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https://www.readbyqxmd.com/read/29785465/causes-and-treatment-of-acute-ischemic-stroke-during-pregnancy
#1
REVIEW
Ina Terón, Melissa S Eng, Jeffrey M Katz
PURPOSE OF REVIEW: Treatment recommendations for pregnancy associated ischemic stroke are scarce. This may be due to the fact that, in general, obstetricians tend not to make recommendations for stroke patients and neurologists are not commonly involved in the care of pregnant women. Herein, we review the multiple etiologies of ischemic stroke during pregnancy, considerations for diagnostic testing, and acute treatment and prevention options, including associated risks specific to the pregnant and puerperal state...
May 21, 2018: Current Treatment Options in Neurology
https://www.readbyqxmd.com/read/29784219/an-attempt-to-stem-the-tide-exploring-the-effect-of-a-90-day-transitional-care-intervention-on-readmissions-to-an-acute-male-psychiatric-unit-in-south-africa
#2
Ulla A Botha, Marise Coetzee, Liezl Koen, Dana J H Niehaus
INTRODUCTION: Pressure on inpatient beds often results in premature discharges, which may precipitate early readmission. This has prompted an increased interest in transitional care interventions to bridge the gap between in- and outpatient care to reduce such readmissions. Our study aimed to assess the effect of a Transitional Care Service (TCS) on readmission rates in a high pressure inpatient service which utilizes a premature discharge policy to address bed pressures. METHODS: Sixty male patients identified for crisis discharge were offered a TCS for the first ninety days after discharge...
June 2018: Archives of Psychiatric Nursing
https://www.readbyqxmd.com/read/29784137/factors-influencing-the-documentation-of-fertility-related-discussions-for-adolescents-and-young-adults-with-cancer
#3
G Skaczkowski, V White, K Thompson, H Bibby, M Coory, R Pinkerton, W Nicholls, L M Orme, R Conyers, M B Phillips, M Osborn, R Harrup, A Anazodo
PURPOSE: A cancer diagnosis and treatment may have significant implications for a young patient's future fertility. Documentation of fertility-related discussions and actions is crucial to providing the best follow-up care, which may occur for many years post-treatment. This study examined the rate of medical record documentation of fertility-related discussions and fertility preservation (FP) procedures for adolescents and young adults (AYAs) with cancer in Australia. METHODS: A retrospective review of medical records for 941 patients in all six Australian states...
June 2018: European Journal of Oncology Nursing: the Official Journal of European Oncology Nursing Society
https://www.readbyqxmd.com/read/29783928/physical-activity-intervention-for-elderly-patients-with-reduced-physical-performance-after-acute-coronary-syndrome-hulk-study-rationale-and-design-of-a-randomized-clinical-trial
#4
Elisabetta Tonet, Elisa Maietti, Giorgio Chiaranda, Francesco Vitali, Matteo Serenelli, Giulia Bugani, Gianni Mazzoni, Rossella Ruggiero, Jonathan Myers, Giovanni Quinto Villani, Ursula Corvi, Giovanni Pasanisi, Simone Biscaglia, Rita Pavasini, Giulia Ricci Lucchi, Gianluigi Sella, Roberto Ferrari, Stefano Volpato, Gianluca Campo, Giovanni Grazzi
BACKGROUND: Reduced physical performance and impaired mobility are common in elderly patients after acute coronary syndrome (ACS) and they represent independent risk factors for disability, morbidity, hospital readmission and mortality. Regular physical exercise represents a means for improving functional capacity. Nevertheless, its clinical benefit has been less investigated in elderly patients in the early phase after ACS. The HULK trial aims to investigate the clinical benefit of an early, tailored low-cost physical activity intervention in comparison to standard of care in elderly ACS patients with reduced physical performance...
May 21, 2018: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/29781780/physical-therapists-know-function-an-opinion-on-mobility-and-level-of-activity-during-hospitalization-for-adult-inpatients
#5
Audrey M Johnson, Janice Kuperstein, Dana Howell, Esther E Dupont-Versteegden
Negative consequences of immobility during hospitalization are widely known and remain undisputed. Evidence of low mobility for general medicine adult inpatients persists. Patients who experience hospital acquired functional decline due to low mobility require costly post-acute care services. The impact of immobility on post-acute care physical function and quality of life is directly at odds with value-based care. New Medicare payment models emphasize value-based care to promote care improvement and better patient outcomes...
