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https://www.readbyqxmd.com/read/29753454/response-of-a-local-hospital-to-a-burn-disaster-contributory-factors-leading-to-zero-mortality-outcomes
#1
Eng-Kean Yeong, Ciaran P O'Boyle, Hui-Fu Huang, Hao-Chih Tai, Yen-Chun Hsu, Shu-Yang Chuang, Yu-Feng Wu, Che-Wei Chang, Tom J Liu, Hong-Shiee Lai
OBJECTIVE: To investigate the outcomes of a local healthcare system in managing a burn mass casualty incident (BMCI). METHODS: Thirty-three victims admitted to the National Taiwan University Hospital within 96h of the explosion were included in the study. Data were recorded on: patient demographics, Baux score, laboratory data, management response, treatment strategies, and outcomes. Case notes from June 27, 2015 to November 2015 were reviewed with a focus on fluid resuscitation, ventilation support, nutrition, infection control, sepsis treatment, and wound closure plan...
May 9, 2018: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/29737781/epidemiology-and-prognoses-in-a-medical-intermediate-care-unit
#2
Mona Morland, Rolf Haagensen, Fredrik A Dahl, Jan-Erik Berdal
BACKGROUND: The purpose of medical intermediate care units is the observation and treatment of patients with incipient or manifest organ failure. We wished to obtain data on which conditions result in admission to these units and the prognosis for these patients. MATERIAL AND METHOD: All patients admitted to the medical intermediate care unit at Akershus University Hospital in 2014 were registered prospectively with reason for admission, period of hospitalisation, degree of severity, comorbidity, last place of hospitalisation prior to medical intermediate care and treatment limitations (do-not-resuscitate order and/or do-not-intubate order)...
May 8, 2018: Tidsskrift for Den Norske Lægeforening: Tidsskrift for Praktisk Medicin, Ny Række
https://www.readbyqxmd.com/read/29730659/myxedema-coma-due-to-hashimoto-thyroiditis-a-rare-but-real-presentation-of-failure-to-thrive-in-infancy
#3
Ryan A Heksch, Rohan K Henry
BACKGROUND: Hashimoto thyroiditis (HT) is uncommon in infancy, and myxedema coma (MC) is even less common. While prior reports have documented these entities separately, to our knowledge, MC in combination with HT has not been reported before in this age group. METHODS/RESULTS: A 10-month-old female presented with ptosis, lethargy, dysphagia, and failure to thrive (FTT). She developed hypotension, bradycardia, hypothermia, and apnea requiring intubation. Initial thyroid-stimulating hormone was 422 μIU/mL, and free thyroxine was < 0...
May 4, 2018: Hormone Research in Pædiatrics
https://www.readbyqxmd.com/read/29726931/comparable-perioperative-outcomes-and-mid-term-survival-in-prosthetic-valve-endocarditis-and-native-valve-endocarditis
#4
Makoto Mori, Kayoko Shioda, Max Jordan Nguemeni Tiako, Syed Usman Bin Mahmood, Abeel A Mangi, James J Yun, Umer Darr, Philip Yi Kit Pang, Arnar Geirsson
OBJECTIVES: Cardiac surgery for prosthetic valve endocarditis (PVE) represents one of the highest risk surgeries with in-hospital mortality of 20%. Given the complex nature of the operation, the operative outcome is likely strongly susceptible to the surgeon's experience and centre case volume, as measurements often are not apparent in large observational studies. We sought to evaluate operative outcomes and mid-term survival of patients with PVE compared with those of native valve endocarditis (NVE) at a tertiary care hospital...
May 2, 2018: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29708570/longer-operative-time-is-associated-with-increased-adverse-events-after-anterior-cervical-diskectomy-and-fusion-15-minute-intervals-matter
#5
Nathaniel T Ondeck, Daniel D Bohl, Ryan P McLynn, Jonathan J Cui, Patawut Bovonratwet, Kern Singh, Jonathan N Grauer
Little is known about the impact of operative time, as an independent and interval variable, on general health perioperative outcomes following anterior cervical diskectomy and fusion. Therefore, patients undergoing a 1-level anterior cervical diskectomy and fusion were identified in the American College of Surgeons National Surgical Quality Improvement Program. Operative time (as an interval variable) was tested for association with perioperative outcomes using a multivariate regression that was adjusted for differences in baseline characteristics...
