1/9. Fatal aspergillus myocarditis following short-term corticosteroid therapy for chronic obstructive pulmonary disease.A 58-y-old man with chronic obstructive pulmonary disease (COPD) was admitted for treatment of an acute exacerbation of his illness. The patient's condition initially improved after therapy with oxygen, bronchodilators, antibiotic and methylprednisolone (40 mg every 8 h) was started. Soon afterwards, however, the patient's clinical status deteriorated and he died on the fifth hospital day. Post-mortem examination revealed unsuspected, isolated fungal myocarditis. The fungus was later identified as aspergillus by indirect immunofluorescence. To our knowledge, this is the first case of fatal aspergillus myocarditis related to short-term (< 1 week) steroid therapy in a COPD patient. We believe that this case provides further evidence to support the possibility of life-threatening infections in COPD patients who receive even a short course of corticosteroid treatment.- - - - - - - - - - ranking = 1keywords = illness (Clic here for more details about this article) |
2/9. Storytelling and the interpretation of meaning in qualitative research.AIM: This paper reviews literature on narrative analysis and illustrates the meaning-making function of stories of chronic illness through analysis and discussion of two case studies from a study of acute episodes of chronic obstructive pulmonary disease (COPD). BACKGROUND: Individuals living with COPD experience acute exacerbations characterized by extreme dyspnea, but there has been little research to provide understanding of these events from the perspectives of individuals with COPD, family caregivers, and nurses. Narrative analysis -- considered in the context of the aims of qualitative research -- illuminates how these people make sense of acute exacerbation events by telling stories. DESIGN AND methods: In an ethnographic study, 10 patient-family nurse units in two Canadian general hospitals participated in interviews concerning acute episodes of COPD. Narrative analysis enabled identification of several story forms and their functions. RESULTS: Examples were found of a story told twice with different meanings, and of a patient's 'death story' used to communicate distrust of the nurse's ability to recognize the seriousness of distress and implications for its potential course. These examples are presented, and interpreted with respect to issues of meaning. CONCLUSIONS: The analysis indicates that stories told by patients in the context of nurse-client interactions inform understanding of the individual's acute exacerbation events beyond the biophysical.- - - - - - - - - - ranking = 6802.3089655281keywords = chronic illness, illness (Clic here for more details about this article) |
3/9. Withdrawal of life support: intensive caring at the end of life.The technology and expertise of critical care practice support patients through life-threatening illnesses. Most recover; some die quickly; others, however, linger--neither improving nor acutely dying, alive but with a dwindling capacity to recover from their injury or illness. Management of these patients is often dominated by the question: Is it appropriate to continue life-sustaining therapy? patients rarely participate in these pivotal discussions because they are either too sick or too heavily sedated. As a result, the decision often falls to the family or the surrogate decision maker, in consultation with the medical team. Decisions of such import are emotionally stressful and are often a source of disagreement. Failure to resolve such disagreements may create conflict that compromises patient care, engenders guilt among family members, and creates dissatisfaction for health care professionals. However, the potential for strained communications is mitigated if clinicians provide timely clinical and prognostic information and support the patient and family with aggressive symptom control, a comfortable setting, and continuous psychosocial support. Effective communication includes sharing the burden of decision making with family members. This shift from individual responsibility to patient-focused consensus often permits the family to understand, perhaps reluctantly and with great sadness, that intensive caring may involve letting go of life-sustaining interventions.- - - - - - - - - - ranking = 2keywords = illness (Clic here for more details about this article) |
4/9. advance care planning for fatal chronic illness: avoiding commonplace errors and unwarranted suffering.patients with eventually fatal illnesses often receive routine treatments in response to health problems rather than treatments arising from planning that incorporates the patient's situation and preferences. This paper considers the case of an elderly man with advanced lung disease who had mechanical ventilation and aggressive intensive care, in part because his nursing home clinicians did not complete an advance care plan and his do-not-resuscitate order did not accompany him to the hospital. The errors that led to his hospitalization and his unwanted treatment there demonstrate how the ordinary lack of advance care planning is deleterious for patients who are nearing the end of life. We discuss serious, recurring, and generally unnoticed errors in planning for care near the end of life and possible steps toward improvement. Repairing these shortcomings will require quality improvement and system redesign efforts, methods familiar from patient safety initiatives. Reliable improvement will also require making it unacceptable for clinicians to fail to plan ahead for care during fatal chronic illness.- - - - - - - - - - ranking = 34012.54482764keywords = chronic illness, illness (Clic here for more details about this article) |
