A Transpersonal Theory of Healing Following Youth Suicide

Youth suicide is a complex and perplexing public health problem. This article presents a brief overview of related literature, describes a transpersonal theory of healing following youth suicide, and provides practice implications. Individual healing is conceptually described as a transpersonal journey characterized by the inter-relationships among three healing patterns: Self-reflection (thinking), Self-care (acting), and Self-transcendence (being). During our interactions with survivors, as professionals, we need to be mindful that we do not inadvertently and prematurely abort the self-transcendent healing pattern. One way of facilitating healing is to be fully present with survivors in each and every moment.     

Care of the adult Hodgkin lymphoma survivor

Of those individuals diagnosed with Hodgkin lymphoma, 85% will survive and may be affected by residual effects of their cancer and its therapy (chemotherapy, radiation therapy, stem cell transplantation). Hodgkin lymphoma survivors are at risk of developing secondary malignancies, cardiovascular disease, pulmonary disease, thyroid disease, infertility, premature menopause, chronic fatigue, and psychosocial issues. These conditions usually have a long latency and therefore present years or decades after Hodgkin lymphoma treatment, when the patient's care is being managed by a primary care provider. This review summarizes these unique potential medical and psychologic sequelae of Hodgkin lymphoma, and provides screening and management recommendations.     

Risks and diagnosis of coronary artery disease in Hodgkin lymphoma survivors

Higher mortality rates are reported because of cardiovascular diseases in individuals living in industrialized areas of the World.In cancer patients,cardiotoxic chemotherapeutic agents and/or mediastinal radiotherapy are additional risk factors for the development of coronary artery disease.An improved survival rate for patients with Hodgkin lymphoma was reported in recent decades.Determining and handling the long-term effects of cancer treatment have become more important nowadays,parallel to the good results reached in survival rates.Mediastinal radiotherapy and cardiotoxic chemotherapeutic agents are routinely used to treat Hodgkin lymphoma but are commonly associated with a variety of cardiovascular complications.Drugs used in cancer treatment and radiotherapy may cause deleterious effects on contractile capacity and conduction system of the heart.Approximately ten years after the completion of all therapies,the cardiovascular disease risk peaks in patients who survived from Hodgkin lymphoma.The value of coronary computed tomography angiography as a diagnostic tool in determining coronary artery disease as early as possible is underlined in this review,in patients who are in remission and carry the risk of coronary artery disease probably because of chemo/radiotherapy used in their treatment.Survivors of Hodgkin lymphoma especially treated with combined chemoradiotherapy at younger ages are candidates for coronary computed tomography angiography.     

Effectiveness of cognitive interventions on cognitive outcomes of adult intensive care unit survivors: A scoping review

BackgroundCognitive impairments have been identified as significant under-recognised negative sequelae of postintensive care syndrome. No treatment guidelines exist for cognitive interventions addressing the devastating consequences of impairments and their potential impact on outcomes of intensive care unit (ICU) survivors.AimThe aim of the study was to identify all available cognitive interventions and measurable outcomes for the cognitive rehabilitation of adult ICU survivors, as reported in published articles. Secondary aims included to critically synthesise existing evidence in improving adult ICU survivors' cognitive outcomes after ICU discharge and to extract implications for future research.MethodsA scoping review was conducted based on a rigorous literature search (CINAHL, Embase, MEDLINE, PubMed, SCOPUS, Cochrane Library, and Google Scholar) using predefined keywords. The protocol was based on current guidelines. Eligibility criteria included published (i) experimental and quasi-experimental studies reporting the effects of cognitive interventions on cognitive outcomes of adult critical illness survivors after hospital discharge and (ii) protocols identifying cognitive interventions with predefined cognitive outcome measures.ResultsSeven studies were included: three experimental studies, two quasi-experimental studies, and two published protocols. Significant heterogeneity in the type of interventions, outcome measures, and assessment tools was noted. Interventions included variations of goal management training and an integrated multidisciplinary model. The setting, delivery, and duration of interventions varied. Cognitive outcomes included variations of global cognitive function and executive function. Overall, the evidence on the effects of cognitive interventions, as compared with routine care, in improving global cognitive function is inconclusive. More evidence support exists with respect to improving executive function.ConclusionAlthough various cognitive intervention approaches have shown some positive effects on outcomes of ICU survivors after hospital discharge, the high risk of bias and high heterogeneity across studies preclude conclusions about the most appropriate post-ICU care to rehabilitate cognitive deficits in critical care survivors. This review highlighted a number of methodological limitations that require further investigation.     

