The Use of Acceptance and Commitment Therapy in Substance Use Disorders: A Review of Literature.

Background: Acceptance and commitment therapy (ACT) is a form of behavioral therapy that teaches people to learn to accept rather than avoid challenging situations in their lives. ACT has shown to be an intervention with great success in the reduction of various mental disorders and substance use disorders (SUDs). The core of ACT when used in SUD treatment is guiding people to accept the urges and symptoms associated with substance misuse (acceptance) and use psychological flexibility and value-based interventions to reduce those urges and the symptoms (commitment).

Vascular Access Device Care and Management: A Comprehensive Organizational Approach.

The Infusion Nurses Society asserts that a comprehensive organizational approach to vascular access device (VAD) care and management is imperative to ensure safe and efficacious patient care. It is essential that each organization (1) develops policies and procedures to align VAD care and management with recognized standards of practice; (2) integrates unique aspects of organization-selected VAD care products into policies and procedures and establishes expectations for adherence to these organizational directives; (3) develops a framework for gathering and analyzing clinical data related to patient outcomes for VAD care and management; (4) utilizes quality outcome data to facilitate evidence-based best practices within the organization; and (5) evaluates and facilitates educational programming to validate clinician competency.

Preoperative cytologic interpretation of noninvasive follicular thyroid neoplasm with papillary-like nuclear features: a 1-year multi-institutional experience.

Introduction: Encapsulated follicular variant of papillary thyroid carcinoma (PTC) has an indolent behavior; hence, a change in terminology to "noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)" has been proposed. Data are scant on the fine-needle aspiration (FNA) diagnosis of nodules proven to be NIFTP upon resection. The aim was to evaluate the FNA diagnosis of nodules diagnosed as NIFTP upon resection.

Knowledge Translation of the PERC Rule for Suspected Pulmonary Embolism: A Blueprint for Reducing the Number of CT Pulmonary Angiograms.

Introduction: Computerized decision support decreases the number of computed tomography pulmonary angiograms (CTPA) for pulmonary embolism (PE) ordered in emergency departments, but it is not always well accepted by emergency physicians. We studied a department-endorsed, evidence-based clinical protocol that included the PE rule-out criteria (PERC) rule, multi-modal education using principles of knowledge translation (KT), and clinical decision support embedded in our order entry system, to decrease the number of unnecessary CTPA ordered.

Methods: We performed a historically controlled observational before-after study for one year pre- and post-implementation of a departmentally-endorsed protocol.

Differences in noninvasive thermometer measurements in the adult emergency department.

Purpose: Detection of accurate temperature in the emergency department (ED) is integral for assessment, treatment, and disposition. The primary objective was to compare temperature measurements from noninvasive temperature devices in the adult ED. The secondary objective was to evaluate the discrepancy between febrile and afebrile patients.

Emergency repair of aortic dissection in a 37-week parturient: a case report.

Aortic dissection is a life-threatening condition with a 50% mortality rate in the first 48 hours and a 3-month mortality rate of 90% in untreated patients. Aortic dissection is a rare complication of pregnancy, but there is significant morbidity and mortality for the mother and infant. A 43-year-old woman with a 37-week intrauterine pregnancy was admitted to the emergency department 6 hours after the onset of tightness in her throat and neck pain.

Use of alternatives to air-fluidized support surfaces in the care of complex wounds in postflap and postgraft patients.

Air-fluidized support surface therapy has many drawbacks, such as dehydration, in an already difficult recovery for those wound patients who have undergone flap and graft surgery. In addition, patient care and handling are also problematic. Patients complain of discomfort, and the instability of the surface interferes with patient stability in side lying and semi-Fowler's positions.

The role of magnetic resonance imaging mammography in the surgical management of the index breast cancer.

Hypothesis: Preoperative magnetic resonance imaging (MRI) mammography, after positive fine-needle aspiration (FNA) or stereotactic biopsy, may alter surgical management of the index breast cancer.

Design: Review of MRI mammograms compared with conventional mammograms and clinical examination.

Setting: Rural community hospital.

Airway considerations for professional singers--a survey of expert opinion.

The objective of this study was to survey physician experts in voice disorders/treatment to establish consensus guidelines for translaryngeal intubation (TLI) and tracheotomy when treating professional singers or other voice professionals. A written survey was sent to all physician members of the Voice Foundation seeking opinions/recommendations about route of TLI, duration of TLI before tracheotomy, size of endotracheal and tracheotomy tubes, and special interventions during patient care as these might differ between professional singers and nonsingers. Fifty-five percent of the physicians responded, of whom 73% classified their experience in voice care as "extensive.

