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https://www.readbyqxmd.com/read/28930709/responding-to-moral-distress-and-ethical-concerns-at-the-intersection-of-medical-illness-and-unmet-mental-health-needs
#1
Donna D McKlindon, Pamela Nathanson, Chris Feudtner
Some of the most difficult clinical ethics consultations involve patients who have both medical and mental health needs, as these cases can result in considerable moral distress on the part of the bedside staff. In this article we examine the issues that such consults raise through the illustrative example of a particular case: several years ago our ethics consultation service received a request from a critical care attending physician who was considering a rarely performed psychosurgical intervention to address intractable and life-threatening agitation and aggression in an adolescent patient for whom standard treatments had proven unsuccessful...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28927578/the-critical-care-pain-observation-tool-is-reliable-in-non-agitated-but-not-in-agitated-intubated-patients
#2
Hoda Chookalayia, Mehdi Heidarzadeh, Mohammad Hassanpour-Darghah, Masoomeh Aghamohammadi-Kalkhoran, Mansoreh Karimollahi
OBJECTIVE: The Critical-Care Pain. OBSERVATION: Tool is one of the instruments developed to assess pain in patients who are unable to communicate verbally. The study aimed to survey the psychometric properties of Critical-Care Pain. OBSERVATION: Tool in four groups of non-verbal patients according to their Richmond Agitation Sedation Score (RASS). STUDY DESIGN AND METHODOLOGY: 65 critically ill patients (medical, surgical, trauma) were assessed using the critical care pain observation tool on six occasions (before, during and after nociceptive and non-nociceptive procedures)...
September 15, 2017: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/28927477/frequency-and-subgroups-of-neuropsychiatric-symptoms-in-mild-cognitive-impairment-and-different-stages-of-dementia-in-alzheimer-s-disease
#3
N Siafarikas, G Selbaek, T Fladby, J Šaltytė Benth, E Auning, D Aarsland
BACKGROUND: Neuropsychiatric symptoms (NPS), such as depression, apathy, agitation, and psychotic symptoms are common in mild cognitive impairment (MCI) and dementia in Alzheimer's disease (AD). Subgroups of NPS have been reported. Yet the relationship of NPS and their subgroups to different stages of cognitive impairment is unclear. Most previous studies are based on small sample sizes and show conflicting results. We sought to examine the frequency of NPS and their subgroups in MCI and different stages of dementia in AD...
September 20, 2017: International Psychogeriatrics
https://www.readbyqxmd.com/read/28927394/laboratory-markers-of-cardiac-and-metabolic-complications-after-generalized-tonic-clonic-seizures
#4
Robert D Nass, Sina Meiling, René P Andrié, Christian E Elger, Rainer Surges
BACKGROUND: Generalized tonic-clonic seizures (GTCS) frequently lead to emergency inpatient referrals. Laboratory blood values are routinely performed on admission to detect underlying causes and metabolic or cardiac complications. Our goal was to assess the nature and frequency of complications occurring in association with GTCS. METHODS: We retrospectively extracted data from emergency protocols and discharge letters of adult patients admitted to the Department of Epileptology between 01/2010 and 06/2015...
September 19, 2017: BMC Neurology
https://www.readbyqxmd.com/read/28912056/revisiting-unplanned-extubation-in-the-pediatric-intensive-care-unit-what-s-new
#5
REVIEW
Paulo Sérgio Lucas da Silva, Daniela Farah, Marcelo Cunio Machado Fonseca
In 2010, recommendations for preventing unplanned extubations (UEs) in pediatric patients were published based on a literature review. Since then, there have been an increasing number of publications related to UE focusing on children. If the introduction of care bundles and larger body of evidence on UE had impact on UE occurrence, this would have important implications on clinical practice. We searched for relevant publications published between Jan 1, 2010 and Jun 30, 2016 in the MEDLINE, EMBASE, and Cochrane systems...