April 27, 2018: Orthopedics
https://www.readbyqxmd.com/read/29704686/a-novel-nkx3-2-mutation-associated-with-perinatal-lethal-phenotype-of-spondylo-megaepiphyseal-metaphyseal-dysplasia-in-a-neonate
#6
Pelin Ozlem Simsek-Kiper, Can Kosukcu, Ozlem Akgun-Dogan, Rahsan Gocmen, Gulen Eda Utine, Tutku Soyer, Ayse Korkmaz-Toygar, Gen Nishimura, Mehmet Alikasifoglu, Koray Boduroglu
Spondylo-megaepiphyseal-metaphyseal dysplasia (SMMD) is an autosomal recessive skeletal dysplasia, characterized by disproportionate short stature with a short and stiff neck and trunk. SMMD is caused by inactivating mutations in NKX3-2, which encodes a homeobox-containing protein. Because of the rarity of the disorder, the diagnostic feature has not been fully established yet. We describe an affected newborn with dysmorphic facial features and severe short trunk. The patient required immediate intubation at the delivery room and duodenal atresia was detected during his course in neonatal intensive care unit...
April 25, 2018: European Journal of Medical Genetics
https://www.readbyqxmd.com/read/29690950/safety-of-tracheal-intubation-in-the-presence-of-cardiac-disease-in-paediatric-icus
#7
Eleanor A Gradidge, Adnan Bakar, David Tellez, Michael Ruppe, Sarah Tallent, Geoffrey Bird, Natasha Lavin, Anthony Lee, Vinay Nadkarni, Michelle Adu-Darko, Jesse Bain, Katherine Biagas, Aline Branca, Ryan K Breuer, Calvin Brown, Kris Bysani, Guillaume Emeriaud, Sandeep Gangadharan, John S Giuliano, Joy D Howell, Conrad Krawiec, Jan Hau Lee, Simon Li, Keith Meyer, Michael Miksa, Natalie Napolitano, Sholeen Nett, Gabrielle Nuthall, Alberto Orioles, Erin B Owen, Margaret M Parker, Simon Parsons, Lee A Polikoff, Kyle Rehder, Osamu Saito, Ron C Sanders, Asha Shenoi, Dennis W Simon, Peter W Skippen, Keiko Tarquinio, Anne Thompson, Iris Toedt-Pingel, Karen Walson, Akira Nishisaki
IntroductionChildren with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.Materials and methodsWe sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry...
April 25, 2018: Cardiology in the Young
https://www.readbyqxmd.com/read/29674403/unexpected-case-of-pneumomediastinum-and-subcutaneous-emphysema-primary-or-secondary-aetiology
#8
Amanda J L Cheng, Timothy J Sadler
A 77-year-old man was admitted with a relapse of antineutrophil cytoplasmic antibody-positive vasculitis with pulmonary involvement and acute kidney injury. There was a background of pulmonary fibrosis (non-specific interstitial pneumonia type pattern) and superadded pulmonary haemorrhage, acute pulmonary oedema and sepsis. The patient was intubated for 4 days and remained dependent on high flow oxygen and continuous positive airway pressure after extubation. A chest radiograph performed 2 weeks after extubation demonstrated unexpected, extensive pneumomediastinum and subcutaneous emphysema...
April 19, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29616405/ventilator-associated-pneumonia-in-pediatric-intensive-care-unit-incidence-risk-factors-and-etiological-agents
#9
Gnanaguru Vijay, Anirban Mandal, Jhuma Sankar, Arti Kapil, Rakesh Lodha, S K Kabra
OBJECTIVES: To study the incidence, etiology and risk factors associated with ventilator associated pneumonia (VAP) in children. METHODS: This prospective cohort study was conducted on patients admitted to the Pediatric Intensive Care Unit (PICU) of a tertiary care institute of North India, from June 2012 through March 2014, who received mechanical ventilation for more than 24 h. All enrolled children were assessed daily for development of ventilator associated pneumonia (VAP) using the case definition given by Centers for Disease Control and Prevention (CDC)...
April 4, 2018: Indian Journal of Pediatrics
https://www.readbyqxmd.com/read/29599112/clinical-monitoring-of-well-appearing-infants-born-to-mothers-with-chorioamnionitis
#10
Neha S Joshi, Arun Gupta, Jessica M Allan, Ronald S Cohen, Janelle L Aby, Brittany Weldon, Juliann L Kim, William E Benitz, Adam Frymoyer
BACKGROUND: The risk of early-onset sepsis is low in well-appearing late-preterm and term infants even in the setting of chorioamnionitis. The empirical antibiotic strategies for chorioamnionitis-exposed infants that are recommended by national guidelines result in antibiotic exposure for numerous well-appearing, uninfected infants. We aimed to reduce unnecessary antibiotic use in chorioamnionitis-exposed infants through the implementation of a treatment approach that focused on clinical presentation to determine the need for antibiotics...
