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https://www.readbyqxmd.com/read/28647723/a-retrospective-cohort-study-of-high-impact-users-among-patients-with-cerebrovascular-conditions
#1
Ahsan Rao, Alice Jones, Alex Bottle, Ara Darzi, Paul Aylin
OBJECTIVE: To apply group-based trajectory modelling (GBTM) to the hospital administrative data to evaluate, model and visualise trends and changes in the frequency of long-term hospital care use of the subgroups of patients with cerebrovascular conditions. DESIGN: A retrospective cohort study of patients with cerebrovascular conditions. SETTINGS: Secondary care of all patients with cerebrovascular conditions admitted to English National Hospital Service hospitals...
June 24, 2017: BMJ Open
https://www.readbyqxmd.com/read/28647562/post-operative-complications-of-spina-bifida-patients-undergoing-urological-laparotomy-a-multi-institutional-analysis
#2
Christopher J Loftus, David C Moore, Joshua A Cohn, Douglas F Milam, Roger R Dmochowski, Dan Wood, Melissa R Kaufman, Hadley M Wood
OBJECTIVE: To characterize peri-operative morbidity and mortality of adult spina bifida patients undergoing laparotomy. METHODS: We retrospectively studied the post-operative complications of 59 operations of spina bifida patients undergoing abdominal laparotomies for urological indications at three institutions. We evaluated post-operative complications using the Clavien-Dindo classification scale. RESULTS: The overall complication rate was 91...
June 21, 2017: Urology
https://www.readbyqxmd.com/read/28647219/higher-mortality-of-severe-influenza-patients-with-probable-aspergillosis-than-those-with-and-without-other-coinfections
#3
Yee-Huang Ku, Khee-Siang Chan, Chun-Chieh Yang, Che-Kim Tan, Yin-Ching Chuang, Wen-Liang Yu
BACKGROUND/PURPOSE: Aspergillus-associated infection might comprise up to 23-29% of severe influenza patients from the community throughout stay in an intensive care unit (ICU). In Taiwan, cases of severe influenza with aspergillosis are increasingly reported. Therefore, we describe the relative risk of mortality among severe influenza patients with aspergillosis and other coinfections compared to severe influenza patients without Aspergillus coinfections. METHODS: We retrospectively reviewed 124 adult patients with severe influenza in a tertiary medical center in southern Taiwan from January 2015 through March 2016...
June 21, 2017: Journal of the Formosan Medical Association, Taiwan Yi Zhi
https://www.readbyqxmd.com/read/28647057/prevalence-of-obstructive-sleep-apnoea-in-acute-coronary-syndrome-routine-screening-in-intensive-coronary-care-units
#4
S Morra, F Bughin, K Solecki, M Aboubadra, B Lattuca, F Gouzi, J-C Macia, T-T Cung, S Cade, F Cransac, J-M Davy, Y Dauvilliers, D Corrado, F Roubille
INTRODUCTION: Increased evidence has shown that, despite the maximum care afforded to patients admitted with acute coronary syndromes (ACS), a residual risk of mortality remains, in which obstructive sleep apnoea (OSA) appears to be a largely undiagnosed factor, particularly in the intensive cardiac care unit (ICCU). The purpose of this study is to determine whether the systematic screening for sleep-disordered breathing (SDB) is feasible and may be recommended. The aims of our study are to determine: (1) The estimated prevalence of OSA in patients admitted to the ICCU for ACS determined by a validated, user-friendly portable screening device; (2) The feasibility of the screening in this context; (3) To assess any negative impact of OSA on the severity of ACS...
June 21, 2017: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/28646925/stress-ulcer-prophylaxis-versus-placebo-or-no-prophylaxis-in-adult-hospitalised-acutely-ill-patients-protocol-for-a-systematic-review-with-meta-analysis-and-trial-sequential-analysis
#5
Søren Marker, Anders Perner, Jørn Wetterslev, Marija Barbateskovic, Janus Christian Jakobsen, Mette Krag, Anders Granholm, Carl Thomas Anthon, Morten Hylander Møller
BACKGROUND: Stress ulcer prophylaxis is considered standard of care in many critically ill patients in the intensive care unit (ICU). However, the quality of evidence supporting this has recently been questioned, and clinical equipoise exists. Whether there is overall benefit or harm of stress ulcer prophylaxis in adult hospitalised acutely ill patients is unknown. Accordingly, we aim to assess patient-important benefits and harms of stress ulcer prophylaxis versus placebo or no treatment in adult hospitalised acutely ill patients with high risk of gastrointestinal bleeding irrespective of hospital setting...
