- Pulseless electrical activity following traumatic cardiac arrest: Sign of life or death? [Journal Article]
- IInjury 2019 May 24
- CONCLUSIONS: Following pre-hospital traumatic cardiac arrest, PEA on arrival portends death. Although CWM is associated with survival to admission, it is not associated with meaningful survival. Heroic resuscitative measures may be unwarranted for PEA following pre-hospital traumatic arrest, regardless of CWM.
- The Imperative of Palliation in the Management of Rabies Encephalomyelitis. [Review]
- TMTrop Med Infect Dis 2017 Oct 04; 2(4)
- The aim of this review is to guide clinicians in the practical management of patients suffering from rabies encephalomyelitis. This condition is eminently preventable by modern post-exposure vaccinat…
The aim of this review is to guide clinicians in the practical management of patients suffering from rabies encephalomyelitis. This condition is eminently preventable by modern post-exposure vaccination, but is virtually always fatal in unvaccinated people. In the absence of any proven effective antiviral or other treatment, palliative care is an imperative to minimise suffering. Suspicion of rabies encephalomyelitis depends on recognising the classic symptomatology and eliciting a history of exposure to a possibly rabid mammal. Potentially treatable differential diagnoses must be eliminated, notably other infective encephalopathies. Laboratory confirmation of suspected rabies is not usually possible in many endemic areas, but is essential for public health surveillance. In a disease as agonising and terrifying as rabies encephalomyelitis, alleviation of distressing symptoms is the primary concern and overriding responsibility of medical staff. Calm, quiet conditions should be created, allowing relatives to communicate with the dying patient in safety and privacy. Palliative management must address thirst and dehydration, fever, anxiety, fear, restlessness, agitation, seizures, hypersecretion, and pain. As the infection progresses, coma and respiratory, cardiovascular, neurological, endocrine, or gastrointestinal complications will eventually ensue. When the facilities exist, the possibility of intensive care may arise, but although some patients may survive, they will be left with severe neurological sequelae. Recovery from rabies is extremely rare, and heroic measures with intensive care should be considered only in patients who have been previously vaccinated, develop rabies antibody within the first week of illness, or were infected by an American bat rabies virus. However, in most cases, clinicians must have the courage to offer compassionate palliation whenever the diagnosis of rabies encephalomyelitis is inescapable.
- Ethnic and geographic variations in multimorbidty: Evidence from three large cohorts. [Journal Article]
- SSSoc Sci Med 2018; 211:198-206
- A common characteristic of patients seen at the Veterans Health Administration (VHA) is a high number of concurrent comorbidities (i.e. multimorbidity). This study (i) examines the magnitude and patt…
A common characteristic of patients seen at the Veterans Health Administration (VHA) is a high number of concurrent comorbidities (i.e. multimorbidity). This study (i) examines the magnitude and patterns of multimorbidity by race/ethnicity and geography; (ii) compares the level of variation explained by these factors in three multimorbidity measures across three large cohorts. We created three national cohorts for Veterans with chronic kidney disease (CKD:n = 2,190,564), traumatic brain injury (TBI:n = 167,954) and diabetes-mellitus (DM:n = 1,263,906). Multimorbidity was measured by Charlson-Deyo, Elixhauser and Walraven-Elixhauser scores. Multimorbidity differences by race/ethnicity and geography were compared using generalized linear models (GLM). Latent class analysis (LCA) was used to identify groups of conditions that are highly associated with race/ethnic groups. Differences in age (CKD,74.5, TBI,49.7, DM, 66.9 years), race (CKD,80.9%, TBI,76.4%, DM, 63.8% NHW) and geography (CKD,64.4%, TBI,70%, DM, 70.9% urban) were observed among the three cohorts. Accounting for these differences, GLM results showed that risk of multimorbidity in non-Hispanic blacks (NHB) with CKD were 1.16 times higher in urban areas and 1.10 times higher in rural areas compared to non-Hispanic whites (NHW) with CKD. DM and TBI showed similar results with risk for NHB, 1.05 higher in urban areas and 0.97 lower in rural areas for both diseases. Overall, our results show that (i) multimorbidity risk was higher for NHB in urban areas compared to rural areas in all three cohorts; (ii) multimorbidity risk was higher for Hispanics in urban areas compared to rural areas in the DM and CKD cohorts; and (iii) the highest overall multimorbidity risk of any race group or location exists for Hispanics in insular islands for all three disease cohorts. These findings are consistent among the three multimorbidity measures. In fact, our LCA also showed that a three class LC model based on Elixhauser or Charlson provides good discrimination by type and extent of multimorbidity.
