the characterisation of dysphoric states and provides an empirical framework to enhance research into the aetiology and treatment of depression. PMID:16633525

CLARKE, DAVID M.; KISSANE, DAVID W.; TRAUER, TOM; SMITH, GRAEME C.

2005-01-01

191

Sodium Intake, Dietary Knowledge, and Illness Perceptions of Controlled and Uncontrolled Rural Hypertensive Patients  

PubMed Central

Introduction and Objectives. Nutritional knowledge of the patients is important in dietary adherence. This study aimed to determine the relationship between illness perceptions and nutritional knowledge with the amounts of sodium intake among rural hypertensive patients. Methods. In a cross-sectional study, 671 hypertensive patients were selected in a multistage random sampling from the rural areas of Ardabil city, Iran, in 2013. Data were collected using a questionnaire consisting of four sections and were analyzed using Pearson correlation and multiple linear regressions by SPSS-18. Results. The mean of sodium intake in the uncontrolled hypertensive patients was 3599 ± 258?mg/day and significantly greater than controlled group (2654 ± 540?mg/day) (P < 0.001). Knowledge and illness perceptions could predict 47.2% of the variation in sodium intake of uncontrolled group. A significant negative relationship was found between knowledge and illness perceptions of uncontrolled hypertensive patients with dietary sodium intake (r = ?0.66, P < 0.001 and r = ?0.65, P < 0.001, resp.). Conclusion. Considering the fact that patients' nutritional knowledge and illness perceptions could highly predict their sodium intake, the importance of paying more attention to improve patients' information and perceptions about hypertension is undeniable, especially among the uncontrolled hypertensive patients. PMID:24678414

Azadbakht, Leila; Sharifirad, Gholamreza; Mahaki, Behzad; Sharghi, Afshan

2014-01-01

192

Somatisation: illness perspectives of asylum seeker and refugee patients from the former country of Yugoslavia  

Microsoft Academic Search

BACKGROUND: Somatisation is particularly challenging in multicultural contexts where patients and physicians often differ in terms of their illness-related beliefs and practices and health care expectations. This paper reports on a exploratory study aimed at better understanding how asylum seeker and refugee patients from the former country of Yugoslavia who were identified by their physicians as somatising make sense of

Noelle Junod Perron; Patricia Hudelson

2006-01-01

193

MPCS: Mobile-Phone Based Patient Compliance System for Chronic Illness Care  

E-print Network

, there is increasing interest in using mobile phones and wearable sensors for remote health monitoring [39], [17], [23MPCS: Mobile-Phone Based Patient Compliance System for Chronic Illness Care Guanling Chen, Bo Yan patients adopt this self-centered approach for long-term care. In this position paper, we propose Mobile-phone

Kotz, David

194

Causes of death and determinants of outcome in critically ill patients  

Microsoft Academic Search

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,

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

195

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

Microsoft Academic Search

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

Robert Horne; John Weinman

1999-01-01

196

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

Microsoft Academic Search

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

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

2004-01-01

197

Dental Hygiene Students' Preparation for Treatment of Patients with Mental Illnesses.  

ERIC Educational Resources Information Center

A survey of 138 dental hygiene programs gathered information on didactic and clinical experiences for preparing students to treat patients with mental illnesses. Although most curricula addressed the issue, inadequate time was allotted. Over half did not provide oral care to these patients; few felt the community's need was met. (MSE)

Lemon, Sherry; Reveal, Marge

1991-01-01

198

In 1995 a correlation between malnutrition and poor outcome in critically ill patients still exists  

Microsoft Academic Search

After more than two decades of nutritional awareness, we designed a prospective study to determine whether malnutrition is still a significant issue in hospitalized patients. Patients admitted to an intensive care unit (ICU) were divided into well-nourished and malnourished groups, according to their nutritional status as assessed by serum albumin level and weight\\/height ratio. Severity of illness, as assessed by

Manuel Giner; Alessandro Laviano; Michael M. Meguid; John R. Gleason

1996-01-01

199

ASSERTIVE COMMUNITY TREATMENT (ACT) FOR PATIENTS WITH SEVERE MENTAL ILLNESS: EXPERIENCE IN MALAYSIA  

Microsoft Academic Search

Psychiatric community-based services are being developed in Malaysia currently to ensure more comprehensive mental health care to especially patients with severe mental illness. Assertive Community Treatment (ACT) as one of the earliest component of community-based services has been observed to be useful and able to provide favourable outcomes in this group of patients. Though the paradigm shift has gradually occurred

Z Ruzanna; M Marhani

200

Psychopathology, Treatment Outcome and Attitude Toward Mental Illness in Mexican American and European Patients  

Microsoft Academic Search

Lower socio-economic European American and Mexican American psychiatric in- patients were compared on degree of psychopathology, response to treatment and attitude toward mental illness and hospitalization. The Mexican American patients were proportionately under-represented, but did not differ from the European Americans in degree of psychopathology at admission nor in response to treatment — both groups showing a high degree of

Harry H. Lawson; Marvin W. Kahn; Elliott M. Heiman

1982-01-01

201

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

PubMed Central

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

2013-01-01

202

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

PubMed Central

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

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

2008-01-01

203

Long-term outcome of patients with neurotic illness in general practice.  

PubMed Central

OBJECTIVE--To determine the 11 year outcome of neurotic disorder in general practice. DESIGN--Cohort study over 11 years. SETTING--Two general practices in Warwickshire England. SUBJECTS--100 patients selected to be representative of those identified nationally by general practitioners as having neurotic disorders. MAIN OUTCOME MEASURES--Mortality, morbidity, and use of health services. RESULTS--At 11 years 87 subjects were traced. The 11 year standardised mortality ratio was 173 (95% confidence interval 164 to 200). 47 were cases on the general health questionnaire, 32 had a relapsing or chronic psychiatric course, and 49 a relapsing or chronic physical course. Treatment for psychiatric illness was mainly drugs. The mean number of consultations per year was 10.8 (median 8.7). A persistent psychiatric diagnosis at one year follow up was associated with high attendance ( > 12 visits a year for 11 years) at follow up after age, sex, and physical illness were adjusted for. Severity of psychiatric illness (general health questionnaire score) at outset predicted general health questionnaire score at 11 year follow up, course of psychiatric illness, and high consultation rate. CONCLUSION--These data support the view that a neurotic illness can become chronic and is associated with raised mortality from all causes and high use of services. Such patients need effective intervention, particularly those with a more severe illness who do not recover within one year. PMID:8664767

Lloyd, K. R.; Jenkins, R.; Mann, A.

1996-01-01

204

Assessing placement of nasoduodenal tube and its usefulness in maintaining nutrition in critically ill patients.  

PubMed

Nutritional supplements to the critically ill patients are one of the major issues to be discussed. Enteric feeding is advantageous over parentral feeding because it maintains gut integrity and prevents bacterial translocation. Small intestinal feeding shows significant beneficial results. Nasoduodenal tube placement and its confirmation by serial pH monitoring and by radiological examination was done; and time taken to reach duodenum was assessed. This study was done in 40 critically ill patients, who were divided into two groups (Group 1 and Group2). Early enteric feeding via a nasoduodenal tube was found to be preferable with parentral therapy when there are no contraindications. Advantages of nasoduodenal tube feeding in critical ill patients were that feeding can be continued even in the absence of bowel sounds and passage of flatus. Insignificant complications were noted. PMID:19558064

Nayak, S K; Sherchan, M; Dutta Poudel, S; Chamling Rai, J; Shrestha, R; Shretha, B C; Shrestha, S; Bhattacharyya, P

2008-12-01

205

Can Metaphors and Analogies Improve Communication with Seriously Ill Patients?  

PubMed Central

Abstract Objective It is not known how often physicians use metaphors and analogies, or whether they improve patients' perceptions of their physicians' ability to communicate effectively. Therefore, the objective of this study was to determine whether the use of metaphors and analogies in difficult conversations is associated with better patient ratings of their physicians' communication skills. Design Cross-sectional observational study of audio-recorded conversations between patients and physicians. Setting Three outpatient oncology practices. Patients Ninety-four patients with advanced cancer and 52 physicians. Intervention None. Main outcome measures Conversations were reviewed and coded for the presence of metaphors and analogies. Patients also completed a 6-item rating of their physician's ability to communicate. Results In a sample of 101 conversations, coders identified 193 metaphors and 75 analogies. Metaphors appeared in approximately twice as many conversations as analogies did (65/101, 64% versus 31/101, 31%; sign test p?patient ratings of communication (??=?0.27; p?=?0.006), as did physicians who used more analogies (Spearman ??=?0.34; p?

Pickard, Amy; Fishman, Jessica M.; Alexander, Stewart C.; Arnold, Robert M.; Pollak, Kathryn I.; Tulsky, James A.

2010-01-01

206

Development of disaster pamphlets based on health needs of patients with chronic illnesses.  

PubMed

The aim of this research was to develop a pamphlet that would enable patients with diabetes, rheumatic diseases, chronic respiratory disease, and dialysis treatment to be aware of changes in their physical conditions at an early stage of a disaster, cope with these changes, maintain self-care measures, and recover their health. Illness-specific pamphlets were produced based on disaster-related literature, news articles, surveys of victims of the Great Hanshin-Awaji Earthquake Disaster and Typhoon Tokage, and other sources. Each pamphlet consisted of seven sections-each section includes items common to all illnesses as well as items specific to each illness. The first section, "Physical Self-Care", contains a checklist of 18 common physical symptoms as well as symptoms specific to each illness, and goes on to explain what the symptoms may indicate and what should be done about them. The main aim of the "Changes in Mental Health Conditions" section is to detect posttraumatic stress disorder (PTSD) at an early stage. The section "Preventing the Deterioration of Chronic Illnesses" is designed to prevent the worsening of each illness through the provision of information on cold prevention, adjustment to the living environment, and ways of coping with stress. In the sections, "Medication Control" and "Importance of Having Medical Examinations", spaces are provided to list medications currently being used and details of the hospital address, in order to ensure the continued use of medications. The section, "Preparing for Evacuations" gives a list of everyday items and medical items needed to be prepared for a disaster. Finally, the "Methods of Contact in an Emergency" section provides details of how to use the voicemail service. The following content-specific to each illness also was explained in detail: (1) for diabetes, complications arising from the deterioration of the illness, attention to nutrition, and insulin management; (2) for rheumatic diseases, a checklist of factors indicating the worsening of the illness and methods of coping with stress; (3) for chronic respiratory disease, prevention of respiratory infections and management of supplemental oxygen; and (4) for patients requiring dialysis, conditions of dialysis (such as dry weight, dialyzer, number of dialysis treatments, and dialysis hours) and what to do if a disaster occurs during dialysis. It is expected that these pamphlets will be useful to patients with chronic illnesses, and will be used to prepare for disasters, thereby helping the patients cope with the unusual situation that during a disaster and recover as soon as possible. PMID:20845325

Motoki, Emi; Mori, Kikuko; Kaji, Hidesuke; Nonami, Yoko; Fukano, Chika; Kayano, Tomonori; Kawada, Terue; Kimura, Yukari; Yasui, Kumiko; Ueki, Hiroko; Ugai, Kazuhiro

2010-01-01

207

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

PubMed Central

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

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

208

Echocardiographic estimation of mean pulmonary artery pressure in critically ill patients  

PubMed Central

Background Indirect assessment of mean pulmonary arterial pressure (MPAP) may assist management of critically ill patients with pulmonary hypertension and right heart dysfunction. MPAP can be estimated as the sum of echocardiographically derived mean right ventricular to right atrial systolic pressure gradient and right atrial pressure; however, this has not been validated in critically ill patients. Methods This prospective validation study was conducted in patients undergoing pulmonary artery catheterisation during intensive care admission. Pulmonary artery catheter (PAC) measurements of MPAP were contemporaneously compared to MPAP estimated utilising transthoracic echocardiography (TTE)-derived mean right ventricular to right atrial systolic pressure gradient added to invasively measured right atrial pressure. Results Of 53 patients assessed, 23 had estimable MPAP using TTE. The mean difference between TTE- and PAC-derived MPAP was 1.9?mmHg (SD 5.0), with upper and lower limits of agreement of 11.6 and ?7.9?mmHg, respectively. The median absolute percentage difference between TTE- and PAC-derived MPAP was 7.5%. Inter-rater reliability assessment was performed for 15 patients, giving an intra-class correlation coefficient of 0.96 (95% confidence intervals, 0.89 to 0.99). Conclusions This echocardiographic method of estimating MPAP in critically ill patients was not equivalent to invasively measured MPAP, based on our predefined clinically acceptable range (±5?mmHg). The accuracy of this method in critically ill patients was similar to the results obtained in ambulatory patients and compared favourably with regard to the accuracy with echocardiographic estimation of systolic pulmonary arterial pressure. The utility of this technique is limited by frequent inability to obtain an adequate tricuspid regurgitant time-velocity integral in critically ill patients. PMID:25024842

2014-01-01

209

Evaluating the efficiency of california providers in caring for patients with chronic illnesses.  

PubMed

In this paper we compare the relative efficiency of health care providers in managing patients with severe chronic illnesses over fixed periods of time. To minimize the contribution of differences in severity of illness to differences in care management, we evaluate performance over fixed intervals prior to death for patients who died during a five-year period, 1999-2003. Medicare spending, hospital bed and full-time equivalent (FTE) physician inputs, and utilization varied extensively between regions, among hospitals located within a given region, and among hospitals belonging to a given hospital system. The data point to important opportunities to improve efficiency. PMID:16291779

Wennberg, John E; Fisher, Elliott S; Baker, Laurence; Sharp, Sandra M; Bronner, Kristen K

2005-01-01

210

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

SciTech Connect

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.

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

1991-12-01

211

Anemia and blood transfusion in the critically ill patient: role of erythropoietin  

PubMed Central

Critically ill patients receive an extraordinarily large number of blood transfusions. Between 40% and 50% of all patients admitted to intensive care units receive at least 1 red blood cell (RBC) unit during their stay, and the average is close to 5 RBC units. RBC transfusion is not risk free. There is little evidence that 'routine' transfusion of stored allogeneic RBCs is beneficial to critically ill patients. The efficacy of perioperative recombinant human erythropoietin (rHuEPO) has been demonstrated in a variety of elective surgical settings. Similarly, in critically ill patients with multiple organ failure, rHuEPO therapy will also stimulate erythropoiesis. In a randomized, placebo-controlled trial, therapy with rHuEPO resulted in a significant reduction in RBC transfusions. Despite receiving fewer RBC transfusions, patients in the rHuEPO group had a significantly greater increase in hematocrit. Strategies to increase the production of RBCs are complementary to other approaches to reduce blood loss in the intensive care unit, and they decrease the transfusion threshold in the management of all critically ill patients. PMID:15196323

2004-01-01

212

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

PubMed

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

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

2014-11-01

213

[Burden of illness in Polish patients with reflux disease].  

PubMed

The clinical and socioeconomic burden of gastro-esophageal reflux disease (GERD) is considerable. The primary symptom of GERD is heartburn, but it may also be associated with extraesophageal manifestations, such as asthma, chest pain and otolaryngologic disorders. The objective of the study was to describe the impact of heartburn on patients' Health-Related Quality of Life (HRQL) in Poland, using validated generic and disease-specific instruments to measure patient-reported outcomes. Patients with symptoms of heartburn completed the Polish versions of the Gastrointestinal Symptom Rating Scale (GSRS), the Quality of Life in Reflux and Dyspepsia questionnaire (QOLRAD), the Short Form-36 (SF-36) and the Hospital Anxiety and Depression (HAD) scale. Frequency and severity of heartburn during the previous 7 days were also recorded. 135 patients completed the assessments (mean age of 44 years, SD = 15; 61% female). 55% of patients had moderate symptoms and nearly two thirds (64%) had symptoms on 5 or more days in the previous week. Patients were most bothered by symptoms of reflux (mean GSRS score of 4.1, on a scale of 1 [not bothered] to 7 [very bothered]), indigestion (3.5) and abdominal pain (3.2). As a result of their symptoms, patients experienced impaired vitality (mean QOLRAD score of 3.8, on a scale of 1 to 7, where 1 represents the most severe impact on daily functioning), problems with food and drink (3.9), emotional distress (4.1) and sleep disturbance (4.7). Using HAD, 32% of heartburn patients were anxious and 10% were depressed. In conclusion it should be stated that there is consistent evidence that GERD substantially impairs all aspects of health-related quality of life. PMID:16013413

Regu?a, Jaros?aw; Kulich, Károly R; Stasiewicz, Jan; Jasi?ski, Boles?aw; Carlsson, Jonas; Wiklund, Ingela

2005-01-01

214

Clinical features of invasive bronchial-pulmonary aspergillosis in critically ill patients with chronic obstructive respiratory diseases: a prospective study  

Microsoft Academic Search

INTRODUCTION: Critically ill patients with chronic obstructive respiratory diseases (CORD) who require intensive care unit (ICU) admission are at particular risk for invasive bronchial-pulmonary aspergillosis (IBPA). The purpose of this study is to investigate clinical features for rapid recognition of IBPA in critically ill patients with CORD. METHODS: We included 55 consecutive CORD patients in a respiratory ICU in a

Hangyong He; Lin Ding; Fang Li; Qingyuan Zhan

2011-01-01

215

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

PubMed Central

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

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

2014-01-01

216

[Absence from work and illness behavior in patients with chronic pain].  

PubMed

Factors relating to working status, i.e. whether the subject is still at work or on workmen's compensation, have been studied in chronic pain patients. Sociodemographic and pain variables were not correlated with absence from work, nor was diagnosis. However, beliefs and attitudes concerning pain differed between patients still working and those on workmen's compensation. In chronic pain patients medical attention should focus not only on description of symptoms but also on the "illness behaviour" dimension. PMID:7973536

Allaz, A F; Binyet, S; Desmeules, J; Piguet, V; Dayer, P

1994-11-12

217

Impact of two different comorbidity measures on the 6-month mortality of critically ill cancer patients  

Microsoft Academic Search

Objective: To evaluate the impact of two different comorbidity measures on the 6-month mortality of severely ill cancer patients. Design and setting: Prospective cohort study in a ten-bed oncological medical- surgical intensive care unit (ICU). Patients: A total of 772 consecutive patients were included over a 45- month period. The mean age was 57.6€16.4 years, and 642 (83%) pa- tients

Márcio Soares; Jorge I. F. Salluh; Carlos Gil Ferreira; Ronir R. Luiz; Nelson Spector; José R. Rocco

2005-01-01

218

Importance of pre-existing co-morbidities for prognosis of septicemia in critically ill patients  

Microsoft Academic Search

Objective: ~Ib determine admission characteris- tics associated with the outcome of septicemia in critical- ly ill patients and more specifically assess the prognostic value of pre-existing co-morbidities. Design: 5 year-retrospective cohort study. Setting: Surgical Intensive Care Unit (ICU-20 beds) in a 1600 bed-tertiary care center. Patients: Among 5457 patients admitted to the ICU be- tween 1984 and 1988, 176 (3.2%)

D. Pittet; B. Thiévent; R. P. Wenzel; N. Li; G. Gurman; P. M. Suter

1993-01-01

219

Toxic Bradycardias in the Critically Ill Poisoned Patient  

PubMed Central

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

Givens, Melissa L.

2012-01-01

220

Clinical review: Use of helium-oxygen in critically ill patients  

PubMed Central

Use of helium-oxygen (He/O2) mixtures in critically ill patients is supported by a reliable and well understood theoretical rationale and by numerous experimental observations. Breathing He/O2 can benefit critically ill patients with severe respiratory compromise mainly by reducing airway resistance in obstructive syndromes such as acute asthma and decompensated chronic obstructive pulmonary disease. However, the benefit from He/O2 in terms of respiratory mechanics diminishes rapidly with increasing oxygen concentration in the gaseous mixture. Safe use of He/O2 in the intensive care unit requires specific equipment and supervision by adequately experienced personnel. The available clinical data on inhaled He/O2 mixtures are insufficient to prove that this therapy has benefit with respect to outcome variables. For these reasons, He/O2 is not currently a standard of care in critically ill patients with acute obstructive syndromes, apart from in some, well defined situations. Its role in critically ill patients must be more precisely defined if we are to identify those patients who could benefit from this therapeutic approach. PMID:17210068

Gainnier, Marc; Forel, Jean-Marie

2006-01-01

221

Heart-related anxieties in relation to general anxiety and severity of illness in cardiology patients.  

PubMed

Absence of an adequate reason for anxiety is a criterion for pathological anxiety. However, the presence of danger or fear-provoking stimuli may even be a risk factor for anxiety and does not exclude that there is additionally pathological anxiety too. The question is, to what degree can heart-related anxiety be explained by the severity of illness or trait anxiety? Two hundred and nine patients (37.8% women) from a cardiology inpatient unit completed the Heart-Anxiety-Questionnaire, Progression-Anxiety-Questionnaire, Job-Anxiety-Scale and the State-Trait-Anxiety-Inventory. The severity of cardiac illness was rated by the treating cardiologists using the Multidimensional Severity of Morbidity Rating. Time absent from work due to sickness was assessed as an indicator for illness-related impairment. Heart anxiety was significantly related to progression anxiety and, to a lesser extent, trait anxiety and indicators of subjective symptoms of somatic illness. No association was found with medical ratings for prognosis, multimorbidity, or reduction in life expectancy. Heart-related anxiety is a symptom of an anxiety disorder. Although partially dependent on subjective suffering, it cannot be explained by the severity of medical illness. Treatment of health-related anxieties should focus on how to cope with subjective symptoms of illness. PMID:23473360

Muschalla, Beate; Glatz, Johannes; Linden, Michael

2014-01-01

222

High-quality chronic care delivery improves experiences of chronically ill patients receiving care  

PubMed Central

Objective Investigate whether high-quality chronic care delivery improved the experiences of patients. Design This study had a longitudinal design. Setting and Participants We surveyed professionals and patients in 17 disease management programs targeting patients with cardiovascular diseases, chronic obstructive pulmonary disease, heart failure, stroke, comorbidity and eating disorders. Main Outcome Measures Patients completed questionnaires including the Patient Assessment of Chronic Illness Care (PACIC) [T1 (2010), 2637/4576 (58%); T2 (2011), 2314/4330 (53%)]. Professionals' Assessment of Chronic Illness Care (ACIC) scores [T1, 150/274 (55%); T2, 225/325 (68%)] were used as a context variable for care delivery. We used two-tailed, paired t-tests to investigate improvements in chronic illness care quality and patients' experiences with chronic care delivery. We employed multilevel analyses to investigate the predictive role of chronic care delivery quality in improving patients' experiences with care delivery. Results Overall, care quality and patients' experiences with chronic illness care delivery significantly improved. PACIC scores improved significantly from 2.89 at T1 to 2.96 at T2 and ACIC-S scores improved significantly from 6.83 at T1 to 7.18 at T2. After adjusting for patients' experiences with care delivery at T1, age, educational level, marital status, gender and mental and physical quality of life, analyses showed that the quality of chronic care delivery at T1 (P < 0.001) and changes in care delivery quality (P < 0.001) predicted patients' experiences with chronic care delivery at T2. Conclusion This research showed that care quality and changes therein predict more positive experiences of patients with various chronic conditions over time. PMID:24123243

Cramm, Jane Murray; Nieboer, Anna Petra

2013-01-01

223

Infectious Etiologies of Acute Febrile Illness among Patients Seeking Health Care in South-Central Cambodia  

PubMed Central

The agents of human febrile illness can vary by region and country suggesting that diagnosis, treatment, and control programs need to be based on a methodical evaluation of area-specific etiologies. From December 2006 to December 2009, 9,997 individuals presenting with acute febrile illness at nine health care clinics in south-central Cambodia were enrolled in a study to elucidate the etiologies. Upon enrollment, respiratory specimens, whole blood, and serum were collected. Testing was performed for viral, bacterial, and parasitic pathogens. Etiologies were identified in 38.0% of patients. Influenza was the most frequent pathogen, followed by dengue, malaria, and bacterial pathogens isolated from blood culture. In addition, 3.5% of enrolled patients were infected with more than one pathogen. Our data provide the first systematic assessment of the etiologies of acute febrile illness in south-central Cambodia. Data from syndromic-based surveillance studies can help guide public health responses in developing nations. PMID:22302857

Kasper, Matthew R.; Blair, Patrick J.; Touch, Sok; Sokhal, Buth; Yasuda, Chadwick Y.; Williams, Maya; Richards, Allen L.; Burgess, Timothy H.; Wierzba, Thomas F.; Putnam, Shannon D.