June 24, 2017: Systematic Reviews
https://www.readbyqxmd.com/read/28645982/a-multicentre-randomised-controlled-non-inferiority-trial-comparing-nasal-high-flow-with-nasal-continuous-positive-airway-pressure-as-primary-support-for-newborn-infants-with-early-respiratory-distress-born-in-australian-non-tertiary-special-care-nurseries
#6
Brett J Manley, Calum T Roberts, Gaston R B Arnolda, Ian M R Wright, Louise S Owen, Kim M Dalziel, Jann P Foster, Peter G Davis, Adam G Buckmaster
INTRODUCTION: Nasal high-flow (nHF) therapy is a popular mode of respiratory support for newborn infants. Evidence for nHF use is predominantly from neonatal intensive care units (NICUs). There are no randomised trials of nHF use in non-tertiary special care nurseries (SCNs). We hypothesise that nHF is non-inferior to nasal continuous positive airway pressure (CPAP) as primary support for newborn infants with respiratory distress, in the population cared for in non-tertiary SCNs. METHODS AND ANALYSIS: The HUNTER trial is an unblinded Australian multicentre, randomised, non-inferiority trial...
June 23, 2017: BMJ Open
https://www.readbyqxmd.com/read/28645964/the-predictive-value-of-serial-changes-in-diaphragm-function-during-the-spontaneous-breathing-trial-for-weaning-outcome-a-study-protocol
#7
Pengmin Zhou, Zhongheng Zhang, Yucai Hong, Huabo Cai, Hui Zhao, Peifeng Xu, Yiming Zhao, Shengping Lin, Xuchang Qin, JiaWei Guo, Yun Pan, Junru Dai
INTRODUCTION: There is a variety of tools being used in clinical practice for the prediction of weaning success from mechanical ventilation. However, their diagnostic performances are less than satisfactory. The purpose of this study is to investigate the value of serial changes in diaphragm function measured by ultrasound during the spontaneous breathing trial (SBT) as a weaning predictor. METHODS AND ANALYSIS: This is a prospective observational study conducted in a 10-bed medical emergency intensive care unit (EICU) in a university-affiliated hospital...
June 23, 2017: BMJ Open
https://www.readbyqxmd.com/read/28645736/liver-transplantation-in-the-most-severely-ill-cirrhotic-patients-a-multicenter-study-in-acute-on-chronic-liver-failure-grade-3
#8
Florent Artru, Alexandre Louvet, Isaac Ruiz, Eric Levesque, Julien Labreuche, Jose Ursic-Bedoya, Guillaume Lassailly, Sebastien Dharancy, Emmanuel Boleslawski, Gilles Lebuffe, Eric Kipnis, Philippe Ichai, Audrey Coilly, Eleonora De Martin, Teresa Maria Antonini, Eric Vibert, Samir Jaber, Astrid Herrerro, Didier Samuel, Alain Duhamel, Georges-Philippe Pageaux, Philippe Mathurin, Faouzi Saliba
BACKGROUND & AIMS: Liver transplantation (LT) for the most severely ill patients with cirrhosis with dysfunction of several organs (accurately assessed by the acute-on-chronic liver failure (ACLF) classification) remains controversial. We aimed to report the results of LT in patients with ACL3 and to compare these patients to non-transplanted patients with cirrhosis and multiple organ dysfunction and to patients transplanted with lower ACLF grade. -Methods: All patients with ACLF3 transplanted in 3 liver ICU were retrospectively included...
