Hemodialysis: A model for extreme physiology in a vulnerable patient population

2018 ◽  
Vol 31 (5) ◽  
pp. 500-506 ◽  
Author(s):  
Jeroen P. Kooman ◽  
Krassimir Katzarski ◽  
Frank M. van der Sande ◽  
Karel M. Leunissen ◽  
Peter Kotanko
Keyword(s):  
Patient Population ◽  
Vulnerable Patient ◽  
Vulnerable Patient Population

Medical error in the care of the unrepresented: disclosure and apology for a vulnerable patient population

2019 ◽  
Vol 45 (12) ◽  
pp. 821-823 ◽  
Author(s):  
Arjun S Byju ◽  
Kajsa Mayo
Keyword(s):  
Medical Error ◽  
Patient Population ◽  
Moral Distress ◽  
Moral Worth ◽  
Vulnerable Patient ◽  
Surrogate Decision Makers ◽  
Surrogate Decision ◽  
Or Team ◽  
Made In ◽  
Vulnerable Patient Population

Defined as patients who ‘lack decision-making capacity and a surrogate decision-maker’, the unrepresented (sometimes referred to as the ‘unbefriended’, ‘isolated patients’ and/or ‘patients without surrogates’) present a major quandary to clinicians and ethicists, especially in handling errors made in their care. A novel concern presented in the care of the unrepresented is how to address an error when there is seemingly no one to whom it can be disclosed. Given that the number of unrepresented Americans is expected to rise in the coming decades, and some fraction of them will experience a medical error, creating protocols that answer this troubling question is of the utmost importance. This paper attempts to begin that conversation, first arguing that the precarious position of unrepresented patients, particularly in regards to errors made in their care, demands their recognition as a vulnerable patient population. Next, it asserts that the ethical obligation to disclose error still exists for the unrepresented because the moral status of error does not change with the presence or absence of surrogate decision-makers. Finally, this paper concludes that in outwardly acknowledging wrongdoing, a clinician or team leader can alleviate significant moral distress, satisfy the standards of a genuine apology, and validate the inherent and equivalent moral worth of the unrepresented patient.

Tu1000 Formal Hepatitis B (HBV) Education Improves Not Only Knowledge but Also Acceptance of Antiviral Therapy Among the HBV-Infected Vulnerable Patient Population

2014 ◽  
Vol 146 (5) ◽  
pp. S-1002
Author(s):  
Blaire E. Burman ◽  
Colina Yim ◽  
Donna M. Evon ◽  
Mauricio Lisker-Melman ◽  
Harry Janssen ◽  
...  
Keyword(s):  
Hepatitis B ◽  
Antiviral Therapy ◽  
Patient Population ◽  
Vulnerable Patient ◽  
Vulnerable Patient Population

scholarly journals Concurrence of Porin Loss and Modular Amplification of β-Lactamase Encoding Genes Drives Carbapenem Resistance in a Cohort of Recurrent Enterobacterales Bacteremia

2019 ◽  
Author(s):  
William C. Shropshire ◽  
Samuel L. Aitken ◽  
Reed Pifer ◽  
Jiwoong Kim ◽  
Micah M. Bhatti ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Outer Membrane ◽  
Patient Population ◽  
Carbapenem Resistance ◽  
Carbapenem Resistant ◽  
Outer Membrane Porin ◽  
Long Read ◽  
Vulnerable Patient ◽  
Vulnerable Patient Population

