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| Sunday, 11 January 2004 |
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Features |  |
| News Business Features Editorial
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Intensive Care Unit Psychosis by DR. D. P. ATUKORALE When an illness of catastrophic nature such as a heart attack (myocardial infarction) which usually strikes a man in the middle of an otherwise healthy life, at the peak of ones career, when he is most useful to society and his family, the stress can be most detrimental and may lead to severe depression and anxiety.
In the ICU the patient is surrounded by machines and the monitors and the impersonal contact with technical equipment makes the patient dehumanized, helpless and hopeless.To make matters worse some doctors and nurses in the ICU have hardly any time to speak to patients and examine them as some of the ICU doctors and nurses depend on the information provided by the monitoring equipment. The touch of a hand or a few soothing words of reassurance addressed directly to the patients by doctors and nurses can calm down and restore hope in ICU patients. Some of these patients admitted to ICU may be confused and disoriented. The ICU nurses play a major role in determining the mental state of the ICU patients and thus the rate of their recovery. A few soothing and kind words from an understanding nurse can help the ICU patients to get over stress and the anxiety and depression which is usually transient. Some patients use denial to cope with their fear. Those who reject the reality of their illness may baulk at the necessity of treatment. Those who accept the reality of the illness have the best outcome and are less prone to ICU psychosis. The combination of strange surroundings, illness, medication and disturbed sleep can lead to ICU psychosis. The incidence of ICU syndrome differs from country to country. The incidence appears to be higher among Sri Lankans as compared to British patients. ICU syndrome is higher in elderly patients who find themselves suddenly immobilized in strange and frightening surroundings and there are some doctors who treat them as senile or psychiatric cases when all that is necessary is a few kind words by some familiar person to help them to calm down and become oriented. If each ICU cubicle is provided with clocks and glass window, patients are less prone to be disoriented. Even if the patient is unable to talk, if the patient can be talked to, these patients improve. In some ICUs in UK, the family physician (G.P.) is encouraged to visit the ICU patient. One advantage of the G.P. visiting the ICU patients is that the busy physician (V.P.) or the surgeon (V.S.) in charge of the patient in the ICU may not be able to spare a few minutes talking to the relatives of the ICU patient who may be having severe stress and who may have so many questions to ask about the patient. The relatives obviously would like to know from the VP or VS why the patient got the acute illness (e.g. heart attack) and what the patient should do to get a speedy recovery and return the patient to gainful life and prevent the recurrence. As mentioned earlier, some present day specialists tend to be more technically oriented and more concerned with machines, laboratory reports, scans x-ray and 2D - Echos than the ICU patient. Short acting tranquilizers are required by many ICU patients especially those who show heightened reactions to stress. Sometimes the ICU ward rounds by VP or VS accompanied by a battalion of junior doctors and medical students make the ICU patient very nervous especially if the consultant does not speak to the patient. During the ward rounds by specialists, blood pressure and heart rate of patients can go up and there have been instances when ICU patients have got serious rhythm disturbances (palpitations) of the heart during such ward rounds. In some patients depression sets in after admission to ICU. This has been likened to mourning after the loss; in this case a sense of lost potential or lost physical ability . Generally depression is transient and the patients stress level can be reduced through reassurance. Authoritative information can dispel concerns caused by harmful myths and misconceptions about certain acute illnesses such as heart attacks. Psychiatric consultation is not necessary in majority of cases of ICU syndrome. In patients with loss of appetite, severe insomnia, feeling of isolation and general apathy which may indicate serious depression, professional psychiatric care is indicated if above symptoms are not due to drugs such as cimetidine, betablockers and other drugs used in the ICU. ************** Lab tests: What every patient must know These tests if carried out correctly and under sterile conditions are an important prelude to actual treatment. Accurate results depend largely on the co-operation and understanding between clinician's, laboratory workers and patients.
1. What investigation to request in given circumstances. In case of complicated investigations the clinician and the Pathologist should agree a programme of investigation and discuss the results.