September 11, 2017: Heart & Lung: the Journal of Critical Care
https://www.readbyqxmd.com/read/28911339/emerging-treatments-for-the-behavioral-and-psychological-symptoms-of-dementia
#6
Abhinav Anand, Puneet Khurana, Jasneet Chawla, Neha Sharma, Navneet Khurana
Dementia is referred to a loss of memory and decline in other mental abilities at levels critical enough to hinder performance of daily activities. It can be of several types, depending on the underlying pathophysiology. The behavioral and psychological symptoms of dementia (BPSD) are various, but the most clinically significant are depression, apathy, and anxiety. Other BPSD include agitation, aberrant motor behavior, elation, hallucinations, and alterations in sleep and appetite. About 90% of sufferers of dementia are affected by BPSD during the course of the illness...
September 15, 2017: CNS Spectrums
https://www.readbyqxmd.com/read/28904548/effect-of-family-patient-communication-on-the-incidence-of-delirium-in-hospitalized-patients-in-cardiovascular-surgery-icu
#7
Maryam Eghbali-Babadi, Nasrin Shokrollahi, Tayebe Mehrabi
BACKGROUND: Cardiovascular diseases are the most important causes of morbidity and mortality in the world, and cardiac surgery is one of the treatments that have complication for patients. One of the most important current psychological complications after cardiac surgery is delirium. For its prevention and treatment, considerable attention should be paid to the role of family. This study has been conducted for assessing the effect of the relationship between the family and patient on the incidence of delirium in hospitalized patients in cardiovascular surgery intensive care unit (ICU) of Isfahan Shahid Chamran hospital...
July 2017: Iranian Journal of Nursing and Midwifery Research
https://www.readbyqxmd.com/read/28903347/retrospective-analysis-of-risk-factors-associated-with-kawasaki-disease-in-china
#8
Lihua Bai, Tienan Feng, Lifang Yang, Yi Zhang, Xuejuan Jiang, Jiayao Liao, Lihua Chen, Xiaoyan Feng, Yanming Rong, Yuehua Li, Zhiqiang Qin, Jing Qiao
In order to provide early intervention for coronary artery lesion (CAL) caused by Kawasaki Disease (KD), we analyzed clinical characteristics of typical and incomplete KD cases from 1998 to 2008 in Northwest and Central China. A total of 383 patients included 298 cases of typical KD and 85 cases of incomplete KD. The morbidity of incomplete KD was 28.5%, a percentage significantly lower than that of typical KD. The occurrence of bulbar conjunctiva congestion, erythra, crissum red, film-like decrustation, lip red, rhagades, raspberry tongue, bilateral toe-end decrustation, limb sclerosis, cervical lymph nodes enlargement, agitation and irritability in incomplete KD group was lower than that in the group of typical KD (p < 0...
August 15, 2017: Oncotarget
https://www.readbyqxmd.com/read/28902944/fixation-of-the-short-term-central-venous-catheter-a-comparison-of-two-techniques
#9
Mário Lúcio Marques Leal, Ana Beatriz Alkmim Teixeira Loyola, Alexandre Ciappina Hueb, José Dias da Silva, Marcos Mesquita, Luiz Francisley de Paiva, Mauricio Landulfo Jorge Guerrieri, João Paulo Nunes Fernandes, Artur Costa Barros, Lydia Masako Ferreira
Purpose: To compare the fixation of the central venous catheter (CVC) using two suture techniques. Methods: A clinical, analytical, interventional, longitudinal, prospective, controlled, single-blind and randomized study in adult, intensive care unit (ICU) patients. After admission and indication of CVC use, the patients were allocated to the Wing group (n = 35, catheter fixation with clamping wings and retainers) or Shoelace group (n = 35, catheter fixation using shoelace cross-tied sutures around the device)...
August 2017: Acta Cirúrgica Brasileira
https://www.readbyqxmd.com/read/28895757/intoxications-in-the-strida-project-involving-a-panorama-of-psychostimulant-pyrovalerone-derivatives-mdpv-copycats
#10
Olof Beck, Matilda Bäckberg, Patrick Signell, Anders Helander
CONTEXT: An increasing number of new psychoactive substances (NPS) of different chemical classes have become available through marketing and sale over the Internet. This report from the Swedish STRIDA project presents the prevalence, laboratory results, and clinical features in intoxications involving 11 stimulant pyrovalerone NPS derivatives over a 5-year period. STUDY DESIGN: Case series of consecutive patients with admitted or suspected intake of NPS presenting to Swedish hospitals for emergency treatment from January 2011 to March 2016...
