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Renal Supportive care

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https://www.readbyqxmd.com/read/28339843/availability-and-cost-of-extracorporeal-treatments-for-poisonings-and-other-emergency-indications-a-worldwide-survey
#1
Josée Bouchard, Valery Lavergne, Darren M Roberts, Monique Cormier, Genevieve Morissette, Marc Ghannoum
Background: Extracorporeal treatments (ECTRs) are used for different conditions, including replacement of organ function and poisoning. Current recommendations for ECTRs in various poisonings suggest that intermittent haemodialysis (IHD) is the most efficient technique. However, the practicality of these recommendations is poorly defined in view of limited information on availability and cost worldwide. Methods: A survey invitation to an Internet-based questionnaire was emailed between January 2014 and March 2015 to members of international societies to determine the availability, time to initiation and cost of ECTRs (including filters, dialysate, catheter, anticoagulant and nursing/physician salary)...
February 23, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28332186/a-pilot-study-of-ultrasound-evaluation-of-gastric-emptying-in-patients-with-end-stage-renal-failure-a-comparison-with-healthy-controls
#2
C Chen, L Liu, C Y Wang, S-W Choi, V M Yuen
This prospective study was designed to evaluate gastric volume and content in patients with renal failure and healthy controls after an overnight fast, immediately after a light meal and at 6 h after the meal. Thirty subjects in each group were recruited. At each scanning session, gastric antral cross-sectional area was measured in the supine recumbent and right lateral decubitus positions, and a qualitative assessment of gastric contents was made using the Perlas three-point grading system. Six hours after the meal, the mean (SD) antral cross-sectional area in the supine position was 471 (195) mm(2) in patients with renal failure and 319 (106) mm(2) in healthy controls (p = 0...
March 23, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28331172/an-anti-coagulation-conundrum-implantation-of-total-artificial-heart-in-a-patient-with-heparin-induced-thrombocytopenia-type-ii
#3
Theodore J Cios, Yuliana Salamanca-Padilla, Dmitri Guvakov
BACKGROUND Heparin-induced thrombocytopenia (HIT) is a rare but life-threatening complication of heparin administration. It can present a major clinical dilemma for physicians caring for patients requiring life-saving urgent or emergent cardiac surgery. Studies have been published examining the use of alternative anticoagulants for patients undergoing cardiopulmonary bypass (CPB), however, evidence does not clearly support any particular approach. Presently, there are no large-scale, prospective randomized studies examining the impact of alternative anticoagulants on clinical outcomes for HIT-positive patients requiring cardiac surgery...
March 23, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28321822/the-exciting-bench-to-bedside-journey-of-cell-therapies-for-acute-kidney-injury-and-renal-transplantation
#4
REVIEW
Sergio Dellepiane, Davide Medica, Alessandro Domenico Quercia, Vincenzo Cantaluppi
Acute kidney injury (AKI) is characterized by an increasing incidence and poor outcomes in both developed and undeveloped countries. AKI is also acquiring importance in the setting of kidney transplantation (KT): besides all the classical forms of AKI that KT patients may undergo, several transplant-specific injuries can also lead to the loss of graft function. The mechanisms of tissue damage in native and grafted kidneys share several common pathogenic elements. Since appropriate therapeutic treatments are still lacking-probably due to the disease complexity-clinicians are forced to provide only supportive care...
March 21, 2017: Journal of Nephrology
https://www.readbyqxmd.com/read/28321803/prognosis-of-cirrhotic-patients-admitted-to-intensive-care-unit-a-meta-analysis
#5
Delphine Weil, Eric Levesque, Marc McPhail, Rodrigo Cavallazzi, Eleni Theocharidou, Evangelos Cholongitas, Arnaud Galbois, Heng Chih Pan, Constantine J Karvellas, Bertrand Sauneuf, René Robert, Jérome Fichet, Gaël Piton, Thierry Thevenot, Gilles Capellier, Vincent Di Martino
BACKGROUND: The best predictors of short- and medium-term mortality of cirrhotic patients receiving intensive care support are unknown. METHODS: We conducted meta-analyses from 13 studies (2523 cirrhotics) after selection of original articles and response to a standardized questionnaire by the corresponding authors. End-points were in-ICU, in-hospital, and 6-month mortality in ICU survivors. A total of 301 pooled analyses, including 95 analyses restricted to 6-month mortality among ICU survivors, were conducted considering 249 variables (including reason for admission, organ replacement therapy, and composite prognostic scores)...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28300009/prenatal-diagnosis-of-aortopulmonary-window-associated-with-aberrant-subclavian-artery
#6
Adetola F Louis-Jacques, Sarah Obican, Thieu Nguyen, Anthony Odibo
Aortopulmonary window is a rare cardiac developmental anomaly characterised by a communication between the ascending aorta and the pulmonary artery. Aortopulmonary window may be isolated or associated with cardiac defects such as ventricular septal defect, atrial septal defect, interrupted aortic arch, and tetralogy of Fallot. We report a case of aortopulmonary window associated with aberrant subclavian artery based on fetal two-dimensional echocardiogram. The mother was referred for fetal echocardiography because of multiple fetal anomalies...
