scholarly journals Cryptogenic cervical intramedullary abscess with rapidly progressive myelopathy: illustrative case

2021 ◽  
Vol 1 (4) ◽  
Author(s):  
Nebras M. Warsi ◽  
Ann Wilson ◽  
Armaan K. Malhotra ◽  
Jerry C. Ku ◽  
Ahmed A. Najjar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Decision Making ◽  
Demyelinating Disease ◽  
Clinical Decision ◽  
Illustrative Case ◽  
Dermal Sinus ◽  
Progressive Myelopathy ◽  
Intramedullary Abscess ◽  
Infectious Risk ◽  
First Case

BACKGROUNDThe purpose of the present case report is to highlight the presentation, workup, clinical decision making, and operative intervention for a 68-year-old woman who developed rapidly progressive myelopathy secondary to idiopathic cervical intramedullary abscess.OBSERVATIONSThe patient underwent laminectomy and aspiration/biopsy of the lesion. Intraoperatively, division of the posterior median sulcus released a large volume of purulent material growing the oral pathogens Eikenella corrodens and Gemella morbillorum. Broad-spectrum antibiotics were initiated postoperatively. At the 6-month follow-up, the patient had almost completely recovered with some persistent hand dysesthesia. Complete infectious workup, including full dental assessment and an echocardiogram, failed to reveal the source of her infection.LESSONSThe authors report the first case of cryptogenic spinal intramedullary abscess secondary to Eikenella spp. and Gemella spp. coinfection. Intramedullary abscesses are exceptionally rare and most commonly develop in children with dermal sinus malformations or in the context of immunosuppression. In adults without risk factors, they can readily be mistaken for more common pathologies in this age group, such as intramedullary neoplasms or demyelinating disease. Prompt diagnosis and management based on rapidly progressive myelopathy, assessment of infectious risk factors and/or symptoms, and targeted imaging are critical to avoid potentially devastating neurological sequelae.

A Woman With Headaches and a Tumefactive Brain Lesion

2021 ◽  
pp. 202-203
Author(s):  
Andrew McKeon
Keyword(s):  
Corpus Callosum ◽  
Clinical Decision Making ◽  
Demyelinating Disease ◽  
Brain Lesion ◽  
Brain Magnetic Resonance Imaging ◽  
Corticosteroid Treatment ◽  
Mass Effect ◽  
Clinical Decision ◽  
Contrast Imaging ◽  
Language Deficit

A 65-year-old woman sought care for a 6-month history of confusion and emotional disturbance that was initially ascribed to stress. She then had development of headaches over several weeks, which prompted brain magnetic resonance imaging with contrast. Imaging showed a mass emanating bilaterally from the splenium of the corpus callosum with heterogeneous T1 postgadolinium enhancement. Neurologic examination indicated left homonymous hemianopia, but she was otherwise normal. She had neither alexia nor other language deficit that may appear with a splenial corpus callosum lesion. A biopsy of the brain mass was performed. Histologic analysis of the biopsy specimen revealed glioblastoma multiforme. Corticosteroid treatment was prescribed, which relieved her headache. Radiation therapy and chemotherapy (temozolomide) were recommended. No further follow-up information was available. In neurologic clinical practice, a large corpus callosum–based lesion is sometimes encountered. The localization of such lesions is not specific for any one diagnosis, but radiologic characteristics can aid clinical decision making. Although the radiologic appearance of a lesion spreading out into both hemispheres from the corpus callosum can indicate butterfly glioma, the differential diagnosis also includes tumefactive demyelinating disease and lymphoma, which can also have a callosal localization and produce mass effect.

Reversibility of Delirium in Palliative Care (DRAFT)

2018 ◽  
Author(s):  
Tiffany Shaw ◽  
Eric Prommer
Keyword(s):  
Risk Factors ◽  
Decision Making ◽  
Palliative Care ◽  
Clinical Case ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Factors Associated ◽  
Frequent Event ◽  
Study Intervention

Delirium is a frequent event in patients with advanced cancer. Untreated delirium affects assessment of symptoms, impairs communication including participation in clinical decision-making. This study used specific diagnostic criteria for delirium and prospectively identified precipitating causes of delirium. The study identified factors associated with reversible and irreversible delirium. Impact of delirium on prognosis was evaluated. This chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case. Topics covered include delirium, neoplasms, palliative care, polypharmacy, risk factors, and therapeutics.

