The health and social consequences of an alcohol related admission to critical care: a qualitative study

Objective: To examine the impact of critical care on future alcohol-related behaviour. Further, it aimed to explore patterns of recovery for patients with and without alcohol use disorders beyond the hospital environment. Design: In-depth, semistructured interviews with participants ( patients) 3–7 months post intensive care discharge. Setting: The setting for this study was a 20-bedded mixed intensive care unit (ICU), in a large teaching hospital in Scotland. On admission, patients were allocated to one of the three alcohol groups: low risk, harmful/hazardous and alcohol dependency. Participants: 21 participants who received mechanical ventilation for greater than 3 days were interviewed between March 2013 and June 2014. Interventions: None. Measurements and main results: Four themes which impacted on recovery from ICU were identified in this patient group: psychological resilience, support for activities of daily living, social support and cohesion and the impact of alcohol use disorders on recovery. Participants also discussed the importance of personalised goal setting and appropriate and timely rehabilitation for alcohol-related behaviours during the critical care recovery period. Conclusions: There is a significant interplay between alcohol misuse and recovery from critical illness. This study has demonstrated that at present, there is a haphazard approach to rehabilitation for patients after ICU. A more targeted rehabilitation pathway for patients leaving critical care, with specific emphasis on alcohol misuse if appropriate, requires to be generated

Evolution, Perfection, and Theories of Language

In this article it is argued that evolutionary plausibility must be made an important constraining factor when building theories of language. Recent suggestions that presume that language is necessarily a perfect or optimal system are at odds with this position, evolutionary theory showing us that evolution is a meliorizing agent often producing imperfect solutions. Perfection of the linguistic system is something that must be demonstrated, rather than presumed. Empirically, examples of imperfection are found not only in nature and in human cognition, but also in language — in the form of ambiguity, redundancy, irregularity, movement, locality conditions, and extra-grammatical idioms. Here it is argued that language is neither perfect nor optimal, and shown how theories of language which place these proper-ties at their core run into both conceptual and empirical problems

The utility of scoring systems in critically ill cirrhotic patients admitted to a general intensive care unit

Purpose: This study aimed to establish which prognostic scoring tool provides the greatest discriminative ability when assessing critically ill cirrhotic patients in a general intensive care unit (ICU) setting.<p></p> Methods: This was a 12-month, single-centered prospective cohort study performed in a general, nontransplant ICU. Forty clinical and demographic variables were collected on admission to calculate 8 prospective scoring tools. Patients were followed up to obtain ICU and inhospital mortality. Receiver operating characteristic curve analysis was used to determine the discriminative ability of the scores. Univariate and multivariate analyses were used to identify any independent predictors of mortality in these patients. The incorporation of any significant variables into the scoring tools was assessed.<p></p> Results: Fifty-nine cirrhotic patients were admitted over the study period, with an ICU mortality of 31%. All scores other than the renal-specific Acute Kidney Injury Network score had similar discriminative abilities, producing area under the curves of between 0.70 and 0.76. None reached the clinically applicable level of 0.8. The Sequential Organ Failure Assessment score was the best performing score. Lactate and ascites were individual predictors of ICU mortality with statistically significant odds ratios of 1.69 and 5.91, respectively. When lactate was incorporated into the Child-Pugh score, its prognostic accuracy increased to a clinically applicable level (area under the curve, 0.86).<p></p> Conclusions: This investigation suggests that established prognostic scoring systems should be used with caution when applied to the general, nontransplant ICU as compared to specialist centers. Our data suggest that serum arterial lactate may improve the prognostic ability of these scores

