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"Coma Patients."
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Coma : a novel
They called it \"minor surgery,\" but Nancy Greenly, Sean Berman and a dozen others -- all admitted to Boston Memorial Hospital for routine procedures -- were victims of the same inexplicable, hideous tragedy on the operating table. They never woke up. Susan Wheeler is a third-year medical student working as a trainee at Boston Memorial Hospital. Two patients during her residency mysteriously go into comas immediately after their operations due to complications from anesthesia. Susan begins to investigate the causes behind both of these alarming comas and discovers the oxygen line in Operating Room 8 has been tampered with to induce carbon monoxide poisoning. Then Susan discovers the evil nature of the Jefferson Institute, an intensive care facility where patients are suspended from the ceiling and kept alive until they can be harvested for healthy organs. Is she a participant in -- or a victim of -- a large-scale black market dealing in human organs?
Book
The predictive role of composite inflammatory ratio parameters in the conscious awareness recovery after severe acute ischemic stroke: a retrospective cohort study
Background
Inflammatory mechanisms play a significant role in ischemic stroke. Peripheral neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), which are indicators capable of reflecting the magnitude of the inflammatory response, have been research hotspots. However, few research findings evaluate the prediction significance of these biomarkers in the recovery of conscious awareness following severe acute ischemic stroke.
Methods
This was a retrospective cohort study of 142 patients with consciousness disorders after acute ischemic stroke (GCS score ≤ 8) treated from January 2022 to May 2024. The cases were divided into three groups according to the GCS score at discharge as died/ vegetative state (GCS ≤ 3),moderate/ severe coma(GCS = 4–11) and mild coma/ normal (GCS:12–15). Demographic and clinical assessment data were reviewed and abstracted. NLR, PLR, SII and SIRI were calculated based on the peripheral blood tests at admission. The study investigated the correlation between changes in GCS scores from admission to discharge (calculated as the GCS score at discharge minus the baseline GCS score, where a negative value indicates worsening and a positive value indicates improvement) and the levels of NLR, PLR, SII, and SIRI.
Results
The level of NLR, PLR, SII and SIRI in died/ vegetative state group were significantly higher than those in moderate/ severe coma group (
p
= 0.0429,
p
= 0.0215,
p
= 0.0288,
p
= 0.026, respectively) and mild coma/ normal group (
p
= 0.0085,
p
= 0.0079,
p
= 0.0019,
p
= 0.0017, respectively). The area under the curve (AUC) values of NLR, PLR, SII, and SIRI to prognosis were 0.670, 0.661, 0.677, and 0.609, respectively. Spearman correlation analysis indicated NLR, PLR and SII were negatively correlated with GCS scores increase during hospitalization (
r
=- 0.317,
p
<0.0001 for NLR,
r
= -0.285,
p
= 0.001 for PLR,
r
= -0.3331,
p
< 0.0001 for SII,
r
= -0.199,
p
= 0.018 for SIRI).However, ordinal logistic regression analyses failed to indicate that NLR, PLR, SII and SIRI were independent predictors of poor consciousness response for severe acute ischemic stroke coma patients after adjusting for other confounders.
Conclusion
Patients with poorer consciousness outcomes exhibited a tendency towards elevated NLR, PLR, SII, and SIRI levels which were inversely correlated with GCS scores increase during hospitalization. However, the four indexes did not exhibit sufficient promise to be the valuable predictors for the prognosis of recovery from consciousness following severe acute ischemic stroke.
Journal Article
Artificial Nutrition and Hydration and the Permanently Unconscious Patient
During the past few decades, high-profile cases like that of Terry Schiavo have fueled the public debate over forgoing or withdrawing artificial nutrition and hydration from patients in a persistent vegetative state (PVS). These cases, whether involving adults or young children, have forced many to begin thinking in a measured and careful way about the moral legitimacy of allowing patients to die. Can families forgo or withdraw artificial hydration and nutrition from their loved ones when no hope of recovery seems possible? Many Catholics know that Catholic moral theology has formulated a well-developed and well-reasoned position on this and other end-of-life issues, one that distinguishes between \"ordinary\" and \"extraordinary\" treatment. But recent events have caused uncertainty and confusion and even acrimony among the faithful. In his 2004 allocution, Pope John Paul II proposed that artificial nutrition and hydration is a form of basic care, thus suggesting that the provision of such care to patients neurologically incapable of feeding themselves should be considered a moral obligation. The pope's address, which seemed to have offered a new development to decades of Catholic health care ethics, sparked a contentious debate among the faithful over how best to treat permanently unconscious patients within the tenets of Catholic morality. In this comprehensive and balanced volume, Ronald Hamel and James Walter present twenty-one essays and articles, contributed by physicians, clergy, theologians, and ethicists, to reflect the spectrum of perspectives on the issues that define the Catholic debate. Organized into six parts, each with its own introduction, the essays offer clinical information on PVS and feeding tubes; discussions on the Catholic moral tradition and how it might be changing; ecclesiastical and pastoral statements on forgoing or withdrawing nutrition and hydration; theological and ethical analyses on the issue; commentary on Pope John Paul II's 2004 allocution; and the theological commentary, court decisions, and public policy resulting from the Clarence Herbert and Claire Conroy legal cases. A valuable resource for students and scholars, this teachable volume invites theological dialogue and ethical discussion on one of the most contested issues in the church today.
