A Social Work Approach in High-Tech Neurosurgery and Social Work Research Approaches in Health Care

2014 ◽  
pp. 212-234
Author(s):  
Colin Pritchard
Keyword(s):  
Social Work ◽  
Cost Effective ◽  
Support Service ◽  
Social Model ◽  
High Tech ◽  
Control Group ◽  
Surgical Patient ◽  
Threatening Condition ◽  
Life Threatening ◽  
Changing Patterns

Psychiatric social work is inherently inter-disciplinary with an interactive bio-psycho-social model of behaviour. This chapter mainly focuses upon an innovative study in neurosurgery. Sub-Arachnoid Haemorrhage (SAH) is a life-threatening condition and survivors are often left with serious cognitive impairment. Patients and their carers led the design of a two-year controlled prospective study of a patient and family support service, using the Specialist Neurovascular Nurse (SNVN) to speed rehabilitation and family readjustment. Cost-effective measures found the SNVN group gained significant psychosocial and fiscal benefits when compared to the control group, thus highlighting the effectiveness of a social work approach in neurosurgery. Other studies in healthcare, including surgical patient safety, effectiveness in reducing mortality, cultural influence on suicide rates and implications for prevention, and the implications of the changing patterns of neurological mortality in Western nations, are briefly described.

A Social Work Approach in High-Tech Neurosurgery and Social Work Research Approaches in Health Care

2016 ◽  
pp. 1338-1360
Author(s):  
Colin Pritchard
Keyword(s):  
Social Work ◽  
Cost Effective ◽  
Support Service ◽  
Social Model ◽  
High Tech ◽  
Control Group ◽  
Surgical Patient ◽  
Threatening Condition ◽  
Life Threatening ◽  
Changing Patterns

Psychiatric social work is inherently inter-disciplinary with an interactive bio-psycho-social model of behaviour. This chapter mainly focuses upon an innovative study in neurosurgery. Sub-arachnoid haemorrhage (SAH) is a life-threatening condition and survivors are often left with serious cognitive impairment. Patients and their carers led the design of a two-year controlled prospective study of a patient and family support service, using the Specialist Neurovascular Nurse (SNVN) to speed rehabilitation and family readjustment. Cost-effective measures found the SNVN group gained significant psychosocial and fiscal benefits when compared to the control group, thus highlighting the effectiveness of a social work approach in neurosurgery. Other studies in healthcare, including surgical patient safety, effectiveness in reducing mortality, cultural influence on suicide rates and implications for prevention, and the implications of the changing patterns of neurological mortality in Western nations, are briefly described.

scholarly journals HLA Class II-DRB,-DQA and –DQB Genotypes in Peripheral Blood Shows Shifts During the Course of Sepsis

2019 ◽  
Vol 73 (1) ◽  
pp. 10-16
Author(s):  
Linda Bāra ◽  
Jeļena Eglīte ◽  
Pēteris Ošs ◽  
Vinita Cauce ◽  
Vilnis Lietuvietis ◽  
...  
Keyword(s):  
Human Leukocyte ◽  
Class Ii ◽  
Hla Class Ii ◽  
University Hospital ◽  
Control Group ◽  
Hla Dr ◽  
Group Data ◽  
Threatening Condition ◽  
Life Threatening ◽  
Genetically Determined

Abstract Undeniably, sepsis is still a profoundly damaging and life-threatening condition for many individuals. With multiple changes in sepsis patients it is difficult to precisely classify an individual’s response in sepsis as proinflammatory or immunosuppressed. The aim of this study was to investigate genetically determined predisposition to developed sepsis by analysis of distribution of human leukocyte antigen (HLA) class II genes. Samples from patients with sepsis were collected at Pauls Stradiņš Clinical University Hospital, Latvia, in an intensive care unit between October 2016 and May 2017. The study group included 62 patients with sepsis, who were genotyped for HLA-DR; DQ using real time polymerase chain reaction – sequence specific primer (RT PCR-SSP). As a control group, data of 100 individuals were taken from the genetic bank of RSU Joint Laboratory of Clinical Immunology and Immunogenetics. The summarised results showed that the frequency of alleles DRB1*04:01 (OR = 5.54; 95% CI = 1.88–16.29); DRB1*07:01 (OR = 19.03; 95% CI = 2/37–152.82); DQA1*05:01 (OR = 14.17; 95% CI = 5.67–35.4); and DQB1*02:01 (OR = 50.00; 95% CI = 2.90–861.81) were significantly increased in patients with sepsis compared to the control group patients. The frequency of DRB1*16:01 (OR = 0.17, 95% CI = 0.04–0.59); DRB1*17:01 (OR = 0.04; 95% CI = 0.00–0.69); DQA1*01:01 (OR = 0.04; 95% CI = 0.00–0.31); DQA1*01:02 (OR = 0.03; 95% CI = 0.00–0.23); DQB1*02:02 (OR = 0.12; 95% CI = 0.03–0.42) alleles was lower in sepsis patients than in control subjects. The most frequent HLA-DRB1/DQA1/DQB1 haplotypes that was significantly increased in patients with sepsis were: DRB1*01:01/DQA1*05:01/DQB1*03:01 (OR = 12.6; 95% CI = 1.51–105.0; p < 0.003). Sepsis patients with pneumonia and alleles and DRB1 04:01; 07:01, DQB1 02:01 had the highest mortality rate. Undoubtedly, our preliminary data showed that development of sepsis can be associated with alleles and haplotypes of HLA class II genes. For more precise conclusion the research should be continued to include a larger patient group.