March 16, 2017: Cardiology in the Young
https://www.readbyqxmd.com/read/28296531/risk-factors-associated-with-acute-kidney-injury-in-a-cohort-of-20-575-arthroplasty-patients
#7
Pyry Jämsä, Esa Jämsen, Leo-Pekka Lyytikäinen, Jarkko Kalliovalkama, Antti Eskelinen, Niku Oksala
Background and purpose - Patients developing postoperative acute kidney injury (AKI) are at risk of higher morbidity and mortality. In arthroplasty patients, many pre- and perioperative factors are associated with AKI but some of the risk factors are unclear. We report the incidence of postoperative AKI, the conditions associated with it, and survival rates in AKI patients. Patients and methods - We obtained data from 20,575 consecutive hip or knee arthroplasties. Postoperative AKI, occurring within 7 days after the operation, was defined using the risk, injury, failure, loss, and end-stage (RIFLE) criteria...
March 15, 2017: Acta Orthopaedica
https://www.readbyqxmd.com/read/28295959/the-albuminuria-lowering-response-to-dapagliflozin-is-variable-and-reproducible-between-individual-patients
#8
Sergei I Petrykiv, Gozewijn D Laverman, Dick de Zeeuw, Hiddo J L Heerspink
AIMS: Albuminuria reduction is essential for renal and cardiovascular protection. We characterized the efficacy of dapagliflozin, a sodium-glucose co-transporter 2 inhibitor, on albuminuria. Secondly, we assessed whether the albuminuria lowering effect varies between patients, and whether this variability in response is reproducible. MATERIAL AND METHODS: A double-blind, randomized, placebo controlled crossover trial was conducted. Patients with type 2 diabetes and albumin:creatinine ratio >100 mg/g on a stable dose of an Angiotensin Converting Enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) were enrolled...
March 14, 2017: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/28295151/use-of-life-support-in-acutely-admitted-icu-patients-an-international-cohort-study
#9
T S Meyhoff, M Krag, P B Hjortrup, A Perner, M H Møller
BACKGROUND: Use of life support in intensive care unit (ICU) patients has been associated with increased risk of poor outcome. The prognostic importance of the duration of support is less studied. We assessed the use of life support and the association between its duration and 90-day mortality in a contemporary cohort of acutely admitted adult ICU patients. METHODS: We performed a post-hoc analysis of the SUP-ICU 7-day inception cohort study (n = 1034), which was conducted in 97 ICUs in 11 countries...
March 10, 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28290769/sequencing-brain-metastases-and-opportunities-for-targeted-therapies
#10
Ugonma N Chukwueke, Priscilla K Brastianos
CNS metastases have long been recognized as a common and late complication of systemic malignancies. They represent the most common tumor of the brain. As outcomes and overall survival improve with better tolerated and more durable responses from therapies for systemic cancers, the incidence and prevalence of brain metastases is likely to increase. Among the most common systemic cancers leading to brain metastases include lung, melanoma, breast (triple-negative histology) and renal cell cancers. To date, there has been infrequent involvement of gastrointestinal and gynecologic malignancies; however, this may also change, reflecting improvement in overall survival and therapeutic regimens...
March 14, 2017: Pharmacogenomics
https://www.readbyqxmd.com/read/28284824/-report-on-chronic-dialysis-in-france-in-2016
#11
Société Francophone de Néphrologie Dialyse Et Transplantation
The report on dialysis in France in 2016 from the French Speaking Society of Nephrology Dialysis and Transplantation (SFNDT) provides an exhaustive and documented inventory on dialysis in France. It underlines the organizations that are important in 2016 to maintain a high quality dialysis. Several measures are proposed to maintain and improve the care of dialysis in France: (1) The regulation of dialysis treatment in France must be maintained; (2) a burden of care indicator is proposed to ensure that patients requiring the most care are treated in the centers...
