Assessing and Caring for ICU Delirium and Post-Intensive Care Syndrome | Dr Wesley Ely (Pt 1)
Tune into our discussion with Dr. Wesley Ely about the importance of neurological care in the ICU, how we can methodically assess, care and prevent ICU delirium, and what post-intensive care syndrome (PICS) is.
Dr. Wesley Ely is a pulmonary medicine and critical care specialist and professor at Vanderbilt University Medical Center. He is most well-known for his research and advocacy work improving the care and outcomes of critically ill patients with ICU-acquired brain disease. He is co-director of the Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center - which consists of over 90 investigators and has amassed thousands of patients into cohort studies and RCTs, and built the methodology and tools for ICU acquired brain disease research, including the ABCDEF Bundle. Dr. Ely has over 550 peer-reviewed publications and won the 2022 Christopher Award for Literature, for his book Every Deep Drawn Breath. His full biography, along with a wealth of resources for ICU delirium, including the A2F bundle, can be found on https://www.icudelirium.org/
What are your experiences of neurological care in critically ill patinents?
Should D-dimers be used in general practice/family medicine?
Doctors of G-Med, please help me settle this. I had a disagreement with one of my colleagues today about the value of D-dimers in family mediicne/ general practice. In my opinion, either the patient is suspected of having a VTE or not. If they are, they should be referred to an acute triage unit that can follow up any investigations they request promptly. And yet my colleagues argue that there are tools like Well's score which suggest that there is a place for D-dimers when cases are unclear and we want VTEs to be (close to) definitively excluded. I would be happy to hear the opinions of other physicians.
Muscle weakness and hematuria/proteinuria
A 37 year old woman presented with progressive muscle weakness, muscle pain and skin stiffness. She also has weight loss, night sweats and dysphagia. This woman has a history hematuria and mild proteinuria, which was found incidentally on routine tests 3 years ago. At them time, serum total protein and albumin was normal. Urine elctrophoresis showed a normal range of protein factors. Renal biopsy showed mild focal mesnagial proliferation and negative immunoflorescence. She was given prednislone and cyclosporine which was eventually discontinued when urine protein got better. Other tests, including HbA1c, hepatitis B and C serology, ANA, anti-dsDNA, C3, C4, anti-GBM, and ANCA, were all normal. All renal function tests were normal.The question is - do you think her new symptoms are associated with her previous glomerulopnephritis? How would you investigate next?
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Internal Medicine
Turkey
I think, this patient's weight loss, loss of strength, and difficulty swallowing require investigation of malignancy and paraneoplastic syndrome. For example; such as lung cancer and lambert eaton syndrome. First of all, the patient's abdomen and thorax tomography should be taken. According to the result, it is necessary to plan gastroscopy in addition.
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General Medicine
Mexico
Precisamente estoy pasando por un cuadro florido de síntomas de LES, aunque mis laboratoriales están casi normales, el ultrasonido articular reporta inflamación muy severa de todas mis articulaciones interfalángicas, así como del nervio mediano, además de inflamación facetaria de L3 a L5 e inflamación severa de articulación coxofemoral, de predominio izquierdo, tengo mialgias generalizadas, artralgias, fatiga extrema. Todo comenzó exactamente un año después de mi último refuerzo con la vacuna de astra Zeneca. Mañana tengo cita con mi reumatólogo. No puedo trabajar por la falta de fuerza y la fatiga extenuante. Saludos desde México.
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Surgery
Guatemala
Investigar sobre uso de drogas, cocaina u otras...Imunocompomiso
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Biological Aging Accelerated With Breast Cancer Diagnosis, Treatment
TUESDAY, July 25, 2023 (HealthDay News) -- Breast cancer diagnosis and treatment is associated with accelerated biological aging, according to a study published online July 19 in the Journal of the National Cancer Institute.
