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Critical care medicine

Ewa A Woźnica, Małgorzata Inglot, Ryszard K Woźnica, Lidia Łysenko
Despite continuous progress in medicine, sepsis remains the main cause of deaths in the intensive care unit. Liver failure complicating sepsis/septic shock has a significant impact on mortality in this group of patients. The pathophysiology of sepsis-associated liver dysfunction is very complicated and still not well understood. According to the Surviving Sepsis Campaign (SSC) Guidelines, the diagnosis of liver dysfunction during sepsis is based on the increase in bilirubin concentration >2 mg/dL and the occurrence of coagulation disorders with INR > 1...
March 20, 2018: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
Daniel K Ting, Eddy S Lang
Clinical question Should I use apneic oxygenation when intubating patients in the emergency department to increase peri-intubation oxygen saturation and first-pass success? Article chosen Oliveira JE, Silva L, Cabrera D, Barrionuevo P, et al. Effectiveness of apneic oxygenation during intubation: a systematic review and meta-analysis. Ann Emerg Med 2017;70(4):483-94. OBJECTIVE: The purpose of this study was to synthesize and appraise the apneic oxygenation literature for its effect on peri-intubation outcomes...
March 20, 2018: CJEM
Arnaud W Thille, Tommaso Mauri, Daniel Talmor
No abstract text is available yet for this article.
March 19, 2018: American Journal of Respiratory and Critical Care Medicine
Raimund Lechner, Thomas Küpper, Markus Tannheimer
INTRODUCTION: History is full of examples of the influence of the mountain environment on warfare. The aim of this article is to identify the main environmental hazards and summarize countermeasures to mitigate the impact of this unique environment. METHODS: A selective PubMed and Internet search was conducted. Additionally, we searched bibliographies for useful supplemental literature and included the recommendations of the leading mountain medicine and wilderness medicine societies...
March 15, 2018: Wilderness & Environmental Medicine
Mohanned Mustafa, Easwaradhas Gladston Chelliah, Michael Hughes
Patients with systemic rheumatic diseases (SRDs) may require admission to the intensive care unit (ICU) throughout the course of their disease. Therefore, the rheumatologist needs an understanding of the factors which may influence the course of patients with SRDs who are admitted to ICU. These include the causes for admission, patient characteristics including comorbidities and drug therapies, outcome (in-ICU mortality and causes of death), and prognostic factors. Infections and exacerbation/complications of SRDs are the most common (and potentially reversible) reasons for both admission and death on ICU...
March 16, 2018: Rheumatology International
Laura Feetham, Sabine Kleinert
No abstract text is available yet for this article.
March 13, 2018: Lancet Respiratory Medicine
Ganbold Lundeg, Amanda Baric, David C Pescod, Keith Pescod
Anesthesia in Mongolia has undergone a period of major development over the past 17 years, thanks to the work of the Mongolian Society of Anesthesiologists (MSA) and the support of the World Federation of Societies of Anaesthesiologists and the Australian Society of Anaesthetists. The specialty has made major advances in training and in its standing among medical specialties in Mongolia. The MSA has produced members who are leaders in the development of anesthesia as well as emergency medicine and critical care...
April 2018: Anesthesia and Analgesia
Jean Louis Trouillet, Olivier Collange, Fouad Belafia, François Blot, Gilles Capellier, Eric Cesareo, Jean-Michel Constantin, Alexandre Demoule, Jean-Luc Diehl, Pierre-Grégoire Guinot, Franck Jegoux, Erwan L'Her, Charles-Edouard Luyt, Yazine Mahjoub, Julien Mayaux, Hervé Quintard, François Ravat, Sebastien Vergez, Julien Amour, Max Guillot
Tracheotomy is widely used in intensive care units, albeit with great disparities between medical teams in terms of frequency and modality. Indications and techniques are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of tracheotomy in adult critically ill patients developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method...
March 15, 2018: Annals of Intensive Care
D Czock, V Schwenger, D Kindgen-Milles, M Joannidis, S John, M Schmitz, A Jörres, A Zarbock, M Oppert, J T Kielstein, C Willam
BACKGROUND: Many anti-infective drugs require dose adjustments in critically ill patients with acute kidney injury (AKI) and renal replacement therapy, in order to achieve adequate therapeutic drug concentrations. OBJECTIVES: The fundamental pharmacokinetic and pharmacodynamic principles of drug dose adjustment are presented. Recommendations on anti-infective drug dosage in intensive care are provided. MATERIALS AND METHODS: We established dose recommendations of selected anti-infective drugs based on information in the summary of product characteristics, published studies and recommendations, pharmacokinetic and pharmacodynamic considerations, and the experience and expert opinion of the authors...
March 15, 2018: Medizinische Klinik, Intensivmedizin und Notfallmedizin
(no author information available yet)
Vets Now has launched a new fast-track induction programme for vets who want to work in emergency and critical care medicine. Clinical director Amanda Boag describes what's involved.
March 17, 2018: Veterinary Record
Kathleen A Calzone, Jean Jenkins, Stacey Culp, Laurie Badzek
BACKGROUND: The Precision Medicine Initiative will accelerate genomic discoveries that improve health care, necessitating a genomic competent workforce. PURPOSE: This study assessed leadership team (administrator/educator) year-long interventions to improve registered nurses' (RNs) capacity to integrate genomics into practice. METHODS: We examined genomic competency outcomes in 8,150 RNs. DISCUSSION: Awareness and intention to learn more increased compared with controls...
