Importance of sample volume to the measurement and interpretation of plasma osmolality
ConclusionsThese results demonstrate that Posm measured by freezing point depression will be ~7 mmol/kg higher when using 20 μL vs 250 μL sample volumes. Approximately half of this effect may be due to plasma proteins. Posm sample volume should be carefully considered when calculating the osmole gap or assessing hydration status.
In our complex society, stressful or negative life experiences have typically been considered to induce a substantial change from one set of living conditions to another. Life remodeling, resulting from adversities, involves significant challenges because of the need to adapt to new circumstances. That may often impair the ability to cope with new life settings, exposing the risk of clinical distress and possible long-term psychological illnesses, resulting in symptoms of depression, anxiety, fatigue and stress.
CONCLUSIONS: Associations were found between antidepressants and many other types of drugs for both men and women; indicating comorbidity between depression and other conditions. Further, some of the associations between antidepressants and other drugs were found to be specific among women. Whether this indicates that men and women differ in comorbidity between depression and other conditions cannot be concluded based on this cross-sectional study. However, comorbidity impairs the possibility of recovery; in the somatic condition as well as the depression. Thus, physicians need to be aware that the association between anti...
CONCLUSIONS: Although CLP has expanded over the last three years, somatic and psychiatric departments wish for its further expansion. The service provision is at an acceptable level during the daytime, but not during weekends and holidays. We found that 20% of all referrals are rejected and that 80-90% of all physicians wanted outpatient services for short-term follow-up and for help with undiagnosed, unclear, unexplained, (indeterminate) conditions. DISCUSSION: The service works satisfactorily during ordinary working hours. There is a need to establish outpatient services and to strengthen the services outside these h...
Mark J. Schiller
Zan Wang, Yanmin Shi, Fangfang Liu, Nan Jia, Junya Gao, Xiaomin Pang, Fang Deng
People with advanced medical illness often experience anxiety, feelings of hopelessness and loss of meaning and value of life. Some conclude that their life is not worth living and desire to hasten their deaths. Currently available treatments for depression, anxiety, and spiritual distress often fail to alleviate suffering among people who are seriously ill. Research involving psilocybin and related compounds have shown significant benefit suggesting that this class of drugs may offer therapeutic potential in treating persistent, non-physical suffering.
Latinos with advanced cancer are unlikely to access palliative care and can have high distress. To address this, we adapted and combined two successful interventions, a patient navigator and a counseling intervention. In prior work, the patient navigator intervention increased advance care planning for Latinos, and the counseling intervention reduced depression in a general population using behavioral activation and interpersonal psychotherapy.
Best available data estimates 0.6-0.7 percent of the U.S. population identify as transgender. Transgender people have not only faced societal discrimination, they have also endured discrimination in health care settings. A 2011 survey of 6,500 transgender individuals showed that 19% of respondents reported refusal of medical care, 28% experienced harassment in a medical setting, and 50% interacted with providers who had a complete lack of understanding of the care they needed. As a result of discrimination and other psychosocial challenges, transgender individuals experience high levels of postponing health care and suffer...
Centers for Disease Control and Prevention (CDC) guidelines on opioid prescribing for chronic pain recommend co-prescribing naloxone for patients with risk factors for Overdose or Serious Opioid-induced Respiratory Depression (OSORD). While palliative care is excluded from this guideline overall, many patients receiving palliative care need chronic opioid therapy; prevalence of OSORD risk factors in this population is unexplored.
In our current context of a national opioid shortage, Palliative Care teams need to look at alternative options that can provide equal or better analgesia. While there is an emerging evidence base for the use of ketamine in the treatment of refractory depression1, the evidence base for the use of ketamine for palliation of pain remains thin, though primarily positive.2, 3 Ketamine has been used topically, orally and intravenously for the palliation of pain, and orally and intravenously for the treatment of refractory depression, though it is FDA approved only as an anesthetic.