scholarly journals Profile of hippocampal volumes and stroke risk varies by neuropsychological definition of mild cognitive impairment

2009 ◽  
Vol 15 (6) ◽  
pp. 890-897 ◽  
Author(s):  
AMY J. JAK ◽  
STEPHANIE URBAN ◽  
ASHLEY McCAULEY ◽  
KATHERINE J. BANGEN ◽  
LISA DELANO-WOOD ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Stroke Risk ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Community Dwelling ◽  
Cognitive Domain ◽  
Diagnostic Approaches ◽  
Definition Of

AbstractWide-ranging conceptual and diagnostic approaches to defining mild cognitive impairment (MCI) have led to highly variable prevalence and progression rates. We sought to examine whether bilateral hippocampal volumes and cerebrovascular risk factors in individuals characterized by two different neuropsychological definitions of MCI subtypes would also differ. Participants were 65 nondemented, community-dwelling, older adults, ages 62–91 years, drawn from a larger group of individuals enrolled in a longitudinal study of normal aging. A comprehensive neuropsychological definition of MCI that required the presence of more than one impaired score in a cognitive domain resulted in expected anatomical results; hippocampal volumes were significantly smaller in the aMCI group as compared to cognitively normal or nonamnestic MCI participants. However, a typical definitional scheme for classifying MCI based only on the presence of one impaired score within a cognitive domain did not result in hippocampal differences between groups. Global stroke risk factors did not differ between the two definitional schemes, although the relationship between stroke risk variables and neuropsychological performance did vary by diagnostic approach. The comprehensive approach demonstrated associations between stroke risk and cognition, whereas the typical approach did not. Use of more sophisticated clinical decision-making and diagnostic approaches that incorporate comprehensive neuropsychological assessment techniques is supported by this convergence of neuropsychological, neuropathological, and stroke risk findings. (JINS, 2009, 15, 890–897.)

The Elderly Psychiatric Patient with Positive Syphilis Serology: The Problem of Neurosyphilis

1998 ◽  
Vol 28 (3) ◽  
pp. 333-339 ◽  
Author(s):  
Ishwer L. Bharwani ◽  
Charles O. Hershey
Keyword(s):  
Elderly Patients ◽  
Clinical Decision Making ◽  
Relevant Literature ◽  
Clinical Decision ◽  
The Elderly ◽  
Illustrative Case ◽  
Positive Serology ◽  
Important Indicator ◽  
Syphilis Serology ◽  
Latent Syphilis

Objective: Older patients have a high prevalence of neurological and psychiatric disorders. They also have a baseline prevalence of late latent syphilis or positive syphilis serology. Thus the clinical question arises as to whether a neuropsychiatric disorder in a geriatric patient is neurosyphilis or if the positive serology is incidental. Method: An illustrative case example is used to illustrate this dilemma. The relevant literature is reviewed. Results: The cerebrospinal fluid (CSF) protein is an important indicator of inflammatory activity in the central nervous system and is used as a clinical guide in the diagnosis. Elderly patients have higher values of normal CSF protein than younger patients. Conclusions: Given the importance of CSF protein in the diagnosis of neurosyphilis, physicians must include this knowledge, that elderly patients have higher CSF protein values, in their clinical decision making in the differentiation between neurosyphilis and late latent syphilis in the elderly patient.

scholarly journals Assessment of violence risk in 440 psychiatric patients in China: examining the feasibility and acceptability of a novel and scalable approach (FoVOx)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shaoling Zhong ◽  
◽  
Rongqin Yu ◽  
Robert Cornish ◽  
Xiaoping Wang ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Risk Assessment ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Psychiatric Patients ◽  
Clinical Decision ◽  
Violence Risk ◽  
Violence Risk Assessment ◽  
Risk Categories

