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https://www.readbyqxmd.com/read/28229241/acquired-prolongation-of-qt-interval-as-a-risk-factor-for-torsade-de-pointes-ventricular-tachycardia-a-narrative-review-for-the-anesthesiologist-and-intensivist
#1
REVIEW
Arsen Uvelin, Jasmina Pejaković, Vesna Mijatović
More than 70% of intensive care unit (ICU) patients experience heart rhythm disturbances, and these patients have correspondingly higher mortality rates. Consequently, one of the standards of care in ICUs is continuous electrocardiography monitoring. One of the potentially preventable dysrhythmic events is the occurrence of torsade de pointes ventricular tachycardia in the setting of acquired prolonged QT interval. This type of ventricular tachycardia can be malignant because it often progresses to ventricular fibrillation...
February 22, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28227144/optimal-medication-dosing-from-suboptimal-clinical-examples-a-deep-reinforcement-learning-approach
#2
Shamim Nemati, Mohammad M Ghassemi, Gari D Clifford, Shamim Nemati, Mohammad M Ghassemi, Gari D Clifford, Gari D Clifford, Mohammad M Ghassemi
Misdosing medications with sensitive therapeutic windows, such as heparin, can place patients at unnecessary risk, increase length of hospital stay, and lead to wasted hospital resources. In this work, we present a clinician-in-the-loop sequential decision making framework, which provides an individualized dosing policy adapted to each patient's evolving clinical phenotype. We employed retrospective data from the publicly available MIMIC II intensive care unit database, and developed a deep reinforcement learning algorithm that learns an optimal heparin dosing policy from sample dosing trails and their associated outcomes in large electronic medical records...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28221284/pain-interference-and-physical-function-demonstrate-poor-longitudinal-association-in-people-living-with-pain-a-promis-investigation
#3
Nicholas V Karayannis, John A Sturgeon, Ming Chih-Kao, Corinne Cooley, Sean C Mackey
A primary goal in managing pain is to reduce pain and increase physical function (PF). This goal is also tied to continuing payment for treatment services in many practice guidelines. Pain interference (PI) is often used as a proxy for measurement and reporting of PF in these guidelines. A common assumption is that reductions in PI will translate into improvement in PF over time. This assumption needs to be tested in a clinical environment. Consequently, we used the patient reported outcomes measurement information system (PROMIS) to describe the topology of the longitudinal relationship between PI in relation to PF...
February 16, 2017: Pain
https://www.readbyqxmd.com/read/28218628/childhood-obesity-screening-and-treatment-practices-of-pediatric-healthcare-providers
#4
Amanda Staiano, Arwen Marker, Michelle Liu, Ellery Hayden, Daniel Hsia, Stephanie Broyles
This study evaluated physicians' childhood obesity screening and treatment practices. A 26-question survey was delivered to pediatric providers in-person or via mail, e-mail, or fax throughout Louisiana. Fifty-seven providers completed the survey, the majority in primary care clinics. Five providers met at least four of seven clinical guidelines, but no provider met all of the guidelines. Whereas 88% of providers screened for obesity, 7% met guidelines for referring patients with obesity to weight management services...
January 2017: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
https://www.readbyqxmd.com/read/28216701/impact-of-modified-quality-control-checklist-on-protocol-adherence-and-outcomes-in-a-post-surgical-intensive-care-unit
#5
Lakshmi Kumar, Meenu Dominic, Sunil Rajan, Sanjeev Singh
BACKGROUND AND AIMS: Quality improvement (QI) is the sum of all activities that create desired changes in the quality. An effective QI system results in a stepwise increase in quality of care. The efficiency of any health-care unit is judged by its quality indicators. We aimed to evaluate the impact of QI initiatives on outcomes in a surgical Intensive Care Unit (ICU). METHODS: This was an observational study carried out using a compliance checklist, developed from the combination of the World Health Organization surgery checklist and Society for Healthcare Epidemiology of America guidelines for the prevention of infections...
