Psychiatric Treatment Strategies for Patients at Risk of Dying Suddenly

Contrast-induced nephropathy is an iatrogenic disease caused by the administration of iodinated contrast material to certain at-risk patients. The clinical features include renal failure, with oliguria, anuria, and electrolyte derangements. Contrast-induced nephropathy can prolong hospitalization, result in greater morbidity and mortality, and increase patients’ costs. A variety of preventive and treatment strategies exist, including use of alternative imaging. Critical care nurses need to understand the nephropathy and the patients at risk and to develop a familiarity with prevention, treatment, and outcome.

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Changes in depression in a cohort of Danish HIV-positive individuals: time for routine screening

Sexual Health ◽

10.1071/sh10067 ◽

2011 ◽

Vol 8 (2) ◽

pp. 214 ◽

Cited By ~ 6

Author(s):

Lotte Rodkjaer ◽

Tinne Laursen ◽

Nils B. Christensen ◽

Kirsten Lomborg ◽

Lars Ostergaard ◽

...

Keyword(s):

At Risk ◽

Major Depression ◽

Psychiatric Treatment ◽

Routine Screening ◽

Hiv Positive ◽

Unsafe Sex ◽

Patients At Risk ◽

Emotional Strain ◽

Living With Hiv ◽

Not At Risk

Background: The aim of this study was to follow a cohort of HIV-positive individuals for 3 years in order to assess changes in depression, adherence, unsafe sex and emotional strains from living with HIV. Methods: Participants were assessed for depression, adherence, emotional strain and unsafe sex via a questionnaire. The Beck Depression Inventory II (BDI) was used to assess the prevalence and severity of depressive symptoms. Patients with a BDI score of 20 or above (moderate to major depression) were offered a clinical evaluation by a consultant psychiatrist. Results: In 2005, 205 HIV-positive individuals participated in the study. Symptoms of depression (BDI >14) were observed in 77 (38%) and major depression (BDI ≥20) in 53 (26%) individuals. In 2008, 148 participants were retested (72% of original sample). Depression (BDI >14) was observed in 38 (26%) and symptoms of major depression (BDI ≥20) in 24 (16%) individuals. Patients at risk of moderate to major depression were more likely to be non-adherent to medications, to practice unsafe sex and to suffer from emotional strains compared with patients not at risk of depression, both at baseline (2005) and follow-up (2008). Conclusion: This study demonstrated a decline in depression scores over time and an association between the risk of depression and low medication adherence, stress and unsafe sex. We recommend routine screening for depression to be conducted regularly to provide full evaluations and relevant psychiatric treatment.

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Lessons from an Educational Invasive Fungal Disease Conference on Hospital Antifungal Stewardship Practices across the UK and Ireland

Journal of Fungi ◽

10.3390/jof7100801 ◽

2021 ◽

Vol 7 (10) ◽

pp. 801

Author(s):

Alida Fe Talento ◽

Malcolm Qualie ◽

Laura Cottom ◽

Matthijs Backx ◽

P. Lewis White

Keyword(s):

At Risk ◽

Treatment Strategies ◽

Invasive Fungal Disease ◽

Fungal Disease ◽

Diagnostic Tools ◽

Optimal Time ◽

Rapid Diagnostics ◽

Antifungal Stewardship ◽

Patients At Risk ◽

The Uk

Invasive fungal disease (IFD) is a growing health burden. High mortality rates, increasing numbers of at-risk hosts, and a limited availability of rapid diagnostics and therapeutic options mean that patients are increasingly exposed to unnecessary antifungals. High rates of prescriptions promote patient exposure to undue toxicity and drive the emergence of resistance. Antifungal stewardship (AFS) aims to guide antifungal usage and reduce unnecessary exposure and antifungal consumption whilst maintaining or improving outcomes. Here, we examine several AFS approaches from hospitals across the UK and Ireland to demonstrate the benefits of AFS practices and support the broader implementation of AFS as both a necessary and achievable strategy. Since the accuracy and turnaround times (TATs) of diagnostic tools can impact treatment decisions, several AFS strategies have included the development and implementation of diagnostic-driven care pathways. AFS informed treatment strategies can help stratify patients on a risk basis ensuring the right patients receive antifungals at the optimal time. Using a multidisciplinary approach is also key due to the complexity of managing and treating patients at risk of IFD. Through knowledge sharing, such as The Gilead Antifungal Information Network (GAIN), we hope to drive practices that improve patient management and support the preservation of antifungals for future use.

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