A Case of Recurrent Dissociative Episodes in a Patient with Congenital Defects

Case Report Marie, a 30 year old American-born Hispanic female, was first seen in the emergency room with suicidal ideation (the impulse to jump in front of an oncoming car), depression, anxiety, and distress about always getting attacked so much

The Treatment of a Borderline Patient Complicated by Involvement with a Charismatic Religious Cult: A Case Report

Introduction Although much has been written about cults in recent years, many questions remain. Do cults recruit subjects by brainw ashing them or do individuals gravitate to cults to fulfill unmet needs? This paper will review some essential points of cult phenomena and discuss the treatment of one patient who was involved in a charismatic religious cult

The Use of Light in the Treatment of Depression

INTRODUCTION Light has recently been reported to be a useful treatment in affective illness (1,2, 3, 4, 5, 6). What type of patients respond to this type of treatment ? What is the theoretical mechanism of action of light therapy and what are the implications of this research for the existing theories of affective illness? This review will seek answers to these questions by summarizing the recently reported studies of the effects of light on depression , by reviewing the pertinent contributions from neuroanatomy, endocrinology and circadian rhythm physiology, and, finally, by suggesting some points of integration of these recent findings with existing theories of depression

Using Psychoanalytically Oriented Psychotherapy with the Elderly

Psychotherapy with the elderly, like geriatric medicine, has become a subject of renewed interest. This paper will review some pertinent aspects of the subject and hopefully dispel some myths. A case will be presented where psychoanalytically oriented psychotherapy was employed. In this case, forced termination was necessary after one year due to the therapist graduating from residency

Improving Early Antibiotic Administration for Treatment of Sepsis at Children’s Hospital of Richmond at VCU: 2012-2019

Background: The Surviving Sepsis Campaign recommends initiating IV antibiotic administration within one hour of recognition of severe sepsis. Several studies have shown that prompt blood culture collection, administration of broad-spectrum antibiotics, and fluid resuscitation following recognition improves child survival. Objective: Our goal was to evaluate effectiveness of sepsis initiatives and institutional changes in the timing of early antibiotic administration at Children’s Hospital of Richmond at VCU. Methods: We formed a Pediatric Sepsis Committee with representatives from each unit in 2013. In 2016, the committee began tracking time from the order of a first stat dose IV antibiotic to administration as a marker of early treatment and reviewed data on a monthly basis with run charts for overall and unit-specific data. Other interventions included improved availability of antibiotics in automated dispensing machines, sepsis screening and alert systems, sepsis huddles, and auto-generated pages to charge nurses upon order of stat IV antibiotics. We included percent of stat antibiotics administered in less than one hour from order across all pediatric units since 2012. Results: Across all units, the centerline of first dose stat antibiotics delivered within one hour improved from a baseline of 34% in 2012 to 76% in 2019. The NICU and PICU centerlines improved by 53% and 48%, respectively since 2012. The Pediatric ED improved from 66% in 2012 to 84% in 2016. The Acute Care Pediatrics (ACP) Unit centerline improved from 24% in 2012 to 50% in 2017. Conclusion: Time from order to stat antibiotic administration has improved in all units receiving quality improvement initiatives. These improvements have been made possible by widespread emphasis on the dangers of untreated sepsis, multidisciplinary collaboration between nursing and physician staff, structural pharmacy changes and electronic alerts. Further studies are needed to determine impact on patient outcomes

Emergency Department and Radiological Cost of Delayed Diagnosis of Cannabinoid Hyperemesis.

Background. Chronic cannabis use has become prevalent with decriminalization, medical prescription, and recreational legalization in numerous US states. With this increasing incidence of chronic cannabis use a new clinical syndrome has become apparent in emergency departments and hospitals across the country, termed Cannabinoid Hyperemesis (CH). CH has been described as cyclical vomiting and abdominal pain in the setting of chronic cannabis use, which is often temporarily relieved by hot showers. CH presents a diagnostic challenge to clinicians who do not have a high clinical suspicion for the syndrome and can result in high costs and resource utilization for hospitals and patients. This study investigates the expenditures associated with delayed CH evaluation and delayed diagnosis. Methods. This is a retrospective observational study of 17 patients diagnosed with CH at three medical centers in the United States from 2010 to 2015, consisting of two academic centers and a community hospital. Emergency department (ED) costs were calculated and analyzed for patients eventually diagnosed with CH. Results. For the 17 patients treated, the total cost for combined ED visits and radiologic evaluations was an average of $76,920.92 per patient. On average these patients had 17.9 ED visits before the diagnosis of CH was made. Conclusion. CH provides a diagnostic challenge to clinicians without a high suspicion of the syndrome and may become increasingly prevalent with current trends toward cannabis legalization. The diagnosis of CH can be made primarily through a thorough history and physical examination. Awareness of this syndrome can save institutions money, prevent inappropriate utilization of healthcare resources, and save patients from unnecessary diagnostic tests

