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critical care paed

Deborah Dillon, Faye Gary
Implementation of the Affordable Care Act (2010) enabled more than 30 million people to have new access to primary care services. On the basis of current utilization patterns, demand for primary care providers is expected to grow more rapidly than physician supply. This imbalance is expected to worsen, as the aging population requires more health care resources. In addition, more patients are requiring critical care services and physician numbers are not keeping with this growing need. Restrictions on resident physician practice hours have impacted inpatient care as well...
January 2017: Nursing Administration Quarterly
Kun Peng, Patrick Parkinson, Jessica L Boland, Qian Gao, Yesaya C Wenas, Christopher L Davies, Ziyuan Li, Lan Fu, Michael B Johnston, Hark H Tan, Chennupati Jagadish
Terahertz time-domain spectroscopy (THz-TDS) has emerged as a powerful tool for materials characterization and imaging. A trend toward size reduction, higher component integration, and performance improvement for advanced THz-TDS systems is of increasing interest. The use of single semiconducting nanowires for terahertz (THz) detection is a nascent field that has great potential to realize future highly integrated THz systems. In order to develop such components, optimized material optoelectronic properties and careful device design are necessary...
August 10, 2016: Nano Letters
Jane S Thornton, Pierre Frémont, Karim Khan, Paul Poirier, Jonathon Fowles, Greg D Wells, Renata J Frankovich
Non-communicable disease is a leading threat to global health. Physical inactivity is a large contributor to this problem; in fact, the WHO ranks it as the fourth leading risk factor for overall morbidity and mortality worldwide. In Canada, at least 4 of 5 adults do not meet the Canadian Physical Activity Guidelines of 150 min of moderate-to-vigorous physical activity per week. Physicians play an important role in the dissemination of physical activity (PA) recommendations to a broad segment of the population, as over 80% of Canadians visit their doctors every year and prefer to get health information directly from them...
September 2016: British Journal of Sports Medicine
Wan-Ting Wu, Yung-Lung Wu, Shaw-Min Hou, Chun-Mei Kang, Chi-Hung Huang, Yu-Ju Huang, Victoria Yue An Wang, Pa-Chun Wang
This article reports the results from a study that employed an interprofessional crew resource management (CRM) education programme in the emergency and critical care departments. The study aimed to investigate the effectiveness of this intervention of participants' satisfaction and safety attitude changes using a satisfaction questionnaire and the Human Factors Attitude Survey (HFAS). Overall, participants responded positively to the CRM training-93.4% were satisfied, 93.1% agreed that it enhanced patient safety and care quality, 85...
July 2016: Journal of Interprofessional Care
Alethea Tan, Sarah Smailes, Thessa Friebel, Ashish Magdum, Quentin Frew, Naguib El-Muttardi, Peter Dziewulski
Burn survival has improved with advancements in fluid resuscitation, surgical wound management, wound dressings, access to antibiotics and nutritional support for burn patients. Despite these advancements, the presence of smoke inhalation injury in addition to a cutaneous burn still significantly increases morbidity and mortality. The pathophysiology of smoke inhalation has been well studied in animal models. Translation of this knowledge into effectiveness of clinical management and correlation with patient outcomes including the paediatric population, is still limited...
August 2016: Burns: Journal of the International Society for Burn Injuries
Adam Kuchnia, Carrie Earthman, Levi Teigen, Abigail Cole, Marina Mourtzakis, Michael Paris, Willem Looijaard, Peter Weijs, Heleen Oudemans-van Straaten, Gregory Beilman, Andrew Day, Roger Leung, Charlene Compher, Rupinder Dhaliwal, Sarah Peterson, Hannah Roosevelt, Daren K Heyland
BACKGROUND: In critically ill patients, muscle loss is associated with adverse outcomes. Raw bioelectrical impedance analysis (BIA) parameters (eg, phase angle [PA] and impedance ratio [IR]) have received attention as potential markers of muscularity, nutrition status, and clinical outcomes. Our objective was to test whether PA and IR could be used to assess low muscularity and predict clinical outcomes. METHODS: Patients (≥18 years) having an abdominal computed tomography (CT) scan and admitted to intensive care underwent multifrequency BIA within 72 hours of scan...
May 24, 2016: JPEN. Journal of Parenteral and Enteral Nutrition
Martina Zaninotto, Giorgia Miolo, Adriano Guiotto, Silvia Marton, Mario Plebani
BACKGROUND: The quality performance and the comparability between results of pharmacies point-of-care-testing (POCT) and institutional laboratories have been evaluated. METHODS: Eight pharmacies participated in the project: a capillary specimen collected by the pharmacist and, simultaneously, a lithium-heparin sample drawn by a physician of laboratory medicine for the pharmacy customers (n=106) were analyzed in the pharmacy and in the laboratory, respectively. Glucose, cholesterol, HDL-cholesterol, triglycerides, creatinine, uric acid, aspartate aminotransferase, alanine aminotransferase, were measured using: Reflotron, n=5; Samsung, n=1; Cardiocheck PA, n=1; Cholestech LDX, n=1 and Cobas 8000...