April 2018: Pediatrics
https://www.readbyqxmd.com/read/29577558/a-systematic-review-and-meta-analysis-comparing-adverse-events-and-functional-outcomes-of-different-pouch-designs-after-restorative-proctocolectomy
#11
REVIEW
Constantinos Simillis, Thalia Afxentiou, Gianluca Pellino, Christos Kontovounisios, Shahnawaz Rasheed, Omar Faiz, Paris P Tekkis
AIM: There is no consensus as to which ileoanal pouch design provides better outcomes after restorative proctocolectomy. This study compares different pouch designs. METHOD: A systematic review of the literature was performed. A random effects meta-analytical model was used to compare adverse events and functional outcome. RESULTS: Thirty comparative studies comparing J, W, S and K pouch designs were included. No significant differences were identified between the different pouch designs with regards to anastomotic dehiscence, anastomotic stricture, pelvic sepsis, wound infection, pouch fistula, pouch ischaemia, perioperative haemorrhage, small bowel obstruction, pouchitis and sexual dysfunction...
March 25, 2018: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
https://www.readbyqxmd.com/read/29576361/can-energy-intake-alter-clinical-and-hospital-outcomes-in-picu
#12
Bodil M K Larsen, Megan R Beggs, Amanda Y Leong, Sung Hyun Kang, Rabin Persad, Gonzalo Garcia Guerra
BACKGROUND & AIMS: Energy is essential for the treatment and recovery of children admitted to Pediatric Intensive Care Units (PICU). There are significant immediate and long-term health consequences of both under- and over-feeding in this population. Energy requirements of critically ill children vary depending on age, nutritional status, sepsis, fever, pharmacotherapy, and duration and stage of critical illness. This study aimed to determine the incidence of over- and under-feeding and to compare hospital outcomes between these feeding categories...
April 2018: Clinical Nutrition ESPEN
https://www.readbyqxmd.com/read/29548723/helpful-only-when-elevated-initial-serum-lactate-in-stable-emergency-department-patients-with-sepsis-is-specific-but-not-sensitive-for-future-deterioration
#13
Shannon M Fernando, Douglas P Barnaby, Christophe L Herry, E John Gallagher, Nathan I Shapiro, Andrew J E Seely
BACKGROUND: Early emergency department (ED) identification of septic patients at risk of deterioration is critical. Lactate is associated with 28-day mortality in admitted patients, but little evidence exists on its use in predicting short-term deterioration. OBJECTIVE: Our aim was to determine the role of initial serum lactate for prediction of short-term deterioration in stable ED patients with suspected sepsis. METHODS: We conducted a prospective cohort study of adult ED sepsis patients...
March 13, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29455437/live-donor-liver-transplantation-for-acute-liver-failure-a-single-center-experience
#14
Siddharth Mehrotra, Naimish Mehta, Prashantha S Rao, Shailendra Lalwani, Vivek Mangla, Samiran Nundy
INTRODUCTION: Acute liver failure (ALF) is an indication for emergency liver transplantation (LT). Although centers performing only deceased donor liver transplants (DDLT) have shown improved outcomes in this situation, they still have relatively long waiting lists. An alternative would be living donor liver transplantation (LDLT), which has shown equivalent outcomes in the elective situation but there is limited evidence of its results in ALF. AIM: The purpose of this study was to assess the outcomes in patients with ALF undergoing emergency LDLT in our center in Delhi, India...
January 2018: Indian Journal of Gastroenterology: Official Journal of the Indian Society of Gastroenterology
https://www.readbyqxmd.com/read/29433878/the-effect-of-resident-involvement-on-bariatric-surgical-outcomes-an-acs-nsqip-analysis
#15
Ivy N Haskins, Jihad Kudsi, Kathleen Hayes, Richard L Amdur, Paul P Lin, Khashayar Vaziri
BACKGROUND: Surgical residency training programs in the United States are modeled on the principle of graduated responsibility. Residents are given greater responsibility and autonomy in the operating room and during perioperative care as they gain surgical skills and progress through their training. The impact of this method of surgical training on patient outcomes remains unknown. The purpose of this study is to compare early patient morbidity and mortality after bariatric surgery in cases with and without resident participation using the American College of Surgeons National Surgical Quality Improvement Program database...