A source of serious error can be failure to identifies correctly the source of a specimen from a given patient. Therefore all clinical details required should be filled in correctly and legibly. Request must also indicate the exact nature of the material sent, its source and the precise nature of the investigation's required. For many biochemical tests it is necessary to record the exact time at which the specimen is collected. It is desirable that the patient's tentative diagnosis be recorded with relevant clinical comment. A note of current antibiotic therapy is necessary with all requests for bacteriological examination. It is also essential that the specimens reach the laboratory fresh and in the correct kind of container which can be best obtained from the laboratory that is going to make the investigation. All containers must be perfectly clean and preferably sterile. This is very essential for bacteriological specimen. Containers for blood should be completely dry, with properly fitting lids. Blood obtained by venepuncture should be placed immediately in a container suitable for the purpose for which it is to be used. Heparin and sequestrene (EDTA) are the most generally useful anticoagulant for most haematological investigations. Blood glucose bottles contain Sodium Fluoride. For blood group and serological investigation blood should be taken into a dry sterile bottle or tube. The interpretation of any laboratory test will depend on the relevance of the test to the presumptive diagnosis and the interpreter's knowledge of Pathology. Biochemistry and Physiology. The task of a clinical laboratory is to put these disciplines to work in the solution of a diagnostic problem. A. D. T. Maithripala, Medical Lab Technologist ************** Some answers on why you should .... Quit Smoking ! Q. Why does smoking affect the heart ? A. Tobacco smoke is packed with poisons that can damage the heart and blood vessels; * Nicotine - an addictive poison, makes the heart beat faster, and makes blood pressure soar temporarily. It also increases the risk of blood clots. * Carbon monoxide - a poisonous gas released when tobacco burns. Inhaled by the smoker, it dramatically cuts the amount of oxygen the blood can carry around the body and to the heart. So when you smoke, your heart has to work harder and it gets less oxygen. Q: How much at risk is the smoker ? A. Smoking dramatically increases the risk of developing heart disease, lung cancer and many other diseases. These diseases are not always fatal but can seriously affect your quality of life. Smoke and you are more likely to die before you retire. Forty percent of heavy smokers (those smoking over 20 cigarettes a day) die before retirement age, compared to only 15 percent of non-smokers. Q. What about the risk for the passive smoker ? A. Cigarettes give off two types of smoke - mainstream smoke' is filtered by the cigarette and inhaled by the smoker. The other type is sidestream smoke which goes directly from the end of the cigarette into the air. As it is not filtered it contains higher concentrations of harmful substances than the mainstream smoke. Children who are exposed to their parents' sidestream smoke are more prone than other children to serious chest illnesses such as pneumonia, lung cancer and bronchitis. They are also more likely to smoke if their parents do. Smoking or not smoking People are quitting smoking for many reasons - the terrible smell, the high cost, increasing pressure from non-smokers, lack of fitness, but perhaps most of all, the growing realisation that smoking is one of the greatest health hazards mankind has ever faced. Ask most people about the health risks of smoking and lung cancer will be the swift reply. It often comes as a surprise that heart disease caused by smoking kills as many people as lung cancer. Middle aged male smokers are twice as likely to suffer the crippling chest pains of angina; One in three 40 year old men who smoke 20 or more cigarettes a day will die of a heart attack before reaching retirement. In fact, smoking doubles your risk of dying from heart disease. Add to that the risk of cancer, the hacking cough, bronchitis, diseases linked to the circulatory system, sore throats, ulcers, and it's little wonder that people choosing the healthy heart option say no to tobacco. It is not too late to quit smoking - do you agree ? Sent by Maruthaai Ravindhiran ************** Broiler chickens: how safe are they ? by Dr. A. Nandakumar Today consumers of broiler chicken and other poultry products are increasingly influenced by voices from outside the industry. Some of which portray an incomplete and often inaccurate picture of poultry products. Moreover, some special interested fanatical groups who confuse the consumer that modern animal husbandry has little regards for animal welfare and other health problems. The reason for such confusion is the wide knowledge gap between the consumer and the poultry products. Broiler's are a hybrid variety of chicken which was researched in the early '60s for meat purpose. Broilers are not fattened using hormones. Like