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https://www.readbyqxmd.com/read/29033075/multi-drug-resistant-organism-infections-in-a-medical-icu-association-to-clinical-features-and-impact-upon-outcome
#1
E E Magira, S Islam, M S Niederman
OBJECTIVE: To define clinical features associated with Intensive Care Unit (ICU) infections caused by multi-drug resistant organisms (MDRO) and their impact on patient outcome. DESIGN: A single-center, retrospective case-control study was carried out between January 2010 and May 2010. SETTING: A medical ICU (MICU) in the United States. PATIENTS: The study included a total of 127 MDRO-positive patients and 186 MDRO-negative patients...
October 12, 2017: Medicina Intensiva
https://www.readbyqxmd.com/read/29016485/a-medically-supervised-pregnancy-exercise-intervention-in-obese-women-a-randomized-controlled-trial
#2
Niamh Daly, Maria Farren, Aoife McKeating, Ruth OʼKelly, Mary Stapleton, Michael J Turner
OBJECTIVE: To evaluate whether an intensive, medically supervised exercise intervention improved maternal glycemia and gestational weight gain in obese pregnant women when compared with routine prenatal care. METHODS: This randomized controlled trial compared a medically supervised exercise intervention with routine prenatal care. The primary outcome was a reduction in mean maternal fasting plasma glucose in the intervention group by 6.9 mg/dL at the time of a 75-g oral glucose tolerance test at 24-28 weeks of gestation...
October 6, 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28977759/the-role-of-danger-signals-in-the-pathogenesis-and-perpetuation-of-critical-illness
#3
Kevin C Ma, Edward J Schenck, Maria A Pabon, Augustine M K Choi
The innate immune system induces inflammation through induction of multiple pathways including the TNFα/NF-κB signaling as well as the NLRP3 inflammasome cascade activation with production of inflammatory molecules. Pathogen associated molecular patterns are immunogenic costimulatory molecules that can activate the innate immune system in the presence of foreign pathogens. These molecularly distinct, foreign, particles initiate inflammatory and cell death cascades of the innate immune response through the binding of pathogen recognition receptors such as toll like receptors...
October 4, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28965053/point-of-care-testing-for-streptomycin-based-on-aptamer-recognizing-and-digital-image-colorimetry-by-smartphone
#4
Bixia Lin, Ying Yu, Yujuan Cao, Manli Guo, Debin Zhu, Jiaxing Dai, Minshi Zheng
The rapid detection of antibiotic residual in everyday life is very important for food safety. In order to realize the on-site and visual detection of antibiotic, a POCT method was established by using digital image colorimetry based on smartphone. Streptomycin was taken as the analyte model of antibiotics, streptomycin aptamer preferentially recognized analyte, and the excess aptamer hybridized with the complementary DNA to form the dsDNA. SYBR Green I combined with the dsDNA and then emitted obvious green fluorescence, thus the fluorescence intensity decreased with the increasing of streptomycin concentration...
September 20, 2017: Biosensors & Bioelectronics
https://www.readbyqxmd.com/read/28930959/outcomes-after-concomitant-traumatic-brain-injury-and-hemorrhagic-shock-a-secondary-analysis-from-the-pragmatic-randomized-optimal-platelets-and-plasma-ratios-trial
#5
RANDOMIZED CONTROLLED TRIAL
Samuel M Galvagno, Erin E Fox, Savitri N Appana, Sarah Baraniuk, Patrick L Bosarge, Eileen M Bulger, Rachel A Callcut, Bryan A Cotton, Michael Goodman, Kenji Inaba, Terence O'Keeffe, Martin A Schreiber, Charles E Wade, Thomas M Scalea, John B Holcomb, Deborah M Stein
BACKGROUND: Often the clinician is faced with a diagnostic and therapeutic dilemma in patients with concomitant traumatic brain injury (TBI) and hemorrhagic shock (HS), as rapid deterioration from either can be fatal. Knowledge about outcomes after concomitant TBI and HS may help prioritize the emergent management of these patients. We hypothesized that patients with concomitant TBI and HS (TBI + HS) had worse outcomes and required more intensive care compared with patients with only one of these injuries...
