An Evaluation of Preexisting Psychiatric Diagnosis: Patient Outcomes in an Intensive Care Setting

Abstract BACKGROUND: Mental health is a state of well-being in which an individual is able to acknowledge ability levels, cope with the normal stresses of life, be a productive member of society and contribute to the community. An important consideration for DNP prepared nurses is implementing principles of the Collaborative Care Model as a guiding framework to improve access to evidence-based mental health care in a medical care setting. PURPOSE: The purpose of this DNP project was to examine the demographic, clinical and treatment characteristics of patients with both medical and psychiatric diagnoses admitted to an Intensive Care Unit (ICU) of a hospital in a large healthcare system located in a metropolitan area in the southeast United States. METHODS: For the study in this DNP project, an exploratory, descriptive design with a retrospective medical record review was conducted on 100 patients with both medical and psychiatric diagnosis admitted to the ICU between July 1, 2018 and December 31, 2018. This study was an exploration of demographic, clinical and treatment characteristics of patients with both a medical and psychiatric diagnosis admitted to the ICU during the study period. The relationships among and between the psychiatric medication reconciliation status, type of psychiatric treatments received, length of stay and discharge disposition of the study sample were explored. RESULTS: Those who had psychiatric diagnosis on admission were more likely to be female (60.0% vs. 40%), have a neurological condition as the admitting diagnosis (63%) and suffer from co-existing medical diagnosis including cardiac/pulmonary (83%). The nonexclusive, primary psychiatric diagnosis was anxiety (75%), follow by depression (63%) with nearly three quarters of the sample on a psychiatric medication prior to admission (71%). The most common psychiatric medication was an antidepressant/mood stabilizer (56%). There were no significant differences in admission diagnosis, co-existing medical diagnosis, restraint use, PRN medication use, psych consult, disposition or length of stay between those with and without psychiatric medications on admission. CONCLUSION: There remains limited research concerning collaborative care in the inpatient healthcare setting. The preliminary findings of this DNP project suggest the need for more exploratory research that can guide practice and policies to enhance care for patients with psychiatric and medical comorbidities in the ICU setting

The potential for material circularity and independence in the U.S. steel sector

Achieving a U.S. circular economy would reduce environmental impacts and increase material independence. This article calculates maximum recycled contents (RCs) and recycling rates (RRs) in an independent U.S. steel sector, and estimates the potential to displace current imports with recycled scrap that is currently destined for landfill, hibernating stocks, or export (LHSE). A U.S. dynamic material flow analysis (1880–2100) is conducted to estimate annual steel consumption and scrap generation. The results are coupled with a linear optimization model that minimizes primary steel demand while satisfying the volumetric and compositional demands of new consumption. The compositional analysis examines only copper content because it is of greatest concern to recyclers.The best estimate is that the maximum independent RR is already constrained by copper contamination. Without interventions, this maximum RR will gradually decline throughout the century. The annual consumption to scrap availability ratio (C2SR) will decrease from around 1.4 today. Concurrently, the maximum RC rises but then plateaus below 75% as the RR falls. This highlights a conflict in the conditions for a circular economy: a C2SR approaching unity is a necessary condition for a high RC but leads to fewer opportunities for scrap contaminant dilution, which decreases the RR. Improved product design for recycling and deployment of scrap refining technologies will be needed to reach higher RCs. In 2017, the mass of U.S. scrap destined for LHSE exceeded direct steel imports. Domestic recycling of scrap exports alone could have displaced 36% of direct steel imports, reducing the U.S. deficit by $5.5 billion.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/156151/3/jiec12971-sup-0001-SuppMatS1.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/156151/2/jiec12971_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/156151/1/jiec12971.pd

Community-acquired pneumonia in children: cell-free plasma sequencing for diagnosis and management.