June 20, 2017: Journal of Hepatology
https://www.readbyqxmd.com/read/28645517/glucose-control-diabetes-status-and-mortality-in-critically-ill-patients-the-continuum-from-intensive-care-unit-admission-to-hospital-discharge
#9
James S Krinsley, Paula Maurer, Sharon Holewinski, Roy Hayes, Douglas McComsey, Guillermo E Umpierrez, Stanley A Nasraway
OBJECTIVE: To describe the relationships among glycemic control, diabetes mellitus (DM) status, and mortality in critically ill patients from intensive care unit (ICU) admission to hospital discharge. PATIENTS AND METHODS: This is a retrospective investigation of 6387 ICU patients with 5 or more blood glucose (BG) tests and 4462 ICU survivors admitted to 2 academic medical centers from July 1, 2010, through December 31, 2014. We studied the relationships among mean BG level, hypoglycemia (BG level <70 mg/dL [to convert to mmol/L, multiply by 0...
June 7, 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28645516/the-search-continues-for-optimal-intensive-care-unit-glucose-management-and-measurement
#10
EDITORIAL
Micah T Long, Ann M Sheehy, Douglas B Coursin
No abstract text is available yet for this article.
June 7, 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28645462/analgosedation-practices-and-the-impact-of-sedation-depth-on-clinical-outcomes-among-patients-requiring-mechanical-ventilation-in-the-emergency-department-a-cohort-study
#11
Robert J Stephens, Enyo Ablordeppey, Anne M Drewry, Christopher Palmer, Brian T Wessman, Nicholas M Mohr, Brian W Roberts, Stephen Y Liang, Marin H Kollef, Brian M Fuller
BACKGROUND: Analgesia and sedation are cornerstone therapies for mechanically ventilated patients. Despite data showing that early deep sedation in the intensive care unit influences outcome, this has not been investigated in the emergency department (ED). Therefore, ED-based sedation practices, and their influence on outcome, remain incompletely defined. This study's objectives were to describe ED sedation practices in mechanically ventilated patients, and to test the hypothesis that ED sedation depth is associated with worse outcomes METHODS: This was a cohort study on a prospectively compiled ED registry of adult, mechanically ventilated patients at a single academic medical center...
June 20, 2017: Chest
https://www.readbyqxmd.com/read/28645302/untangling-glycaemia-and-mortality-in-critical-care
#12
Vincent Uyttendaele, Jennifer L Dickson, Geoffrey M Shaw, Thomas Desaive, J Geoffrey Chase
BACKGROUND: Hyperglycaemia is associated with adverse outcomes in the intensive care unit, and initial studies suggested outcome benefits of glycaemic control (GC). However, subsequent studies often failed to replicate these results, and they were often unable to achieve consistent, safe control, raising questions about the benefit or harm of GC as well as the nature of the association of glycaemia with mortality and clinical outcomes. In this study, we evaluated if non-survivors are harder to control than survivors and determined if glycaemic outcome is a function of patient condition and eventual outcome or of the glycaemic control provided...
June 24, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28645181/the-clinical-benefits-of-perioperative-antioxidant-vitamin-therapy-in-patients-undergoing-cardiac-surgery-a-meta-analysis
#13
Jun Geng, Ju Qian, Weijun Si, Hao Cheng, Fuhai Ji, Zhenya Shen
The clinical benefits of perioperative antioxidant vitamin therapy in cardiac patients remain controversial. Here, we conducted a meta-analysis to determine the strength of the evidence supporting the perioperative use of antioxidant vitamins in patients undergoing cardiac surgery. We searched 4 databases (PubMed, EMBASE, Science Citation Index and Cochrane Library) for randomized controlled trials that reported the effects of antioxidant vitamin therapy on patients undergoing cardiac surgery until 6 June 2016...
June 22, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28644831/inflammatory-and-vascular-placental-lesions-are-associated-with-neonatal-amplitude-integrated-eeg-recording-in-early-premature-neonates
#14
Dorit Paz-Levy, Letizia Schreiber, Offer Erez, Sharon Goshen, Justin Richardson, VIadimir Drunov, Orna Staretz Chacham, Eilon Shany
INTRODUCTION: Placental histologic examination can assist in revealing the mechanism leading to preterm birth. Accumulating evidence suggests an association between intrauterine pathological processes, morbidity and mortality of premature infants, and their long term outcome. Neonatal brain activity is increasingly monitored in neonatal intensive care units by amplitude integrated EEG (aEEG) and indices of background activity and sleep cycling patterns were correlated with long term outcome...