May 21, 2018: Hospital Topics
https://www.readbyqxmd.com/read/29778325/tranexamic-acid-for-hyperacute-primary-intracerebral-haemorrhage-tich-2-an-international-randomised-placebo-controlled-phase-3-superiority-trial
#6
Nikola Sprigg, Katie Flaherty, Jason P Appleton, Rustam Al-Shahi Salman, Daniel Bereczki, Maia Beridze, Hanne Christensen, Alfonso Ciccone, Ronan Collins, Anna Czlonkowska, Robert A Dineen, Lelia Duley, Juan Jose Egea-Guerrero, Timothy J England, Kailash Krishnan, Ann Charlotte Laska, Zhe Kang Law, Serefnur Ozturk, Stuart J Pocock, Ian Roberts, Thompson G Robinson, Christine Roffe, David Seiffge, Polly Scutt, Jegan Thanabalan, David Werring, David Whynes, Philip M Bath
BACKGROUND: Tranexamic acid can prevent death due to bleeding after trauma and post-partum haemorrhage. We aimed to assess whether tranexamic acid reduces haematoma expansion and improves outcome in adults with stroke due to intracerebral haemorrhage. METHODS: We did an international, randomised placebo-controlled trial in adults with intracerebral haemorrhage from acute stroke units at 124 hospital sites in 12 countries. Participants were randomly assigned (1:1) to receive 1 g intravenous tranexamic acid bolus followed by an 8 h infusion of 1 g tranexamic acid or a matching placebo, within 8 h of symptom onset...
May 15, 2018: Lancet
https://www.readbyqxmd.com/read/29778317/appropriate-use-of-noninvasive-ischemia-testing-to-guide-revascularization-decision-making-following-acute-st-elevation-myocardial-infarction-in-latin-american-countries-results-from-an-expert-panel-meeting-of-the-international-atomic-energy-agency
#7
I Berrocal, A Peix, F Mut, L J Shaw, G Karthikeyan, E Estrada Lobato, D Paez
Across Latin American and Caribbean countries, cardiovascular disease and especially ischemic heart disease is currently the main cause of death both in men and in women. For most Latin American and Caribbean countries, public and community health efforts aim to define care strategies which are both clinically and cost effective and promote primary and secondary prevention, resulting in improved patient outcomes. The optimal approach to deal with acute events such as ST-elevation myocardial infarction (STEMI) is a matter of controversy; however, there is an expanding role for assessing residual ischemic burden in STEMI patients following primary percutaneous coronary intervention...
May 16, 2018: Revista Española de Medicina Nuclear e Imagen Molecular
https://www.readbyqxmd.com/read/29777456/distal-bowel-re-feeding-in-patients-with-proximal-jejunostomy
#8
Anand Nagar, Siddharth Mehrotra, Amitabh Yadav, Vivek Mangla, Shailendra Lalwani, Naimish Mehta, Samiran Nundy
BACKGROUND: Patients who have a proximal jejunostomy are difficult to manage because of their high stoma output which results in fluid and electrolyte imbalance with repeated hospital admissions and the necessity for expensive parenteral nutrition (PN). There are few reports on the use of re-feeding of the proximal effluents in this situation. METHODS: We here relate our experience with this manoeuvre in 35 patients between Jan 2010 and Feb 2016 who had stomas less than 120 cm away from the duodenojejunal flexure...
May 18, 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/29773516/lymphoedema-management-to-prevent-acute-dermatolymphangioadenitis-in-podoconiosis-in-northern-ethiopia-golbet-a-pragmatic-randomised-controlled-trial
#9
Henok Negussie, Meseret Molla, Moses Ngari, James A Berkley, Esther Kivaya, Patricia Njuguna, Greg Fegan, Abreham Tamiru, Abebe Kelemework, Trudie Lang, Melanie J Newport, Andy McKay, Fikre Enquoselassie, Gail Davey
BACKGROUND: Podoconiosis (also known as endemic, non-filarial elephantiasis) affects about 4 million subsistence farmers in tropical Africa. Poor awareness of the condition and inadequate evidence for the efficacy of treatment mean that no government in an endemic country yet offers lymphoedema management for patients with podoconiosis. Among patients with filarial lymphoedema, trials suggest that limb care is effective in reducing the most disabling sequelae: episodes of acute dermatolymphangioadenitis...
May 14, 2018: Lancet Global Health
https://www.readbyqxmd.com/read/29773297/the-clinical-practice-of-high-flow-nasal-cannula-oxygen-therapy-in-adults-a-japanese-cross-sectional-multicenter-survey
#10
Jiro Ito, Kazuma Nagata, Susumu Sato, Akira Shiraki, Naoki Nishimura, Shinyu Izumi, Ryo Tachikawa, Takeshi Morimoto, Keisuke Tomii
BACKGROUND: High-flow nasal cannula oxygen therapy (HFNC) is widely used mainly in the acute care setting, but limited data are available on real-world practice in adults. The objective of this study was to describe HFNC practices in Japanese adults. METHODS: A retrospective cross-sectional multicenter survey of adult patients receiving HFNC from January through March 2015 was conducted in 33 participating hospitals in Japan. RESULTS: We obtained information on 321 patients (median age, 76; 218 men, 103 women; median estimated PaO2 /FI O2, 178 mm Hg) from 22 hospitals...