Community-acquired pneumonia (CAP) is a common cause of pediatric hospital admission. Empiric antibiotic therapy for hospitalized children with serious CAP now targets the most likely pathogen(s), including those that may demonstrate significant antibiotic resistance. Cell-free plasma next-generation sequencing (CFPNGS) was first made available for Pediatric Infectious Diseases physicians in June 1, 2017, to supplement standard-of-care diagnostic techniques. A retrospective chart review was performed for children hospitalized with CAP between June 1, 2017, and January 22, 2018, to evaluate the impact of CFPNGS. We identified 15 hospitalized children with CAP without other underlying medical conditions for whom CFPNGS was performed. CFPNGS identified a pathogen in 13 of 15 (86%) children compared with 47% for those using standard culture and PCR-based methods alone. Changes in antibiotic management were made in 7 of 15 (47%) of children as a result of CFPNGS

Food Protein-Induced Enterocolitis Syndrome as a Cause for Infant Hypotension

Infants with food protein-induced enterocolitis syndrome (FPIES) may present to the emergency department (ED) with vomiting and hypotension. A previously healthy, 5-month-old male presented with vomiting and hypotension 2 to 3 hours after eating squash. The patient was resuscitated with intravenous fluids, antibiotics, and admitted for presumed sepsis. No source of infection was ever found and the patient was discharged. The patient returned 8 days later with the same symptoms after eating sweet potatoes; the diagnosis of FPIES was made during this admission. Two additional ED visits occurred requiring hydration after new food exposure. FPIES should be considered in infants presenting with gastrointestinal complaints and hypotension. A dietary history, including if a new food has been introduced in the last few hours, may help facilitate earlier recognition of the syndrome

Prospectus, September 9, 2004

https://spark.parkland.edu/prospectus_2004/1018/thumbnail.jp

Preparing for and Responding to Disturbance: Examples from the Forest Sector in Sweden and Canada

Coping or adaptation following large-scale disturbance may depend on the political system and its preparedness and policy development in relation to risks. Adaptive or foresight planning is necessary in order to account and plan for potential risks that may increase or take place concurrently with climate change. Forests constitute relevant examples of large-scale renewable resource systems that have been directly affected by recent environmental and social changes, and where different levels of management may influence each other. This article views disturbances in the forest sectors of Sweden and Canada, two large forest nations with comparable forestry experiences, in order to elucidate the preparedness and existing responses to multiple potential stresses. The article concludes that the two countries are exposed to stresses that indicate the importance of the governing and institutional system particularly with regard to multi-level systems including federal and EU levels. While economic change largely results in privatization of risk onto individual companies and their economic resources (in Canada coupled with a contestation of institutional systems and equity in these), storm and pest outbreaks in particular challenge institutional capacities at administrative levels, within the context provided by governance and tenure systems.In Sweden, funding from the research agency FORMAS, the MISTRA Arctic Futures programme, and the Future Forests programme (funded by research agency MISTRA, the forest industries, Umeå University and the Swedish University of Agricultural Sciences) as well as from the EU for data collection is acknowledged. Ryan Bullock acknowledges funding provided by the Social Sciences and Humanities Research Council and by the Mistra Arctic Futures programme for preparing this paper.https://www.mdpi.com/1999-4907/2/2/50

Alterations to the Gastrointestinal Microbiome Associated with Methamphetamine Use among Young Men who have Sex with Men.

Methamphetamine (MA) use is a major public health problem in the United States, especially among people living with HIV (PLWH). Many MA-induced neurotoxic effects are mediated by inflammation and gut microbiota may play a role in this process, yet the effects of MA on the microbiome have not been adequately explored. Therefore, we performed 16S rRNA gene sequencing on rectal swab samples from 381 men who have sex with men, 48% of whom were PLWH and 41% of whom used MA. We compared microbiome composition between MA users and non-users while testing for potential interactions with HIV and controlling for numerous confounders using inverse probability of treatment weighting. We found that MA use explained significant variation in overall composition (R2 = 0.005, p = 0.008) and was associated with elevated Finegoldia, Parvimonas, Peptoniphilus, and Porphyromonas and reduced Butyricicoccus and Faecalibacterium, among others. Genera including Actinomyces and Streptobacillus interacted with HIV status, such that they were increased in HIV+ MA users. Finegoldia and Peptoniphilus increased with increasing frequency of MA use, among others. In summary, MA use was associated with a microbial imbalance favoring pro-inflammatory bacteria, including some with neuroactive potential and others that have previously been associated with poor HIV outcomes