Jacob K. Kresovich, Ph.D., from the H. Lee Moffitt Cancer Center & Research Institute in Tampa, Florida, and colleagues generated DNA methylation data on paired blood samples collected an average of 7.7 years apart among 417 women enrolled in the prospective Sister Study cohort. Data were used to calculate three epigenetic metrics of biological aging. Overall, 190 of the women sampled were diagnosed and treated for breast cancer between blood draws (diagnoses occurred an average of 3.5 years after the initial blood draw) and 227 remained free of breast cancer.
The researchers found that compared with women who remained cancer-free, those diagnosed and treated for breast cancer had higher biological aging at the second blood draw as measured by all three metrics and after accounting for covariates and biological aging metrics measured at baseline. Radiation had a strong positive association with biological aging in case-only analyses assessing associations with different breast cancer therapies.
"Radiation is a valuable treatment option for breast cancer, and we don't yet know why it was most strongly associated with biological age," a coauthor said in a statement. "This finding supports efforts to minimize radiation exposures when possible and to find ways to mitigate adverse health effects among the approximately 4 million breast cancer survivors living in the United States."
Copyright © 2020 HealthDay. All rights reserved.
Sleep Architecture, Sleep Apnea Affect Global Cognition
TUESDAY, July 25, 2023 (HealthDay News) -- Better sleep consolidation and lack of obstructive sleep apnea (OSA) are associated with better global cognition, according to a study published online July 18 in JAMA Network Open to coincide with the annual Alzheimer's Association International Conference, held from July 16 to 20 in Amsterdam.
Matthew P. Pase, Ph.D., from the Turner Institute for Brain and Mental Health at Monash University in Melbourne, Australia, and colleagues examined the association of sleep architecture and OSA with cognitive function in the Sleep and Dementia Consortium, which curated data from five population-based cohorts across the United States. The pooled analyses without stroke or dementia included 5,946 participants who were followed for five years.
The researchers found that the median wake after sleep onset time varied from 44 to 101 minutes and prevalence of moderate-to-severe OSA varied from 16.9 to 28.9 percent. Across cohorts, better global cognition was seen in association with higher sleep maintenance efficiency and lower wake after sleep onset (pooled β per 1 percent increase, 0.08; pooled β per 1-minute increase, −0.07). Poorer global cognition was seen in association with mild-to-severe OSA (apnea-hypopnea index [AHI] ≥5) versus AHI <5 (pooled β, −0.06); comparable results were seen for moderate-to-severe OSA versus AHI <5 (pooled β, −0.06). There was no association seen for differences in sleep stages with cognition.
"Future Sleep and Dementia Consortium analyses will build upon these findings to further investigate whether and how poor sleep may be associated with cognitive impairment and dementia," the authors write.
Two authors disclosed ties to the pharmaceutical industry.
Copyright © 2020 HealthDay. All rights reserved.
Could AI be an unexpected catalyst for physician burnout?
From enhancing diagnostic precision to streamlining administrative workflows, AI is touted as a solution to many of health care’s long-standing inefficiencies. Yet, the transformative power of AI is a double-edged sword, and its integration may bear unintended repercussions for not only patients but also physicians.
Physician burnout, a pervasive issue characterized by emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment, remains an escalating concern within the health care industry. This syndrome is particularly pronounced in high-mortality specialties such as oncology and veterinary medicine, where the emotional toll of the practice is exacerbated by the more frequent reality of patient loss (and daily within veterinary medicine). With its potential to enhance efficiency, support physicians in simpler cases, and automate certain aspects of their workflows, AI is widely regarded as a possible solution to address the burnout crisis in health care. It could alleviate some of the burden on physicians, freeing them to see more patients, focus on other relevant tasks, or spend time on wellness.
Though we are optimistic about the future of AI in health care, it is worth considering, could AI potentially increase physician burnout instead? As AI evolves and improves, physicians may find themselves confronting an escalating amount of time spent on complex, high-risk tasks without the mental breaks of simpler cases. This shift could inadvertently increase emotional and cognitive load as they grapple with a greater frequency of complex cases and interactions. Could AI, in mitigating one aspect of physicians’ stress, inadvertently amplify another, leading to an overall intensification of burnout rates?...Read more
What do you think? Could AI increase physician burnout?
