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Healthcare Payment Systems
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
The underlying disease state or condition of a patient determines the SOI and ROM scores.5 Higher SOI and ROM scores are assigned to patients with multiple serious diseases and the interactions between those diseases. Severity of Illness refers to the extent of physiological decompensation or organ damage and loss of function. Risk of Mortality refers to a patient’s risk of dying. There are four classifications: – Minor– Moderate– Major– Extreme
Specialist ServicesAcute Inpatient
Published in Cathy Laver-Bradbury, Margaret J.J. Thompson, Christopher Gale, Christine M. Hooper, Child and Adolescent Mental Health, 2021
When a young person with severe mental illness has difficulties that cannot be managed by family or community services, they may require admission to an inpatient psychiatric unit. The usual reasons for an inpatient stay include: The severity of illness.The risk to self, usually suicide/self-harm, or to others.When there is uncertainty about diagnosis and a period of assessment is required.When treatment options in the community have been exhausted and it is felt that a more intensive approach may be of benefit.The need to try complex medication regimes such as Clozapine which is an atypical antipsychotic requiring close monitoring and weekly blood tests.
Control Risk Regression
Published in Christopher H. Schmid, Theo Stijnen, Ian R. White, Handbook of Meta-Analysis, 2020
Annamaria Guolo, Christopher H. Schmid, Theo Stijnen
Heterogeneity of treatment effects across studies is a consequence of differences among studies arising from a variety of sources including study designs, patient characteristics, and types of interventions. As noted in Chapter 7, meta-regression can help quantify the contributions of these patient, study, and design factors to the overall heterogeneity. Unfortunately, not all sources of heterogeneity are always measured and available, but some may be related to differences in how severely ill patients in each study are. Severity of illness can often be approximated by the underlying risk with which outcomes occur in a given study. In such cases, the proportion or rate of events in the control or reference group may serve as a useful surrogate for the underlying, latent risk (Brand and Kragt, 1992; Schmid et al., 1998, 2004; van Houwelingen et al., 2002; Chaimani, 2015). The inclusion of the control risk in meta-analysis gives rise to what is called control risk regression.
Bodies in lockdown: Young women’s narratives of falling severely ill with ME/CFS during childhood and adolescence
Published in Health Care for Women International, 2023
Silje Helen Krabbe, Anne Marit Mengshoel, Wenche Schrøder Bjorbækmo, Unni Sveen, Karen Synne Groven
The second narrative, “Gradually developing unhomeliness and being pushed toward the edge”, illustrates how participants became more and more aware of their illness. Although the severity of illness fluctuates, these fluctuations are unpredictable, and over time there is a downward spiral of becoming worse. Participants’ being-in-the-world gradually becomes less and less familiar. Despite this, the women, being just children or adolescents at the time, seek to maintain an ordinary life and normal activities as per the advice they receive from physicians and other people around them. At the same time, the process of falling ill is experienced as an alternation of feelings of ‘homelikeness’ and of feeling more and more ‘unhomelike’ being in the world (Svenaeus, 2011). However, this understanding is not acknowledged by others, who tend to disregard participants’ lived experiences. Instead of being helped to understand the meaning of their pain and exhaustion, participants are told to ignore their unfamiliar body. They now try to suppress what their bodies, now at the forefront of their attention, are telling them. They live in an unfamiliar world of pain and intense exhaustion: what Leder (1990) describes as a bodily dys-appearance.
Elevated sTREM2 and NFL levels in patients with sepsis associated encephalopathy
Published in International Journal of Neuroscience, 2023
Günseli Orhun, Figen Esen, Vuslat Yilmaz, Canan Ulusoy, Elif Şanlı, Elif Yıldırım, Hakan Gürvit, Perihan Ergin Özcan, Serra Sencer, Nerses Bebek, Erdem Tüzün
This prospective observational study was conducted in an adult multidisciplinary ICU. Patients were enrolled at our institution between January 2015 and December 2015. SAE was defined as acute alterations in the neurologic status due to sepsis that is out of keeping with the degree of any sedative treatment. These alterations included the altered mental status (delirium or coma), clinically detectable or electroencephalographic seizures, and focal neurological deficits. Consecutive 11 patients with severe sepsis and septic shock, as per relevant criteria [21], who were spending not less than 48 h in the ICU and had an acute-onset encephalopathy were enrolled. Patients with any preexisting central nervous system disease or a medical history suggestive of dementia were excluded. The severity of illness at enrollment was assessed using the Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score 2 (SAPS2) and the Sequential Organ Failure Assessment (SOFA) scores. Neurological recovery was assessed using the extended Glasgow Coma Scale (GOSE) during discharge. Fifteen age and gender-matched primary headache patients with normal CSF cell count and protein concentration values and unrevealing contrast-enhanced brain MRI features were enrolled as control participants. The study was approved by the institutional review board (approval number: 2013/98) and written informed consent was obtained from patients or their surrogates.
Current understanding of the etiology of cyclic vomiting syndrome and therapeutic strategies in its management
Published in Expert Review of Clinical Pharmacology, 2022
Rosita Frazier, Thangam Venkatesan
A multidisciplinary approach with a biopsychosocial care model is recommended in patients with CVS, like other DGBIs. Management consists of a combination of lifestyle measures, pharmacotherapy, and addressing comorbid conditions like anxiety, depression, and autonomic dysfunction [56]. The goals for therapeutic interventions are to lengthen symptom-free intervals, reduce the frequency and severity of episodes, improve quality of life, and restore the patient to as normal functioning. Pharmacological intervention is based on the severity of illness. Prophylactic and abortive medications used in CVS are summarized in Table 2. While there are no validated tools to assess the severity of illness, experts have relied on arbitrary criteria based on th duration and frequency of illness, the need for hospitalization or acute care in the ED, and the impact on activities of daily living. An algorithm for the management of CVS as recommended by recent guidelines in the management of CVS is shown below in Figure 3 [56].