2012-01-01

224

Comparison of three severity scores for critically ill cancer patients  

Microsoft Academic Search

Objective To compare three scoring systems, the Acute Physiology and Chronic Health Evaluation (APACHE) II, the Simplified Acute Physiology Score (SAPS) II and a modified Mortality Probability Model II (ICU cancer mortality model, ICMM) for their prognostic value for mortality during hospital stay in a group of cancer patients admitted to a medical ICU. Design Prospective cohort study. Setting Medical

Peter Schellongowski; Michael Benesch; Thomas Lang; Friederike Traunmüller; Christian Zauner; Klaus Laczika; Gottfried J. Locker; Michael Frass; Thomas Staudinger

2004-01-01

225

Constructs of burden of illness in older patients with breast cancer: a comparison of measurement methods.  

PubMed Central

OBJECTIVE. The burden of illness can influence treatment decisions, but there are limited data comparing the performance of different illness burden measures. We assessed the correlations between five previously validated measures of illness burden and global health and physical function and evaluated how each measure correlates with breast cancer treatment patterns in older women. DATA SOURCE: A cohort of 718 women > 67 years with early-stage breast cancer formed the study group. STUDY DESIGN/DATA COLLECTION METHODS: The study made a cross-sectional comparison of illness burden measures (Charlson index, Index of Co-existent Diseases, cardiopulmonary burden of illness, patient-specific life expectancy, and disease counts) and physical function and self-rated global health status. Data were collected from records and patient interviews. PRINCIPAL FINDINGS: All of the measures were significantly correlated with each other and with physical function and self-rated health (p < .001). After controlling for age and stage, life expectancy had the largest effect on surgical treatment, followed by self-rated physical function and health; life expectancy was also independent of physical function. For instance, women with higher life expectancy and better self-rated physical function and health were more likely to receive breast conservation and radiation than sicker women. Women with higher physical functioning were more likely to receive adjuvant chemotherapy than women with lower functioning. CONCLUSIONS: Several measures of illness burden were associated with breast cancer therapy, but each measure accounted for only a small amount of variance in treatment patterns. Future work is needed to develop and validate measures of burden of illness that are feasible, comprehensive, and relevant for diverse clinical and health services objectives. PMID:11775669

Mandelblatt, J S; Bierman, A S; Gold, K; Zhang, Y; Ng, J H; Maserejan, N; Hwang, Y T; Meropol, N J; Hadley, J; Silliman, R A

2001-01-01

226

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

PubMed Central

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

2014-01-01

227

[Patient care and ethics. IV. The terminal patient who concealed the truth].  

PubMed

In this article a case is discussed in which a dentist is placed in a dilemma. He is working on a comprehensive treatment but his patient has deliberately concealed his terminal state of health. By chance he was told about the actual health situation of his patient. The question is discussed whether there is a moral justification to carry on with the treatment. PMID:12051173

Strijbos, S; Eijkman, M A

1992-09-01

228

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

PubMed

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

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

2014-07-01

229

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

PubMed Central

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

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

2014-01-01

230

Effects of Gender, Ethnicity, and Medical Illness on Drinking Cessation in Older Primary Care Patients  

Microsoft Academic Search

Objective: This study examined the effects of gender, ethnicity, and medical illness on cessation of alcohol consumption in late life by analyzing characteristics that distinguish current drinkers from former drinkers. Method: Participants were 211 medical patients aged 55 to 91 years, recruited from four urban public sector primary care clinics. Respondents completed the Short Michigan Alcohol Screening Test and provided

Derek D. Satre; Patricia A. Areán

2005-01-01

231

Role of cardiac troponin as a prognosticator in critically ill patients  

Microsoft Academic Search

In a recent issue of Critical Care, Dr King and colleagues [1] described the role of cardiac troponin as a prognosticator in critically ill medical patients. They concluded that elevated troponin levels measured on admission are associated with an increased mortality rate. Our experience [2] supports that reported by King and coworkers. Our retrospective case note study, conducted in 180

Andrew J Turley; Jacqui A Gedney

2005-01-01

232

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

PubMed Central

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

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

2014-01-01

233

Postoperative Bacterial\\/Fungal Infections: A Challenging Problem in Critically Ill Patients after Abdominal Surgery  

Microsoft Academic Search

Critically ill patients after extended surgical procedures are at high risk for postoperative infections. The overall incidence of sepsis increased constantly over the last decade, whereas sepsis-related mortality decreased, due to new intensive care options. After extended intra-abdominal surgery the abdomen is the predominant focus of sepsis, followed by respiratory tract infections. Unspecific clinical signs lead to the diagnosis of

C. Lichtenstern; J. Schmidt; H. P. Knaebel; E. Martin; M. W. Büchler; M. A. Weigand

2007-01-01

234

Plasma DNA concentration as a predictor of mortality and sepsis in critically ill patients  

Microsoft Academic Search

INTRODUCTION: Risk stratification of severely ill patients remains problematic, resulting in increased interest in potential circulating markers, such as cytokines, procalcitonin and brain natriuretic peptide. Recent reports have indicated the usefulness of plasma DNA as a prognostic marker in various disease states such as trauma, myocardial infarction and stroke. The present study assesses the significance of raised levels of plasma

Andrew Rhodes; Stephen J Wort; Helen Thomas; Paul Collinson; E David Bennett

2006-01-01

235

Adults Living with Limited Literacy and Chronic Illness: Patient Education Experiences  

ERIC Educational Resources Information Center

The purpose of this study was to investigate how Canadian adults living with limited literacy and chronic illness made meaning of their patient education experiences. The study used a hermeneutic phenomenological research design and employed three data sources over a nine-month period. Data was interpreted and analyzed as it was collected,…

King, Judy; Taylor, Maurice C.

2010-01-01

236

ADMISSION TO THE INTENSIVE CARE UNIT AND WELL-BEING IN PATIENTS WITH ADVANCED CHRONIC ILLNESS  

PubMed Central

Purpose To describe the association of intensive care with trajectories of functional, emotional, social, and physical well-being in patients with 3 common advanced illnesses Methods Cross-sectional cohort study of 42 patients admitted to the intensive care unit selected from 210 patients with stage IV breast, prostate, or colon cancer or stage IIIb or IV lung cancer; New York Heart Association class III or IV congestive heart failure; and chronic obstructive pulmonary disease with hypercapnea (Pco2 > 46 mm Hg). Scores on subscales of the Functional Assessment of Chronic Illness Therapy-General survey were measured monthly for 6 months before and after admission to the intensive care unit and were analyzed by using the unit admission date as a point of discontinuous change to illustrate trajectories before and after the admission. Results Overall, trajectories of well-being declined sharply after admission to the intensive care unit. Declines in physical, functional, and emotional well-being were statistically significant. During the 6 months after admission, physical, functional, and emotional well-being scores trended back up to baseline while social well-being scores continued to decline. Conclusions Well-being trajectories declined sharply after admission to the intensive care unit, with recovery in the subsequent 6 months, and may be characterized by common patterns. These results help to better describe intensive care as a marker for advancing illness in patients with advanced chronic illness. PMID:23635931

Chiarchiaro, Jared; Olsen, Maren K.; Steinhauser, Karen E.; Tulsky, James A.

2013-01-01

237

The rectal trumpet: Use of a nasopharyngeal airway to contain fecal incontinence in critically ill patients  

Microsoft Academic Search

Objective: Our objective was to determine if a nasopharyngeal airway (rectal trumpet) could be used as a fecal containment device with less trauma than traditional devices, such as a fecal incontinence pouch or balloon rectal catheter. Design: A single-subject clinical series was used. Setting and Subjects: A nonrandom sample of critically ill adult and geriatric patients (n = 22) with

Tracy A. Grogan; David J. Kramer

2002-01-01

238

Coping Styles of Patients with Life-Threatening Illness: A Literature Review  

ERIC Educational Resources Information Center

The literature consists of numerous references to coping styles of patients facing life-threatening illness, but the general consensus denotes the following as the predominant ones: denial, depression, anger, suicide, anxiety and fear reactions, psychosomatic compaining, schizoid-type and neurotic-type reactions, regression, dependency, and…

Shady, Gary

1978-01-01

239

Etomidate for critically ill patients. Pro: yes we can use it.  

PubMed

Etomidate is used to induce anaesthesia in critically ill patients in many environments, including pre-hospital care, in the emergency and critical care departments and in the operating theatre. It has a favourable cardiovascular profile, but its use has courted controversy because it suppresses adrenal function which some believe is associated with worse outcome, particularly in patients with sepsis. Because there is much evidence of harm associated with hypotension in critically ill patients, it is important to use an anaesthetic induction drug which is less likely to cause hypotension. Etomidate undoubtedly causes adrenal suppression, but the clinical consequences of this remain unclear. There is no convincing or consistent evidence that etomidate is associated with harm, particularly if adjustment is made for pre-existing severity of illness. The etomidate debate is currently in clinical equipoise in which there is genuine uncertainty within the expert medical community. We review briefly the arguments in favour of continuing to use etomidate in critically ill patients. PMID:22907611

Ray, David C; McKeown, Dermot W

2012-11-01

240

The seriously ill hospitalized patient: Preferred role in end-of-life decision making?  

Microsoft Academic Search

Purpose: The objective of this study was to further our understanding of the decision-making process near the end of life. Specifically, we ascertained the seriously ill patients' preferred role in the decision-making process, what factors were associated with this role, and how this stated preference related to physicians' perception of preferred role. Materials and Methods: Prospective cohort study of hospitalized

Daren K. Heyland; Joan Tranmer; C. J. O'Callaghan; Amiram Gafni

2003-01-01

241

Current concepts in combination antibiotic therapy for critically ill patients  

PubMed Central

Widespread emergence of multidrug resistant (MDR) bacterial pathogens is a problem of global dimension. MDR infections are difficult to treat and frequently associated with high mortality. More than one antibiotic is commonly used to treat such infections, but scientific evidence does not favor use of combination therapy in most cases. However, there are certain subgroups where combination therapy may be beneficial, e.g. sepsis due to carbapenem-resistant Enterobacteriaceae (CRE), bacteremic pneumococcal pneumonia, and patients with multiple organ failure. Well-designed prospective studies are needed to clearly define the role of combination therapy in these subgroups. PMID:24914260

Ahmed, Armin; Azim, Afzal; Gurjar, Mohan; Baronia, Arvind Kumar

2014-01-01

242

Inflammation biomarkers and delirium in critically ill patients: new insights?  

PubMed

The pathophysiological mechanism of the serious and frequently occurring disorder delirium is poorly understood. Inflammation and sepsis are known risk factors for ICU delirium and therefore these patients are highly susceptible to delirium. Several studies have been performed to determine which cytokines are most associated with delirium but the results are inconclusive. Also, new biomarkers associated with brain dysfunction and cognitive impairment are still recognized and need to be studied to determine their relation with delirium. In this commentary we address some limitations concerning an interesting new study that warrants directions for future studies. PMID:25042374

Sobbi, Shokoufeh Cheheili; van den Boogaard, Mark

2014-01-01

243

Individualised antibiotic dosing for patients who are critically ill: challenges and potential solutions.  

PubMed

Infections in critically ill patients are associated with persistently poor clinical outcomes. These patients have severely altered and variable antibiotic pharmacokinetics and are infected by less susceptible pathogens. Antibiotic dosing that does not account for these features is likely to result in suboptimum outcomes. In this Review, we explore the challenges related to patients and pathogens that contribute to inadequate antibiotic dosing and discuss how to implement a process for individualised antibiotic therapy that increases the accuracy of dosing and optimises care for critically ill patients. To improve antibiotic dosing, any physiological changes in patients that could alter antibiotic concentrations should first be established; such changes include altered fluid status, changes in serum albumin concentrations and renal and hepatic function, and microvascular failure. Second, antibiotic susceptibility of pathogens should be confirmed with microbiological techniques. Data for bacterial susceptibility could then be combined with measured data for antibiotic concentrations (when available) in clinical dosing software, which uses pharmacokinetic/pharmacodynamic derived models from critically ill patients to predict accurately the dosing needs for individual patients. Individualisation of dosing could optimise antibiotic exposure and maximise effectiveness. PMID:24768475

Roberts, Jason A; Abdul-Aziz, Mohd H; Lipman, Jeffrey; Mouton, Johan W; Vinks, Alexander A; Felton, Timothy W; Hope, William W; Farkas, Andras; Neely, Michael N; Schentag, Jerome J; Drusano, George; Frey, Otto R; Theuretzbacher, Ursula; Kuti, Joseph L

2014-06-01

244

Ivabradine: potential clinical applications in critically ill patients.  

PubMed

It has been extensively demonstrated that an elevated heart rate is a modifiable, independent risk factor for cardiovascular events. A high heart rate increases myocardial oxygen consumption and reduces diastolic perfusion time. It can also increase ventricular diastolic pressures and induce ventricular arrhythmias. Critical care patients are prone to develop a stress induced cardiac impairment and consequently an increase in sympathetic tone. This in turn increases heart rate. In this setting, however, heart rate lowering might be difficult because the effects of inotropic drugs could be hindered by heart rate reducing drugs like beta-blockers. Ivabradine is a new selective antagonist of funny channels. It lowers heart rate, reducing the diastolic depolarization slope. Moreover, ivabradine is not active on sympathetic pathways, thus avoiding any interference with inotropic amines. We reviewed the literature available regarding heart rate control in critical care patients, focusing our interest on the use of ivabradine to assess the potential benefits of the drug in this particular setting. PMID:23064879

De Santis, Vincenzo; Vitale, Domenico; Santoro, Anna; Magliocca, Aurora; Porto, Andrea Giuseppe; Nencini, Cecilia; Tritapepe, Luigi

2013-03-01

245

Efficacy of lifestyle interventions in physical health management of patients with severe mental illness.  

PubMed

Awareness of the importance of maintaining physical health for patients with severe mental illnesses has recently been on the increase. Although there are several elements contributing to poor physical health among these patients as compared with the general population, risk factors for cardiovascular disease such as smoking, diabetes mellitus, hypertension, dyslipidemia, metabolic syndrome, and obesity are of particular significance due to their relationship with mortality and morbidity. These patients present higher vulnerability to cardiovascular risk factors based on several issues, such as genetic predisposition to certain pathologies, poor eating habits and sedentary lifestyles, high proportions of smokers and drug abusers, less access to regular health care services, and potential adverse events during pharmacological treatment. Nevertheless, there is ample scientific evidence supporting the benefits of lifestyle interventions based on diet and exercise designed to minimize and reduce the negative impact of these risk factors on the physical health of patients with severe mental illnesses. PMID:21929761

Chacón, Fernando; Mora, Fernando; Gervás-Ríos, Alicia; Gilaberte, Inmaculada

2011-01-01

246

Efficacy of lifestyle interventions in physical health management of patients with severe mental illness  

PubMed Central

Awareness of the importance of maintaining physical health for patients with severe mental illnesses has recently been on the increase. Although there are several elements contributing to poor physical health among these patients as compared with the general population, risk factors for cardiovascular disease such as smoking, diabetes mellitus, hypertension, dyslipidemia, metabolic syndrome, and obesity are of particular significance due to their relationship with mortality and morbidity. These patients present higher vulnerability to cardiovascular risk factors based on several issues, such as genetic predisposition to certain pathologies, poor eating habits and sedentary lifestyles, high proportions of smokers and drug abusers, less access to regular health care services, and potential adverse events during pharmacological treatment. Nevertheless, there is ample scientific evidence supporting the benefits of lifestyle interventions based on diet and exercise designed to minimize and reduce the negative impact of these risk factors on the physical health of patients with severe mental illnesses. PMID:21929761

2011-01-01

247

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

PubMed Central

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

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

2014-01-01

248

Sustained low-efficiency dialysis (SLED) with prostacyclin in critically ill patients with acute renal failure  

Microsoft Academic Search

Background. Prostacyclin is an easy-to-use and safe antihaemostatic drug for continuous renal replacement therapies (RRTs). No study has been performed so far about its use in critically ill patients with acute renal failure (ARF) treated with sustained low-efficiency dialysis (SLED), a hybrid modality between conventional intermittent and continuous RRTs. Methods. We studied 35 consecutive ICU patients with ARF, in whom

Enrico Fiaccadori; Umberto Maggiore; Elisabetta Parenti; Roberto Giacosa; Edoardo Picetti; Carlo Rotelli; Dante Tagliavini; Aderville Cabassi

2007-01-01

249

Reinstitutionalization Following Psychiatric Discharge among VA Patients with Serious Mental Illness: A National Longitudinal Study  

Microsoft Academic Search

Patterns of reinstitutionalization following psychiatric hospitalization for individuals with serious mental illnesses (SMI)\\u000a vary by medical and psychiatric health care settings. This report presents rates of reinstitutionalization across care settings\\u000a for 35,527 patients following psychiatric discharge in the Department of Veterans Affairs (VA) health system, a national health\\u000a care system. Over a 7-year follow-up period, 30,417 patients (86%) were reinstitutionalized.

Cheryl Irmiter; John F. McCarthy; Kristen L. Barry; Soheil Soliman; Frederic C. Blow

2007-01-01

250

Disseminated enteroinvasive aspergillosis in a critically ill patient without severe immunocompromise  

PubMed Central

Invasive aspergillosis (IA) is a rapidly progressive and often fatal infectious disease described classically in patients who are highly immunocompromised. However, there has been increasing evidence that IA may affect critically ill patients without traditional risk factors. We present a case of a 47-year-old man without conventional risk factors for IA who presented with impending sepsis and proceeded to have a complicated hospital course with a postmortem diagnosis of invasive gastrointestinal aspergillosis of the small bowel. PMID:24968426

Fieber, Jennifer H.; Atladottir, Jorunn; Solomon, Daniel G.; Maerz, Linda L.; Reddy, Vikram; Mitchell-Richards, Kisha; Longo, Walter E.

2013-01-01

251

Disseminated enteroinvasive aspergillosis in a critically ill patient without severe immunocompromise.  

PubMed

Invasive aspergillosis (IA) is a rapidly progressive and often fatal infectious disease described classically in patients who are highly immunocompromised. However, there has been increasing evidence that IA may affect critically ill patients without traditional risk factors. We present a case of a 47-year-old man without conventional risk factors for IA who presented with impending sepsis and proceeded to have a complicated hospital course with a postmortem diagnosis of invasive gastrointestinal aspergillosis of the small bowel. PMID:24968426

Fieber, Jennifer H; Atladóttir, Jórunn; Solomon, Daniel G; Maerz, Linda L; Reddy, Vikram; Mitchell-Richards, Kisha; Longo, Walter E

2013-01-01

252

Tonometry to assess the adequacy of splanchnic oxygenation in the critically ill patient  

Microsoft Academic Search

Tonometry, a relatively non-invasive technique for indirectly measuring the intramucosal pH (pHi) of the gastrointestinal tract, has recently been developed for use in critically ill patients. Reports in the literature suggest that the technique is of greatest benefit to patients at risk of developing reductions in splanchnic oxygenation (decreased O2 delivery) in whom early detection of the ischemic episode could

J. Arnold; J. Hendriks; C. Ince; H. Bruining

1994-01-01

253

Extended-duration rivaroxaban thromboprophylaxis in acutely ill medical patients: MAGELLAN study protocol  

Microsoft Academic Search

Patients with acute medical illnesses are at increased risk of venous thromboembolism (VTE), a significant cause of morbidity\\u000a and mortality. Thromboprophylaxis is recommended in these patients but questions remain regarding the optimal duration of\\u000a therapy. The aim of this study is to determine whether oral rivaroxaban is non-inferior to standard-duration (approximately\\u000a 10 days) subcutaneous (s.c.) enoxaparin for the prevention of VTE

Alexander Thomas Cohen; Theodore Erich Spiro; Harry Roger Büller; Lloyd Haskell; Dayi Hu; Russell Hull; Alexandre Mebazaa; Geno Merli; Sebastian Schellong; Alex Spyropoulos; Victor Tapson

2011-01-01

254

A Qualitative Exploration of a Patient-Centered Coaching Intervention to Improve Care Transitions in Chronically Ill Older Adults  

Microsoft Academic Search

Persons with chronic illness frequently find they need to navigate the health care system but are ill equipped to do so. Using interview data from 32 participants, this study explored patients' experiences with a coaching intervention that provided patients with support and tools to enhance self-management during care transitions. The findings suggest the efficacy of the model in enhancing self-management,

Carla Parry; Heidi M. Kramer; Eric A. Coleman

2006-01-01

255

Patterns of depression in medical patients and their relationship with causal attributions for illness.  

PubMed

The present study investigated the factor structure of the Beck Depression Inventory (BDI), and causal attributions for the development of illness in a sample of 102 inpatients of a thoracic surgery department, with the main objective of examining the power of causal attributions and functional support in predicting different factors derived from the BDI. The results revealed that the BDI clusters into affective/motivational, somatic/vegetative, self-blame and self-punitiveness dimensions. Causal attributions for the development of illness were represented by family conflicts, environmental adversity, finance/health problems, bad luck, and four self-related clusters. Examination of the predictors of the BDI dimensions showed that causal attributions to uncontrollable, unmodifiable variables were predictors for the affective/motivational dimension, whereas illness severity and greater age were related to the somatic/vegetative symptomatology. The results supported the recommendations for the exclusion of such symptoms in assessing depression severity among medical patients. PMID:3269555

Karanci, N A

1988-01-01

256

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

PubMed

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

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

2012-08-01

257

Terminal sedation for existential distress  

Microsoft Academic Search

Although sedation for existential distress has been actively discussed in the palliative care literature, empirical reports are limited. A retrospective cohort study was performed to clarify the physical conditions of terminally ill cancer patients who expressed existential distress and received sedation.Of 248 consecutive hospice inpatients, 20 patients expressed a belief that their lives were meaningless and received sedation.The target symptoms

Tatsuya Morita; Junichi Tsunoda; Satoshi Inoue; Satoshi Chihara

2000-01-01

258

Incidence of gastric mucosal injury as measured by reactance in critically ill patients.  