A review of "chest tubes" during donor care and after transplantation.

Thoracostomy tubes, also called chest tubes, are commonly present after transplantation or during donor care. The function of the thoracostomy tube is to provide a conduit for transporting fluid, gas, or blood from the pleural cavity to an attached drainage unit. Malfunction of the tube or parts of the unit assembly may lead to serious consequences and jeopardize transplant recipient recovery or donor organs.

Tetany following resuscitation after abruptio placentae.

Background: Serum ionized calcium and magnesium are normally decreased during later stages of pregnancy. A further rapid decline may be caused by the rapid infusion of blood bank products in which citrate is used as an anticoagulant/preservative. Tetany, as reported here, may be precipitated by such infusions.

Using pressure-limited mechanical ventilation in caring for organ donors.

Pressure-limited (controlled) ventilation is commonly employed to provide mechanical ventilation in the intensive care unit when lung compliance is poor or when airway resistance is irreversibly high. Modification of the inspiratory-expiratory ratio to include inspiratory-expiratory ratio reversal and permissive hypercapnia can also be used when lung disease or injury is severe. Because other donor organs often can be saved for transplantation even when the lungs have been badly damaged, the organ procurement coordinator should adopt pressure-limited ventilation as well as inspiratory-expiratory ratio reversal and permissive hypercapnia as potentially helpful methods while providing mechanical ventilation to selected donors.

Challenges in donor care.

This article is provided as a self-study feature on care of organ donors. Questions and possible responses are provided. Review all the responses for each question.

Declining critical care research publications by authors from U.S. Institutions, 1990-1999.

Purpose: To determine whether the proportion of authors from U.S. institutions to those from non-U.

Credentialing for critical care in small hospitals.

Objective: To assess credentialing practices for critical care admissions and procedures in smaller hospitals within the United States.

Methods: A questionnaire was sent to credentialing coordinators of 500 randomly selected American Hospital Association hospitals with fewer than 300 beds.

Measurements And Main Results: Most hospitals validate qualifications for intensive care unit (ICU) admitting and procedural privileges through recommendations only.

Cutaneous lupus erythematosus.

Lupus erythematosus (LE) has many different clinical manifestations including a variety of cutaneous findings. Some of the cutaneous manifestations are not specific for LE, such as photosensitivity reactions, oral ulcers, alopecia, urticaria, vasculitis, vesiculo-bullous lesions, acral changes, cutaneous mucinoses, and cutaneous calcinosis. Other findings are specific for LE in that they are found only in patients who have lupus erythematosus.

Regulation of coagulation abnormalities and temperature in organ donors.

The 3 most common reasons for abnormal coagulation of blood in organ donors result from prior medications, consumption or dilution of coagulation factors and platelets during massive transfusion, and disseminated intravascular coagulation. Evaluation and treatment of these conditions are reviewed, and recommendations are provided for ordering appropriate laboratory tests and blood bank products.

Recommendations for mechanical ventilation during donor care.

The organ procurement coordinator usually directs adjustments to the mechanical ventilator during donor care. It is often difficult to achieve optimal oxygen uptake and carbon dioxide removal while avoiding barotrauma or undesirable effects on the cardiac output. Interrelationships among a variety of ventilator parameters must be understood in order to achieve the desired goal of providing the best organs possible.

Management of variations in blood pressure during care of organ donors.

The organ procurement coordinator commonly must correct and maintain the arterial blood pressure during donor care. This article reviews considerations in the accurate measurement of the blood pressure, causes of hypertension and hypotension, and desirable standards to use in order to provide adequate organ perfusion. Recommendations are presented for treatment of hypotension in a titrated response of intravenous fluids, inotropic support, and vasopressor infusion to maintain the mean arterial pressure above 65 mm Hg.

Maintaining acid-base balance in organ donors.

An abnormal blood pH may cause the loss of donor organs through harmful physiological consequences. The organ procurement coordinator must correctly analyze the acid-base abnormality and treat its cause while normalizing the blood pH. We recommend that treatment of acidemia or alkalemia be first directed toward changing parameters on the mechanical ventilator, using the Paco2 to modify blood pH.