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https://www.readbyqxmd.com/read/29908152/reducing-readmissions-in-patients-with-both-heart-failure-and-chronic-obstructive-pulmonary-disease
#1
REVIEW
Ravi Kalhan, R Kannan Mutharasan
Patients with both chronic obstructive pulmonary disease (COPD) and heart failure (HF) pose particularly high costs to the healthcare system. These diseases arise from similar root causes, have overlapping symptoms, and share similar clinical courses. Because of these strong parallels, strategies to reduce readmissions in patients with both conditions share synergies. Here we present 10 practical tips to reduce readmissions in this challenging population. 1: Diagnose the population accurately. 2: Detect admissions for exacerbations early and consider risk-stratification...
June 13, 2018: Chest
https://www.readbyqxmd.com/read/29907872/the-current-state-of-the-art-for-biological-therapies-and-new-small-molecules-in-inflammatory-bowel-disease
#2
REVIEW
Sudarshan Paramsothy, Adam K Rosenstein, Saurabh Mehandru, Jean-Frederic Colombel
The emergence of biologic therapies is arguably the greatest therapeutic advance in the care of inflammatory bowel disease (IBD) to date, allowing directed treatments targeted at highly specific molecules shown to play critical roles in disease pathogenesis, with advantages in potency and selectivity. Furthermore, a large number of new biologic and small-molecule therapies in IBD targeting a variety of pathways are at various stages of development that should soon lead to a dramatic expansion in our therapeutic armamentarium...
June 15, 2018: Mucosal Immunology
https://www.readbyqxmd.com/read/29907323/taking-the-measure-of-the-profession-physician-associations-in-the-measurement-age
#3
REVIEW
Baruch Levi, Amos Zehavi, David Chinitz
Systematic measurement of healthcare services enables evaluation of health professionals' quality of work. Whereas policy makers find measurement a useful mechanism for quality improvement, a public choice perspective implies that physicians would resent such an initiative, which undermines their professional autonomy. In this article, we compare two healthcare systems of economically developed countries - Israel and the UK. Both systems share common features such as universal coverage, strong state intervention, and enthusiasm for New Public Management...
June 8, 2018: Health Policy
https://www.readbyqxmd.com/read/29907274/a-targeted-management-approach-to-cardiogenic-shock
#4
REVIEW
Mithun Chakravarthy, Masaki Tsukashita, Srinivas Murali
Cardiogenic shock is a clinical syndrome characterized by low cardiac output and sustained tissue hypoperfusion resulting in end-organ dysfunction and death. In-hospital mortality rates range from 50% to 60%. Urgent diagnosis, timely transfer to a tertiary or quaternary medical facility with critical care management capabilities and multidisciplinary shock teams is a must to increase survival. Aggressive, hemodynamically guided medical management with careful monitoring of clinical and hemodynamic parameters with timely use of appropriate mechanical circulatory support devices is often necessary...
July 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29907270/avoiding-respiratory-and-peripheral-muscle-injury-during-mechanical-ventilation-diaphragm-protective-ventilation-and-early-mobilization
#5
REVIEW
Annia Schreiber, Michele Bertoni, Ewan C Goligher
Both limb muscle weakness and respiratory muscle weakness are exceedingly common in critically ill patients. Respiratory muscle weakness prolongs ventilator dependence, predisposing to nosocomial complications and death. Limb muscle weakness persists for months after discharge from intensive care and results in poor long-term functional status and quality of life. Major mechanisms of muscle injury include critical illness polymyoneuropathy, sepsis, pharmacologic exposures, metabolic derangements, and excessive muscle loading and unloading...
July 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29907267/critical-care-airway-management
#6
REVIEW
Etieno U Umobong, Paul H Mayo
Critical care airway management is associated with a variety of complications, including severe oxygen desaturation, life-threatening hypotension, and death. This article reviews aspects of airway management that are relevant to intensivists and emergency medicine clinicians tasked with improving the quality of urgent endotracheal intubation in the critically ill patient.
July 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29907211/comparison-of-dexmedetomidine-versus-propofol-on-hemodynamics-in-surgical-critically-ill-patients
#7
Ya-Fei Chang, Anne Chao, Po-Yuan Shih, Yen-Chun Hsu, Chen-Tse Lee, Yu-Wen Tien, Yu-Chang Yeh, Lee-Wei Chen
BACKGROUND: Sedation with dexmedetomidine and propofol may cause hypotension or bradycardia. This study aimed to compare the effects of dexmedetomidine and propofol on hemodynamics and clinical outcomes in surgical intensive care unit (ICU) patients after major abdominal surgery. MATERIALS AND METHODS: Enrolled patients were randomly allocated to the dexmedetomidine or propofol group. Cardiac index was measured using a continuous noninvasive cardiac output monitor on the basis of chest bioreactance...
