Crying in my Car—Poetry vs Distancing Campo, Rafael
JAMA : the journal of the American Medical Association,
06/2023, Letnik:
329, Številka:
22
Journal Article
Recenzirano
Campo discusses the poem "Birds". The poet, a medical trainee, struggles to balance caring about her patients with the clinical distance she's been taught to maintain to take care of them. This ...familiar tension might be traced to Sir William Osler, revered exemplar of clinical practice, who advocated "cool detachment" to the point of suppressing facial expressions when treating patients. Medical sociologists and educators expanded on and advanced "detached concern" and "distancing" as key goals of medical training.
Body failure Mitchinson, Wendy
Body failure,
2013, 20131030, 2013, 2013-10-30
eBook
In this energetic new study, Wendy Mitchinson traces medical perspectives on the treatment of women in Canada in the first half of the twentieth century.
Promoting Treatment Adherence provides health care providers with a comprehensive set of information and strategies for understanding and promoting treatment adherence across a wide range of ...treatment types and clinical populations. The information is presented in a practical how-to manner, and is intended as a resource that practitioners can draw from to improve skills in promoting treatment adherence.
Leave passes provide authorized leave for hospitalized patients from a psychiatric inpatient unit. Although providing day passes was once a relatively common practice, there are relatively few data ...describing their safety and efficacy. This descriptive study examines the use of leave passes in an adult inpatient unit at a university hospital between 2017 and 2021, with attention to reasons for granting the day pass, duration, and outcome of the pass. During the study period, 10 patients with primary psychotic or mood disorders received 12 passes for housing coordination, COVID-19 vaccination, or major family events. There were no fatalities or abscondments. One patient experienced severe agitation and engaged in nonsuicidal self-injurious behavior. A second patient showed mild, redirectable psychomotor agitation upon return to the unit. The remaining 10 passes were uneventful. Our findings support the view that patients with diverse diagnoses can safely be provided leave from an inpatient setting with adequate planning and support, yielding a low incidence of adverse events.
IntroductionBrS is diagnosed in patients with ST-segment elevation with type 1 morphology ≥ 2mm in one or more leads among the right precordial leads V1 and/or V2 positioned in the second, third or ...fourth intercostal space. This may be spontaneous or after provocation challenge with intravenous administration of a sodium channel blocker (i.e. ajmaline, flecainide, procainamide or pilsicainide). The specific protocol for ajmaline provocation challenge for diagnosis of BrS has been debated between ICC services worldwide. Concerns regarding safety and false positive rates are perceived to be associated with a more rapid infusion protocol. This retrospective observational cohort study describes the safety and positivity rates for patients undergoing ajmaline provocation challenge by both protocols over ten years.MethodsData on consecutive adults undergoing ajmaline challenge test from Mach 2011 to March 2021 were retrospectively collected. Patient demographics, indication for testing, genetic information, adverse events and positivity rates were compared by test protocol used. Slow protocol was defined as total dose of 1mg/kg ajmaline capped at 100mg, given at rate of 10mg/min. Rapid protocol was defined as 1mg/kg ajmaline capped at 100mg given in 10 divided doses over 5 minutes.ResultsA total of 414 ajmaline challenges were included (251 (61%) slow vs. 163 (39%) rapid protocol) Mean age 41 ± 16yrs; 50% male. Indications for conducting the test were a) family history of BrS 182 (44%), b) family history of SADS/SUD 138 (33%), c) OOHCA 26 (6%), d) abnormal ECG 47 (11%) and e) syncope 21 (5%). There was no difference in positivity rate between the two protocols (slow (23%) vs. rapid protocol (17%), p=0.13) table 1. Comparison of patients by provocation result regardless of the protocol used showed a predominance of (males, 51% in both groups, p=0.96) and (similar mean age of patients, p=0.91). Positive patients were more likely to have (a family history of BrS, p=0.006) or (an SCN5A genetic variant, p<0.05). Patients whose indication was (a family history of SADS/SUD, p<0.05) or (abnormal ECG, p<0.05) were more likely to yield a negative ajmaline test table 2. A single patient experienced ventricular ectopy with the slow protocol. While there were no dysrhythmias with the rapid protocol, two patients experienced QRS broadening necessitating early termination of the protocol but this was not statistically significant. Two patients developed jaundice post provocation with slow protocol, both of which resolved spontaneously.Abstract 12 Table 1Demographics of patients by ajmaline challenge protocol Group A: Slow protocol (1mg/kg over 10 minutes) Group B: Rapid protocol (1mg/kg over 5 minutes) p-value No of tests, n (%) 251 (61%) 163 (39%) p=0.61 (ns) Age (mean ± sd) years 40 ± 16 43 ± 15 p=0.09 (ns) Gender (male: female) 136 : 115 75 : 88 p=0.10 (ns) Indications:a) Family History of BrSb) Family history of SADS/SUDc) History of OOHCAd) ECG abnormalitye) Unexplained syncope 10578173417 77609134 p=0.28 (ns)p=0.23 (ns)p=0.61 (ns)p=0.08 (ns)p=0.05 (trend) Positive result, n (%) 57 (23%) 27 (17%) p=0.13 (ns) Ventricular Arrhythmia 1 (ventricular ectopy) 0 QRS broadening resulting in shortening of protocol 0 2 Jaundice 2 0 *BrS: Brugada syndrome, SADS/SUD: Sudden arrhythmic death syndrome/Sudden unexplained death, OOHCA: Out of hospital cardiac arrest, ns: non-significant, sig: significant.Abstract 12 Table 2Comparison of patients by ajmaline challenge resultAjmaline challenge result Age (mean) Gender Male (%) a) Family Hx BrS b) Family Hx of SADS/SUD c) Hx of OOHCA d) ECG abnormality e) Unexplained syncope SCN5A variant positive Positive results 41.2 43/84 (51%) 48/84 (57%) 14/84 (17%) 3/84 (4%) 16/84 (19%) 3/84 (4%) 15/84 (18%) Negative results 41.4 168/330 (51%) 134/330 (41%) 124/330 (38%) 23/330 (7%) 31/330 (9%) 18/330 (5%) 5/330 (2%) p-value p=0.91 (ns) p=0.96 (ns) p=0.006 (trend) p<0.05 (sig) p=0.25 (ns) p<0.05 (sig) p=0.48 (ns) p<0.05 (sig) *BrS: Brugada syndrome, SADS/SUD: Sudden arrhythmic death syndrome/Sudden unexplained death, OOHCA: Out of hospital cardiac arrest, Hx: history, ns: non-significant, sig: significant.ConclusionThe NI ICC service have performed 414 ajmaline test over the last ten years. Patients with a family history of BrS are more likely to have a positive provocation challenge, whilst the yield from patients with a family history of SADS/SUD or simply abnormal ECG in the absence of symptoms is low. Our overall positivity rate was 20% with no difference in positivity between the rapid and slow protocols. Both protocols have proven safe to date in our centre, with no significant dysrhythmias or conduction disease identified to date with either protocol. Our incidence of drug induced jaundice was 1 in 207 patients which is higher than previously published and both occurred with the slow protocol. Our data suggests that the rapid protocol is safe and does not result in an increased positivity rate, therefore we will continue with rapid protocol for efficiency in our unit.