The Lithium Toxic Patient in the Medical Hospital: Diagnostic and Management Dilemmas

1993 ◽  
Vol 23 (1) ◽  
pp. 55-62 ◽  
Author(s):  
Dilip Ramchandani ◽  
Barbara A. Schindler
Keyword(s):  
Risk Factors ◽  
General Hospital ◽  
Clinical Picture ◽  
Hospital Setting ◽  
Signs And Symptoms ◽  
Lithium Toxicity ◽  
Psychiatric Consultation ◽  
Diagnostic Skills ◽  
Increased Risk ◽  
Toxic Reactions

Objective: Patients with lithium toxicity can pose difficulties in diagnosis and management in the general hospital setting. The authors examined patients who were referred to the Psychiatric Consultation-Liaison Service with suspicion of lithium overdose to delineate and characterize medical and psychiatric risk factors for toxicity and to follow the course and resolution of their toxicity. Method: The authors reviewed the charts of patients with lithium levels >1.5 mEq/L who were admitted consecutively to a general hospital over an 18-month period. Results: Of twelve patients, eight were found to have developed lithium toxicity due to incidental and iatrogenic factors. These patients presented with a variety of confusing signs and symptoms. Hypothyroidism and coexisting organic illness contributed to the lack of clarity in their clinical picture. Conclusion: The widening scope of indication for lithium therapy leads to increased risk of toxic reactions which challenge the diagnostic skills of the consulting psychiatrist in a general hospital setting.

Fatigue: Has It Affected Your Compassion?

2017 ◽  
Vol 36 (5) ◽  
pp. 289-293
Author(s):  
Bobbi S. Greiner ◽  
Gail A. Poskey
Keyword(s):  
Risk Factors ◽  
Compassion Fatigue ◽  
Work Productivity ◽  
Signs And Symptoms ◽  
Poor Quality ◽  
Job Dissatisfaction ◽  
Job Turnover ◽  
Additional Stress ◽  
Increased Risk

AbstractCompassion fatigue is a concept used to describe how various stressors affect individuals who work in health care and other caregiving professions. The results of compassion fatigue may include decreased work productivity, poor quality of care, safety concerns, job dissatisfaction, and job turnover. The NICU professionals are at an increased risk for experiencing compassion fatigue because of the nature of working with critically ill infants, their families, and the additional stress of the workplace. The purpose of this article is for the NICU professional to understand compassion fatigue, identify the risk factors, recognize the signs and symptoms, and offer strategies to implement within the NICU environment.

scholarly journals Predictive Factors for Positive HIV Test Results in a Hospital Setting

2021 ◽  
Vol 16 (3) ◽  
Author(s):  
Sulmaz Ghahramani ◽  
Hassan Joulaei ◽  
Amir Human Hoveidaei ◽  
Mohammad Reza Rajabi ◽  
Kamran Bagheri Lankarani
Keyword(s):  
Risk Factors ◽  
Hospital Admission ◽  
Hiv Testing ◽  
General Hospital ◽  
Hospital Setting ◽  
Hiv Positive ◽  
Control Group ◽  
Test Results ◽  
Hiv Test ◽  
Test Result

Background: Hospital admission for any reason provides the situation for voluntary HIV testing and consultation. Identifying the predictors of positivity may lead to a cost-effective method while enhancing professionalism. Objectives: To find the predictors of HIV-positive test result in a general hospital in Shiraz compared to a control group. Methods: In this case-control study, the records of all patients who received HIV testing upon their hospitalization in a general hospital in Shiraz, south of Iran, from January 2017 to the end of December 2017 were reviewed. For each HIV-positive case, at least one control from the same ward in the hospital with negative HIV test result was randomly selected. Based on the best-fitted model of logistic regression, the probability of positive HIV test results was estimated for each participant according to the risk factors, and a receiver operating characteristic (ROC) curve was drawn. Results: Out of 7333 persons who accepted to be tested, 77 patients tested positive for HIV, of whom 55 (71.4%) were male with the mean age of 41.5 ± 9.5 years. None of the HIV-positive patients were intravenous drug users, nor had they a history of imprisonment. The odds ratio (OR) was 21 for hepatitis-positive patients (hepatitis B and/or C) compared to negative ones, which was seven times higher in opium addicts than non-opium addicts. We developed a model using age, sex, opium addiction, and HBV and HCV status to predict the probability of being positive for HIV with an AUC of 0.853 (95% confidence interval 0.797 to 0.909). Conclusions: Hospital admission could be an appropriate momentum for providing voluntary counseling and testing. Infection with HBV and HCV are important risk factors for HIV infection, and additional testing should be offered, especially to these patients.