November 13, 2017: Nursing Outlook
Asad Zaman Khan, Aslam Khan, Arshad Naseem
OBJECTIVE: To assess the safety of percutaneous tracheostomy when performed by physician intensivists. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Adult Medical ICU in the Department of Critical Care Medicine, Military Hospital, Rawalpindi, Pakistan, from September 2013 to August 2016. METHODOLOGY: Departmental record for percutaneous tracheostomies, performed by physician intensivifts, was evaluated...
March 2018: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Dafina Ilijazi, Mohammad Abufaraj, Melanie R Hassler, Iris E Ertl, David D'Andrea, Shahrokh F Shariat
Bladder cancer (BCa) is the fifth most frequently diagnosed cancer worldwide and is, in fact, the most expensive cancer on a per-patient to treat basis. There is a critical need to implement new tests into clinical practice to improve the quality of clinical care, decrease unnecessary invasive therapies and ultimately save costs. Currently, no molecular or genetic biomarker has been widely integrated into daily clinical practice. However, major milestones have been achieved in our understanding of the molecular alterations in BCa that will provide the basis for integrating molecular and genetic biomarkers into clinical decision making to guide management...
March 15, 2018: Expert Review of Molecular Diagnostics
Matheus Roque, Sandro C Esteves
Varicocele, the leading cause of male infertility, can impair sperm quality and fertility via various oxidative stress mechanisms. An imbalance between excessive reactive oxygen species production and antioxidant protection causes alterations in nuclear and mitochondrial sperm DNA, thus rendering a subset of varicocele men less fertile. In particular, sperm DNA fragmentation is usually elevated in men with clinical varicocele in both abnormal and normal semen parameters by the current World Health Organization criteria...
March 14, 2018: International Urology and Nephrology
Sergio Buccheri, Gottfried H Sodeck, Davide Capodanno
In modern medicine, the results of a comprehensive and methodologically sound meta-analysis bring the most robust, high-quality information to support evidence-based decision-making. With recent developments in newer meta-analytic approaches, iteration of statistical paradigms and software implementations, network and patient-level meta-analyses have recently gained popularity alongside conventional pairwise study-level meta-analyses. However, pitfalls are common in this challenging and rapidly evolving field of statistics...
April 1, 2018: European Journal of Cardio-thoracic Surgery
Bibb Allen, Mythreyi Chatfield, Judy Burleson, William T Thorwarth
In September of 2014, the American College of Radiology joined a number of other organizations in sponsoring the 2015 National Academy of Medicine report, Improving Diagnosis In Health Care. Our presentation to the Academy emphasized that although diagnostic errors in imaging are commonly considered to result only from failures in disease detection or misinterpretation of a perceived abnormality, most errors in diagnosis result from failures in information gathering, aggregation, dissemination and ultimately integration of that information into our patients' clinical problems...
September 26, 2017: Diagnosis
David E Newman-Toker, J Matthew Austin, Jordan Derk, Melissa Danforth, Mark L Graber
BACKGROUND: A 2015 National Academy of Medicine report on improving diagnosis in health care made recommendations for direct action by hospitals and health systems. Little is known about how health care provider organizations are addressing diagnostic safety/quality. METHODS: This study is an anonymous online survey of safety professionals from US hospitals and health systems in July-August 2016. The survey was sent to those attending a Leapfrog Group webinar on misdiagnosis (n=188)...
June 27, 2017: Diagnosis
Utpal Bhalala, Praveen Khilnani
Pediatric critical care services in India have grown with leaps and bounds. There has been a growing need of physicians specially trained in pediatric critical care medicine (PCCM) in India. Physicians returning to India after their formal training in PCCM abroad have partly supported this growing need. Development of formal PCCM training programs in India has been a huge step toward supporting the growing clinical needs. This article focuses on advances in pediatric critical care training in India and its future directions...
2018: Frontiers in Pediatrics
Christy J W Ledford, Carla L Fisher, David A Moss, Paul F Crawford
INTRODUCTION: Although an increasing number of physicians are completing medical acupuncture training, only half of those physicians are able to successfully incorporate acupuncture into practice. We conducted a qualitative study to identify the factors and barriers that can enhance and impede physicians' delivery of and patients' engagement in medical acupuncture within the family medicine clinic. METHODS: We conducted interviews with 15 family physicians and 17 patients in a US family medicine clinic that has integrated medical acupuncture into its practice...
March 2018: Journal of the American Board of Family Medicine: JABFM
Jasper M Smit, Reinder Raadsen, Michiel J Blans, Manfred Petjak, Peter M Van de Ven, Pieter R Tuinman
BACKGROUND: Insertion of a central venous catheter (CVC) is common practice in critical care medicine. Complications arising from CVC placement are mostly due to a pneumothorax or malposition. Correct position is currently confirmed by chest x-ray, while ultrasonography might be a more suitable option. We performed a meta-analysis of the available studies with the primary aim of synthesizing information regarding detection of CVC-related complications and misplacement using ultrasound (US)...
March 13, 2018: Critical Care: the Official Journal of the Critical Care Forum
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