January 2017: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/28216060/incidence-of-fever-in-labor-and-risk-of-neonatal-sepsis
#6
Craig V Towers, Angela Yates, Nikki Zite, Casey Smith, Lindsey Chernicky, Bobby Howard
BACKGROUND: The current recommendation regarding the management of a term newborn delivered of a mother with an intrapartum fever or a diagnosis of clinical chorioamnionitis is that the neonate should have baseline laboratory work drawn along with blood cultures and be universally treated with antibiotics until culture results return. These guidelines report that the rate of intrapartum fever is about 3%; however, a few large studies suggest that the rate is higher at about 7%. OBJECTIVE: To prospectively evaluate the rate of fever during labor in a large number of deliveries and determine the rate of early onset neonatal sepsis in newborns delivered from mothers with an intrapartum fever compared with the newborns that delivered from mothers that did not have an intrapartum fever...
February 16, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28215131/angiotensin-ii-for-the-treatment-of-high-output-shock-3-athos-3-protocol-for-a-phase-iii-double-blind-randomised-controlled-trial
#7
Lakhmir S Chawla, James A Russell, Sean M Bagshaw, Andrew D Shaw, Stuart L Goldstein, Mitchell P Fink, George F Tidmarsh
OBJECTIVE: Catecholamine-resistant hypotension (CRH) is characterised by inadequate response to standard doses of vasopressors, and increased mortality. Our Angiotensin II for the Treatment of High-Output Shock 3 (ATHOS-3) trial compares the efficacy and safety of angiotensin II (ANGII) versus placebo in CRH. DESIGN, SETTING AND PARTICIPANTS: A phase III, multicentre, randomised, placebo-controlled trial of LJPC-501 (synthetic ANGII) for CRH in up to 120 intensive care units...
March 2017: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/28213888/transfusion-in-critical-care-a-uk-regional-audit-of-current-practice
#8
J O M Plumb, M G Taylor, E Clissold, M P W Grocott, R Gill
A consistent message within critical care publications has been that a restrictive transfusion strategy is non-inferior, and possibly superior, to a liberal strategy for stable, non-bleeding critically ill patients. Translation into clinical practice has, however, been slow. Here, we describe the degree of adherence to UK best practice guidelines in a regional network of nine intensive care units within Wessex. All transfusions given during a 2-month period were included (n = 444). Those given for active bleeding or within 24 h of major surgery, trauma or gastrointestinal bleeding were excluded (n = 148)...
February 18, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28213597/retrospective-examination-of-lipid-lowering-treatment-patterns-in-a-real-world-high-risk-cohort-in-the-uk-in-2014-comparison-with-the-national-institute-for-health-and-care-excellence-nice-2014-lipid-modification-guidelines
#9
Dylan L Steen, Irfan Khan, David Ansell, Robert J Sanchez, Kausik K Ray
BACKGROUND: In 2014, guidelines from the National Institute for Health and Care Excellence (NICE) provided updated recommendations on lipid-modifying therapy (LMT). We assessed clinical practice contemporaneous to release of these guidelines in a UK general practice setting for secondary and high-risk primary-prevention populations, and extrapolated the findings to UK nation level. METHODS: Patients from The Health Improvement Network database with the following criteria were included: lipid profile in 2014 (index date); ≥20 years of age; ≥2 years representation in database prior to index; ≥1 statin indication either for atherosclerotic cardiovascular disease (ASCVD) or the non-ASCVD conditions high-risk diabetes mellitus and/or chronic kidney disease...
February 17, 2017: BMJ Open
https://www.readbyqxmd.com/read/28209517/inadvertent-hypothermia-and-mortality-in-critically-ill-adults-systematic-review-and-meta-analysis
#10
REVIEW
Panagiotis Kiekkas, Fotini Fligou, Michael Igoumenidis, Nikolaos Stefanopoulos, Evangelos Konstantinou, Vasilios Karamouzos, Diamanto Aretha
OBJECTIVE: Considering that inadvertent hypothermia (IH) is common in Intensive Care Unit (ICU) patients and can be followed by severe complications, this systematic review identified, appraised and synthesized the published literature about the association between IH and mortality in adults admitted to the ICU. DATA SOURCES: By using key terms, literature searches were conducted in Pubmed, CINAHL, Cochrane Library, Web of Science and EMBASE. REVIEW METHODS: According to PRISMA guidelines, articles published between 1980-2016 in English-language, peer-reviewed journals were considered...
