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Critical Care*

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
Joon-Myoung Kwon, Youngnam Lee, Yeha Lee, Seungwoo Lee, Hyunho Park, Jinsik Park
AIM: Triage is important in identifying high-risk patients amongst many less urgent patients as emergency department (ED) overcrowding has become a national crisis recently. This study aims to validate that a Deep-learning-based Triage and Acuity Score (DTAS) identifies high-risk patients more accurately than existing triage and acuity scores using a large national dataset. METHODS: We conducted a retrospective observational cohort study using data from the Korean National Emergency Department Information System (NEDIS), which collected data on visits in real time from 151 EDs...
2018: PloS One
Francisco Valdez Dos Santos, Gerson Cipriano, Luciana Vieira, Adriana M Güntzel Chiappa, Graziella B F Cipriano, Paulo Vieira, Julio G Zago, Mariah Castilhos, Marianne L da Silva, Gaspar R Chiappa
BACKGROUND: Early mobilization can be employed to minimize the duration of intensive care. However, a protocol combining neuromuscular electrical stimulation (NMES) with early mobilization has not yet been tested in ICU patients. Our aim was to assess the efficacy of NMES, exercise (EX), and combined therapy (NMES + EX) on duration of mechanical ventilation (MV) in critically ill patients. METHODS: The participants in this randomized double-blind trial were prospectively recruited within 24 hours following admission to the intensive care unit of a tertiary hospital...
October 15, 2018: Physiotherapy Theory and Practice
J Kevin Dorsey, Austin M Beason, Steven J Verhulst
PROBLEM: The traditional clerkship model of brief encounters between faculty and students results in reduced meaningful learning opportunities due to the lack of a relationship that enables repeated observation, supervisor feedback, trust formation, and growth. INTERVENTION: Clinical clerkships at our institution were restructured to decrease fragmentation of supervision and foster an educational alliance between faculty and student. A mixed-methods approach was used to study the impact of this curriculum reform on the student experience in the obstetrics and gynecology clerkship...
October 15, 2018: Teaching and Learning in Medicine
Hussain S Lalani, Wangari Waweru-Siika, Peter S Kussin
No abstract text is available yet for this article.
October 15, 2018: Annals of the American Thoracic Society
Sunkaru Touray, Baboucarr Sanyang
No abstract text is available yet for this article.
October 15, 2018: Annals of the American Thoracic Society
Berit Lindahl, Sue Kirk
AIM: To analyse and synthesise the research that has investigated the experience of home in relation to home mechanical ventilation (HMV). METHOD: Systematic integrative review. Four electronic databases (CINAHL, PubMed, Scopus and ISI Web of Knowledge) were searched between January 2010 and April 2017 as well as reference lists of included studies. Quantitative and qualitative studies meeting the inclusion criteria were critically appraised. Study findings were inductively analysed and synthesised using the integrative approach...
October 15, 2018: Scandinavian Journal of Caring Sciences
Erin M Nystrom, Andrea M Nei
Continuous renal replacement therapy (CRRT) is the modality of choice in critically ill patients with hemodynamic instability requiring renal replacement therapy. The goal of this review is to discuss an overview of CRRT types, components, and important considerations for nutrition support provision. Evidence basis for guidelines and our recommendations are reviewed. Nutrition support-related implications include the possibility of calorie gain with citrate-based anticoagulation, calorie loss with glucose-free replacement fluids and dialysate, and significant amino acid losses in effluent...
October 15, 2018: Nutrition in Clinical Practice
Danielle E Bear, Elizabeth Smith, Nicholas A Barrett
The use of extracorporeal membrane oxygenation (ECMO) for both severe respiratory and cardiac failure is increasing. Because these patients are some of the sickest in the intensive care unit, a multidisciplinary approach to their treatment, including appropriate nutrition therapy, is warranted. Currently, limited data exist on the optimal timing, type, and amount of nutrition to be provided. This review focuses on describing the current nutrition practices in patients receiving ECMO, details research that is currently being undertaken, and lists important research questions that require exploration in this field...
