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https://www.readbyqxmd.com/read/30312224/ethics-of-outbreaks-position-statement-part-1-therapies-treatment-limitations-and-duty-to-treat
#1
Thomas J Papadimos, Evadne G Marcolini, Mehrnaz Hadian, George E Hardart, Nicholas Ward, Mitchell M Levy, Stanislaw P Stawicki, Judy E Davidson
OBJECTIVES: Outbreaks of disease, especially those that are declared a Public Health Emergency of International Concern, present substantial ethical challenges. Here we start a discourse (with a continuation of the dialogue in Ethics of Outbreaks Position Statement. Part 2: Family-Centered Care) concerning the ethics of the provision of medical care, research challenges and behaviors during a Public Health Emergency of International Concern with a focus on the proper conduct of clinical or epidemiologic research, clinical trial designs, unregistered medical interventions (including vaccine introduction, devices, pharmaceuticals, who gets treated, vulnerable populations, and methods of data collection), economic losses, and whether there is a duty of health care providers to provide care in such emergencies, and highlighting the need to understand cultural diversity and local communities in these efforts...
November 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/30303868/best-practices-for-postoperative-brain-health-recommendations-from-the-fifth-international-perioperative-neurotoxicity-working-group
#2
Miles Berger, Katie J Schenning, Charles H Brown, Stacie G Deiner, Robert A Whittington, Roderic G Eckenhoff, Martin S Angst, Sinziana Avramescu, Alex Bekker, Marek Brzezinski, Greg Crosby, Deborah J Culley, Maryellen Eckenhoff, Lars I Eriksson, Lis Evered, Jim Ibinson, Richard P Kline, Andy Kofke, Daqing Ma, Joseph P Mathew, Mervyn Maze, Beverley A Orser, Catherine C Price, David A Scott, Brendan Silbert, Diansan Su, Niccolo Terrando, Dian-Shi Wang, Huafeng Wei, Zhoncong Xie, Zhiyi Zuo
As part of the American Society of Anesthesiology Brain Health Initiative goal of improving perioperative brain health for older patients, over 30 experts met at the fifth International Perioperative Neurotoxicity Workshop in San Francisco, CA, in May 2016, to discuss best practices for optimizing perioperative brain health in older adults (ie, >65 years of age). The objective of this workshop was to discuss and develop consensus solutions to improve patient management and outcomes and to discuss what older adults should be told (and by whom) about postoperative brain health risks...
October 9, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/30300176/emergency-department-airway-management-responsibilities-in-the-united-states
#3
Chukwudi Chiaghana, Christopher Giordano, Danielle Cobb, Terrie Vasilopoulos, Patrick J Tighe, Joshua W Sappenfield
BACKGROUND: In the 1990s, emergency medicine (EM) physicians were responsible for intubating about half of the patients requiring airway management in emergency rooms. Since then, no studies have characterized the airway management responsibilities in the emergency room. METHODS: A survey was sent via the Eastern Association for Surgery and Trauma and the Trauma Anesthesiology Society listservs, as well as by direct solicitation. Information was collected on trauma center level, geographical location, department responsible for intubation in the emergency room, department responsible for intubation in the trauma bay, whether these roles differed for pediatrics, whether an anesthesiologist was available "in-house" 24 hours a day, and whether there was a protocol for anesthesiologists to assist as backup during intubations...
October 8, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/30266431/perceptions-attitudes-and-practices-of-french-junior-physicians-regarding-antibiotic-use-and-resistance
#4
C Lévin, N Thilly, M Dousak, G Beraud, M Klesnik, S Uhan, D Nathwani, B Beovic, C Pulcini
OBJECTIVES: To assess the perceptions, attitudes, and practices of French junior physicians regarding antibiotic use and resistance, and then to identify the characteristics of junior physicians associated with appropriate practices of antibiotic use. METHOD: European junior physicians received an email invitation to complete a 49 item web questionnaire between September 2015 and January 2016. We present the French data. Multivariate regression models were used to identify the characteristics of junior physicians associated with appropriate prescription practices and with consideration of the antibiotic prescription consequences...
