scholarly journals A cohort study of unstable overdose patients treated with intravenous lipid emulsion therapy

CJEM ◽  
2016 ◽  
Vol 19 (04) ◽  
pp. 256-264 ◽  
Author(s):  
Shazma Mithani ◽  
Kathryn Dong ◽  
Ashlea Wilmott ◽  
Heather Podmoroff ◽  
Nadim Lalani ◽  
...  
Keyword(s):  
Lipid Emulsion ◽  
Beta Blockers ◽  
A Priori ◽  
Hemodynamic Instability ◽  
Primary Objective ◽  
Future Research ◽  
Poison Center ◽  
Channel Blockers ◽  
Intravenous Lipid Emulsion ◽  
Change In Mean

AbstractObjectivesIntravenous lipid emulsion (ILE) has been used increasingly over the last decade for a range of drug overdoses. Although the use of ILE in local anesthetic toxicity (LAST) is well established, the hemodynamic effectiveness of ILE in non-LAST poisonings is still unclear. Thus, the primary objective of this study was to examine a cohort of poisoned patients in whom ILE was administered.MethodsConsecutive patients were identified by calls to a regional poison center from May 1, 2012 to May 30, 2014. Patients were enrolled if they ingested a drug, developed hemodynamic instability, failed conventional treatment, and received ILE therapy. Data were collected by medical record review. The primary outcome was the change in mean arterial pressure (MAP) in the first hour after ILE administration. Secondary outcomes included survival, length of stay, and the effect of drug class on patient outcome.ResultsThirty-six patients were enrolled. Agents ingested included calcium channel blockers and beta blockers (10/36, 27.8%), tricyclic antidepressants (5/36, 13.9%), bupropion (3/36, 8.3%), and antiepileptic agents (1/36, 2.8%). Seventeen patients (47.2%) ingested multiple agents. Twenty-five patients survived (69.0%). Overall, MAP increased by 13.79 mm Hg (95% CI 1.43–26.15); this did not meet oura prioridefinition of clinical significance.ConclusionsOur study did not find a clinically important improvement in MAP after ILE administration. Until future research is done to more definitively study its efficacy, ILE should remain a potential treatment option for hemodynamically unstable overdose patients only after conventional therapy has failed.

Intravenous Lipid Emulsion for Management of Systemic Toxic Effects of Drugs

2016 ◽  
Vol 27 (4) ◽  
pp. 394-404 ◽  
Author(s):  
Jaclyn O’Connor ◽  
Suprat Saely Wilson
Keyword(s):  
Emergency Department ◽  
Local Anesthetics ◽  
Lipid Emulsion ◽  
Rescue Therapy ◽  
Hemodynamic Instability ◽  
The United States ◽  
Emergency Department Visits ◽  
Toxic Effects ◽  
Intravenous Lipid Emulsion ◽  
The Past

The incidence of toxic effects of drugs leading to emergency department visits has increased in the United States in the past several years. Most of these patients can be adequately managed by supportive care alone. However, pharmacological antidotes may be necessary, particularly in patients with hemodynamic instability. In severe cases refractory to conventional antidote therapy, rescue therapy with intravenous lipid emulsion (ILE) may be necessary. Traditionally, ILE has been used as an antidote of choice in treating toxic effects of local anesthetics. But data continue to emerge on the successful use of ILE to treat overdoses of drugs other than local anesthetics, particularly lipophilic medications. The recommended ILE dose is a 1.5 mL/kg bolus followed by infusion of 15 mL/kg per hour, with repeat dosing permissible for continued hemodynamic instability. Use of ILE should be considered early as a rescue therapy in the settings of lipophilic medication overdoses when cardiovascular compromise or cardiac arrest is present.

scholarly journals Failure of intravenous lipid emulsion in treatment of cardiotoxicity caused by mixed overdose including dihydropyridine calcium channel blockers

2016 ◽  
Vol 73 (1) ◽  
pp. 88-91 ◽  
Author(s):  
Jasmina Jovic-Stosic ◽  
Vesna Putic ◽  
Dragan Zivanovic ◽  
Milica Mladenov ◽  
Gordana Brajkovic ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Lipid Emulsion ◽  
Ventricular Rate ◽  
Channel Blockers ◽  
Av Block ◽  
Intravenous Lipid Emulsion