March 8, 2017: Néphrologie & Thérapeutique
https://www.readbyqxmd.com/read/28273373/acute-care-management-of-the-hiv-infected-patient-a-report-from-the-hiv-practice-and-research-network-of-the-american-college-of-clinical-pharmacy
#12
Spencer H Durham, Melissa E Badowski, Michelle D Liedtke, R Chris Rathbun, Patricia Pecora Fulco
OBJECTIVE: HIV-infected patients admitted to the hospital have complex antiretroviral therapy (ART) regimens with an increased medication error rate upon admission. This report is intended to provide a resource for clinicians managing HIV-infected patients and ART in the inpatient setting. METHODS: A survey of the authors was conducted to evaluate common issues that arise during an acute hospitalization for HIV-infected patients. After a group consensus, a review of the medical literature was performed to determine the supporting evidence for the following HIV associated hospital queries: admission/discharge orders, antiretroviral hospital formularies, laboratory monitoring, altered hepatic/renal function, drug-drug interactions (DDIs), enteral administration, and therapeutic drug monitoring...
March 8, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28263341/risk-factors-for-mortality-in-asian-children-admitted-to-the-paediatric-intensive-care-unit-after-haematopoietic-stem-cell-transplantation
#13
Haripriya Santhanam, Jacqueline Sm Ong, Liang Shen, Poh Lin Tan, Pei Lin Koh
INTRODUCTION: This study aimed to investigate the risk factors associated with mortality in haematopoietic stem cell transplant (HSCT) patients admitted to our paediatric intensive care unit (PICU) over an 8-year period. MATERIALS AND METHODS: A retrospective chart review was conducted of all HSCT patients requiring PICU admission at our centre (a tertiary care university hospital in Singapore) from January 2002 to December 2010. Chief outcome measures were survival at the time of PICU discharge and survival at 6 months after initial PICU admission...
February 2017: Annals of the Academy of Medicine, Singapore
https://www.readbyqxmd.com/read/28262413/checkmate-025-randomized-phase-3-study-outcomes-by-key-baseline-factors-and-prior-therapy-for-nivolumab-versus-everolimus-in-advanced-renal-cell-carcinoma
#14
Bernard Escudier, Padmanee Sharma, David F McDermott, Saby George, Hans J Hammers, Sandhya Srinivas, Scott S Tykodi, Jeffrey A Sosman, Giuseppe Procopio, Elizabeth R Plimack, Daniel Castellano, Howard Gurney, Frede Donskov, Katriina Peltola, John Wagstaff, Thomas C Gauler, Takeshi Ueda, Huanyu Zhao, Ian M Waxman, Robert J Motzer
BACKGROUND: The randomized, phase 3 CheckMate 025 study of nivolumab (n=410) versus everolimus (n=411) in previously treated adults (75% male; 88% white) with advanced renal cell carcinoma (aRCC) demonstrated significantly improved overall survival (OS) and objective response rate (ORR). OBJECTIVE: To investigate which baseline factors were associated with OS and ORR benefit with nivolumab versus everolimus. DESIGN, SETTING, AND PARTICIPANTS: Subgroup OS analyses were performed using Kaplan-Meier methodology...
March 2, 2017: European Urology
https://www.readbyqxmd.com/read/28259059/evaluation-of-medication-related-clinical-decision-support-alert-overrides-in-the-intensive-care-unit
#15
Adrian Wong, Mary G Amato, Diane L Seger, Sarah P Slight, Patrick E Beeler, Patricia C Dykes, Julie M Fiskio, Elizabeth R Silvers, E John Orav, Tewodros Eguale, David W Bates
PURPOSE: Medication-related clinical decision support (CDS) has been identified as a method to improve patient outcomes but is historically frequently overridden and may be inappropriately so. Patients in the intensive care unit (ICU) are at a higher risk of harm from adverse drug events (ADEs) and these overrides may increase patient harm. The objective of this study is to determine appropriateness of overridden medication-related CDS overrides in the ICU. MATERIALS AND METHODS: We evaluated overridden medication-related alerts of four alert categories from January 2009 to December 2011...
