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Acute and critical care

Robert Reid, Evelyn Rising, Arthur Kaufman, Amanda Bassett, Martha Cole McGrew, Helene Silverblatt, Michael Haederle
An unlikely partnership between a private, place-based foundation and the University of New Mexico's Office for Community Health resulted in an innovative approach for addressing a critical shortage of health professionals in an isolated, rural setting in the southeastern corner of New Mexico. Many place-based private foundations are focused locally and are naturally disinclined to engage distally located public universities for local projects. Large public universities do not often focus resources on small communities located far from their campuses...
October 20, 2018: Journal of Community Health
Tamara Merz, Martin Wepler, Benedikt Nußbaum, Josef Vogt, Enrico Calzia, Rui Wang, Csaba Szabo, Peter Radermacher, Oscar McCook
BACKGROUND: Sepsis is associated with disturbed glucose metabolism and reduced mitochondrial activity and biogenesis, ultimately leading to multiple organ dysfunction, e.g., acute kidney injury (AKI). Cystathionine-γ-lyase (CSE), the major cardiovascular source of endogenous H2 S release, is implicated in the regulation of glucose metabolism and mitochondrial activity through a PGC1α-dependent mechanism, and critical for kidney function. Atherosclerosis is associated with mitochondrial dysfunction and reduced CSE expression...
October 20, 2018: Intensive Care Medicine Experimental
Hiroshi Nonogi
The in-hospital mortality rate of acute myocardial infarction (AMI) has dramatically decreased due to the treatment at the coronary care unit (CCU), especially with the progress of arrhythmia therapy and reperfusion therapy. On the other hand, severe heart failure and multiple organ failure are increasing due to aging populations and multiple organ diseases. As a result, patients with AMI without complications are less likely to be admitted to the CCU, and cardiologists staying in the CCU have also decreased...
October 17, 2018: Journal of Cardiology
Nirupama Yechoor, Amir Adeli, Shaheryar Hafeez
INTRODUCTION: Although overall mortality of status epilepticus is high, baseline patient characteristics and co-morbidities may be helpful to predict outcomes and shape treatment decisions. Two previously published scoring systems exist to predict outcomes: the Status Epilepticus Severity Score (STESS) and the Epidemiology-based Mortality Score in Status Epilepticus (EMSE). However, a comparison of the two scores has not previously been completed in an American intensive care unit. We hypothesize that both scores will adequately predict the primary outcome of in-hospital death, but that the EMSE may more accurately predict functional outcomes, and significantly impact treatment decisions for both clinicians and families...
October 3, 2018: Epilepsy Research
Nina C Silander, David J Chesire, Kamela S Scott
The primary medical goals of acute care are restoration of physical health and return to physical function. However, in response to traumatic events and injuries, psychological factors are critical to one's overall recovery. Both pre-morbid psychiatric comorbidities and post-injury psychological compromise affect physical and psychological recovery in inpatient trauma populations. The Psychological Services Program (PSP), a model trauma/acute care program, addresses these critical factors in a Level 1 Trauma Center...
October 19, 2018: Journal of Clinical Psychology in Medical Settings
Sarah Donnelly, Geraldine Prizeman, Diarmuid Ó Coimín, Bettina Korn, Geralyn Hynes
BACKGROUND: End-of-life care (EoLC) is an experience that touches the lives of everyone. Dying in an acute hospital is a common occurrence in developed countries across the world. Previous studies have shown that there is wide variation in EoLC and at times is experienced as being of poor quality. Assessing and measuring the quality of care provided is a key component of all healthcare systems. This paper reports on the qualitative analysis of open-ended free text questions that were asked as part of a post-bereavement survey conducted in two adult acute hospitals in Ireland...
October 19, 2018: BMC Palliative Care
Alyssa A Riley, Mary Watson, Carolyn Smith, Danielle Guffey, Charles G Minard, Helen Currier, Ayse Akcan Arikan
BACKGROUND: To evaluate changes in population characteristics and outcomes in a large single-center pediatric patient cohort treated with continuous renal replacement therapy (CRRT) over a 10 year course, coincident with multiple institutional practice changes in CRRT delivery. METHODS: A retrospective cohort study with comparative analysis of all patients treated from 2004 to 2013 with CRRT in the neonatal, pediatric, and cardiovascular intensive care units within a free-standing pediatric tertiary care hospital...
October 19, 2018: BMC Nephrology
Wei-Ting Tseng, Tiao-Lai Huang
BACKGROUND: Patients with psychiatric disorders in critical condition are difficult to treat. In this study, we report on a patient with underlying schizoaffective disorder who developed catatonia, cardiac arrest, and pulmonary embolism, as well as a successful treatment strategy. CASE PRESENTATION: The inpatient is a 41-year-old morbidly obese male with schizoaffective disorder whose clozapine dosage was titrated from 100 mg to 175 mg due to auditory hallucination and agitation...