PubMed

Gastric reactance has been proposed as a measure of mucosal ischemic injury in the critically ill. The purpose of this study was to evaluate the incidence of gastric mucosal injury as measured by gastric reactance in different subgroups of critical patients. We studied 100 adult patients admitted to 7 different hospital intensive care units, requiring a nasogastric tube. Gastric impedance measurements were continuously obtained from each patient for 24 hours. Patients were managed based on conventional protocols by hospital staff, blinded to the changes in gastric impedance parameters. The low-frequency central reactance (X L) reflects tissue edema caused by prolonged ischemia. The previously reported threshold of X L ? 13 - j? was used to classify injured mucosa; 80% of all patients had mean X L above this threshold. No significant differences were found in the incidence of mucosal ischemia between medical versus surgical, hemodynamic versus respiratory or neurological patients. Significant lower urine output was found in patients with X L above threshold (P < .01); also, there was a significant effect of fluid balance in those patients (P < .05). More complicated patients had higher average reactance. This study shows that gastric ischemia as estimated by gastric reactance has a very high incidence in the critically ill, independently of the reason for admission. High reactance is related with higher morbidity in agreement with other reports using different methods of assessing splanchnic hypoperfusion in this patient population. PMID:22733726

Beltran, Nohra E; Ceron, Ulises; Sanchez-Miranda, Gustavo; Remolina, Miguel; Godinez, Maria M; Peralta, Itzel Y; Sacristan, Emilio

2013-01-01

259

Overview of managing medical comorbidities in patients with severe mental illness.  

PubMed

Patients with severe mental disorders have increased mortality rates compared with the general population. The leading cause of death for individuals with psychotic illnesses or bipolar disorder is cardiovascular disease (CVD), which is often the result of patients' health problems associated with their psychiatric disorders, including, but not limited to, obesity, metabolic syndrome, and diabetes. Such problems occur more often and have worse outcomes in patients with serious mental illness than the general population because of a combination of factors such as inadequate access to quality care, poor lifestyle choices, and the association between some antipsychotic medications and weight gain. Coordinated somatic and psychiatric treatment, weight-neutral or weight-reducing pharmaceuticals, and behavioral weight management programs may help lessen the burden of CVD in the mental health population. PMID:19573473

McIntyre, Roger S

2009-06-01

260

Diversion of patients with mental illness from court-ordered care to immigration detention.  

PubMed

Over 350,000 immigrants are detained by U.S. Immigration and Customs Enforcement (ICE) each year. An unknown fraction of these detainees have serious mental illnesses and are taken into ICE custody even though a criminal court has ordered them to enter inpatient mental health care. The authors report findings from 16 such cases in which they have provided advocacy over the past four years. In some cases, they were able to secure release of detainees into inpatient care in community (nonforensic) settings, which involved substantial logistical challenges. Given the well-documented concerns about securing adequate care for ICE detainees with mental illness, a logical policy change would be for ICE to allow these patients to enter court-ordered inpatient care. This move would improve care for patients and would also unburden ICE from the untenable proposition of caring for patients that the criminal justice system has deemed unfit for incarceration. PMID:22476303

Venters, Homer; Keller, Allen S

2012-04-01

261

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

PubMed

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

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

2014-02-01

262

Quantitative Evaluation of the Severity of Acute Illness in Adult Patients with Tick-Borne Encephalitis  

PubMed Central

The aim of the present study was to quantify the severity of acute illness in patients with tick-borne encephalitis and to ascertain this approach by comparing it to standard clinical assessment. We designed scoring system for quantification of the severity of acute illness in patients with tick-borne encephalitis. Certain number of points was allotted to the presence, intensity, and duration of individual symptoms/signs. According to the obtained score the disease was classified as mild, moderate, and severe. Tick-borne encephalitis was assessed clinically as mild when only signs/symptoms of meningeal involvement were found, moderate in case of monofocal neurological signs and/or mild to moderate signs/symptoms of central nervous system dysfunction, and severe in patients with multifocal neurological signs and/or symptoms of severe dysfunction of central nervous system. By designed scoring system 282 adult patients, 146 males and 136 females, average aged 52.2?±?15.5 years (range 15–82 years), with confirmed tick-borne encephalitis, were prospectively assessed. In 279/282 (98.9%) patients the severity according to clinical assessment matched with the score ranges for mild, moderate, and severe disease. The proposed approach enables precise and straightforward appraisal of the severity of acute illness and could be useful for comparison of findings within/between study groups. PMID:24895617

Bogovic, Petra; Logar, Mateja; Avsic-Zupanc, Tatjana; Strle, Franc; Lotric-Furlan, Stanka

2014-01-01

263

BK viremia in critically ill surgical patients with hemorrhagic or septic shock  

PubMed Central

Background Infections with polyomavirus BK virus (BKV) are a common cause of renal dysfunction after renal transplantation and may also be harmful in surgical patients with shock. The aim of the present study was to determine the frequency of BKV viremia in critically ill surgical patients with septic or hemorrhagic shock, and, if viremia is detectable, whether viremia may be associated with renal dysfunction. Findings A total of 125 plasma samples from 44 critically ill surgical patients with septic or hemorrhagic shock were tested by real-time polymerase chain reaction (PCR) for BKV DNA during their stay on the intensive care unit (ICU). BKV viremia occurred in four patients, i.e. in three of the septic and in one of the hemorrhagic shock group. There was no association between viremia and renal dysfunction. All positive samples contained a low viral load (< 500 copies/ml). Conclusions Since BK viremia was rarely found and with low viral load only in critically ill surgical patients with shock, it is very unlikely that BK viremia results in BK nephropathy later on. PMID:22339896

2012-01-01

264

Clinical review: optimizing enteral nutrition for critically ill patients - a simple data-driven formula  

PubMed Central

In modern critical care, the paradigm of 'therapeutic nutrition' is replacing traditional 'supportive nutrition'. Standard enteral formulas meet basic macro- and micronutrient needs; therapeutic enteral formulas meet these basic needs and also contain specific pharmaconutrients that may attenuate hyperinflammatory responses, enhance the immune responses to infection, or improve gastrointestinal tolerance. Choosing the right enteral feeding formula may positively affect a patient's outcome; targeted use of therapeutic formulas can reduce the incidence of infectious complications, shorten lengths of stay in the ICU and in the hospital, and lower risk for mortality. In this paper, we review principles of how to feed (enteral, parenteral, or both) and when to feed (early versus delayed start) patients who are critically ill. We discuss what to feed these patients in the context of specific pharmaconutrients in specialized feeding formulations, that is, arginine, glutamine, antioxidants, certain ?-3 and ?-6 fatty acids, hydrolyzed proteins, and medium-chain triglycerides. We summarize current expert guidelines for nutrition in patients with critical illness, and we present specific clinical evidence on the use of enteral formulas supplemented with anti-inflammatory or immune-modulating nutrients, and gastrointestinal tolerance-promoting nutritional formulas. Finally, we introduce an algorithm to help bedside clinicians make data-driven feeding decisions for patients with critical illness. PMID:22136305

2011-01-01

265

Is Vitamin D Insufficiency Associated with Mortality of Critically Ill Patients?  

PubMed Central

Objective. To evaluate the vitamin D status of our critically ill patients and its relevance to mortality. Patients and Methods. We performed a prospective observational study in the medical intensive care unit of a university hospital between October 2009 and March 2011. Vitamin D levels were measured and insufficiency was defined as <20?ng/mL. Results. Two hundred and one patients were included in the study. The median age was 66 (56–77) and the majority of patients were male (56%). The median serum level of vitamin D was 14,9?ng/mL and 139 (69%) patients were vitamin D insufficient on admission. While we grouped the ICU patients as vitamin D insufficient and sufficient, vitamin D insufficient patients had more severe acute diseases and worse laboratory values on admission. These patients had more morbidities and were exposed to more invasive therapies during stay. The mortality rate was significantly higher in the vitamin D insufficient group compared to the vitamin D sufficient group (43% versus 26%, P = 0,027). However, logistic regression analysis demonstrated that vitamin D insufficiency was not an independent risk factor for mortality. Conclusion. Vitamin D insufficiency is common in our critically ill patients (69%), but it is not an independent risk factor for mortality. PMID:24455224

Turkoglu, Melda; Tuncel, Ayse Fitnat; Cand?r, Burcu Arslan; Bildac?, Yelda Deligoz; Pasaoglu, Hatice

2013-01-01

266

Intensity of Renal Support in Critically Ill Patients with Acute Kidney Injury  

PubMed Central

BACKGROUND The optimal intensity of renal-replacement therapy in critically ill patients with acute kidney injury is controversial. METHODS We randomly assigned critically ill patients with acute kidney injury and failure of at least one nonrenal organ or sepsis to receive intensive or less intensive renal-replacement therapy. The primary end point was death from any cause by day 60. In both study groups, hemodynamically stable patients underwent intermittent hemodialysis, and hemodynamically unstable patients underwent continuous venovenous hemodiafiltration or sustained low-efficiency dialysis. Patients receiving the intensive treatment strategy underwent intermittent hemodialysis and sustained low-efficiency dialysis six times per week and continuous venovenous hemodiafiltration at 35 ml per kilogram of body weight per hour; for patients receiving the less-intensive treatment strategy, the corresponding treatments were provided thrice weekly and at 20 ml per kilogram per hour. RESULTS Baseline characteristics of the 1124 patients in the two groups were similar. The rate of death from any cause by day 60 was 53.6% with intensive therapy and 51.5% with less-intensive therapy (odds ratio, 1.09; 95% confidence interval, 0.86 to 1.40; P = 0.47). There was no significant difference between the two groups in the duration of renalreplacement therapy or the rate of recovery of kidney function or nonrenal organ failure. Hypotension during intermittent dialysis occurred in more patients randomly assigned to receive intensive therapy, although the frequency of hemodialysis sessions complicated by hypotension was similar in the two groups. CONCLUSIONS Intensive renal support in critically ill patients with acute kidney injury did not decrease mortality, improve recovery of kidney function, or reduce the rate of nonrenal organ failure as compared with less-intensive therapy involving a defined dose of intermittent hemodialysis three times per week and continuous renal-replacement therapy at 20 ml per kilogram per hour. (ClinicalTrials.gov number, NCT00076219.) PMID:18492867

2008-01-01

267

[Patient-provider communication in chronic illness: current state of research in selected areas].  

PubMed

Communication between patient and providers is extremely important, especially for the treatment of chronically ill patients, characterized by a biopsychosocial disease model. This article presents an overview of the current status of research on patient-provider communication in 3 selected areas: the communication preferences of chronically ill persons, the correlation between communication and relevant endpoints, and interventions to improve patient-provider communication. One major result of the research is that patients display a rather high degree of inter- and intra-individual variability with respect to the preference of certain communication styles (e.g. patient participation); there are differences among them, and they develop varying preferences in the course of their illness. However, communicative behavior of the provider that is generally perceived by many patients to be positive can also be identified: affective behavior (for example, asking the patient about his/her feelings, being sensitive to these feelings and responding to them), providing information in an understandable, proactive manner, and attempting to understand the patient's perceptions, expectations, and cognitive concepts. Successful communication requires a certain congruence between the patient's communication preferences and the provider's behavior. It has been sufficiently documented in literature that successful communication leads to greater adherence. The correlation to patient satisfaction is not documented quite as clearly but has often been shown. The findings vary with respect to the improvement in the patient's health status. The effectiveness of communication training for providers has been documented quite well regarding the immediate endpoints in patient-provider interaction (e.g., patient-oriented behavior); the evidence with respect to medium-term endpoints such as patient satisfaction varies, also due to the number of possible operationalizations of the endpoints. Supplementing provider training with communication-related training for patients appears to be an important and useful method as many studies have shown that the behavior of providers can be influenced using relatively simple measures that start with the patient. There is a need for further development of research on patient-provider communication, in particular with respect to a more solid theoretical basis, integration of methods including qualitative and quantitative methods, self-evaluations, and interaction analyses, and also concerning conducting more longitudinal studies. PMID:20963669

Farin, E

2010-10-01

268

Antibiotic dosing in critically ill patients receiving CRRT: underdosing is overprevalent.  

PubMed

Published CRRT drug dosing algorithms and other dosing guidelines appear to result in underdosed antibiotics, leading to failure to attain pharmacodynamic targets. High mortality rates persist with inadequate antibiotic therapy as the most important risk factor for death. Reasons for unintended antibiotic underdosing in patients receiving CRRT are many. Underdosing may result from lack of the recognition that better hepatic function in AKI patients yields higher nonrenal antibiotic clearance compared to ESRD patients. Other factors include the variability in body size and fluid composition of patients, the serious consequence of delayed achievement of antibiotic pharmacodynamic targets in septic patients, potential subtherapeutic antibiotic concentrations at the infection site, and the influence of RRT intensity on antibiotic concentrations. Too often, clinicians weigh the benefits of overcautious antibiotic dosing to avoid antibiotic toxicity too heavily against the benefits of rapid attainment of therapeutic antibiotic concentrations in critically ill patients receiving CRRT. We urge clinicians to prescribe antibiotics aggressively for these vulnerable patients. PMID:25204875

Lewis, Susan J; Mueller, Bruce A

2014-01-01

269

Effect of Parenteral Selenium Supplementation in Critically Ill Patients: A Systematic Review and Meta-Analysis  

PubMed Central

Background It is currently unclear whether parenteral selenium supplementation should be recommended in the management of critically ill patients. Here we conducted a systematic review and meta-analysis to assess the efficacy of parenteral selenium supplementation on clinical outcomes. Methods/Principal Findings Randomized trials investigating parenteral selenium supplementation administered in addition to standard of care to critically ill patients were included. CENTRAL, Medline, EMBASE, the Science Citation Index, and CINAHL were searched with complementary manual searches. The primary outcome was all-cause mortality. Trials published in any language were included. Two authors independently extracted data and assessed trial quality. A third author was consulted to resolve disagreements and for quality assurance. Twelve trials were included and meta-analysis was performed on nine trials that recruited critically ill septic patients. These comprised 965 participants in total. Of these, 148 patients (30.7%) in the treatment groups, and 180 patients (37.3%) in control groups died. Parenteral selenium treatment significantly reduced all-cause mortality in critically ill patients with sepsis (relative risk [RR] 0.83, 95% CI 0.70–0.99, p?=?0.04, I2?=?0%). Subgroup analyses demonstrated that the administration schedule employing longer duration (RR 0.77, 95% CI 0.63–0.94, p?=?0.01, I2?=?0%), loading boluses (RR 0.73, 95% CI 0.58–0.94, p?=?0.01, I2?=?0%) or high-dose selenium treatment (RR 0.77, 95% CI 0.61–0.99, p?=?0.04, I2?=?0%) might be associated with a lower mortality risk. There was no evidence of adverse events. Conclusions/Significance Parenteral selenium supplementation reduces risk of mortality among critically ill patients with sepsis. Owing to the varied methodological quality of the studies, future high-quality randomized trials that directly focus on the effect of adequate-duration of parenteral selenium supplementation for severe septic patients are needed to confirm our results. Clinicians should consider these findings when treating this high-risk population. Systematic Review Registration PROSPERO 2011; CRD42011001768 PMID:23372722

Huang, Ting-Shuo; Shyu, Yu-Chiau; Chen, Huang-Yang; Lin, Li-Mei; Lo, Chia-Ying; Yuan, Shin-Sheng; Chen, Pei-Jer

2013-01-01

270

Dexmedetomidine infusion for more than 24 hours in critically ill patients: sedative and cardiovascular effects  

Microsoft Academic Search

Objective To assess the potential of dexmedetomidine for targeted sedation in complex Intensive Care (ICU) patients for >24 h.Design Prospective, open label, clinical trial.Setting Tertiary general ICU.Patients Twenty critically ill patients, mean APACHE II 23(±9).Interventions A continuous infusion of dexmedetomidine, median infusion time 71.5 (35–168) h, starting at 0.4?g·kg·h without a loading dose and adjusted (0.2–0.7?g·kg·h) to a target Ramsay Sedation Score

Yahya Shehabi; Urban Ruettimann; Harriet Adamson; Richard Innes; Mathieu Ickeringill

2004-01-01

271

Investigational tests and treatments performed in terminal stage cancer patients in two weeks before death: Turkish oncology group (TOG) study.  

PubMed

Although more palliative care is necessary for terminally ill cancer patients, excess investigational tests, invasive procedures, and treatments are given instead. Between November 2009 and December 2013, six hundred and twenty-four patients with end-stage cancer who were died at inpatient setting evaluated retrospectively. Patients' characteristics, sites of tumor and metastasis, tests and invasive procedures, treatments performed in the last 2 weeks before death were collected from the hospital files and analyzed. Median age of 624 patients was 58 (range 16-96) years. More than half of the patients (370, 59.3 %) were men. The most frequent cancer sites were gastrointestinal (GI) system (32.2 %), lung (24.0 %), and breast (11.1 %). Frequent metastatic sites were liver (34.8 %), bone (31.5 %), lung (23.3 %), and/or brain (16.9 %). Causes of death were respiratory failure, infections, and/or liver failure in 49.9, 23.9, and 19.4 % of patients, respectively. Radiological tests performed in the last 2 weeks before death were ultrasonography, computed tomography, magnetic resonance imaging, bone scan in 25.6, 16.3, 11.4, and 3.8 % of patients, respectively. Treatments received were intravenous (i.v) serum infusion, blood transfusion, total parenteral nutrition (TPN), human albumin infusion in 55.9, 44.1, 34.9, and 9.5 % of patients, respectively. Invasive procedures such as invasive pain relief, terminal sedation, and chemotherapy performed in 12.6, 4.4, and 10.0 % of patients, respectively. Central venous catheter application, paracentesis, thoracentesis, and GI endoscopy were applied in 41.7, 9.8, 5.6, and 3.4 % of the patients, respectively. Radiological tests, invasive procedures, TPN, and human albumin transfusion were used excessively in terminal stage cancer patients in our medical oncology inpatient clinics. Invasive pain relief and terminal sedation were still underused in our cancer clinics. There is an urgent need in developing national palliative care program to improve the understanding of end-of-life care in our medical oncology clinics. PMID:25412940

Türker, Ibrahim; Kömürcü, Seref; Ar?can, Ali; Doruk, Hatice; Ozy?lkan, Ozgür; Co?kun, Hasan Senol; Colak, Dil?en; Uçgül Çavu?o?lu, Emel; Ata, Alper; Sezer, Ahmet; Ye?il Ç?nk?r, Havva; Senler, Filiz Cay; Arpac?, Fikret

2014-12-01

272

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

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

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

2008-01-01

273

Suspected ventilator-associated respiratory infection in severely ill patients: a prospective observational study  

PubMed Central

Introduction Ventilator-associated respiratory infection (VARI) is an important cause of morbidity in critically-ill patients. Clinical trials performed in heterogeneous populations have suggested there are limited benefits from invasive diagnostic testing to identify patients at risk or to target antimicrobial therapy. However, multiple patient subgroups (for example, immunocompromised, antibiotic-treated) have traditionally been excluded from randomization. We hypothesized that a prospective surveillance study would better identify patients with suspected VARI (sVARI) at high risk for adverse clinical outcomes, and who might be specifically targeted in future trials. Methods We performed a prospective observational study in all patients ventilated for greater than 48 hours. sVARI was identified by surveillance for changes in white blood cell count, temperature, sputum, and/or new chest X-ray infiltrates. Indices of disease co-morbidity, as well as mortality, duration of mechanical ventilation, and length of hospital or ICU stay were correlated with sVARI. Results Of 1806 patients admitted to the ICU over 14 months, 267 were ventilated for greater than 48 hours, and 77 developed sVARI. Incidence of sVARI was associated with iatrogenic immunosuppression or admission for respiratory illness. Any sVARI, whether suspected ventilator-associated pneumonia (sVAP) or ventilator-associated tracheobronchitis (sVAT), was associated with increased length of stay and duration of mechanical ventilation. Conclusions Clinical surveillance for sVARI identifies patients at risk for increased morbidity. Iatrogenically immunosuppressed patients, a subgroup previously excluded from randomized clinical trials, represent a growing proportion of the critically-ill at risk for sVARI who might be targeted for future investigations on diagnostic or therapeutic modalities. PMID:24148702

2013-01-01

274

Cytokine Expression Profile of Dengue Patients at Different Phases of Illness  

PubMed Central

Background Dengue is an important medical problem, with symptoms ranging from mild dengue fever to severe forms of the disease, where vascular leakage leads to hypovolemic shock. Cytokines have been implicated to play a role in the progression of severe dengue disease; however, their profile in dengue patients and the synergy that leads to continued plasma leakage is not clearly understood. Herein, we investigated the cytokine kinetics and profiles of dengue patients at different phases of illness to further understand the role of cytokines in dengue disease. Methods and Findings Circulating levels of 29 different types of cytokines were assessed by bead-based ELISA method in dengue patients at the 3 different phases of illness. The association between significant changes in the levels of cytokines and clinical parameters were analyzed. At the febrile phase, IP-10 was significant in dengue patients with and without warning signs. However, MIP-1? was found to be significant in only patients with warning signs at this phase. IP-10 was also significant in both with and without warning signs patients during defervescence. At this phase, MIP-1? and G-CSF were significant in patients without warning signs, whereas MCP-1 was noted to be elevated significantly in patients with warning signs. Significant correlations between the levels of VEGF, RANTES, IL-7, IL-12, PDGF and IL-5 with platelets; VEGF with lymphocytes and neutrophils; G-CSF and IP-10 with atypical lymphocytes and various other cytokines with the liver enzymes were observed in this study. Conclusions The cytokine profile patterns discovered between the different phases of illness indicate an essential role in dengue pathogenesis and with further studies may serve as predictive markers for progression to dengue with warning signs. PMID:23284941

Rathakrishnan, Anusyah; Wang, Seok Mui; Hu, Yongli; Khan, Asif M.; Ponnampalavanar, Sasheela; Lum, Lucy Chai See; Manikam, Rishya; Sekaran, Shamala Devi

2012-01-01

275

Assisted suicide in the care of mentally ill patients: the Lucio Magri's case.  