September 25, 2018: Médecine et Maladies Infectieuses
https://www.readbyqxmd.com/read/30234621/a-dedicated-pediatric-spine-deformity-team-significantly-reduces-surgical-time-and-cost
#5
John M Flynn, Brendan M Striano, Wallis T Muhly, Blair Kraus, Wudbhav N Sankar, Vaidehi Mehta, Michael Blum, Barbara DeZayas, Jeffrey Feldman, Ron Keren
BACKGROUND: As high-quality health care becomes increasingly expensive, improvement projects are focused on reducing cost and increasing value. To increase value by reducing operating room (OR) utilization, we studied the effect of a dedicated team approach for posterior spinal fusion (PSF) for scoliosis. METHODS: With institutional support, an interdisciplinary, dedicated team was assembled. Members developed standardized protocols for anesthetic management and patient transport, positioning, preparation, draping, imaging, and wake-up...
September 19, 2018: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/30234534/development-and-multidisciplinary-preliminary-validation-of-a-3-dimensional-printed-pediatric-airway-model-for-emergency-airway-front-of-neck-access-procedures
#6
Kevin J Kovatch, Allison R Powell, Kevin Green, Chelsea L Reighard, Glenn E Green, Virginia T Gauger, Deborah M Rooney, David A Zopf
BACKGROUND: Pediatric-specific difficult airway guidelines include algorithms for 3 scenarios: unanticipated difficult tracheal intubation, difficult mask ventilation, and cannot intubate/cannot ventilate. While rare, these instances may require front-of-neck access (FONA) to secure an airway until a definitive airway can be established. The aim of this study was to develop a pediatric FONA simulator evaluated by both anesthesiology and otolaryngology providers, promoting multidisciplinary airway management...
September 18, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/30153372/antithrombotic-therapy-management-of-adult-and-pediatric-cardiac-surgery-patients
#7
REVIEW
L Baumann Kreuziger, K Karkouti, J Tweddell, M P Massicotte
Despite the development of catheter-based interventions for ischemic and valvular heart disease, hundreds of thousands of people undergo open heart surgery annually for coronary artery bypass graft (CABG), valve replacement or cardiac assist device implantation. Cardiac surgery patients are unique because therapeutic anticoagulation is required during cardiopulmonary bypass. Developmental hemostasis and altered drug metabolism affect management in children. This narrative review summarizes the current evidence-based and consensus guidelines regarding perioperative, intraoperative and postoperative antithrombotic therapy in patients undergoing cardiac surgery...
August 28, 2018: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/30145594/is-the-mayfield-head-holder-obligatory-for-intracranial-aneurysm-clipping
#8
Zeferino Demartini, Luana Antunes Maranha Gatto, Tatiane Coghetto da Rocha, Adriano Keijiro Maeda, Adriana Valerio, Gelson Luis Koppe, Alexandre Novicki Francisco
Intracranial aneurysm surgery is commonly performed using pinned head holders, which pose a higher risk for the pediatric population. Several authors recommend avoiding the use of this device when it is not strictly necessary, and this is currently possible considering advances in anesthesiology and monitoring. As the literature on microsurgery without skull clamp use is scant, we report the case of a 15-year-old boy presenting with a subarachnoid hemorrhage after rupture of a middle cerebral artery aneurysm...
2018: Pediatric Neurosurgery
https://www.readbyqxmd.com/read/30103101/selected-highlights-from-clinical-anesthesia-and-pain-management
#9
REVIEW
Mark C Kendall, Dominic V Pisano, Alexander D Cohen, Michelle Gorgone, Zachary L McCormick, Christopher J Malgieri
STUDY OBJECTIVE: To review research highlights of manuscripts published in 2017 that pertain to all aspects of the clinical practice of anesthesiology. DESIGN: Narrative review. SETTING: N/A. MATERIALS: The major themes addressed in this review include recent studies examining airway management, obstetrical and gynecological anesthesia, pediatric anesthesia, cardiac anesthesia, regional analgesia and pain management...
August 10, 2018: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/30043501/best-life-bringing-ecmo-simulation-to-life-how-medical-simulation-improved-a-regional-ecmo-program
#10
Mateusz Puślecki, Marcin Ligowski, Marek Dąbrowski, Sebastian Stefaniak, Małgorzata Ładzińska, Piotr Ładziński, Aleksander Pawlak, Marcin Zieliński, Agata Dąbrowska, Aniela Artyńska, Mariusz Gezela, Paweł Sobczyński, Łukasz Szarpak, Bartłomiej Perek, Marek Jemielity
The implemented "ECMO for Greater Poland" program takes full advantage of the ECMO (extracorporeal membrane oxygenation) perfusion therapy to promote health for 3.5 million inhabitants in the region. The predominant subjects of implementation are patients with hypothermia, with severe reversible respiratory failure (RRF), and treatment of other critical states leading to heart failure such as sudden cardiac arrest, cardiogenic shock or acute intoxication. Finally, it promotes donation after circulatory death (DCD) strategy in selected organ donor cases...