February 13, 2017: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/28206996/the-quest-for-sustained-multiple-morbidity-reduction-in-very-low-birth-weight-infants-the-antifragility-project
#11
J W Kaempf, N M Schmidt, S Rogers, C Novack, M Friant, L Wang, N Tipping
OBJECTIVE: Can a comprehensive, explicitly directive evidence-based guideline for all therapies that might affect the major morbidities of very low-birth-weight (VLBW) infants help a neonatal intensive care unit (NICU) further improve generally favorable morbidity rates? Can Antifragility principles of provider adaptive growth from stressors, enhanced infant risk assessment and adherence to effective therapies minimize unproven treatments and reduce all morbidities? STUDY DESIGN: Prospectively planned observational trial in VLBW infants: control group born October 2011 to September 2013 and study group October 2013 to September 2015...
February 16, 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/28199895/a-rapid-and-robust-uhplc-dad-method-for-the-quantification-of-amphotericin-b-in-human-plasma
#12
Sebastiano Barco, Alessia Zunino, Antonio D'Avolio, Laura Barbagallo, Angelo Maffia, Gino Tripodi, Elio Castagnola, Giuliana Cangemi
Amphotericin B is an antifungal drug widely used in Intensive Care Units. Therapeutic drug monitoring (TDM) of amphotericin B is recommended for the assessment of toxicity surveillance and treatment optimization. In this paper we described the development and validation of a new Ultra High Performance Liquid Chromatography coupled to Diode Array Detection (UHPLC-DAD) method for the quantification of Amphotericin B in 200μL human plasma over a wide range of concentrations (0.125-10mg/L). The new method has been validated following international guidelines on bioanalytical method validation and showed high selectivity, high accuracy and precision and high process efficiency...
February 8, 2017: Journal of Pharmaceutical and Biomedical Analysis
https://www.readbyqxmd.com/read/28199038/the-duration-of-intrapartum-maternal-hyperglycaemia-predicts-neonatal-hypoglycaemia-in-women-with-pre-existing-diabetes
#13
T Joshi, C Oldmeadow, J Attia, K Wynne
AIM: There is a high incidence of neonatal hypoglycaemia in neonates born to mothers with pre-existing diabetes. This often necessitates admission to the neonatal intensive care. Guidelines suggest maintaining intrapartum blood glucose levels (BGLs) of 4-7 mmol/l in women with diabetes to reduce the risk of neonatal hypoglycaemia. This study assessed whether intrapartum BGLs in women with pre-gestational Type 1 and 2 diabetes were predictive of neonatal hypoglycaemia. METHODS: A retrospective analysis of 261 births delivered at a tertiary hospital in Australia from 2009 to 2014...
February 15, 2017: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/28195835/neonatal-resuscitation-program-rolling-refresher-maintaining-chest-compression-proficiency-through-the-use-of-simulation-based-education
#14
Jose R Cepeda Brito, Patrick G Hughes, Kimberly S Firestone, Fabiana Ortiz Figueroa, Karan Johnson, Terra Ruthenburg, Robyn McKinney, M David Gothard, Rami Ahmed
BACKGROUND: Structured training courses have shown to improve patient outcomes; however, guidelines are inconsistently applied in up to 50% of all neonatal resuscitations. This is partly due to the fact that psychomotor skills needed for resuscitation decay within 6 months to a year from the completion of a certification course. Currently, there are no recommendations on how often refresher training should occur to prevent skill decay. PURPOSE: Improve provider proficiency and confidence in the performance of neonatal resuscitation with a focus on chest compression effectiveness...
February 10, 2017: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
https://www.readbyqxmd.com/read/28194862/patterns-of-care-and-survival-of-adjuvant-radiation-for-major-salivary-adenoid-cystic-carcinoma
#15
Anna Lee, Babak Givi, Virginia W Osborn, David Schwartz, David Schreiber
OBJECTIVES/HYPOTHESIS: National Cancer Care Network guidelines suggest consideration of adjuvant radiation even for early stage adenoid cystic carcinoma of the salivary glands. We used the National Cancer Data Base (NCDB) to analyze practice patterns and outcomes of postoperative radiotherapy for adenoid cystic carcinomas. STUDY DESIGN: Retrospective NCDB review. METHODS: Patients with nonmetastatic adenoid cystic carcinoma of the parotid, submandibular, or another major salivary gland from 2004 to 2012 were identified...