Risk Factors for Frailty in Critical Care Survivors: A secondary analysis

ObjectivesThe purpose of this study was to investigate the prevalence of frailty and its risk factors among critical care survivors who were discharged after receiving treatment in an intensive care unit.MethodsThis was a secondary analysis using data from a methodological study conducted between June and August 2018. The sample included 494 adults who had been admitted to the intensive care unit for more than 48 hours within a year. Only post-intensive care frailty was evaluated using the Kihon Checklist. The sociodemographic and intensive care-related risk factors for frailty were analysed using multivariate logistic regression.ResultsThe prevalence of frailty in the sample was 65.8%. The risk factors for frailty were female sex (adjusted odds ratio [aOR] = 1.68, 95% CI: 1.02–2.78), aged 70 years or older (aOR = 4.16, 95% CI: 2.00–8.65), unemployment (aOR = 2.41, 95% CI: 1.39–4.17) and longer ICU days (aOR = 2.29, 95% CI: 1.35–3.91). Analysis of differences in risk factors according to sex revealed that risk factors for frailty were unemployment and longer ICU length of stay for male and older age for female.ConclusionHealth care providers should be aware of frailty risk factors in female and male patients and provide patient-specific interventions for preventing frailty.     

Physical capacities assessment in critically ill patients: An exploratory study

BackgroundThe severity of muscle weakness after critical illness is very heterogeneous. To identify those patients who may maximally benefit from early exercises would be highly valuable. This implies an assessment of physical capacities, comprised at least of strength measurement and functional tests.ObjectivesThe objective of this study was to investigate the relationship between muscle strength and functional tests in an intensive care unit (ICU) setting.MethodsAdults with ICU length of stay ≥2 days were included. Handgrip strength (HG) and maximal isometric quadriceps strength (QS) were assessed using standardised protocols as soon as patients were alert and able to obey commands. At the same time, their maximal level of mobilisation capabilities and their autonomy were assessed using ICU Mobility Scale (ICU-MS) and Barthel Index, respectively.ResultsNinety-three patients with a median age of 64 [57–71.5] years, body mass index of 26.4 [23.4–29.6] kg/m², and Simplified Acute Physiology Score II of 33 [27.7–41] were included. Absolute and relative QS were, respectively, 146.7 [108.5–196.6] N and 1.87 [1.43–2.51] N/kg. HG was 22 [16–31] kg. The ICU-MS score was 4 [1–5]. A significant positive correlation was observed between HG and absolute QS (r_s = 0.695, p < 0.001) and between HG and relative QS (r_s = 0.428, p < 0.001). The ICU-MS score correlated with HG, with a weak positive relationship (r_s = 0.215, p = 0.039), but not with QS. The ICU-MS score did not statistically differ between the weakest and strongest patients for absolute or relative QS, but was lower in patients with the lowest HG values (p = 0.01). A weak positive correlation was observed between the Barthel Index and muscle strengths (maximum r_s = 0.414, p < 0.001).ConclusionsThe present results suggest that, during ICU stay, there is no strong association between muscle strength and functional test such as the ICU-MS or Barthel Index. Muscle dynamometry and functional tests are probably complementary tools for physical capacities quantification.     

侵华日军鼠疫细菌战幸存者F1抗体血清调查

目的 通过对日军鼠疫细菌战幸存者流行病学资料调查和F1抗体检测分析,为浙江省丽水市历史上鼠疫暴发是日军细菌战所引发提供生物学证据. 方法 通过浙西南侵华日军细菌战档案抢救与保护中心寻访到丽水市36名鼠疫细菌战受害幸存者,采用回顾性个案调查的方法进行流行病学调查,并采集静脉血标本进行鼠疫F1抗体检测. 结果 时隔70年,仍能从当年国民政府诊断为鼠疫患者的25%的幸存者中检测到高滴度F1抗体. 结论 日军细菌战制造了一个严重的细菌污染区,留下长期隐患,给丽水市当地居民带来了巨大的伤害.