PubMed

A year after Mario Monicelli's suicide, the death of another famous person in Italy, Lucio Magri, reawakened the Italian debate on social, ethical and juridical issues in end-of-life decisions. Unlike Monicelli, Lucio Magri decided to end his own life in Switzerland with the help of a physician because his mental illness rendered his life unbearable. Both Monicelli and Magri suffered from a severe depression. The authors analyze the ethical issues regarding the right to die for mentally ill patients and neurological disabled patients, discussing the decision-making autonomy in persons suffering from severe depression. The role of the psychiatry in the management of end-of-life decision requests is considered along with pros and cons of suicide prevention and rationale suicide. PMID:24365684

Frati, Paola; Gulino, Matteo; Mancarella, Paola; Cecchi, Rossana; Ferracuti, Stefano

2014-01-01

276

Personality and Physician-Assessed Illness Burden in Older Primary Care Patients Over Four Years  

PubMed Central

Background Personality traits have been associated with physician-rated illness burden cross-sectionally, but longitudinal associations between personality and objective medical morbidity remain unclear. Purpose To examine associations between personality and physician-rated illness burden 4 years prospectively in older primary care patients. Method At baseline, patients (average age = 75, SD = 6.6, 62% female) completed the NEO-Five Factor Inventory. At baseline and 4 yearly follow-ups, a physician completed the Cumulative Illness Rating Scale based on medical records. Results Linear mixed effects models revealed that higher neuroticism and lower conscientiousness predicted worse average illness burden longitudinally. Relatively disagreeable persons (25th percentile) accumulated morbidity at a 33% faster rate than agreeable (75th percentile) peers. At the final follow-up, a person at the 75th percentile of neuroticism and the 25th percentile of conscientiousness and agreeableness showed morbidity comparable to a peer of average personality but 10 years older. An individual at the 25th percentile of neuroticism and 75th percentile of conscientiousness and agreeableness showed end-point illness burden comparable to a peer of average personality but 10 years younger. 21% of the morbidity associated with neuroticism was explained by total cholesterol. History of hypertension, smoking, alcohol/drug abuse, and affective symptoms of depression each explained 10% or less of the other observed personality effects. Conclusion Personality plays a non-trivial role in healthy aging among older persons. Brief personality assessment may identify at-risk older persons for closer monitoring, enhance the accuracy of medical prognosis, and provide clues for clinical interventions to promote better health. PMID:23567416

Chapman, Benjamin P.; Roberts, Brent; Lyness, Jeff; Duberstein, Paul

2012-01-01

277

Critically ill patients in emergency department may be characterized by low amplitude and high variability of amplitude of pulse photoplethysmography  

PubMed Central

Background The aim of the present pilot study was to determine if pulse photoplethysmography amplitude (PPGA) could be used as an indicator of critical illness and as a predictor of higher need of care in emergency department patients. Methods This was a prospective observational study. We collected vital signs and one minute of pulse photoplethysmograph signal from 251 consecutive patients admitted to a university hospital emergency department. The patients were divided in two groups regarding to the modified Early Warning Score (mEWS): > 3 (critically ill) and???3 (non-critically ill). Photoplethysmography characteristics were compared between the groups. Results Sufficient data for analysis was acquired from 212 patients (84.5%). Patients in critically ill group more frequently required intubation and invasive hemodynamic monitoring in the ED and received more intravenous fluids. Mean pulse photoplethysmography amplitude (PPGA) was significantly lower in critically ill patients (median 1.105 [95% CI of mean 0.9946-2.302] vs. 2.476 [95% CI of mean 2.239-2.714], P?=?0.0257). Higher variability of PPGA significantly correlated with higher amount of fluids received in the ED (r?=?0.1501, p?=?0.0296). Conclusions This pilot study revealed differences in PPGA characteristics between critically ill and non-critically ill patients. Further studies are needed to determine if these easily available parameters could help increase accuracy in triage when used in addition to routine monitoring of vital signs. PMID:23799988

2013-01-01

278

Recommendations for the intra-hospital transport of critically ill patients  

Microsoft Academic Search

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

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

2010-01-01

279

On-line computer monitoring of the seriously-ill patient  

Microsoft Academic Search

A digital computer system for on-line monitoring of seriously-ill patients is described. This system is in continuous operation\\u000a and is used routinely to determine and report twenty-six variables including heart, pulse and respiration rates, systolic,\\u000a diastolic and mean arterial pressure, venous pressure, body temperatures, cardiac output and urine flow. Both analog and digital\\u000a displays of real time and summary data

R. E. Jensen; H. Shubin; P. F. Meagher; M. H. Weil

1966-01-01

280

Living With Advanced Illness: Longitudinal Study of Patient, Family, and Caregiver Needs  

PubMed Central

Background and Objectives: Inpatient palliative care (IPC) consults are associated with improved quality of care and less intensive utilization. However, little is known about how the needs of patients with advanced illness and the needs of their families and caregivers evolve or how effectively those needs are addressed. The objectives of this study were 1) to summarize findings in the literature about the needs of patients with advanced illness and the needs of their families and caregivers; 2) to identify the primary needs of patients, families, and caregivers across the continuum of care from their vantage point; and 3) to learn how IPC teams affect the care experience. Methods: We used a longitudinal, video-ethnographic approach to observe and to interview 12 patients and their families before, during, and after an IPC consult at 3 urban medical centers. Additional interviews took place up to 12 months after discharge. Results: Five patient/family/caregiver needs were important to all family units. IPC teams responded effectively to a variety of needs that were not met in the hospital, but some postdischarge needs, beyond the scope of IPC or health care coverage, were not completely met. Conclusion: Findings built upon the needs identified in the literature. The longitudinal approach highlighted changes in needs of patients, families, and caregivers in response to emerging medical and nonmedical developments, from their perspective. Areas for improvement include clear, integrated communications in the hospital and coordinated, comprehensive postdischarge support for patients not under hospice care and for their caregivers. PMID:23012596

Tallman, Karen; Greenwald, Ruth; Reidenouer, Alice; Pantel, Laurel

2012-01-01

281

Recommendations for the intra-hospital transport of critically ill patients  

PubMed Central

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 ill patient. The reference bibliographies of each of the selected articles between 1998 and 2009 were also studied. Results This review focuses on the analysis and overcoming of IHT-related risks, the associated adverse events, and their nature and incidence. The suggested preventive measures are also reviewed. A check-list for quick execution of IHT is then put forward and justified. Conclusions Despite improvements in IHT practices, significant risks are still involved. Basic training, good clinical sense and a risk-benefit analysis are currently the only deciding factors. A critically ill patient, prepared and accompanied by an inexperienced team, is a risky combination. The development of adapted equipment and the widespread use of check-lists and proper training programmes would increase the safety of IHT and reduce the risks in the long-term. Further investigation is required in order to evaluate the protective role of such preventive measures. PMID:20470381

2010-01-01

282

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

PubMed Central

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

2014-01-01

283

Intensive insulin treatment improves forearm blood flow in critically ill patients: a randomized parallel design clinical trial  

Microsoft Academic Search

INTRODUCTION: Intensive insulin treatment of critically ill patients was seen as a promising method of treatment, though recent studies showed that reducing the blood glucose level below 6 mmol\\/l had a detrimental outcome. The mechanisms of the effects of insulin in the critically ill are not completely understood. The purpose of the study was to test the hypothesis that intensive

Ivan Žuran; Pavel Poredoš; Rafael Skale; Gorazd Voga; Lucija Gabrš?ek; Roman Parežnik

2009-01-01

284

Ratings of Patient–Provider Communication Among Veterans: Serious Mental Illnesses, Substance Use Disorders, and the Moderating Role of Trust  

Microsoft Academic Search

Many individuals with a mental illness are not satisfied with their communication with their primary provider. The present study examined the relationship of serious mental illness (SMI), substance use disorder (SUD), and trust for the provider with provider communication. The sample included Veterans Administration (VA) patients throughout the United States who either had a SMI diagnosis (schizophrenia or bipolar disorder)

Amy S. B. Bohnert; Kara Zivin; Deborah E. Welsh; Amy M. Kilbourne

2011-01-01

285

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

Microsoft Academic Search

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

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

2010-01-01

286

Manual muscle strength testing of critically ill patients: feasibility and interobserver agreement  

PubMed Central

Introduction It has been proposed that intensive care unit (ICU)-acquired weakness (ICUAW) should be assessed using the sum of manual muscle strength test scores in 12 muscle groups (the sum score). This approach has been tested in patients with Guillain-Barré syndrome, yet little is known about the feasibility or test characteristics in other critically ill patients. We studied the feasibility and interobserver agreement of this sum score in a mixed cohort of critically ill and injured patients. Methods We enrolled patients requiring more than 3 days of mechanical ventilation. Two observers performed systematic strength assessments of each patient. The primary outcome measure was interobserver agreement of weakness as a binary outcome (ICUAW is sum score less than 48; "no ICUAW" is a sum score greater than or equal to 48) using the Cohen's kappa statistic. Results We identified 135 patients who met the inclusion criteria. Most were precluded from study participation by altered mental status or polytrauma. Thirty-four participants were enrolled, and 30 of these individuals completed assessments conducted by both observers. Six met the criteria for ICUAW recorded by at least one observer. The observers agreed on the diagnosis of ICUAW for 93% of participants (Cohen's kappa = 0.76; 95% confidence interval (CI), 0.44 to 1.0). Observer agreement was fair in the ICU (Cohen's kappa = 0.38), and agreement was perfect after ICU discharge (Cohen's kappa = 1.0). Absolute values of sum scores were similar between observers (intraclass correlation coefficient 0.83; 95% CI, 0.67 to 0.91), but they differed between observers by six points or more for 23% of the participants. Conclusions Manual muscle testing (MMT) during critical illness was not possible for most patients because of coma, delirium and/or injury. Among patients who were able to participate in testing, we found that interobserver agreement regarding ICUAW was good, particularly when evaluated after ICU discharge. MMT is insufficient for early detection of ICU-acquired neuromuscular dysfunction in most patients and may be unreliable during critical illness. PMID:21276225

2011-01-01

287

Leprosy-like illness in a patient with Mycobacterium lepromatosis from Ontario, Canada.  

PubMed

Here we present the first case of a patient from Ottawa Canada, presenting with leprosy-like illness associated with Mycobacterium lepromatosis. The patient had no history of travel to leprosy-endemic areas or any obvious risk factors. Clinically, the patient presented with an anesthetic maculopapular rash on the trunk, back, and extremities. A skin biopsy of a lesion revealed a dermal lymphohistiocytic infiltration involving the vessels with an inflammatory process extending to the nerves. A neurological exam also identified a severe sensorimotor polyneuropathy. Concurrently, the patient was diagnosed with non-resectable, non small cell carcinoma of the lung, further complicating his clinical presentation. A Kinyoun stain of nasal blows and a Fite stain of the skin biopsy revealed few to moderate acid fast bacilli respectively. Cultures of the skin biopsy and multiple nasal blows were negative. Molecular studies of a skin biopsy sample including sequence analysis of a 765 bp region of the 16s rRNA gene eventually identified the organism with 100% homology to M. lepromatosis. The patient was treated for leprosy and appeared to improve slightly on therapy but died as a result of his malignancy approximately five months after the initiation of therapy. This represents the first case of a patient with M. lepromatosis like illness outside of Mexico and Singapore. PMID:22270208

Jessamine, Peter G; Desjardins, Marc; Gillis, Tom; Scollard, David; Jamieson, Frances; Broukhanski, George; Chedore, Pam; McCarthy, Anne

2012-02-01

288

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

Microsoft Academic Search

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

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

2005-01-01

289

Human Rights Act 1998 and mental health legislation: implications for the management of mentally ill patients.  

PubMed

In the management of mentally ill patients, there is a tension between protecting the rights of individual patients and safeguarding public safety. The Human Rights Act 1998 emphasises on the former while two recent white papers focus on the latter. This article first examines the extent to which the Mental Health Act 1983 is consistent with the Human Rights Act. It argues that while the recent white papers exploit the gaps in the judgments given by the European courts, its compatibility with human rights is very doubtful. The practical implications of the Human Rights Act for doctors are discussed. PMID:11884706

Leung, W-C

2002-03-01

290

A Holistic Approach to MRSA Eradication in Critically Ill Patients with MRSA Pneumonia  

Microsoft Academic Search

Background:  The number of Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia cases is increasing in many European countries. In this observational study in one medical and three surgical\\u000a ICUs multiple interventions for the treatment and eradication of nosocomial MRSA-pneumonia were used.\\u000a \\u000a \\u000a \\u000a Patients and Methods:  Twenty-one critically ill patients (age: 59 14 years, 15 males\\/6 females, 18 ventilator-associated, 3 nosocomial, clinical\\u000a pulmonary infection score >

C. Wenisch; H. Laferl; M. Szell; K. H. Smolle; A. Grisold; G. Bertha; R. Krause

2006-01-01

291

Impact of a Specialized Neurointensive Care Team on Outcomes of Critically Ill Acute Ischemic Stroke Patients  

Microsoft Academic Search

Background and Purpose  Dedicated stroke units are associated with improved patient outcomes after acute ischemic stroke in general. However, it is\\u000a unknown whether the population of critically ill ischemic stroke patients admitted to the neurocritical care unit (NCCU) benefit\\u000a from primary management by a specialized neurocritical care team (NCT). This study is intended to investigate such benefit.\\u000a \\u000a \\u000a \\u000a Methods  A retrospective chart review

Eric M. Bershad; Eliahu S. Feen; Olga H. Hernandez; M. Fareed K. Suri; Jose I. Suarez

2008-01-01

292

Perfectionism, Type D personality, and illness-related coping styles in cardiac rehabilitation patients.  

PubMed

This study investigated the associations among trait perfectionism, perfectionistic self-presentation, Type D personality, and illness-specific coping styles in 100 cardiac rehabilitation patients. Participants completed the Multidimensional Perfectionism Scale, the Perfectionistic Self-Presentation Scale, the Type D Scale-14, and the Coping with Health Injuries and Problems Scale. Correlational analyses established that emotional preoccupation coping was associated with trait perfectionism, perfectionistic self-presentation, and Type D personality. Perfectionism was linked with both facets of the Type D construct (negative emotionality and social inhibition). Our results suggest that perfectionistic Type D patients have maladaptive coping with potential negative implications for their cardiac rehabilitation outcomes. PMID:23493864

Shanmugasegaram, Shamila; Flett, Gordon L; Madan, Mina; Oh, Paul; Marzolini, Susan; Reitav, Jaan; Hewitt, Paul L; Sturman, Edward D

2014-03-01

293

Inpatient Management of Diabetes Mellitus among Noncritically Ill Patients at University Hospital of Puerto Rico.  

PubMed

Objective: To describe the state of glycemic control in noncritically ill diabetic patients admitted to the Puerto Rico University Hospital and adherence to current standard of care guidelines for the treatment of diabetes.Methods: This was a retrospective study of patients admitted to a general medicine ward with diabetes mellitus as a secondary diagnosis. Clinical data for the first 5 days and the last 24 hours of hospitalization were analyzed.Results: A total of 147 noncritically ill diabetic patients were evaluated. The rates of hyperglycemia (blood glucose ?180 mg/dL) and hypoglycemia (blood glucose <70 mg/dL) were 56.7 and 2.8%, respectively. Nearly 60% of patients were hyperglycemic during the first 24 hours of hospitalization (mean random blood glucose, 226.5 mg/dL), and 54.2% were hyperglycemic during the last 24 hours of hospitalization (mean random blood glucose, 196.51 mg/dL). The mean random last glucose value before discharge was 189.6 mg/dL. Most patients were treated with subcutaneous insulin, with basal insulin alone (60%) used as the most common regimen. The proportion of patients classified as uncontrolled receiving basal-bolus therapy increased from 54.3% on day 1 to 60% on day 5, with 40% continuing to receive only basal insulin. Most of the uncontrolled patients had their insulin dose increased (70.1%); however, a substantial proportion had no change (23.7%) or even a decrease (6.2%) in their insulin dose.Conclusion: The management of hospitalized diabetic patients is suboptimal, probably due to clinical inertia, manifested by absence of appropriate modification of insulin regimen and intensification of dose in uncontrolled diabetic patients. A comprehensive educational diabetes management program, along with standardized insulin orders, should be implemented to improve the care of these patients. PMID:24325996

Allende-Vigo, Myriam Zaydee; González-Rosario, Rafael A; González, Loida; Sánchez, Viviana; Vega, Mónica A; Alvarado, Milliette; Ramón, Raul O

2014-05-01

294

Current issues on safety of prokinetics in critically ill patients with feed intolerance  

PubMed Central

Feed intolerance in the setting of critical illness should be treated promptly given its adverse impact on morbidity and mortality. The technical difficulty of postpyloric feeding tube placement and the morbidities associated with parenteral nutrition prevent these approaches being considered as first-line nutrition. Prokinetic agents are currently the mainstay of therapy for feed intolerance in the critically ill. Current information is limited but suggests that erythromycin or metoclopramide (alone or in combination) are effective in the management of feed intolerance in the critically ill and not associated with significant cardiac, haemodynamic or neurological adverse effects. However, diarrhoea is a very common gastrointestinal side effect, and can occur in up to 49% of patients who receive both erythromycin and metoclopramide. Fortunately, the diarrhoea associated with prokinetic treatments has not been linked to Clostridium difficile infection and settles soon after the drugs are ceased. Therefore, prolonged or prophylactic use of prokinetics should be avoided. If diarrhoea occurs, the drugs should be stopped immediately. To minimize avoidable adverse effects the ongoing need for prokinetic drugs in these patient should be reviewed daily. PMID:25083212

Yi Mei, Swee Lin Chen

2011-01-01

295

Clinical and pharmacokinetic characteristics of aminoglycoside nephrotoxicity in 201 critically ill patients.  

PubMed Central

We studied 201 critically ill patients during 267 courses of gentamicin (139 courses) or tobramycin (128 courses) therapy. Clinical and pharmacokinetic data were obtained on 240 of 267 courses (120 courses each of gentamicin and tobramycin). Two judgments of nephrotoxicity and its cause were made independently in this study, using a clinical and a pharmacokinetic definition of nephrotoxicity. The two sets of criteria were generally in good agreement, as all but 10 of 41 patients who were judged nephrotoxic by pharmacokinetic criteria were independently judged nephrotoxic by the clinical definition. Groups of patients judged nontoxic did not differ from groups judged nephrotoxic in age, sex, weight, initial creatinine clearance, total dose given, duration of treatment, initial aminoglycoside trough serum levels, number of dosage adjustments, concurrent use of furosemide, or concurrent cephalosporins. Prior aminoglycosides (usually gentamicin) had been used more frequently in the nontoxic group (P less than 0.05). Two major conclusions of this study are at variance with those of previous investigators; (i) we found no clinical parameters of value in predicting nephrotoxicity in critically ill patients; and (ii) aminoglycoside serum concentrations, once in the therapeutic range, were of limited value in prevention of aminoglycoside nephrotoxicity in our patients. PMID:7103453

Schentag, J J; Cerra, F B; Plaut, M E

1982-01-01

296

Whole body protein kinetics during hypocaloric and normocaloric feeding in critically ill patients  

PubMed Central

Introduction Optimal feeding of critically ill patients in the ICU is controversial. Existing guidelines rest on rather weak evidence. Whole body protein kinetics may be an attractive technique for assessing optimal protein intake. In this study, critically ill patients were investigated during hypocaloric and normocaloric IV nutrition. Methods Neurosurgical patients on mechanical ventilation (n?=?16) were studied during a 48-hour period. In random order 50% and 100% of measured energy expenditure was given as IV nutrition during 24 hours, corresponding to hypocaloric and normocaloric nutrition, respectively. At the end of each period, whole body protein turnover was measured using d5-phenylalanine and 13C-leucine tracers. Results The phenylalanine tracer indicated that whole-body protein synthesis was lower during hypocaloric feeding, while whole-body protein degradation and amino acid oxidation were unaltered, which resulted in a more negative protein balance, namely ?1.9?±?2.1 versus ?0.7?±?1.3 mg phenylalanine/kg/h (P?=?0.014). The leucine tracer indicated that whole body protein synthesis and degradation and amino acid oxidation were unaltered, but the protein balance was negative during hypocaloric feeding, namely ?0.3?±?0.5 versus 0.6?±?0.5 mg leucine/kg/h (P?patient group studied, hypocaloric feeding was associated with a more negative protein balance, but the amino acid oxidation was not different. The protein kinetics measurements and the study’s investigational protocol were useful for assessing the efficacy of nutrition support on protein metabolism in critically ill patients. PMID:23883571

2013-01-01

297

The Perfidious Experiences of Men as Palliative Caregivers of People Living with HIV/AIDS and other Terminal illnesses in Botswana. Eclectic Data Sources  

PubMed Central

Aim: The aim and objective of this scientific research article is to explore the literature with intent to raise attention to the perfidiousness of the experiences of men as palliative caregivers of people living with HIV/AIDS and other terminal illnesses. Methods: The article has utilized eclectic data sources in Botswana and elsewhere. Results: The findings indicate that care giving position of men has been found beset by: retrogressive gender unfriendly cultures; patriarchy; weaker gender empowerment campaigns; and inadequate male involvement in care. Conclusions: The article recommends: (1) a paradigm shift of structural gender dynamics; (2) making AIDS care programmes both gender sensitive and gender neutral; (3) Strengthening gender mainstreaming; (4) diluting cultures and patriarchy; (5) and signing and domesticating SADC gender protocol and other gender friendly international agreements by Botswana government. PMID:21218009

Kangethe, Simon

2010-01-01

298

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

PubMed

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

Ben-Zeev, D

2014-12-01

299

Instituting a music listening intervention for critically ill patients receiving mechanical ventilation: Exemplars from two patient cases  

PubMed Central

Music is an ideal intervention to reduce anxiety and promote relaxation in critically ill patients receiving mechanical ventilatory support. This article reviews the basis for a music listening intervention and describes two case examples with patients utilizing a music listening intervention to illustrate the implementation and use of the music listening protocol in this dynamic environment. The case examples illustrate the importance and necessity of engaging a music therapist in not only assessing the music preferences of patients, but also for implementing a music listening protocol to manage the varied and challenging needs of patients in the critical care setting. Additionally, the case examples presented in this paper demonstrate the wide array of music patients prefer and how the ease of a music listening protocol allows mechanically ventilated patients to engage in managing their own anxiety during this distressful experience. PMID:22081788

Heiderscheit, Annie; Chlan, Linda; Donley, Kim

2011-01-01

300

Hypocaloric, high-protein nutrition therapy for critically ill patients with obesity.  

PubMed

We published the first article that addressed hypocaloric, high-protein enteral nutrition therapy for critically ill patients with obesity more than 10 years ago. This study demonstrated that it was possible to successfully achieve this mode of therapy with a commercially available high-protein enteral formula and concurrent use of protein supplements. This study was also the first to demonstrate improved clinical outcomes with the use of hypocaloric, high-protein nutrition therapy. The results of this study, its unique findings, and shortcomings are discussed. Subsequent studies have added clarity to the effective use of this therapy, including its use in home parenteral nutrition patients, patients with class III obesity, and older patients with obesity. PMID:25049263

Dickerson, Roland N

2014-12-01

301

Emotional responses of family members of a critically ill patient: a hermeneutic analysis.  