July 25, 2018: Artificial Organs
https://www.readbyqxmd.com/read/30007770/-morbidity-and-mortality-conferences-in-lower-saxony-implementation-status-and-further-development-needs
#11
David L B Schwappach, Lynn Häsler, Lena Strodtmann, Anouk Siggelkow
BACKGROUND: Morbidity and mortality conferences (M&MC) are a tool to foster individual and organizational learning in hospitals, and they are important to improve patient safety. So far, no data has been available about the implementation of M&MC in Lower Saxony and the characteristics of M&MCs. The aim of this study was to assess the status quo of M&MC in Lower Saxony and to identify the potential for improvement. METHODS: A cross-sectional survey study was conducted among chief physicians in surgery, internal medicine, anesthesiology/intensive care, gynecology/obstetrics and pediatrics (response rate: 50 %)...
September 2018: Zeitschrift Für Evidenz, Fortbildung und Qualität Im Gesundheitswesen
https://www.readbyqxmd.com/read/29975374/hospitalizations-due-to-alcohol-intoxication-among-children-and-adolescents-data-from-one-clinical-hospital-in-poland
#12
Halla Kamińska, Aneta Gawlik, Tomasz Gawlik, Ewa Małecka-Tendera
OBJECTIVES: To determine the frequency of hospitalizations due to alcohol intoxication (AI) at the Pediatric Health Center, and to attempt to identify factors contributing to the occurrence of intoxication in the population of children and adolescents. METHODS: Medical documentation of 227 patients hospitalized due to AI. 108 (48%) patients were girls and 119 (52%) patients were boys. The mean age of the study group was 14.9 years ±2.1. Data regarding patients, their families and the circumstances of intoxication underwent analysis...
April 30, 2018: Psychiatria Polska
https://www.readbyqxmd.com/read/29963611/medical-education-for-generation-z-everything-online-an-analysis-of-internet-based-media-use-by-teachers-in-medicine
#13
Markus Vogelsang, Katrin Rockenbauch, Hermann Wrigge, Wolfgang Heinke, Gunther Hempel
Aim: The aims of this study were to gain an overview of the web-based media used during the clinical phase of medical study at German medical schools and to identify the resources needed for web-based media use. Also examined were the influences on web-based media use, for instance, the assessment of their suitability for use in teaching. Method: An online survey of 264 teacher coordinators in internal medicine, surgery, anesthesiology, gynecology, pediatrics and psychiatry was conducted in March and April, 2016...
2018: GMS Journal for Medical Education
https://www.readbyqxmd.com/read/29962622/the-comparison-of-the-efficacy-and-safety-of-midazolam-ketamine-and-midazolam-combined-with-ketamine-administered-nasally-for-premedication-in-children
#14
Mehmet Erdem Akçay, Ebru Tarıkçı Kılıç, Mehmet Salim Akdemir
Background: In this prospective, randomized study, we evaluated the intranasal administration of Midazolam ketamine combination, midazolam, and ketamine in premedication for children. Material and Methods: We studied 60 American Society of Anesthesiology physical status Classes I and II children aged between 1 and 10 years undergoing ear nose throat operations. All cases were premedicated 15 min before operation with intranasal administration of 0.2 mg/kg midazolam in Group M, 5 mg/kg Ketamine in Group K, and 0...
April 2018: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29944482/critical-friends-health-professionals-experiences-of-collegial-feedback-in-a-clinical-setting
#15
Elisabeth Carlson, Frida Nygren, Anne Wennick
INTRODUCTION: A critical friend is a trusted person who asks provocative questions, provides data to be examined through another lens, and offers critique of a person's work as part of collegial feedback. However, empirical evidence presenting the use of collegial feedback to develop health professionals' competence in clinical settings seems to be scarce. The aim of this study was to explore health professionals' experiences of observing each other as critical friends in a clinical setting, as part of a continuous professional development initiative...
