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https://www.readbyqxmd.com/read/29223743/early-vs-late-tracheostomy-in-intensive-care-settings-impact-on-icu-and-hospital-costs
#1
Brent Herritt, Dipayan Chaudhuri, Kednapa Thavorn, Dalibor Kubelik, Kwadwo Kyeremanteng
INTRODUCTION: Up to 12% of the 800,000 patients who undergo mechanical ventilation in the United States every year require tracheostomies. A recent systematic review showed that early tracheostomy was associated with better outcomes: more ventilator-free days, shorter ICU stays, less sedation and reduced long-term mortality. However, the financial impact of early tracheostomies remain unknown. OBJECTIVES: To conduct a cost-analysis on the timing of tracheostomy in mechanically ventilated patients...
December 7, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29222705/tai-chi-and-qigong-for-cancer-related-symptoms-and-quality-of-life-a-systematic-review-and-meta-analysis
#2
REVIEW
Peter M Wayne, M S Lee, J Novakowski, K Osypiuk, J Ligibel, L E Carlson, R Song
PURPOSE: This study aims to summarize and critically evaluate the effects of Tai Chi and Qigong (TCQ) mind-body exercises on symptoms and quality of life (QOL) in cancer survivors. METHODS: A systematic search in four electronic databases targeted randomized and non-randomized clinical studies evaluating TCQ for fatigue, sleep difficulty, depression, pain, and QOL in cancer patients, published through August 2016. Meta-analysis was used to estimate effect sizes (ES, Hedges' g) and publication bias for randomized controlled trials (RCTs)...
December 8, 2017: Journal of Cancer Survivorship: Research and Practice
https://www.readbyqxmd.com/read/29220303/locally-aggressive-connective-tissue-tumors
#3
Mrinal M Gounder, David M Thomas, William D Tap
In this review, we highlight the complexities of the natural history, biology, and clinical management of three intermediate connective tissue tumors: desmoid tumor (DT) or aggressive fibromatosis, tenosynovial giant cell tumor (TGCT) or diffuse-type pigmented villonodular synovitis (dtPVNS), and giant cell tumor of bone (GCTB). Intermediate histologies include tumors of both soft tissue and bone origin and are locally aggressive and rarely metastatic. Some common aspects to these tumors are that they can be locally infiltrative and/or impinge on critical organs, which leads to disfigurement, pain, loss of function and mobility, neurovascular compromise, and occasionally life-threatening consequences, such as mesenteric, bowel, ureteral, and/or bladder obstruction...
December 8, 2017: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/29214963/ideology-and-palliative-care-moral-hazards-at-the-bedside
#4
Rosamond Rhodes, James J Strain
Palliative care has had a long-standing commitment to teaching medical students and other medical professionals about pain management, communication, supporting patients in their decisions, and providing compassionate end-of-life care. Palliative care programs also have a critical role in helping patients understand medical conditions, and in supporting them in dealing with pain, fear of dying, and the experiences of the terminal phase of their lives. We applaud their efforts to provide that critical training and fully support their continued important work in meeting the needs of patients and families...
January 2018: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
https://www.readbyqxmd.com/read/29212080/clinical-evaluation-of-continuous-renal-replacement-therapy-in-combination-with-ultrasound-guided-percutaneous-transhepatic-gallbladder-drainage-for-acute-severe-biliary-pancreatitis-a-retrospective-study
#5
Qingyun Zhu, Xinting Pan, Yongxian Cao, Hongqiao Wang, Ning Yu, Fuguo Liu, Shigang Yang, Yunlong Wang, Yunbo Sun, Zhengbin Wang
BACKGROUND/AIMS: This study aimed to report the clinical efficacy of continuous renal replacement therapy (CRRT) in combination with ultrasound-guided percutaneous transhepatic gallbladder drainage (PTGD) (CRRT+PTGD) in the treatment of acute severe biliary pancreatitis (ASBP). METHODS: Between January 2010 and January 2016, 40 cases of patients with ASBP who received routine CRRT (CRRT group) and 40 of those who received CRRT+PTGD (CRRT+PTGD group) at the Affiliated Hospital of Qingdao University (Qingdao, China) were retrospectively reviewed...
