critical care & emergency

Background: Carefully calibrated large-scale computational models of epidemic spread represent a powerful tool to support the decision-making process during epidemic emergencies. Epidemic models are being increasingly used for generating forecasts of the spatial-temporal progression of epidemics at different spatial scales and for assessing the likely impact of different intervention strategies. However, the management and analysis of simulation ensembles stemming from large-scale computational models pose challenges, particularly when dealing with multiple interdependent parameters, spanning multiple layers and geospatial frames, affected by complex dynamic processes operating at different resolutions...

Short bowel syndrome (SBS), one of the commonest types of intestinal failure, usually secondary to extensive bowel resection, traditionally has been associated with a high mortality rate and hence a big challenge for the treating surgeons. It requires comprehensive clinical care to minimise the morbidities and mortality associated with the condition. We report a retrospective review of a series of seven patients with SBS, who presented at our surgical emergency within a period of 1 year and their outcome so as to encourage others in managing such a challenge with more positive mindsets...

CONTEXT: End of life care for people with dementia can be poor, involving emergency hospital admissions, burdensome treatments of uncertain value and under-treatment of pain and other symptoms. Advance care planning (ACP) is identified, in England and elsewhere, as a means of improving end of life outcomes for people with dementia and their carers. OBJECTIVE: To systematically and critically review empirical evidence concerning the effectiveness of ACP in improving end of life outcomes for people with dementia and their carers...

BACKGROUND: Despite the large numbers in health care industry, little is known about the clinical nonlicensed personnel (CNLP) in U.S. hospitals and how their staffing has changed over time. PURPOSE: The purpose of this analysis is to better understand the conformation and recent trends in CNLP staffing in U.S. hospitals from 2010 to 2015. METHODS: Using Premier's OperationsAdvisor database, we examined trends in staffing of 25 CNLP jobs and graduate nurses (GNs) in U...

The therapeutic approach in multiple sclerosis (MS) is radically changing. From the early stages of MS, a hard-hitting approach to treatment is taken with strong anti-inflammatory drugs being a possible therapeutic option. Areas covered: The concept of induction therapy is emerging in the MS therapeutic scenario. Expert opinion: Not all the MS licensed drugs are suitable candidates for induction therapy. The upcoming challenge will be to identify, after a careful and individual assessment of risk/benefit ratio, the ideal patient who is a candidate to such aggressive therapeutic approach...

BACKGROUND: Disseminated nontuberculous mycobacterium infections have occurred following surgical procedures involving extracorporeal circulation; contaminated water from heater-cooler devices (HCDs) has been implicated as the source. The purpose of this review was to evaluate the public health concern and to educate physicians who care for this patient population. METHODS: The Food and Drug Administration Medical Device Reporting (MDR) database was queried for reports received between January 2010 and August 2016 for patient infections and device contaminations associated with the use of HCDs...

With the emerging interest in documenting and understanding muscle atrophy and function in critically ill patients and survivors, ultrasonography has transformational potential in measuring muscle quantity and quality. Here, we discuss the importance of quantifying skeletal muscle in the ICU setting. We also identify the merits and limitations of various modalities that are capable of accurately and precisely measuring muscularity. Ultrasound is emerging as a potentially powerful tool for skeletal muscle quantification; however, there are key challenges that need to be addressed in future work to ensure useful interpretation and comparability of results across diverse observational and interventional studies...

Background The implementation of innovations in practice is a critical factor for change and development processes in health and home care. We therefore analyze how an innovative tool - a mobility agreement to maintain physical mobility of home care clients - was implemented in Finnish home care. Methods Our study involves ethnographic research of 13 home care visits, two years after the mobility agreement was implemented. We analyze the emergence of contradictions, the motives of the actors and the use of artifacts supporting or inhibiting the implementation...

There is sometimes dissonance between the medical services that the general public expects an ED to provide and the acute critical care that emergency clinicians hope to provide. One explanation for this is that the ED is both a territory and a meeting place for a cornucopia of clinicians, some of whom are not ED clinicians themselves. Roles are sometimes ambiguous and location-specific. Recently, one Queensland mother believed that her son's suicide could have been prevented had emergency staff been better educated...

OBJECTIVE: To systematically review qualitative literature of TB treatment experiences on immigrant populations of low-prevalence countries. METHODS: Critical Interpretive Synthesis (CIS). On October 23, 2013, MEDLINE, CINAHL, Embase, PsychINFO and ProQuest were systematically searched. Grey literature and reference lists were hand-searched. Initial papers included were restricted to studies of immigrant patient perspectives; after a model was developed, a second set of papers was included to test the emerging theory...