scholarly journals Ischemic Stroke in Infants and Children: Practical Management in Emergency

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Sara Ciccone ◽  
Michela Cappella ◽  
Caterina Borgna-Pignatti
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Rare Disease ◽  
Clinical Picture ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Signs And Symptoms ◽  
The Subject ◽  
Underlying Diseases ◽  
In Infants And Children

Stroke is a rare disease in children, with an estimated incidence 13/100000 and a significant impact on morbidity and mortality. Clinical presentation and risk factors, present in almost half of pediatric patients, are not the same as in adults. The diagnosis of stroke in children is often delayed because signs and symptoms can be subtle and nonspecific. History and clinical examination should exclude underlying diseases or predisposing factors. Neuroimaging is crucial in defining diagnosis. Other tests might be necessary, according to the clinical picture. We present here the most recent practical directions on how to diagnose and manage arterial stroke in children, according to different international guidelines on the subject.

scholarly journals Prevalence of aminoglycoside therapy and other determinant factors that induce hearing loss in neonates

2020 ◽  
Vol 6 (8) ◽  
pp. 1425
Author(s):  
Nassor R. Hamad ◽  
Retnosari Andrajati ◽  
Rina Mutiara ◽  
Risma Kerina Kaban ◽  
Rajesh Kumar Das
Keyword(s):  
Risk Factors ◽  
Hearing Loss ◽  
General Hospital ◽  
Gestational Age ◽  
Early Stage ◽  
Craniofacial Anomalies ◽  
Neonatal Hearing Screening ◽  
Aminoglycoside Therapy ◽  
Increased Risk ◽  
Gestational Age At Birth

<p class="abstract"><strong>Background:</strong> Hearing loss is the most common disorder in neonates; it can be best managed if it is diagnosed at early stage of life. The global prevalence of permanent neonatal hearing loss mainly occurs in developing countries, which accounts 0.5 to 5.0 per 1000 live births. The objective of this study was to determine the prevalence of aminoglycoside therapy and other risk factors that induce hearing loss in neonates admitted at NICU at Cipto-Mangunkusumo General Hospital (CMGH).</p><p class="abstract"><strong>Methods:</strong> This was a case-control study conducted among 112 neonates at Cipto-Mangunkusumo General Hospital (CMGH). Data from neonatal hearing screening were retrospectively collected from hospital electronic medical records and medical files. Only patients treated at neonatal unit from November 2018 to October 2019 were recruited.  </p><p class="abstract"><strong>Results:</strong> Out of 112 neonates studied, the gestational age at birth (GA) and craniofacial anomalies were considered risk factors for hearing loss since they were statistically significant (p&lt;0.05). The study showed no statistical significant association in gender, birth weight, mechanical ventilation, NICU stay period (&gt;5 days), hyperbilirubinemia (&gt;20 mg/dl), asphyxia, and aminoglycoside therapy (p&gt;0.05).</p><p class="abstract"><strong>Conclusions:</strong> The prevalence of hearing loss in neonates with lower gestational age less than 37 weeks and craniofacial anomalies are significant higher compare to neonates born full term. They are more associated with 3 and 6 times increased risk of hearing loss in neonates.</p>

Benzodiazepine and Z-drug Prescribing for Elderly People in a General Hospital: A Complete Audit Cycle

2012 ◽  
Vol 29 (2) ◽  
pp. 128-131
Author(s):  
Catherine Dolan ◽  
Sami Omer ◽  
Deirdre Glynn ◽  
Michelle Corcoran ◽  
Geraldine McCarthy
Keyword(s):  
General Hospital ◽  
Adult Population ◽  
Hospital Setting ◽  
Adverse Outcomes ◽  
Drug Prescribing ◽  
Consensus Guidelines ◽  
Number Of Patients ◽  
Increased Risk ◽  
Prescribing Practice ◽  
Audit Cycle