Introduction. Calcium channel blockers and beta-blockers are among the most frequently ingested cardiovascular drugs in self-poisoning causing significant mortality. Intravenous lipid emulsion (ILE) is reported as a potentially novel antidote for treatment of acute poisoning caused by some of these drugs. Case report. We presented two cases of poisoning with these drugs. The case 1, a 24-year-old woman ingested amplodipine, metformin and gliclazide for self-poisoning. She presented with tachycardia and hypotension. Laboratory analyses revealed hyperglycaemia and metabolic acidosis. Despite the treatment which included fluid resuscitation, vasopressors, intravenous calcium, glucagon and ILE, circulatory shock occurred. The patient died 10 hours after admission due to cardiac arrest refractory to cardiopulmonary resuscitation. The case 2, a 41-year old man, was found in a coma with empty packages of nifedipine, metoprolol and diazepam tablets. On admission vital signs included Glasgow Coma Scale (GCS) of 3, weak palpable pulses, undetectable blood pressure, and irregular breathing with oxygen saturation of 60%. An electrocardiography showed AV block (Mobitz II) with ventricular rate of 44/min with progression to third degree of AV block. In attempt to increase heart rate and blood pressure the following agents were administered: atropine boluses, normal saline with dopamine, glucagon, calcium chloride and ILE. Temporary transvenous pacemaker was placed, electrical capture was recorded, but without improvement in haemodynamics. Three hours after admission cardiac arrest happened and cardiopulmonary resuscitation was unsuccessful. Conclusion. Intravenous lipid emulsion may be ineffective in acute poisonings with amlodipine, nifedipine or metoprolol.

Prophetic Leadership Model: Conceptualizing a Prophet’s Leadership Behaviour, Leader-Follower Mutuality and Altruism to Decision Making Quality

2015 ◽  
Vol 3 (1) ◽  
pp. 93
Author(s):  
Nik Maheran Nik Muhammad
Keyword(s):  
Decision Making ◽  
Social Network ◽  
A Priori ◽  
Complex Function ◽  
Spiritual Leadership ◽  
Leadership Theory ◽  
Future Research ◽  
Leadership Model ◽  
Leadership Behaviour ◽  
Current Leadership

This article advocates that research is lacking on the connection between leadership theory and social network theory. To date, little empirical research has been conducted on leadership and social networks. Thus, the proposition of this article goes beyond traditional leadership models to advocate for a fuller and more integrative focus that is multilevel, multi-component and interdisciplinary, while recognizing that leadership is a complex function of both the organisational leaders and the followers who perform tasks, all of which subsequently leads to decision making qualities. Indeed, the current leadership model focuses on leadership behaviour and the ability to gain followers mutuality, to achieve decision making quality involving the integration of leadership and social network theories. Given the apparent mutable palette of contemporary leadership theory, this emergent construct of the leadership paradigm can expand the poles of the leadership continuum and contribute to a richer and deeper understanding of the relationships and responsibilities of leaders and followers as they relate to decision making qualities. This new construct, which is termed prophetic leadership, explores the literature of the life experiences of the prophet in the ‘Abrahamic Faith’ religion. Drawing on a priori links between the personality trait and spiritual leadership that has recently garnered the interest of scholars, the present study asserts a normative leadership theory that links the personal quality of a leader, posture and principal (based on the Prophet’s leadership behaviour) to synergy and decision making quality. Altruism is proposed to enhance relationships between leadership behaviour and decision making quality. For future research, much work needs to be done specifically aiming to (a) achieve greater clarity of construct definitions, (b) address measurement issues, and (c) avoid construct redundancy.

Prophetic Leadership Model: Conceptualizing a Prophet’s Leadership Behaviour, Leader-Follower Mutuality and Altruism to Decision Making Quality

2015 ◽  
Vol 1 (3) ◽  
pp. 93
Author(s):  
Nik Maheran Nik Muhammad
Keyword(s):  
Decision Making ◽  
Social Network ◽  
A Priori ◽  
Complex Function ◽  
Spiritual Leadership ◽  
Leadership Theory ◽  
Future Research ◽  
Leadership Model ◽  
Leadership Behaviour ◽  
Current Leadership