May 2018: Respiratory Investigation
https://www.readbyqxmd.com/read/29771731/effect-of-intravenous-dexmedetomidine-during-general-anesthesia-on-acute-postoperative-pain-in-adults-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#11
Xiuqin Wang, Naifu Liu, Jinlong Chen, Zan Xu, Fumei Wang, Chuan Ding
BACKGROUND: Dexmedetomidine has been shown to have an analgesic effect. However, no consensus was reached in previous studies. METHODS: Electronic databases such as PubMed, Embase, and Cochrane Central were searched for relevant randomized controlled trials (RCTs). The relative risk (RR) and weighted mean difference (WMD) were used to analyze the outcomes. Random-effects model was used for meta-analysis. RESULTS: Compared to the normal saline group, patients using dexmedetomidine showed a significantly decreased pain intensity within 6 hours (WMD=-0...
May 16, 2018: Clinical Journal of Pain
https://www.readbyqxmd.com/read/29771700/the-effect-of-iv-amino-acid-supplementation-on-mortality-in-icu-patients-may-be-dependent-on-kidney-function-post-hoc-subgroup-analyses-of-a-multicenter-randomized-trial
#12
Ran Zhu, Matilde J Allingstrup, Anders Perner, Gordon S Doig
OBJECTIVES: We investigated whether preexisting kidney function determines if ICU patients may benefit from increased (2.0 g/kg/d) protein intake. DESIGN: Post hoc, hypothesis-generating, subgroup analysis of a multicenter, phase 2, randomized clinical trial. All analyses were conducted by intention to treat and maintained group allocation. Ninety-day mortality was the primary outcome. SETTING: ICUs of 16 hospitals throughout Australia and New Zealand...
May 15, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29769203/early-and-chronic-dipeptidyl-peptidase-iv-inhibition-and-cardiovascular-events-in-patients-with-type-2-diabetes-mellitus-after-an-acute-coronary-syndrome-a-landmark-analysis-of-the-examine-trial
#13
Abhinav Sharma, Christopher P Cannon, William B White, Yuyin Liu, George L Bakris, William C Cushman, Faiez Zannad
BACKGROUND: Antihyperglycemic therapies may increase the risk of cardiovascular events including hospitalization for heart failure. There is a paucity of data evaluating the cardiovascular safety of antihyperglycemic therapies in the high-risk period following an acute coronary syndrome (ACS). METHODS AND RESULTS: The EXAMINE (Examination of Cardiovascular Outcomes with Alogliptin versus Standard of Care) trial randomized 5380 patients who were 15 to 90 days post ACS to the dipeptidyl dipeptidase-IV (DPP-IV) inhibitor alogliptin versus placebo; mean follow-up was 18 months...
May 16, 2018: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29768487/an-observational-study-the-utility-of-perfusion-index-as-a-discharge-criterion-for-pain-assessment-in-the-postanesthesia-care-unit
#14
Chun-Lin Chu, Yi-You Huang, Ying-Hou Chen, Ling-Ping Lai, Huei-Ming Yeh
Acute post-operative pain can remain untreated if patients cannot express themselves. The perfusion index (PI) may decrease when pain activates sympathetic tone and may increase after analgesics are administered. We evaluated if the perfusion index is a feasible indicator for objectively assessing pain relief in the postanesthesia care unit (PACU) and calculated the changes in PI measurements at the time of discharge from the PACU relative to baseline PI measurements to examine if the PI is a useful criterion for discharging patients from the postanesthesia care unit...
2018: PloS One
https://www.readbyqxmd.com/read/29767833/post-operative-care-of-interventional-therapy-for-40-liver-cancer-patients-with-obstructive-jaundice
#15
De-Ping Tong, Li-Qin Wu, Xiao-Ping Chen, Yi Li
The care of 40 patients with primary liver cancer with obstructive jaundice treated with liver puncture bile drainage or biliary stent implantation was reported. Treated with the interventional therapy, patients were observed closely to identify symptoms of hepatic encephalopathy and pain; diet care was well performed. Bile drainage tube and skin acre were performed carefully. Liver function, bilirubin and other biochemical indicators were monitored; occurrence of bleeding, acute pancreatitis, biliary tract infection, leakage of ascites around drainage tube and other complication were observed with good discharge instruction...