July 2018: Journal of Continuing Education in the Health Professions
https://www.readbyqxmd.com/read/29923936/multiple-micronutrient-plasma-level-changes-are-related-to-oxidative-stress-intensity-in-critically-ill-children
#16
Frédéric V Valla, Muriel Bost, Sylvain Roche, Marion Pitance, Charlotte Cuerq, Jenna Ridout, René Ecochard, Tiphanie Ginhoux, Amandine Bellon, Carole Ford-Chessel, Aurélie Portefaix, Etienne Javouhey, Emilie Blond
OBJECTIVES: Micronutrient supplementation in critically ill adults remains controversial. In the pediatric setting, the impact of oxidative stress on the overall micronutrient status has been poorly explored, due to the limited number of studies and to confounding factors (i.e., malnutrition or extra losses). In order to better understand this phenomenon, we aim to describe micronutrient status, focusing on seven micronutrients, in well-nourished critically ill children presenting with severe oxidative stress...
September 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29905842/opioid-prescribing-and-polypharmacy-in-children-with-chronic-musculoskeletal-pain
#17
Sabrina Gmuca, Rui Xiao, Pamela F Weiss, David D Sherry, Andrea M Knight, Jeffrey S Gerber
Objective: Thirty percent of adults with fibromyalgia receive an opioid, but the prevalence of opioid prescribing in pediatric chronic musculoskeletal pain is unknown. The aims of this study were to determine the prevalence of and factors associated with opioid exposure and polypharmacy among children with chronic musculoskeletal pain. Methods: In this retrospective cohort study using health care claims data from 2000 to 2013, the index date was the first ICD-9 code 729...
June 13, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/29886608/-prenatal-interventional-therapy-in-two-cases-with-critical-pulmonary-stenosis-or-pulmonary-atresia-with-intact-ventricular-septum
#18
C C Pang, W Pan, Z W Zhang, C B Zhou, Y F Li, X Zhang, F Z Han, Y X Sun, S Wang, J Zhuang
Objectives: Two cases who underwent fetal pulmonary valvuloplasty (FPV) for pulmonary atresia with intact ventricular septum (PA-IVS) or critical pulmonary stenosis with intact ventricular septum (CPS-IVS) successfully were reported. The aim of the report was to explore the criteria for case selection, the technical essentials of FPV, and the postpartum outcome of the fetus. Methods: One case with PA-IVS and the other with CPS-IVS were enrolled in September 2016 and February 2017 in Guangdong General Hospital, and both cases were diagnosed with severe right ventricular dysplasia and tricuspid regurgitation by fetal echocardiogram...
June 2, 2018: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
https://www.readbyqxmd.com/read/29789877/-meta-analyses-on-measurement-precision-of-non-invasive-hemodynamic-monitoring-technologies-in-adults
#19
G Pestel, K Fukui, M Higashi, I Schmidtmann, C Werner
An ideal non-invasive monitoring system should provide accurate and reproducible measurements of clinically relevant variables that enables clinicians to guide therapy accordingly. The monitor should be rapid, easy to use, readily available at the bedside, operator-independent, cost-effective and should have a minimal risk and side effect profile for patients. An example is the introduction of pulse oximetry, which has become established for non-invasive monitoring of oxygenation worldwide. A corresponding non-invasive monitoring of hemodynamics and perfusion could optimize the anesthesiological treatment to the needs in individual cases...
June 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/29760370/using-eye-tracking-technology-to-compare-the-effectiveness-of-malignant-hyperthermia-cognitive-aid-design
#20
Roderick King, Jaber Hanhan, T Kyle Harrison, Alex Kou, Steven K Howard, Lindsay K Borg, Cynthia Shum, Ankeet D Udani, Edward R Mariano
BACKGROUND: Malignant hyperthermia is a rare but potentially fatal complication of anesthesia, and several different cognitive aids designed to facilitate a timely and accurate response to this crisis currently exist. Eye tracking technology can measure voluntary and involuntary eye movements, gaze fixation within an area of interest, and speed of visual response and has been used to a limited extent in anesthesiology. METHODS: With eye tracking technology, we compared the accessibility of five malignant hyperthermia cognitive aids by collecting gaze data from twelve volunteer participants...
August 2018: Korean Journal of Anesthesiology
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