ABSTRACTBackgroundCarbapenem resistant Enterobacterales (CRE) remain urgent antimicrobial resistance threats. Approximately half of CRE clinical isolates lack carbapenem hydrolyzing enzymes and develop carbapenem resistance through alternative mechanisms. The purpose of this study was to elucidate the development of carbapenem resistance mechanisms from clonal, recurrent extended-spectrum β-lactamase positive Enterobacterales (ESBL-E) bacteremia isolates in a vulnerable patient population.MethodsThis study investigated a historical, retrospective cohort of ESBL-E bacteremia cases in the University of Texas MD Anderson Cancer Center (MDACC) from January 2015 to July 2016. Phylogenetic and comparative genomic analyses were performed to identify clonal, recurrent ESBL-E isolates developing carbapenem resistance. Oxford Nanopore Technology (ONT) long-read and Illumina short-read sequencing data were used to generate consensus assemblies and to identify signatures of mobile genetic element mediated amplification and transposition of antimicrobial resistance genes. Serial passaging experiments were performed on a set of clinical ST131 ESBL-E isolates to recapitulate in vivo observations. qPCR and qRT-PCR were used to determine respective copy number and transcript levels of β-lactamase genes.Results116 ESBL-E bacteremia cases were identified, 16 of which had documented recurrent infections. Four serial, recurrent isolates displayed a carbapenem resistant phenotype, three without the acquisition of a known carbapenemase. These three isolates had non-carbapenemase-producing CRE (non-CP-CRE) mechanisms driven by IS26- and ISEcp1-mediated amplification of respective translocatable units (TU) and transposition units (TPU) harboring both blaOXA-1 and blaCTX-M variants with concomitant outer membrane porin disruption. The TU and TPU structures inserted into the open reading frames of outer membrane porin genes in a subset of non-CP-CRE isolates. Serial passage of an index ST131 ESBL-E isolate under selective carbapenem exposure resulted in chromosomal amplification of modular, TUs harboring β-lactamase genes with concomitant porin inactivation, recapitulating the in vivo carbapenem resistance progression. Long-read sequencing of two additional MDACC bacteremia strains identified similar non-CP-CRE mechanisms observed in the serial isolates.ConclusionsNon-CP-CRE de novo mechanisms were the primary driver of CRE development in recurrent bacteremia cases within this vulnerable patient population. The incorporation of long-read ONT data into AMR surveillance platforms is critical to identify high-risk CRE isolates that are difficult to identify with low-resolution phenotypic and molecular characterization methods.

COVID-19 clinical course and outcomes in a predominantly black, vulnerable patient population in New York City

2021 ◽  
Vol 7 (2) ◽  
pp. 81
Author(s):  
Priyanka Parmar ◽  
Alecia James ◽  
Sabrina Rosengarten ◽  
Alvin Oommen ◽  
MichaelA Joseph ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
York City ◽  
Patient Population ◽  
Clinical Course ◽  
Predominantly Black ◽  
Vulnerable Patient ◽  
Vulnerable Patient Population

Older Adults with First-Onset Schizophrenia: An Under-Recognized and Under-Served Patient Population

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Thuswaldner J ◽  
Keyword(s):  
Older Adults ◽  
Patient Population ◽  
Late Onset ◽  
Early Adulthood ◽  
Further Education ◽  
Learning Objectives ◽  
Residency Programs ◽  
First Onset ◽  
Vulnerable Patient ◽  
Vulnerable Patient Population

Schizophrenia is typically understood to be a disorder with onset in early adulthood, but nearly a quarter of patients are estimated to develop schizophrenia after age 40. Late-onset schizophrenia (patients with onset after age 40) and very-late onset schizophrenia (patients with onset after age 60) are historically an under-recognized and under-served population. Reasons for this are manifold, and may include barriers such as inconsistent terminology used to describe these patients, challenges with diagnosing, and lack of resources and research for these patients. To overcome these barriers, the DSM should include these subsets and provide clear diagnostic criteria. Incorporating these subsets into the learning objectives of medical school and residency programs would also promote further education and thus recognition of these patients. Finally, allocating funds towards resources and research in first-onset diagnosis of schizophrenia in adults over 40 would optimize treatment and improve understanding of this vulnerable patient population.

scholarly journals A universal right to pain relief: balancing the risks in a vulnerable patient population