scholarly journals Right ventricular thrombus, a challenge in imaging diagnostics: a case series

2021 ◽  
Author(s):  
Massimo Barbagallo ◽  
Daryl Naef ◽  
Pascal Köpfli ◽  
Urs Hufschmid ◽  
Tilo Niemann ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Case Series ◽  
General Medicine ◽  
High Sensitivity ◽  
Cost Effective ◽  
Ventricular Thrombus ◽  
Threatening Condition ◽  
Life Threatening ◽  
Therapeutic Decision Making ◽  
Sensitivity Specificity

Abstract Background Presence of right ventricular thrombus (RVT) is a rare but life-threatening condition, thus immediate diagnosis and therapy are mandatory. Unfortunately, detection and distinction from intraventricular tumor masses or vegetations represents a complex task. Furthermore, consecutive therapy is principally led by clinical presentation without considering morphological features of the thrombus. Current literature suggests a multimodal non-invasive imaging approach. In this paper, we discuss the role of cardiac magnetic resonance (CMR) for the detection of RVT in patients with pulmonary embolism (PE). We consider the relatively expensive and not broadly available imaging procedure and weigh it up to its assumed high sensitivity, specificity and importance for differential diagnosis and therapeutic decision making. Case Summary In this case series we report three cases of RVT with concomitant PE, whereof two were missed during routine cardiac workup by transthoracic echocardiography (TTE) and computer tomography (CT). CMR led to detection and further characterization of the thrombi in both cases. These patients were diagnosed and treated at the Cantonal Hospital of Baden in the division of General Medicine. Conclusions CMR reliably detects and characterizes RVT, even under unfavourable conditions for echocardiography such as arrhythmia, adiposity or in posterior position of RVT. Obtained information could facilitate the choice of therapeutic approach (anticoagulation vs. systemic lysis, vs. surgical thrombectomy). Future risk-stratification scores will promote cost-effective use of CMR.

scholarly journals CLINICAL-PSYCHOPATHOLOGICAL FEATURES OF PATIENTS WITH DEMENTIA IN ALZHEIMER’S DISEASE WITH HIGH RISK OF SUICIDE

2017 ◽  
Vol 4 (4) ◽  
pp. 203-210
Author(s):  
I, Mudrenko
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
High Risk ◽  
Indirect Aggression ◽  
Control Group ◽  
Basal Nuclei ◽  
Threatening Condition ◽  
Life Threatening ◽  
Risk Predictors ◽  
Depressive Episodes