November 30, 2017: Kidney & Blood Pressure Research
https://www.readbyqxmd.com/read/29202259/bedside-lung-ultrasound-in-the-care-of-the-critically-ill
#6
Máté Rudas, Sam Orde, Marek Nalos
OBJECTIVE: To describe the technique and review the utility of bedside lung ultrasound in acute care. SUMMARY: Lung ultrasound is a useful point-of-care investigation in acute care, especially in patients with dyspnoea or haemodynamic instability. Although normal lung parenchyma is not accessible to ultrasound, distinctive artefacts arising from parietal and visceral pleura indirectly imply the presence of normal lung. As aeration of lung tissue reduces with disease process, visual assessment of several pathologic entities by ultrasound becomes possible...
December 2017: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/29196586/implementing-a-multicomponent-intervention-to-prevent-delirium-among-critically-ill-patients
#7
Felipe Martínez, Ana María Donoso, Carla Marquez, Eduardo Labarca
BACKGROUND: Delirium is common among the critically ill. Nonpharmacologic interventions are reportedly effective in reducing incident delirium, but limited data specific to this population exist. OBJECTIVES: To assess the efficacy and describe the implementation strategy of a multicomponent intervention to prevent delirium in an intensive care unit. METHODS: A before-and-after study was conducted in an intensive care unit between May 2014 through August 2015...
December 2017: Critical Care Nurse
https://www.readbyqxmd.com/read/29196585/feasibility-of-a-nurse-managed-pain-agitation-and-delirium-protocol-in-the-surgical-intensive-care-unit
#8
Alan Rozycki, Andrew S Jarrell, Rachel M Kruer, Samantha Young, Pedro A Mendez-Tellez
BACKGROUND: Society of Critical Care Medicine guidelines recommend the use of pain, agitation, and delirium protocols in the intensive care unit. The feasibility of nurse management of such protocols in the surgical intensive care unit has not been well assessed. OBJECTIVES: To evaluate the percentage of adherent medication interventions for patients assessed by using a pain, sedation, and delirium protocol. METHODS: Data on all adult patients admitted to a surgical intensive care unit from January 2013 through September 2013 who were assessed at least once by using a pain, sedation, and delirium protocol were retrospectively reviewed...
December 2017: Critical Care Nurse
https://www.readbyqxmd.com/read/29196241/scleroderma-skin-ulcers-definition-classification-and-treatment-strategies-our-experience-and-review-of-the-literature
#9
REVIEW
Dilia Giuggioli, Andreina Manfredi, Lumetti Federica, Colaci Michele, Clodoveo Ferri
BACKGROUND: Skin ulcers (SU) are one of the most frequent manifestations of systemic sclerosis (SSc). SSc-SU are very painful, often persistent and recurrent; they may lead to marked impairment of patient's activities and quality of life. Despite their severe impact on the whole SSc patient's management, the proposed definition, classification criteria, and therapeutic strategies of SSc-SU are still controversial. OBJECTIVE: The present study aimed to elaborate a comprehensive proposal of definition, classification, and therapeutic strategy of SSc-SU on the basis of our long-term single center experience along with a careful revision of the world literature on the same topic...
November 28, 2017: Autoimmunity Reviews
https://www.readbyqxmd.com/read/29194167/critical-care-nurses-pain-experiences-and-the-prognostic-factors
#10
Sevim Çelik, Nurten Taşdemir, Ayşe Öksüzoğlu, Elif Dirimeşe, Sema Koçaşli
OBJECTIVE: The objective of this study was to determine the emergence of pain in critical-care nurses and the prognostic risk factors. DESIGN: This study is a cross-sectional descriptive research. SETTING AND SUBJECTS: This study was conducted with the participation of 111 critical-care nurses in Zonguldak province, Turkey. INTERVENTIONS: The data were collected using a survey form and the Cornell Musculoskeletal Discomfort Questionnaire between August and November 2015...
