Defining the practice of "no escalation of care" in the ICU.

Objective: Withdrawal or withholding of life-sustaining therapies precedes most deaths in the modern ICU. As goals of care for critically ill patients change from curative to palliative, this transition often occurs abruptly, but a slower more staggered approach may also be used. One such approach is "no escalation of care", often the first step in this transition at the end-of-life.

Recognizing and reporting elder abuse and neglect.

Elder abuse (physical, sexual, or psychological) and neglect (by caretakers or self-neglect) are major public health problems. Most cases are not identified by clinicians and reported to the appropriate government agencies. There are some barriers to clinician identification and reporting of cases of elder abuse or neglect.

A case study of delayed serotonin syndrome: lessons learned.

Serotonin syndrome is a potentially life-threatening condition that results from excessive serotonin agonism of the central and peripheral nervous system. Though serotonin syndrome is most often associated with ingestion of more than one serotonergic drug, many other mechanisms have been associated with serotonergic excess. This case study presents a 79-year-old African-American female, an assisted living resident, who presented to the emergency department with altered mental status, acute onset of "chills," reduced appetite, urinary incontinence, and an elevated temperature of 103 degrees F (39.