2019 ◽  
Vol 3 (2) ◽  
pp. 62-64 ◽  
Author(s):  
Fiona Moultrie ◽  
Adam Shriver ◽  
Caroline Hartley ◽  
Dominic Wilkinson ◽  
Andrew K Ewer ◽  
...  
Keyword(s):  
Pain Relief ◽  
Patient Population ◽  
Vulnerable Patient ◽  
Vulnerable Patient Population

scholarly journals Dalbavancin as Secondary Therapy for Serious Staphylococcus aureus Infections in a Vulnerable Patient Population

2019 ◽  
Vol 6 (2) ◽  
Author(s):  
Chloe Bryson-Cahn ◽  
Alison M Beieler ◽  
Jeannie D Chan ◽  
Robert D Harrington ◽  
Shireesha Dhanireddy
Keyword(s):  
Staphylococcus Aureus ◽  
Treatment Failure ◽  
Patient Population ◽  
Response To Treatment ◽  
Off Label Use ◽  
Septic Thrombophlebitis ◽  
Off Label ◽  
Vulnerable Patient ◽  
Persons Who Use Drugs ◽  
Vulnerable Patient Population

Abstract We retrospectively evaluated off-label use of dalbavancin as secondary therapy in 32 patients with serious Staphylococcus aureus infections (endocarditis, osteomyelitis, septic thrombophlebitis, epidural infection) who were also persons who use drugs. The majority of patients (56%) had a clinical response to treatment. Only 1 patient who completed the intended dalbavancin course experienced a treatment failure.

scholarly journals Effect of single family rooms for preterm infants on neurodevelopment: study protocol for a systematic review

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e015818 ◽  
Author(s):  
Nicole R van Veenendaal ◽  
Sophie R D van der Schoor ◽  
Jacqueline Limpens ◽  
Anne A M W van Kempen ◽  
Johannes B van Goudoever
Keyword(s):  
Systematic Review ◽  
Hospital Stay ◽  
Preterm Infants ◽  
Systematic Reviews ◽  
Patient Population ◽  
Neurodevelopmental Outcome ◽  
Single Family ◽  
Vulnerable Patient ◽  
Neonatal Ward ◽  
Vulnerable Patient Population

IntroductionPreterm infants are at an increased risk for neurodevelopmental delay. They have to endure many stressors in early life, including parent-infant separation, noise and painful procedures during hospitalisation in the highly technological environment of the modern neonatal ward. Currently, a shift is being noticed in the architectural design of neonatal wards towards single family rooms instead of the common open bay units. The influence of the hospital environment on health and specifically neurodevelopment in this vulnerable patient population remains under discussion.ObjectivesTo assess the effect of single family rooms during hospitalisation primarily on neurodevelopment in preterm infants. Secondary outcome measures will be neonatal (ie, breastfeeding rates, sepsis, growth during hospital stay, length of hospital stay) and parental (ie, parental stress, satisfaction, participation, presence and self-efficacy).Methods and analysisThe PRISMA-P 2015 (Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015) 17 items checklist was used for the generation of the protocol for this review. The following PICO was formulated: Population: preterm infants with need of hospitalisation in the neonatal ward; Intervention: single family rooms; Comparison: standard neonatal care in open bay units; Outcome: neurodevelopmental outcome of infants from 9 months onwards. If at least two studies, with low or moderate risk of bias, suitable for inclusion are found a meta-analysis will be performed. If quantitative synthesis is not appropriate the data will be presented descriptively.Dissemination plansThis will be the first review, systematically assessing the effect of single family rooms on neurodevelopmental outcome in preterm infants. Clinical practice could possibly be optimised to ameliorate neurodevelopment in this vulnerable patient population based on these insights. This systematic review will be published in an international peer-reviewed journal.RegistrationWe registered this systematic review protocol with the PROSPERO (International Prospective Register of Systematic Reviews) on 2 November 2016 (registration number: CRD42016050643).EthicsWe will use data from patients enrolled in studies and/or trials already approved by the relevant ethical committees and therefore this systematic review requires no further permissions.

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