Abstract Background Violence risk assessment is a routine part of clinical services in mental health, and in particular secure psychiatric hospitals. The use of prediction models and risk tools can assist clinical decision-making on risk management, including decisions about further assessments, referral, hospitalization and treatment. In recent years, scalable evidence-based tools, such as Forensic Psychiatry and Violent Oxford (FoVOx), have been developed and validated for patients with mental illness. However, their acceptability and utility in clinical settings is not known. Therefore, we conducted a clinical impact study in multiple institutions that provided specialist mental health service. Methods We followed a two-step mixed-methods design. In phase one, we examined baseline risk factors on 330 psychiatric patients from seven forensic psychiatric institutes in China. In phase two, we conducted semi-structured interviews with 11 clinicians regarding violence risk assessment from ten mental health centres. We compared the FoVOx score on each admission (n = 110) to unstructured clinical risk assessment and used a thematic analysis to assess clinician views on the accuracy and utility of this tool. Results The median estimated probability of violent reoffending (FoVOx score) within 1 year was 7% (range 1–40%). There was fair agreement (72/99, 73% agreement) on the risk categories between FoVOx and clinicians’ assessment on risk categories, and moderate agreement (10/12, 83% agreement) when examining low and high risk categories. In a majority of cases (56/101, 55%), clinicians thought the FoVOx score was an accurate representation of the violent risk of an individual patient. Clinicians suggested some additional clinical, social and criminal risk factors should be considered during any comprehensive assessment. In addition, FoVOx was considered to be helpful in assisting clinical decision-making and individual risk assessment. Ten out of 11 clinicians reported that FoVOx was easy to use, eight out of 11 was practical, and all clinicians would consider using it in the future. Conclusions Clinicians found that violence risk assessment could be improved by using a simple, scalable tool, and that FoVOx was feasible and practical to use.

scholarly journals Diagnósticos de enfermagem de pacientes em tratamento radioterápico

2018 ◽  
Vol 12 (11) ◽  
pp. 3060
Author(s):  
Camila Marcon ◽  
Gabriela Vicari ◽  
Patricia Poltroni ◽  
Aline Maffissoni ◽  
Kauana Dall' Agnese Caregnatto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Radiation Therapy ◽  
Skin Color ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Related Factors ◽  
Cross Sectional ◽  
Color Changes ◽  
Factores De Riesgo ◽  
Nursing Diagnoses

RESUMOObjetivo: identificar a incidência dos diagnósticos de enfermagem, bem como características definidoras, fatores relacionados e fatores de risco, com base na taxonomia NANDA-I de pacientes em tratamento radioterápico. Método: trata-se de estudo quantitativo, transversal, exploratório-descritivo, realizado com 60 pacientes em um ambulatório. Resultados: identificou-se 23 Diagnósticos de Enfermagem, sendo os mais incidentes: risco de integridade da pele prejudicada (35%), mobilidade física prejudicada (15%) e eliminação urinária prejudicada (7%). As características definidoras evidenciadas foram amplitude limitada de movimentos (15,3%), incontinência e dificuldade para deglutir (7,2%). Dentre os fatores relacionados, estão dor (18,3%), desconforto (10,7%) e radiação (6%) e os fatores de risco radiação (56%), mudanças na pigmentação da pele/mudanças no turgor da pele (26,3%) e estado nutricional desequilibrado (6,3%). Conclusão: os resultados do estudo contribuem para atender às necessidades de saúde dos pacientes em tratamento radioterápico e na tomada de decisão clínica pelo enfermeiro. Descritores: Enfermagem; Oncologia; Radioterapia; Processos de Enfermagem; Diagnóstico de Enfermagem; Pesquisa em Enfermagem.ABSTRACT Objective: to identify the incidence of nursing diagnoses, as well as defining characteristics, related factors and risk factors, based on the NANDA-I taxonomy of patients undergoing radiation therapy. Method: quantitative, cross-sectional, exploratory and descriptive study, performed with 60 patients in an outpatient clinic. Results: 23 Nursing Diagnoses were identified, of which the most prevalent were risk for impaired skin integrity (35%), impaired physical mobility (15%) and impaired urinary elimination (7%). The defining characteristics were limited transfer ability (15.3%), incontinence and impaired swallowing (7.2%). The related factors were pain (18.3%), discomfort (10.7%) and radiation (6%), and the risk factors are radiation (56%), skin color changes/alteration in skin turgor (26.3%) and imbalanced nutritional state (6.3%). Conclusion: The results of the present may study contribute to meet the health needs of patients undergoing radiation therapy and clinical decision making by the nurse. Descriptors: Nursing; Oncology; Radiotherapy; Nursing Process; Nursing Diagnosis; Nursing Research.RESUMEN Objetivo: identificar la incidencia de los diagnósticos de enfermería, así como características definidoras, factores relacionados y factores de riesgo, con base en la taxonomía NANDA-I de pacientes en tratamiento radioterápico. Método: estudio cuantitativo, transversal, exploratorio-descriptivo, realizado con 60 pacientes en un ambulatorio. Resultados: se identificaron 23 Diagnósticos de Enfermería, siendo los más incidentes: riesgo de integridad de la piel perjudicada (35%), movilidad física perjudicada (15%) y eliminación urinaria perjudicada (7%). Las características definidoras evidenciadas fueron amplitud limitada de movimientos (15,3%), incontinencia y dificultad para deglutir (7,2%). Dentro de los factores relacionados, están el dolor (18,3%), el malestar (10,7%) y la radiación (6%) y los factores de riesgo radiación (56%), cambios en la pigmentación de la piel/cambios en la turgencia de la piel (26,3%) y estado nutricional desequilibrado (6,3%). Conclusión: los resultados del estudio contribuyen para atender a las necesidades de salud de los pacientes en tratamiento radioterápico y en la tomada de decisión clínica por el enfermero. Descriptores: Enfermería; Oncología Médica; Radioterapia; Proceso de Enfermería; Diagnóstico de Enfermería; Investigación en Enfermería.