This article advocates that research is lacking on the connection between leadership theory and social network theory. To date, little empirical research has been conducted on leadership and social networks. Thus, the proposition of this article goes beyond traditional leadership models to advocate for a fuller and more integrative focus that is multilevel, multi-component and interdisciplinary, while recognizing that leadership is a complex function of both the organisational leaders and the followers who perform tasks, all of which subsequently leads to decision making qualities. Indeed, the current leadership model focuses on leadership behaviour and the ability to gain followers mutuality, to achieve decision making quality involving the integration of leadership and social network theories. Given the apparent mutable palette of contemporary leadership theory, this emergent construct of the leadership paradigm can expand the poles of the leadership continuum and contribute to a richer and deeper understanding of the relationships and responsibilities of leaders and followers as they relate to decision making qualities. This new construct, which is termed prophetic leadership, explores the literature of the life experiences of the prophet in the ‘Abrahamic Faith’ religion. Drawing on a priori links between the personality trait and spiritual leadership that has recently garnered the interest of scholars, the present study asserts a normative leadership theory that links the personal quality of a leader, posture and principal (based on the Prophet’s leadership behaviour) to synergy and decision making quality. Altruism is proposed to enhance relationships between leadership behaviour and decision making quality. For future research, much work needs to be done specifically aiming to (a) achieve greater clarity of construct definitions, (b) address measurement issues, and (c) avoid construct redundancy.

Corporate Fraud Prevention and Detection: Revisiting the Literature

2015 ◽  
Vol 4 (1) ◽  
Author(s):  
Deepa Mangala ◽  
Pooja Kumari
Keyword(s):  
Fraud Detection ◽  
Primary Objective ◽  
Future Research ◽  
Business Organization ◽  
Corporate Fraud ◽  
Top Executives ◽  
Red Flag ◽  
Worldwide Phenomenon ◽  
Research Gap ◽  
Prevention Methods

Fraud has become a worldwide phenomenon and prime issue of concern. It dwells in all countries and affects all types of organizations irrespective of their size, profitability or industry. The primary objective of this paper is to provide an in-depth understanding of literature related to corporate fraud in order to understand why fraud occurs and how to combat it. Research studies published during the period commencing from the year 1984 to 2014 have been reviewed. The study aims to provide an in-depth discussion on significant red flags that may exist before fraud occurrence. It, also, provides a comprehensive view about fraud detection and prevention methods. Findings reveal that red flag is an important mechanism to prevent fraud. Application of single fraud detection technique will not curb the fraud effectively. Also, the top executives were found to be responsible for implementing anti-fraud policies and techniques within business organization. Further, the present study tries to discern the research gap in existing literature and explore the area of future research.

scholarly journals Decision Making from the Experience of Orthognathic Surgery Patients: A Grounded Theory Approach

2021 ◽  
pp. 238008442110144
Author(s):  
N.R. Paul ◽  
S.R. Baker ◽  
B.J. Gibson
Keyword(s):  
Decision Making ◽  
Grounded Theory ◽  
Treatment Options ◽  
Study Data ◽  
Primary Objective ◽  
Major Surgery ◽  
Future Research ◽  
Decision Making Process ◽  
Theory Approach

Introduction: Patients’ decisions to undergo major surgery such as orthognathic treatment are not just about how the decision is made but what influences the decision. Objectives: The primary objective of the study was to identify the key processes involved in patients’ experience of decision making for orthognathic treatment. Methods: This study reports some of the findings of a larger grounded theory study. Data were collected through face-to-face interviews of patients who were seen for orthognathic treatment at a teaching hospital in the United Kingdom. Twenty-two participants were recruited (age range 18–66 y), of whom 12 (male = 2, female = 10) were 6 to 8 wk postsurgery, 6 (male = 2, female = 4) were in the decision-making stage, and 4 (male = 0, female = 4) were 1 to 2 y postsurgery. Additional data were also collected from online blogs and forums on jaw surgery. The data analysis stages of grounded theory methodology were undertaken, including open and selective coding. Results: The study identified the central role of dental care professionals (DCPs) in several underlying processes associated with decision making, including legitimating, mediating, scheduling, projecting, and supporting patients’ decisions. Six categories were related to key aspects of decision making. These were awareness about their underlying dentofacial problems and treatment options available, the information available about the treatment, the temporality of when surgery would be undertaken, the motivations and expectation of patients, social support, and fear of the surgery, hospitalization, and potentially disliking their new face. Conclusion: The decision-making process for orthognathic treatment is complex, multifactorial, and heavily influenced by the role of DCPs in patient care. Understanding the magnitude of this role will enable DCPs to more clearly participate in improving patients’ decision-making process. The findings of this study can inform future quantitative studies. Knowledge Transfer Statement: The results of this study can be used both for informing clinical practice around enabling decision making for orthognathic treatment and also for designing future research. The findings can better inform clinicians about the importance of their role in the patients’ decision-making process for orthognathic treatment and the means to improve the patient experience. It is suggested that further research could be conducted to measure some of the key constructs identified within our grounded theory and assess how these change during the treatment process.

