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https://www.readbyqxmd.com/read/28601131/detection-and-management-of-preexisting-cognitive-impairment-in-the-critical-care-unit
#1
REVIEW
Mark A Oldham, Walter Piddoubny, Ryan Peterson, Hochang B Lee
Older adults account for half of intensive care unit (ICU) admissions and ICU days, and approximately 2 in 5 older adults in the ICU have preexisting cognitive impairment (PCI). PCI identification is important for risk stratification and may influence ICU utilization and decision-making surrogacy. PCI is overlooked in more than half of patients without screening; however, screening instruments can identify PCI in less than 5 minutes. Management of PCI in the ICU involves addressing associated neuropsychiatric symptoms...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28601133/assessment-and-management-of-toxidromes-in-the-critical-care-unit
#2
REVIEW
J J Rasimas, Courtney M Sinclair
The most important diagnostic factor in uncovering a toxic etiology for delirium or critical illness is the clinician's openness to the possibility of its existence. Therefore, a consulting psychiatrist, already prepared to perform the detail-oriented work of sorting out behavioral manifestations of disease, can be a vital asset at the bedside if also attuned to the role of purposeful, accidental, and iatrogenic exposures in the intensive care unit. This article summarizes the presentation, evaluation, and treatment of toxidromes relevant to the work of acute psychosomatic medicine...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28601134/substance-use-intoxication-and-withdrawal-in-the-critical-care-setting
#3
REVIEW
Joseph H Donroe, Jeanette M Tetrault
Substance use is common among individuals admitted to the critical care setting and may complicate treatment of underlying disorders. Management issues include the effects of intoxication as well as the risk posed by substance-withdrawal syndromes in patients being treated for critical illness. This article reviews the epidemiology of substance use in this population and the identification and treatment of common intoxication and withdrawal syndromes. The authors stress the importance of long-term planning as part of the overall treatment protocol beyond the acute presentation...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28601136/psychiatric-aspects-of-lung-disease-in-critical-care
#4
REVIEW
Yelizaveta Sher
Respiratory conditions are some of the most common indications for admission to critical care units. Psychiatric disorders and symptoms are highly comorbid with lung disease. They can occur as a risk factor to lung disease, as a co-occurring condition, as a consequence of a pulmonary condition, or as a treatment side effect either from medications or assistive devices. Patients can experience a myriad of mood, anxiety, and cognitive disorder symptoms and conditions in critical care units. Intensivists and psychiatrists must be aware of the interplay between pulmonary and psychiatric symptoms as well as medication effects and interactions...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28601138/psychiatric-disorders-and-suicidality-in-the-intensive-care-unit
#5
REVIEW
Renee M Garcia
Suicidality is a general term that describes the continuum of suicidal ideation, intent, self-injurious behavior, attempts, and completed suicide. Suicidality across the entire spectrum is a public health concern with significant impact, including billions in work loss and medical costs. There are many challenges to managing suicidality in an intensive care unit setting, which will be reviewed here. Additionally, this article will review the prevalence of suicide attempts in different psychiatric diagnoses, conducting a suicide assessment, role of involuntary psychiatric holds, and most common challenges encountered in the ICU setting...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28601139/posttraumatic-stress-disorder-phenomena-after-critical-illness
#6
REVIEW
Oscar Joseph Bienvenu, Ted-Avi Gerstenblith
This article focuses on a psychiatric morbidity in critical illness survivors, posttraumatic stress disorder (PTSD). We present a case in the second person, because it is helpful to imagine what being critically ill can be like from the perspective of a patient without medical training. One-fifth of critical illness survivors have clinically relevant PTSD symptoms in the year after intensive care, and markers of risk include prior psychiatric illness, benzodiazepine administration in the intensive care unit (ICU), and early post-ICU memories of frightening, nightmare-like experiences during intensive care...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28601143/psychiatric-and-palliative-care-in-the-intensive-care-unit
#7
REVIEW
Stephanie M Harman
Palliative care is specialized medical care focused on patients with serious illness and their families. In the intensive care unit (ICU), palliative care encompasses core skills to support patients and their families throughout their ICU course and post-ICU stays. Psychiatric symptoms are common among patients approaching the end of life and require particular attention in the setting of sedating medications, typically used when patients require ventilators and other life-sustaining treatments. For patients with preexisting severe mental illness who have a concurrent serious medical illness, a palliative psychiatric approach can address complex symptom management and support ethical and value-based shared decision making...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28601142/medical-complications-of-psychiatric-treatment-an-update
#8
REVIEW
Sheila C Lahijani, Kirk A Harris
Psychiatric medications are used commonly in hospitalized patients and are particularly indicated in patients who are critically ill to manage many conditions. Due to their many indications in the intensive care unit (ICU), psychiatric medications should be closely monitored in these medically compromised patients for adverse reactions and medical complications because they may affect essentially all organ systems. These range from life-threatening reactions to other less significant effects, such as sedation, to other detrimental complications, such as pancreatitis...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28505614/pulmonary-involvement-in-adult-patients-with-inborn-errors-of-metabolism
#9
Christel Tran, Frederic Barbey, Romain Lazor, Luisa Bonafé
Inborn errors of metabolism (IEM) are rare individually, but taken together, they affect 1 in 1,000 people. Most of the disease becomes apparent at the pediatric age; however, with the identification of late-onset forms, and with improved survival, several of these conditions may be found in adults of all ages. While the lung is not typically a primary site of clinical disease in patients with IEM, in some of them it can be a significantly affected organ with associated severe respiratory complications. Lung involvement can be a late- onset feature of a complex multisystemic disease, but sometimes it can also be the only manifestation of underlying IEM...
