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https://www.readbyqxmd.com/read/100001003/emergency-management-of-sepsis-the-simple-stuff-saves-lives
#1
David Sweet, Julian Marsden, Kendall Ho, Christina Krause, James A Russell
Many emergency departments have implemented sepsis protocols since the 2001 publication of results from the early goal-directed therapy trial, which showed early targeted resuscitation lowers mortality. As part of an attempt to improve clinical and operational outcomes for emergency departments across British Columbia, we reviewed sepsis management literature and considered sepsis protocol implementation in the province’s emergency departments. During the literature review we found that many observational studies confirmed an association between implementation of emergency sepsis protocols and decreased mortality...
May 2012: BC medical journal: BCMJ
https://www.readbyqxmd.com/read/28743181/feasibility-and-safety-of-hyperthermic-intraperitoneal-chemotherapy-using-5-fluorouracil-combined-with-cisplatin-and-mitomycin-c-in-patients-undergoing-gastrectomy-for-advanced-gastric-cancer
#2
Satoshi Murata, Hiroshi Yamamoto, Hiroyuki Naitoh, Tsuyoshi Yamaguchi, Sachiko Kaida, Tomoharu Shimizu, Hisanori Shiomi, Shigeyuki Naka, Tohru Tani, Masaji Tani
BACKGROUND AND OBJECTIVES: We conducted a dose-finding study for 5-fluorouracil (5-FU) administered with cisplatin (CDDP) and mitomycin C (MMC) to find an improved regimen for hyperthermic intraperitoneal chemotherapy (HIPEC) for advanced gastric cancer (GC). METHODS: The appropriate HIPEC regimen previously determined in vitro was 5-FU (200 µg/mL), MMC (2 µg/mL), and CDDP (10 µg/mL) at hyperthermic conditions (42°C) for 30 min. This was a clinical study to determine the recommended dose of 5-FU in combination with MMC and CDDP at 42°C for 30 min and to evaluate HIPEC safety in patients at high risk of developing peritoneal metastases following GC surgery...
July 25, 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28743147/-development-of-anaesthesia-related-mortality-and-impact-on-perioperative-outcome
#3
Peter Rosenberger, Berthold Drexler
Achievements in anaesthesiology form the basis for the tremendous development of surgical therapy. Reliable monitoring technology, which is scrutinized on a regular basis using checklists, is allowing anaesthesia at the borders of physiology. During the last decades, anaesthesia-related mortality has been decreasing considerably. Well-trained anaesthesiology staff, who considers patient- and procedure-specific risks in anaesthetic management, is of major importance. Furthermore, postoperative care in specialised units and intensive care wards is a key factor of improved patient outcome after surgery...
July 2017: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/28743122/utility-of-transbronchial-lung-cryobiopsy-in-non-interstitial-diseases
#4
Olivia Sánchez-Cabral, Dina Martínez-Mendoza, Sebastián Fernandez-Bussy, Berenice López-González, Carolina Perea-Talamantes, Rosa María Rivera-Rosales, César Luna-Rivero, José Arturo Martínez-Orozco, Luis Felipe Flores-Suárez, Patricio Santillán-Doherty, Gustavo Reyes-Terán
BACKGROUND: Transbronchial lung cryobiopsy (TLCB), performed with a flexible cryoprobe, is an interventional pulmonology procedure that has proved its diagnostic value for interstitial pulmonary disease. However, it has not been explored extensively as a diagnostic tool for patients with non-interstitial lung pathology, including infectious and malignant diseases. OBJECTIVE: To evaluate the diagnostic yield and safety of an interventional pulmonology approach that integrates TLCB and bronchoalveolar lavage (BAL) for the diagnosis of non-interstitial pulmonary disease...
July 26, 2017: Respiration; International Review of Thoracic Diseases
https://www.readbyqxmd.com/read/28742711/readiness-of-us-general-surgery-residents-for-independent-practice
#5
Brian C George, Jordan D Bohnen, Reed G Williams, Shari L Meyerson, Mary C Schuller, Michael J Clark, Andreas H Meier, Laura Torbeck, Samuel P Mandell, John T Mullen, Douglas S Smink, Rebecca E Scully, Jeffrey G Chipman, Edward D Auyang, Kyla P Terhune, Paul E Wise, Jennifer N Choi, Eugene F Foley, Justin B Dimick, Michael A Choti, Nathaniel J Soper, Keith D Lillemoe, Joseph B Zwischenberger, Gary L Dunnington, Debra A DaRosa, Jonathan P Fryer
OBJECTIVE: This study evaluates the current state of the General Surgery (GS) residency training model by investigating resident operative performance and autonomy. BACKGROUND: The American Board of Surgery has designated 132 procedures as being "Core" to the practice of GS. GS residents are expected to be able to safely and independently perform those procedures by the time they graduate. There is growing concern that not all residents achieve that standard. Lack of operative autonomy may play a role...