October 15, 2018: Nutrition in Clinical Practice
Maria G Grammatikopoulou, Xenophon Theodoridis, Konstantinos Gkiouras, Eleni-Maria Stamouli, Myrsini-Eleni Mavrantoni, Theodore Dardavessis, Dimitrios P Bogdanos
BACKGROUND: Severe burns are associated with a plethora of profound metabolic, immunologic, and physiologic responses, demanding prompt and adequate management. The objective of the present study was to review, compare, and critically appraise medical nutrition therapy guidelines for adult patients with severe burns, and produce salient points for the future update of relevant guidelines. METHODS: A total of 8 clinical practice guidelines developed by the American Burn Association (ABA), the European Burn Association (EBA), the European Society for Parenteral and Enteral Nutrition (ESPEN), the Midlands National Health Service, the Society for Critical Care Medicine (SCCM)/American Society for Parenteral and Enteral Nutrition (ASPEN), the Spanish Society of Intensive Care Medicine and Coronary Units and Spanish Society of Parenteral and Enteral Nutrition, the Indian Association for Parenteral and Enteral Nutrition (IAPEN), and the International Society for Burn Injury regarding medical nutrition therapy in burn patients was independently reviewed by a team of 4 multidisciplinary researchers using the Appraisal of Guidelines for Research & Evaluation (AGREE II) instrument...
October 15, 2018: JPEN. Journal of Parenteral and Enteral Nutrition
M Ghoddusi Johari, M H Dabaghmanesh, H Zare, A R Safaeian, Gh Abdollahifard
Background: Diabetes is a serious chronic disease, and its increasing prevalence is a global concern. If diabetes mellitus is left untreated, poor control of blood glucose may cause long-term complications. A big challenge encountered by clinicians is the clinical management of diabetes. Many IT-based interventions such ad CDSS have been made to improve the adherence to the standard care for chronic diseases. Objective: The aim of this study is to establish a decision support system of diabetes management based on diabetes care guidelines in order to reduce medical errors and increase adherence to guidelines...
September 2018: Journal of Biomedical Physics & Engineering
Hongsheng Ren, Bo Song, Pengcheng Li, Cheng Huan, Yufeng Chu, Min Ding, Yuping Wang, Qingchun Yao, Peng Wang, Guoqiang Qi, Chunting Wang
Background: We explored the effects of high-volume hemofiltration(HVHF) by different ultrasound directing on the plasma N-terminal pro-B-type natriuretic peptide(NT-Pro-BNP), extra vascular lung water index (EVLWI), liquid net balance quantity and prognosis in patients with septic shock. Methods: Overall, 107 intensive patients with septic shock were enrolled by retrospective analysis from Department of Intensive Care Unit (ICU) of the Shandong Provincial Hospital affiliated to Shandong University from 2014-2017...
September 2018: Iranian Journal of Public Health
Stephen G Bowden, Seunggu Jude Han
Neurosurgeons have played an essential role in glioma management and research for over a century. While the past twenty years have played witness to many exciting developments in glioma biology, diagnosis, and classification, relatively few novel, effective treatment strategies have been introduced. The role of neurosurgery in glioma management has been clarified, with a large body of evidence in support of maximal safe resection. However, neurosurgeons have also played a critical role in translational research during this period...
2018: Frontiers in Oncology
Sibtain Ahmed, Imran Siddiqui, Lena Jafri, Madiha Hashmi, Aysha Habib Khan, Farooq Ghani
Background: Sepsis is the leading cause of mortality in critically ill patients. Procalcitonin (PCT) is a promising marker for identification of bacterial sepsis. The aim of this study was to determine the diagnostic accuracy of serum PCT concentration in patients with suspected sepsis admitted to mixed medical-surgical Intensive care unit (ICU). Material and methods: A cross-sectional study conducted at section of Chemical Pathology, Department of Pathology and Laboratory Medicine and ICU...