February 20, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28254855/training-and-maintaining-developing-a-successful-and-dynamic-continuous-renal-replacement-therapy-program
#16
Heather Przybyl, Jill Evans, Laurie Haley, Jodi Bisek, Emily Beck
Continuous renal replacement therapy (CRRT) is commonly used to support critically ill patients with acute kidney injury or chronic renal disease whose condition is too unstable for them to tolerate intermittent hemodialysis. Current publications related to CRRT programs in the United States and Canada note key themes related to the development and maintenance of CRRT training programs. A successful CRRT training program should consider and incorporate adult learning principles whenever possible. A variety of teaching methods to deliver information to nurses, including online learning modules, didactic lecture, return demonstration, and high-fidelity patient simulation are key to training programs for this high-risk complex therapy...
2017: AACN Advanced Critical Care
https://www.readbyqxmd.com/read/28254854/continuous-renal-replacement-therapy-update-an-emphasis-on-safe-and-high-quality-care
#17
Hildy Schell-Chaple
Continuous renal replacement therapy (CRRT) was introduced more than 40 years ago as a renal support option for critically ill patients who had contraindications to intermittent hemodialysis and peritoneal dialysis. Despite being the most common renal support therapy used in intensive care units today, the tremendous variability in CRRT management challenges the interpretation of findings from CRRT outcome studies. The lack of standardization in practice and training of clinicians along with the high risk of CRRT-related adverse events has been the impetus for the recent expert consensus work on identifying quality indicators for CRRT programs...
2017: AACN Advanced Critical Care
https://www.readbyqxmd.com/read/28250986/severe-tuberculosis-requiring-intensive-care-a-descriptive-analysis
#18
Raquel Pacheco Duro, Paulo Figueiredo Dias, Alcina Azevedo Ferreira, Sandra Margarida Xerinda, Carlos Lima Alves, António Carlos Sarmento, Lurdes Campos Dos Santos
Background. This study aims to describe the characteristics of tuberculosis (TB) patients requiring intensive care and to determine the in-hospital mortality and the associated predictive factors. Methods. Retrospective cohort study of all TB patients admitted to the ICU of the Infectious Diseases Department of Centro Hospitalar de São João (Porto, Portugal) between January 2007 and July 2014. Comorbid diagnoses, clinical features, radiological and laboratory investigations, and outcomes were reviewed. Univariate analysis was performed to identify risk factors for death...
2017: Critical Care Research and Practice
https://www.readbyqxmd.com/read/28247473/preoperative-intra-aortic-balloon-pump-use-in-high-risk-patients-prior-to-coronary-artery-bypass-graft-surgery-decreases-the-risk-for-morbidity-and-mortality-a-meta-analysis-of-9-212-patients
#19
REVIEW
Antje-Christin Deppe, Carolyn Weber, Oliver J Liakopoulos, Mohamed Zeriouh, Ingo Slottosch, Maximilian Scherner, Elmar W Kuhn, Yeong-Hoon Choi, Thorsten Wahlers
AIMS: Prophylactic intra-aortic balloon pump (IABP) support for high-risk patients before coronary artery bypass grafting (CABG) is controversial. This meta-analysis sought to determine the current role of preoperative IABP support. METHODS: We performed a meta-analysis of randomized (RCT) and observational trials (OT) that fulfilled the following criteria: (1) Group comparison of patients with prophylactic IABP implantation before CABG with a control group; (2) reporting at least one desired clinical endpoint, including all-cause mortality, myocardial infarction, cerebrovascular accident (CVA), and renal failure...
March 2017: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/28238456/ethical-issues-in-dialysis-therapy
#20
Vivekanand Jha, Dominique E Martin, Joanne M Bargman, Simon Davies, John Feehally, Fred Finkelstein, David Harris, Madhukar Misra, Giuseppe Remuzzi, Adeera Levin
Treatment for end-stage kidney disease is a major economic challenge and a public health concern worldwide. Renal-replacement therapy poses several practical and ethical dilemmas of global relevance for patients, clinicians, and policy makers. These include how to: promote patients' best interests; increase access to dialysis while maintaining procedural and distributive justice; minimise the influence of financial incentives and competing interests; ensure quality of care in service delivery and access to non-dialytic supportive care when needed; minimise the financial burden on patients and health-care system; and protect the interests of vulnerable groups during crisis situations...
February 23, 2017: Lancet
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