March 2018: Journal of Surgical Research
https://www.readbyqxmd.com/read/29426264/comparison-between-maternal-and-neonatal-outcome-of-pprom-in-the-cases-of-amniotic-fluid-index-afi-of-more-and-less-than-5-cm
#16
Ashraf Sadat Mousavi, Neda Hashemi, Maryam Kashanian, Narges Sheikhansari, Arash Bordbar, Shayesteh Parashi
The study was performed on pregnant women with a gestational age of 26-32 weeks of pregnancy, who had been admitted to the hospital with a confirmed diagnosis of premature rupture of membranes. In all eligible women, ultrasounds were performed for the evaluation of amniotic fluid index. Then, the women were divided into two groups according to amniotic fluid index of ≥5 cm and <5 cm. These women were followed and monitored up to delivery. The women of the two groups did not have significant difference between them according to age, gestational age at the time of ruptured membrane, body mass index, gravidity, parity, gestational age at delivery and route of delivery...
February 9, 2018: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/29421911/intrathoracic-leak-after-an-ivor-lewis-procedure-for-an-esophageal-neoplasm-treated-with-a-stent
#17
Natalia Afonso Luis, María Asunción Acosta Mérida, Joaquín Marchena Gómez
A 75-year-old male who underwent an Ivor Lewis esophagectomy due to a distal adenocarcinoma had a leak at the gastroplasty on the 5th day after surgery, which required two surgeries and a primary suture. He was transferred to our hospital due to a poor outcome and endoscopy revealed a 2.5cm gap perianastomotically on the gastroplasty wall, for which a stent was placed. Due to hemodynamic impairment, a thoracotomy procedure was performed, which revealed stent protrusion into the cavity. The patient underwent an esophagogastric anastomosis resection, cervical esophagostomy and gastrostomy...
April 2018: Revista Española de Enfermedades Digestivas
https://www.readbyqxmd.com/read/29413725/current-practices-and-safety-of-medication-use-during-rapid-sequence-intubation
#18
Christine M Groth, Nicole M Acquisto, Tina Khadem
PURPOSE: Characterize medication practices during and immediately after rapid sequence intubation (RSI) by provider/location and evaluate adverse drug events. MATERIALS AND METHODS: This was a multicenter, observational, cross-sectional study of adult and pediatric intensive care unit and emergency department patients over a 24-h period surrounding first intubation. RESULTS: A total of 404 patients from 34 geographically diverse institutions were included (mean age 58 ± 22 years, males 59%, pediatric 8%)...
June 2018: Journal of Critical Care
https://www.readbyqxmd.com/read/29406378/downward-trend-in-pediatric-resident-laryngoscopy-participation-in-picus
#19
Aayush Gabrani, Taiki Kojima, Ronald C Sanders, Asha Shenoi, Vicki Montgomery, Simon J Parsons, Sandeep Gangadharan, Sholeen Nett, Natalie Napolitano, Keiko Tarquinio, Dennis W Simon, Anthony Lee, Guillaume Emeriaud, Michelle Adu-Darko, John S Giuliano, Keith Meyer, Ana Lia Graciano, David A Turner, Conrad Krawiec, Adnan M Bakar, Lee A Polikoff, Margaret Parker, Ilana Harwayne-Gidansky, Benjamin Crulli, Paula Vanderford, Ryan K Breuer, Eleanor Gradidge, Aline Branca, Lily B Grater-Welt, David Tellez, Lisa V Wright, Matthew Pinto, Vinay Nadkarni, Akira Nishisaki
OBJECTIVES: As of July 2013, pediatric resident trainee guidelines in the United States no longer require proficiency in nonneonatal tracheal intubation. We hypothesized that laryngoscopy by pediatric residents has decreased over time, with a more pronounced decrease after this guideline change. DESIGN: Prospective cohort study. SETTING: Twenty-five PICUs at various children's hospitals across the United States. PATIENTS: Tracheal intubations performed in PICUs from July 2010 to June 2016 in the multicenter tracheal intubation database (National Emergency Airway Registry for Children)...
February 5, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29363502/prevention-of-bronchopulmonary-dysplasia-in-extremely-low-gestational-age-neonates-current-evidence
#20
REVIEW
Christian F Poets, Laila Lorenz
Bronchopulmonary dysplasia (BPD) is one of the most frequent complications in extremely low gestational age neonates, but has remained largely unchanged in rate. We reviewed data on BPD prevention focusing on recent meta-analyses. Interventions with proven effectiveness in reducing BPD include the primary use of non-invasive respiratory support, the application of surfactant without endotracheal ventilation and the use of volume-targeted ventilation in infants requiring endotracheal intubation. Following extubation, synchronised nasal ventilation is more effective than continuous positive airway pressure in reducing BPD...
May 2018: Archives of Disease in Childhood. Fetal and Neonatal Edition
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