Acute stroke: pathophysiology, diagnosis, and treatment

Stroke, a neurologic event due to altered cerebral circulation, is the third leading cause of death in the United States. Risk factors for stroke include hypertension, family history, and diabetes mellitus. The subtypes of stroke are ischemia, infarction, and hemorrhage. Ischemia and infarction are the result of atherosclerotic development of thrombi and emboli. Decreased and/or absent cerebral circulation causes neuronal cellular injury and death. Intracerebral hemorrhage occurs from rupture of cerebral vessels often as the result of hypertension. Patient assessment and diagnosis include the use of computed tomography scans, magnetic resonance imaging, and the National Institute of Health Stroke Scale, and treatment depends on the etiology of the stroke. Thrombolytic therapy is the mainstay of treatment for thrombotic and embolic events. Current recommendations for future stroke care include the development of designated stroke centers. Directions for research in stroke treatment includes examining neuroprotective therapies.     

Ethics, technology, and the high cost of dying: a public forum

To increase public awareness of the complexity of the issues surrounding care for the terminally ill, a county medical society and a local hospital council co-sponsored a public forum in October 1985. Panel members discussed the case of a terminally ill cancer patient from the medical, psychologic, economic, legal, and family perspectives. Panel members stressed the importance of helping the dying person to choose the preferred treatment and to achieve an emotionally satisfying death. The audience responded by pointing out the barriers to achieving death with dignity, which include poverty, lack of social support, and difficulty in facing and talking about death. In an evaluation questionnaire, the audience indicated that the emotional aspects and the communication problems involved in care for the terminally ill caused them more concern than the legal and ethical issues.     

2004-2008年贵州省独山县住院死亡病例根本死因分析

目的了解2004-2008年贵州省独山县住院死亡病例的死因模式。方法对独山县人民医院2004-2008年296例死亡病例进行根本死因统计分析。结果住院死亡病例占同期出院病例（39 465例）的0.75%;男性死亡193例,女性103例,男女性别比为1.87∶1;5岁以下69例（23.31%）,其中新生儿34例（占5岁以下的49.28%）;5～19岁25例（8.45%）;20～49岁96例（32.43%）;50～69岁59例（19.93%）;70岁以上47例（15.88%）。根本病因以伤害而死亡的人数位居各系统疾病死亡之首,其次是神经系统疾病、呼吸系统疾病、起源于围生期某些情况、循环系统疾病等。结论伤害对人类健康影响日益突出,心脑血管疾病死亡逐年增多,呼吸系统疾病、起源于围生期某些情况不可忽视,针对住院死亡主要成因,积极开展伤害防范、慢性病三级预防、加强妇幼保健工作和提高新生儿疾病诊治水平,是当地当前卫生工作的主要任务。     

Cholesterol, cholesterol lowering agents/statins, and urologic disease: part I - knowing your numbers

Educating patients on the basic cardiovascular disease (CVD) risk markers such as cholesterol can be difficult in any medical setting, but especially in urology where patients are being evaluated for non-cardiovascular conditions. Primary reasons for discussing cholesterol or cardiac risk factors and assessment in urology include (a) the primary cause of death of men and women in the United States and most countries around the world is CVD; (b) the primary or secondary cause of death from the largest cancer prevention trials (high or average risk) is CVD; (c) the primary or secondary cause of death in men with prostate cancer is CVD; (d) there may be a correlation in some of the mechanisms that contribute to CVD and mechanisms that contribute to numerous urologic conditions, such as benign prostatic hyperplasia, bladder cancer, erectile dysfunction, female sexual dysfunction, kidney cancer, and prostate cancer; and (e) one of the better methods to monitor the success of lifestyle changes for the patient in urology is to monitor these CVD markers, as is the case in some lifestyle studies of men with prostate cancer.     

"Fret no more my child ... for I'm all over heaven all day": religious beliefs in the bereavement of African American, middle-aged daughters coping with the death of an elderly mother

This article examines the ways in which religious beliefs of 30 African American, middle-aged daughters help them cope with the death of their elderly mothers. This qualitative, exploratory study found that daughters use their beliefs to move through states of grief that allow them to prepare, relinquish control, accept death, and maintain a connection to their mothers beyond death. Important themes identified in this study include the belief in an afterlife and the reunification of family members there. Findings suggest that religious beliefs provide a means for adult daughters to cope with the tasks of living in the present yet maintain a tie with their deceased mothers that serves to enhance their religious beliefs and fortitude in daily living.     