May 16, 2018: European Journal of Cancer Care
https://www.readbyqxmd.com/read/29767829/homeopathy-in-the-age-of-antimicrobial-resistance-is-it-a-viable-treatment-for-upper-respiratory-tract-infections
#16
Alison Fixsen
BACKGROUND:  Acute upper respiratory tract infections (URTIs) and their complications are the most frequent cause of antibiotic prescribing in primary care. With multi-resistant organisms proliferating, appropriate alternative treatments to these conditions are urgently required. Homeopathy presents one solution; however, there are many methods of homeopathic prescribing. This review of the literature considers firstly whether homeopathy offers a viable alternative therapeutic solution for acute URTIs and their complications, and secondly how such homeopathic intervention might take place...
May 2018: Homeopathy: the Journal of the Faculty of Homeopathy
https://www.readbyqxmd.com/read/29767322/management-of-cardiogenic-shock-complicating-myocardial-infarction
#17
REVIEW
Alexandre Mebazaa, Alain Combes, Sean van Diepen, Alexa Hollinger, Jaon N Katz, Giovanni Landoni, Ludhmila Abrahao Hajjar, Johan Lassus, Guillaume Lebreton, Gilles Montalescot, Jin Joo Park, Susanna Price, Alessandro Sionis, Demetris Yannopolos, Veli-Pekka Harjola, Bruno Levy, Holger Thiele
Up to 10% of acute coronary syndromes are complicated by cardiogenic shock (CS) with contemporary mortality rates of 40-50%. The extent of ischemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis in this patient population. Individualized patient risk assessment plays an important role in determining appropriate revascularization, drug treatment with inotropes and vasopressors, mechanical circulatory support, intensive care support of other organ systems, hospital level of care triage, and allocation of clinical resources...
May 16, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29766640/subclinical-inflammation-phenotypes-and-long-term-outcomes-after-pediatric-kidney-transplantation
#18
Michael E Seifert, Megan V Yanik, Daniel I Feig, Vera Hauptfeld-Dolejsek, Elizabeth C Mroczek-Musulman, David R Kelly, Frida Rosenblum, Roslyn B Mannon
The implementation of surveillance biopsies in pediatric kidney transplantation remains controversial. Surveillance biopsies detect subclinical injury prior to clinical dysfunction, which could allow for early interventions that prolong allograft survival. We conducted a single-center retrospective cohort study of 120 consecutive pediatric kidney recipients, of whom 103 had surveillance biopsies ≤ 6 months post-transplant. We tested the hypothesis that subclinical inflammation (borderline or T cell-mediated rejection without clinical dysfunction) is associated with a 5-year composite endpoint of acute rejection and allograft failure...
May 15, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29766275/implementing-cough-reflex-testing-in-a-clinical-pathway-for-acute-stroke-a-pragmatic-randomised-controlled-trial
#19
Makaela Field, Rachel Wenke, Arman Sabet, Melissa Lawrie, Elizabeth Cardell
Silent aspiration is common after stroke and can lead to subsequent pneumonia. While standard bedside dysphagia assessments are ineffective at predicting silent aspiration, cough reflex testing (CRT) has shown promise for identifying patients at risk of silent aspiration. We investigated the impact of CRT on patient and service outcomes when embedded into a clinical pathway. 488 acute stoke patients were randomly allocated to receive either CRT or standard care (i.e. bedside assessment). Primary outcomes included confirmed pneumonia within 3 months post stroke and length of acute inpatient stay...
May 15, 2018: Dysphagia
https://www.readbyqxmd.com/read/29766216/impact-of-angiotensin-converting-enzyme-inhibitors-or-receptor-blockers-on-post-icu-discharge-outcome-in-patients-with-acute-kidney-injury
#20
Etienne Gayat, Alexa Hollinger, Alain Cariou, Nicolas Deye, Antoine Vieillard-Baron, Samir Jaber, Benjamin G Chousterman, Qin Lu, Pierre François Laterre, Xavier Monnet, Michael Darmon, Marc Leone, Bertrand Guidet, Romain Sonneville, Jean-Yves Lefrant, Marie-Céline Fournier, Matthieu Resche-Rigon, Alexandre Mebazaa, Matthieu Legrand
PURPOSE: Acute kidney injury (AKI) is associated with the activation of the renin-angiotensin system. Whether angiotensin-converting enzyme inhibitors (ACEi) or angiotensin-receptor blockers (ARB) improve outcome in patients recovering from AKI remains unexplored. The purpose was to investigate the association between prescription of ACEi/ARB at intensive care unit (ICU) discharge and 1-year outcome in patients recovering from AKI. METHODS: Association between ACEi/ARB and 1-year mortality rate was explored in 1551 patients discharged from 21 European ICUs in an observational cohort...
May 15, 2018: Intensive Care Medicine
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