2017: PloS One
https://www.readbyqxmd.com/read/28644785/what-should-physicians-do-when-they-disagree-clinically-and-ethically-with-a-surrogate-s-wishes
#15
Terri Traudt, Joan Liaschenko
When patients' surrogates and physicians disagree about the appropriateness of aggressive treatment in intensive care units (ICUs), physicians can experience surrogates' demands as sources of moral distress. This article addresses the virtues and communication strategies needed to respond appropriately in such situations. Specifically, we offer a framework and language that rely on moral community to facilitate common ground and alleviate moral distress.
June 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28644698/sleep-disturbance-after-hospitalization-and-critical-illness-a-systematic-review
#16
Marcus T Altman, Melissa P Knauert, Margaret A Pisani
BACKGROUND: Sleep disturbance during intensive care unit (ICU) admission is common and severe. Sleep disturbance has been observed in survivors of critical illness even after transfer out of the ICU. Not only is sleep important to overall health and well-being, but patients after critical illness are also in a physiologically vulnerable state. Understanding how sleep disturbance impacts recovery from critical illness after hospital discharge is therefore clinically meaningful. OBJECTIVE: This systematic review aimed to summarize studies that identify the prevalence of and risk factors for sleep disturbance after hospital discharge for critical illness survivors...
June 23, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28644335/practice-bulletin-number-179-breast-cancer-risk-assessment-and-screening-in-average-risk-women
#17
(no author information available yet)
Breast cancer is the most commonly diagnosed cancer in women in the United States and the second leading cause of cancer death in American women (1). Regular screening mammography starting at age 40 years reduces breast cancer mortality in average-risk women (2). Screening, however, also exposes women to harm through false-positive test results and overdiagnosis of biologically indolent lesions. Differences in balancing benefits and harms have led to differences among major guidelines about what age to start, what age to stop, and how frequently to recommend mammography screening in average-risk women (2-4)...
July 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28644328/practice-bulletin-no-179-summary-breast-cancer-risk-assessment-and-screening-in-average-risk-women
#18
(no author information available yet)
Breast cancer is the most commonly diagnosed cancer in women in the United States and the second leading cause of cancer death in American women (1). Regular screening mammography starting at age 40 years reduces breast cancer mortality in average-risk women (2). Screening, however, also exposes women to harm through false-positive test results and overdiagnosis of biologically indolent lesions. Differences in balancing benefits and harms have led to differences among major guidelines about what age to start, what age to stop, and how frequently to recommend mammography screening in average-risk women (2-4)...
July 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28644313/unique-clinical-features-of-los-angeles-grade-d-esophagitis-suggest-that-factors-other-than-gastroesophageal-reflux-contribute-to-its-pathogenesis
#19
Anh D Nguyen, Stuart J Spechler, Monique N Shuler, Rhonda F Souza, Kerry B Dunbar
BACKGROUND: The Los Angeles (LA) grade of reflux esophagitis (A to D) is assumed to reflect severity of the underlying gastroesophageal reflux disease (GERD). Thus, LA-D esophagitis patients might be expected to have the most conditions predisposing to GERD (eg, obesity, hiatal hernia), and the highest frequency of GERD symptoms. GOALS: The main goal of this study is to compare clinical features of patients with the most severe (LA-D) and mildest (LA-A) grades of esophagitis...
June 21, 2017: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/28644310/predictors-of-mortality-in-cirrhosis-inpatients-with-clostridium-difficile-infection
#20
Elliot Z Smith, Patrick G Northup, Curtis K Argo
BACKGROUND: Clostridium difficile is a bacterial pathogen associated with significant morbidity and mortality in patients with cirrhosis. GOALS: Our primary aim is to identify variables that are predictive of poor outcomes in cirrhosis patients with C. difficile infection (CDI). We also aim to further characterize the risk factors for developing CDI and risk of mortality in this patient population. STUDY: A total of 200 subjects with a diagnosis of cirrhosis and CDI were matched to 200 cirrhosis inpatients without CDI...
June 21, 2017: Journal of Clinical Gastroenterology
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