Pneumonia in the long-term care setting: etiology, management, and prevention

1.Nursing-home acquired pneumonia (NHAP) is a major cause of death and disability among elderly nursing home residents, despite the availability of new antimicrobials and diagnostic techniques. 2. Elderly individuals with NHAP have vague clinical presentations and unique institutional limitations can lead to delays in diagnosis, treatment, and poor resident outcomes. 3. Successful management of the resident with pneumonia includes choice of antibiotic therapy, excellent nursing care, and thoughtful consideration of treatment setting. 4. Preventive strategies to reduce the risk of NHAP include attention to vaccination status and oral hygiene care to reduce bacterial colonization of potential respiratory pathogens.     

Predictors of Complicated Grief: A Systematic Review of Empirical Studies

A systematic review of the literature on predictors of complicated grief (CG) was undertaken with the aim of clarifying the current knowledge and to inform future planning and work in CG following bereavement. Predictors of CG prior to the death include previous loss, exposure to trauma, a previous psychiatric history, attachment style, and the relationship to the deceased. Factors associated with the death include violent death, the quality of the caregiving or dying experience, close kinship relationship to the deceased, marital closeness and dependency, and lack of preparation for the death. Perceived social support played a key role after death, along with cognitive appraisals and high distress at the time of the death. Inconsistent definitions of CG and measurement tools were noted in the earlier studies reviewed. Limitations identified in the studies included use of cross-sectional designs, heterogeneous samples, high attrition, demographic differences between cases and controls, differences in length of time since death, and differences in types of death experienced. Notwithstanding these limitations, some consistent findings have emerged. Further research into conceptualizations of CG in terms of attachment theory and constructivist and cognitive-behavioral concepts of finding purpose and meaning after bereavement is warranted.     

Death influence in clinical practice: A course for graduate students

A course for graduate instruction was designed to provide for analysis and study of the social, cultural, and psychological conditions that influence death in modem society. The course was open to any graduate student with an interest in the topic, xoith enrollment limited to 16 participants. The formal objectives emphasize the cognitive focus of the course, but there is an overall goal of facilitating an integration of intellectual and emotional learnings in relation to death and dying. Methods of instruction include weekly seminars, experiential out-of-class assignments, specific written assignments, and readings. Seminar topics include social values and death in human society, cultural variations and death expectations, death and the family, institutional death: its fortns and effects, life versus death: an occupational dilemma, recovery care versus comfort care: nurses' problems, dying as a Personal experience, effect of dying on social interaction, and unresolved problems and major issues. Follow-up evaluation by questionnaire for students enrolled betiveen 1971 and 1979 produced a response rate of 55.8 percent with a generally favorable evaluation. The instructor made deliberate efforts to use the seminar as a situation for encouraging the integration of emotional and cognitive learnings. A variety of instructional strategies are described.     

Communicable respiratory threats in the ED: tuberculosis, influenza, SARS, and other aerosolized infections

Respiratory infections are the most common communicable infectious diseases. EDs are the front line for patients with respiratory infections because of their acute nature and because the ED is the principal site of health care for those at highest risk. These diseases include influenza, tuberculosis, and measles, together accounting for 25% of infectious causes of death worldwide. These are emerging and biothreat agents that follow the same route of transmission, such as pneumonic plague. We discuss epidemiology, pathogenesis, diagnosis, and treatment of each agent. Emphasis is on the ED's role as a public health prevention arena, with attention to education and disease prevention, early identification of disease in patients at risk, and reduction of illnesses.     

Pulmonary hypertension in the critical care setting: classification, pathophysiology, diagnosis, and management

Pulmonary hypertension (PH) is common in the critical care setting, and may be a target for specific therapy. Moderate degrees of pulmonary hypertension are most often the consequence of acute or chronic heart failure, hypoxemia, or acute pulmonary embolism, and may be relatively rapidly reversible. The consequences of more severe forms of PH, both acute and chronic, can include hypotension; low cardiac output; right heart failure with congestion of the liver, gut, and kidneys; and varying degrees of hypoxemia, each of which can lead to death or severe disability. We review the physiology, definitions, classification, pathogenesis, diagnostic tools, and algorithms for diagnosis and specific treatments for the various causes of PH as seen in the critical care setting.     

The National Lung Screening Trial's Endpoint Verification Process: determining the cause of death

Background

Randomized controlled trials (RCTs) evaluating cancer screening modalities usually employ cause-specific mortality as their primary endpoint. Because death certificate cause of death can be inaccurate, RCTs frequently use review committees to assign an underlying cause of death. We describe the National Lung Screening Trial's (NLST's) death review approach, the Endpoint Verification Process (EVP), which strives to minimize errors in assignment of cause of death due to lung cancer.