The study involved comprehensive clinical-anamnestic, neuroimaging and pathopsychological examination of 75 patients with dementia in Alzheimer's disease. The patients were divided into main group with a high risk of suicide (36 patients), group without signs of suicidal behavior (SB) and control group (39 patients). Patients with SB were found to have the damage of basal nuclei and alba; expansion of the cerebral fissures; subcortical damage in insular, frontal, occipital, parietal regions; hippocampal atrophy. The following factors of suicide risk in patients with Alzheimer's disease were determined: psychic trauma (life-threatening condition, loss of work or money); communicative (lack of emotional, financial and communicative support); anamnestic (suicidal attempts and depressive episodes in past); personal (physical, verbal and indirect aggression, irritability, susceptibility, negativism, suspicion and feeling of guilt); clinical (hallucinatory-paranoid syndrome). Specified predictors serve as target symptoms for psychoprophylaxis.Key words: dementia in Alzheimer's disease, suicidal risk, predictors of suicide, clinical and psychopathological peculiarities. КЛІНІКО-ПСИХОПАТОЛОГІЧНІ ОСОБЛИВОСТІ ХВОРИХ НА ДЕМЕНЦІЮ ПРИ ХВОРОБІ АЛЬЦГЕЙМЕРА З ВИСОКИМ РИЗИКОМ СУЇЦИДУМудренко І.Г.      Проведено комплексне клініко-анамнестичне, нейровізуалізаційне та патопсихологічне обстеження, обстежено 75 хворих з деменцією при хворобі Альцгеймера. Серед них виділено основну групу з високим ризиком суїциду (36 хворих) та без ознак суїцидальної поведінки (СП), контрольну (39 хворих). У хворих з СП частіше виявлялись враження базальних ядер та білої речовини півкуль мозку; розширення щілин мозку; субкортикальне враження в інсулярній, лобній, потиличній, тім’яній ділянках; атрофія гіппокампу. Встановлені наступні фактори ризику суїциду у хворих на хворобу Альцгеймера: психотравмуючі (небезпечна для життя хвороба, втрата роботи чи грошей); комунікативні (відсутність емоційної, фінансової та комунікативної  підтримки); анамнестичні (суїцидальні спроби та депресивні епізоди в минулому); особистісні (фізична, вербальна та непряма агресія, роздратованість, образливість, негативізм та підозрілість та почуття провини); клінічні (галюцинаторно-параноїдний синдром). Виділені предиктори будуть слугувати симптомами-мішенями для формування психопрофілактичних заходів.Ключові слова: деменція при хворобі Альцгеймера, суїцидальний ризик, предиктори суїциду, клініко-психопатологічні особливості. КЛИНИКО-ПСИХОПАТОЛОГИЧЕСКИЕ ОСОБЕННОСТИ БОЛЬНЫХ С ДЕМЕНЦИЕЙ ПРИ БОЛЕЗНИ АЛЬЦГЕЙМЕРА С ВЫСОКИМ РИСКОМ СУИЦИДАМудренко И.Г.Проведено комплексное клинико-анамнестическое, нейровизуализационное и патопсихологическое обследование 75 больных с деменцией при болезни Альцгеймера. Среди них выделено основную группу с высоким риском суицида (36 больных) и без признаков суицидального поведения (СП) контрольную (39 больных). У больных с СП чаще выявлялось поражение базальных ядер и белого вещества полушарий мезга, расширение щелей мезга, субкортикальное поражение в инсулярной, лобной, затылочной, теменной одластях; атрофия гиппокампа. Установлены следующие факторы риска суицида у больных болезнью Альцгеймера: психотравмирующие (опасная для жизни болезнь, потеря работы или денег); коммуникативные (отсутствие эмоциональной, финансовой и коммуникативной поддержки) анамнестические (суицидальные попытки и депрессивные эпизоды в прошлом) личностные (физическая, вербальная и косвенная агрессия, раздражительность, обидчивость, негативизм и подозрительность и чувство вины); клинические (галлюцинаторно-параноидный синдром). ВКлючевые слова: деменция при болезни Альцгеймера, суицидальный риск, предикторы суицида, клинико-психопатологические особенности.

scholarly journals Detection of (1,3)-β-d-Glucan in Cerebrospinal Fluid in Histoplasma Meningitis

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S76-S76
Author(s):  
Thein Myint ◽  
Karen Bloch ◽  
Luke Raymond-Guillen ◽  
L Joseph Wheat
Keyword(s):  
Control Group ◽  
Limited Data ◽  
Cns Involvement ◽  
Cns Inflammation ◽  
Fungal Meningitis ◽  
Laboratory Confirmation ◽  
Threatening Condition ◽  
Biologic Marker ◽  
Life Threatening ◽  
Csf Pleocytosis