AbstractBackground: Use of benzodiazepines and Z-drugs in the elderly is associated with adverse outcomes such as increased risk of falls and fractures and cognitive impairment. We aimed to assess the prescribing practice of benzodiazepine and Z-drugs in those aged over 65 years in a general hospital against evidence based standards and to examine the effects of multidisciplinary feedback, as well as determine the prevalence of usage.Methods: All case-notes and medication charts of patients over the age of sixty five on surgical and medical wards in Sligo General Hospital (SGH) were retrieved and analysed over a two-day period in 2008. Data was collected in relation to benzodiazepine and Z-drug prescribing. We followed up on this initial data collection by screening discharge summaries at six weeks to assess benzodiazepine and Z-drug prescribing on discharge. Audit results were disseminated together with consensus guidelines on the prescribing of these medications in older adult population to all general practitioners in County Sligo. Educational sessions were held for both doctors and nurses in SGH. The audit cycle was completed by a re-audit of benzodiazepine and Z-drug prescribing six months from original study using identical methods.Results: We found a high prevalence of benzodiazepine and Z-drug use in original audit, 54% (38/70) of the group audited. The prevalence fell to 46% (32/70) at the re-audit post intervention. This result was not statistically significant. The percentage of patients commenced on benzodiazepine and Z-drugs prior to admission fell from 36% (25/70) at the initial audit to 23% (16/70) at the re-audit.Conclusion: Prescribing practices were not in keeping with consensus guidelines as highlighted by this relatively basic audit cycle. Multidisciplinary feedback and letters to GPs resulted in some reduction in the number of patients prescribed benzodiazepines and Z-drugs. Ongoing educational strategies aimed at relevant health care workers with regular audit of medication use within the general hospital setting is pertinent to further improve prescribing practice.

Foot Pathology and Inappropriate Footwear as Risk Factors for Falls in a Subacute Aged-Care Hospital

2007 ◽  
Vol 97 (3) ◽  
pp. 213-217 ◽  
Author(s):  
Rebecca L. Jessup
Keyword(s):  
Risk Factors ◽  
Hospital Setting ◽  
Clinical Problem ◽  
Aged Care ◽  
Care Hospital ◽  
Increased Risk ◽  
Risk Of Falls ◽  
History Of ◽  
Risk Factors For Falls ◽  
Hospital Wards

Background: Falls are a major clinical problem in the hospital setting. This study examined the prevalence of foot pathology and footwear type likely to increase the risk of falls in two subacute-care hospital wards serving elderly patients. Methods: Two wards of a subacute aged-care hospital were selected for study. Patients were assessed for the presence of foot pathology, and their footwear was evaluated for characteristics identified in the literature as placing individuals at increased risk of falls. Results: Of 44 patients assessed, 98% had foot pathology, and 41% had foot pathology requiring podiatric medical management. Eighty-six percent of inpatients wore footwear that was likely to increase their risk of falls, with 66% wearing slippers or moccasins. Conclusions: The results of this study demonstrate the need for hospital inpatients who are identified as being at high risk for falling, or have a history of falls, to undergo an assessment of their foot pathology and footwear so that appropriate measures can be taken to address these risk factors. (J Am Podiatr Med Assoc 97(3): 213–217, 2007)

The Nurse as a Psychiatric Consultation Team Member

1971 ◽  
Vol 2 (2) ◽  
pp. 108-115 ◽  
Author(s):  
David Barton ◽  
Margaret T. Kelso
Keyword(s):  
General Hospital ◽  
Hospital Setting ◽  
Psychological Adaptation ◽  
Psychological Aspects ◽  
Self Awareness ◽  
Psychiatric Consultation ◽  
Consultation Process ◽  
Therapeutic Milieu ◽  
Care Givers ◽  
Consultation Team

A better understanding of the psychological aspects of illness and hospitalization necessitates increased attention to the patient's interpersonal transactions with care-givers in the general hospital setting. Ward nurses are key individuals in these transactions; they can play an important part in facilitating the patient's psychological adaptation in response to the stress of illness. To bring the nurse-patient relationship into the scope of the consultation process, the University of Virginia psychiatric consultation team includes a nurse as a member. As a participant observer in the general hospital milieu, the “consultation team nurse” is able to aid ward nurses in facilitating patients' psychological adaptations through reinforcing the therapeutic relationships and intervening in situations where antitherapeutic emotional responses to patients have developed. Her activities also include the gathering of information from ward nurses for diagnostic purposes, the giving of direct psychiatric care where appropriate, and the provision of perspective for the team from the viewpoint of the nurse. Her presence and activities encourage closer scrutiny of nurse-patient transactions, allowing insights into patients' interpersonal responses at times of stress, providing a self-awareness for care-givers, and enabling the consultation team to investigate and better understand the psychological aspects of nursing care. This approach serves to aid in the development of a psychologically therapeutic milieu in the general hospital.