External validation of a claims-based algorithm for classifying kidney-cancer surgeries

<p>Abstract</p> <p>Background</p> <p>Unlike other malignancies, there is no literature supporting the accuracy of medical claims data for identifying surgical treatments among patients with kidney cancer. We sought to validate externally a previously published Medicare-claims-based algorithm for classifying surgical treatments among patients with early-stage kidney cancer. To achieve this aim, we compared procedure assignments based on Medicare claims with the type of surgery specified in SEER registry data and clinical operative reports.</p> <p>Methods</p> <p>Using linked SEER-Medicare data, we calculated the agreement between Medicare claims and SEER data for identification of cancer-directed surgery among 6,515 patients diagnosed with early-stage kidney cancer. Next, for a subset of 120 cases, we determined the agreement between the claims algorithm and the medical record. Finally, using the medical record as the reference-standard, we calculated the sensitivity, specificity, and positive and negative predictive values of the claims algorithm.</p> <p>Results</p> <p>Among 6,515 cases, Medicare claims and SEER data identified 5,483 (84.1%) and 5,774 (88.6%) patients, respectively, who underwent cancer-directed surgery (observed agreement = 93%, κ = 0.69, 95% CI 0.66 – 0.71). The two data sources demonstrated 97% agreement for classification of partial versus radical nephrectomy (κ = 0.83, 95% CI 0.81 – 0.86). We observed 97% agreement between the claims algorithm and clinical operative reports; the positive predictive value of the claims algorithm exceeded 90% for identification of both partial nephrectomy and laparoscopic surgery.</p> <p>Conclusion</p> <p>Medicare claims represent an accurate data source for ascertainment of population-based patterns of surgical care among patients with early-stage kidney cancer.</p

Portable, Battery-Operated, Low-Cost, Bright Field and Fluorescence Microscope

This study describes the design and evaluation of a portable bright-field and fluorescence microscope that can be manufactured for $240 USD. The microscope uses a battery-operated LED-based flashlight as the light source and achieves a resolution of 0.8 µm at 1000× magnification in fluorescence mode. We tested the diagnostic capability of this new instrument to identify infections caused by the human pathogen, Mycobacterium tuberculosis. Sixty-four direct, decontaminated, and serially diluted smears were prepared from sputa obtained from 19 patients suspected to have M. tuberculosis infection. Slides were stained with auramine orange and evaluated as being positive or negative for M. tuberculosis with both the new portable fluorescence microscope and a laboratory grade fluorescence microscope. Concordant results were obtained in 98.4% of cases. This highly portable, low cost, fluorescence microscope may be a useful diagnostic tool to expand the availability of M. tuberculosis testing at the point-of-care in low resource settings

A unique therapeutic approach to emesis and itch with a proanthocyanidin-rich genonutrient

<p>Abstract</p> <p>Background</p> <p>We examined the therapeutic potential of a proprietary <it>Croton palanostigma </it>extract (Zangrado^®) in the management of emesis and itch.</p> <p>Methods</p> <p>Emesis was induced in ferrets with morphine-6-glucuronide (0.05 mg/kg sc) in the presence of Zangrado (3 mg/kg, ip) and the cannabinoid receptor 1 antagonist, AM 251 (5 mg/kg, ip). Topical Zangrado (1%) was assessed for anti-pruretic actions in the 5-HT-induced scratching model in rats and evaluated in capsaicin-induced gastric hyperemia as measured by laser doppler flow. In the <it>Apc</it>^<it>Min</it>mouse model of precancerous adenomatosis polyposis, mice received Zangrado (100 μg/ml in drinking water) from the age of 6 – 16 weeks for effects on polyp number. In RAW 264.7 cells Zangrado was examined for effects on lipopolysaccharide-induced nitrite production.</p> <p>Results</p> <p>Zangrado was a highly effective anti-emetic, reducing morphine-induced vomiting and retching by 77%. These benefits were not associated with sedation or hypothermia and were not reversed by cannabinoid receptor antagonism. Itch responses were blocked in both the morphine and 5-HT models. Zangrado did not exacerbate the <it>Apc</it>^<it>Min</it>condition rather health was improved. Capsaicin-induced hyperemia was blocked by Zangrado, which also attenuated the production of nitric oxide by activated macrophages.</p> <p>Conclusion</p> <p>Zangrado is an effective anti-emetic and anti-itch therapy that is devoid of common side-effects, cannabinoid-independent and broadly suppresses sensory afferent nerve activation. This complementary medicine represents a promising new approach to the management of nausea, itch and irritable bowel syndrome.</p