Exacerbation Of Chronic Illness Research Articles

A 365-Day Record of Maternal Admissions in Intensive Care Unit at the University of Port Harcourt Teaching Hospital in Nigeria

BACKGROUND. The intensive care unit provides critically ill patients with the necessary monitoring, care and supports to optimize their organ/system functions. Parturients are often at risk of sudden deteriorations or exacerbation of chronic illnesses from direct or indirect causes and would often require admissions into the intensive care or high dependency unit. This study is aimed at looking at the trends of maternal admissions in 365 days at the intensive care unit of a tertiary teaching hospital in Southern part of Nigeria, a country that contributes significantly to the global proportion of maternal morbidity and mortality. METHODS. The study adopted a retrospective approach. All critically ill parturients admitted and requiring organ support or close monitoring in the ICU had their files and ICU documents reviewed. The review was held from January-December 2018. RESULTS. Thirty-nine (39) parturients with a mean age (years) of 33 ± 1.3 were admitted, representing 2.9% of annual deliveries. All admissions were postnatal and came predominantly from the unbooked labour ward (51%) and the time lag from maternal deteriorations to presentation to the ICU was 72 ± 10 hours. The main indications for admissions were due to postpartum haemorrhage (33.3%), complications of hypertensive disorders of pregnancy (30.9%) and sepsis (25.6%). Nineteen (48.7%) patients died from obstetric haemorrhage, complications of hypertensive disorders of pregnancy, sepsis and pulmonary embolism. CONCLUSION. The trend of maternal admissions at this specific time frame reflects the burden of maternal critical care in our environment. It highlights the need to holistically tackle the known scourge with improved care.

Collaborative Care Rises to the Pandemic Challenge

Collaborative Care Rises to the Pandemic Challenge

Impact of Natural Disasters on Health Outcomes and Cancer Among Older Adults.

There is growing evidence that older adults exposed to natural disasters are at disproportionate risk for adverse health events such as all-cause mortality, injury, hospital admissions, stroke, displacement, cardiopulmonary distress, stress-related mental health problems, and exacerbation of chronic illnesses. Typically, analyses of the health consequences of natural disasters focus only on the populations impacted for the duration and immediate aftermath of the disaster. With few exceptions, the long-term effects of natural disasters on older adult health have not been examined. This article describes the potential consequences of exposure to natural disasters that contribute to cancer and disruption of cancer care treatment systems for older adults. It is argued that exposures to floods and wildfires in particular present an underestimated threat to the onset and/or progression of cancer and cancer care management in older adults. We propose that these impacts should be examined not only from an emergency preparedness perspective during the event but also from a public health focus that prospectively assesses risks for cancer and other health disparities. Recommendations for comprehensive longitudinal risk assessment and emergency preparedness models that address the full impact of natural disasters on the health and well-being of vulnerable, at risk, older adults are offered.

The Medical Care of the Elderly from the Care Provider's Point of View

The aging of the population presents modern Western society with a variety of different challenges, especially in the areas of health and medicine. On the one hand, there is the demand of the elderly patients to receive medical treatments that are supposed to improve or preserve the existing quality of life and to prevent the extension of a life without quality, with suffering and pain. On the other hand, aging is accompanied by the appearance and exacerbation of chronic illnesses, reduces the treatment benefits of medical activities and increases the risks of irreversible physical dependence. Furthermore, the lack of consensus among the physicians regarding the willingness of treatment and the proper timing of the treatment of the elderly – pose questions about the quality of the treatment for the elderly. Thus, in the opinion of different care-providers and in comparison to other age groups in modern Western society, the elderly do not enjoy the treatment advantages of medical activities proven in the treatment of other age groups in society.