Sex Differences in the Superficial Femoral Artery Occlusion Pressure

The measurement of arterial occlusion pressure (AOP) prior to the use of blood flow restriction during exercise is recommended. Not all previous studies that have included both male and female participants have reported sex differences in AOP. PURPOSE: The purpose of this study was to compare the superficial femoral artery AOP of the dominant and non-dominant legs between males and females. METHODS: Ultrasound (GE LOGIQ) was used to detect blood flow through the superficial femoral artery of both legs in a random order in 20 males and 20 females. Circumference of the upper thigh, leg volume, and skinfold thickness were measured in both legs. Blood pressure was continuously monitored using a CNAP device. An inflatable cuff was placed around the upper thigh. The cuff was inflated to 50 mmHg and then inflated continuously (10 mmHg/10 s) until arterial blood flow and pulse waves were no longer detectable by the ultrasound. The AOP was then measured in the opposite leg. The AOP data were analyzed with a mixed model analysis of variance while maintaining a family-wise p-value of 0.05. RESULTS: The AOP of the dominant leg in males (209.4 ± 29.4 mmHg) and females (212.3 ± 8.3 mmHg) were not significantly different (p=0.844). Likewise, the AOP of the non-dominant leg in males (206.8 ± 32.5 mmHg) was not significantly different (p=0.804) than the AOP in the non-dominant legs of females (203.5 ± 50.9 mmHg). When combining the data for the dominant and non-dominant legs, the average AOP for males (208.1 ± 30.6 mmHg) and females (207.9 ± 53.1 mmHg) were not significantly different (p=0.986). Thigh circumference was the only variable that significantly (p=0.027) contributed to AOP. On the average the thigh circumference in the dominant and non-dominant legs of males (59.6 ± 5.5; 59.2 ± 5.2 cm) was greater than that for females (56.0 ± 2.9; 55.6 ± 3.2 cm), respectively. There were no sex differences in thigh skinfold thickness or thigh volume between males and females in either the dominant or non-dominant legs. CONCLUSION: There were no significant differences in AOP of the superficial femoral artery of the dominant and non-dominant legs between males females despite males having larger legs. Factors other than limb circumference likely have a role in determining AOP

Differences in Arterial Occlusion Pressure of the Superficial Femoral Artery Between the Dominant and Non-Dominant Legs

The arterial occlusion pressure (AOP) is dependent on limb circumference. Previous research seldom reports the AOP of both limbs. PURPOSE: The purpose of this study was to compare the superficial femoral artery AOP measured in the dominant and non-dominant legs. METHODS: Ultrasound (GE LOGIQ) was used to detect blood flow through the superficial femoral artery of both legs in a random order in 20 males and 20 females. Circumference of the upper thigh, leg volume, and skinfold thickness were measured in both legs. Blood pressure was continuously monitored using a CNAP device. An inflatable cuff was placed around the upper thigh. The cuff was inflated to 50 mmHg and then inflated continuously (10 mmHg/10 s) until arterial blood flow and pulse waves were no longer detectable by the ultrasound. The AOP was then measured in the opposite leg. The AOP data were analyzed with a mixed model analysis of variance while maintaining a family-wise p-value of 0.05. RESULTS: In males, the AOP of the dominant (209.4 ± 29.4 mmHg) and non-dominant legs (206.8 ± 32.5 mmHg) were not significantly different (p=0.790). Likewise, in females the AOP of the dominant (212.3 ± 58.3 mmHg) and non-dominant legs (203.5 ± 50.9 mmHg) were not significantly different (p=0.386). When combining the data for males and females, the AOP of the dominant (210.9 ± 45.6 mmHg) and non-dominant legs (205.2 ± 40.7 mmHg) were not significantly different (p=0.412). Thigh circumference was the only variable that significantly (p=0.027) contributed to AOP. In both males and females, there were no differences in thigh skinfold thickness, circumference, and volume between the dominant and non-dominant legs. The dominant leg was larger in 24 (60%) of the subjects; the larger leg had a higher AOP in 19 (47.5%) of the subjects; and the dominant leg had a higher AOP in 26 (65%) of the subjects. Although the AOP between the dominant and nondominant legs was not statistically significant, the largest difference in AOP between the two legs was 124 mmHg. CONCLUSION: There were no significant differences in AOP of the superficial femoral artery between the dominant and non-dominant legs in either males or females. Because of the potentially larger differences in the AOP between the two legs, we recommend measuring the AOP in both limbs when using blood flow restriction during exercise