Abstract 155: Prevalence of Self-Reported Risk Factors for Myocardial Infarction Among Patients With Venous Thromboembolism

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Julie Vanderpoel ◽  
Brahim Bookhart ◽  
Hillary J Gross ◽  
Marco DiBonaventura
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Venous Thromboembolism ◽  
Potential Risk ◽  
Clinical Decision Making ◽  
Smoking Status ◽  
Patient Characteristics ◽  
Clinical Decision ◽  
Family Medical History ◽  
The Mean

Objective: To identify the prevalence of risk factors that may be associated with a future myocardial infarction (MI) among patients with venous thromboembolism (VTE). Methods: This study was conducted using the 2010 wave of the National Health and Wellness Survey (NHWS). The NHWS is a self-administered, Internet-based questionnaire from a nationwide sample of adults (N=75,000). Only patients with a diagnosis of VTE, defined as a self-reported diagnosis of deep vein thrombosis (DVT), pulmonary embolism (PE), or both, were included in the analysis. Self-reported patient characteristics that may be potential risk factors for MI were collected, including sociodemographic characteristics, family medical history, and health behaviors (such as smoking status), as well as comorbidities. Included risk factors were based on a literature search. The risk factors were not weighted based on the strength of their potential association with a future MI. Thus, risk factors of varying significance were included and weighted equally. Findings: A total of 814 patients with VTE (519 with DVT, 196 with PE, and 99 with DVT and PE) were included in the analysis. Approximately 53% of the patients were female, and the mean age was 57 years. Among these patients, the mean number of reported risk factors that may be associated with a future MI was 5.6. Approximately 23% (n=189) of patients reported ≤3 risk factors, 55% (n=446) of patients had 4-7 risk factors, and 22% (n=179) of patients had ≥8 risk factors. Some of the more commonly reported risk factors included male gender (47%, n=381), obesity (53%, n=428), hypertension (53%, n=427), hyperlipidemia (49%, n=401), type 2 diabetes (21%, n=167), a family history of cardiovascular disease (81%, n=663), and currently smoking (22%, n=175). Conclusions: A high proportion of patients with VTE have risk factors for a future MI. Awareness of the prevalence of MI risk factors among patients with VTE may support optimal clinical decision-making for these patients. Providers should be cognizant of the potential risk for MI among patients with VTE when selecting treatment approaches. Additional research that considers the relative importance of each potential risk factor is needed to elucidate these findings.

