Prevention of nosocomial infection, especially with MRSA, is a high priority. In this trial involving 74 ICUs at 43 hospitals, universal decolonization with the use of chlorhexidine and mupirocin was ...associated with a decrease in all-cause bloodstream infections.
Health care–associated infection is a leading cause of preventable illness and death and often results from colonizing bacteria that overcome body defenses.
1
–
5
Among the pathogens causing health care–associated infection, methicillin-resistant
Staphylococcus aureus
(MRSA) has been given priority as a target of reduction efforts because of its virulence and disease spectrum, multidrug-resistant profile, and increasing prevalence in health care settings, particularly among patients in the intensive care unit (ICU). Hospitals commonly screen patients in the ICU for nasal carriage of MRSA and use contact precautions with carriers.
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Nine states mandate such screening.
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Decolonization has been used to reduce transmission . . .
Morris comments on billing patients for forced psychiatric care. Surprise medical billing, in which patients face unexpected out-of-pocket medical costs, has attracted widespread attention. Surprise ...medical bills have various consequences for patients and families, including loss of income or savings, worsened credit scores, use of resources for legal counsel or litigation, and psychological stress. Billing patients for involuntary psychiatric care deserves more attention for several reasons. First, these patients may be held financially liable for care they did not authorize and even actively refused. Compared with most medical care, involuntary psychiatric care is different in that patients can be detained for evaluation and treatment against their expressed wishes.
Background and Objectives
Although gaming disorder is increasingly recognized, there has been limited consideration of the impact of free‐to‐play games with in‐game purchases, also called ...microtransactions.
Methods
Case report (n = 1).
Results
A patient with posttraumatic stress disorder, major depressive disorder in remission, polysubstance use disorders in remission, and opioid use disorder on buprenorphine/naloxone developed gaming disorder (based on International Classification of Diseases, 11th revision) and spent up to 40% of his monthly income on microtransactions within a smartphone game. Treatment consisted of relinquishing access to electronic payment mechanisms, motivational interviewing, and couples therapy.
Discussion and Conclusions
The case highlights how in‐game purchases may cause patients with gaming disorder to experience financial consequences, and the need for further characterization of the clinical ramifications of microtransactions.
Scientific Significance
To the best of our knowledge, this is the first report in the medical literature of a patient with gaming disorder developing excessive in‐game spending from expenditures on microtransactions. (Am J Addict 2020;29:528–530)
The goal of therapy for bradycardia or tachycardia is to rapidly identify and treat patients who are hemodynamically unstable or symptomatic due to the arrhythmia. Drugs or, when appropriate, pacing ...may be used to control unstable or symptomatic bradycardia. Cardioversion or drugs or both may be used to control unstable or symptomatic tachycardia. ACLS providers should closely monitor stable patients pending expert consultation and should be prepared to aggressively treat those with evidence of decompensation.
The introduction of selective serotonin reuptake inhibitors (SSRIs) had a major impact on the treatment of depression, but there remain large numbers of patients whose symptoms are resistant to these ...and other agents. In recent years, drugs with alternative mechanisms of action have become the focus of efforts to develop novel treatments for patients with treatment-refractory depression. Some of these agents have mind-altering actions and/or abuse potential, but how best to focus attention on these risks has been a matter of some debate, and we have described a risk in minimizing the associated risksin adopting these newer agentsinto general use. Brexanolone is a member of a new class of antidepressants, the neurosteroid GABAA receptor modulators, that has been approved for the treatment of postpartum depression. Although the rationale for using neurosteroids for postpartum depression is to correct a deficit in postparturition neurosteroid activity, the agents may behave more like a benzodiazepine than as a specific neuroendocrine replacement strategy.
Air Pollution and Cardiovascular Injury Simkhovich, Boris Z., MD, PhD; Kleinman, Michael T., PhD; Kloner, Robert A., MD, PhD, FACC
Journal of the American College of Cardiology,
08/2008, Letnik:
52, Številka:
9
Journal Article
Recenzirano
Odprti dostop
Air Pollution and Cardiovascular Injury: Epidemiology, Toxicology, and Mechanisms Boris Z. Simkhovich, Michael T. Kleinman, Robert A. Kloner Recent epidemiologic studies show that increased levels of ...air pollutants are positively associated with cardiovascular morbidity and mortality. Inhalation of air pollutants affects heart rate, heart rate variability, blood pressure, vascular tone, blood coagulability, and the progression of atherosclerosis. Major mechanisms of inhalation-mediated cardiovascular toxicity include activation of pro-inflammatory pathways and generation of reactive oxygen species. In addition, inhaled ultrafine particles may be translocated into the circulation and transported to the vasculature and heart where they can induce cardiac arrhythmias and decrease cardiac contractility and coronary flow.
Physicians have traditionally asked about substance use within the Social History section of the consultation note. Drawing on social science theory and using the authors’ own experiences as ...generalists and addiction scholars, we consider the possible unintended harms associated with this approach. The inclusion of the substance use history within the Social History reproduces the discourse of substance use disorders as “life-style choices” rather than medical conditions, and reinforces stigma among healthcare workers through the attribution of personal responsibility for complications associated with problematic substance use. The ongoing placement of the substance use history within the Social History may lead to a failure to diagnose and make appropriate management plans for clients with substance use disorders. These missed opportunities may include inadequate withdrawal management leading to discharge before medically advised, insufficient use of evidence-based pharmacotherapy and psychotherapy, polypharmacy, medical complications, and repeated admissions to hospital. We argue instead that the Substance Use History should be a stand-alone section within the consultation note. This new section would reduce the invisibility of substance use disorders within our medical systems and model that these chronic medical conditions are amenable to prevention, treatment and harm reduction through the application of evidence-based practices.
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