Abstract Background Central nervous system (CNS) histoplasmosis is a life-threatening condition, and represents a diagnostic and therapeutic challenge. Although CSF (1,3)-β-d-glucan (CSF BDG) is available as a biologic marker for diagnosis of fungal meningitis, there are limited data on its use for diagnosis of Histoplasma meningitis. We evaluated CSF BDG detection using the Fungitell assay in patients with CNS histoplasmosis and controls. Methods Patients were classified as cases if there was CNS inflammation (CSF WBC ≥ 5 mm3/ml) plus laboratory confirmation of H. capsulatumin CNS samples or from extra-CNS sites with no alternative etiology for CSF pleocytosis. Controls were patients with histoplasmosis but no evidence of CNS involvement, an alternative diagnosis, or other fungal meningitis. Results In total, 47 cases and 153 controls were evaluated (Table 1). Forty-nine percent of patients with CNS histoplasmosis and 43.8% of controls were immunocompromised. CSF BDG was positive in 25 (53.2%) cases using a level of ≥80 pg/ml, the median CSF BDG level was 140.5 pg/ml (range from &lt;31 to 500 pg/ml). The detection of CSF BDG level ≥80 pg/ml was not associated with positive CSF Histoplasma antigen (P = 0.28) or positive CSF Histoplasma culture (P = 0.56). The sensitivity for detection of CSF BDG was 53.2% and the specificity was 87.3%, compared with 78.7% &#x2028;(P = 0.009) and 96.4% (P = 0.003), respectively, for detection of antigen. CSF BDG was positive in 20 of 153 (13.1%) patients in the control group. Seven of 11 (63.6%) other CNS fungal meningitis cases (five Cryptococcus, two Aspergillus, two Blastomyces, one Candida, and one suspected fungal meningitis) had CSF BDG ≥80 pg/ml. Conclusion A positive CSF BDG supports the diagnosis of fungal meningitis but cannot distinguish among the different etiologies. The sensitivity and specificity of detection of CSF BDG was lower than that of antigen detection. Disclosures L. J. Wheat, MiraVista: President and owner, equity and Salary

May-Thurner syndrome – Are we aware enough?

VASA ◽  
2019 ◽  
Vol 48 (5) ◽  
pp. 381-388 ◽  
Author(s):  
Katalin Mako ◽  
Attila Puskas
Keyword(s):  
Contraceptive Use ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Vein Thrombosis ◽  
Compression Syndrome ◽  
Threatening Condition ◽  
Life Threatening ◽  
Iliac Vein Compression ◽  
Iliac Vein Compression Syndrome ◽  
The Right

Summary. Iliac vein compression syndrome (May-Thurner syndrome – MTS) is an anatomically variable clinical condition in which the left common iliac vein is compressed between the right common iliac artery and the underlying spine. This anatomic variant results in an increased incidence of left iliac or iliofemoral vein thrombosis. It predominantly affects young women in the second or third decades of life with preponderance during pregnancy or oral contraceptive use. Although MTS is rare, its true prevalence is underestimated but it can be a life-threatening condition due to development of pulmonary embolism (PE). In this case based review the authors present three cases of MTS. All patients had been previously confirmed with PE, but despite they were admitted to hospital, diagnosed and correctly treated for PE and investigated for thrombophilia, the iliac vein compression syndrome was not suspected or investigated. With this presentation the authors would like to emphasize that MTS is mostly underdiagnosed, and it needs to be ruled out in left iliofemoral vein thrombosis in young individuals.

Severe Alveolar Hemorrhage – What’s in it for the Gastroenterologist?

2016 ◽  
Vol 25 (4) ◽  
pp. 555-558
Author(s):  
Alina Popp
Keyword(s):  
Celiac Disease ◽  
International Normalized Ratio ◽  
Gluten Free Diet ◽  
Alveolar Hemorrhage ◽  
Severe Anemia ◽  
Gluten Free ◽  
Pulmonary Infiltrates ◽  
Pulmonary Hemosiderosis ◽  
Threatening Condition ◽  
Life Threatening

Background: Alveolar hemorrhage is a potentially life-threatening condition which is usually managed by the pulmonologist. When considering its etiology, there is a rare association that sets the disease into the hands of the gastroenterologist. Case presentation: We report the case of a 48 year-old female who was admitted to the intensive care unit for severe anemia and hemoptysis. On imaging, diffuse pulmonary infiltrates suggestive of alveolar hemorrhage were detected and a diagnosis of pulmonary hemosiderosis was made. She received cortisone therapy and hematologic correction of anemia, with slow recovery. In search of an etiology for the pulmonary hemosiderosis, an extensive workup was done, and celiac disease specific serology was found positive. After confirmation of celiac disease by biopsy, a diagnosis of Lane-Hamilton syndrome was established. The patient was recommended a gluten-free diet and at 6 months follow-up, resolution of anemia and pulmonary infiltrates were observed. Conclusion: Although the association is rare, celiac disease should be considered in a patient with idiopathic pulmonary hemosiderosis. In our case, severe anemia and alveolar infiltrates markedly improved with glucocorticoids and gluten-free diet. Abbreviations: APTT: activated partial thromboplastin time; BAL: bronchoalveolar lavage; CD: celiac disease; Cd: crypt depth; GFD: gluten-free diet; GI: gastrointestinal; IEL: intraepithelial lymphocyte; INR: international normalized ratio; IPH: idiopathic pu

LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS: A PROSPECTIVE STUDY.