2017: Respiration; International Review of Thoracic Diseases
https://www.readbyqxmd.com/read/28531883/conventional-versus-ultrasound-guided-transbronchial-needle-aspiration-for-the-diagnosis-of-hilar-mediastinal-lymph-adenopathies-a-randomized-controlled-trial
#10
Martina Bonifazi, Irene Tramacere, Lina Zuccatosta, Federico Mei, Michele Sediari, Maria Cristina Paonessa, Stefano Gasparini
BACKGROUND: Conventional transbronchial needle aspiration (c-TBNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) are both valuable diagnostic techniques for the diagnosis of hilar/mediastinal lesions. Although a superiority of EBUS-TBNA over c-TBNA may be expected, evidence-based data on a direct comparison between these 2 procedures are still lacking. OBJECTIVES: We aimed to test the superiority of EBUS-TBNA over c-TBNA in a randomized trial and to evaluate the cost-effectiveness profile of a staged strategy, including c-TBNA as initial test followed by EBUS-TBNA, in case of inconclusive results at rapid on-site evaluation...
2017: Respiration; International Review of Thoracic Diseases
https://www.readbyqxmd.com/read/28389257/physiotherapy-and-speech-and-language-therapy-intervention-for-chronic-cough
#11
REVIEW
Surinder S Birring, Sarah Floyd, Charles C Reilly, Peter Siu Pan Cho
There are few effective pharmacological therapies available to treat refractory chronic cough. Functional MRI studies of the brain have recently shown that patients with chronic cough have dysfunctional inhibitory control of cough. Self-management therapies delivered by physiotherapists or speech therapists are effective at suppressing cough. They enable patients to consciously suppress the urge to cough. The intervention consists of education, laryngeal hygiene, cough suppression and distraction measures and behaviour modification...
April 4, 2017: Pulmonary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28412479/cough-in-exercise-and-athletes
#12
REVIEW
J H Hull, J W Dickinson, A R Jackson
Cough is the most common respiratory symptom reported by athletes and can significantly impact on health status, ability to train and athletic performance. The presence of cough in an athlete is typically taken to indicate exercise-induced bronchoconstriction (EIB), yet in many athletes with chronic cough there is no objective evidence of airway hyper-responsiveness (AHR) or heightened airway inflammation. Moreover, cough in athletes often fails to respond to a therapeutic asthma strategy, thus further work is urgently needed to progress our understanding of the pathophysiology of exercise-associated cough in this unique population...
April 12, 2017: Pulmonary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28476638/cough-management-in-primary-secondary-and-tertiary-settings
#13
REVIEW
Kay Wang, Nikki Milojevic, Bryan Sheinman, Omar S Usmani
This review reflects upon the management of cough in primary, secondary and tertiary care settings. It reviews the burden of cough, the diagnostic tools employed to investigate the cause of cough and pragmatic treatment strategies. A clinical case vignette presenting in primary care highlights the challenges of managing cough by family practitioners. An approach to establishing a persistent cough clinic service in secondary care is described. Finally, the entity of idiopathic cough in tertiary care and the specialist approaches to treating recalcitrant cough are addressed...
May 2, 2017: Pulmonary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28527922/bronchodilator-therapy-for-chronic-cough
#14
REVIEW
Maria Gabriella Matera, Paola Rogliani, Alessandro Zanasi, Mario Cazzola
Experimental studies indicate that airway calibre increases the sensitivity of the afferents involved in the cough reflex but it has proved difficult to demonstrate that airway calibre increases the sensitivity of the afferents involved in the cough reflex. Therefore, bronchodilators might have a role, although rather minor, in the treatment of cough. However, although bronchodilators represent the standard of care in the treatment of airway obstruction associated with asthma or COPD, controversy persists regarding the mechanism(s) by which these agents alleviate cough...