- Psychopathy and Pride: Testing Lykken's Hypothesis Regarding the Implications of Fearlessness for Prosocial and Antisocial Behavior. [Journal Article]
- FPFront Psychol 2018; 9:185
- Despite widespread assumptions that psychopathy is associated with serious and repeated law-breaking, individuals with psychopathic personality traits do not invariably become chronic criminal offend…
Despite widespread assumptions that psychopathy is associated with serious and repeated law-breaking, individuals with psychopathic personality traits do not invariably become chronic criminal offenders. As a partial explanation for this finding, Lykken (1995) ventured that a fearless temperament underlies both psychopathic traits and heroic behavior, and that heroic individuals' early exposure to effective socializing forces such as warm parenting or healthy self-esteem often fosters a characteristic adaption that tends to beget "successful" behaviors, thereby differentiating heroes from convicts. In this study, we investigate relations between psychopathy, principally its fearless dominance dimension, pride, and prosocial and antisocial behavior in a community sample (N = 339). Fearless dominance and self-centered impulsivity components of psychopathy yielded differential relations with authentic and hubristic pride (Tracy and Robins, 2004), such that fearless dominance was significantly positively correlated with both facets of pride while self-centered Impulsivity was significantly negatively correlated with authentic pride and significantly positively correlated with hubristic pride. Further, authentic pride moderated (potentiated) the relation between fearless dominance and transformational leadership, one of the two outcome measures for prosocial behavior employed in our investigation. Authentic pride did not moderate the relations between fearless dominance and either our other measure of prosocial behavior (heroism) or antisocial behavior, nor did positive parenting moderate the relations between psychopathy components and social behavior. Unexpectedly, hubristic pride significantly moderated the relation between impulsive-antisocial features and antisocial behavior in a protective manner.
- Heroic Measures for an American Hero: Attempting to Save the Life of General Douglas MacArthur. [Historical Article]
- ASAm Surg 2017 Dec 01; 83(12):1329-1335
- General Douglas MacArthur was a towering public figure on an international stage for the first half of the 20th century. He was healthy throughout his life but developed a series of medical problems …
General Douglas MacArthur was a towering public figure on an international stage for the first half of the 20th century. He was healthy throughout his life but developed a series of medical problems when he entered his 80s. This article reviews the General's medical care during two separate life-threatening medical crises that required surgical intervention. The first episode occurred in 1960 when MacArthur presented with renal failure due to an obstructed prostate. Four years later after his 84th birthday, MacArthur developed bile duct obstruction from common duct stones. He underwent an uncomplicated cholecystectomy and common duct exploration but developed variceal bleeding requiring an emergent splenorenal shunt. His terminal event was precipitated by strangulated bowel in long-ignored very large inguinal hernias. MacArthur died, despite state-of-the-art surgical intervention, due to renal failure and hepatic coma.