5/9. Venous thromboembolic risk and prevention in acute medical illness.We describe a case in which an elderly woman is hospitalised for acute medical illness and ask how this patient's risk of venous thromboembolism should be assessed and managed. venous thromboembolism was previously regarded as a surgical problem, but occurs at least as frequently among medical patients. The risk of venous thromboembolism varies, but recent studies have provided detailed data on the risk in patients with acute medical illness, in particular those patients with acute heart failure, respiratory failure and acute infectious disease. As the evidence has accumulated, specific guidelines recommend provision of thromboprophylaxis to patients at risk. An approach to venous thromboembolic risk assessment and prevention in acutely ill medical patients is presented.- - - - - - - - - - ranking = 6keywords = illness (Clic here for more details about this article) |
6/9. critical illness myopathy associated with hyperthyroidism.A 51-year-old woman was admitted to the intensive care unit for exacerbation of chronic obstructive pulmonary disease. She received antibiotics, neuromuscular blocking agents, and steroids. After 8 days in the intensive care unit, she was noted to be severely weak, her serum creatine kinase had risen to 1,692 U/L (normal, 20-220 U/L), and a muscle biopsy was consistent with critical illness myopathy. As a result of evaluating for resting tachycardia, the patient was found to be hyperthyroid. Her weakness rapidly improved within 1 month after treatment of her hyperthyroidism with iodine-131 and methimazole. The metabolic alterations associated with hyperthyroidism may enhance the risk of developing critical illness myopathy after the administration of antibiotics, neuromuscular blocking agents, and steroids in the intensive care unit.- - - - - - - - - - ranking = 6keywords = illness (Clic here for more details about this article) |
7/9. A smoking related triad: PAD, COPD and CCF.BACKGROUND: tobacco smoking is the modifiable risk factor responsible for the greatest burden of disease (loss of health and premature mortality) in australia. OBJECTIVE: This article discusses the complexities of management of a patient suffering from a smoking related triad of illnesses: peripheral arterial disease, chronic obstructive pulmonary disease and ischaemic heart disease related congestive cardiac failure. DISCUSSION: As well as considering optimal management of the individual conditions, the patient's mental health and overall quality of life needs to be considered. Even at this late stage, smoking cessation is critically important. The patient is likely to require 6-8 medications, creating the potential for interactions and confusion, so careful medication management and patient education is required. The support of a multidisciplinary team will be required, with coordination of care being the key. Care planning and case conferencing between the general practitioner, the patient and other health professionals is essential for optimal care.- - - - - - - - - - ranking = 1keywords = illness (Clic here for more details about this article) |
8/9. It takes my breath away: end-stage COPD. Part 1: a case study and an overview of COPD.End-stage chronic obstructive pulmonary disease (COPD) is a progressive illness without a cure. Because of its unpredictable trajectory, prognosis is difficult as, even in end-stage disease, patients may experience exacerbations and stabilization. There are many symptoms to manage until ultimately, respiratory function is severely compromised. Home care nurses provide much of the care at home and can make a difference in promoting advanced care planning and optimal comfort. This article reviews COPD, the management of subsequent symptoms, and the role of the home care nurse.- - - - - - - - - - ranking = 1keywords = illness (Clic here for more details about this article) |
9/9. Putting policy into practice: the example of COPD.Chronic lung disease is one of the commonest reasons for consulting a health professional, and there may be as many as 3 million people in the UK with undiagnosed chronic obstructive pulmonary disease (COPD). This fourth article in a series on long-term conditions examines the policy developments that have been put in place to manage the burden of chronic disease in england and wales, and argues that more remains to be done if COPD is to be properly addressed.- - - - - - - - - - ranking = 3311.4185831961keywords = chronic disease (Clic here for more details about this article) |