August 2018: Journal of Surgical Research
https://www.readbyqxmd.com/read/29907209/using-artificial-intelligence-to-predict-prolonged-mechanical-ventilation-and-tracheostomy-placement
#8
Joshua Parreco, Antonio Hidalgo, Jonathan J Parks, Robert Kozol, Rishi Rattan
BACKGROUND: Early identification of critically ill patients who will require prolonged mechanical ventilation (PMV) has proven to be difficult. The purpose of this study was to use machine learning to identify patients at risk for PMV and tracheostomy placement. MATERIALS AND METHODS: The Multiparameter Intelligent Monitoring in Intensive Care III database was queried for all intensive care unit (ICU) stays with mechanical ventilation. PMV was defined as ventilation >7 d...
August 2018: Journal of Surgical Research
https://www.readbyqxmd.com/read/29907141/serum-and-urine-fgf23-and-igfbp-7-for-the-prediction-of-acute-kidney-injury-in-critically-ill-children
#9
Zhenjiang Bai, Fang Fang, Zhong Xu, Chunjiu Lu, Xueqin Wang, Jiao Chen, Jian Pan, Jian Wang, Yanhong Li
BACKGROUND: Fibroblast growth factor 23 (FGF23) and insulin-like growth factor binding protein 7 (IGFBP-7) are suggested to be biomarkers for predicting acute kidney injury (AKI). We compared them with proposed AKI biomarker of cystatin C (CysC), and aimed (1) to examine whether concentrations of these biomarkers vary with age, body weight, illness severity assessed by pediatric risk of mortality III score, and kidney function assessed by estimated glomerular filtration rate (eGFR), (2) to determine the association between these biomarkers and AKI, and (3) to evaluate whether these biomarkers could serve as early independent predictors of AKI in critically ill children...
June 15, 2018: BMC Pediatrics
https://www.readbyqxmd.com/read/29906795/national-survey-of-neonatal-intensive-care-unit-medication-safety-practices
#10
Rachel G Greenberg, P Brian Smith, Carl Bose, Reese H Clark, C Michael Cotten, Chris DeRienzo
OBJECTIVE:  We conducted a detailed survey to identify medication safety practices among a large network of United States neonatal intensive care units (NICUs). METHODS:  We created a 53-question survey to assess 300 U.S. NICU's demographics, medication safety practices, adverse drug event (ADE) reporting, and ADE response plans. RESULTS:  Among the 164 (55%) NICUs that responded to the survey, more than 85% adhered to practices including use of electronic health records, computerized physician order entry, and clinical decision support; fewer reported adopting barcoding, formal safety surveys, and formal culture training; 137 of 164 (84%) developed at least one NICU-specific order-set with a median of 10 order-sets...
June 15, 2018: American Journal of Perinatology
https://www.readbyqxmd.com/read/29906667/the-high-cost-of-critical-care-unit-over-utilization-for-patients-with-nste-acs
#11
Sean van Diepen, Dat T Tran, Justin A Ezekowitz, David A Zygun, Jason N Katz, Renato D Lopes, L Kristin Newby, Finlay A McAlister, Padma Kaul
BACKGROUND: There is substantial variability among hospitals in critical care unit (CCU) utilization for patients admitted with non-ST-Segment Elevation Acute Coronary Syndromes (NSTE ACS). We estimated the potential cost saving if all hospitals adopted low CCU utilization practices for patients with NSTE ACS. METHODS: National hospital claims data were used to identify all patients with a primary diagnosis of NSTE ACS initially admitted to an acute care hospital between 2007 and 2013...
May 19, 2018: American Heart Journal
https://www.readbyqxmd.com/read/29906268/combined-international-external-quality-assessment-results-of-medical-laboratory-performance-and-reporting-of-samples-with-known-antimicrobial-resistance
#12
Michael A Noble, Robert Rennie
BACKGROUND: Reporting on the presence of antimicrobial resistance is of considerable concern both for individual patient care and for understanding the underlying health status within the community at large. Antimicrobial resistance is solely dependent upon clinical laboratory detection and thus can be impacted upon by the quality and competence of medical laboratories. Proficiency testing or external quality assessment (PT/EQA) is the international standard for the direct measurement of medical laboratory performance on critical testing...
June 15, 2018: Diagnosis
https://www.readbyqxmd.com/read/29906203/radiographic-review-of-current-therapeutic-and-monitoring-devices-in-the-chest
#13
Christopher J G Sigakis, Susan K Mathai, Thomas D Suby-Long, Nicole L Restauri, Daniel Ocazionez, Tami J Bang, Carlos S Restrepo, Peter B Sachs, Daniel Vargas
Chest radiographs are obtained as a standard part of clinical care. Rapid advancements in medical technology have resulted in a myriad of new medical devices, and familiarity with their imaging appearance is a critical yet increasingly difficult endeavor. Many modern thoracic medical devices are new renditions of old designs and are often smaller than older versions. In addition, multiple device designs serving the same purpose may have varying morphologies and positions within the chest. The radiologist must be able to recognize and correctly identify the proper positioning of state-of-the-art medical devices and identify any potential complications that could impact patient care and management...