Methods

Deaths selected for review include those with a notation of lung cancer on the death certificate and those occurring among participants ever diagnosed with lung cancer. Other criteria that trigger death review include, but are not limited to, death within 6 months of a screen suspicious for lung cancer and death within 60 days of certain diagnostic evaluation procedures associated with a screen suspicious for lung cancer or a lung cancer diagnosis. EVP requires concordance on whether death was due to lung cancer. Deaths are first reviewed by the EVP chair. If concordance is not achieved, the death is next reviewed by an Endpoint Verification Team (EVT) member. If concordance between the chair- and member-assigned cause of death is not achieved, the death is next reviewed by a group of at least three EVT members. Cause of death is assigned at the step in which concordance was achieved, or if necessary, at the team review.

Conclusions

NLST's EVP is designed to produce a highly accurate count of lung cancer deaths.     

Parkinson's: symptoms, treatments and research

Parkinson's is a incurable progressive neurological condition caused by a degeneration of dopamine-producing cells. The most common symptoms of the condition include slowness of movement, tremor and muscle stiffness; other symptoms include sleep difficulties, depression and anxiety. Parkinson's is usually controlled by medication but other treatments and therapies, such as occupational therapy, physiotherapy and speech and language therapy, can also be effective in controlling and managing symptoms. The timing of this medication is key to the successful management of Parkinson's. Delays to initiating medication or missed doses can have serious consequences, and it can take some time for symptoms to stabilize. Research into treatments for Parkinson's and, ultimately, finding a cure for the condition, is ongoing. Parkinson's UK researchers are working on projects to identify the causes of cell death and tests to detect the condition at its earliest possible stage. Current treatments can help to ease the symptoms but none can repair the damage in the brain or slow the progress of the condition; now, Parkinson's UK researchers are working to develop new treatments that can.     

Death influence in clinical practice: A course for graduate students

Abstract

A course for graduate instruction was designed to provide for analysis and study of the social, cultural, and psychological conditions that influence death in modem society. The course was open to any graduate student with an interest in the topic, xoith enrollment limited to 16 participants. The formal objectives emphasize the cognitive focus of the course, but there is an overall goal of facilitating an integration of intellectual and emotional learnings in relation to death and dying. Methods of instruction include weekly seminars, experiential out-of-class assignments, specific written assignments, and readings. Seminar topics include social values and death in human society, cultural variations and death expectations, death and the family, institutional death: its fortns and effects, life versus death: an occupational dilemma, recovery care versus comfort care: nurses' problems, dying as a Personal experience, effect of dying on social interaction, and unresolved problems and major issues. Follow-up evaluation by questionnaire for students enrolled betiveen 1971 and 1979 produced a response rate of 55.8 percent with a generally favorable evaluation. The instructor made deliberate efforts to use the seminar as a situation for encouraging the integration of emotional and cognitive learnings. A variety of instructional strategies are described.     

Abuse across the lifespan: prevalence, risk, and protective factors

The results of abuse may include repeated abuse, chronic pain, and physical and emotional illnesses. For some, the result is death, but others thrive. Males and females are abused at similar rates, but males are more likely to experience physical assault and females are more likely to experience sexual assault. Males and females experience psychological abuse at the same rates and there is evidence that the effects of psychological abuse are as detrimental to long-term functioning as the effects of physical abuse. This article discusses partner violence in adults and adolescents, child maltreatment, and peer abuse in children and adolescents.     

Mechanisms of blast induced brain injuries,experimental studies in rats

Traumatic brain injuries (TBI) potentially induced by blast waves from detonations result in significant diagnostic problems. It may be assumed that several mechanisms contribute to the injury. This study is an attempt to characterize the presumed components of the blast induced TBI. Our experimental models include a blast tube in which an anesthetized rat can be exposed to controlled detonations of explosives that result in a pressure wave with a magnitude between 130 and 260 kPa. In this model, the animal is fixed with a metal net to avoid head acceleration forces. The second model is a controlled penetration of a 2 mm thick needle. In the third model the animal is subjected to a high-speed sagittal rotation angular acceleration. Immunohistochemical labeling for amyloid precursor protein revealed signs of diffuse axonal injury (DAI) in the penetration and rotation models. Signs of punctuate inflammation were observed after focal and rotation injury. Exposure in the blast tube did not induce DAI or detectable cell death, but functional changes. Affymetrix Gene arrays showed changes in the expression in a large number of gene families including cell death, inflammation and neurotransmitters in the hippocampus after both acceleration and penetration injuries. Exposure to the primary blast wave induced limited shifts in gene expression in the hippocampus. The most interesting findings were a downregulation of genes involved in neurogenesis and synaptic transmission. These experiments indicate that rotational acceleration may be a critical factor for DAI and other acute changes after blast TBI. The further exploration of the mechanisms of blast TBI will have to include a search for long-term effects.     

