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Ill Adults (ill + adult)
Terms modified by Ill Adults Selected AbstractsAdults with chronic eating disorders.EUROPEAN EATING DISORDERS REVIEW, Issue 4 2005Two-year follow-up after inpatient treatment Abstract Objective The aims of this prospective study were (1) to report on the 2-year outcome of chronically ill adult eating disorder patients, (2) to investigate whether a specialized inpatient treatment might influence the course of the illness, and (3) to search for prognostic factors. Method Seventy-two patients were treated in a 4,5-month specialized group treatment programme for chronically ill adults with eating disorders. Sixty-five (90%) with mean age of 30 years were available for the follow-up assessment. Results Forty-six (71%) patients had improved at the 2-year follow-up and 17 (26%) did not meet diagnostic criteria for an eating disorder. The symptom reductions per time were statistically significantly larger during the inpatient period compared to the waiting-list and follow-up periods. No significant predictors of treatment outcome were found. Patients with avoidant personality disorder had a higher level of distress at all times, but improved at the same rate as the others. Conclusion At the 2-year follow-up, there were substantial reductions in eating disorder symptoms and general psychiatric symptoms. Most of the improvement occurred during inpatient treatment, which might be an option for chronic eating disorders. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association. [source] The development and initial validation of the Terminally Ill Grief or Depression Scale (TIGDS)INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 4 2005Vyjeyanthi S. Periyakoil Abstract Patients often experience ,preparatory-grief' as they cope with the dying process. Some may be depressed. The Terminally Ill Grief or Depression Scale (TIGDS), comprising grief and depression sub-scales, is a new self-report measure designed to differentiate between preparatory-grief and depression in adult inpatients. The initial 100-item inventory was assembled based on literature review, interviews with clinicians and dying patients and then shortened to 42 items based on consensus expert opinion. Validity and reliability were tested in a sample of 55 terminally ill adults. The consensus clinical opinion was used as the gold standard to differentiate between preparatory grief and depression. The intra-class correlation coefficient was high (it was calculated to estimate the test-retest reliability for the 47 patients who had completed the TIGDS twice , retest was administered 2 to 7 days after the initial test), ranging from 0.86 (grief) to 0.97 (depression). The validity of TIGDS was assessed using a receiver operating characteristic curve analysis, comparing the first test with the clinical criterion. The first and only variable and cut-point was the depression score (chi-square = 18.4,p < 0.001, cut point = 3). The sensitivity of the TIGDS was 0.727 and specificity was 0.886 for the depression = 3 cutoff score. The construct validity of the TIGDS was tested by comparing with the Hospital Anxiety and Depression Scale (HADS). The TIGDS depression subscale showed strong convergent validity and the TIGDS grief subscale showed strong discriminant validity with the HADS total score. Copyright © 2005 John Wiley & Sons, Ltd. [source] Item selection and content validity of the Critical-Care Pain Observation Tool for non-verbal adultsJOURNAL OF ADVANCED NURSING, Issue 1 2009Céline Gélinas Abstract Title.,Item selection and content validity of the Critical-Care Pain Observation Tool for non-verbal adults. Aim., This paper is a report of the item selection process and evaluation of the content validity of the Critical-Care Pain Observation Tool for non-verbal critically ill adults. Background., Critically ill patients experience moderate to severe pain in the intensive care unit. While critical care clinicians strive to obtain the patient's self-report of pain, many factors compromise the patient's ability to communicate verbally. Pain assessment methods often need to match the communication capabilities of the patient. In non-verbal patients, observable behavioural and physiological indicators become important indices for pain assessment. Method., A mixed method study design was used for the development of the Critical-Care Pain Observation Tool in 2002,2003. More specifically, a four-step process was undertaken: (1) literature review, (2) review of 52 patients' medical files, (3) focus groups with 48 critical care nurses, and interviews with 12 physicians, and (4) evaluation of content validity with 17 clinicians using a self-administered questionnaire. Results., Item selection was derived from different sources of information which were convergent and complementary in their content. An initial version of the Critical-Care Pain Observation Tool was developed including both behavioural and physiological indicators. Because physiological indicators received more criticism than support, only the four behaviours with content validity indices >0·80 were included in the Critical-Care Pain Observation Tool: facial expression, body movements, muscle tension and compliance with the ventilator. Conclusion., Item selection and expert opinions are relevant aspects of tool development. While further evaluation is planned, the Critical-Care Pain Observation Tool appears as a useful instrument to assess pain in critically ill patients. [source] Stress ulcer prophylaxis for non-critically ill patients on a teaching serviceJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 5 2007Kevin O. Hwang MD Abstract Rationale, Doctors frequently give non-critically ill patients unjustified stress ulcer prophylaxis (SUP). It is unknown if this practice also occurs during residency training. Objective, To evaluate the pattern of SUP given to non-critically ill medical patients on the teaching service of an internal medicine residency programme. Methods, This was a retrospective cohort study of non-critically ill adults admitted to the internal medicine teaching service of a community hospital from August 2003 to July 2004. We assessed receipt of SUP, association of SUP with risk factors for stress ulcer bleeding; appropriateness of SUP according to evidence-based criteria; and incidence of stress ulcer bleeding. Results, Of the 774 patient records reviewed, 545 were included in the study. The average age was 55.4 years. Patients were more likely to receive SUP if they had more risk factors for stress ulcer bleeding (P < 0.001). Overall, 54.9% (299 of 545) of