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https://www.readbyqxmd.com/read/28097621/practice-patterns-of-venous-thromboembolism-prophylaxis-in-underweight-critically-ill-patients-with-neurologic-injury
#1
Kevin Betthauser, Hannah Pope, Mollie Gowan, Theresa Human
PURPOSE: Venous thromboembolism (VTE) prophylaxis in underweight patients with neurologic injury remains unaddressed by guidelines and primary literature. This study aimed to describe VTE prophylaxis strategies employed in this population and compare the impact of underweight and non-obese patients on thrombotic and bleeding events. METHODS: A retrospective review of adults admitted with a diagnosis of neurologic injury to a neurology/neurosurgery intensive care unit (ICU) over 6 years...
January 17, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28093644/guidelines-for-proton-pump-inhibitor-prescriptions-in-paediatric-intensive-care-unit
#2
P Joret-Descout, S Dauger, M Bellaiche, O Bourdon, S Prot-Labarthe
Background Stress ulcer prophylaxis (SUP) is recommended in some situations to prevent upper gastrointestinal bleeding and is a component of standard care for patients admitted to the intensive care unit (ICU). Proton pump inhibitors (PPIs), already among the most widely prescribed drug classes, are being increasingly used. Objective To describe PPI prescribing patterns and their changes after the dissemination of guidelines. Setting Paediatric ICU (PICU), Robert-Debré Teaching Hospital, Paris, France, which admits about 800 patients annually, from full-term neonates to 18-year-olds...
January 17, 2017: International Journal of Clinical Pharmacy
https://www.readbyqxmd.com/read/28092317/ideal-site-for-skin-temperature-probe-placement-on-infants-in-the-nicu-a-review-of-literature
#3
Rachel A Joseph, Sarah Derstine, Michaela Killian
BACKGROUND: Maintaining normothermia and prevention of hypothermia are critical determinants of morbidity and mortality in infants. Noninvasive monitoring of skin temperature using skin temperature probes (STPs) has been a practice in neonatal intensive care units (NICUs) for decades. Incubators and radiant warmers use feedback mechanisms from the STP readings to determine the heat output to maintain normothermia. Placing the STP on an ideal site on the infant's body is essential for optimum servo control of the temperature...
January 12, 2017: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
https://www.readbyqxmd.com/read/28092204/impact-of-combination-therapy-and-early-de-escalation-on-outcome-of-ventilator-associated-pneumonia-caused-by-pseudomonas-aeruginosa
#4
Laurène Deconinck, Agnès Meybeck, Pierre Patoz, Nicolas Van Grunderbeeck, Nicolas Boussekey, Arnaud Chiche, Pierre-Yves Delannoy, Hugues Georges, Olivier Leroy
BACKGROUND: Pseudomonas aeruginosa is a common cause of ventilator-associated pneumonia (VAP). Guidelines recommend dual coverage of P. aeruginosa, but the beneficial effect of combination therapy is controversial. We described antibiotic prescriptions and evaluated the clinical impact of initial combination antibiotic therapy and de-escalation strategy in patients with VAP caused by P. aeruginosa. METHODS: Between 1994 and 2014, all 100 patients with VAP caused by P...
January 16, 2017: Infectious Diseases
https://www.readbyqxmd.com/read/28089059/management-of-hospitalized-asthmatic-children-before-transport
#5
Brande Mazzeo, Rami Bzeih, Robert Schultz, Melissa Tavolieri, Alicia Fraser, Sabrina M Heidemann
Asthmatic children are at risk for respiratory failure and should be appropriately treated before transport. The objectives were to find out if the Pediatric Advanced Life Support guidelines for asthma treatment were followed in the emergency department (ED); to determine if additional treatment during transport or within the first 2 hours of admission was needed; and to compare the management of intubated asthmatics by the ED, transport team, and the intensive care unit (ICU) physician. The records for children diagnosed with acute asthma over 7 years who were transported by the intensive care transport team were reviewed...