May 17, 2017: Pulmonary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28052805/hypereosinophilic-syndrome
#15
REVIEW
Heung R Noh, Gil G Magpantay
BACKGROUND: Hypereosinophilic syndrome (HES) is a myeloproliferative disorder characterized by persistent eosinophilia associated with multiple organ damage. OBJECTIVE: To increase awareness of the rare but potentially life-threatening disease and to provide a brief overview of the clinical presentation, diagnosis, and management of HES. METHODS: Pertinent data from the patient's clinical course was incorporated with salient articles on the topic...
January 1, 2017: Allergy and Asthma Proceedings:
https://www.readbyqxmd.com/read/28552544/lung-manifestations-in-the-rheumatic-diseases
#16
REVIEW
Tracy J Doyle, Paul F Dellaripa
Lung ailments in rheumatic diseases present unique challenges for diagnosis and management and are a source of significant morbidity and mortality for patients. Unlike the idiopathic interstitial pneumonias, patients with rheumatic diseases experience lung disease in the context of a systemic disease that may make it more difficult to recognize and that may present greater risks with treatment. Despite recent advances in our awareness of these diseases, there is still a significant lack of understanding of natural history to elucidate which patients will have disease that is progressive and thus warrants treatment...
May 25, 2017: Chest
https://www.readbyqxmd.com/read/28362938/the-use-of-noncarbapenem-%C3%AE-lactams-for-the-treatment-of-extended-spectrum-%C3%AE-lactamase-infections
#17
Pranita D Tamma, Jesus Rodriguez-Bano
The continued rise in infections caused by extended-spectrum β-lactamase (ESBL)-producing pathogens is recognized globally as one of the most pressing concerns facing the healthcare community. Carbapenems are widely regarded as the antibiotics of choice for the treatment of ESBL-producing infections, even when in vitro activity to other β-lactams has been demonstrated. However, indiscriminant carbapenem use is not without consequence, and carbapenem overuse has contributed to the emergence of carbapenem-resistant Enterobacteriaceae...
April 1, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28369295/cranial-imaging-before-lumbar-puncture-in-adults-with-community-acquired-meningitis-clinical-utility-and-adherence-to-the-infectious-diseases-society-of-america-guidelines
#18
Lucrecia Salazar, Rodrigo Hasbun
Background.: The Infectious Diseases Society of America (IDSA) guidelines delineate criteria for the use of computed tomography (CT) scan of the head before lumbar puncture (LP) in adults with community-acquired meningitis (CAM). There are limited data to document adherence to these guidelines and assess the clinical utility of brain imaging. Methods.: This was a retrospective analysis from January 2005 to January 2010 in Houston, Texas. Results...
June 15, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28369361/long-term-outcome-of-pulmonary-resection-for-nontuberculous-mycobacterial-pulmonary-disease
#19
Takanori Asakura, Nobutaka Hayakawa, Naoki Hasegawa, Ho Namkoong, Ken Takeuchi, Shoji Suzuki, Makoto Ishii, Tomoko Bestuyaku, Yoshiaki Abe, Motofumi Ouchi
BACKGROUND: Pulmonary resection along with multiple antimicrobial therapy has produced favorable outcomes at a few centers. However, little is known regarding the risk factors for long-term survival and microbiological recurrence after pulmonary resection for nontuberculous mycobacterial pulmonary disease (NTMPD). We evaluated the long-term outcomes of pulmonary resection, including microbiological recurrence and survival. METHODS: This retrospective cohort study included 125 patients (median age, 60 years) with NTMPD treated by pulmonary resection at two referral centers between January 1994 and August 2015...
March 25, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28379314/comparative-effectiveness-of-cefazolin-versus-nafcillin-or-oxacillin-for-treatment-of-methicillin-susceptible-staphylococcus-aureus-infections-complicated-by-bacteremia-a-nationwide-cohort-study
#20
Jennifer S McDanel, Mary-Claire Roghmann, Eli N Perencevich, Michael E Ohl, Michihiko Goto, Daniel J Livorsi, Makoto Jones, Justin P Albertson, Rajeshwari Nair, Amy M J O'Shea, Marin L Schweizer
Background: To treat patients with methicillin-susceptible S. aureus (MSSA) infections, beta-lactams are recommended for definitive therapy; however the comparative effectiveness of individual beta-lactams is unknown. This study compared definitive therapy with cefazolin versus nafcillin or oxacillin among patients with MSSA infections complicated by bacteremia. Methods: This retrospective study included patients admitted to 119 Veterans Administration hospitals from 2003 to 2010...
March 31, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
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