scholarly journals Visualization approaches to support healthy aging: A systematic review

2016 ◽  
Vol 23 (3) ◽  
pp. 600 ◽  
Author(s):  
Uba Backonja ◽  
Nai-Ching Chi ◽  
Yong Choi ◽  
Amanda K Hall ◽  
Thai Le ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Behaviors ◽  
Healthy Aging ◽  
A Priori ◽  
Aging In Place ◽  
Future Research ◽  
Health Technologies ◽  
Data Visualizations ◽  
Informatics Tools

Background: Health technologies have the potential to support the growing number of older adults who are aging in place. Many tools include visualizations (data visualizations, visualizations of physical representations). However, the role of visualizations in supporting aging in place remains largely unexplored.Objective: To synthesize and identify gaps in the literature evaluating visualizations (data visualizations and visualizations of physical representations), for informatics tools to support healthy aging.Methods: We conducted a search in CINAHL, Embase, Engineering Village, PsycINFO, PubMed, and Web of Science using a priori defined terms for publications in English describing community-based studies evaluating visualizations used by adults aged ≥65 years.Results: Six out of the identified 251 publications were eligible. Most studies were user studies and varied methodological quality. Three visualizations of virtual representations supported performing at-home exercises. Participants found visual representations either (a) helpful, motivational, and supported their understanding of their health behaviors or (b) not an improvement over alternatives. Three data visualizations supported understanding of one’s health. Participants were able to interpret data visualizations that used precise data and encodings that were more concrete better than those that did not provide precision or were abstract. Participants found data visualizations helpful in understanding their overall health and granular data.Conclusions: Studies we identified used visualizations to promote engagement in exercises or understandings of one’s health. Future research could overcome methodological limitations of studies we identified to develop visualizations that older adults could use with ease and accuracy to support their health behaviors and decision-making.

scholarly journals Antihypertensive Drugs and the Risk of Cancer: A Nationwide Cohort Study

2021 ◽  
Vol 10 (4) ◽  
pp. 771
Author(s):  
In-Jeong Cho ◽  
Jeong-Hun Shin ◽  
Mi-Hyang Jung ◽  
Chae Young Kang ◽  
Jinseub Hwang ◽  
...  
Keyword(s):  
Antihypertensive Drugs ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Channel Blockers ◽  
Antihypertensive Medications ◽  
Converting Enzyme Inhibitors ◽  
Incident Cancer ◽  
Increased Risk ◽  
Risk Of Cancer

We sought to assess the association between common antihypertensive drugs and the risk of incident cancer in treated hypertensive patients. Using the Korean National Health Insurance Service database, the risk of cancer incidence was analyzed in patients with hypertension who were initially free of cancer and used the following antihypertensive drug classes: Angiotensin-converting enzyme inhibitors (ACEIs); angiotensin receptor blockers (ARBs); beta blockers (BBs); calcium channel blockers (CCBs); and diuretics. During a median follow-up of 8.6 years, there were 4513 (6.4%) overall cancer incidences from an initial 70,549 individuals taking antihypertensive drugs. ARB use was associated with a decreased risk for overall cancer in a crude model (hazard ratio (HR): 0.744, 95% confidence interval (CI): 0.696–0.794) and a fully adjusted model (HR: 0.833, 95% CI: 0.775–0.896) compared with individuals not taking ARBs. Other antihypertensive drugs, including ACEIs, CCBs, BBs, and diuretics, did not show significant associations with incident cancer overall. The long-term use of ARBs was significantly associated with a reduced risk of incident cancer over time. The users of common antihypertensive medications were not associated with an increased risk of cancer overall compared to users of other classes of antihypertensive drugs. ARB use was independently associated with a decreased risk of cancer overall compared to other antihypertensive drugs.

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