January 2017: Air Medical Journal
https://www.readbyqxmd.com/read/28079867/reducing-peripherally-inserted-central-catheters-in-the-neonatal-intensive-care-unit
#6
A J Vachharajani, N A Vachharajani, H Morris, A Niesen, A Elward, D A Linck, A M Mathur
OBJECTIVE: Our objective was to safely reduce the number of peripherally inserted central catheters (PICCs) inserted in infants with umbilical venous catheter using quality improvement methods. STUDY DESIGN: In a tertiary neonatal intensive care unit, a questionnaire designed to prompt critical thinking around the decision to place a PICC, along with an updated standardized feeding guideline was introduced. PICC insertion in 86 infants with umbilical venous catheter (pre intervention) with birth weight 1000-1500 g were compared with 115 infants (post intervention) using Fisher's exact test...
January 12, 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/28079487/adopting-universal-testing-for-hiv-in-intensive-care-for-patients-admitted-with-severe-pneumonia-results-from-our-change-in-practice
#7
Rory Sharvill, Arnold Fernandes, Kate Allen, Jeremy Astin
Early identification of HIV infection is of obvious benefit to patients' health, yet many remain unaware of their diagnosis, with detrimental consequences. Current guidelines suggest patients with pneumonia are offered an HIV test. Early diagnosis of HIV infection in critically ill patients within intensive care is vital in reducing mortality and morbidity. In 2015, we established automated HIV testing for patients with pneumonia admitted to our intensive care unit. Prior to our change in practice, our HIV testing rate in patients with pneumonia was 29% within two weeks of admission...
January 2017: International Journal of STD & AIDS
https://www.readbyqxmd.com/read/28078833/clinical-profile-and-outcome-of-patients-with-severe-sepsis-treated-in-an-intensive-care-unit-in-india
#8
T T Paary, M S Kalaiselvan, M K Renuka, A S Arunkumar
Introduction: Sepsis is the leading cause of intensive care unit (ICU) admissions and is associated with high mortality. Objectives: To identify the incidence, risk factors and outcome of patients with severe sepsis and septic shock. Methods: A prospective observational study was done in a multidisciplinary ICU over a period of 18 months. We included all adult patients admitted to ICU with features of severe sepsis and septic shock as per SCCM/ACCP guidelines...
30, 2016: Ceylon Medical Journal
https://www.readbyqxmd.com/read/28078682/population-pharmacokinetics-of-intravenous-clonidine-for-sedation-during-pediatric-extracorporeal-membrane-oxygenation-ecmo-and-continuous-veno-venous-hemofiltration-cvvh
#9
Niina Kleiber, Ron A A Mathôt, Maurice J Ahsman, Enno D Wildschut, Dick Tibboel, Saskia N de Wildt
AIMS: Clonidine is used for sedation in the pediatric intensive care unit. Extracorporeal membrane oxygenation (ECMO) provides temporary support if respiratory and cardiac function is threatened. ECMO influences the pharmacokinetics of drugs. Clonidine during pediatric ECMO cannot be effectively titrated as PK data are lacking. The aim of this study is to describe clonidine PK in a particular ECMO system and propose dosing guidelines for children on this particular ECMO circuit. METHODS: All children below the age of 18 who received clonidine during ECMO were eligible...
January 12, 2017: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28074578/managing-conflicts-between-physicians-and-surrogates
#10
Carol Bayley
Two articles in this issue of the Hastings Center Report explore two sides of the same problematic coin. In "The Limits of Surrogates' Moral Authority and Physician Professionalism," Jeffrey Berger discusses the moral problem of a surrogate refusing a treatment, palliative sedation, on behalf of a patient whose suffering is refractory to intensive palliative efforts provided by a multidisciplinary team. In "After the DNR: Surrogates Who Persist in Requesting Cardiopulmonary Resuscitation," Ellen Robinson and her colleagues analyze data from a study of cases in which physicians wished not to perform cardiopulmonary resuscitation on patients whom they thought it would harm...