scholarly journals Knowledge, Awareness and Practices of Saudi Females about Osteoporosis

2021 ◽  
pp. 75-87
Author(s):  
Bushra Dhuhayyan Alhazmi ◽  
Mohammed Kanan Alshammari
Keyword(s):  
Risk Factors ◽  
Bone Fractures ◽  
Bone Microarchitecture ◽  
Signs And Symptoms ◽  
Arabic Language ◽  
University Education ◽  
Age Group ◽  
Cross Sectional ◽  
Sufficient Knowledge ◽  
Increased Risk

Introduction: Osteoporosis is a common skeletal disease that is characterized by reduction of bone mass and loss of bone microarchitecture leading to increased risk of bone fractures. Objective: To assess knowledge, awareness and practices of Saudi females about osteoporosis. Methodology: Cross-sectional study for 3 months (November, December 2019 and January 2020) on random sample of 537 Saudi females, the data was collected by using a questionnaire in Arabic language, data were analyzed by means of Descriptive statistics. Results: Among the participants, there were 43% in the age group of (18-25 years) and 19% in the age group of (26-35 years), 41% completed university education. The main source of information about osteoporosis was friends and relatives (33%). Mean score of participant’s sufficient knowledge about risk factors of osteoporosis was 52%, mean score of participant’s sufficient knowledge about prevention and treatment of osteoporosis was 67%, mean score of participant’s sufficient knowledge about signs & symptoms of osteoporosis was 43%, mean score of participant’s sufficient knowledge about diagnosis of osteoporosis was 17% and the overall mean score of sufficient knowledge about osteoporosis was 45%. About 55% of study participants previously got vitamin D screening, 46% previously got calcium screening in blood, 8% previously got screened with DXA. Conclusion: The results of the present study indicate that the knowledge and awareness about osteoporosis among Saudi females are poor. The participants lacked knowledge relating to risk factors, signs and symptoms, diagnosis and prevention of osteoporosis and the practice regarding the prevention and detection of osteoporosis is poor.

scholarly journals Determinant of Hypertension, Obesity and Smoking on Stroke Events in Hospital Patients at Regional General Hospital of Rokan Hulu Riau District, 2018 (Epidemiology and Public Health)

2020 ◽  
Vol 2 (1) ◽  
pp. 384-389
Author(s):  
Armaliza Permata Sari ◽  
Rahayu Lubis ◽  
Zulfendri
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
General Hospital ◽  
Communicable Disease ◽  
Hospitalized Patients ◽  
Bivariate Analysis ◽  
P Value ◽  
A Value ◽  
Increased Risk ◽  
Regression Tests

Stroke is one of the most dominant non-communicable disease complications that can cause death and disability, the number of sufferers continues to increase. The number one cause of death stroke in Indonesia with a proportion of 15.4%. Many factors can cause a stroke, namely factors that can be modified and factors that cannot be modified. This study aims to determine the determinants of hypertension, obesity, smoking of the incidence of stroke in hospitalized patients at the Regional General Hospital of Rokan Hulu Regency, Riau. This type of research is an observational analytic study with a case-control study design with a total sample of 100 people (50 cases and 50 controls) with a ratio of 1: 1. Sampling was done by purposive sampling and using a questionnaire. The independent variables are hypertension, obesity, and smoking. Hypertension using a sphygmomanometer, Obesity using Body Mass Index (BMI) and smoking using a questionnaire. Data analysis was performed by bivariate analysis using simple logistic regression tests and multivariate analysis using multiple logistic regression tests. The results of bivariate analysis with risk factors for stroke events, the most dominant risk factors were hypertension with a value of p = 0.001 and (OR = 5.441, 95% Cl = 2,210-13,397), Obesity with a value of p = 0.026 and (OR = 1,712, 95% Cl = 0,690-4,244), and smoking with p value = 0,037 and (OR = 1,822, 95% Cl = 0,717-4,632). Hypertension is the most dominant risk factor for the incidence of stroke in hospitalized patients in Rokan Hulu District Hospital, while the increased risk of stroke with obesity and smoking is not statistically significant in this study.

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