September 12, 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/28888071/the-effect-of-ventricular-assist-device-associated-biomaterials-on-human-blood-leukocytes
#11
Gemma Radley, Ina Laura Pieper, Catherine A Thornton
Ventricular assist devices (VADs) are an effective bridging or destination therapy for patients with advanced stage heart failure. These devices remain susceptible to adverse events including infection, bleeding, and thrombus; events linked to the foreign body response. Therefore, the biocompatibility of all biomaterials used is crucial to the success of medical devices. Biomaterials common in VADs-DLC: diamond-like carbon coated stainless steel; Sap: single-crystal sapphire; SiN: silicon nitride; Ti: titanium alloy; and ZTA: zirconia-toughened alumina-were tested for their biocompatibility through incubation with whole human blood for 2 h with mild agitation...
September 9, 2017: Journal of Biomedical Materials Research. Part B, Applied Biomaterials
https://www.readbyqxmd.com/read/28887041/partial-anomalous-pulmonary-venous-connection-in-a-dog
#12
Chloe L Thorn, Naomi R Ford, Meg M Sleeper
A 2-year-old male intact Belgian Malinois was presented for exercise intolerance. A grade III/VI left basilar systolic murmur was detected. Echocardiography revealed moderate right atrial and ventricular dilation and increased pulmonic outflow velocity. Thoracic radiographs showed right heart enlargement and a dilated caudal vena cava. In addition, on the left lateral projection, an enlarged aberrant right cranial pulmonary lobar vein was suspected to be diverging ventrally from the course of the right cranial lobar bronchus and inserting more ventrally than normal in the region of the right atrium...
September 5, 2017: Journal of Veterinary Cardiology: the Official Journal of the European Society of Veterinary Cardiology
https://www.readbyqxmd.com/read/28886752/protocol-for-the-management-of-psychiatric-patients-with-psychomotor-agitation
#13
Eduard Vieta, Marina Garriga, Laura Cardete, Miquel Bernardo, María Lombraña, Jordi Blanch, Rosa Catalán, Mireia Vázquez, Victòria Soler, Noélia Ortuño, Anabel Martínez-Arán
BACKGROUND: Psychomotor agitation (PMA) is a state of motor restlessness and mental tension that requires prompt recognition, appropriate assessment and management to minimize anxiety for the patient and reduce the risk for escalation to aggression and violence. Standardized and applicable protocols and algorithms can assist healthcare providers to identify patients at risk of PMA, achieve timely diagnosis and implement minimally invasive management strategies to ensure patient and staff safety and resolution of the episode...
September 8, 2017: BMC Psychiatry
https://www.readbyqxmd.com/read/28882192/satisfaction-with-quality-of-icu-care-for-patients-and-families-the-euroq2-project
#14
Hanne Irene Jensen, Rik T Gerritsen, Matty Koopmans, Lois Downey, Ruth A Engelberg, J Randall Curtis, Peter E Spronk, Jan G Zijlstra, Helle Ørding
BACKGROUND: Families' perspectives are of great importance in evaluating quality of care in the intensive care unit (ICU). This Danish-Dutch study tested a European adaptation of the "Family Satisfaction in the ICU" (euroFS-ICU). The aim of the study was to examine assessments of satisfaction with care in a large cohort of Danish and Dutch family members and to examine the measurement characteristics of the euroFS-ICU. METHODS: Data were from 11 Danish and 10 Dutch ICUs and included family members of patients admitted to the ICU for 48 hours or more...
September 7, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28882156/comparative-safety-and-efficacy-of-pharmacological-and-non-pharmacological-interventions-for-the-behavioral-and-psychological-symptoms-of-dementia-protocol-for-a-systematic-review-and-network-meta-analysis
#15
Jennifer Watt, Zahra Goodarzi, Andrea C Tricco, Areti-Angeliki Veroniki, Sharon E Straus
BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) are highly prevalent in patients with dementia. Both pharmacological and non-pharmacological strategies are commonly used to treat these symptoms, but their comparative safety and efficacy is unknown. METHODS: We will conduct a systematic review of the published and unpublished literature to retrieve all articles pertaining to outcomes of safety and efficacy associated with pharmacological and non-pharmacological treatments of BPSD for patients living in the community and institutionalized care settings...