January 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28074412/a-scientific-rationale-to-improve-resistance-training-prescription-in-exercise-oncology
#11
Ciaran M Fairman, Michael C Zourdos, Eric R Helms, Brian C Focht
To date, the prevailing evidence in the field of exercise oncology supports the safety and efficacy of resistance training to attenuate many oncology treatment-related adverse effects, such as risk for cardiovascular disease, increased fatigue, and diminished physical functioning and quality of life. Moreover, findings in the extant literature supporting the benefits of exercise for survivors of and patients with cancer have resulted in the release of exercise guidelines from several international agencies...
January 10, 2017: Sports Medicine
https://www.readbyqxmd.com/read/28074295/-neuraxial-anaesthesia-and-noacs
#12
T Standl
BACKGROUND: Cardiovascular comorbidities in surgical patients are frequent and have a substantial impact on the postoperative outcome. Neuraxial blockades are able to reduce perioperative morbidity and mortality. The increasing use of new oral anticoagulants (NOAC) requires a high level of attention, especially in patients undergoing neuraxial blockades or requiring postoperative analgesia. OBJECTIVE: The goal of this article is to present the benefit of neuraxial anaesthesia and analgesia in patients with cardiovascular risks and perioperative management of NOAC in this setting...
January 10, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28068137/meeting-evolving-workforce-needs-preparing-psychologists-for-leadership-in-the-patient-centered-medical-home
#13
Abbie O Beacham, Kristi S Van Sickle, Parinda Khatri, Mana K Ali, Daniel Reimer, Eugene W Farber, Nadine J Kaslow
Behavioral health integration in the patient-centered medical home (PCMH) offers opportunities for psychologists to play leadership roles. Widespread practice transition to PCMH models of care are expected to substantially impact the psychology workforce. Conservative estimates suggest that approximately 90% of the 93,000 clinically trained psychologists would be required to meet projected need in these settings. This has implications for how health service psychologists are trained. In addition to relevant clinical competencies, they must be versed in system/program development, administration, evaluation, quality improvement, and interprofessional collaboration...
January 2017: American Psychologist
https://www.readbyqxmd.com/read/28063084/methodological-issues-surrounding-the-use-of-baseline-health-related-quality-of-life-data-to-inform-trial-based-economic-evaluations-of-interventions-within-emergency-and-critical-care-settings-a-systematic-literature-review
#14
REVIEW
Melina Dritsaki, Felix Achana, James Mason, Stavros Petrou
BACKGROUND: Trial-based cost-utility analyses require health-related quality of life data that generate utility values in order to express health outcomes in terms of quality-adjusted life years (QALYs). Assessments of baseline health-related quality of life are problematic where trial participants are incapacitated or critically ill at the time of randomisation. This review aims to identify and critique methods for handling non-availability of baseline health-related quality of life data in trial-based cost-utility analyses within emergency and critical illness settings...
January 6, 2017: PharmacoEconomics
https://www.readbyqxmd.com/read/28056820/prevalence-of-multidrug-resistant-organisms-in-refugee-patients-medical-tourists-and-domestic-patients-admitted-to-a-german-university-hospital
#15
Claudia Reinheimer, Volkhard A J Kempf, Katalin Jozsa, Thomas A Wichelhaus, Michael Hogardt, Fiona O'Rourke, Christian Brandt
BACKGROUND: Patients with contact to healthcare-system in high-prevalence countries (HPC) and refugee patients in hospital settings (REF) have previously been identified to be at risk of carrying multidrug-resistant organisms (MDRO). Comparative studies addressing the epidemiology of MDRO in patients transferred from hospitals abroad (ABROAD) and REF are lacking but are necessary to introduce refined infection control measures. METHODS: From December 2015 to June 2016, 117 REF, 84 ABROAD and 495 patients admitted to intensive care unit, with no refugee history or pre-treatment abroad (ICU), at University Hospital Frankfurt, Germany (UHF) were screened for MDRO on day of admittance...