any other hybrid variety of plants and vegetables, the broiler chicken was invented to cater to the growing number of human population. In the recent past there have been much criticism, on some advertisements appearing in the media to consume more chicken. It is a known fact that vegetarian diets have health benefits over the non vegetarian diets. But one should not forget there are hundreds and thousands of meat eaters and poultry meat producers living in this country. Is it possible to turn these meat eaters to vegetarians overnight in the name of religion, animal welfare and health problems ? Is it not the duty of the industry to cater to this sector of people with clean, healthy and safe food supply ? Dr. D.P. Atukorala in his article "No scientific basis that chicken is heart healthy" on the newspapers has said that chicken raised for broiler meat are routinely given antibiotics and hormones (To make the chicken fatter in a matter of weeks) and these antibiotics and hormones could have undesirable effect on consumers. These statements are baseless and confusing to the consumer. One should have adequate knowledge on broiler industry and animal husbandry to talk about. Antibiotics are used with a certain purpose. In the 2001 "Judicious use of Antimicrobials for Poultry Producers" manual published by the US Food and Drug administration's center for Veterinary Medicine, the American Medical Association defined the therapeutic use of antibiotic as "treatment, control and prevention of bacterial disease". This definition sends a clear message that antibiotics are vital to use in food animals for disease, treatment control and prevention to ensure a healthy animal and a safe food supply. 90 per cent of antibiotics used world over in poultry industry are used as a growth promoter and prophylactic agent rather than treatment. However, on the basis of antibiotic used per Kg live weight, there is three times less use in animals than in humans. Nevertheless with the growing criticism on usage of antimicrobials in feed, the antibiotics are phased out gradually and probiotics, prebiotics (Oligosaccharides), herb mixtures are used in broiler feed to enhance the absorption of food and easy digestion. No hormone preparations are allowed to be used. US food and Drug administration center for Veterinary medicine does not permit any hormonal preparations. The thought of using hormones is just a myth by some individuals. Practically it is not possible to use hormones on the broiler as its lifespan is short as 39 to 45 days. It is believed that food animals such as beef cattle in the western countries are treated with hormones to fatten them. A three ounce serving of skin removed chicken has low as 100 calories, high unsaturated fatty acids, low saturated fats 0.3 gms, only 60 mg of cholesterol, (Daily maximum recommended intake 300 mg). Chicken is also rich in essential fatty acids, phospolipids and vitamins. Sri Lankans consume 12.5 million Kgs of beef, 0.8 million kgs mutton, I million kgs of pork and 60 million kgs of poultry meat and by products. Further how safe are vegetarian diets ? Pesticides are used indiscriminately in almost all vegetables. Today even infants, babies and children are vulnerable to the residual effects from the milk, milk by products, fruits and vegetables. Environmentalists and health experts are more concerned about pesticide rather than any other issue. Every one knows that most fruits in Sri Lanka are made to ripe by using certain chemical. A recent headline on D/N revealed the alarming levels of banned pesticides used in Sri Lanka. These pesticides not only have residual effect on the vegetables and fruits but also pollute the ground water. |
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Same is true when a patient is admitted to Intensive Care Unit (ICU)
after open heart surgery or if patient gets an acute illness such as acute
infective polyneuritis which usually requires admission to ICU if the
muscles of respiration are affected. Reducing anxiety and stress in such
patients admitted to ICU is very crucial.
A. D. T. Maithripala, a medical lab technologist discusses what
patients should be aware of when taking a lab test Pathology now embraces
a series of specialized subjects and clinicians cannot be expected to be
familiar with the detailed performance of all tests that they request. In
order to get a correct report it is necessary to know the following:
The result of any laboratory investigation is only one part of the
information required to make a diagnosis. It may have as much or as little
significance as any other physical finding. The plan of investigation has
to be decided from the facts elicited by history taking and physical
examination. Certain investigations are often necessary to monitor the
natural history of a disease and its treatment. For example - The white
blood cell count has to be followed serially in cases of Leukaemia and the
sedimentation rate in Rheumatoid Arthritis. Tests should not be repeated
without good reason and if repeated, the interval between them should be
logically decided.