September 7, 2017: Systematic Reviews
https://www.readbyqxmd.com/read/28880362/cold-platelets-for-trauma-associated-bleeding-regulatory-approval-accreditation-approval-and-practice-implementation-just-the-tip-of-the-iceberg
#16
James R Stubbs, Sheryl A Tran, Richard L Emery, Scott A Hammel, De Anna L Haugen, Martin D Zielinski, Scott P Zietlow, Donald Jenkins
BACKGROUND: Laboratory and clinical evidence suggest that cold-stored platelets (CS-PLTs) might be preferable to room temperature platelets (RT-PLTs) for active bleeding. Ease of prehospital use plus potential hemostatic superiority led our facility to pursue approval of CS-PLTs for actively bleeding trauma patients. STUDY DESIGN AND METHODS: From November 18, 2013, through October 8, 2015, correspondence was exchanged between our facility, the AABB, and the US Food and Drug Administration (FDA)...
September 6, 2017: Transfusion
https://www.readbyqxmd.com/read/28880357/-the-use-of-dexmedetomidine-in-extreme-agitation
#17
E Roosens, J P Mulier, G Heylens, J De Fruyt
In clinical practice antipsychotics, benzodiazepines and/or antihistamines are used to calm agitated patients. If agitation persists and patients have contraindications for these substances, then anesthetics, such as propofol, can also be used as well, to serve as a sedative. Our attention was drawn to a particular case in which dexmedetomidine was used as a sedative.<br/> AIM: To study the literature on the use of α2-agonists, such as dexmedetomidine, in the treatment of extreme agitation.<br/> METHOD: We reviewed the relevant scientific literature...
2017: Tijdschrift Voor Psychiatrie
https://www.readbyqxmd.com/read/28877705/loxapine-to-control-agitation-during-weaning-from-mechanical-ventilation
#18
Stéphane Gaudry, Benjamin Sztrymf, Romain Sonneville, Bruno Megarbane, Guillaume Van Der Meersch, Dominique Vodovar, Yves Cohen, Jean-Damien Ricard, David Hajage, Laurence Salomon, Didier Dreyfuss
BACKGROUND: Weaning from mechanical ventilation (MV) may be impeded by the occurrence of agitation. Loxapine has the ability to control agitation without affecting spontaneous ventilation. The aim of this study was to establish whether loxapine would reduce MV weaning duration in agitated patients. METHODS: We performed a multicentre, double-blind, placebo-controlled, parallel group, randomised trial. Patients who were potential candidates for weaning but exhibited agitation (Richmond Agitation-Sedation Scale score ≥ 2) after sedation withdrawal were randomly assigned to receive either loxapine or placebo...
September 6, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28876970/responding-to-ten-common-delirium-misconceptions-with-best-evidence-an-educational-review-for-clinicians
#19
Mark A Oldham, Nina M Flanagan, Ariba Khan, Olga Boukrina, Edward R Marcantonio
Delirium (acute confusion) is a serious, common health condition, and it predicts poor outcomes, including greater rates of mortality, institutionalization, prolonged hospitalization, and cognitive impairment. Expedient diagnosis and management are critical to address modifiable delirium causes and improve both quality of care and outcomes. Moreover, more than a third of delirium is preventable. Despite the clear significance of delirium and our increasingly sophisticated understanding of the condition, the gap between evidence and practice persists...
September 6, 2017: Journal of Neuropsychiatry and Clinical Neurosciences
https://www.readbyqxmd.com/read/28874082/impact-of-multiple-daily-clinical-pharmacist-enforced-assessments-on-time-in-target-sedation-range
#20
Bryan D Lizza, Benjamin Jagow, David Hensler, Craig J Cooper, Elizabeth J Short, Matthew B Maas, Andrew M Naidech, Richard G Wunderink
OBJECTIVES: Incorporation of a single daily assessment by a clinical pharmacist to improve adherence with a sedation protocol is associated with reduced duration of mechanical ventilation and intensive care unit (ICU) length of stay (LOS). We test the feasibility of incorporating a clinical pharmacist into more frequent sedation assessments and observed whether there are any potential differences in the sedatives administered. METHODS: Prospective, quasi-experimental, pilot study of patients admitted to the medical ICU...
January 1, 2017: Journal of Pharmacy Practice
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