June 15, 2018: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://www.readbyqxmd.com/read/29905929/beyond-classic-risk-adjustment-socioeconomic-status-and-hospital-performance-in-urologic-oncology-surgery
#14
Anobel Y Odisho, Ruth Etzioni, John L Gore
BACKGROUND: Safety-net hospitals (SNHs) care for more patients of low socioeconomic status (SES) than non-SNHs and are disproportionately punished under SES-naive Medicare readmission risk-adjustment models. This study was designed to develop a risk-adjustment framework that incorporates SES and to assess the impact on readmission rates. METHODS: California Office of Statewide Health Planning and Development data from 2007 to 2011 were used to identify patients undergoing radical cystectomy (RC) for bladder cancer (n = 3771) or partial nephrectomy (PN; n = 5556) or radical nephrectomy (RN; n = 13,136) for kidney cancer...
June 15, 2018: Cancer
https://www.readbyqxmd.com/read/29905785/healthcare-services-for-syrian-refugees-in-jordan-a-systematic-review
#15
R El Arab, M Sagbakken
Background: This review aims to explore the healthcare needs and access to healthcare services among Syrian refugees in Jordan. Furthermore, it identifies possible ways of responding to such needs within the framework of the structural challenges faced in this particular context. Methods: Through qualitative techniques, this study systematically reviewed nine articles identified in academic and international organizations' databases. Six articles are from scholarly sources, while three are published reports or commentary articles; thus, there are variations in methodological rigour...
June 13, 2018: European Journal of Public Health
https://www.readbyqxmd.com/read/29905634/ability-to-assent-in-pediatric-critical-care-research-a-prospective-environmental-scan-of-two-canadian-picus
#16
Katharine J O'Hearn, Dori-Ann Martin, Maryse Dagenais, Kusum Menon
OBJECTIVES: To determine the number of patients considered not appropriate to approach for assent within the first 24 hours of PICU admission. DESIGN: Exploratory prospective 1-month environmental scan. SETTING: Two tertiary Canadian PICUs. PATIENTS: Ninety patients age newborn to 17 years old admitted to the PICU during September 2016 (Site 1) or May 2017 (Site 2). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: At PICU admission, 81% of patients were deemed not appropriate to approach for assent most commonly due to age, influence of psychotropic medications, and/or mechanical ventilation...
June 13, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29905632/an-ethical-claim-for-providing-medical-recommendations-in-pediatric-intensive-care
#17
Katie M Moynihan, Melanie A Jansen, Shih-Ning Liaw, Peta M A Alexander, Robert D Truog
The Declaration of Geneva was recently revised to emphasize patient autonomy and the importance of clinicians sharing medical knowledge. This reflects the welcome evolution of the doctor-patient relationship from one of paternalism to more informed, shared decision-making. Unfortunately, there is an increasing trend for clinicians to avoid making recommendations, instead providing a "menu" of care options from which patients and families must choose. This seems to be underpinned by the belief that it is unacceptably paternalistic to give guidance as to which course of action may be best to take...
June 13, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29905618/repeated-measures-designs-and-analysis-of-longitudinal-data-if-at-first-you-do-not-succeed-try-try-again
#18
Patrick Schober, Thomas R Vetter
Anesthesia, critical care, perioperative, and pain research often involves study designs in which the same outcome variable is repeatedly measured or observed over time on the same patients. Such repeatedly measured data are referred to as longitudinal data, and longitudinal study designs are commonly used to investigate changes in an outcome over time and to compare these changes among treatment groups. From a statistical perspective, longitudinal studies usually increase the precision of estimated treatment effects, thus increasing the power to detect such effects...
June 12, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29905575/ce-original-research-the-efficacy-and-safety-of-an-rn-driven-ketamine-protocol-for-adjunctive-analgesia-during-burn-wound-care
#19
Laura Baumgartner, Nicole Townsend, Katie Winkelman, Robert MacLaren
Findings indicate that adjunctive low-dose ketamine was safe and provided pain relief. ABSTRACT: Objectives: Traditional analgesic regimens often fail to control the severe pain patients experience during burn wound care, and the drugs are frequently administered at doses that can cause oversedation and respiratory depression. Ketamine may be an ideal agent for adjunctive analgesia in such patients because of its unique mechanism of action and lack of association with respiratory depression...
June 13, 2018: American Journal of Nursing
https://www.readbyqxmd.com/read/29905521/contrast-enhanced-ultrasound-to-visualize-hemodynamic-changes-after-rodent-spinal-cord-injury
#20
Zin Z Khaing, Lindsay N Cates, Dane M DeWees, Alexander Hannah, Pierre Mourad, Matthew Bruce, Christoph P Hofstetter
OBJECTIVE Traumatic spinal cord injury (tSCI) causes an almost complete loss of blood flow at the site of injury (primary injury) as well as significant hypoperfusion in the penumbra of the injury. Hypoperfusion in the penumbra progresses after injury to the spinal cord and is likely to be a major contributor to progressive cell death of spinal cord tissue that was initially viable (secondary injury). Neuroprotective treatment strategies seek to limit secondary injury. Clinical monitoring of the temporal and spatial patterns of blood flow within the contused spinal cord is currently not feasible...
June 15, 2018: Journal of Neurosurgery. Spine
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