Antibiotic therapy for Klebsiella pneumoniae bacteremia: Implications of production of extended-spectrum beta-lactamases

The prevalence of extended-spectrum beta-lactamase (ESBL) production by Klebsiella pneumonia approaches 50% in some countries, with particularly high rates in eastern Europe and Latin America. No randomized trials have ever been performed on treatment of bacteremia due to ESBL-producing organisms; existing data comes only from retrospective, single-institution studies. In a prospective study of 455 consecutive episodes of Klebsiella pneumoniae bacteremia in 12 hospitals in 7 countries, 85 episodes were due to an ESBL-producing organism. Failure to use an antibiotic active against ESBL-producing K. pneumoniae was associated with extremely high mortality. Use of a carbapenem ( primarily imipenem) was associated with a significantly lower 14-day mortality than was use of other antibiotics active in vitro. Multivariate analysis including other predictors of mortality showed that use of a carbapenem during the 5-day period after onset of bacteremia due to an ESBL-producing organism was independently associated with lower mortality. Antibiotic choice is particularly important in seriously ill patients with infections due to ESBL-producing K. pneumoniae.

Physicians' attitudes towards end-of-life decisions: a comparison between seven countries

In the context of an European collaborative research project (EURELD), a study on attitudes towards medical end-of-life decisions was conducted among physicians in Belgium, Denmark, Italy, the Netherlands, Sweden and Switzerland. Australia also joined the consortium. A written questionnaire with structured questions was sent to practising physicians from specialties frequently involved in the care of dying patients. 10,139 questionnaires were studied. Response rate was equal to or larger than 50% in all countries except Italy (39%). Apart from general agreement with respect to the alleviation of pain and symptoms with possible life-shortening effect, there was large variation in support-between and within countries-for medical decision that may result in the hastening of death. A principal component factor analysis found that 58% of the variance of the responses is explained by four factors. 'Country' explained the largest part of the variation of the standardized factor scores. (c) 2004 Elsevier Ltd. All rights reserved.

Desperately seeking donors: The 'saviour siblings' decision in quintaville v human fertilisation embryology authority (UK)

The recent House of Lords decision in Quintavalle v Human Fertilisation and Embryology Authority has raised difficult and complex issues regarding the extent to which embryo selection and reproductive technology can be used as a means of rectifying genetic disorders and treating critically ill children. This comment outlines the facts of Quintavalle and explores how the House of Lords approached the legal, ethical and policy issues that arose out of the Human Fertilisation and Embryology Authority's (UK) decision to allow reproductive and embryo technology to be used to produce a 'saviour sibling' whose tissue could be used to save the life of a critically ill child. Particular attention will be given to the implications of the decision in Quintavalle for Australian family and medical law and policy. As part of this focus, the comment explores the current Australian legislative and policy framework regarding the use of genetic and reproductive technology as a mechanism through which to assist critically ill siblings. It is argued that the present Australian framework would appear to impose significant limits on the medical uses of genetic technology and, in this context, would seem to reflect many of the principles that were articulated by the House of Lords in Quintavalle.

Antibiotic resistance in the intensive care unit: A primer in bacteriology

The clinical use of potent, well-tolerated, broad-spectrum antibiotics has been paralleled by the development of resistance in bacteria, and the prevalence of highly resistant bacteria in some intensive care units is despairingly commonplace. The intensive care community faces the realistic prospect of untreatable nosocomial infections and should be searching for new approaches to diagnose and manage resistant bacteria. In this review, we discuss some of the relevant underlying biology, with a particular focus on genetic transfer vehicles and the relationship of selection pressure to their movements. It is an attempt to demystify the relevant language and concepts for the anaesthetist and intensivist, to explain some of the reasons for the emergence of resistance in bacteria, and to provide a contextual basis for discussion of management approaches such as selective decontamination and antibiotic cycling.

Caring for the Caregiver: Emotional Challenges of Pediatric Palliative Care Nurses

Pediatric Palliative Care (PPC) nurses provide quality-of-life for critically ill children. This paper looks at how PPC nurses cope with caregiver emotions within the conceptual framework of emotional labor and emotional intelligence.

Arteterapia en el final de la vida

El arteterapia permite una aproximación creativa biográfica particularmente valiosa en la etapa final de la vida. La persona enferma presenta múltiples necesidades – físicas, emocionales, sociales y espirituales – que solo una atención holística puede pretender abarcar, tal como lo contempla la filosofía de los cuidados paliativos. El arteterapeuta integrado en el equipo interdisciplinar contribuye a aliviar y acompañar el sufrimiento del paciente y su familia. Se presentan aquí las bases teóricas y la metodología de la intervención, así como el marco sanitario en el cual se inscribe.