Interdisciplinary doctoral research supervision: A scoping review

This scoping literature review examines the topic of interdisciplinary doctoral research supervision. Interdisciplinary doctoral research programs are expanding in response to encouragement from funding agencies and enthusiasm from faculty and students. In an acknowledgement that the search for creative and innovative solutions to complex problems is best addressed through interdisciplinary collaborations, research-intensive universities are increasingly encouraging interdisciplinary projects and programs. The expansion of interdisciplinary research to the context of doctoral research may impact several core components of the doctorate: the enactment of the student–supervisor relationship, the process of forming and working with a supervisory committee, and the process and outcomes of doctoral research. In order to ensure that interdisciplinary doctoral supervision occurs in a positive and effective way, it is necessary to understand the distinct needs and challenges of interdisciplinary students and their supervisors, through scholarship about this phenomenon. Résumé Cet article retrace la recherche existante dans le domaine de l’interdisciplinarité ainsi que l’encadrement de recherches doctorales. Les programmes interdisciplinaires de recherches doctorales répondent à l’incitation des organismes de financement et à l’enthousiasme des professeurs et des étudiants et, de ce fait, deviennent de plus en plus nombreux. Les universités centrées sur la recherche encouragent la création de projets et de programmes interdisciplinaires, car elles sont convaincues que les solutions innovatrices et créatives aux problèmes complexes se réalisent par le truchement de collaborations interdisciplinaires. La demande croissante de recherche interdisciplinaire crée cependant un effet important sur plusieurs composantes centrales du doctorat : la mise en œuvre de la relation étudiantsuperviseur; le processus de formation et de travail du comité de supervision; et les processus et résultats de la recherche doctorale. Pour que l’encadrement doctoral interdisciplinaire se déroule de façon positive et efficace, il est donc nécessaire de comprendre clairement quels sont les différents besoins et défis des étudiants et de leurs superviseurs, en fonction du savoir déjà existant dans le domaine

Do alcohol use disorders impact on long term outcomes from intensive care?

Introduction: There is limited evidence regarding the impact of alcohol use disorders on long term outcomes from intensive care. The aims of this study were to analyse the nature and complications of alcohol related admissions to intensive care and determine whether alcohol use disorders impact on survival at six months post ICU discharge.<p></p> Method: This was an 18 month prospective observational cohort study in a 20 bedded mixed ICU, in a large teaching hospital in Scotland. On admission patients were allocated to one of three alcohol groups: low risk, harmful/hazardous, or alcohol dependency.<p></p> Results: 34.4% of patients were admitted with an alcohol use disorder. Those with an alcohol related admission (either harmful/hazardous or alcohol dependent) had an increased odds of developing septic shock during their admission, compared with the low risk group (OR 1.67; 95% CI 1.13-2.47, p = 0.01). After adjustment for all lifestyle factors which were significantly different between the groups, alcohol dependence was associated with more than a twofold increased odds of ICU mortality (OR 2.28; 95% CI 1.2-4.69, p = 0.01) and hospital mortality (OR 2.43; 95% CI 1.28-4.621, p = 0.004). After adjustment for deprivation category and age, alcohol dependence was associated with an almost two fold increased odds of mortality at six months post ICU discharge (HR 1.86; CI 1.30-2.70, p = 0.001).<p></p> Conclusion: Alcohol use disorders are a significant risk factor for the development of septic shock in intensive care. Further, alcohol dependency is independently associated with poorer long term outcomes from intensive care.<p></p&gt

The utility of modified Butler-Leggett criteria for right ventricular hypertrophy in detection of clinically significant shunt ratio in ostium secundum-type atrial septal defect in adults

Background: This study was performed to test the hypothesis that there exists a correlation between the Butler-Leggett (BL) criterion for right ventricular hypertrophy on the electrocardiogram and the Qp/Qs shunt ratio in adults with ostium secundum atrial septal defects (ASDs). Methods: Demographic, cardiac catheterization, ASD closure, and electrocardiographic data were acquired on 70 patients with secundum ASDs closed percutaneously. Simple linear regression and logistic regression models were created to test the hypothesis. Results: The mean Qp/Qs ratio and BL criterion value were 1.61 +/- 0.46 and 0.11 +/- 0.41, respectively. The BL criterion values correlated with shunt ratios (r(2) = 0.11 and P = .004). A BL criterion value greater than 0 mV predicted a significant shunt ratio (Qp/Qs \u3e or = 1.5) (odds ratio, 4.8; 95% confidence interval, 1.3, 18.1; P = or \u3c.0001) with a sensitivity of 0.68 and specificity of 0.65. Conclusion: Our results indicate that there is limited utility of the BL criterion at detecting right ventricular volume overload, although a BL criterion value greater than 0 mV being used to identify patients with significant intracardiac shunts yielded a sensitivity of 0.68 and specificity of 0.65