January 5, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/28052800/clinical-diagnosis-and-management-of-anaphylaxis-in-infancy
#16
Emine Dibek Misirlioglu, Emine Vezir, Müge Toyran, Murat Capanoglu, Hakan Guvenir, Ersoy Civelek, Can Naci Kocabas
BACKGROUND: Anaphylaxis is increasingly reported in infancy. Diagnosis and management of anaphylaxis is difficult, and data are limited in infants. The aim of the present study was to determine the clinical course and management strategies used for anaphylaxis in infancy. METHODS: Patients attending to our clinic and who had anaphylaxis under 2 years old were evaluated. Sixty-three patients were enrolled for the study. The mean ± standard deviation age was 10.6 ± 6...
January 1, 2017: Allergy and Asthma Proceedings:
https://www.readbyqxmd.com/read/28051772/characterizing-teamwork-in-cardiovascular-care-outcomes-a-network-analytics-approach
#17
Matthew B Carson, Denise M Scholtens, Conor N Frailey, Stephanie J Gravenor, Emilie S Powell, Amy Y Wang, Gayle Shier Kricke, Faraz S Ahmad, R Kannan Mutharasan, Nicholas D Soulakis
BACKGROUND: The nature of teamwork in healthcare is complex and interdisciplinary, and provider collaboration based on shared patient encounters is crucial to its success. Characterizing the intensity of working relationships with risk-adjusted patient outcomes supplies insight into provider interactions in a hospital environment. METHODS AND RESULTS: We extracted 4 years of patient, provider, and activity data for encounters in an inpatient cardiology unit from Northwestern Medicine's Enterprise Data Warehouse...
November 2016: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28049525/nutrition-therapy-with-high-intensity-interval-training-to-improve-prostate-cancer-related-fatigue-in-men-on-androgen-deprivation-therapy-a-study-protocol
#18
Brenton J Baguley, Tina L Skinner, Michael D Leveritt, Olivia R L Wright
BACKGROUND: Cancer-related fatigue is one of the most prevalent, prolonged and distressing side effects of prostate cancer treatment with androgen deprivation therapy. Preliminary evidence suggests natural therapies such as nutrition therapy and structured exercise prescription can reduce symptoms of cancer-related fatigue. Men appear to change their habitual dietary patterns after prostate cancer diagnosis, yet prostate-specific dietary guidelines provide limited support for managing adverse side effects of treatment...
January 3, 2017: BMC Cancer
https://www.readbyqxmd.com/read/28049382/use-of-intracranial-pressure-monitoring-in-bacterial-meningitis-a-10-year-follow-up-on-outcome-and-intracranial-pressure-versus-head-ct-scans
#19
Lykke Larsen, Frantz R Poulsen, Troels H Nielsen, Carl-Henrik Nordström, Mette K Schulz, Åse B Andersen
BACKGROUND: The aim of this study was to evaluate the clinical outcome of patients with severe bacterial meningitis where intracranial pressure (ICP) monitoring has been performed. METHODS: A retrospective observational study including patients admitted 1st(.) January 2005 to 31st(.) December 2014. Thirty nine patients age 18-89 years were included. All the patients received intensive care with mechanical ventilation, ICP monitoring, sedation, antibiotics and corticosteroids according to current guidelines...
January 3, 2017: Infectious Diseases
https://www.readbyqxmd.com/read/28048964/variability-in-antibiotic-regimens-for-surgical-necrotizing-enterocolitis-highlights-the-need-for-new-guidelines
#20
Brian P Blackwood, Catherine J Hunter, Julia Grabowski
BACKGROUND: Necrotizing enterocolitis or NEC is the most common gastrointestinal emergency in the newborn. The etiology of NEC remains unknown, and treatment consists of antibiotic therapy and supportive care with the addition of surgical intervention as necessary. Unlike most surgical diseases, clear guidelines for the type and duration of peri-operative antibiotic therapy have not been established. Our aim was to review the antibiotic regimen(s) applied to surgical patients with NEC within a single neonatal intensive care unit (NICU) and to evaluate outcomes and help develop guidelines for antibiotic administration in this patient population...
January 3, 2017: Surgical Infections
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