February 14, 2017: Laryngoscope
https://www.readbyqxmd.com/read/28193194/the-objective-physical-activity-and-cardiovascular-disease-health-in-older-women-opach-study
#16
Andrea Z LaCroix, Eileen Rillamas-Sun, David Buchner, Kelly R Evenson, Chongzhi Di, I-Min Lee, Steve Marshall, Michael J LaMonte, Julie Hunt, Lesley Fels Tinker, Marcia Stefanick, Cora E Lewis, John Bellettiere, Amy H Herring
BACKGROUND: Limited evidence exists to inform physical activity (PA) and sedentary behavior guidelines for older people, especially women. Rigorous evidence on the amounts, intensities, and movement patterns associated with better health in later life is needed. METHODS/DESIGN: The Objective PA and Cardiovascular Health (OPACH) Study is an ancillary study to the Women's Health Initiative (WHI) Program that examines associations of accelerometer-assessed PA and sedentary behavior with cardiovascular and fall events...
February 14, 2017: BMC Public Health
https://www.readbyqxmd.com/read/28193080/inappropriate-packed-rbc-transfusion-in-a-tertiary-care-center
#17
Anahita Sadeghi, Safieh Belali, Ali Ali Asgari, Zahra Morovat, Reza Malekzadeh, Ashkan Emadi
INTRODUCTION: Transfusion of packed red blood cells (pRBC) with appropriate indications is not only important for patient safety and well-being but is also crucial for proper utilization of resources and health care-related cost reduction. We aimed to investigate the clinical appropriateness of blood transfusion in Shariati Hospital, one of the largest academic medical centers in Tehran. METHODS: In this prospective observational study, 1000 transfusions of allogenic pRBCs from April 1st to October 31st, 2015 were included...
February 2017: Archives of Iranian Medicine
https://www.readbyqxmd.com/read/28191605/integrating-palliative-care-into-routine-care-of-patients-with-heart-failure-models-for-clinical-collaboration
#18
REVIEW
Warren H Lewin, Kristen G Schaefer
Heart failure (HF) affects nearly 5.7 million Americans and is described as a chronic incurable illness carrying a poor prognosis. Patients living with HF experience significant symptoms including dyspnea, pain, anxiety, fatigue, and depression. As the illness advances into later stages, symptoms become more intense and refractory to standard treatments, leading to recurrent acute-care utilization and contributing to poor quality of life. Advanced HF symptoms have been described to be as burdensome, if not more than, those in cancer populations...
February 13, 2017: Heart Failure Reviews
https://www.readbyqxmd.com/read/28190583/fibrinogen-is-an-independent-predictor-of-mortality-in-major-trauma-patients-a-five-year-statewide-cohort-study
#19
Zoe K McQuilten, Erica M Wood, Michael Bailey, Peter A Cameron, David J Cooper
INTRODUCTION: Fibrinogen may be reduced following traumatic injury due to loss from haemorrhage, increased consumption and reduced synthesis. In the absence of clinical trials, guidelines for fibrinogen replacement are based on expert opinion and vary internationally. We aimed to determine prevalence and predictors of low fibrinogen on admission in major trauma patients and investigate association of fibrinogen levels with patient outcomes. PATIENTS AND METHODS: Data on all major trauma patients (January 2007-July 2011) identified through a prospective statewide trauma registry in Victoria, Australia were linked with laboratory and transfusion data...
November 21, 2016: Injury
https://www.readbyqxmd.com/read/28188975/contemporary-analysis-of-maternal-and-neonatal-morbidity-after-uterine-rupture-a-nationwide-population-based-study
#20
Gustavo Vilchez, Jing Dai, Komal Kumar, Moraima Lagos, Robert J Sokol
AIM: Uterine rupture is a rare but feared perinatal event. Despite abundant research and changes to guidelines implemented to reduce this complication, evaluation of whether uterine rupture still engenders significant maternal/neonatal morbidity has not been conducted. We analyzed recent cases of maternal/neonatal morbidity after uterine rupture. METHODS: Deliveries complicated by uterine rupture from 2011 to 2012 in the United States were selected. Comparison cases without uterine rupture were used as controls...
February 11, 2017: Journal of Obstetrics and Gynaecology Research
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