ABSTRACT
BACKGROUND: Women's reflections on existential meaning-making in relation to giving birth may seem indistinct in maternity services and have not been thoroughly explored in secular contexts. However, research suggests that childbirth accentuates spiritual and existential considerations and needs even in secular contexts highlighting the importance of care for such needs in maternity care practices. The objectives of this study were two-fold: Firstly, to explore how first-time mothers, living in a secular context, experience their first birth in relation to existential meaning-making. Secondly, to describe the relationship between existential meaning-making reflections and gestational week at birth. METHODS: A nationwide cross-sectional study in Denmark based on the questionnaire "Faith, existence and motherhood" was conducted in 2011. Eight core items related to birth experience informed this study. The cohort was sampled from the Danish Medical Birth Registry and consisted of 913 mothers having given birth 6-18 months previously. Twenty-eight per cent had given birth preterm (PT) and 72% had given birth at full-term (FT). A total of 517 mothers responded. RESULTS: In relation to the birth of their first child, both FT and PT mothers answered, that they had existential meaning-making reflections. The consent to the 8 items ranged from 17 to 73% among FT mothers and from 19 to 58% among PT mothers. Mothers who gave birth preterm mainly identified the negative aspects of birth, whereas mothers, who gave birth at full-term, to a higher degree identified positive aspects. CONCLUSIONS: Findings suggest that not only traumatic birth events accentuate existential reflections, but that even normal childbirth to most mothers is an existential event. However, the quality of existential reflections differs when comparing normal and traumatic birth. The study points towards change in education and organization of maternity care to better care for existential needs and reflections specific to every new mother and birthing woman.
Subject(s)
Existentialism , Mothers , Parturition , Premature Birth , Spirituality , Adult , Cross-Sectional Studies , Existentialism/psychology , Female , Humans , Mothers/psychology , Mothers/statistics & numerical data , Parturition/psychology , Pregnancy , Premature Birth/psychology , Surveys and QuestionnairesABSTRACT
Formation of an intestinal pharmacobezoar is a rare condition. It may form after intake of various oral pharmaceutical preparations of drugs, both as a result of an acute overdose and through chronic use of therapeutic doses of a drug. We report a case with a patient presenting with an oesophageal pharmacobezoar and complete obstruction of the oesophagus and severe toxic symptoms and death related to oral ingestion of multiple drugs.
Subject(s)
Bezoars , Esophageal Stenosis/chemically induced , Esophagus , Aged, 80 and over , Autopsy , Drug Overdose , Esophageal Stenosis/diagnostic imaging , Esophageal Stenosis/therapy , Fatal Outcome , Humans , Male , Suicide, Attempted , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: This study was conducted to investigate whether point-of-care (POC) procalcitonin (PCT) measurement can reduce redundant antibiotic treatment in patients hospitalized with acute exacerbation of COPD (AECOPD). METHODS: One-hundred and twenty adult patients admitted with AECOPD were enrolled in this open-label randomized trial. Patients were allocated to either the POC PCT-guided intervention arm (n=62) or the control arm, in which antibiotic therapy followed local guidelines (n=58). RESULTS: The median duration of antibiotic exposure was 3.5 (interquartile range [IQR] 0-10) days in the PCT-arm vs 8.5 (IQR 1-11) days in the control arm (P=0.0169, Wilcoxon) for the intention-to-treat population. The proportion of patients using antibiotics for ≥5 days within the 28-day follow-up was 41.9% (PCT-arm) vs 67.2% (P=0.006, Fisher's exact) in the intention-to-treat population. For the per-protocol population, the proportions were 21.1% (PCT-arm) vs 73.9% (P<0.00001, Fisher's exact). Within 28-day follow-up, one patient died in the PCT-arm and two died in the control arm. A composite harm end point consisting of death, rehospitalization, or intensive care unit admission, all within 28 days, showed no apparent difference. CONCLUSION: Our study shows that the implementation of a POC PCT-guided algorithm can be used to substantially reduce antibiotic exposure in patients hospitalized with AECOPD, with no apparent harm.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Calcitonin/blood , Clinical Decision-Making , Hospitalization , Lung/drug effects , Point-of-Care Systems , Point-of-Care Testing , Pulmonary Disease, Chronic Obstructive/drug therapy , Aged , Aged, 80 and over , Algorithms , Biomarkers/blood , Denmark , Disease Progression , Drug Administration Schedule , Drug Resistance, Bacterial , Female , Guideline Adherence , Humans , Lung/physiopathology , Male , Middle Aged , Patient Selection , Practice Guidelines as Topic , Predictive Value of Tests , Pulmonary Disease, Chronic Obstructive/blood , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/physiopathology , Time Factors , Treatment Outcome , Unnecessary ProceduresABSTRACT
PURPOSE: We sought to investigate whether preadmission quality of life could act as a predictor of mortality among patients admitted to the intensive care unit (ICU). MATERIALS AND METHODS: This is a prospective observational study of all patients above the age of 18 years admitted to the ICU with a length of stay longer than 24 hours. Short form 36 (SF-36) and Acute Physiology and Chronic Health Evaluation II (APACHE II) were used. Mortality was assessed during ICU admission, 30, and 90 days hereafter. RESULTS: We included 318 patients. No patients were lost to follow-up. Using the physical component summary of short form 12 (SF-12) as a predictor of ICU mortality, the area under the curve (0.70; confidence interval, 0.62-0.77) was comparable with that of APACHE II (0.74; confidence interval, 0.67-0.82). The difference between SF-12 and SF-36 was nonsignificant. CONCLUSIONS: Preadmission quality of life, assessed by SF-36 and SF-12, is as good at predicting ICU, 30-, and 90-day mortality as APACHE II in patients admitted to the ICU for longer than 24 hours. This indicates that estimated preadmission quality of life, potentially available in the pre-ICU setting, could aid decision making regarding ICU admission and deserves more attention by those caring for critically ill patients.
Subject(s)
Critical Care , Health Status , Hospital Mortality , Quality of Life , Survivors/statistics & numerical data , APACHE , Aged , Aged, 80 and over , Alcohol Drinking/epidemiology , Area Under Curve , Cohort Studies , Confidence Intervals , Critical Illness , Decision Making , Female , Humans , Intensive Care Units , Length of Stay , Male , Middle Aged , Patient Admission , Prospective Studies , Surveys and Questionnaires , Young AdultABSTRACT
The prognostic significance of eosinophilia after myeloablative allogeneic stem cell transplantation (ASCT) remains to be established. Patients, whom developed chronic graft-versus-host disease (cGVHD) after ASCT, were included (n = 142). Eosinophil count was analyzed at cGVHD onset. We observed no significant association between EO and the grade of cGVHD, thrombocytopenia, nor extensive skin involvement. Importantly, we observed no significant association between cGVHD with concomitant eosinophilia and long-term clinical outcomes, and subgroup analyses revealed a considerable confounding effect of ongoing steroid treatment. In conclusion, we advocate that prognostic conclusions regarding cGVHD with concomitant eosinophilia after ASCT should be interpreted with caution.
