Psychosomatics
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Patients in the general hospital are routinely asked to make decisions about their medical care. However, some of them are unable to express a choice, understand the information provided, weigh the options, or make a decision for themselves; when this occurs, the task of making an appropriate medical decision is left to another-a substitute decision-maker (SDM). ⋯ Our pilot investigation suggests that there is need for improvement in our evaluation and documentation of altered mental status and a patient's ability to make informed decisions. To this end, several quality-improvement suggestions are discussed.
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Letter Case Reports
Bath salt abuse: neuropsychiatric effects of cathinone derivatives.
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Randomized Controlled Trial
Individual risk profiles for postoperative delirium after joint replacement surgery.
Delirium occurs in nearly half of older patients after joint replacement surgery. However, risk profiles for developing delirium have not been established. ⋯ Although use of prophylactic olanzapine reduced the incidence of delirium, subsets of patients remained likely to develop delirium. The risk of developing delirium may be reduced through prophylactic dispensation of olanzapine, maintaining optimal perfusion and oxygenation, and limiting intra-operative opioids.
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Compassion is an attribute central to professionalism and modern clinical care, yet little is known about how compassion is acquired and preserved in medical training. We sought to understand whether personal illness experiences are thought by residents to foster compassion. ⋯ Health care trainees' own illness experiences may increase compassionate patient care practices and foster empathy.