January 2018: Dimensions of Critical Care Nursing: DCCN
https://www.readbyqxmd.com/read/29194144/thoracic-epidural-analgesia-and-mortality-in-acute-pancreatitis-a-multicenter-propensity-analysis
#11
Matthieu Jabaudon, Nouria Belhadj-Tahar, Thomas Rimmelé, Olivier Joannes-Boyau, Stéphanie Bulyez, Jean-Yves Lefrant, Yannick Malledant, Marc Leone, Paer-Selim Abback, Fabienne Tamion, Hervé Dupont, Brice Lortat-Jacob, Philippe Guerci, Thomas Kerforne, Raphael Cinotti, Laurent Jacob, Philippe Verdier, Thierry Dugernier, Bruno Pereira, Jean-Michel Constantin
OBJECTIVE: Recent preclinical and clinical data suggest that thoracic epidural analgesia, a technique primarily aimed at decreasing pain, might exert anti-inflammatory effects, enhance splanchnic and pancreatic blood flow during acute pancreatitis; however, the influence of epidural analgesia on mortality remains under investigated in this setting. This study was therefore designed to assess the impact of epidural analgesia on mortality in ICU patients with acute pancreatitis. DESIGN: Multicenter retrospective, observational, cohort study...
November 30, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29189705/validation-of-the-italian-version-of-the-critical-pain-observation-tool-in-brain-injured-critically-ill-adults
#12
Francesco Sulla, Nilson De Souza Ramos, Noemi Terzi, Tania Trenta, Mariella Uneddu, Melanny Alessandra Zaldivar Cruces, Leopoldo Sarli
BACKGROUND AND AIM: Pain in intensive care units (ICUs) is a frequent and often undermanaged problem. Brain-injured patients are often unable to reliably self-report their pain, calling forth the need to use behavioural scales such as the Critical-Care Pain Observation Tool (CPOT). This study aimed to test the reliability and validity of the Italian CPOT use with brain-injured ICU adults. METHOD: A sample of 50 adults critical care patients was included. Each patient was assessed by two independent observers at three predefined times - at rest; during mobilization for hygiene; 20 minutes later - using the CPOT, PAINAD, and NRS...
November 30, 2017: Acta Bio-medica: Atenei Parmensis
https://www.readbyqxmd.com/read/29174328/variation-in-hospital-admission-rates-between-a-tertiary-care-and-two-freestanding-emergency-departments
#13
Erin L Simon, Cedric Dark, Mitch Kovacs, Sunita Shakya, Craig A Meek
BACKGROUND: Recently, freestanding emergency departments (FSEDs) have grown significantly in number. Critics have expressed concern that FSEDs may increase healthcare costs. OBJECTIVE: We determined whether admission rates for identical diagnoses varied among the same group of physicians according to clinical setting. METHODS: This was a retrospective comparison of adult admission rates (n=3230) for chest pain, chronic obstructive pulmonary disease (COPD), asthma, and congestive heart failure (CHF) between a hospital-based ED (HBED) and two FSEDs throughout 2015...
October 29, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29170335/38%C3%A2-a-comparison-of-two-interventions-in-the-treatment-of-severe-ankle-sprains-and-distal-fibular-avulsion-fractures-a-patient-perspective
#14
Sarah Powell
: Stable ankle injuries are highly prevalent in Emergency Departments across the UK. Appropriate management to enable patients to experience a smooth recovery and prevent chronic ankle instability or reoccurrence is a priority. Current literature states that stable ankle fractures and severe ankle sprains can be successfully managed with the below knee plaster or the aircast brace and crutches. The functional brace has proved to be clinically effective in several reports. There has however, been no research to measure patient satisfaction levels between these two treatments...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29169385/standardised-outcomes-in-nephrology-polycystic-kidney-disease-song-pkd-study-protocol-for-establishing-a-core-outcome-set-in-polycystic-kidney-disease
#15
Yeoungjee Cho, Benedicte Sautenet, Gopala Rangan, Jonathan C Craig, Albert C M Ong, Arlene Chapman, Curie Ahn, Dongping Chen, Helen Coolican, Juliana Tze-Wah Kao, Ron Gansevoort, Ronald Perrone, Tess Harris, Vicente Torres, York Pei, Peter G Kerr, Jessica Ryan, Talia Gutman, Martin Howell, Angela Ju, Karine E Manera, Armando Teixeira-Pinto, Lorraine A Hamiwka, Allison Tong
BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is the most common potentially life threatening inherited kidney disease and is responsible for 5-10% of cases of end-stage kidney disease (ESKD). Cystic kidneys may enlarge up to 20 times the weight of a normal kidney due to the growth of renal cysts, and patients with ADPKD have an increased risk of morbidity, premature mortality, and other life-time complications including renal and hepatic cyst and urinary tract infection, intracranial aneurysm, diverticulosis, and kidney pain which impair quality of life...