October 19, 2018: BMC Psychiatry
Freja Stæhr Holm, Pradeesh Sivapalan, Niels Seersholm, Theis Skovsgaard Itenov, Per Hjort Christensen, Jens-Ulrik Stæhr Jensen
BACKGROUND: Gelsolin is an actin-scavenger controlling the tissue damage from actin in the blood. Gelsolin levels in circulation drops when tissue damage and corresponding actin release is pronounced due to catabolic conditions. The purpose of this study was to determine if low plasma gelsolin independently predicts a reduced chance of weaning from ventilator-demanding respiratory failure in critically ill patients within 28 days from admission. RESULTS: This cohort study included 746 critically ill patients with ventilator-demanding respiratory failure from the randomized clinical trial, "Procalcitonin And Survival Study"...
October 18, 2018: Shock
Yutaka Igarashi, Shoji Yokobori, Hidetoshi Yamana, Kosuke Nagakura, Jun Hagiwara, Tomohiko Masuno, Hiroyuki Yokota
Aim: In Japan, standard prehospital care is provided by emergency medical services teams. Doctor-staffed ambulances play a role in facilitating the immediate treatment of critically ill patients to increase the survival rates. However, little is known about their activities. We revealed the present situation of doctor-staffed ambulances in Japan. Methods: First, we surveyed all the fire departments in Japan and determined whether a doctor-staffed ambulance was present within their district boundary...
October 2018: Acute Medicine & Surgery
N He, Y Y Yan, Y Q Ying, M Yi, G Q Yao, Q G Ge, S D Zhai
Pharmacokinetic parameters can be significantly altered for acute kidney injury (AKI), extracorporeal membrane oxygenation (ECMO) and continuous veno-venous hemofiltration therapy (CVVH). Here we reported a case of individualized vancomycin dosing for a patient diagnosed as severe acute pancreatitis treated with concurrent ECMO and CVVH. A 65 kg 32-year-old woman was admitted to hospital presented with severe acute pancreatitis (SAP), respiratory failure, metabotropic acidosis and hyperkalemia. She was admitted to intensive care unit (ICU) on hospital day 1 and was initiated on CVVH...
October 18, 2018: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
Hangsak Huy, Tae-Don Kim, Won Sam Kim, Dong Oh Kim, Jae-Eun Byun, Mi Jeong Kim, Young-Jun Park, Suk Ran Yoon, Ji-Yoon Noh, Jungwoon Lee, Kyoo-Hyung Lee, Inpyo Choi, Haiyoung Jung
Overcoming drug resistance is one of key issues in treating refractory acute myeloid leukemia (AML). The Toll-like receptor 4 (TLR4) signaling pathway is involved in many aspects of biological functions of AML cells, including the regulation of pro-inflammatory cytokine products, myeloid differentiation, and survival of AML cells. Thus, targeting TLR4 of AML patients for therapeutic purposes should be carefully addressed. In this regard, we investigated the possible role of TLR4 as a regulatory factor against fludarabine (FA) cytotoxicity activity...
October 15, 2018: Biochemical and Biophysical Research Communications
Jason D Chodakowski, Daniel Mark Courtney
PURPOSE OF REVIEW: We provide a timely update on treatment care issues facing clinicians and patients with acute pulmonary embolism accompanied by either right ventricular strain (sub-massive pulmonary embolism) or shock (massive pulmonary embolism). RECENT FINDINGS: Care and research changes over the last several years have resulted in four important trends: more consensus and accuracy in the way acute pulmonary embolism severity is described and communicated among acute care clinicians and researchers, increased availability and use of risk prediction scoring systems, increased use of advanced invasive therapy in the setting of severe right ventricular dysfunction, and emergence of multidisciplinary pulmonary embolism response teams to guide standard care decision-making...
October 12, 2018: Current Opinion in Critical Care
Laura Krone Larsen, Vibe G Frøkjaer, Jette Stub Nielsen, Yoanna Skrobik, Yvonne Winkler, Kirsten Møller, Marian Petersen, Ingrid Egerod
BACKGROUND: Delirium is underinvestigated in the neuro-critically ill, although the harmful effect of delirium is well established in patients in medical and surgical intensive care units (ICU).To detect delirium, a valid tool is needed. We hypothesized that delirium screening would be feasible in patients with acute brain injury and we aimed to validate and compare the Confusion Assessment Method for the ICU and the Intensive Care Delirium Screening Checklist against clinical International Classification of Diseases-10 criteria as reference...