Reassembled, Slightly Askew:Composition & Sound Design

Reassembled, Slightly Askew is an autobiographical, immersive audio-based artwork based on Shannon Sickels’ experience of falling critically ill with a rare brain infection and her journey of rehabilitation with an acquired brain injury. Audience members experience Reassembled individually, listening to the audio via headphones while lying on a bed. The piece makes use of binaural microphone technology and spatial sound design techniques, causing listeners to feel they are inside Shannon’s head, viscerally experiencing her descent into coma, brain surgeries, early days in the hospital, and re-integration into the world with a hidden disability. It is a new kind of storytelling, never done before about this topic, that places the listener safely in the first-person perspective with the aim of increasing empathy and understanding. Reassembled… was made through a 5-year collaboration with an interdisciplinary team of artists led by Shannon Sickels (writer & performer), Paul Stapleton (composer & sound designer), Anna Newell (director), Hanna Slattne (dramaturgy), Stevie Prickett (choreography), and Shannon’s consultant neurosurgeon and head injury nurse. It’s development and production has been made possible with the support of a Wellcome Trust Arts Award, the Arts Council NI, Sonic Arts Research Centre, Belfast's Metropolitan Arts Centre, and grants from the Arts & Disability Award Ireland scheme. In its 2015 premiere year, Reassembled had 99 shows across Northern Ireland, including at the Cathedral Quarter Arts Festival (the MAC, Belfast) and BOUNCE Arts & Disability Forum Festival (Lyric Theatre, Belfast). It was awarded 5 stars in the Stage, a Hospital Club h100 Theatre & Performance Award, and been shared at medical conferences and trainings across the UK. It continues to be presented in diverse artistic and educational contexts, including as part of A Nation’s Theatre Festival in 2016 at Battersea Arts Centre in London where it was given 4 star reviews in the Guardian, Time Out London and the Evening Standard. "A real-life ordeal, captured by a daring, disorientating artistic collaboration, which works brilliantly on so many levels…It should be available on prescription.” — The Stage ★★★★★ www.reassembled.co.uk Audio clips and documentary footage available here: http://www.paulstapleton.net/portfolio/reassembled-slightly-askew

Non-invasive diagnosis of pediatric tuberculosis

Thesis (Master's)--University of Washington, 2016-08

Remotivation Therapy

Remotivation refers to a variety of group therapy techniques used with chronically mentally ill patients in inpatient settings to stimulate their communication, vocational, and social skills and interest in their environment (Keane and O’Toole 2003). The National Remotivation Therapy Organization (NRTO) defines remotivation ther- apy (RT) as a small-group therapeutic modality, designed to help clients by promoting self- esteem, awareness, and socialization (National Remotivation Therapy Organization 2003). As the concept itself suggests, remotivation relates to the creation of interest in life, i.e., in a person’s daily activities, talents, hobbies, and social rela- tionships with family and friends.

Remotivation Therapy

Remotivation refers to a variety of group therapy techniques used with chronically mentally ill patients in inpatient settings to stimulate their communication, vocational, and social skills and interest in their environment (Keane and O’Toole 2003). The National Remotivation Therapy Organization (NRTO) defines remotivation ther- apy (RT) as a small-group therapeutic modality, designed to help clients by promoting self- esteem, awareness, and socialization (National Remotivation Therapy Organization 2003). As the concept itself suggests, remotivation relates to the creation of interest in life, i.e., in a person’s daily activities, talents, hobbies, and social rela- tionships with family and friends.

Terminally ill cancer patients’ wish to hasten death

This exploratory study investigated factors associated with the wish to hasten death among a sample of terminally ill cancer patients. Semi-structured interviews conducted on a total of 72 hospice and home palliative care patients were subjected to qualitative analysis using QSRNUDIST. The main themes to emerge suggested that patients with a high wish to hasten death had greater concerns with physical symptoms and psychologica l suffering, perceived themselves to be more of a burden to others, and experienced higher levels of demoralization, while also reporting less confidence in symptom control, fewer social supports, less satisfaction with life experiences and fewer religious beliefs when compared with patients who had a moderate or no wish to hasten death. The implications of these findings will be discussed.