July 24, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28742544/the-marginal-costs-of-adverse-drug-events-associated-with-exposures-to-anticoagulants-and-hypoglycemic-agents-during-hospitalization
#6
William D Spector, Rhona Limcangco, Michael F Furukawa, William E Encinosa
BACKGROUND: Anticoagulants and hypoglycemic agents are 2 of the most challenging drug classes for medical management in the hospital resulting in many adverse drug events (ADE). OBJECTIVE: Estimating the marginal cost (MC) of ADEs associated with anticoagulants and hypoglycemic agents for adults in 5 patient groups during their hospital stay and the total annual ADE costs for all patients exposed to these drugs during their stay. RESEARCH DESIGN AND SUBJECT: Data are from 2010 to 2013 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases and Medicare Patient Safety Monitoring System (MPSMS)...
July 24, 2017: Medical Care
https://www.readbyqxmd.com/read/28742381/systemic-error-in-radiology
#7
Stephen Waite, Jinel Moore Scott, Alan Legasto, Srinivas Kolla, Brian Gale, Elizabeth A Krupinski
OBJECTIVE: Interpretive errors in diagnostic imaging result in significant patient morbidity and mortality, but the importance of errors and process failures in the imaging cycle other than during image interpretation is underappreciated. In this article, we describe these errors and potential solutions, providing a framework to improve patient safety and understand the changing roles of radiologists beyond image interpretation. CONCLUSION: For comprehensive improvements to health care delivery, other failures in the cycle besides diagnostic interpretive error-such as ordering inappropriate studies, PACS failures, and a lack of accurate clinician contact information (with resultant communication failure)-should be recognized as contributors to patient harm because they lead to wasted resources and delayed care...
July 25, 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/28742291/evaluating-the-effect-of-the-changes-in-fda-guidelines-for-clozapine-monitoring
#8
Ryan S Sultan, Mark Olfson, Christoph U Correll, Erica J Duncan
BACKGROUND: Concerns exist that clozapine is underutilized in the management of treatment-resistant schizophrenia. Although a 2015 change in the US Food and Drug Administration (FDA) monitoring recommendations lowered the threshold of the absolute neutrophil count for treatment interruption from 1,500/μL to 1,000/μL and removed white blood cell count thresholds from the monitoring algorithm, the implications of this policy change on clozapine interruptions remain unknown. METHODS: We analyzed outpatient prescribing records for antipsychotic medications in the Veterans Integrated Service Network 7 (VISN 7) database between 1999 and 2012 to assess the potential impact of the recent changes in FDA neutropenia monitoring recommendations on clozapine treatment discontinuation...
July 18, 2017: Journal of Clinical Psychiatry
https://www.readbyqxmd.com/read/28742225/the-efficacy-and-safety-of-lixisenatide-in-a-predominantly-asian-population-with-type-2-diabetes-insufficiently-controlled-with-basal-insulin-the-getgoal-l-c-randomized-trial
#9
W Yang, K Min, Z Zhou, L Li, X Xu, D Zhu, A Venkateshwar Rao, L S Murthy, N Zhang, I Li, E Niemoeller, S Shang
AIMS: To assess the effects on glycaemic control of lixisenatide versus placebo as add-on treatment to basal insulin (BI) ± metformin on glycated haemoglobin (HbA1c) reduction in patients with insufficiently controlled type 2 diabetes (T2D). METHODS: Patients (n = 448) with inadequately controlled T2D were randomized (1:1) to lixisenatide or placebo as add-on to BI ± metformin for 24 weeks after an 8-week run-in phase, during which BI was titrated to a target self-monitored plasma glucose (SMPG; 4...
July 25, 2017: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/28742067/long-term-microdystrophin-gene-therapy-is-effective-in-a-canine-model-of-duchenne-muscular-dystrophy
#10
Caroline Le Guiner, Laurent Servais, Marie Montus, Thibaut Larcher, Bodvaël Fraysse, Sophie Moullec, Marine Allais, Virginie François, Maeva Dutilleul, Alberto Malerba, Taeyoung Koo, Jean-Laurent Thibaut, Béatrice Matot, Marie Devaux, Johanne Le Duff, Jack-Yves Deschamps, Inès Barthelemy, Stéphane Blot, Isabelle Testault, Karim Wahbi, Stéphane Ederhy, Samia Martin, Philippe Veron, Christophe Georger, Takis Athanasopoulos, Carole Masurier, Federico Mingozzi, Pierre Carlier, Bernard Gjata, Jean-Yves Hogrel, Oumeya Adjali, Fulvio Mavilio, Thomas Voit, Philippe Moullier, George Dickson
Duchenne muscular dystrophy (DMD) is an incurable X-linked muscle-wasting disease caused by mutations in the dystrophin gene. Gene therapy using highly functional microdystrophin genes and recombinant adeno-associated virus (rAAV) vectors is an attractive strategy to treat DMD. Here we show that locoregional and systemic delivery of a rAAV2/8 vector expressing a canine microdystrophin (cMD1) is effective in restoring dystrophin expression and stabilizing clinical symptoms in studies performed on a total of 12 treated golden retriever muscular dystrophy (GRMD) dogs...