PubMed

This study used an exploratory design with a hermeneutic approach. The aim was to increase the understanding of the emotional responses of family members during the patient's critical care. Interviews from the main researcher's previous study about relatives of patients in an intensive care unit (ICU) were used. Two of these interviews were chosen, one with the mother and one with the father of an adult young patient, who became critically ill and admitted to a general ICU in south-west Sweden. The present study identified six feelings describing the emotional responses of the family members. The family members experienced feelings of uncertainty, feelings of abandonment, feelings of desertion from the loved one, feelings of being close to the deathbed, feelings of being in a no-man's-land and feelings of attachment. The experienced feelings described in this article can contribute to expanding healthcare professionals understanding of the family members' emotional responses during the patient's critical care. PMID:25345232

Rnanicmt, Ingrid Johansson

2014-01-01

302

Reinstitutionalization following psychiatric discharge among VA patients with serious mental illness: a national longitudinal study.  

PubMed

Patterns of reinstitutionalization following psychiatric hospitalization for individuals with serious mental illnesses (SMI) vary by medical and psychiatric health care settings. This report presents rates of reinstitutionalization across care settings for 35,527 patients following psychiatric discharge in the Department of Veterans Affairs (VA) health system, a national health care system. Over a 7-year follow-up period, 30,417 patients (86%) were reinstitutionalized. Among these patients, 73% were initially reinstitutionalized to inpatient psychiatric settings. Homelessness, medical morbidity, and substance use were associated with increased risks for reinstitutionalization. Despite the VA's increased emphasis on outpatient services delivery, the vast majority of patients experienced reinstitutionalization in the follow-up period. Study findings may inform efforts to refine psychiatric and medical assessment for service delivery for this vulnerable population. PMID:17763982

Irmiter, Cheryl; McCarthy, John F; Barry, Kristen L; Soliman, Soheil; Blow, Frederic C

2007-12-01

303

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

PubMed

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

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

2014-02-01

304

Increased total serum random cortisol levels predict mortality in critically ill trauma patients.  

PubMed

Dysfunction in the hypothalamopituitary adrenal axis is thought to exist; however, there continues to be controversy about what level of serum cortisol corresponds to adrenal insufficiency. Few studies have focused on the significance of serum random cortisol in the critically ill trauma patient. Trauma patients with total serum random cortisol levels drawn in the intensive care unit within the first seven days of hospitalization were retrospectively reviewed. The primary outcome measured was in-hospital mortality. Two hundred forty-two patients were analyzed. Nonsurvivors had significantly higher mean cortisol levels than survivors (28.7 ± 15.80 ?g/dL vs 22.9 ± 12.35 ?g/dL, P = 0.01). Patients with cortisol 30 ?g/dL or greater were more likely to die with odds ratio of 2.7 (95% confidence interval [CI], 1.5 to 5). The odds ratio increased to 4.0 and 3.8 (95% CI, 1.4 to 11.4 and 1.3 to 10.9) when cortisol was drawn on hospital Day 2 and Days 3 through 7, respectively. Among nonsurvivors, patients with an injury severity score less than 25 had significantly higher cortisol levels than patients with an Injury Severity Score 25 or higher (35.3 ± 19.21 ?g/dL vs 25.7 ± 13.21 ?g/dL, P = 0.009). Patients with massive transfusion, traumatic brain injury, spinal cord injury, or solid organ injury did not have significantly different cortisol levels. The covariate-adjusted area under the receiver operating characteristic curve indicated that cortisol level has a 77 per cent accuracy in differentiating survivors from nonsurvivors. Higher cortisol levels were predictive of mortality in critically ill trauma patients. Whether serum cortisol level is a marker that can be modified remains an area of interest for future study. PMID:25347501

Pandya, Urmil; Polite, Nathan; Wood, Teresa; Lieber, Michael

2014-11-01

305

Delta neutrophil index as an early marker of disease severity in critically ill patients with sepsis  

PubMed Central

Background The immature granulocyte count has been reported to be a marker of infection and sepsis. The difference in leukocyte subfractions (delta neutrophil index, DNI) in ADVIA 2120 reflects the fraction of circulating immature granulocytes in the blood. This study evaluated the clinical utility of DNI as a severity and prediction marker in critically ill patients with sepsis. Methods One hundred and three patients admitted to the medical intensive care unit with sepsis were studied. DNI (the difference in leukocyte subfractions identified by myeloperoxidase and nuclear lobularity channels) was determined using a specific blood cell analyzer. Results Forty four patients (42.7%) were diagnosed with severe sepsis/septic shock. Overt disseminated intravascular coagulation (DIC) occurred in 40 (38.8%). DNI was significantly higher in patients with severe sepsis/septic shock and overt DIC than in patients without (p < 0.05). DNI correlated with DIC score (r = 0.54, p < 0.001). We observed a monotonic increase in the proportion of overt DIC and severe sepsis/septic shock associated with increasing quartiles of DNI (p < 0.001). A DNI value > 6.5% was a better indicator of severe sepsis/septic shock than C-reactive protein, lactate, white blood cell count, and absolute neutrophil count (sensitivity, 81.3%; specificity, 91.0%; positive predictive value, 88.6%; and negative predictive value, 84.7%). In 36 (82%) of the 44 patients with severe sepsis/septic shock, DNI values were already elevated up to 12 hours before the onset of organ/circulatory failure. Conclusions DNI may be used as a marker of disease severity in critically ill patients with sepsis. High levels of DNI may help to identify patients with an impending risk of developing severe sepsis/septic shock. PMID:22040292

2011-01-01

306

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

PubMed

Infectious diseases and impaired renal function often occur in critically ill patients, and delaying the start of appropriate empiric antimicrobial therapy or starting inappropriate therapy has been associated with poor outcomes. Our primary objective was to critically review and discuss the influence of chronic kidney disease (CKD) and acute kidney injury (AKI) on the clinical pharmacokinetic and pharmacodynamic properties of antimicrobial agents. The effect of continuous renal replacement therapies (CRRTs) and intermittent hemodialysis (IHD) on drug disposition in these two populations was also evaluated. Finally, proposed dosing strategies for selected antimicrobials in critically ill adult patients as well as those receiving CRRT or IHD have been compiled. We conducted a PubMed search (January 1980-March 2008) to identify all English-language literature published in which dosing recommendations were proposed for antimicrobials commonly used in critically ill patients, including those receiving CRRT or IHD. All pertinent reviews, selected studies, and associated references were evaluated to ensure their relevance. Forty antimicrobial, antifungal, and antiviral agents commonly used in critically ill patients were included for review. Dosage recommendations were synthesized from the 42 reviewed articles and peer-reviewed, evidence-based clinical drug databases to generate initial guidance for the determination of antimicrobial dosing strategies for critically ill adults. Because of the evolving process of critical illness, whether in patients with AKI or in those with CKD, prospective adaptation of these initial dosing recommendations to meet the needs of each individual patient will often rely on prospectively collected clinical and laboratory data. PMID:19397464

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

2009-05-01

307

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 ...

308

Beta-lactam dosing in critically ill patients with septic shock and continuous renal replacement therapy.  

PubMed

Although early and appropriate antibiotic therapy remains the most important intervention for successful treatment of septic shock, data guiding optimization of beta-lactam prescription in critically ill patients prescribed with continuous renal replacement therapy (CRRT) are still limited. Being small hydrophilic molecules, beta-lactams are likely to be cleared by CRRT to a significant extent. As a result, additional variability may be introduced to the per se variable antibiotic concentrations in critically ill patients. This article aims to describe the current clinical scenario for beta-lactam dosing in critically ill patients with septic shock and CRRT, to highlight the sources of variability among the different studies that reduce extrapolation to clinical practice, and to identify the opportunities for future research and improvement in this field. Three frequently prescribed beta-lactams (meropenem, piperacillin and ceftriaxone) were chosen for review. Our findings showed that present dosing recommendations are based on studies with drawbacks limiting their applicability in the clinical setting. In general, current antibiotic dosing regimens for CRRT follow a one-size-fits-all fashion despite emerging clinical data suggesting that drug clearance is partially dependent on CRRT modality and intensity. Moreover, some studies pool data from heterogeneous populations with CRRT that may exhibit different pharmacokinetics (for example, admission diagnoses different to septic shock, such as trauma), which also limit their extrapolation to critically ill patients with septic shock. Finally, there is still no consensus regarding the %T>MIC (percentage of dosing interval when concentration of the antibiotic is above the minimum inhibitory concentration of the pathogen) value that should be chosen as the pharmacodynamic target for antibiotic therapy in patients with septic shock and CRRT. For empirically optimized dosing, during the first day a loading dose is required to compensate the increased volume of distribution, regardless of impaired organ function. An additional loading dose may be required when CRRT is initiated due to steady-state equilibrium breakage driven by clearance variation. From day 2, dosing must be adjusted to CRRT settings and residual renal function. Therapeutic drug monitoring of beta-lactams may be regarded as a useful tool to daily individualize dosing and to ensure optimal antibiotic exposure. PMID:25042938

Ulldemolins, Marta; Vaquer, Sergi; Llauradó-Serra, Mireia; Pontes, Caridad; Calvo, Gonzalo; Soy, Dolors; Martín-Loeches, Ignacio

2014-01-01

309

Infective and non-infective endocarditis in critically ill patients: a clinical-pathological study.  

PubMed

The aims of this study are to estimate the incidence, the outcome and the associated risk factors of infective and non-infective endocarditis (IE and NIE, respectively) in intensive care unit (ICU) patients. We studied the post-mortem findings and the clinical data of the patients who died in our ICU between 1996 and 2010. Of the 765 reviewed autopsies, 21 patients (2.7%) presented cardiac vegetations. These cases consisted of 12 IEs and 9 NIEs. Three patients with IE had a mechanical prosthetic valve, and in 11 cases invasive devices had been used. Multiple peripheral embolisms were discovered at autopsy. In particular, the brain appeared to be more affected in patients with IE, while pulmonary embolisms were commonly associated with NIE. Blood cultures were positive in nine patients with IE. The imaging diagnostics (transthoracic and transesophageal echocardiography) which were seldom performed in both groups, proved to be of little help. As a consequence, an IE was correctly diagnosed before death in three patients (25%) and suspected in two other cases (17%), while a NIE was diagnosed before death in one patient alone. In conclusions, critically ill patients admitted to general ICUs, multiple factors related both to the underlying conditions and to performed procedures can facilitate the occurrence of IE and NIE making, at the same time, their diagnosis challenging. Many cases, in fact, are diagnosed only at autopsy. Yet again, post-mortem examination proves to be an invaluable tool for the evaluation of diagnostic accuracy in critical care. PMID:24519321

Berlot, Giorgio; Calderan, Cristina; Fiorenza, Cristina; Cappelli, Davide; Addesa, Stefano; Bussani, Rossana

2014-10-01

310

Case-Control Study of Drug Monitoring of ?-Lactams in Obese Critically Ill Patients  

PubMed Central

Severe sepsis and septic shock can alter the pharmacokinetics of broad-spectrum ?-lactams (meropenem, ceftazidime/cefepime, and piperacillin-tazobactam), resulting in inappropriate serum concentrations. Obesity may further modify the pharmacokinetics of these agents. We reviewed our data on critically ill obese patients (body mass index of ?30 kg/m2) treated with a broad-spectrum ?-lactam in whom therapeutic drug monitoring was performed and compared the data to those obtained in critically nonobese patients (body mass index of <25 kg/m2) to assess whether there were differences in reaching optimal drug concentrations for the treatment of nosocomial infections. Sixty-eight serum levels were obtained from 49 obese patients. There was considerable variability in ?-lactam serum concentrations (coefficient of variation of 50% to 92% for the three drugs). Standard drug regimens of ?-lactams resulted in insufficient serum concentrations in 32% of the patients and overdosed concentrations in 25%. Continuous renal replacement therapy was identified by multivariable analysis as a risk factor for overdosage and a protective factor for insufficient ?-lactam serum concentrations. The serum drug levels from the obese cohort were well matched for age, gender, renal function, and sequential organ failure assessment (SOFA) score to 68 serum levels measured in 59 nonobese patients. The only difference observed between the two cohorts was in the subgroup of patients treated with meropenem and who were not receiving continuous renal replacement therapy: serum concentrations were lower in the obese cohort. No differences were observed in pharmacokinetic variables between the two groups. Routine therapeutic drug monitoring of ?-lactams should be continued in obese critically ill patients. PMID:23147743

Taccone, Fabio Silvio; Wolff, Fleur; Cotton, Frederic; Beumier, Marjorie; De Backer, Daniel; Roisin, Sandrine; Lorent, Sophie; Surin, Rudy; Seyler, Lucie; Vincent, Jean-Louis; Jacobs, Frederique

2013-01-01

311

Effect of Diuretic Use on 30-Day Postdialysis Mortality in Critically Ill Patients Receiving Acute Dialysis  

PubMed Central

Background The impact of diuretic usage and dosage on the mortality of critically ill patients with acute kidney injury is still unclear. Methods and Results In this prospective, multicenter, observational study, 572 patients with postsurgical acute kidney injury receiving hemodialysis were recruited and followed daily. Thirty-day postdialysis mortality was analyzed using Cox's proportional hazards model with time-dependent covariates. The mean age of the 572 patients was 60.8±16.6 years. Patients with lower serum creatinine (p?=?0.031) and blood lactate (p?=?0.033) at ICU admission, lower predialysis urine output (p?=?0.001) and PaO2/FiO2 (p?=?0.039), as well as diabetes (p?=?0.037) and heart failure (p?=?0.049) were more likely to receive diuretics. A total of 280 (49.0%) patients died within 30 days after acute dialysis initiation. The analysis of 30-day postdialysis mortality by fitting propensity score-adjusted Cox's proportional hazards models with time-dependent covariates showed that higher 3-day accumulated diuretic doses after dialysis initiation (HR?=?1.449, p?=?0.021) could increase the hazard rate of death. Moreover, higher time-varying 3-day accumulative diuretic doses were associated with hypotension (p<0.001) and less intense hemodialysis (p<0.001) during the acute dialysis period. Background and Significance Higher time-varying 3-day accumulative diuretic dose predicts mortality in postsurgical critically ill patients requiring acute dialysis. Higher diuretic doses are associated with hypotension and a lower intensity of dialysis. Caution should be employed before loop diuretics are administered to postsurgical patients during the acute dialysis period. PMID:22431960

Shiao, Chih-Chung; Lin, Yu-Feng; Wu, Pei-Chen; Chao, Chia-Ter; Hu, Fu-Chang; Huang, Tao-Min; Yeh, Yu-Chang; Tsai, I-Jung; Kao, Tze-Wah; Han, Yin-Yi; Wu, Wen-Chung; Hou, Chun-Cheng; Young, Guang-Huar; Ko, Wen-Je; Tsai, Tun-Jun; Wu, Kwan-Dun

2012-01-01

312

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

PubMed Central

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

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

2014-01-01

313

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

PubMed

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

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

314

Illness perceptions of low back pain patients in primary care: What are they, do they change and are they associated with outcome?  

Microsoft Academic Search

We describe the illness perceptions of patients with low back pain, how they change over 6 months, and their associations with clinical outcome. Consecutive patients consulting eight general practices were eligible to take part in a prospective cohort study, providing data within 3 weeks of consultation and 6 months later. Illness perceptions were measured using the Revised Illness Perception Questionnaire

Nadine E. Foster; Annette Bishop; Elaine Thomas; Chris Main; Rob Horne; John Weinman; Elaine Hay

2008-01-01

315

Insulin Requirements in Non-Critically Ill Hospitalized Patients With Diabetes and Steroid-Induced Hyperglycemia  

PubMed Central

Objective Steroid-induced hyperglycemia is common in hospitalized patients with diabetes mellitus. Guidelines for glucose management in this setting are lacking. Methods We conducted a retrospective chart review of non-critically ill patients with diabetes receiving steroids, hospitalized from January 2009 to October 2012. Fifty-eight patients were identified from 247 consults. Multivariable linear regression was used to assess median daily insulin requirements of normoglycemic patients compared with hyperglycemic patients. Results Of the 58 total patients included in our study, 20 achieved normoglycemia during admission (patient-day weighted mean blood glucose [PDWMBG] level = 154 ± 16 mg/dL) and 38 remained hyperglycemic (PDWMBG level= 243 ± 39 mg/dL; P < 0.001). There were no differences between the 2 patient groups in age, sex, race, body weight, renal function, HbA1c level, glucose-altering medications, diabetes type, or disease duration. Following multivariable adjustment, compared with hyperglycemic patients, normoglycemic patients required similar units of basal insulin (median [interquartile range])(23.6 [17.9, 31.2] vs 20.1 [16.5, 24.4]; P = 0.35); higher units of nutritional insulin (45.5 [34.2, 60.4] vs 20.1 [16.4, 24.5]; P < 0.001]; and lower units of correctional insulin (5.8 [4.1, 8.1] vs 13.0 [10.2, 16.5]; P < 0.001]). Patients achieving normoglycemia required a significantly lower percentage of correction insulin (total daily dose [TDD]: 7.4% vs 23.4%; P < 0.001) and a higher percentage of nutritional insulin (TDD: 58.1% vs 36.2%; P < 0.001) than hyperglycemic patients. There was no difference in the TDD per kilogram, TDD per milligram hydrocortisone dose, or TDD per milligram hydrocortisone dose per kilogram weight between the 2 groups. Conclusion The data suggest that non-critically ill patients with hyperglycemia receiving steroids require a higher percentage of TDD insulin therapy as nutritional insulin to achieve normoglycemia. PMID:24769781

Spanakis, Elias K.; Shah, Nina; Malhotra, Keya; Kemmerer, Terri; Yeh, Hsin-Chieh; Golden, Sherita Hill

2014-01-01

316

Acid–base status of critically ill patients with acute renal failure: analysis based on Stewart–Figge methodology  

Microsoft Academic Search

INTRODUCTION: The aim of the present study is to understand the nature of acid–base disorders in critically ill patients with acute renal failure (ARF) using the biophysical principles described by Stewart and Figge. A retrospective controlled study was carried out in the intensive care unit of a tertiary hospital. MATERIALS AND METHODS: Forty patients with ARF, 40 patients matched for

Jens Rocktaeschel; Hiroshi Morimatsu; Shigehiko Uchino; Donna Goldsmith; Stephanie Poustie; David Story; Geoffrey Gutteridge; Rinaldo Bellomo

2003-01-01

317

Perceived autonomy and self-esteem in Dutch dialysis patients: The importance of illness and treatment perceptions  

Microsoft Academic Search

Compared to healthy people, end-stage renal disease (ESRD) patients participate less in paid jobs and social activities. This study explored the perceived autonomy, state self-esteem and labour participation in ESRD patients on dialysis, and the role illness and treatment perceptions play in these concepts. Patients completed questionnaires at home or in the dialysis centre (N = 166). Data were analysed

Daphne L. Jansen; Mieke Rijken; Monique Heijmans; Elisabeth W. Boeschoten

2010-01-01

318

Superficial temporal artery pseudoaneurysm: a conservative approach in a critically ill patient.  

PubMed

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. PMID:16988876

Grasso, Rosario Francesco; Quattrocchi, Carlo Cosimo; Crucitti, Pierfilippo; Carboni, Giampiero; Coppola, Roberto; Zobel, Bruno Beomonte

2007-01-01

319

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

Microsoft Academic Search

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

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

2007-01-01

320

The role of endocrine mechanisms in ventilator-associated lung injury in critically ill patients.  

PubMed

The critically ill subjects are represented by a heterogeneous group of patients suffering from a life-threatening event of different origin, e.g. trauma, cardiopulmonary failure, surgery or sepsis. The majority of these patients are dependent on the artificial lung ventilation, which means a life-saving chance for them. However, the artificial lung ventilation may trigger ventilation-associated lung injury (VALI). The mechanical ventilation at higher volumes (volutrauma) and pressure (barotrauma) can cause histological changes in the lungs including impairments in the gap and adherens junctions and desmosomes. The injured lung epithelium may lead to an impairment of the surfactant production and function, and this may not only contribute to the pathophysiology of VALI but also to acute respiratory distress syndrome. Other components of VALI are atelectrauma and toxic effects of the oxygen. Collectively, all these effects may result in a lung inflammation associated with a subsequent profibrotic changes, endothelial dysfunction, and activation of the local and systemic endocrine responses such as the renin-angiotensin system (RAS). The present review is aimed to describe some of the pathophysiologic aspects of VALI providing a basis for novel therapeutic strategies in the critically ill patients. PMID:22808908

Penesova, A; Galusova, A; Vigas, M; Vlcek, M; Imrich, R; Majek, M

2012-07-01

321

Increased mortality among the critically ill patients admitted on weekends: a global trend.  

PubMed

Critical illness and injury have no concept of time and do not always occur within regular business hours or at times conducive to optimal hospital function. In fact, it is a global trend that critically ill patients admitted to hospitals on weekends suffer higher mortality rates than those admitted during the week. Using a Canadian nursing lens, it is clear that there are some obvious differences in hospital function on weekends that include decreased hospital staffing, access to diagnostic services, intensivist coverage and the reluctance of patients to seek care on weekends. However, the exact differences contributing to the increased mortality in this patient population on weekends and the solutions remain unclear in the literature, and further research is needed. Possible solutions include moving to a "closed" ICU system, increasing nurse staffing, intensivist coverage and diagnostic accessibility, and creating a true seven-day hospital system. Finally, it is unclear exactly how to solve the nurse staffing portion of this problem, as it appears internally linked to the nursing profession and externally to hospital management, recruiting difficulties and financial restraints, and a problem that will take more than change in nursing management strategy to resolve. PMID:21941813

Degenhardt, Natalie

2011-01-01

322

Convulsions in a critically ill patient on hemodialysis: Possible role of low dose colistin.  

PubMed

The increasing prevalence of multi-drug resistant Gram-negative pathogens in intensive care units has led to the revival of colistin. Colistin had gone into disrepute in early 1970s because of numerous reports of adverse renal and neurological effects. The renewed interest in colistin has also revived the discussion about its toxicity. The neurotoxicity reported in literature is usually with higher doses of colistin. We present a case report of seizures in a critically ill-patient, possibly with low dose colistin. A 47-year-old hypertensive female with chronic kidney disease-5 with sepsis on colistimethate sodium 1 million units (80 mg), intravenous once daily, developed paresthesias and seizures on 12(th) day of therapy, which were subsequently controlled after withdrawl of the drug. To conclude, colistin should be considered as a cause of convulsions in critically ill-patients with renal failure, even when given in low dose and patient receiving intermittent hemodialysis, when other obvious causes have been ruled out. When possible, cessation of therapy may be considered. PMID:25190957

Sodhi, Kanwalpreet; Kohli, Rahul; Kaur, Basjinder; Garg, Sidhartha; Shrivastava, Anupam; Kumar, Manender

2014-07-01

323

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

PubMed

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

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

324

Rural experiences with mental illness: through the eyes of patients and their families.  

