Family and Staff Perspectives on Service Use for Individuals With Intellectual Disabilities in Crisis

Carers of individuals with an intellectual disability are often responsible for managing their children's psychiatric crises when they arise. The purpose of this study was to examine the experiences of families using crisis and short-term transitional supports from the perspectives of families and of crisis and transitional support staff. Three focus groups were conducted. Families and staff were asked to discuss their positive experiences and challenges when accessing and utilizing crisis and transitional support services. Families and staff spoke about their positive experiences with crisis and transitional supports, the staff characteristics that enabled these positive experiences, the challenges they encountered with crisis and transitional support services as well as the general service system, and the impact that these service limitations had on families. Findings highlight the importance of understanding family needs in order to help them address crises before, during, and after they occur.     

Risk of adrenal crisis in dental patients: Results of a systematic search of the literature

BackgroundThe authors performed a systematic search of the literature to identify the frequency of, risk of experiencing and factors associated with adrenal crises in dental patients.MethodsThe authors searched PubMed and Ovid MEDLINE (1947-June 20, 2012) and Embase (1974-2012) for English-language articles related to cases of adrenal crisis in dentistry and extracted and analyzed data from the articles. The six authors determined whether the cases identified met a consensus definition of adrenal crisis.ResultsOf 148 articles identified in the initial screening, 34 articles were included in the final review, from which six cases met the criteria of adrenal crisis. The authors categorized four cases as “suggestive of adrenal crisis” and two cases as “consistent with adrenal crisis.” Risk factors were significant adrenal insufficiency, pain, infection, having undergone an invasive procedure, having received a barbiturate general anesthetic, and poor health status and stability at the time of presentation. The authors estimated risk to be less than one in 650,000 in patients with adrenal insufficiency.ConclusionsAdrenal crisis is rare in dental patients, with only six reports of it having been published in the past 66 years. Risk is associated with unrecognized adrenal insufficiency, poor health status and stability at the time of treatment, pain, infection, having undergone an invasive procedure and having received a barbiturate general anesthetic.Clinical ImplicationsRisk of adrenal crisis is reduced through proper evaluation of the patient, identification of risk factors and following appropriate preventive measures.     

Clinical profile and outcome of myasthenic crisis in a tertiary care hospital: A prospective study

Background:

The present understanding of the clinical course, complications, and outcome of myasthenic crisis (MC) is based chiefly on observational studies and retrospective case series.

Aim:

To study the baseline demographic and clinical variables, risk factors, complications, outcome, and mortality in patients of MC.

Materials and Methods:

All patients of myasthenia gravis (MG) who presented with myasthenic crisis between July 2009 and December 2010 were included.

Results:

Ten patients of MC were included in this study. The median age of the patients was 40.5 years (range 14-71 years). Seven were females and three were males. Nine had generalized MG and one patient had oculobulbar involvement only. Median duration of disease was 3 years (range 1 month to17 years). Two patients had thymoma. Two patients had history of thymectomy in the past. Infection was the most common triggering factor accounting for five cases (50%) followed by inadequate treatment/drug withdrawal in three (30%) and steroid initiation and hypokalemia in the remaining two patients (20%). Median duration of MC was 12 days (range 3-28 days). Mortality was in 3 out of 10 (30%) during MC. Management in the intensive care unit (ICU) and treatment with plasma exchange/intravenous immunoglobulins were associated with good outcome.

Conclusions:

Ventilator support and management in intensive care unit are the most important components in the management of MC. The high mortality rate seen in present study may be more reflective of the actual ground reality in resource constrained developing countries, however, larger prospective studies are needed to confirm these findings.     

Psychosocial Development in South Korean Couples and Its Effects on Marital Relationships

This study explored psychosocial development in South Korean couples and its impact on their marital satisfaction and marital crisis. A sample of 100 cohabiting married Korean couples (n?=?200) and 100 premarital couples (n?=?200) participated in this study. Findings showed that partners in same-couple relationships were more likely to reach the same stages of psychosocial development. Married couples displayed different levels of marital satisfaction and marital crisis depending on which stage of psychosocial development they found themselves in. The results of this study also revealed that partners who successfully resolved psychosocial developmental tasks and conflicts had higher marital satisfaction and lower marital crisis. Implications for practice and future research are discussed.     

生物剂量估算技术在核与辐射事故医学救援中的应用

核与辐射事故医学救援中,对事故人员进行分类诊断可使医疗资源得以充分利用,从而大大提高救援效率。生物剂量估算技术是目前判断外照射放射损伤程度的有效方法。利用生物剂量估算技术进行受照人员的分类诊断,对核与辐射事故医学救援的高效、有序具有重要意义。该文针对现有生物剂量估算技术的特点及其在核与辐射事故医学救援分类诊断中的应用进行了分析讨论。     

Variable hemodynamic response to sodium nitroprusside in hypertensive crisis

Five patients, three males and two females, admitted with severe hypertensive crisis underwent hemodynamic investigations before and during vasodilator therapy with sodium nitroprusside. In three hypervolemic patients with congestive heart failure and/or renal insufficiency, the drug induced a rapid fall in systemic arterial pressure and a beneficial effect on cardiac performance, as shown by a shift of the ventricular function curves to the left. In two hypovolemic patients, the hemodynamic response was quite different; vasodilator therapy induced a confusing clinical picture characterized by significant fluctuations in blood pressure, a severe fall in cardiac output and clinical signs of shock in spite of normal blood pressure. Hemodynamic response to vasodilator therapy with sodium nitroprusside in hypertensive crisis appears to be directly related to the circulating blood volume. The syndrome of hypertension associated with hypovolemia needs to be recognized promptly in order to avoid inappropriate therapyl; in such cases volume expansion under precise hemodynamic monitoring appears to be an effective means of stabilizing the cardiocirculatory conditions.