July 25, 2017: Nature Communications
https://www.readbyqxmd.com/read/28742015/topical-tranexamic-acid-reduces-transfusion-rates-in-simultaneous-bilateral-total-knee-arthroplasty-a-retrospective-case-series
#11
Christopher Kim, Sam S Park, Herman S Dhotar, Anthony V Perruccio, Michael G Zywiel, J Roderick Davey
BACKGROUND: Topical tranexamic acid (TA) has been reported to be effective in reducing postoperative bleeding and transfusions after TKA. The main objective of this study was to retrospectively assess the effectiveness and safety of topical TA administration in patients undergoing simultaneous bilateral TKA. METHODS: We conducted a retrospective chart review of consecutive cohorts of patients undergoing simultaneous bilateral TKA. We compared the patients who received TA with patients from a similar time frame who did not receive TA...
August 1, 2017: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/28741970/efficacy-and-safety-of-once-weekly-semaglutide-for-the-treatment-of-type-2-diabetes
#12
Xueying Tan, Xiaojing Cao, Minzhi Zhou, Ping Zou, Jingbo Hu
Type 2 diabetes is a chronic metabolic disease characterized by persistent hyperglycemia resulting from progressive deficient of insulin in patients with a background of insulin resistance. Current treatment algorithms recommended by American Diabetes Association/The European Association for the Study of Diabetes promote a patient-centered approach that takes into account a comprehensive consideration of pharmacological properties of drugs, including glucose-lowering action, effects on body weight, correction on multiple pathophysiologic defects, tolerability, and long-term safety...
July 25, 2017: Expert Opinion on Investigational Drugs
https://www.readbyqxmd.com/read/28741967/iglarlixi-a-titratable-once-daily-fixed-ratio-combination-of-basal-insulin-and-lixisenatide-for-intensifying-type-2-diabetes-management-for-patients-inadequately-controlled-on-basal-insulin-with-or-without-oral-agents
#13
Neil Skolnik, Renell S Dupree, Eric L Johnson
BACKGROUND: Achieving and maintaining glycemic control is important for people with type 2 diabetes (T2D) in order to reduce disease-related complications and mortality; however, about half of US patients fail to meet glycemic targets. iGlarLixi, a titratable fixed-ratio combination of insulin glargine 100 U/mL (iGlar) and lixisenatide for once-daily administration, was recently approved by the US Food and Drug Administration for use in adults with T2D inadequately controlled on basal insulin (<60 U daily) or lixisenatide...
July 25, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28741965/cost-effectiveness-of-dolutegravir-abacavir-lamivudine-in-hiv-1-treatment-na%C3%A3-ve-tn-patients-in-france
#14
Gilles Pialoux, Anne-Geneviève Marcelin, Hélène Cawston, Caroline Guilmet, Laurent Finkielsztejn, Audrey Laurisse, Céline Aubin
OBJECTIVES: To evaluate the cost-effectiveness of an integrase inhibitor (INI), dolutegravir (DTG), in combination with abacavir (ABC)/lamivudine (3TC) in France, in treatment-naïve (TN) HIV adult patients. METHODS: The ARAMIS microsimulation Markov model, evaluates costs and effects of DTG vs. first-line ARVs options including INIs (raltegravir, elvitegravir/c), protease inhibitors (PIs) (darunavir/r, atazanavir/r, lopinavir/r), non-nucleoside reverse transcriptase inhibitors (efavirenz and rilpivirine)...
July 25, 2017: Expert Review of Pharmacoeconomics & Outcomes Research
https://www.readbyqxmd.com/read/28741871/pharmacodynamics-pharmacokinetics-safety-and-tolerability-of-the-novel-dual-glucose-dependent-insulinotropic-polypeptide-glucagon-like-peptide-1-agonist-rg7697-after-single-subcutaneous-administration-in-healthy-subjects
#15
Agnès Portron, Shirin Jadidi, Neena Sarkar, Richard DiMarchi, Christophe Schmitt
AIMS: To evaluate the pharmacodynamics, pharmacokinetics and safety of single subcutaneous (s.c.) injection of ascending doses of RG7697, a dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 agonist, in healthy subjects. METHODS: A total of 51 healthy volunteers were enrolled in this double-blind, placebo-controlled study investigating RG7697 doses ranging from 0.03 to 5 mg. Adverse events (AEs) were monitored and drug concentrations, fasting glycaemic variables, vital signs, ECG, antibody formation and routine laboratory variables were assessed...