- Psychopathy and heroism in first responders: Traits cut from the same cloth? [Journal Article]
- PDPersonal Disord 2018; 9(4):354-368
- Some scholars have posited that certain traits associated with psychopathy-namely, fearlessness, boldness, and willingness to take risks-are associated with greater engagement in heroic and altruisti…
Some scholars have posited that certain traits associated with psychopathy-namely, fearlessness, boldness, and willingness to take risks-are associated with greater engagement in heroic and altruistic acts; nevertheless, this conjecture has received little empirical attention. We examined the relations among psychopathic traits, heroism, altruism, workplace deviance, and leadership in first-responder (n = 138) and civilian (n = 104) samples recruited by means of an online platform. Across samples, fearless dominance, boldness, sensation seeking, and several other psychopathy-related variables were positively and significantly associated with everyday heroism and altruism. First responders scored significantly higher than did civilians on measures of psychopathy, fearlessness, boldness, heroism, and altruism, and reported significantly greater workplace deviance and participation in leadership activities. Our results support previous suggestions of ties between psychopathic traits, especially fearlessness and heroism, although they leave unresolved the question of why certain antisocial and prosocial behaviors appear to covary. (PsycINFO Database Record
- Recognition and Management of Pediatric Salt Toxicity. [Review]
- PEPediatr Emerg Care 2018; 34(11):820-824
- CONCLUSIONS: The approach to treatment differs between salt toxicity and hypernatremia, focusing on rapid correction of serum osmolality rather than gradual normalization of serum sodium concentrations. Consultation of nephrology and child protection services are strongly recommended in the comprehensive treatment approach.
- Effect of psychotherapy for depression via home telehealth on glycemic control in adults with type 2 diabetes: Subgroup analysis of a randomized clinical trial. [Randomized Controlled Trial]
- JTJ Telemed Telecare 2018; 24(9):596-602
- Objective We evaluated the impact of telemedicine-delivered behaviour activation treatment (BAT) on glycemic control in a subgroup of older adults with diabetes who participated in a randomized contr…
Objective We evaluated the impact of telemedicine-delivered behaviour activation treatment (BAT) on glycemic control in a subgroup of older adults with diabetes who participated in a randomized controlled trial for depression. Research design and methods We randomized older adults with major depression to same-room or telemedicine BAT. Each group received eight weekly sessions. For the subgroup analysis, we identified individuals with type 2 diabetes and obtained hemoglobin A1c at baseline and 12 months' follow-up. We used mixed-effects models (MEM) for repeated measures analysis to compare the longitudinal mean A1c. We estimated model-derived mean A1c values and considered an adjusted model to account for baseline health status. Results We included 90 individuals with type 2 diabetes of the original 241 in the subgroup analysis (43 in telemedicine and 47 in same room). Treatment groups were not significantly different at baseline for demographics, depression, anxiety or A1c levels (telemedicine 6.9 vs. same room 7.3, p = 0.19). Baseline mean A1c for the telemedicine group remained at 6.9 (55 mmol/mol) at 12 months, whereas baseline mean A1c for the same-room group increased to 7.7 (61 mmol/mol). Longitudinal trajectories of model-derived mean A1c indicated a significant main effect of treatment group on mean A1c value at study end (difference = -0.82, 95% CI -1.41, -0.24). Adjusted analyses gave comparable results. Conclusions Telemedicine-delivered BAT was superior to same room in achieving lower mean A1c values in participants with type 2 diabetes, suggesting BAT-delivered via telemedicine is a viable treatment option for adults with diabetes.
- Reducing concussion symptoms among teenage youth: Evaluation of a mobile health app. [Clinical Trial, Phase II]
- BIBrain Inj 2017; 31(10):1279-1286
- CONCLUSIONS: Mobile apps incorporating social game mechanics and a heroic narrative may promote health management among teenagers with unresolved concussion symptoms.
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- Drug information update. Unconventional treatment strategies for schizophrenia: polypharmacy and heroic dosing. [Journal Article]
- BBBJPsych Bull 2017; 41(3):164-168
- The majority of patients respond to antipsychotic monotherapy at standard doses, but a subset of patients will require more heroic measures that include antipsychotic polypharmacy and high-dose monot…
The majority of patients respond to antipsychotic monotherapy at standard doses, but a subset of patients will require more heroic measures that include antipsychotic polypharmacy and high-dose monotherapy. Indeed, research has shown that roughly 30% of patients with psychosis are prescribed multiple antipsychotic medications. We discuss the potential benefits and challenges of these approaches and provide a rationale for why and when they should be utilised.