patients received SUP. Of these 299 patients, at least 58.5% did not warrant SUP, depending on the criteria used. Of the entire cohort of 545 non-critically ill patients, 32.1% to 54.9% received unjustified SUP, depending on the criteria applied. There were no cases of stress ulcer bleeding. Conclusions, Many non-critically ill patients on the teaching service received unjustified SUP, suggesting the need for institutional protocols and educational interventions to promote evidence-based practice during residency training. [source] Development of clinical guidelines for prone positioning in critically ill adultsNURSING IN CRITICAL CARE, Issue 2 2004Article first published online: 25 FEB 200, Catherine Rowe Summary , Literature reveals evidence that prone positioning can improve the oxygenation of critically ill patients suffering from acute lung injury or acute respiratory distress syndrome , Multicentre evidence, however, does not support the claim that it improves patients' outcome , The implementation of multiprofessional guidelines by which to direct the manoeuvre will facilitate the safe and effective management of patients in the prone position. They will thus heighten multiprofessional awareness of the technique and promote its proactive use at such time so as to achieve maximum clinical benefit [source] Inter-hospital transfers of acutely ill adults in Scotland,ANAESTHESIA, Issue 2 2010M. J. Fried Summary The transfer of acutely ill adults who were transported between hospitals by the Scottish Ambulance Service was audited in order to determine the number of transfers and to quantify the incidence of adverse events. Patients over 16 years of age requiring intervention/vital signs monitoring during transfer or a nursing/medical escort from the outset were defined as acutely ill adults. Three thousand and forty-eight audit forms were received, of which 2396 were suitable for inclusion in the audit. Transfers primarily occurred for specialist management (1580; 66%) or specialist investigation (550; 23%). Clinicians escorted 825 (34%) patients and were away from their hospital a median (IQR [range]) of 2 h (01:24,3:30 [00:05,17:33]) h:min Clinical intervention was required in 84 transfers (4%). The median (IQR [range]) time for 248 transfers (10.3%) requiring assisted ventilation was 28 min (00:17,00:50 [00:04,02:55]). The incidence of unsecured medical equipment (in escorted transfers only) was significantly lower in dedicated transport teams (2/205, 1%) vs non-dedicated (113/620, 18%; p = 0.004). Medical equipment failures were less common in the transfer of patients requiring assisted ventilation (1/156, 0.6% vs 9/97, 9%; p = 0.001). [source] Protective mechanisms of activated protein C in severe inflammatory disordersBRITISH JOURNAL OF PHARMACOLOGY, Issue 4 2009Arne P Neyrinck The protein C system is an important natural anticoagulant mechanism mediated by activated protein C (APC) that regulates the activity of factors VIIIa and Va. Besides well-defined anticoagulant properties, APC also demonstrates anti-inflammatory, anti-apoptotic and endothelial barrier-stabilizing effects that are collectively referred to as the cytoprotective effects of APC. Many of these beneficial effects are mediated through its co-receptor endothelial protein C receptor, and the protease-activated receptor 1, although exact mechanisms remain unclear and are likely pleiotropic in nature. Increased insight into the structure,function relationships of APC facilitated design of APC variants that conserve cytoprotective effects and reduce anticoagulant features, thereby attenuating the risk of severe bleeding with APC therapy. Impairment of the protein C system plays an important role in acute lung injury/acute respiratory distress syndrome and severe sepsis. The pathophysiology of both diseases states involves uncontrolled inflammation, enhanced coagulation and compromised fibrinolysis. This leads to microvascular thrombosis and organ injury. Administration of recombinant human APC to correct the dysregulated protein C system reduced mortality in severe sepsis patients (PROWESS trial), which stimulated further research into its mechanisms of action. Several other clinical trials evaluating recombinant human APC have been completed, including studies in children and less severely ill adults with sepsis as well as a study in acute lung injury. On the whole, these studies have not supported the use of APC in these populations and challenge the field of APC research to search for additional answers. This article is part of a themed issue on Mediators and Receptors in the Resolution of Inflammation. To view this issue visit http://www3.interscience.wiley.com/journal/121548564/issueyear?year=2009 [source] Characteristics and Referral of Emergency Department Patients with Elevated Blood PressureACADEMIC EMERGENCY MEDICINE, Issue 9 2007Brigitte M. Baumann MD, MSCE Objectives: To assess the prevalence, characteristics, and referral to health care of emergency department (ED) patients with elevated blood pressure (BP) and to compare those without a history of hypertension (HTN) with suboptimally controlled, known-hypertensive patients. Methods: A prospective, observational study was conducted in non,critically ill adults with a triage systolic blood pressure (sBP) of ,140 or with a diastolic blood pressure (dBP) of ,90 mmHg. Two additional measurements were obtained, and a standardized questionnaire recorded demographics, medical history, and ED staff referrals. Results: Of 1,719 nonpregnant adults, 991 agreed to participate, of whom 455 had elevated triage BP values. Using the mean of three measurements, 305 (67%) had an sBP of ,140 or a dBP of ,90 mm Hg (mean sBP = 157 and mean dBP = 89 mm Hg). Subjects with no prior history of HTN (n = 105) were predominantly male, younger, and more likely to smoke and consume alcohol than were known-hypertensive patients (n = 200). Three quarters of all subjects had access to primary health care; however, time elapsed since the last BP assessment was greater (155 vs. 53 d, p = 0.03) in subjects with no previous history. These subjects were also less likely to be informed of their elevated BP (33% vs. 50%, p = 0.02) or to be instructed by ED staff to obtain a repeat measurement (13% vs. 31%, p = 0.001). Conclusions: Of ED patients with elevated BP, one third had no prior history, and the remainder were suboptimally controlled hypertensive patients. Both groups were inadequately informed of their elevated BPs, and the group with no prior history of HTN, the population likely to obtain the greatest health benefit, had the lowest referral rate. [source] | ||||||||||