Psychosomatics
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The implementation of emergency codes has become standard practice in hospitals to provide system-wide preparedness for the early detection and prevention of crises. Psychiatric emergencies in medical/surgical locations, however, are not typically regarded as distinct entities from general security threats. The "security-first" paradigm is a nonclinical intervention that focuses on behavioral containment rather than on the treatment of underlying psychopathology. ⋯ Behavioral emergency response teams re-establish patient care within the intervention without omitting security containment. They help rapidly address acute comorbid psychiatric needs without demanding additional psychiatric resources by functioning as trained surrogates of consult-liaison psychiatry as they provide direct clinical oversight into primary teams who would otherwise be unsupported in navigating clinical scenarios extending beyond their typical range of expertise. An analysis using the "Swiss cheese" model of human error trapping offers a comprehensive illustration of how behavioral emergency response teams add multilayered perceptual and mechanistic advantages to barriers commonly encountered when psychiatric emergencies arise in nonpsychiatric settings.
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Comparative Study
Ramelteon is Not Associated With Improved Outcomes Among Critically Ill Delirious Patients: A Single-Center Retrospective Cohort Study.
Delirium commonly affects critically ill patients and is associated with high morbidity and mortality. Some studies have suggested that ramelteon may prevent delirium, but ramelteon's impact on treating delirium is unknown. ⋯ Ramelteon was not associated with increased likelihood of delirium-coma resolution, extubation, or changes in mortality.
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There is limited research regarding the prevalence of post-traumatic stress disorder (PTSD) in civilian multidisciplinary pain clinics. Controlled studies have only examined specific patient populations, such as those with motor vehicle accidents, war veterans, work-related injuries, back pain, and headache. ⋯ The prevalence of PTSD symptoms in our chronic pain population (28%) exceeded the prevalence of PTSD in the general population (7%). Patients with chronic pain who screened positive for PTSD reported higher pain severity and were younger. This emphasizes the need for PTSD screening in the chronic pain population, as early identification and treatment may be effective in reducing the mounting health care costs and disease burden of comorbid chronic pain and PTSD.
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Observational Study
Low Plasma Cholinesterase Activity is Associated With Postoperative Delirium After Noncardiac Surgery in Elderly Patients: AProspective Observational Study.
Postoperative delirium (POD) commonly occurs in elderly patients after noncardiac surgery, resulting in increased morbidity and greater risk of death. However, its pathophysiology is currently unknown. Cholinergic dysfunction has been implicated in delirium pathophysiology, and low plasma cholinesterase activity has been reported as a risk marker of POD. ⋯ Plasma cholinesterase activity may be a candidate biomarker for POD after noncardiac surgery in the elderly Chinese Han population.