July 25, 2017: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/28741868/retrospective-analysis-of-the-efficacy-and-safety-of-eribulin-therapy-for-metastatic-breast-cancer-in-daily-practice
#16
Toshihiro Tanaka, Miho Ueno, Yuta Nakashima, Shotaro Chinen, Eiichi Sato, Michio Masaki, Ai Mogi, Hidenori Sasaki, Kazuo Tamura, Yasushi Takamatsu
BACKGROUND: Evidence of eribulin therapy for metastatic breast cancer (MBC) in clinical practice is not well documented. METHODS: We retrospectively analyzed the safety and efficacy of eribulin in 29 MBC patients from 2011 to 2016 at Fukuoka University Hospital. RESULTS: The median patient age, number of courses, total dose, and relative dose intensity were as follows: 65 years, five courses, 8.6 mg/m(2) , and 75%, respectively. One patient achieved a complete response, (CR) six a partial response (PR), eight stable disease (SD) and 14 patients exhibited progressive disease...
July 25, 2017: Thoracic Cancer
https://www.readbyqxmd.com/read/28741866/a-review-of-available-laser-and-intense-light-source-home-devices-a-dermatologist-s-perspective
#17
REVIEW
Margit Lw Juhász, Melissa K Levin, Ellen S Marmur
BACKGROUND: Home optical devices are becoming an increasingly popular treatment modality sought out by patients for dermatologic pathologies such as acne, hair removal and anti-aging, as these devices are a low-cost and convenient therapy choice. METHODS: An Internet search using PubMed.gov was completed with search terms, "home device dermatology," "home device acne," "home device hair" or "hair removal," and "home device aging." RESULTS: Currently, there are multiple home optical devices available on the market...
July 25, 2017: Journal of Cosmetic Dermatology
https://www.readbyqxmd.com/read/28741791/comparison-of-the-safety-and-effectiveness-of-apixaban-versus-warfarin-in-patients-with-severe-renal-impairment-an-alternative-viewpoint
#18
Megan Z Roberts, T Michael Farley, Ryan E Owens
We thank Dr. Stanton and colleagues for their great work evaluating the clinical outcomes of apixaban in patients with severe renal dysfunction, ultimately concluding apixaban is a reasonable alternative to warfarin.(1) One question that clinicians should ask before applying this conclusion to clinical practice is what dose of apixaban should be used? The authors note that patients were primarily receiving apixaban 2.5 mg twice/day but gave no further breakdown based upon indication or level of renal dysfunction...
July 25, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28741663/carbon-dioxide-flush-of-an-integrated-minimized-perfusion-circuit-prior-to-priming-prevents-spontaneous-air-release-into-the-arterial-line-during-clinical-use
#19
Marco C Stehouwer, Roel de Vroege, Gerard J F Hoohenkerk, Frederik N Hofman, Johannes C Kelder, Bas Buchner, Bastian A de Mol, Peter Bruins
Recently, an oxygenator with an integrated centrifugal blood pump (IP) was designed to minimize priming volume and to reduce blood foreign surface contact even further. The use of this oxygenator with or without integrated arterial filter was compared with a conventional oxygenator and nonintegrated centrifugal pump. To compare the air removal characteristics 60 patients undergoing coronary artery bypass grafting were alternately assigned into one of three groups to be perfused with a minimized extracorporeal circuit either with the conventional oxygenator, the oxygenator with IP, or the oxygenator with IP plus integrated arterial filter (IAF)...
July 25, 2017: Artificial Organs
https://www.readbyqxmd.com/read/28741576/a-randomized-comparison-of-biodegradable-polymer-and-permanent-polymer-coated-platinum-chromium-everolimus-elutingcoronary-stents-in-china-the-evolve-china-study
#20
YaLing Han, Haiwei Liu, Yuejin Yang, Jian Zhang, Kai Xu, Guosheng Fu, Xi Su, Tiemin Jiang, Wenyue Pang, Jiyan Chen, Zuyi Yuan, Hui Li, Haichang Wang, Tao Hong, Huiliang Liu, Fucheng Sun, Dominic J Allocco, Mingdong Zhang, Keith D Dawkins
AIMS: The EVOLVE China randomized study sought to evaluate clinical safety and effectiveness of the SYNERGY bioabsorbable polymer-coated everolimus-eluting stent (EES) for the treatment of patients with coronary heart disease in China. METHODS AND RESULTS: Eligible patients with de novo native coronary artery lesions were randomized (1:1) to receive the SYNERGY or PROMUS Element Plus (PE Plus) stents. The primary endpoint was in-stent late loss at 9 months. Secondary endpoints included death, MI, revascularization, and stent thrombosis through 12 months...
July 25, 2017: EuroIntervention
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