Hypokalemic paralyses: a review of the etiologies, pathophysiology, presentation, and therapy.

Acute hypokalemic paralysis is an uncommon cause of acute weakness. Morbidity and mortality associated with unrecognized disease include respiratory failure and death. Hence, it is imperative for physicians to be knowledgeable about the causes of hypokalemic paralysis, and consider them diagnostically. The hypokalemic paralyses represent a heterogeneous group of disorders with a final common pathway presenting as acute weakness and hypokalemia. Most cases are due to familial hypokalemic paralysis; however, sporadic cases are associated with diverse underlying etiologies including thyrotoxic periodic paralysis, barium poisoning, renal tubular acidosis, primary hyperaldosteronism, licorice ingestion, and gastrointestinal potassium losses. The approach to the patient with hypokalemic paralysis includes a vigorous search for the underlying etiology and potassium replacement therapy. Further therapy depends on the etiology of the hypokalemia. Disposition depends on severity of symptoms, degree of hypokalemia, and chronicity of disease.     

The non-insulin-dependent diabetes, hypertension, microalbuminuria or proteinuria, cardiovascular events, and ramipril (DIABHYCAR) study: design, organization, and patient recruitment. DIABHYCAR Study Group

The non-insulin-dependent DIABetes, HYpertension, microalbuminuria or proteinuria, CARdiovascular events, and Ramipril (DIABHYCAR) study is a randomized, prospective, double-blind, placebo-controlled, multicenter international trial of the ACE inhibitor ramipril (1.25 mg/day) in patients with type II diabetes and micro- or macroalbuminuria. The main outcome of the study is the time to first occurrence of either death from a cardiovascular origin, including sudden death, nonfatal myocardial infarction, stroke, or congestive heart failure, or requirement of hemodialysis or renal transplantation. The study was launched in France in early 1995 with the participation of general practitioners only, but had to be extended to 15 other countries in 1997 due to difficulties in recruitment. Since 2.5 years after the beginning of the trial the observed event rate was much less than anticipated, it was decided to increase recruitment and follow-up duration and to include congestive heart failure in the definition of the main outcome to keep the study power at a satisfactory level. Recruitment ended on April 1, 1998 with 4937 randomized patients. Following the early discontinuation for efficacy of another study of ramipril in high cardiovascular risk patients, the Heart Outcomes Prevention Evaluation study (HOPE), the second interim analysis of DIABHYCAR was performed early (when 406 instead of 500 patients presented a main outcome) and the Data Safety and Monitoring Board recommended that the study continue. Follow-up is planned to end on March 31, 2001.     

Addiction: Part I. Benzodiazepines--side effects, abuse risk and alternatives

Benzodiazepines are widely prescribed for a variety of conditions, particularly anxiety and insomnia. They are relatively safe and, with overdose, rarely result in death. However, used chronically, benzodiazepines can be addicting. These agents are often taken in combination with other drugs of abuse by patients with addiction disorders. In such patients, alternatives to benzodiazepines may be preferable and may include antidepressants, anticonvulsants, buspirone, antihypertensive agents and the newer neuroleptic medications. Caution must be used when prescribing benzodiazepines to patients with a current or remote history of substance abuse.     

Breast, stomach and colorectal cancer screening in Korea

Some issues and activities in cancer screening in Korea are briefly described, in particular those in stomach, breast and colorectal screening. There is randomized trial evidence for the efficacy of screening for breast cancer and colorectal neoplasia. Stomach cancer screening is as yet unproven, but the disease is very common in Korea and one of the leading causes of death. There are major related issues to be addressed by the country in the near future. These include improving uptake and coverage rates, quality control and evaluation. Colorectal cancer will be a major concern as its incidence and mortality rates have been increasing rapidly in recent years.     

Toward a comprehensive model of death anxiety

An integrative, comprehensive model of death anxiety is presented. The model postulates three immediate antecedents of death anxiety: past-related regret, future-related regret, and meaningfulness of death. Past-related regret refers to a person's unfulfilled aspirations that should have been achieved but were not. Future-related regret refers to the anticipation that, as a result of premature death, one cannot achieve important goals in the future. Meaningfulness of death refers to one's concept of death and ability to make sense of it. These three antecedents are related to death salience in a complex way, mediated by coping mechanisms and their effects on one's beliefs about self and the world. The coping mechanisms include (but are not necessarily limited to) life review, life planning, identification with culture, and self-transcending processes. The model's developmental and practical applications are explored.