Additional risk factors for in-hospital ischemic stroke. Hypercoagulation syndrome

The risk of ischemic stroke in inpatients is higher than in the general population. This is due to both the greater comorbidity of inpatients and the presence of additional risk factors, the most studied of which are iatrogenic interventions. At the same time, the higher the probability of developing an ischemic stroke, the more risk factors the patient has. An important link in the pathogenesis of in-hospital ischemic stroke is the activation of the hemostasis system, which is an obligate consequence of a typical pathological process underlying diseases and injuries that led to hospitalization: blood loss, inflammation, mechanical tissue damage, dehydration, etc. In foreign literature, this condition is attributed to the group of acquired thrombophilia, in domestic literature the term hypercoagulation syndrome has become more widespread. Iatrogenic effects can also play an important role in the pathogenesis of hypercoagulation syndrome. It is characterized by increased readiness for thrombosis, clinical and laboratory signs of hypercoagulation, activation of various factors and components of coagulation, decreased fibrinolysis, but without the development of acute thrombosis. Hypercoagulation syndrome is rarely assessed in routine practice as a risk factor for ischemic stroke, however, it can act as an additional and main risk factor for the development of all subtypes of ischemic stroke (according to the TOAST classification), including the ESUS concept. In this regard, it is advisable to distinguish in its structure: chronic (existing before hospitalization: hereditary and/or acquired) and acute (situational, developed as a result of the underlying disease, its complications or iatrogenic effects) hypercoagulation syndromes. To designate a group of acute pathological conditions predisposing to the development of hypercoagulation syndrome, systemic and/or local thrombotic complications, including in-hospital ischemic stroke, and requiring increased preventive measures, it seems pathogenetically justified, understandable and convenient to use the term situational hypercoagulation conditions (1 table, bibliography: 19 refs)

Forms and Ethics of Baloch Midwifery

In Pakistan, the rise of unnecessary uterotonic injections to induce childbirth, sometimes also resulting in hysterectomies, has women returning to dhīnabogs (Baloch midwives) to heal the iatrogenic effects of biomedical interventions; and reinforcing local assumptions about the benefits of Balochi dhawā/medicine, dhīnabogiri or midwifery, and homebirths. Drawing on ethnographic research in Balochistan the chapter traces how dhīnabogs’ work, ethical stances, and critical outlook concerning the iatrogenic effects of biomedical interventions are non-oppositional forms of everyday resistance. The protective role of dhīnabogiri is embedded in the intimate aspects of childbirth that profoundly structure the ethical relationship between the labouring woman and her dhīnabog. This relationship is defined not only by dhīnabogs’ concern for the well-being of mother and child, but also by their character and ethics, which are inscribed in the vernacular and social authorized praxis of dhīnabogs , kawwās (expert midwives) and balluk (granny midwives).

Evaluating Potential Iatrogenic Effects of a Suicide-Focused Research Protocol

Background: Concerns regarding the potential iatrogenic effects of suicide assessment have long impeded suicide research. Aims: We sought to examine the effects of an intensive, suicide-focused assessment protocol on mood, suicidality, and urges to harm oneself or others. Method: Participants were adults admitted to a psychiatric inpatient unit for recent suicidal ideation or behavior, or reasons unrelated to suicide. Our study protocol included clinical interviews evaluating suicide history and laboratory tasks with suicide-related stimuli. We modified an existing measure to create a brief, 6-item interview, the Assessment Session Check-In, which was administered before and after research procedures. Results: These indicated overall reductions in distress, suicidal intent, and urges to harm oneself or others from preassessment to postassessment. Postassessment reductions in stress predicted lower likelihood of a suicide attempt at follow-up. Limitations: Although beneficial to examine a high-risk sample, it is possible that an intensive suicide-focused protocol could prove more problematic for those with lower baseline levels of negative affect and suicidal thoughts. Conclusions: Results challenge the belief that assessing suicide elevates distress or suicidality, even among a high-risk sample of adults admitted to a psychiatric inpatient unit.

COVID-19 Induced New-onset Psychosis: A Case Report from Oman

Neurobehavioral impairment associated with COVID-19 infection has been recently documented in the literature. COVID-19 infection has also been associated with an increased risk for developing psychiatric symptoms, including rare reports on psychosis. We report a case of a 46-year-old male with no significant medical, family, and psychiatric history admitted to the hospital with COVID-19-related psychosis. Possible contributory factors for his condition are discussed, including the relationship between infections and the brain circuitry, inadvertent iatrogenic effects of pharmaceuticals used to manage COVID-19, as well as diathesis-stress associated with the tribulation of the prevailing pandemic.

Review and Document the Process

After reviewing and documenting the process, this chapter argues that it is unethical to stop the ethical decision-making process with implementation. The chapter recommends monitoring and evaluating the consequences of the ethical decision by engaging in post-decision activities. It uses two case studies where well-meaning mental health professionals inadvertently created iatrogenic effects for their clients. It details what went wrong in each case and how outcomes might have been improved. In these situations, mental health professionals are strongly encouraged to re-engage the ethical decision-making process on behalf of their clients, including apologizing for missteps previously made.

Risk, Health, and Physical Enhancement: The Dangers of Health Care as Risk Reduction for Christian Bioethics

Medicine increasingly envisions health promotion in terms of reducing risk as determined by quantitative risk factors, such as blood pressure, blood lipids, or genetic variants. This essay argues that this vision of health care as risk reduction is dangerous for Christian bioethics, since risk can be infinitely reduced leading to a self-defeating spiral of iatrogenic effects. Moreover, it endangers character because this vision of health is connected to a reductionist vision of the body and an understanding of individual risk that undermines the more communal virtue of solidarity. The essay concludes by discussing how recent Thomistic analyses in favor of physical enhancements illustrate some of the problems that envisioning health care in terms of risk reduction holds for Christian bioethics.