eBook
Spiritual Care for Non-Communicative Patients
This book enables chaplains to deliver vital spiritual care to non-responsive patients and their families. With exercises, worksheets and case studies, it demonstrates how chaplains can develop the confidence and skills needed to engage with patients in meaningful ways, while affirming their personhood and bringing comfort to their loved ones.
eBook
The miracle girl : a novel
\"The crowds keep coming. More and more every day, drawn by rumor and whisper and desperate wish. They come to Shaker Street to see eight-year-old Anabelle Vincent, who lies in a coma-like state--unable to move or speak. They come because a visitor experienced what seemed like a miracle and believed it happened because of Anabelle. Word spreads. There are more visitors, more supposed miracles, more stories on TV and the Internet. But is this the divine at work or something else?\"--Amazon.com.
Book
The case of Terri Schiavo : ethics, politics, and death in the 21st century
The case of Terri Schiavo, a young woman who spent 15 years in a persistent vegetative state, has emerged as a watershed in debates over end-of-life care. While many observers had thought the right to refuse medical treatment was well established, this case split a family, divided a nation, and counfounded physicians, legislators, and many of the people they treated or represented. In renewing debates over the importance of advance directives, the appropriate role of artificial hydration and nutrition, and the responsibilities of family members, the case also became one of history's most extensively litigated health care disputes. The Case of Terri Schiavo assembles a team of first-hand participants and content experts to provide thoughtful and nuanced analyses. In addition to a comprehensive overview, the book includes contributions by Ms. Schiavo's guardian ad litem, a neurologist and lawyer who participated in the case, and scholars who examine issues related to litigation, faith, gender, and disability. The volume also includes a powerful dissent from the views of many scholars in the bioethics community. The book is intended for students, health care professionals, policy makers, and other in search of carefully reasoned analyses of the case that will shape our view of death and end-of-life medical care for decades.
eBook
Umbrella
A brother is as easily forgotten as an umbrella. James Joyce, Ulysses Recently having abandoned his RD Laing-influenced experiment in running a therapeutic community - the so-called Concept House in Willesden - maverick psychiatrist Zack Busner arrives at Friern Hospital, a vast Victorian mental asylum in North London, under a professional and a marital cloud. He has every intention of avoiding controversy, but then he encounters Audrey Dearth, a working-class girl from Fulham born in 1890 who has been immured in Friern for decades. A socialist, a feminist and a munitions worker at the Woolwich Arsenal, Audrey fell victim to the encephalitis lethargica sleeping sickness epidemic at the end of the First World War and, like one of the subjects in Oliver Sacks' Awakenings, has been in a coma ever since. Realising that Audrey is just one of a number of post-encephalitics scattered throughout the asylum, Busner becomes involved in an attempt to bring them back to life - with wholly unforeseen consequences.
Effect of auditory stimulation on traumatic coma duration in intensive care unit of Medical Sciences University of Mazandarn, Iran
Background:
Sensory deprivation is one of the common complications of coma patients in the intensive care unit (ICU). The purpose of this study was to investigate the impact of a familiar voice to consciousness level in coma patients.
Methods:
A total of 13 patients with traumatic coma (8 ≥ Glasgow's coma scale [GCS]) admitted in ICU ward were randomly assigned to control and experimental groups. The experimental group was treated twice a daily each time 15 min with a familiar recorded MP3 sound for 2 weeks. The control group received only natural voices of environment. GCS applied to evaluate patients' level of consciousness.
Finding:
Findings showed that duration to reach GCS = 15 was significantly shorter in the experimental group (χ2 = 12/96, P < 0/001).
Conclusion:
These findings imply that providing familiar auditory stimulation programs for coma patients in the ICU could be effective.
Journal Article