PubMed

People living in rural areas are often faced with multiple, complex, and seemingly insurmountable barriers to receiving appropriate treatment for mental health problems. Some of the barriers identified in the research literature include inaccessibility to mental health providers, stigma, and limited resources in the community. Despite existing data regarding rural patients and their families, little is known about their lived, personal experiences. For this reason, the purpose of this study was to determine the experience of patients and family members who are dealing with mental illness in rural communities. Based on this qualitative analysis of patient and family members' experiences in rural areas, issues surrounding mental health and treatment are accompanied by significant stigma, often left unresolved, and exacerbated by practical challenges which hinder access to proper mental health resources, frequently leaving rural residents to cope with inadequate solutions or seek their own, alternative solutions. PMID:23088821

Robinson, W David; Springer, Paul R; Bischoff, Richard; Geske, Jenenne; Backer, Elizabeth; Olson, Michael; Jarzynka, Kimberly; Swinton, Jonathan

2012-12-01

325

Care of the Critically Ill Emergency Department Patient with Acute Kidney Injury  

PubMed Central

Introduction. Acute Kidney Injury (AKI) is common and associated with significant mortality and complications. Exact data on the epidemiology of AKI in the Emergency Department (ED) are sparse. This review aims to summarise the key principles for managing AKI patients in the ED. Principal Findings. Timely resuscitation, goal-directed correction of fluid depletion and hypotension, and appropriate management of the underlying illness are essential in preventing or limiting AKI. There is no specific curative therapy for AKI. Key principles of secondary prevention are identification of patients with early AKI, discontinuation of nephrotoxic medication where possible, attention to fluid resuscitation, and awareness of the risks of contrast-induced nephropathy. In patients with advanced AKI, arrangements for renal replacement therapy need to be made before the onset of life-threatening uraemic complications. Conclusions. Research and guidelines regarding AKI in the ED are lacking and AKI practice from critical care departments should be adopted. PMID:22145079

Joslin, Jennifer; Ostermann, Marlies

2012-01-01

326

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

PubMed Central

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

2013-01-01

327

Clinical review: practical approach to hyponatraemia and hypernatraemia in critically ill patients.  

PubMed

Disturbances in sodium concentration are common in the critically ill patient and associated with increased mortality. The key principle in treatment and prevention is that plasma [Na+] (P-[Na+]) is determined by external water and cation balances. P-[Na+] determines plasma tonicity. An important exception is hyperglycaemia, where P-[Na+] may be reduced despite plasma hypertonicity. The patient is first treated to secure airway, breathing and circulation to diminish secondary organ damage. Symptoms are critical when handling a patient with hyponatraemia. Severe symptoms are treated with 2 ml/kg 3% NaCl bolus infusions irrespective of the supposed duration of hyponatraemia. The goal is to reduce cerebral symptoms. The bolus therapy ensures an immediate and controllable rise in P-[Na+]. A maximum of three boluses are given (increases P-[Na+] about 6 mmol/l). In all patients with hyponatraemia, correction above 10 mmol/l/day must be avoided to reduce the risk of osmotic demyelination. Practical measures for handling a rapid rise in P-[Na+] are discussed. The risk of overcorrection is associated with the mechanisms that cause hyponatraemia. Traditional classifications according to volume status are notoriously difficult to handle in clinical practice. Moreover, multiple combined mechanisms are common. More than one mechanism must therefore be considered for safe and lasting correction. Hypernatraemia is less common than hyponatraemia, but implies that the patient is more ill and has a worse prognosis. A practical approach includes treatment of the underlying diseases and restoration of the distorted water and salt balances. Multiple combined mechanisms are common and must be searched for. Importantly, hypernatraemia is not only a matter of water deficit, and treatment of the critically ill patient with an accumulated fluid balance of 20 litres and corresponding weight gain should not comprise more water, but measures to invoke a negative cation balance. Reduction of hypernatraemia/hypertonicity is critical, but should not exceed 12 mmol/l/day in order to reduce the risk of rebounding brain oedema. PMID:23672688

Overgaard-Steensen, Christian; Ring, Troels

2013-01-01

328

Variations in Patients' Assessment of Chronic Illness Care across Organizational Models of Primary Health Care: A Multilevel Cohort Analysis  

PubMed Central

Purpose: To measure patients' assessment of chronic illness care and its variation across primary healthcare (PHC) models. Methods: We recruited 776 patients with diabetes, heart failure, arthritis or chronic obstructive pulmonary disease from 33 PHC clinics. Face-to-face interviews, followed by a telephone interview at 12 months, were conducted using the Patient Assessment of Chronic Illness Care (PACIC). Multilevel regression was used in the analysis. Results: The mean PACIC score was low at 2.5 on a scale of 1 to 5. PACIC scores were highest among patients affiliated with family medicine groups (mean, 2.78) and lowest for contact models (mean, 2.35). Patients with arthritis and older persons generally reported a lower assessment of chronic care. Conclusion: Family medicine groups represent an integrated model of PHC associated with higher levels of achievement in chronic care. Variations across PHC organizations suggest that some models are more appropriate for improving management of chronic illness. PMID:23968619

Levesque, Jean-Frederic; Feldman, Debbie Ehrmann; Lemieux, Valerie; Tourigny, Andre; Lavoie, Jean-Pierre; Tousignant, Pierre

2012-01-01

329

Bioactivity of enoxaparin in critically ill patients with normal renal function  

PubMed Central

Aim In critically ill patients, reduced anti-FXa plasma activity following subcutaneous administration of enoxaparin or nadroparin has been described. In this study, we aimed to investigate the bioactivity of enoxaparin in critically ill patients and controls. Methods A prospective, controlled, open label study was performed on a medical intensive care unit (ICU) and a general medical ward. Fifteen ICU patients (male = 12, median age 52 years [IQR 40?65], with a median Simplified Acute Physiology Score of 30 [IQR 18?52]) and sex- and age-matched medical ward patients were included. The anti-FXa plasma activity was measured after a single subcutaneous dose of 40 mg enoxaparin. The thrombus size of a clot formed in an ex vivo perfusion chamber and endogenous thrombin potential (ETP) were measured. Results The anti-FXa plasma activity increased significantly after enoxaparin administration, with peak levels at 3 h after treatment, but was comparable between the ICU and medical ward groups (median 0.16 IU ml?1[IQR 0?0.22 IU ml?1]vs. 0.2 IU ml?1[IQR 0.15?0.27 IU ml?1], respectively, P= 0.13). The area under the anti-FXa activity curve from 0–12 h was similar between the groups (median 0.97 IU ml?1 h [IQR 0.59?2.1] and 1.48 IU ml?1 h1[IQR 0.83?1.62], P= 0.42 for the ICU group compared with the control group, respectively). The ETP was lower in the ICU group (P < 0.05) at baseline, but it was comparable at 3 h between the groups. Thrombus size decreased at 3 h compared with predose (P= 0.029) and was not different between the groups. Conclusion Similar bioactivity was achieved with a standard dose of subcutaneous enoxaparin in this selected cohort of ICU and general ward patients with normal renal function. PMID:23227470

Gouya, Ghazaleh; Palkovits, Stefan; Kapiotis, Stylianos; Madl, Christian; Locker, Gottfried; Stella, Alexander; Wolzt, Michael; Heinz, Gottfried

2012-01-01

330

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

PubMed

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

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

2012-08-01

331

Methods to measure target site penetration of antibiotics in critically ill patients.  

PubMed

While several tools are necessary to repair a car, the engineer knows exactly which instrument he has to utilize at different parts of the broken machine. Likewise, depending on the information we are interested in, we have to choose different tools to investigate and consecutively understand the multiple aspects that are involved in pharmacokinetics of antimicrobial agents in critically ill patients. Some techniques, like blood sampling, microdialysis or positrons emission tomography (PET) will allow for obtaining continues concentration time profiles while others like bronchoalveolar lavage (BAL), biopsy or surgical tissue samples can only be used a limited number of times per subject. PET and methods based on tissue homogenization will deliver an average of the actual concentrations in intra - and extracellular compartments while investigations in isolated blood cells or microdialysis allow for more distinguished allocation of a concentration to a defined compartment. The present review aims at discussing the advantages and disadvantages of the various methods used for assessing pharmacokinetics in critically ill patients with regard to specific aspects of pharmacokinetic research and further reviews data of selected antibiotics as examples for applications of the individual techniques. PMID:22946872

Schwameis, Richard; Zeitlinger, Markus

2013-02-01

332

Health Care Providers and Dying Patients: Critical Issues in Terminal Care.  

ERIC Educational Resources Information Center

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…

Benoliel, Jeanne Quint

1988-01-01

333

Communication with terminal cancer patients in palliative care: are there differences between nurses and physicians?  

Microsoft Academic Search

The aim of this study was to find whether there were interprofessional differences in specific elements of communication with terminal cancer patients and decision-making processes that concern such patients. Given that interdisciplinary team work is one of the basic values in palliative care, if there are conflicting views between professions on such important issues it is most important to know

A. Levorato; F. Stiefel; C. Mazzocato; E. Bruera

2001-01-01

334

Elevation of procalcitonin after implantation of an interventional lung assist device in critically ill patients.  

PubMed

A pumpless interventional arteriovenous lung assist device (iLA) facilitates the removal of carbon dioxide from the blood and is used as part of the lung-protective ventilation strategy in patients with acute respiratory distress syndrome (ARDS). In case of bacterial infection, delayed antimicrobial therapy increases the mortality in this group of high-risk critically ill patients, whereas overtreatment promotes bacterial resistance and leads to increased drug toxicity and costs. Besides clinical signs and symptoms, antimicrobial treatment is based on the kinetics of biomarkers such as procalcitonin (PCT). We hereby report an up to 10-fold increase in PCT serum concentrations in four mechanically ventilated patients with ARDS detected within 12-20 hours after iLA implantation in the absence of any infection. Procalcitonin concentrations returned to nearly baseline values in all patients on the fourth day after iLA implantation. We discuss the possible mechanisms of PCT induction in this specific patient population and recommend the onset of antibiotics administration after iLA implantation to be carefully considered in the context of other clinical findings and not solely based on the PCT kinetics. Repeated PCT measurements in short time intervals should be performed in these patients. PMID:24399068

Kott, Matthias; Bewig, Burkhard; Zick, Günther; Schaedler, Dirk; Becher, Tobias; Frerichs, Inéz; Weiler, Norbert

2014-01-01

335

Caregiver burden in chronic mental illness: the role of patient and caregiver characteristics.  

PubMed

The aim of the present study is to identify the relative contribution of patient and caregiver characteristics in a sample of primary carers of patients with chronic mental disorders living in the community. As carers were recruited from caregiver organizations, mainly mothers of an adult child suffering from schizophrenia participated in the study (n = 102). Within a comprehensive transactional stress model, burden was assessed with respect to objective and subjective burden, cognitive-emotional well-being, psychological distress and subjective quality of life. Primary stressors include illness-related characteristics of the patient, and a number of personal dispositions and resources of the caregivers were included as potential moderating variables. Multiple regression analyses were separately calculated for each dimension of burden. Interaction of carers' expressed emotion and external locus of control with the patient's problem with family communication as well as perceived social support was most predictive for objective and subjective burden, whereas carers' neuroticism appeared as the most relevant predictor of their well-being, psychological distress and subjective quality of life. Among the patients' variables, regular employment contributed significantly to reduce carers' distress and enhance their well-being. As the sample was recruited from caregiver organizations, a selection bias has to be taken into account. To reduce caregiver burden, especially mothers' burden, the patients' occupational abilities should be strongly enhanced at an early stage. Family interventions should improve dysfunctional interactions, enhance the carers' social activities and focus more intensely on the carers' own dispositions. PMID:21538092

Möller-Leimkühler, Anne Maria; Wiesheu, Andreas

2012-03-01

336

A Comparison of Predictive Equations of Energy Expenditure and Measured Energy Expenditure in Critically Ill Patients  

PubMed Central

PURPOSE Multiple equations exist for predicting resting energy expenditure (REE). The accuracy of these for estimating caloric requirements of critically ill patients is not clear, especially for obese patients. We sought to compare REE, calculated with published formulas, with measured REE in a cohort of mechanically-ventilated subjects. MATERIALS AND METHODS We retrospectively identified all mechanically-ventilated patients with measured body mass index (BMI) who underwent indirect calorimetry (IC) in the ICU. Limits of agreement and Pitman’s test of difference in variance were performed to compare REE by equations with REE measured by IC. RESULTS 927 patients were identified, including 401 obese patients. There was bias and poor agreement between measured REE and REE predicted by the Harris-Benedict, Owen, ACCP, and Mifflin equations (p > 0.05). There was poor agreement between measured and predicted REE by the Ireton-Jones equation, stratifying by gender. Ireton-Jones was the only equation which was unbiased, for men and those in weight categories I and II. In all cases except Ireton-Jones, predictive equations underestimated measured REE. CONCLUSION None of these equations accurately estimated measured REE in this group of mechanically-ventilated patients, most underestimating caloric needs. Development of improved predictive equations for adequate assessment of energy needs is needed. PMID:22425340

Kross, Erin K.; Sena, Matthew; Schmidt, Karyn; Stapleton, Renee D.

2012-01-01

337

Would you terminate a pregnancy affected by sickle cell disease? Analysis of views of patients in Cameroon.  

PubMed

Sickle cell disease (SCD) is a debilitating illness that affects quality of life and life expectancy for patients. In Cameroon, it is now possible to opt for termination of an affected pregnancy (TAP) where the fetus is found to be affected by SCD. Our earlier studies found that, contrary to the views of Cameroonian physicians, a majority of parents with their children suffering from SCD would choose to abort if the fetuses were found to be affected. What have not yet been investigated are the views of people suffering from/living with SCD. We used a quantitative sociological method, with administered structured questionnaires, to study the attitudes of adult patients suffering from SCD on prenatal genetic diagnosis (PND) and possible TAP. The majority of the 89 participants were urban dwellers (84.3%), women (57.3%), Christian (95.5%) and single (90.9%), with a secondary/tertiary education (79.5%). The majority (89.2%) would consider PND for SCD; almost half (48.5%) would reject TAP while 40.9% would consider it. Respondents who rejected TAP claimed mostly ethical reasons (78.1%) while those who found TAP acceptable cited fear of having an affected child (88.9%) and the poor quality of the affected child's health (81.5%). Cameroonian patients with SCD are generally supportive of PND and a remarkably high number of patients living with SCD reported that they would consider terminating a pregnancy based on their assessment of the future well-being of the child. Research is required to investigate the burden of SCD on families and their quality of life. PMID:23918815

Wonkam, Ambroise; de Vries, Jantina; Royal, Charmaine D; Ramesar, Raj; Angwafo, Fru F

2014-09-01

338

A comparison of early gastric and post-pyloric feeding in critically ill patients: a meta-analysis  

Microsoft Academic Search

Objective  To investigate the potential beneficial and adverse effects of early \\u000apost-pyloric feeding compared with gastric feeding in critically ill adult \\u000apatients with no evidence of impaired gastric emptying.Design  Randomised controlled studies comparing gastric and post-pyloric feeding in \\u000acritically ill adult patients from Cochrane Controlled Trial Register (2005 \\u000aissue 3), EMBASE and MEDLINE databases (1966 to 1 October 2005) without any \\u000alanguage

Kwok M. Ho; Geoffrey J. Dobb; Steven A. R. Webb

2006-01-01

339

Association of adiponectin levels and insulin demand in critically ill patients  

PubMed Central

Purpose: Intensive care unit patients usually have a deregulated glucose homeostasis and present with hyperglycemia and hyperinsulinemia, suggesting overall insulin resistance. Adiponectin has significant anti-inflammatory and insulin-sensitizing effects and is diminished in morbidly obese and in critically ill patients. Reduced adiponectin could contribute to insulin resistance in these patients. We examined how far insulin demand in critically ill patients is correlated with patient adiponectin levels. Patients and methods: Adiponectin, resistin, leptin, insulin demand, minimal and maximal blood sugar levels, epinephrine, and hydrocortisone demand were measured 1 day after diagnosis of severe sepsis or septic shock in 25 patients (8 female, 17 male; median age 65 years; range: 31 to 87 years). Results: Insulin demand (range: 0–8 IU/h; median 3.5 IU) was positively correlated with serum adiponectin levels (median: 10.1 ?g/mL; range: 2.9–47.6 ?g/mL; r = +0.56, P < 0.01). There was no significant correlation between insulin demand and leptin serum levels (median: 18.1 ng/mL; range: 0.3–80.7 ng/mL; r = +0.29, P = 0.08) or resistin serum levels (median: 103.9 ng/mL; range: 14.7–352.3 ng/mL; r = +0.13, P = 0.27). Epinephrine demand (median: 0.08 ?g/kg*min; range: 0.02–0.63 ?g/kg*min) was negatively correlated with male adiponectin levels (r = ?0.58; P < 0.01; females: r = ?0.36; P = 0.19) and positively correlated with resistin levels (r = 0.43; P = 0.02). Patient body mass index (median 26 kg/m2; range: 18–37) was positively correlated with serum leptin (r = 0.60; P < 0.01) but was not correlated with insulin demand (r = 0.19; P = 0.19), or adiponectin (females: r = ?0.37, P = 0.18; males: r = ?0.16, P = 0.27), or resistin levels (r = +0.17; P = 0.21). Conclusion: Adiponectin levels and insulin demand were positively correlated during sepsis. Adiponectin levels were negatively correlated with epinephrine demand in male patients and epinephrine demand was positively correlated with resistin levels, which might have increased insulin resistance. The relationship between adiponectin and insulin action in humans is more complex than often suggested. PMID:21448321

Hillenbrand, Andreas; Weiss, Manfred; Knippschild, Uwe; Stromeyer, Hans G; Henne-Bruns, Doris; Huber-Lang, Markus; Wolf, Anna M

2011-01-01

340

Does the RIFLE Classification Improve Prognostic Value of the APACHE II Score in Critically Ill Patients?  

PubMed Central

Introduction. The RIFLE classification defines three severity criteria for acute kidney injury (AKI): risk, injury, and failure. It was associated with mortality according to the gradation of AKI severity. However, it is not known if the APACHE II score, associated with the RIFLE classification, results in greater discriminatory power in relation to mortality in critical patients. Objective. To analyze whether the RIFLE classification adds value to the performance of APACHE II in predicting mortality in critically ill patients. Methods. An observational prospective cohort of 200 patients admitted to the ICU from July 2010 to July 2011. Results. The age of the sample was 66 (±16.7) years, 53.3% female. ICU mortality was 23.5%. The severity of AKI presented higher risk of death: class risk (RR = 1.89 CI:0.97–3.38, P = 0.001), grade injury (RR = 3.7 CI:1.71–8.08, P = 0.001), and class failure (RR = 4.79 CI:2.10–10.6, P = 0.001). The APACHE II had C-statistics of 0.75, 95% (CI:0.68–0.80, P = 0.001) and 0.80 (95% CI:0.74 to 0.86, P = 0.001) after being incorporated into the RIFLE classification in relation to prediction of death. In the comparison between AUROCs, P = 0.03. Conclusion. The severity of AKI, defined by the RIFLE classification, was a risk marker for mortality in critically ill patients, and improved the performance of APACHE II in predicting the mortality in this population. PMID:24024031

Wahrhaftig, Katia M.; Correia, Luis C. L.; De Souza, Carlos A. M.

2013-01-01

341

Pain assessment tool in the critically ill post-open heart surgery patient population.  

PubMed

Critical-care patients are at higher risk for untreated pain, because they are often unable to communicate owing to altered mental status, mechanical ventilation, and sedation. Pain that is persistent and untreated affects most body systems and results in development of complications chronic pain, and increased length of stay. This descriptive repeated-measures study compared three pain assessment tools in nonverbal critically ill patients in a cardiac postanesthesia care unit (n=24). Tools included the Critical-Care Pain Observation Tool (CPOT), adult Nonverbal Pain Scale (NVPS), and the Faces, Legs, Activity, Cry, and Consolability scale (FLACC). Two painful events, suctioning and repositioning, were studied. Data were collected immediately before the event, 1 minute after, and 20 minutes after. Both the CPOT and the NVPS demonstrated high reliability (Cronbach alpha coefficients 0.89). The NVPS and the CPOT were highly correlated for both raters (r>0.80, p=.00) (11 out of 12 times). Correlations between the two raters was generally moderate to high, but higher with the CPOT. There was more disagreement between raters in overall pain scores for the NVPS. When raters disagreed, it was most often in rating the face component on both scales. Disagreement was highest during the event. Both scales adequately capture pain in the nonverbal sedated critically ill patient based on assessment of patients' face, body movements, muscle tension, and respirations, with the NVPS also considering vital signs. Pictures depicting facial expressions for scoring purposes are helpful. Adequate education and understanding of use of the scales is critical for accurate assessment and subsequent interventions. PMID:20728062

Marmo, Liza; Fowler, Susan

2010-09-01

342

Effect of fiber supplementation on the microbiota in critically ill patients  

PubMed Central

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

O'Keefe, Stephen JD; Ou, Junhai; DeLany, James P; Curry, Scott; Zoetendal, Erwin; Gaskins, H Rex; Gunn, Scott

2011-01-01

343

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

PubMed Central

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

Johansson, Lotta; Bergbom, Ingegerd; Lindahl, Berit

2012-01-01

344

Alignment of patient and primary care practice member perspectives of chronic illness care: a cross-sectional analysis  

PubMed Central

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

2014-01-01

345

Powerlessness in Terminal Care of Demented Patients: An Exploratory Study.  

ERIC Educational Resources Information Center

Interviewed five caregiving nursing staff members involved in dementia care concerning their ambivalent feelings toward spoon-feeding a severely demented patient. Although tube-feeding was regarded as an easier way to provide nourishment, spoon-feeding was preferred because it provided more human contact and love. (Author/NB)

Akerlund, Britt Mari; Norberg, Astrid

1990-01-01

346

Inflammatory and perfusion markers as risk factors and predictors of critically ill patient readmission  

PubMed Central

Objective To assess the performance of central venous oxygen saturation, lactate, base deficit, and C-reactive protein levels and SOFA and SWIFT scores on the day of discharge from the intensive care unit as predictors of patient readmission to the intensive care unit. Methods This prospective and observational study collected data from 1,360 patients who were admitted consecutively to a clinical-surgical intensive care unit from August 2011 to August 2012. The clinical characteristics and laboratory data of readmitted and non-readmitted patients after discharge from the intensive care unit were compared. Using a multivariate analysis, the risk factors independently associated with readmission were identified. Results The C-reactive protein, central venous oxygen saturation, base deficit, and lactate levels and the SWIFT and SOFA scores did not correlate with the readmission of critically ill patients. Increased age and contact isolation because of multidrug-resistant organisms were identified as risk factors that were independently associated with readmission in this study group. Conclusion Inflammatory and perfusion parameters were not associated with patient readmission. Increased age and contact isolation because of multidrug-resistant organisms were identified as predictors of readmission to the intensive care unit. PMID:25028946

dos Santos, Moreno Calcagnotto; Boniatti, Márcio Manozzo; Lincho, Carla Silva; Pellegrini, José Augusto Santos; Vidart, Josi; Rodrigues, Edison Moraes; Vieira, Silvia Regina Rios

2014-01-01

347

Evaluation of the burden of illness for pediatric asthmatic patients and their parents.  