October 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28904962/self-rated-health-as-a-predictor-of-death-after-two-years-the-importance-of-physical-and-mental-wellbeing-postintensive-care
#6
Marie Vejen, Jakob B Bjorner, Morten H Bestle, Anne Lindhardt, Jens U Jensen
INTRODUCTION: The objective of this study is, among half-year intensive care survivors, to determine whether self-assessment of health can predict two-year mortality. METHODS: The study is a prospective cohort study based on the Procalcitonin and Survival Study trial. Half-year survivors from this 1200-patient multicenter intensive care trial were sent the SF-36 questionnaire. We used both a simple one-item question and multiple questions summarized as a Physical Component Summary (PCS) and a Mental Component Summary (MCS) score...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28903892/effectiveness-of-smartmoms-a-novel-ehealth-intervention-for-management-of-gestational-weight-gain-randomized-controlled-pilot-trial
#7
Leanne M Redman, L Anne Gilmore, Jeffrey Breaux, Diana M Thomas, Karen Elkind-Hirsch, Tiffany Stewart, Daniel S Hsia, Jeffrey Burton, John W Apolzan, Loren E Cain, Abby D Altazan, Shelly Ragusa, Heather Brady, Allison Davis, J Mick Tilford, Elizabeth F Sutton, Corby K Martin
BACKGROUND: Two-thirds of pregnant women exceed gestational weight gain (GWG) recommendations. Because excess GWG is associated with adverse outcomes for mother and child, development of scalable and cost-effective approaches to deliver intensive lifestyle programs during pregnancy is urgent. OBJECTIVE: The aim of this study was to decrease the proportion of women who exceed the Institute of Medicine (IOM) 2009 GWG guidelines. METHODS: In a parallel-arm randomized controlled trial, 54 pregnant women (age 18-40 years) who were overweight (n=25) or obese (n=29) were enrolled to test whether an intensive lifestyle intervention (called SmartMoms) decreased the proportion of women with excess GWG, defined as exceeding the 2009 IOM guidelines, compared to no intervention (usual care group)...
September 13, 2017: JMIR MHealth and UHealth
https://www.readbyqxmd.com/read/28891977/polytrauma-defined-by-the-new-berlin-definition-a-validation-test-based-on-propensity-score-matching-approach
#8
Cheng-Shyuan Rau, Shao-Chun Wu, Pao-Jen Kuo, Yi-Chun Chen, Peng-Chen Chien, Hsiao-Yun Hsieh, Ching-Hua Hsieh
Background: Polytrauma patients are expected to have a higher risk of mortality than that obtained by the summation of expected mortality owing to their individual injuries. This study was designed to investigate the outcome of patients with polytrauma, which was defined using the new Berlin definition, as cases with an Abbreviated Injury Scale (AIS) ≥ 3 for two or more different body regions and one or more additional variables from five physiologic parameters (hypotension [systolic blood pressure ≤ 90 mmHg], unconsciousness [Glasgow Coma Scale score ≤ 8], acidosis [base excess ≤ -6...
September 11, 2017: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/28890524/diagnosis-and-management-of-patients-with-paroxysmal-sympathetic-hyperactivity-following-acute-brain-injuries-using-a-consensus-based-diagnostic-tool-a-single-institutional-case-series
#9
Shigeo Godo, Shigemi Irino, Atsuhiro Nakagawa, Yu Kawazoe, Motoo Fujita, Daisuke Kudo, Ryosuke Nomura, Hiroaki Shimokawa, Shigeki Kushimoto
Paroxysmal sympathetic hyperactivity (PSH) is a distinct syndrome of episodic sympathetic hyperactivities following severe acquired brain injury, characterized by paroxysmal transient fever, tachycardia, hypertension, tachypnea, excessive diaphoresis and specific posturing. PSH remains to be an under-recognized condition with a diagnostic pitfall especially in the intensive care unit (ICU) settings due to the high prevalence of concomitant diseases that mimic PSH. A consensus set of diagnostic criteria named PSH-Assessment Measure (PSH-AM) has been developed recently, which is consisted of two components: a diagnosis likelihood tool derived from clinical characteristics of PSH, and a clinical feature scale assigned to the severity of each sympathetic hyperactivity...