Abstract PD-035: THE POLICE IN PICU: BEREAVED PARENTS’ EXPERIENCES

Aims & Objectives: When a child dies unexpectedly from an accident, illness, or exacerbation of chronic illness, a coroner (medical examiner) is often involved to investigate the cause and circumstances of death. In the PICU, this process often begins with the arrival of police officers working on behalf of the coroner, who identify the body and collect statements from the family. The aim of this analysis was to explore bereaved parents’ experiences of the police in PICU as part of routine coronial investigations. Methods Secondary analysis of incidental data from a larger grounded theory study. Nine bereaved parents from two Australian PICUs commented on police presence during semi-structured, audio-recorded interviews. Thematic analysis was used to analyse the data and identify key themes in the parents’ experiences. Results Three key findings were identified in the data. Timing of police interviews demonstrates the immediacy of police presence after a child’s death, and the prolonged length of parental questioning. The impacts of police presence describes the ways the police presence impacted on the parents’ experiences, often leaving them feeling accused of involvement in their child’s death. Finally, The demeanour of the officers explores the inappropriate or unsympathetic attitudes many parents faced from the police officers they encountered. Conclusions These findings suggest that parental experiences of police presence in the PICU as part of coronial investigations may be negative. Although further research is needed to fully understand these experiences, our findings offer areas for improvement in the treatment of bereaved parents in the PICU.

Causes and patterns of readmissions in patients with common comorbidities: retrospective cohort study

#### The paper Work in emergency medicine or medical/surgical assessment can often yield interesting days. Patients come to hospital for various reasons; some present because they are acutely unwell, some present with exacerbations of chronic illnesses, and others present because they require social and multidisciplinary input into their care and home environments. For a junior on the “frontline,” perhaps the most gut-wrenching moment is when you’re asked to see a patient who you’ve recently discharged from your care. You wonder whether you made a mistake in prescribing or if you discharged them too early. Then begins the attempt to diagnose the patient and, rather defensively, to find out whose fault it is that they’ve re-presented to hospital. We know that about a fifth of patients who are discharged from hospital bounce back into hospital via GP referral or re-present through the emergency department within 30 days after discharge.1 Reasons for readmission include adverse drug events, avoidable infection, complications of procedures and treatments, and preventable acute exacerbations of chronic illnesses. The authors of this study wanted to ascertain why patients get readmitted and offer solutions as to how we can reduce the numbers. They hypothesised that patients’ comorbidities could play an important role. Comorbidities can be defined as the simultaneous coexistence of more than one health condition in a single individual—for example, someone who has chronic obstructive pulmonary disease (COPD) and insulin dependent diabetes is said to have both comorbidities.1 There is already evidence to suggest that a patient’s primary diagnosis on readmission (within 30 days) differs from the primary diagnosis responsible for the index—or original—admission, suggesting that there must be other factors at play. Additionally, studies have suggested …

Automated Technology to Speed Recognition of Signs of Illness in Older Adults

Our team has developed a technological innovation that detects changes in health status that indicate impending acute illness or exacerbation of chronic illness before usual assessment methods or self-reports of illness. We successfully used this information in a 1-year prospective study to alert health care providers so they could readily assess the situation and initiate early treatment to improve functional independence. Intervention participants showed significant improvements (as compared with the control group) for the Short Physical Performance Battery gait speed score at Quarter 3 (p = 0.03), hand grip-left at Quarter 2 (p = 0.02), hand grip-right at Quarter 4 (p = 0.05), and the GAITRite functional ambulation profile score at Quarter 2 (p = 0.05). Technological methods such as these could be widely adopted in older adult housing, long-term care settings, and in private homes where older adults wish to remain independent for as long as possible.

Arginine-induced pancreatitis: involvement of the autonomic nervous system?

to the editor: Dawra et al. ([1][1]) were able to trigger acute pancreatitis in mice after the administration of l-arginine. In addition, acute inflammation in the pancreas was associated with lung injury. With respect to this, we would like to offer some insight into the possible physiological,

Deriving a Model of the Necessity to Hospitalize Nursing Home Residents

Although often important to recover from acute medical problems and exacerbations of chronic illness, hospitalizations can be traumatic for nursing home residents and costly for payers. It is important that unnecessary hospitalizations are avoided wherever possible. The authors derived and validated a diagnosis-based model to estimate the clinical necessity of hospitalizing nursing home residents with common conditions using data from an expert panel survey. Model validation involved a linked minimum data set—hospitalization claims data set. The expert panel of 12 experienced geriatricians rated the necessity of hospitalization for 1,948 clinical scenarios containing diagnoses, cognitive and functional status, age, gender, and advance directives. Primary diagnoses with the highest average necessity scores were respiratory failure, acute myocardial infarction, hip fracture, and brain injury. The secondary diagnosis-primary diagnosis interaction with the greatest impact was gastrointestinal bleed on gastroenteritis. Poor cognitive function and presence of an advance directive lowered the risk of hospitalization.