PubMed

To examine the quality-of-life burden of asthma in a pediatric population, we systematically surveyed 100 patients with moderate asthma and one parent of each patient to determine the impact of the disease on day-to-day life. We found that perceptions of burden of illness varied by viewpoint. For patients, the symptoms of asthma form the largest component of the burden of the disease; in addition, more than half of the sample listed various emotional function items that were of at least moderate bother to them. Parents cited worry and concern about the disease and the medications used to treat it and their inability to relieve their child's symptoms as the major components of the burden of the disease. We conclude that although pediatric patients with moderate asthma find the respiratory symptoms of the disease troublesome, few children perceive that their asthma poses a major disruption of their lives. For the parents of these patients, strategies could be implemented by clinicians to ease the common worries and concerns surrounding the child's asthma. PMID:1952296

Townsend, M; Feeny, D H; Guyatt, G H; Furlong, W J; Seip, A E; Dolovich, J

1991-10-01

348

Prevalence of human immunodeficiency virus (HIV) antibody in critically ill emergency patients in Gijón, Spain.  

PubMed

The objective of this study was to find out the prevalence of infection by the human immunodeficiency virus (HIV) in critically ill patients treated in the resuscitation room of the emergency department of Cabueñes Hospital (Gijón, Spain) and to stress the need to adopt universal preventative measures. This was a prospective study that included all the patients treated in the resuscitation room during 1994. It contains a protocolized collection of clinical-epidemiological variables and HIV serology respecting anonymity. The number of accidents with potential risk of contagion and use of preventative measures was directly observed. A total of 202 patients were treated. The prevalence of HIV positive was 4%. Seventy per cent were male and the average age was 31 years. In all the cases drug-taking through the parenteral route was suspected as a possible risk factor for infection. No accidents with risk of contagion were recorded and preventative measures were adopted in all the cases. It is concluded that the prevalence of HIV positive figures detected did not differ from previous studies. Although the profile of the HIV positive patients was well defined in this study, we must insist on the need to take preventative measures with all patients. PMID:11132073

Altuña Egocheaga, A; Maroto, O R; De La Riva Miranda, G; Alonso, P A; Alvarez

2000-06-01

349

Outcome of direct percutaneous endoscopic jejunostomy tube placement for nutritional support in critically ill, mechanically ventilated patients  

Microsoft Academic Search

Purpose: Gastrointestinal function is adversely affected in critically ill mechanically ventilated patients. The most common abnormality is delayed gastric emptying. Among the options for postpyloric feeds, direct percutaneous endoscopic jejunostomy (PEJ) provides a permanent, reliable, and direct access to the small bowel and can be used for full enteral feedings, thus eliminating the need for parenteral nutrition. Patients and Methods:

Rafael Barrera; Mark Schattner; Stephen Nygard; Michael Ahdoot; Allan Ahdoot; Samuel Adeyeye; Jeffrey Groeger; Moshe Shike

2001-01-01

350

Outcome Prediction for Critically Ill Cirrhotic Patients: A Comparison of APACHE II and Child-Pugh Scoring Systems  

Microsoft Academic Search

Cirrhotic patients admitted to the medical intensive care unit (ICU) are associated with high mortality rates. The prognosis of critically ill cirrhotic patients is determined by the extent of hepatic and extrahepatic organ dysfunction. This study was conducted to assess and compare the accuracy of the Child-Pugh classification and APACHE II scores, obtained on the first day of ICU admission,

Yu-Pin Ho; Yung-Chang Chen; Chun Yang; Jau-Min Lien; Yin-Yi Chu; Ji-Tseng Fang; Cheng-Tang Chiu; Pang-Chi Chen; Ming-Hung Tsai

2004-01-01

351

Timing of Tracheostomy in Critically Ill Patients: A Meta-Analysis  

PubMed Central

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

Huang, Huibin; Li, Ying; Ariani, Felinda; Chen, Xiaoli; Lin, Jiandong

2014-01-01

352

Attitude disentangled: a cross-sectional study into the factors underlying attitudes of nurses in Dutch rehabilitation centers toward patients with comorbid mental illness.  

PubMed

In rehabilitation centers, many patients suffer a comorbid mental illness. Nurses have different attitudes toward these patients. A cross-sectional, questionnaire-based study among nurses in Dutch rehabilitation centers was undertaken to clarify the factors that underlie attitudes toward patients with comorbid mental illness. The main factors associated with attitudes were feelings of competence and experiences with dealing with patients with mental illness. Other associations were perceived support; frequency of caring for patients with comorbid mental illness; work experience in mental health care; additional psychiatric training; and the personality traits "extraversion," "emotional stability," and "openness to experience." Perceived support had the strongest association with feelings of competence. PMID:23369124

Kluit, Maria Johanna van der; Goossens, Peter J J; Leeuw, J Rob J de

2013-02-01

353

Adaptation and validation of the patient assessment of chronic illness care in the French context  

PubMed Central

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

2014-01-01

354

Treatment of post-traumatic stress disorder in patients with severe mental illness: a review.  

PubMed

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

Mabey, Linda; van Servellen, Gwen

2014-02-01

355

Caring for critically ill patients with ebola virus disease. Perspectives from west Africa.  

PubMed

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

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

356

The Effect of Age on Illness Cognition, Subjective Well-being and Psychological Distress among Gastric Cancer Patients.  

PubMed

The current study examined illness cognition-thoughts and perceptions-patients hold regarding their illness and psychological adaptation in various age groups. More specifically, we aimed to examine whether illness cognition among cancer patients is related to their age. In addition, such association of illness cognition and age was also examined with respect to subjective well-being and psychological distress. A cross-sectional sample comprised of 123 consecutive post-treatment gastric outpatients. Their mean age was 57.31 (SD?=?12.74), 56.9% (n?=?70) were men and 81.3% (n?=?100) were married. The results indicated a higher level of acceptance and a lower level of psychological distress among the young-old participants (60-69) compared with their counterparts. The oldest group (70+?years) had the highest level of helplessness and psychological distress, and the lowest level of acceptance, satisfaction and affect balance compared with the young-old participants. Among gastric cancer patients, age was found to be a factor relevant to the understanding of illness cognitions (acceptance and sense of helplessness) along with subjective well-being and psychological distress. These findings have practical implications for working with older cancer patients. Implications of these results are discussed. Copyright © 2013 John Wiley & Sons, Ltd. PMID:23963953

Palgi, Yuval; Ben-Ezra, Menachem; Hamama-Raz, Yaira; Shacham Shmueli, Einat; Shrira, Amit

2014-10-01

357

C5a-mediated neutrophil dysfunction is RhoA-dependent and predicts infection in critically ill patients.  

PubMed

Critically ill patients are at heightened risk for nosocomial infections. The anaphylatoxin C5a impairs phagocytosis by neutrophils. However, the mechanisms by which this occurs and the relevance for acquisition of nosocomial infection remain undetermined. We aimed to characterize mechanisms by which C5a inhibits phagocytosis in vitro and in critically ill patients, and to define the relationship between C5a-mediated dysfunction and acquisition of nosocomial infection. In healthy human neutrophils, C5a significantly inhibited RhoA activation, preventing actin polymerization and phagocytosis. RhoA inhibition was mediated by PI3K?. The effects on RhoA, actin, and phagocytosis were fully reversed by GM-CSF. Parallel observations were made in neutrophils from critically ill patients, that is, impaired phagocytosis was associated with inhibition of RhoA and actin polymerization, and reversed by GM-CSF. Among a cohort of 60 critically ill patients, C5a-mediated neutrophil dysfunction (as determined by reduced CD88 expression) was a strong predictor for subsequent acquisition of nosocomial infection (relative risk, 5.8; 95% confidence interval, 1.5-22; P = .0007), and remained independent of time effects as assessed by survival analysis (hazard ratio, 5.0; 95% confidence interval, 1.3-8.3; P = .01). In conclusion, this study provides new insight into the mechanisms underlying immunocompromise in critical illness and suggests novel avenues for therapy and prevention of nosocomial infection. PMID:21292772

Morris, Andrew Conway; Brittan, Mairi; Wilkinson, Thomas S; McAuley, Danny F; Antonelli, Jean; McCulloch, Corrienne; Barr, Laura C; McDonald, Neil A; Dhaliwal, Kev; Jones, Richard O; Mackellar, Annie; Haslett, Christopher; Hay, Alasdair W; Swann, David G; Anderson, Niall; Laurenson, Ian F; Davidson, Donald J; Rossi, Adriano G; Walsh, Timothy S; Simpson, A John

2011-05-12

358

Goal-Oriented Respiratory Management for Critically Ill Patients with Acute Respiratory Distress Syndrome  

PubMed Central

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

Barbas, Carmen Sílvia Valente; Matos, Gustavo Faissol Janot; Amato, Marcelo Britto Passos; Carvalho, Carlos Roberto Ribeiro

2012-01-01

359

Why do patients with chronic illnesses fail to keep their appointments? A telephone interview.  

PubMed

Missed appointments affect patients' health in addition to reducing practice efficiency. This study explored the rate and reasons of non-attendance among patients with chronic illnesses. It was a cross-sectional descriptive study carried out in a family practice clinic over a one-month period in 2004. Those who failed turn up for scheduled appointments were interviewed by telephone based on a structured questionnaire. Out of 671 patients, the non-attendance rate was 16.7%. Sixty-seven percent of non-attenders were successfully interviewed. Males (p = 0.01), Indians (p = 0.015), patients with coronary artery disease (p = 0.017), multiple diseases (> 4) (p = 0.036) and shorter appointment intervals (p = 0.001) were more likely to default. The main reasons for non-attendance were: forgot the appointment dates (32.9%), not feeling well (12.3%), administrative errors (19.1%) and work or family commitments (8.2%). The majority would prefer a reminder through telephone (71.4%), followed by letters (41.3%). In conclusion, appropriate intervention could be taken based on the reasons identified in this study. PMID:16629433

Zailinawati, A H; Ng, C J; Nik-Sherina, H

2006-01-01

360

Efficacy of renal replacement therapy in critically ill patients: a propensity analysis  

PubMed Central

Introduction Although renal replacement therapy (RRT) is a common procedure in critically ill patients with acute kidney injury (AKI), its efficacy remains uncertain. Patients who receive RRT usually have higher mortality rates than those who do not. However, many differences exist in severity patterns between patients with and those without RRT and available results are further confounded by treatment selection bias since no consensus on indications for RRT has been reached so far. Our aim was to account for these biases to accurately assess RRT efficacy, with special attention to RRT timing. Methods We performed a propensity analysis using data of the French longitudinal prospective multicenter Outcomerea database. Two propensity scores for RRT were built to match patients who received RRT to controls who did not despite having a close probability of receiving the procedure. AKI was defined according to RIFLE criteria. The association between RRT and hospital mortality was examined through multivariate conditional logistic regression analyses to control for residual confounding. Sensitivity analyses were conducted to examine the impact of RRT timing. Results Among the 2846 study patients, 545 (19%) received RRT. Crude mortality rates were higher in patients with than in those without RRT (38% vs 17.5%, P < 0.001). After matching and adjustment, RRT was not associated with a reduced hospital mortality. The two propensity models yielded concordant results. Conclusions In our study population, RRT failed to reduce hospital mortality. This result emphasizes the need for randomized studies comparing RRT to conservative management in selected ICU patients, with special focus on RRT timing. PMID:23254304

2012-01-01

361

Evaluation of a Model for Glycemic Prediction in Critically Ill Surgical Patients  

PubMed Central

We evaluated a neural network model for prediction of glucose in critically ill trauma and post-operative cardiothoracic surgical patients. A prospective, feasibility trial evaluating a continuous glucose-monitoring device was performed. After institutional review board approval, clinical data from all consenting surgical intensive care unit patients were converted to an electronic format using novel software. This data was utilized to develop and train a neural network model for real-time prediction of serum glucose concentration implementing a prediction horizon of 75 minutes. Glycemic data from 19 patients were used to “train” the neural network model. Subsequent real-time simulated testing was performed in 5 patients to whom the neural network model was naive. Performance of the model was evaluated by calculating the mean absolute difference percent (MAD%), Clarke Error Grid Analysis, and calculation of the percent of hypoglycemic (?70 mg/dL), normoglycemic (>70 and <150 mg/dL), and hyperglycemic (?150 mg/dL) values accurately predicted by the model; 9,405 data points were analyzed. The models successfully predicted trends in glucose in the 5 test patients. Clark Error Grid Analysis indicated that 100.0% of predictions were clinically acceptable with 87.3% and 12.7% of predicted values falling within regions A and B of the error grid respectively. Overall model error (MAD%) was 9.0% with respect to actual continuous glucose modeling data. Our model successfully predicted 96.7% and 53.6% of the normo- and hyperglycemic values respectively. No hypoglycemic events occurred in these patients. Use of neural network models for real-time prediction of glucose in the surgical intensive care unit setting offers healthcare providers potentially useful information which could facilitate optimization of glycemic control, patient safety, and improved care. Similar models can be implemented across a wider scale of biomedical variables to offer real-time optimization, training, and adaptation that increase predictive accuracy and performance of therapies. PMID:23894489

Pappada, Scott M.; Cameron, Brent D.; Tulman, David B.; Bourey, Raymond E.; Borst, Marilyn J.; Olorunto, William; Bergese, Sergio D.; Evans, David C.; Stawicki, Stanislaw P. A.; Papadimos, Thomas J.

2013-01-01

362

Early Supplemental Parenteral Nutrition is Associated with Increased Infectious Complications in Critically Ill Trauma Patients  

PubMed Central

Background Parenteral nutrition (PN) is often used in severely injured patients when caloric goals are not achieved enterally. The purpose of this study is to determine whether early administration of parenteral nutrition is associated with an increased risk for infection following severe injury. Methods Retrospective cohort study of severely injured blunt trauma patients enrolled from eight trauma centers participating in the “Inflammation and the Host Response to Injury” (Glue Grant) study. We compared patients receiving PN within seven days following injury to a control group who did not receive early PN. We then focused on patients who tolerated at least some enteral nutrition during the first week and evaluated the potential influence of supplemental PN on outcomes in this “enteral tolerant” subgroup. The primary outcome was the occurrence of a nosocomial infection following the first post-injury week. Secondary outcomes included the type of infection and hospital mortality. Results Of the 567 patients enrolled, 95 (17%) received early PN. Early PN use was associated with a greater risk of nosocomial infection (relative risk 2.1; 95% CI 1.6-2.6, P=<0.001). In the enteral tolerant subgroup (n=249), early PN was also associated with an increase in nosocomial infections (RR=1.6; 95% CI 1.2-2.1, P=0.005) in part due to an increased risk of blood stream infection (RR=2.8; 95% CI 1.5-5.3, P=0.002). Mortality tended to be higher in patients receiving additional EN + PN versus EN alone (RR 2.3; 95% CI 1.0-5.2, P=0.06). Conclusion In critically ill trauma patients who are able to tolerate at least some EN, early PN administration may contribute to increased infectious morbidity and a worse clinical outcome. PMID:18926446

Sena, Matthew J.; Utter, Garth H.; Cushcieri, Joseph; Maier, Ronald V.; Tompkins, Ronald G.; Harbrecht, Brian G.; Moore, Ernest E.; O'Keefe, Grant E

2014-01-01

363

Thromboprophylaxis patterns and determinants in critically ill patients: a multicenter audit  

PubMed Central

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

2014-01-01

364

[Involving family members of chronically ill patients in physician-patient communication].  

PubMed

Involving family members in the patient's treatment is central for coping with chronic diseases. The family's functioning and their involvement in the treatment process have a significant influence on compliance as well as on the patient's coping and quality of life. This article illustrates this broad topic through selected aspects. First, the importance of the family for the patient's coping and quality of life is highlighted in certain examples. Criteria for the family's involvement and important topics for the doctor's encounter with family members are introduced. Second, the necessities, problems, and consequences of doctor-family communication are illustrated for the examples of stroke and dementia. Overall, there is only limited time to include the family in in-patient as well as out-patient care. As a result, physician-family communication is not integrated sufficiently in general care, even for chronic diseases. PMID:22936480

Wilz, G; Meichsner, F

2012-09-01

365

Multicomponent antibiotic substances produced by fermentation: implications for regulatory authorities, critically ill patients and generics.  

PubMed

Teicoplanin and polymyxin E (colistin) are antibiotics consisting of multiple, closely related subcomponents, produced by fermentation. The principal components comprise a complex mixture of chemically related, active substances (teicoplanin A(2-1)-A(2-5) and polymyxin E(1-2), respectively), which might be required to be present in specific ratios to ensure optimal antibacterial and clinical efficacy. These subcomponents differ in their fatty acid and amino acid composition and, as such, the lipophilic and protein binding characteristics differ between components. This has therapeutic implications for critically ill patients, as the volume of distribution of the teicoplanin A2 and polymyxin E analogues at the onset of an intravenous infusion may impact on expected pharmacokinetics and influence outcome. PMID:23920094

Brink, Adrian J; Richards, Guy A; Colombo, Gaia; Bortolotti, Fabrizio; Colombo, Paolo; Jehl, François

2014-01-01

366

Today's approach to the critically ill patient with acute kidney injury.  

PubMed

The present review describes recent evidence on all aspects relating to acute kidney injury (AKI): epidemiology, definition, diagnosis, medical and extracorporeal therapy. AKI is often underrecognized, but its outcome still remains unfavorable. In this light, definition, classification and diagnosis of AKI are fundamental today and may be reliably based on recently proposed RIFLE (risk, injury, failure, loss of function, end-stage kidney disease) classification. Pharmacological therapy of AKI is still scarcely effective, but renal replacement therapy has progressed to a more accurate and safe treatment and new interesting high-level trials and observational studies have been performed and are reviewed and commented. In the near future, however, only increased awareness of AKI incidence and early treatment or prevention of kidney injury progression will hopefully improve outcome of critically ill patients with renal failure. PMID:19169028

Ricci, Zaccaria; Ronco, Claudio

2009-01-01

367

Understanding terminology of delirium and long-term cognitive impairment in critically ill patients.  

PubMed

Delirium, an acute brain dysfunction, frequently affects intensive care unit (ICU) patients during the course of a critical illness. Besides the acute morbidities, ICU survivors often experience long-term sequelae in the form of cognitive impairment (LTCI-CI). Though delirium and LTCI-CI are associated with adverse outcomes, little is known on the terminology used to define these acute and chronic co-morbidities. The use of a correct terminology is a key factor to spread the knowledge on clinical conditions. Therefore, we first review the epidemiology, definition of delirium and its related terminology. Second, we report on the epidemiology of LTCI-CI and compare its definition to other forms of cognitive impairments. In particular, we define mild cognitive impairment, dementia and finally postoperative cognitive dysfunction. Future research is needed to interpret the trajectories of LTCI-CI, to differentiate it from neurodegenerative diseases and to provide a formal disease classification. PMID:23040280

Morandi, A; Pandharipande, P P; Jackson, J C; Bellelli, G; Trabucchi, M; Ely, E W

2012-09-01

368

[Perception of nurses about ethical dilemmas related to terminal patients in intensive care units].  

PubMed

The purpose of this study was to learn about nurses' perception about ethical dilemmas in nursing care for terminal patients in the context of a general hospital ICU in the city of São Paulo, and what they take into account when making decisions. The study was performed through interviews with ten nurses working at the ICU, using a qualitative approach based on content analysis. Ethical dilemmas were found to be linked to: diversity of values; presence of terminal patients at the ICU; uncertainties aboutterminality and the limits of intervention to prolong the patients' lives; disagreements in decision-making; non-acceptance of the process of dying by the patients' families and the lack of clarifications for the patient and the family. In addition, the nurses consider their values, the professional ethics, empathy and dialogue with co-workers to make decisions in view of such ethical dilemmas. PMID:19437851

Chaves, Adriano Aparecido Bezerra; Massarollo, Maria Cristina Komatsu Braga

2009-03-01

369

Risk of Clostridium difficile diarrhoea in critically ill patients treated with erythromycin-based prokinetic therapy for feed intolerance  

Microsoft Academic Search

Objective  To determine the incidence of Clostridium difficile (CD) diarrhoea in feed-intolerant, critically ill patients who received erythromycin-based prokinetic therapy.\\u000a \\u000a \\u000a \\u000a Design and setting  Prospective observational study in a mixed intensive care unit.\\u000a \\u000a \\u000a \\u000a Methods  The development of diarrhoea (>?3 loose, liquid stool per day with an estimated total volume???250?ml\\/day) was assessed in\\u000a 180 consecutive critically ill patients who received prokinetic therapy (erythromycin only, n?=?53; metoclopramide,

Nam Q. Nguyen; Katrina Ching; Robert J. Fraser; Marianne J. Chapman; Richard H. Holloway

2008-01-01

370

A retrospective study of 230 consecutive patients hospitalized for presumed travel-related illness (2000–2006)  

Microsoft Academic Search

A good knowledge of morbidity profiles among ill-returned travelers is necessary in order to guide their management. We reviewed\\u000a the medical charts of 230 patients hospitalized in one infectious diseases department in France for presumed travel-related\\u000a illnesses. The male-to-female ratio was 1.6 and the median age was 33 years (interquartile range [IQR], 25–50). Most patients\\u000a (70.9%) were returning from sub-Saharan Africa.

H. Leroy; C. Arvieux; J. Biziragusenyuka; J. M. Chapplain; C. Guiguen; C. Michelet; P. Tattevin

2008-01-01

371

Waiting times in the ambulatory sector - the case of chronically Ill patients  

PubMed Central

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

2013-01-01

372

Rethinking the patient: using Burden of Treatment Theory to understand the changing dynamics of illness  

PubMed Central

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

2014-01-01

373

Increased liver stiffness denotes hepatic dysfunction and mortality risk in critically ill non-cirrhotic patients at a medical ICU  

PubMed Central

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

2011-01-01

374

Soft Set-Based Decision Making for Patients Suspected Influenza-Like Illness  

NASA Astrophysics Data System (ADS)

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.

Herawan, Tutut

375

Predicting Premature Termination within a Randomized Controlled Trial for Binge-Eating Patients  

ERIC Educational Resources Information Center

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…

Fluckiger, Christoph; Meyer, Andrea; Wampold, Bruce E.; Gassmann, Daniel; Messerli-Burgy, Nadine; Munsch, Simone

2011-01-01

376

The families evaluation on management, care and disclosure for terminal stage cancer patients  

Microsoft Academic Search

BACKGROUND: Quality of life is an important concept which is subjective and personal; what is an acceptable quality of life to one may be 'worse than death' to another. The objective of this study was to develop and validate a questionnaire to assess relatives' perceptions and attitudes towards their terminal stage cancer patients' management (information disclosure, treatment choice, hospitalization and

Kyriaki Mystakidou; Efi Parpa; Eleni Tsilika; Ourania Kalaidopoulou; Lambros Vlahos

2002-01-01

377

Variability in physicians' decisions on caring for chronically ill elderly patients: an international study.  