October 16, 2018: Acta Anaesthesiologica Scandinavica
Kuo Du, Anup Ramachandran, James L Weemhoff, Benjamin L Woolbright, Andrew H Jaeschke, Xiaojuan Chao, Wen-Xing Ding, Hartmut Jaeschke
We previously reported that delayed treatment with Mito-tempo (MT), a mitochondria-targeted superoxide dismutase mimetic, protects against the early phase of acetaminophen (APAP) hepatotoxicity by inhibiting peroxynitrite formation. However, whether this protection is sustained to the late phase of toxicity is unknown. To investigate the late protection, C57Bl/6J mice were treated with 300 mg/kg APAP followed by 20 mg/kg MT 1.5 h or 3 h later. We found that both MT treatments protected against the late phase of APAP hepatotoxicity at 12 and 24 h...
October 15, 2018: Archives of Toxicology
Dana A Schinasi, Irini N Kolaitis, Frances M Nadel, Yuemi An-Grogan, Rebekah Burns, Leah Berman, Annie M Quinn, Kathy N Shaw
Background Full disclosure of patient safety events (PSE) is desired by patients and their families, is required by the Joint Commission and many state laws, and is vital to improving patient outcomes. A key barrier to consistent disclosure of patient safety events is a self-reported lack of proper training. Physicians must be trained to recognize when a PSE has occurred and effectively carry out disclosure, all while caring for a patient who is actively experiencing the consequences of an unintended outcome...
August 3, 2018: Curēus
Jared G Blommel, Andres R Chacon, Stuart J Bagatell
Approximately 11 million people living and working in the USA do so without documentation. This group represents a disenfranchised minority with adverse experiences and unique comorbidities that faces significant obstacles to receiving healthcare, including fear of deportation, language barriers, financial barriers and difficulty navigating an inconsistent and fragmented system. Healthcare is therefore often sought once symptoms have become critical, which can lead to more severe disease processes and multiple new diagnoses at presentation even in previously healthy patients...
October 14, 2018: BMJ Case Reports
François Dépret, Louis Boutin, Jiří Jarkovský, Maité Chaussard, Sabri Soussi, Aurélien Bataille, Haikel Oueslati, Nabila Moreno, Christian de Tymowski, Jiří Parenica, Klára Benešová, Thomas Vauchel, Axelle Ferry, Mourad Benyamina, Alexandru Cupaciu, Maxime Coutrot, Jean-Pierre Garnier, Kevin Serror, Marc Chaouat, Alexandre Mebazza, Matthieu Legrand
OBJECTIVE: We aimed at assessing the predictive value of plasmatic Neutrophil Gelatinase Associated Lipocalin (pNGAL) at admission and severity scores to predict major adverse kidney events (MAKE, defined as death and/or need for renal replacement therapy (RRT) and/or non-renal recovery at day 90) in critically ill burn patients. MATERIAL AND METHODS: Single-center cohort study in a burn critical care unit in a tertiary center, including all consecutive severely burn patients (total burned body surface >20%) from January 2012 until January 2015 with a pNGAL dosage at admission...
October 12, 2018: Burns: Journal of the International Society for Burn Injuries
Michael W Sjoding, Timothy P Hofer, Ivan Co, Jakob I McSparron, Theodore J Iwashyna
RATIONALE: Because the Berlin ARDS definition has only moderate reliability, physicians disagree about the diagnosis of ARDS in some patients. Understanding the clinical differences between patients with agreement and disagreement in the diagnosis of ARDS may provide insight into the epidemiology and pathophysiology of this syndrome, and inform strategies to improve reliability of ARDS diagnosis. OBJECTIVES: To characterize patients with diagnostic disagreement in ARDS among critical care trained physicians and compare them to patients with a consensus that ARDS developed...
October 15, 2018: Annals of the American Thoracic Society
Sabry Omar, Garrison L Morgan, Hemang B Panchal, Vinod Thourani, Charanjit S Rihal, Ruchi Patel, Nisharahmed Kherada, Alexander C Egbe, Nirat Beohar
BACKGROUND: Post-myocardial infarction (MI) ventricular septal defects (PIVSD) are an uncommon but life-threatening complication of acute MI. Although surgical closure has been the standard of care, mortality, and recurrence of VSD remain high even after emergent surgery. Transcatheter VSD closure (TCC) devices have become an alternative or adjunct to surgical closure. METHODS: Online database search was performed for studies that included adults with PIVSD who underwent medical treatment (MT) alone, surgical closure (SC) (early or late), and TCC (early, late, or for post-surgical residual VSD)...
August 28, 2018: Journal of Interventional Cardiology
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