By virtue of their religious principles, Jehovah's Witnesses (JWs) generally object to receiving blood products, raising numerous ethical, legal, and medical challenges for providers who care for these patients, especially in the emergent setting. In this review, we discuss several areas relevant to the care of JWs, including the current literature on "bloodless" medical care in the setting of peri- and intra-operative management, acute blood loss, trauma, pregnancy, and malignancy. We have found that medical and administrative efforts in the form of bloodless medicine and surgery programs can be instrumental in helping to reduce risks of morbidity and mortality in these patients...

BACKGROUND: Rivaroxaban is a direct oral anticoagulant designed to dispense with the necessity of laboratory monitoring. However, monitoring rivaroxaban levels is necessary in certain clinical conditions, especially in the critical care setting. METHODS: This is a diagnostic accuracy study evaluating sensitivity and specificity of prothrombin time (PT), activated partial thromboplastin time (aPTT), and Dilute Russell viper venom time (dRVVT), to evaluate the hemorrhagic risk in patients taking rivaroxaban...

OBJECTIVES: To assess the performance of the Yale Observation Scale (YOS) score and unstructured clinician suspicion to identify febrile infants ≤60 days of age with and without serious bacterial infections (SBIs). METHODS: We performed a planned secondary analysis of a prospective cohort of non-critically ill, febrile, full-term infants ≤60 days of age presenting to 1 of 26 participating emergency departments in the Pediatric Emergency Care Applied Research Network...

OBJECTIVES: To examine the relationship between perceived and biological stress and near misses among Emergency Medicine residents. DESIGN: Self-rated stress and stress biomarkers were assessed in residents in Emergency Medicine before and after a day shift. The supervising physicians and residents reported numbers of near misses. SETTING: The study took place in the Emergency Department of a large trauma 1 centre, located in Detroit, USA...

BACKGROUND: Palliative care patients are a particularly vulnerable population and one of the critical phases in patients' trajectories is discharge from specialized in-patient palliative care into outpatient care, where availability of a palliative care infrastructure is highly variable. A relevant number of potentially avoidable readmissions and emergency visits of palliative patients is observed due to rapid exacerbation of symptoms indicating the need for a closer patient monitoring...

BACKGROUND: Rising levels of burnout and decreasing job satisfaction can inhibit healthcare professionals from providing high-quality care due to a corresponding decrease in their ethical sensitivity. AIM: This study aimed to determine the relationship between the level of ethical sensitivity in emergency service nurses and their levels of burnout and job satisfaction. RESEARCH DESIGN: This research employed a descriptive and cross-sectional design...

In sub-Saharan Africa, self-disclosure of HIV-positive status may be a pivotal action for improving access to prevention of mother-to-child transmission services. However, understanding of HIV stigma and disclosure, and their effects on demand for care remains incomplete - particularly in the current context of new antiretroviral therapy guidelines. The purpose of this study was to explore these issues among self-disclosed couples living in southwest Kenya. We conducted 38 in-depth interviews with HIV-positive pregnant or postpartum women and their male partners...

Patient Blood Management underscores a fundamental shift from a product-centered approach to a patient-centric approach through timely application of evidence-based medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis, and minimize blood loss in an effort to improve patient outcome. In this concept, allogeneic blood transfusion is not viewed as the treatment of default for anemic patients, but one among many treatment modalities that should be weighed based on its merits-potentials risks and benefits-for the individual patient in the context of other alternatives...

BACKGROUND: Assessing the impact of cost sharing on healthcare utilization is a critical issue in health economics and health policy. It may affect the utilization of different services, but is yet to be well understood. OBJECTIVE: This paper investigates the effects of reducing cost sharing for outpatient services on hospital admissions by exploring a subsidy policy for children's outpatient services in Japan. METHODS: Data were extracted from the Japanese Diagnosis Procedure Combination database for 2012 and 2013...

Zika virus (ZIKAV) is classically described as causing minor symptoms in adult patients, however neurologic complications have been recognized. The recent outbreak in Central and South America has resulted in serious illness in some adult patients. We report adult patients in Latin America diagnosed with ZIKAV infection admitted to Intensive Care Units (ICUs). METHODS: Multicenter, prospective case series of adult patients with laboratory diagnosis of ZIKAV in 16 ICUs in 8 countries. RESULTS: Between December 1st 2015 and April 2nd 2016, 16 ICUs in 8 countries enrolled 49 critically ill patients with diagnosis of ZIKAV infection...