PubMed Central

OBJECTIVES: To determine what treatment decisions physicians will make when faced with an incompetent elderly patient with life-threatening gastrointestinal bleeding and to identify the factors that affect their decisions. DESIGN: Survey. SETTING: Family practice, medical and geriatrics rounds in academic medical centres and community hospitals in seven countries. PARTICIPANTS: Physicians who regularly cared for incompetent elderly patients. OUTCOME MEASURE: A self-administered questionnaire containing three case vignettes. Each provided the same details on an incompetent elderly patient; however, one gave no information about the wishes of the patient and his family (no directive), the second provided a do-not-resuscitate (DNR) request, and the third included a detailed therapeutic and resuscitative effort chart (DTREC) requesting maximum therapeutic care without admission to the intensive care unit (ICU). The four treatment options were supportive care only, limited therapeutic care, maximum therapeutic care without admission to the ICU and maximum care with admission to the ICU. MAIN RESULTS: Treatment decisions varied and were systematically related to age, level of training and country (p less than 0.001). The older physicians and those in family medicine were less likely than the others to choose aggressive treatment options. Brazilian and US physicians were the most aggressive; Australian physicians were the most conservative. The DNR request resulted in a significant decrease in the number of physicians choosing aggressive options (p less than 0.001). The DTREC resulted in a move toward more aggressive treatment, as outlined in the directive (p less than 0.001). Overall, however, about 40% of the physicians chose a level of care different from what had been requested. Furthermore, over 10% would have tried cardiopulmonary resuscitation despite the DNR request. CONCLUSION: Treatment of incompetent elderly patients with life-threatening illness varies widely within and between countries. Uniform standards should be developed on the basis of societal values and be communicated to physicians. PMID:2018965

Alemayehu, E; Molloy, D W; Guyatt, G H; Singer, J; Penington, G; Basile, J; Eisemann, M; Finucane, P; McMurdo, M E; Powell, C

1991-01-01

378

Etomidate for critically ill patients. Con: do you really want to weaken the frail?  

PubMed

Etomidate is an imidazole-derived hypnotic agent preferentially used for rapid sequence induction of anaesthesia because of its favourable haemodynamic profile. However, 11?-hydroxylase inhibition causes adrenal insufficiency with potentially fatal consequences in specific populations. We review the arguments against the liberal administration of etomidate in critically ill, and especially septic, patients. This review considered only high-quality and prospective studies with a low risk of bias. Three major effects have been observed with the clinical use of a single dose of etomidate. First, independent of the clinical setting, etomidate causes adrenal dysfunction via 11?-hydroxylase inhibition ranging from 12 to 48 h, making the drug unsuitable for use in elective interventions. Second, in a systematic review with meta-analyses, including 3715 septic patients, the relative risk of death with etomidate was 1.22 (95% confidence interval 1.11 to 1.35). Based on this statistically significant and clinically relevant increase in mortality, a single dose of etomidate has to be avoided in patients with septic shock. Third, in small randomised controlled trials, a single dose of etomidate in trauma patients was associated with an increased incidence of pneumonia (56.7 vs. 25.9% in controls), prolonged intensive care stay (6.3 vs. 1.5 days) and prolonged hospital stay (11.6 vs. 6.4 days). Based on these randomised controlled trials, the use of etomidate should be avoided in unstable trauma patients. Midazolam and ketamine are two valid alternatives with similar intubation and haemodynamic conditions as etomidate but without its adverse effects. Therefore, for safety reasons, etomidate should be avoided in the critical conditions of sepsis and trauma. PMID:22965460

de la Grandville, Beatrice; Arroyo, Diego; Walder, Bernhard

2012-11-01

379

Physical therapists should integrate illness perceptions in their assessment in patients with chronic musculoskeletal pain; a qualitative analysis.  

PubMed

In the past decade, scientific evidence has shown that the biomedical model falls short in the treatment of patients with musculoskeletal pain. To understand musculoskeletal pain and a patient's health behavior and beliefs, physical therapists should assess the illness perceptions of their patients. In this quantitative study, we audiotaped the assessments of 19 primary care physical therapists on 27 patients and analyzed if and how illness perceptions were assessed. The Common Sense Model was used as the theoretical framework. We conclude that some of the domains of the Common Sense Model were frequently asked for (identity, causes and consequences), while others (timeline, treatment control, coherence, emotional representation) were used less frequently or seldom mentioned. The overall impression was that the assessments of the physical therapists were still bio-medically oriented in these patients with chronic musculoskeletal pain. PMID:24389339

van Wilgen, Paul; Beetsma, Anneke; Neels, Hedwig; Roussel, Nathalie; Nijs, Jo

2014-06-01

380

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

PubMed Central

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

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

2013-01-01

381

Brain Natriuretic Peptide and N-Terminal proBNP in Chronic Haemodialysis Patients  

Microsoft Academic Search

Background: Brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are released into circulation as a result of congestive heart failure (HF). As HF and water overload are frequent complications in haemodialysis (HD) patients, we decided to study the levels of BNP and NT-proBNP and their changes during HD. Methods: BNP and NT-proBNP levels were determined in 94 HD patients before

Jaroslav Racek; Hana Králová; Ladislav Trefil; Daniel Rajdl; Jaromír Eiselt

2006-01-01

382

Access to Mobile Communication Technology and Willingness to Participate in Automated Telemedicine Calls Among Chronically Ill Patients in Honduras  

PubMed Central

Abstract Objectives: Patients in underdeveloped countries may be left behind by advances in telehealthcare. We surveyed chronically ill patients with low incomes in Honduras to measure their use of mobile technologies and willingness to participate in mobile disease management support. Materials and Methods: 624 chronically ill primary care patients in Honduras were surveyed. We examined variation in telephone access across groups defined by patients' sociodemographic characteristics, diagnoses, and access to care. Logistic regression was used to identify independent correlates of patients' interest in automated telephonic support for disease management. Results: Participants had limited education (mean 4.8 years), and 65% were unemployed. Eighty-four percent had telephone access, and 78% had cell phones. Most respondents had voicemail (61%) and text messaging (58%). Mobile technologies were particularly common among patients who had to forego clinic visits and medications due to cost concerns (each p?patients (>80%) reported that they would be willing to receive automated calls focused on appointment reminders, medication adherence, health status monitoring, and self-care education. Patients were more likely to be willing to participate in automated telemedicine services if they had to cancel a clinic appointment due to transportation problems or forego medication due to cost pressures. Conclusions: Even in this poor region of Honduras, most chronically ill patients have access to mobile technology, and most are willing to participate in automated telephone disease management support. Given barriers to in-person care, new models of mobile healthcare should be developed for chronically ill patients in developing countries. PMID:21062234

Mendoza-Avelares, Milton O.; Milton, Evan C.; Lange, Ilta; Fajardo, Roosevelt

2010-01-01

383

Facility based cross-sectional study of self stigma among people with mental illness: towards patient empowerment approach  

PubMed Central

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

2013-01-01

384

Development and psychometric properties of a questionnaire to assess barriers to feeding critically ill patients  

PubMed Central

Background To successfully implement the recommendations of critical care nutrition guidelines, one potential approach is to identify barriers to providing optimal enteral nutrition (EN) in the intensive care unit (ICU), and then address these barriers systematically. Therefore, the purpose of this study was to develop a questionnaire to assess barriers to enterally feeding critically ill patients and to conduct preliminary validity testing of the new instrument. Methods The content of the questionnaire was guided by a published conceptual framework, literature review, and consultation with experts. The questionnaire was pre-tested on a convenience sample of 32 critical care practitioners, and then field tested with 186 critical care providers working at 5 hospitals in North America. The revised questionnaire was pilot tested at another ICU (n?=?43). Finally, the questionnaire was distributed to a random sample of ICU nurses twice, two weeks apart, to determine test retest reliability (n?=?17). Descriptive statistics, exploratory factor analysis, Cronbach alpha, intraclass correlations (ICC), and kappa coefficients were conducted to assess validity and reliability. Results We developed a questionnaire with 26 potential barriers to delivery of EN asking respondents to rate their importance as barriers in their ICU. Face and content validity of the questionnaire was established through literature review and expert input. The factor analysis indicated a five-factor solution and accounted for 72% of the variance in barriers: guideline recommendations and implementation strategies, delivery of EN to the patient, critical care provider attitudes and behavior, dietitian support, and ICU resources. Overall, the indices of internal reliability for the derived factor subscales and the overall instrument were acceptable (subscale Cronbach alphas range 0.84 – 0.89). However, the test retest reliability was variable and below acceptable thresholds for the majority of items (ICC’s range ?0.13 to 0.70). The within group agreement, an indices reflecting the reliability of aggregating individual responses to the ICU level was also variable (ICC’s range 0.0 to 0.82). Conclusions We developed a questionnaire to identify barriers to enteral feeding in critically ill patients. Additional studies are planned to further revise and evaluate the reliability and validity of the instrument. PMID:24305039

2013-01-01

385

Biomarker-guided antibiotic therapy in adult critically ill patients: a critical review.  

PubMed

Biomarkers of infection, namely C-reactive protein and procalcitonin (PCT), are potentially useful in the diagnosis of infection as well as in the assessment of its response to antibiotic therapy. C-reactive protein variations overtime appears to have a good performance for the diagnosis of infection. Procalcitonin shows a better correlation with clinical severity. In addition, to overcome the worldwide problem of antibiotic overuse as well as misuse, biomarker guidance of antibiotic stewardship represents a promising new approach. In several randomized, controlled trials, including adult critically ill patients, PCT guidance was repeatedly associated with a decrease in the duration of antibiotic therapy. However, these trials present several limitations, namely high rate of patients' exclusion, high rate of algorithm overruling, long duration of antibiotic therapy in the control group, disregard the effect of renal failure on PCT level, and above all a possible higher mortality and higher late organ failure in the PCT arm. In addition, some infections (e.g., endocarditis) as well as frequent nosocomial bacteria (e.g., Pseudomonas aeruginosa) are not suitable to be assessed by PCT algorithms. Therefore, the true value of PCT-guided algorithm of antibiotic stewardship in assisting the clinical decision-making process at the bedside remains uncertain. Future studies should take into account the issues identified in the present review. PMID:22824162

Póvoa, Pedro; Salluh, Jorge I F

2012-01-01

386

Improving confidence for self care in patients with depression and chronic illnesses.  

PubMed

The aim of this study was to examine whether patients who received a multicondition collaborative care intervention for chronic illnesses and depression had greater improvement in self-care knowledge and efficacy, and whether greater knowledge and self-efficacy was positively associated with improved target outcomes. A randomized controlled trial with 214 patients with comorbid depression and poorly controlled diabetes and/or coronary heart disease tested a 12-month team-based intervention that combined self-management support and collaborative care management. At 6 and 12 month outcomes the intervention group showed significant improvements over the usual care group in confidence in ability to follow through with medical regimens important to managing their conditions and to maintain lifestyle changes even during times of stress. Improvements in self care-efficacy were significantly related to improvements in depression, and early improvements in confidence to maintain lifestyle changes even during times of stress explained part of the observed subsequent improvements in depression. PMID:23398269

Ludman, Evette J; Peterson, Do; Katon, Wayne J; Lin, Elizabeth H B; Von Korff, Michael; Ciechanowski, Paul; Young, Bessie; Gensichen, Jochen

2013-01-01

387

The stigma of mental illness in Southern Ghana: attitudes of the urban population and patients’ views  

Microsoft Academic Search

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

Antonia Barke; Seth Nyarko; Dorothee Klecha

388

Hospitalization of influenza-like illness patients recommended by general practitioners in France between 1997 and 2010  

E-print Network

Page 1 Hospitalization of influenza-like illness patients recommended by general practitioners-hospitalization ratio; emerging pathogens; influenza pandemics; surveillance, severity. Corresponding author (present.pelat@gmail.com inserm-00709172,version1-18Jun2012 Author manuscript, published in "Influenza and Other Respiratory

389

Simplified electrophysiological evaluation of peripheral nerves in critically ill patients: the Italian multi-centre CRIMYNE study  

Microsoft Academic Search

INTRODUCTION: Critical illness myopathy and\\/or neuropathy (CRIMYNE) is frequent in intensive care unit (ICU) patients. Although complete electrophysiological tests of peripheral nerves and muscles are essential to diagnose it, they are time-consuming, precluding extensive use in daily ICU practice. We evaluated whether a simplified electrophysiological investigation of only two nerves could be used as an alternative to complete electrophysiological tests.

Nicola Latronico; Guido Bertolini; Bruno Guarneri; Marco Botteri; Elena Peli; Serena Andreoletti; Paola Bera; Davide Luciani; Anna Nardella; Elena Vittorielli; Bruno Simini; Andrea Candiani

2007-01-01

390

Impact of the Pulmonary Artery Catheter in Critically Ill Patients Meta-analysis of Randomized Clinical Trials  

Microsoft Academic Search

Context Randomized clinical trials (RCTs) evaluating the pulmonary artery catheter (PAC) have been limited by small sample size. Some nonrandomized studies suggest that PAC use is associated with increased morbidity and mortality. Objective To estimate the impact of the PAC device in critically ill patients. Data Sources MEDLINE (1985-2005), the Cochrane Controlled Trials Registry (1988- 2005), the National Institutes of

Monica R. Shah; Lynne W. Stevenson; Cynthia Binanay; Christopher M. O'Connor; George Sopko; Robert M. Califf

391

Hospital-acquired sinusitis is a common cause of fever of unknown origin in orotracheally intubated critically ill patients  

Microsoft Academic Search

INTRODUCTION: Sinusitis is a well recognised but insufficiently understood complication of critical illness. It has been linked to nasotracheal intubation, but its occurrence after orotracheal intubation is less clear. We studied the incidence of sinusitis in patients with fever of unknown origin (FUO) in our intensive care unit with the aim of establishing a protocol that would be applicable in

Arthur RH van Zanten; J Mark Dixon; Martine D Nipshagen; Remco de Bree; Armand RJ Girbes; Kees H Polderman

2005-01-01

392

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

Microsoft Academic Search

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

Marcus J Schultz; Robin E Harmsen; Peter E Spronk

2010-01-01

393

Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data  

Microsoft Academic Search

Background: Hyperglycemia is associated with increased mortality in critically ill patients. Randomized trials of in- tensive insulin therapy have reported inconsistent effects on mortality and increased rates of severe hypoglycemia. We conducted a meta-analysis to update the totality of evi- dence regarding the influence of intensive insulin therapy compared with conventional insulin therapy on mortality and severe hypoglycemia in the

Donald E. G. Griesdale; R. J. de Souza; Rob M. van Dam; Daren K. Heyland; Deborah J. Cook; Atul Malhotra; R. Dhaliwal; W. R. Henderson; D. R. Chittock; S. Finfer; D. Talmor

2009-01-01

394

The Adolescent with a Life-Threatening Illness: Cultural Myths and Social Realities.  

ERIC Educational Resources Information Center

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…

Nannis, Ellen D.; And Others

395

Telephone-based health coaching for chronically ill patients: study protocol for a randomized controlled trial  

PubMed Central

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

2013-01-01

396

Prospective Randomized Crossover Study of Simulation vs. Didactics for Teaching Medical Students the Assessment and Management of Critically Ill Patients  

Microsoft Academic Search

Background: Simulation (SIM) allows medical students to manage high-risk\\/low-frequency cases in an environment without patient risk. However, evidence for the efficacy of SIM-based training remains limited. Objective: To compare SIM-based training to traditional didactic lecture (LEC) for teaching medical students to assess and manage critically ill patients with myocardial infarction (MI) and anaphylaxis. Methods: Prospective, randomized, non-blinded crossover study of

Christopher Eric McCoy; Michael Menchine; Craig Anderson; Robert Kollen; Mark I. Langdorf; Shahram Lotfipour

2011-01-01

397

Hyperglycemia related to high-dose glucocorticoid use in noncritically ill patients  

PubMed Central

Background Glucocorticoids commonly cause drug-induced diabetes. This association is well recognized but available evidence does not answer clinically relevant issues in subjects without diabetes. Methods Thirty-five individuals without diabetes with a recent diagnosis of acute lymphoblastic leukemia or non-Hodgkin’s lymphoma on high-dose glucocorticoid therapy were studied. Close systematic monitoring of fasting and postprandial glycemia and fasting insulin determinations, HOMA-insulin resistance and HOMA ?-cell function were performed. The primary objective was to define the incidence of secondary diabetes in patients treated with high-dose glucocorticoids. Secondary objectives were to specify the intensity, the moment it appears and the evolution of hyperglycemia, in addition to the risk factors, mechanisms and impact of continuous and cyclical glucocorticoids on the development of hyperglycemia. Results Mean age of patients was 38.4?±?18.7 years. The incidence of diabetes was 40.6% and was found after the first week; half the time it occurred between the second and fourth. Two-thirds spontaneously normalized by eight weeks. Continuous glucocorticoid administration had a higher incidence of fasting hyperglycemia (P?=?0.003). Mean peak insulin levels were significantly higher in cases of diabetes. Conclusions High-dose prednisone for 2 to 3 months produced an elevated incidence of diabetes, usually with mild hyperglycemia occurring between the second and fourth week, normalizing spontaneously in all cases. Hyperglycemia was more frequent with continuous doses and occurred in cases with increased insulin resistance. The clinical and therapeutic characteristics of our participants, who were otherwise healthy, could represent the clinical setting of many patients with illness from other medical areas that might require high doses of GC for six to twelve weeks. PMID:23557386

2013-01-01

398

Fluconazole pharmacokinetics in a morbidly obese, critically ill patient receiving continuous venovenous hemofiltration.  

PubMed

Current fluconazole dosing strategies can be described using either standardized doses (800 or 400 mg) or as weight-based dosing recommendations (12 mg/kg loading dose followed by 6 mg/kg maintenance dose). The ideal method of fluconazole dosing is still unclear for certain patient populations, such as those receiving renal replacement therapy or the morbidly obese. We describe a 48-year-old man with a body mass index of 84 kg/m(2) who was receiving continuous venovenous hemofiltration (CVVH) and was treated with fluconazole by using a weight-based dose determined by lean body weight, infused at a rate of 200 mg/hour. Blood samples were collected at hour 0 (i.e., ~24 hrs after the loading dose was administered) and at 3.5, 6.8, and 11.3 hours after the start of the 600-mg maintenance dose, infused over 3 hours. Pharmacokinetic parameters calculated were maximum serum concentration 9.64 mg/L, minimum serum concentration 5.98 mg/L, area under the serum concentration-time curve from 0-24 hours (AUC0-24 ) 184.75 mg/L•hour, elimination rate constant 0.0199 hour(-1) , elimination half-life 34.8 hours, and total body clearance 3.25 L/hour. Our data, when combined with previously published literature, do not support using a linear dose-to-AUC approximation to estimate drug dosing needs in the critically ill patient population receiving CVVH. In addition, our results suggest that morbidly obese patients are able to achieve pharmacodynamic goals defined as an AUC:MIC ratio higher than 25 by using a lean body weight for fluconazole dosing calculations. PMID:25074285

Lopez, Natasha D; Phillips, Kristy M

2014-09-01

399

High dose tigecycline in critically ill patients with severe infections due to multidrug-resistant bacteria  

PubMed Central

Introduction The high incidence of multidrug-resistant (MDR) bacteria among patients admitted to ICUs has determined an increase of tigecycline (TGC) use for the treatment of severe infections. Many concerns have been raised about the efficacy of this molecule and increased dosages have been proposed. Our purpose is to investigate TGC safety and efficacy at higher than standard doses. Methods We conducted a retrospective study of prospectively collected data in the ICU of a teaching hospital in Rome. Data from all patients treated with TGC for a microbiologically confirmed infection were analyzed. The safety profile and efficacy of high dosing regimen use were investigated. Results Over the study period, 54 patients (pts) received TGC at a standard dose (SD group: 50 mg every 12 hours) and 46 at a high dose (HD group: 100 mg every 12 hours). Carbapenem-resistant Acinetobacter.baumannii (blaOXA-58 and blaOXA-23 genes) and Klebsiella pneumoniae (blaKPC-3 gene) were the main isolated pathogens (n?=?79). There were no patients requiring TGC discontinuation or dose reduction because of adverse events. In the ventilation-associated pneumonia population (VAP) subgroup (63 patients: 30 received SD and 33 HD), the only independent predictor of clinical cure was the use of high tigecycline dose (odds ratio (OR) 6.25; 95% confidence interval (CI) 1.59 to 24.57; P?=?0.009) whilst initial inadequate antimicrobial treatment (IIAT) (OR 0.18; 95% CI 0.05 to 0.68; P?=?0.01) and higher Sequential Organ Failure Assessment (SOFA) score (OR 0.66; 95% CI 0.51 to 0.87; P?=?0.003) were independently associated with clinical failure. Conclusions TGC was well tolerated at a higher than standard dose in a cohort of critically ill patients with severe infections. In the VAP subgroup the high-dose regimen was associated with better outcomes than conventional administration due to Gram-negative MDR bacteria. PMID:24887101

2014-01-01

400

Learned illness behavior in patients with irritable bowel syndrome and peptic ulcer  

Microsoft Academic Search

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

William E. Whitehead; Carolyn Winget; Al S. Fedoravicius; Susan Wooley; Barry Blackwell

1982-01-01

401

The psychological burden of an initially unexplained illness: patients with sternocostoclavicular hyperostosis before and after delayed diagnosis  

PubMed Central

Background Sternocostoclavicular hyperostosis (SCCH) is a rare, debilitating, chronic inflammatory disorder of the anterior chest wall due to a chronic sterile osteomyelitis of unknown origin. SCCH is largely underdiagnosed and often misdiagnosed. In individual cases it can remain unrecognized for years. The purpose of this study is twofold. Firstly, to evaluate the psychological condition of SCCH patients, both in the sometimes quite extended pre-diagnostic period between first manifestations and confirmed diagnosis of the disease, and in the current situation. Secondly, to investigate the relationships between the pre-diagnostic and the current psychological conditions of confirmed SCCH patients. Methods Structured interviews were held with 52 confirmed SCCH patients. Questionnaires were included to assess posttraumatic stress symptoms, social support, aspects of pain, illness perceptions, self-reported health status, and quality of life. Results SCCH patients reported stronger posttraumatic stress symptoms, more unfavorable illness perceptions, lower health status, and poorer quality of life than healthy individuals and patients with other diseases or traumatic experiences. Psychological distress in the pre-diagnostic period was associated with unfavorable conditions in the current situation. Conclusion SCCH is an illness with serious psychological consequences. Psychological monitoring of patients with unexplained complaints is recommended as long as a diagnosis has not been reached. PMID:20828391

2010-01-01