May 19, 2016: Clinical Chemistry and Laboratory Medicine: CCLM
Toby G Pavey, G M E E Geeske Peeters, Sjaan R Gomersall, Wendy J Brown
OBJECTIVES: To examine the effects of overall level and timing of physical activity (PA) on changes from a healthy body mass index (BMI) category over 12 years in young adult women. PATIENTS AND METHODS: Participants in the Australian Longitudinal Study on Women's Health (younger cohort, born 1973-1978) completed surveys between 2000 (age 22-27 years) and 2012 (age 34-39 years). Physical activity was measured in 2000, 2003, 2006, and 2009 and was categorized as very low, low, active, or very active at each survey, and a cumulative PA score for this 9-year period was created...
June 2016: Mayo Clinic Proceedings
Ebru Ortaç Ersoy, Mine Durusu Tanriover, Serpil Öcal, Meltem Gulsun Akpinar, Arzu Topeli
AIM: Chronic obstructive pulmonary disease (COPD) is one of the leading chronic diseases and a common cause of death. Identification of COPD patients at high risk for complications and mortality is of utmost importance. Computed tomography (CT) can be used to measure the ratio of the diameter of the pulmonary artery (PA) to the diameter of the aorta (A), and PA/A ratio was shown to be correlated with PA pressure (PAP). However, the prognostic value of PA size remains unclear in patients with COPD...
June 2016: Journal of Critical Care
Felipe Lobelo, Heval M Kelli, Sheri Chernetsky Tejedor, Michael Pratt, Michael V McConnell, Seth S Martin, Gregory J Welk
Physical activity (PA) interventions constitute a critical component of cardiovascular disease (CVD) risk reduction programs. Objective mobile health (mHealth) software applications (apps) and wearable activity monitors (WAMs) can advance both assessment and integration of PA counseling in clinical settings and support community-based PA interventions. The use of mHealth technology for CVD risk reduction is promising, but integration into routine clinical care and population health management has proven challenging...
May 2016: Progress in Cardiovascular Diseases
Avihu Z Gazit, Stuart C Sweet, R Mark Grady, Umar S Boston, Charles B Huddleston, David M Hoganson, Mark Shepard, Steve Raithel, Mary Mehegan, Allan Doctor, Philip C Spinella, Pirooz Eghtesady
The management of decompensating critically ill children with severe PH is extremely challenging and requires a multidisciplinary approach. Unfortunately, even with optimal care, these children might continue to deteriorate and develop inadequate systemic perfusion and at times cardiac arrest secondary to a pulmonary hypertensive crisis. Tools to support these children are limited, and at times, the team should proceed with offering extracorporeal support, especially in newly diagnosed patients who have not benefitted from medical therapy prior to their acute deterioration, in patients with severe pulmonary venous disease and in patients with alveolar capillary dysplasia...
March 2016: Pediatric Transplantation
Zesheng Peng, Daofeng Tian, Hongliu Wang, Derek Kai Kong, Shenqi Zhang, Baohui Liu, Gang Deng, Zhou Xu, Liquan Wu, Baowei Ji, Long Wang, Qiang Cai, Mingchang Li, Junmin Wang, Aimin Zhang, Qianxue Chen
Epistaxis due to ruptured internal carotid artery (ICA) aneurysm embedded within a pituitary adenoma (PA) has seldom been reported in the literature. Here we want to elaborate the incidence, mechanisms, clinical manifestations, and treatment strategy for this condition. The first survived case of a patient with epistaxis and pituitary apoplexy due to ruptured aneurysm embedded within PA was reported and the literature was reviewed. A 53-year-old male patient presented to our institution with sudden onset epistaxis and progressive vision loss...
2015: International Journal of Clinical and Experimental Pathology
Muhammad Awais, Sabato Mellone, Lorenzo Chiari
Recent advances in the MEMS devices make it happen to wirelessly integrate miniature motion capturing devices with Smartphones and to use them in personal health care and physical activity monitoring in daily life. There is no ground truth, though, to measure the physical activity (PA) in daily life and because of this, there is no common validation procedure adapted by the researchers for benchmarking the performance of algorithms for PA classification. The major issue in the existing studies for PA classification is the utilization of structured protocol in a controlled setting or simulated daily environment, which limits their implementation in real life conditions where activities are unplanned and unstructured, both in occurrence and in duration...