Emergency Care of the Technology-Assisted Child

Integrated community living has become an achievable goal for many medically complex children. For many children with special health care needs (CSHCN), community living means an increased dependence on emergency medical services and emergency departments (EDs) for assistance with acute medical crises. Because transport times to the tertiary care ED can be prohibitively long, the community ED is more likely to become the site of first contact for the management of acute illnesses, exacerbations of chronic illnesses, and equipment-related problems experienced by CSHCN. Therefore, it is of paramount importance that emergency providers working in community as well as tertiary settings be well equipped to handle emergencies experienced by CSHCN. This article reviews common devices and their complications.

Symptoms in neuroleptic-naive, first-episode schizophrenia: response to risperidone

Analysis of the treatment response of different groups of patients with schizophrenia may further define the range of applications and specificity of novel therapies. Clinical trials of risperidone have focused on patients with exacerbations of chronic illness, largely having had multiple previous admissions and years of prior treatment (Chouinard et al 1993; Lindstrom and von Knorring 1994; Marder and Meibach 1994). Other investigators have reported the response to clozapine by first-episode, treatment-refractory patients with schizophrenia (Szymanski et al 1994); however, no prior studies document the response of first-episode, drug-naive schizophrenia patients to another novel antipsychotic, risperidone.

Role of stress in the exacerbation of chronic illness: Effects of clonidine administration on blood pressure and plasma norepinephrine, cortisol, growth hormone and prolactin concentrations

Systolic blood pressure (SBP), diastolic blood pressure (DBP), and plasma norepinephrine (NE), cortisol (CRT), growth hormone (GH) and prolactin (PRL) were studied before and after clonidine (2.5 μg/kg i.m.) administration in 193 chronic severely ill patients and 193 normal subjects matched by age and sex. During exacerbation periods (positive manifestations of impairment and progressive disease), the patients showed higher NE, CRT and DBP than the normals or when they were investigated during non-exacerbation periods (92 of the 193). Clonidine induced sharp, marked reductions of NE, CRT and DBP, plus a sudden increase of GH, in all the patients during exacerbation periods. Non-significant reductions of NE, CRT and DBP were observed in normals and in patients during non-exacerbation periods. On the other hand, the GH increase registered during exacerbation periods was of an order of magnitude higher than that registered in normals and in patients during non-exacerbation periods. Significant reduction of SBP was registered both in normals and patients (exacerbation and non-exacerbation periods). Some tendency to PRL lowering was observed during exacerbation periods only. A high positive correlation between NE and DBP (pre- and post-clonidine values) was obtained during exacerbation periods in patients, but not in normals or during non-exacerbation periods in the patients. Similarly, a close negative correlation was obtained between CRT and GH (postclonidine values) during exacerbation periods, but not in normals or during non-exacerbation periods. No significant correlation was found between NE and SBP in any group of subjects. The clonidine-induced changes in GH and CRT observed in the patients during exacerbation periods were in striking contrast to the absence of these changes in depressed patients. This finding is consistent with the low rate of depression (6.7%) registered among our patients during exacerbation periods. The high plasma NE and CRT levels registered in chronic severely ill patients during exacerbation periods reflect a central and peripheral sympathetic hyperactivity, accompanied by an overactivity of the pituitary — adrenocortical axis. The strong reduction of DBP, NE and CRT, along with the sharp and great increase of GH, might be useful as indicators in assessing the exacerbation and progression of severe chronic illnesses.

Creating an indoor environmental problem from a nonproblem: a need for cautious evaluation of antibodies against hapten-protein complexes.

An epidemic of illness in three schools in New York State occurred in early 1983. An epidemiological review of the problem led to the conclusion that some of the symptoms could have been explained by irritant reactions to boiler exhaust gases but that a major factor was likely public concern about environmental contamination and heightened awareness of common minor symptoms and of exacerbations of chronic illnesses. Diphenylmethane diisocyanate (MDI) from polyurethane insulation had previously been suspected as a potential cause. An earlier investigation had found low levels of anti MDI-human serum albumin in a small number of subjects who did not have typical symptoms of identified MDI or other hypersensitivity syndromes. Similar antibodies were found in two of nine unaffected children in Chicago, who served as a comparison group. The identification of these antibodies, however, was inappropriately used to support the idea of a school contaminated with MDI in spite of the absence of detectable MDI in the environment. The availability of highly sensitive immunoassays should not be inappropriately used to accelerate the fear of environmental toxins when there is no clinical correlation.