2017: Tohoku Journal of Experimental Medicine
https://www.readbyqxmd.com/read/28834879/effect-of-acid-base-balance-on-postoperative-course-in-children-with-hypoplastic-left-heart-syndrome-after-the-modified-norwood-procedure
#10
Marcin Gładki, Tomasz Składzień, Rafał Żurek, Elżbieta Broniatowska, Elżbieta Wójcik, Janusz H Skalski
Hypoplastic left heart syndrome (HLHS) is a congenital heart defect that requires 3-stage cardiac surgical treatment and multidirectional specialist care. The condition of newborns in the first postoperative days following the modified Norwood procedure is characterized by considerable hemodynamic instability that may result in a sudden cardiac arrest. It is believed that the most important cause of hemodynamic instability is the fluctuations in redistribution between pulmonary and systemic blood flow.The paper analyzes the postoperative course in 40 neonates with HLHS following the modified Norwood procedure performed under deep hypothermic cardiopulmonary bypass hospitalized in Cardiac Surgical Intensive Care Unit (CSICU) in the years 2014-2015...
August 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28737073/bleeding-pelvic-fracture-patients-evolution-of-resuscitation-protocols
#11
T Söderlund, T Ketonen, L Handolin
BACKGROUND AND AIMS: Massive transfusion protocol seems to improve outcome in massively bleeding trauma patients, but not pelvic fracture patients. The aim of this study was to evaluate the effect of massive transfusion protocol on the mortality and fluid resuscitation of shocked pelvic fracture patients. MATERIAL AND METHODS: This is a trauma register study from a single hospital. From the trauma registry patients with pelvic fracture, injury severity score >15, admission base excess below -5, age >15 years, blunt trauma, and primary admission from the scene were identified...
March 1, 2017: Scandinavian Journal of Surgery: SJS
https://www.readbyqxmd.com/read/28695586/intra-operative-protective-mechanical-ventilation-in-lung-transplantation-a-randomised-controlled-trial
#12
G L Verbeek, P S Myles, G P Westall, E Lin, S L Hastings, S F Marasco, J Jaffar, A C Meehan
Primary graft dysfunction occurs in up to 25% of patients after lung transplantation. Contributing factors include ventilator-induced lung injury, cardiopulmonary bypass, ischaemia-reperfusion injury and excessive fluid administration. We evaluated the feasibility, safety and efficacy of an open-lung protective ventilation strategy aimed at reducing ventilator-induced lung injury. We enrolled adult patients scheduled to undergo bilateral sequential lung transplantation, and randomly assigned them to either a control group (volume-controlled ventilation with 5 cmH2 O, positive end-expiratory pressure, low tidal volumes (two-lung ventilation 6 ml...
August 2017: Anaesthesia
https://www.readbyqxmd.com/read/28674611/reducing-the-number-of-unnecessary-liver-function-tests-requested-on-the-paediatric-intensive-care-unit
#13
Lynn Sinitsky, Joe Brierley
Between January and October 2014, Great Ormond Street Hospital Paediatric Intensive Care Unit (PICU) was spending an average £23,392 on blood tests per month. Blood tests should be requested based on previous results and the patient's clinical condition, medication and nutritional status. However, more blood tests were being ordered than clinically indicated: an audit in October 2014 showed liver function tests (LFTs) were requested daily on most patients, even with previous normal results. A driver diagram identified three primary drivers for blood test requesting: decision-making, situational awareness and computer-based ordering...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28658485/association-of-hospital-costs-with-complications-following-total-gastrectomy-for-gastric-adenocarcinoma
#14
Luke V Selby, Renee L Gennarelli, Geoffrey C Schnorr, Stephen B Solomon, Mark A Schattner, Elena B Elkin, Peter B Bach, Vivian E Strong
Importance: Postoperative complications are associated with increased hospital costs following major surgery, but the mechanism by which they increase cost and the categories of care that drive this increase are poorly described. Objective: To describe the association of postoperative complications with hospital costs following total gastrectomy for gastric adenocarcinoma. Design, Setting, and Participants: This retrospective analysis of a prospectively collected gastric cancer surgery database at a single National Cancer Institute-designated comprehensive cancer center included all patients undergoing curative-intent total gastrectomy for gastric adenocarcinoma between January 2009 and December 2012 and was conducted in 2015 and 2016...
June 28, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28638594/high-burden-of-antimicrobial-resistance-among-gram-negative-bacteria-causing-healthcare-associated-infections-in-a-critical-care-unit-of-nepal
#15
Narayan Prasad Parajuli, Subhash Prasad Acharya, Shyam Kumar Mishra, Keshab Parajuli, Basista Prasad Rijal, Bharat Mani Pokhrel
BACKGROUND: Healthcare associated infections (HCAI) and antimicrobial resistance are principal threats to the patients of intensive care units and are the major determining factors for patient outcome. They are associated with increased morbidity, mortality, excess hospitalization and financial costs. The present study is an attempt to investigate the spectrum and antimicrobial resistance of bacterial isolates involved in healthcare associated infections (HCAI) in the patients of a critical care unit at a tertiary care university hospital in Kathmandu, Nepal...