Abstract P126: Risk Factors For Hypertensive Emergencies: A Systematic Review And Meta-analysis

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
Irina Benenson ◽  
Frederick Waldron
Keyword(s):  
Risk Factors ◽  
Full Text ◽  
Clinical Decision Making ◽  
Meta Analysis ◽  
Target Organ Damage ◽  
Grey Literature ◽  
Hypertensive Crisis ◽  
Kidney Injury ◽  
Clinical Decision ◽  
Hypertensive Urgency

Background: Hypertensive emergency (HTNE) is a subtype of hypertensive crisis. In contrast to hypertensive urgency (HTNU), which is a severely elevated BP without acute target organ damage (TOD), HTNE presents with the equally high BP in the presence of potentially life-threatening acute TOD such as myocardial infarction, stroke, pulmonary edema and acute kidney injury. Knowledge on risk factors of HTNE may be used in clinical decision-making to differentiate between HTNE and HTNU in patients presenting with markedly high BP. Method: A search of 4 databases (MEDLINE, Cochrane Database of Systematic Reviews, Web of Science, and CINAHL), 7 grey literature sites and relevant organizational websites revealed 11,387 titles. After duplicates were removed, 9,183 studies were screened by the title and abstract for eligibility. Forty full-text articles were retrieved, and each was assessed for eligibility. Fourteen full-text studies that included 10,376 participants were critically appraised and included in this review. The extracted data were pooled to meta-analysis, where HTNU patients (BP ≥180/110 mmHg without acute TOD) were compared to HTNE patients (BP ≥180/110 mmHg with acute TOD) based on several modifiable and non-modifiable risk factors. Results: Patients with HTNE had higher mean systolic (MD 2.413, 95% CI 0.477,4.350) and diastolic BP (MD 2.043, 95% CI 0.624,3.461) compared to patients with HTNU. HTNE were more common in men (OR 1.390, 95% CI 1.207,1.601), older patients (mean diff 5.282, 95% CI 3.229, 7.335). Diabetes (OR 1.723, 95% CI 1.485, 2.000), hyperlipidemia (OR 2.028, 95% CI 1.642, 2.505), and chronic kidney disease (OR 2.448, 95% CI 1.169, 5.124) increased the risk of HTNE. Non-adherence to antihypertensives (OR 0.939, 95% CI 0.647,1.363) and HTN diagnosis unawareness (OR 0.807, 95% CI 0.564, 1.154) did not change the odds of HTNE. Conclusion: Systolic and diastolic BP are marginally higher in patients with HTNE compared to patients with HTNU. Since these differences are small and not clinically significant, clinicians should rely on other symptoms and signs to differentiate between HTNU and HTNE. Measures to prevent and treat cardiometabolic comorbidities should be implemented in order to mitigate the risk of HTNE.

scholarly journals Comparative Sensitivity of Transthoracic and Transesophageal Echocardiography in Diagnosis of Infective Endocarditis Among Veterans With Staphylococcus aureus Bacteremia

2017 ◽  
Vol 4 (2) ◽  
Author(s):  
Poorani Sekar ◽  
James R. Johnson ◽  
Joseph R. Thurn ◽  
Dimitri M. Drekonja ◽  
Vicki A. Morrison ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Transesophageal Echocardiography ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Valve Surgery ◽  
Related Factors ◽  
Staphylococcus Aureus Bacteremia ◽  
Patient Refusal

Abstract Background Echocardiography is fundamental for diagnosing infective endocarditis (IE) in patients with Staphylococcus aureus bacteremia (SAB), but whether all such patients require transesophageal echocardiography (TEE) is controversial. Methods We identified SAB cases between February 2008 and April 2012. We compared sensitivity and specificity of transthoracic echocardiography (TTE) and TEE for evidence of IE, and we determined impacts of IE risk factors and TTE image quality on comparative sensitivities of TTE and TEE and their impact on clinical decision making. Results Of 215 evaluable SAB cases, 193 (90%) had TTE and 130 (60%) had TEE. In 119 cases with both tests, IE was diagnosed in 29 (24%), for whom endocardial involvement was evident in 25 (86%) by TEE, vs only 6 (21%) by TTE (P < .001). Transesophageal echocardiography was more sensitive than TTE regardless of risk factors. Even among the 66 cases with adequate or better quality TTE images, sensitivity was only 4 of 17 (24%) for TTE, vs 16 of 17 (94%) for TEE (P < .001). Among 130 patients with TEE, the TEE results, alone or with TTE results, influenced treatment duration in 56 (43%) cases and led to valve surgery in at least 4 (6%). It is notable that, despite vigorous efforts to obtain both tests routinely, TEE was not done in 86 cases (40%) for various reasons, including pathophysiological contraindications (14%), patient refusal or other patient-related factors (16%), and provider declination or system issues (10%). Conclusions Patients with SAB should undergo TEE when possible to detect evidence for IE, especially if the results might affect management.

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