Rhode Island medical journal (2013)
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Delirium management begins with non-pharmacologic interventions and treatment of the underlying causes. There are no FDA-approved medications for delirium-related psychosis and agitation, although numerous agents have been studied. ⋯ Studies and expert guidelines support the use of antipsychotics for delirium-related psychosis and agitation, and demonstrate comparable efficacy and safety between first- and second- generation agents. Mounting evidence also suggests that antipsychotics and dexmedetomidine are effective in preventing delirium in surgical and mechanically- ventilated patients, respectively.
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Compassion and compassion fatigue are discussed in the medical literature. However, few studies address physicians and none examine physicians' spiritual beliefs related to their provision of compassionate care. ⋯ Physicians value compassion, linking it to spiritual values and self-care, but identify challenges in daily practice. Further study is needed to explore how to support physicians' provision of compassionate care and prevent burnout.
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Takotsubo cardiomyopathy is a reversible cardiomyopathy which has increasingly been recognized in the differential diagnosis of patients presenting with acute coronary syndrome. It is characterized by transient systolic ventricular dysfunction with regional wall motion abnormalities beyond a single vascular territory and in the absence of significant epicardial coronary artery obstruction. Often, there is an acute emotional or physical stressor immediately preceding the presentation. ⋯ Catecholamine excess and cardiotoxicity is the most compelling putative mechanism. The long-term prognosis is excellent but serious complications including cardiogenic shock and arrhythmias may occur acutely. Supportive treatment is the mainstay of therapy.