2015: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Marjo J M Maas, Simone A van Dulmen, Margaretha H Sagasser, Yvonne F Heerkens, Cees P M van der Vleuten, Maria W G Nijhuis-van der Sanden, Philip J van der Wees
BACKGROUND: Clinical practice guidelines are intended to improve the process and outcomes of patient care. However, their implementation remains a challenge. We designed an implementation strategy, based on peer assessment (PA) focusing on barriers to change in physical therapy care. A previously published randomized controlled trial showed that PA was more effective than the usual strategy "case discussion" in improving adherence to a low back pain guideline. Peer assessment aims to enhance knowledge, communication, and hands-on clinical skills consistent with guideline recommendations...
2015: BMC Medical Education
Matthieu Pierre Platre, Yvon Jaillais
Acidic phospholipids are minor membrane lipids but critically important for signaling events. The main acidic phospholipids are phosphatidylinositol phosphates (PIPs also known as phosphoinositides), phosphatidylserine (PS), and phosphatidic acid (PA). Acidic phospholipids are precursors of second messengers of key signaling cascades or are second messengers themselves. They regulate the localization and activation of many proteins, and are involved in virtually all membrane trafficking events. As such, it is crucial to understand the subcellular localization and dynamics of each of these lipids within the cell...
2016: Methods in Molecular Biology
Brian J Lichtenstein, David B Reuben, Arun S Karlamangla, Weijuan Han, Carol P Roth, Neil S Wenger
The quality of care of older adults in the United States has been consistently shown to be inadequate. This gap between recommended and actual care provides an opportunity to improve the value of health care for older adults. Prior work from the Assessing Care of Vulnerable Elders (ACOVE) investigators first defined, and then sought to improve, clinical practice for common geriatric conditions. A critical component of the ACOVE intervention for practice improvement was an emphasis on the delegation of specific care processes, but the independent effect of delegation on the quality of care has not been evaluated...
October 2015: Journal of the American Geriatrics Society
Amy M Ahasic, Paula Tejera, Yongyue Wei, Li Su, Christos S Mantzoros, Ednan K Bajwa, B Taylor Thompson, David C Christiani
OBJECTIVE: To characterize predictors of insulin-like growth factor-1 and insulin-like growth factor-binding protein-3 in acute critical illness with the hypothesis that acute factors associated with critical illness will more strongly predict circulating insulin-like growth factor-1 and insulin-like growth factor-binding protein-3 than chronic clinical or genetic factors. DESIGN: Observational study nested within a large prospective study using multivariable linear regression to model circulating insulin-like growth factor-1 and insulin-like growth factor-binding protein-3 with acute and chronic clinical variables, and genotype from five polymorphisms in insulin-like growth factor pathway genes...
December 2015: Critical Care Medicine
A-C Merveille, G Bolen, E Krafft, E Roels, S Gomart, A-L Etienne, C Clercx, K Mc Entee
BACKGROUND: Early recognition of left-sided congestive heart failure (CHF) in dogs with degenerative mitral valve disease (DMVD) is important because it influences medical therapy, timing of follow-up, and outcome. HYPOTHESIS: Pulmonary vein diameter-to-pulmonary artery diameter ratio (PV/PA) measured by echocardiography can predict CHF. ANIMALS: Ninety-eight client-owned dogs, 37 controls, and 61 dogs with DMVD. METHODS: Prospective clinical cohort study...
November 2015: Journal of Veterinary Internal Medicine
Paul A Lapchak
Today, there is an enormous amount of excitement in the field of stroke victim care due to the recent success of MR. CLEAN, SWIFT PRIME, ESCAPE, EXTEND-IA, and REVASCAT endovascular trials. Successful intravenous (IV) recombinant tissue plasminogen activator (rt-PA) clinical trials [i.e., National Institute of Neurological Disorders and Stroke (NINDS) rt-PA trial, Third European Cooperative Acute Stroke Study (ECASSIII), and Third International Stroke study (IST-3)] also need to be emphasized. In the recent endovascular and thrombolytic trials, there is statistically significant improvement using both the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Score (mRS) scale, but neither approach promotes complete recovery in patients enrolled within any particular NIHSS or mRS score tier...
October 2015: Translational Stroke Research
LaDonna S Hale, Michelle M Wallace, Courtney R Adams, Michelle L Kaufman, Courtney L Snyder
Selecting resources to support didactic courses is a critical decision, and the advantages and disadvantages must be carefully considered. During clinical rotations, students not only need to possess strong background knowledge but also are expected to be proficient with the same evidence-based POC resources used by clinicians. Students place high value on “real world” learning and therefore may place more value on POC resources that they know practicing clinicians use as compared with medical textbooks...
September 2015: Journal of Physician Assistant Education
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