November 23, 2017: Trials
https://www.readbyqxmd.com/read/29167033/nursing-perceptions-of-the-emergency-severity-index-as-a-triage-tool-in-the-united-arab-emirates-a-qualitative-analysis
#16
Binoy Mistry, Kamna S Balhara, Jeremiah S Hinson, Xavier Anton, Iman Yassin Othman, Maysoon Abdel Latif E'nouz, Norman Agustin Avila, Sophia Henry, Scott Levin, Sarah Stewart De Ramirez
INTRODUCTION: With emergency department crowding becoming an increasing problem across the globe, nursing triage to prioritize patients receiving care is ever more important. ESI is the most common triage system used in the United States and is increasingly used worldwide. This qualitative study that explores emergency nursing perceptions of the ESI identifies strengths, weaknesses, and barriers to implementation of the ESI internationally. METHODS: We conducted a cross-sectional qualitative analysis using semistructured interviews of 27 emergency triage nurses...
November 19, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/29166342/important-considerations-for-performing-prepectoral-breast-reconstruction
#17
Hani Sbitany
Prepectoral breast reconstruction has emerged as an excellent technique for postmastectomy reconstruction, as it allows for full preservation of a patient's pectoralis major muscle and chest wall function. This reduces pain, eliminates animation deformity, and results in high patient satisfaction. Safely performed prepectoral breast reconstruction requires a careful patient selection process before committing to the procedure, taking into account comorbidities, radiation status, and oncologic criteria such as tumor location and breast cancer stage...
December 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/29154919/patient-reported-outcomes-and-opioid-use-by-outpatient-cancer-patients
#18
N Moryl, V Dave, P Glare, A Bokhari, V T Malhotra, A Gulati, J Hung, V Puttanniah, Y Griffo, R Tickoo, A Wiesenthal, S D Horn, C E Inturrisi
The Memorial Sloan-Kettering Pain Registry contains patient characteristics, treatments, and outcomes for a prospective cohort of 1534 chronic pain cancer patients who were seen at outpatient pain service clinics. Average pain intensity (Brief Pain Inventory) was reported as mild by 24.6% of patients, moderate by 41.5%, and severe by 33.9%. The patient's report of average percent pain relief and health state (EQ-5D) was inversely related to average pain intensity category, while measures of pain interference, number of worst pain locations, and physical and psychological distress were directly related to pain intensity category...
November 14, 2017: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/29146105/content-validation-of-behaviours-and-autonomic-responses-for-the-assessment-of-pain-in-critically-ill-adults-with-a-brain-injury
#19
Céline Gélinas, Kathleen A Puntillo, Madalina Boitor, Mélanie Bérubé, Jane Topolovec-Vranic, Anne-Sylvie Ramelet, Aaron M Joffe, Melissa Richard-Lalonde, Francis Bernard, David L Streiner
BACKGROUND: The evidence shows that brain-injured patients express behaviours that are related to their level of consciousness (LOC), and different from other patients in the intensive care unit (ICU). Therefore, existing behavioural scales should be revised to enhance their content and validity for use in these patients. OBJECTIVES: The aim was to evaluate the content relevance of behaviours and autonomic responses for pain assessment of brain-injured ICU patients from the perspective of critical care clinicians...
November 13, 2017: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/29143474/chronic-intestinal-pseudo-obstruction-progress-in-management
#20
REVIEW
G Di Nardo, T B Karunaratne, S Frediani, R De Giorgio
Chronic intestinal pseudo-obstruction (CIPO) is a severe form of gastrointestinal dysmotility (often due to derangement of the innervation/smooth muscle/interstitial cells of Cajal) with recurrent episodes of intestinal subocclusion mimicking a mechanical obstruction. Because of its complexity and heterogeneity, CIPO is often misdiagnosed or remains unrecognized until advanced stages. Management is a critical aspect in CIPO patient care. So far, most prokinetic drugs have not proven efficacy in restoring intestinal propulsion, thus nutritional support, fluid/electrolyte replacement, and antibiotics are the mainstay of treatment...
December 2017: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
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