November 2018: Annals of Medicine and Surgery
Mojtaba Shafiekhani, Mahtabalsadat Mirjalili, Afsaneh Vazin
Managing psychological problems in patients admitted to intensive care unit (ICU) is a big challenge, requiring pharmacological interventions. On the other hand, these patients are more prone to side effects and drug interactions associated with psychotropic drugs use. Benzodiazepines (BZDs), antidepressants, and antipsychotics are commonly used in critically ill patients. Therefore, their therapeutic effects and adverse events are discussed in this study. Different studies have shown that non-BZD drugs are preferred to BZDs for agitation and pain management, but antipsychotic agents are not recommended...
2018: Therapeutics and Clinical Risk Management
Hannes Mayerl, Tanja Trummer, Erwin Stolz, Éva Rásky, Wolfgang Freidl
BACKGROUND: Given that nursing staff play a critical role in the decision regarding use of physical restraints, research has examined nursing professionals' attitudes toward this practice. AIM: Since nursing professionals' views on physical restraint use have not yet been examined in Austria to date, we aimed to explore nursing professionals' attitudes concerning use of physical restraints in nursing homes of Styria (Austria). METHOD: Data were collected from a convenience sample of nursing professionals (N = 355) within 19 Styrian nursing homes, based on a cross-sectional study design...
October 15, 2018: Pflege
Anastasia Yenban Bongajum, Divine Mbiydzenyuy Dufe, Paul Théodore Biyaga Tjek, Daniel Ter Goon, Céline Nguefeu Nkenfou, Julius Mbekem Nwobegahay, Robinson Mbu
BACKGROUND: Evidence from previous research has shown that antiretroviral (ARV) drug initiation to seropositive pregnant women could significantly contribute to eliminating new paediatric infections even when started during labour and delivery. This study therefore seeks to assess missed opportunities for ARV initiation during this critical period of pregnancy to improve outcomes of the prevention of mother-to-child transmission (PMTCT) programmes in Cameroon. METHODS: A retrospective study was conducted on the 2014 PMTCT data for labour and delivery among pregnant women of unknown HIV status within health facilities in six regions of Cameroon (428 eligible facilities)...
October 14, 2018: African Journal of AIDS Research: AJAR
Jing Wang, Harshal P Mahajan, Pamela E Toto, Michael P McCue, Dan Ding
PURPOSE: Individuals with traumatic brain injury (TBI) often experience difficulties in performing kitchen-related sequencing tasks due to cognitive deficits. The primary aim of this study is to examine the feasibility of a context-aware automatic prompting system in assisting individuals with TBI in multi-step cooking tasks. METHOD: Sixteen individuals with TBI participated in the study. A randomized cross-over design was used to compare the automatic prompting method with a conventional user-controlled method through a tablet device...
October 14, 2018: Disability and Rehabilitation. Assistive Technology
L Marcellus
AIM: To describe the current state of evidence on the care of neonates with neonatal abstinence syndrome in countries with low to virtually no medical opioid analgesic consumption. BACKGROUND: While access to opioids for medical use improves globally, misuse grows as a health concern. One unintended consequence has been an increase in the incidence of neonatal abstinence syndrome. Because most evidence is generated in countries with adequate opioid analgesic consumption, a picture of evidence in lower opioid-consuming countries is not available...
October 14, 2018: International Nursing Review
Xian Chen, Jian Song, Zhe-Ning Chen, Tan Jin, Fengqin Long, Hua Xie, Yisong Zheng, Wei Zhuang, Lu Zhang
Engineering fluorescent proteins to be the customized in vivo labels for monitoring cellular dynamic events is critical in biochemical and biomedical studies. The design and development of novel red fluorescent proteins is one of the most important fronts in this field due to their potential of imaging the entire organism. A recent fluorescent protein mutant eqFP650-67-HqAla with the 8-hydroxyquinolin-imidazolinone (HQI) chromophore has the plausible bathochromic shift of ~30 nm in its emission spectrum wavelength comparing to the parent fluorescent protein eqFP650...
October 14, 2018: Journal of Computational Chemistry
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