2017: Antimicrobial Resistance and Infection Control
https://www.readbyqxmd.com/read/28618915/coronary-artery-disease-risk-stratification-and-patient-selection-for-more-aggressive-secondary-prevention
#16
François Schiele, Fiona Ecarnot, Romain Chopard
In patients with stable coronary artery disease, clinical outcomes are predominantly characterized by the consequences of atherosclerosis on the myocardium, but also by complications of atherosclerosis, notably recurrent acute coronary syndrome or stroke. Secondary prevention therapy is therefore key in this patient population. Intensification of secondary prevention therapy is possible, at the price of a therapeutic risk or a high cost, therefore justifying careful selection of patients with a high residual risk and low therapeutic risk...
June 2017: European Journal of Preventive Cardiology
https://www.readbyqxmd.com/read/28590349/outcomes-following-concomitant-traumatic-brain-injury-and-hemorrhagic-shock-a-secondary-analysis-from-the-proppr-trial
#17
Samuel M Galvagno, Erin E Fox, Savitri N Appana, Sarah Baraniuk, Patrick L Bosarge, Eileen M Bulger, Rachel A Callcut, Bryan A Cotton, Michael Goodman, Kenji Inaba, Terence O'Keeffe, Martin A Schreiber, Charles E Wade, Thomas M Scalea, John B Holcomb, Deborah M Stein
BACKGROUND: Often the clinician is faced with a diagnostic and therapeutic dilemma in patients with concomitant traumatic brain injury (TBI) and hemorrhagic shock (HS), as rapid deterioration from either can be fatal. Knowledge about outcomes following concomitant TBI and HS may help prioritize the emergent management of these patients. We hypothesized that patients with concomitant TBI and HS (TBI+HS) had worse outcomes and required more intensive care compared to patients with only one of these injuries...
June 6, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28582445/human-resources-and-models-of-mental-healthcare-integration-into-primary-and-community-care-in-india-case-studies-of-72-programmes
#18
Nadja van Ginneken, Meera S Maheedhariah, Sarah Ghani, Jayashree Ramakrishna, Anusha Raja, Vikram Patel
BACKGROUND: Given the scarcity of specialist mental healthcare in India, diverse community mental healthcare models have evolved. This study explores and compares Indian models of mental healthcare delivered by primary-level workers (PHW), and health workers' roles within these. We aim to describe current service delivery to identify feasible and acceptable models with potential for scaling up. METHODS: Seventy two programmes (governmental and non-governmental) across 12 states were visited...
2017: PloS One
https://www.readbyqxmd.com/read/28535956/highly-unsaturated-fatty-acids-hufa-mediate-and-monitor-food-s-impact-on-health
#19
REVIEW
Bill Lands
A hyperbolic, saturable, competitive dynamic of ligand binding to metabolic enzymes and lipid mediator receptors gives non-linear dose-response interactions that need careful management when planning or interpreting nutrient-based interventions. Relatively indiscriminate metabolism during accumulation of HUFA from n-3 and n-6 nutrients allows the amounts of n-3 and n-6 nutrients to determine the HUFA balance accumulated in tissue phospholipids. However, when HUFA-based eicosanoid actions are more intense with n-6 than n-3 mediators, they cause healthy physiology to shift toward pathophysiology...
May 20, 2017: Prostaglandins & Other Lipid Mediators
https://www.readbyqxmd.com/read/28522319/association-between-gestational-weight-gain-and-perinatal-outcomes-in-women-with-chronic-hypertension
#20
Lynn M Yee, Aaron B Caughey, Yvonne W Cheng
BACKGROUND: Gestational weight gain above or below the 2009 National Academy of Medicine guidelines has been associated with adverse maternal and neonatal outcomes. Although it has been well established that excess gestational weight gain is associated with the development of gestational hypertension and preeclampsia, the relationship between gestational weight gain and adverse perinatal outcomes among women with pregestational (chronic) hypertension is less clear. OBJECTIVE: The objective of this study was to examine the relationship between gestational weight gain above and below National Academy of Medicine guidelines and perinatal outcomes in a large, population-based cohort of women with chronic hypertension...
September 2017: American Journal of Obstetrics and Gynecology
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