2019 ◽  
Author(s):  
Madan Goyal ◽  
R K Goel
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Critical View Of Safety ◽  
Recent Onset ◽  
Conversion To Open Cholecystectomy ◽  
Threatening Condition ◽  
Life Threatening ◽  
Fluid Collections ◽  
A Prospective Study

Acute cholecystitis (AC) is a potentially life-threatening condition. LC was initially considered to be a relative contraindication for laparoscopic cholecystectomy (LC), but with increase in general expertise, early LC was recommended in selected patients1. Aprospective study of LC in grade 1 and 2 AC patients with mild to moderate inflammatory changes in the gallbladder and no significant organ dysfunction, was performed during October 2016 to July 2019. A total of 78 patients, out of 408 cholecystectomies performed during this period, were included in this study. Criteria for diagnosing AC was, recent onset of pain in right hypochondrium, fever, leucocytosis, pericholecystic fluid collections, subserosal oedema on ultrasound, pyocele and other pathological evidence of AC. Patients presented and operated within 4 days of onset of symptoms showed better results as compared to those who could be operated after 4 days and within 14 days. Five patients required conversion to open cholecystectomy because of complex adhesions in 2, critical view of safety was unachievable in 2 and in 1 for troublesome bleeding.

PRO–CF–MED, Clinical Proof of concept for a RNA–targeting Oligonucleotide for a Cystic fibrosis–F508del MEDication, Horizon2020

Impact ◽  
2018 ◽  
Vol 2018 (3) ◽  
pp. 52-54
Author(s):  
Nicolas Lamontagne
Keyword(s):  
Cystic Fibrosis ◽  
Transmembrane Conductance Regulator ◽  
Transmembrane Conductance ◽  
Rna Targeting ◽  
Threatening Condition ◽  
Life Threatening ◽  
Cftr Protein ◽  
Disease Modifying ◽  
Cystic Fibrosis Transmembrane ◽  
Specific Challenge

Cystic fibrosis (CF) is a progressive life–shortening disease caused by a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene leading to a dysfunctional CFTR protein. The disease affects over 70,000 patients worldwide and while many mutations are known, the F508del mutation affects 90% of all patients. The absence of CFTR in the plasma membrane leads to a dramatic decrease in chloride efflux, resulting in viscous mucus that causes severe symptoms in vital organs like the lungs and intestines. For CF patients that suffer from the life threatening F508del mutation only palliative treatment exist. PRO–CF–MED addresses the specific challenge of this call by introducing the first disease modifying medication for the treatment of the CF patients with F508del mutation. The PRO–CF–MED project has been designed to assess the potential clinical efficacy of QR–010, an innovative disease modifying oligonucleotide–based treatment for F508del patients. Partners within PRO–CF–MED have generated very promising preclinical evidence for QR–010 which allows for further clinical assessment of QR–010 in clinical trials. PRO–CF–MED will enable the fast translation of QR–010 towards clinical practice and market authorisation. PRO–CF–MED has the potential to transform this life–threatening condition into a manageable one.

Advanced care planning: thinking ahead for parents, carers, children, and young people

2018 ◽  
Author(s):  
Angela Thompson
Keyword(s):  
Spiritual Needs ◽  
Care Planning ◽  
Best Interest ◽  
Social Emotional ◽  
Children And Young People ◽  
Adult Services ◽  
Active Approach ◽  
Threatening Condition ◽  
Life Threatening ◽  
Advance Care

Advance care planning (ACP) in paediatrics applies from the diagnosis of a life-limiting/life-threatening condition onwards. It encompasses the management of intermittent potentially reversible episodes through to end-of-life care in keeping with the child’s best interest. It is an active approach to managing care and acknowledges the child’s and family’s broader social, emotional, and spiritual needs and keeps the child central and paramount to all planning. It requires transparent discussions and effectively documented agreements that are well communicated, readily accessible, and immediately identifiable. It is essential to regularly review and amend as necessary. They describe the care agreed at that point in time in the child’s best interest, in line with RCPCH guidance. Challenges may particularly occur at the time of transition to adult services.

Sign in / Sign up

Export Citation Format

Share Document