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https://www.readbyqxmd.com/read/28923988/contemporary-management-of-cardiogenic-shock-a-scientific-statement-from-the-american-heart-association
#1
REVIEW
Sean van Diepen, Jason N Katz, Nancy M Albert, Timothy D Henry, Alice K Jacobs, Navin K Kapur, Ahmet Kilic, Venu Menon, E Magnus Ohman, Nancy K Sweitzer, Holger Thiele, Jeffrey B Washam, Mauricio G Cohen
Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities...
September 18, 2017: Circulation
https://www.readbyqxmd.com/read/28922268/early-exercise-in-critically-ill-youth-and-children-a-preliminary-evaluation-the-weecycle-pilot-trial
#2
Karen Choong, Saif Awladthani, Adeeb Khawaji, Heather Clark, Asm Borhan, Ji Cheng, Sam Laskey, Charmaine Neu, Aimee Sarti, Lehana Thabane, Brian W Timmons, Katina Zheng, Samah Al-Harbi
OBJECTIVES: To determine the feasibility of conducting a full trial evaluating the efficacy of early mobilization using in-bed cycling as an adjunct to physiotherapy, on functional outcomes in critically ill children. DESIGN: Single center, pilot, randomized controlled trial. SETTING: Twelve-bed tertiary care, medical-surgical PICU at McMaster Children's Hospital, Hamilton, ON, Canada. PATIENTS: Children 3-17 years old who were limited to bed-rest with an expected PICU stay of at least 48 hours...
September 15, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28918164/telepsychiatry-consultation-for-medical-and-surgical-inpatient-units
#3
Julie A Graziane, Priya Gopalan, Jack Cahalane
BACKGROUND: Telepsychiatry is becoming more commonplace in the provision of psychiatric care. Most commonly used in the outpatient setting, there is little information available in the literature as to the use of telepsychiatry for inpatient medical/surgical consultation. OBJECTIVE: We review the University of Pittsburgh Medical Center's telepsychiatry consultation program that provides consultation to an outlying community-based rural hospital. METHODS: This article examines the 69 telepsychiatry consultations that were performed from November 2014 through February 2016, looking at the patients served, common consultation questions, and patterns of diagnoses and recommendations...
August 12, 2017: Psychosomatics
https://www.readbyqxmd.com/read/28913506/comparison-of-the-long-term-outcomes-of-resident-versus-attending-performed-trabeculectomy
#4
Naveed Nilforushan, Maryam Yadgari, Arezoo Astaraki, Arezoo Miraftabi
PURPOSE: To compare the long-term outcomes obtained by residents and attending surgeons performing trabeculectomy. METHODS: After reviewing medical records of the patients, 41 residents performing trabeculectomy under supervision of attendings were compared to 41 attendings performing trabeculectomy. The primary outcome measure was the surgical success defined in terms of intraocular pressure (IOP) ≤ 21 mmHg (criterion A) and IOP ≤ 16 mmHg (criterion B), with at least 20% reduction in IOP, either with no medication (complete success) or with no more than 2 medications (qualified success)...
September 2017: Journal of Current Ophthalmology
https://www.readbyqxmd.com/read/28904481/external-validation-of-risk-prediction-scores-for-invasive-candidiasis-in-a-medical-surgical-intensive-care-unit-an-observational-study
#5
Armin Ahmed, Arvind Kumar Baronia, Afzal Azim, Rungmei S K Marak, Reema Yadav, Preeti Sharma, Mohan Gurjar, Banani Poddar, Ratender Kumar Singh
BACKGROUND: The aim of this study was to conduct external validation of risk prediction scores for invasive candidiasis. METHODS: We conducted a prospective observational study in a 12-bedded adult medical/surgical Intensive Care Unit (ICU) to evaluate Candida score >3, colonization index (CI) >0.5, corrected CI >0.4 (CCI), and Ostrosky's clinical prediction rule (CPR). Patients' characteristics and risk factors for invasive candidiasis were noted. Patients were divided into two groups; invasive candidiasis and no-invasive candidiasis...
August 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28899445/microbial-disruption-indices-to-detect-colonization-with-multidrug-resistant-organisms
#6
Rafael Araos, Veronica Montgomery, Juan A Ugalde, Graham M Snyder, Erika M C D'Agata
OBJECTIVE To characterize the microbial disruption indices of hospitalized patients to predict colonization with multidrug-resistant organisms (MDROs). DESIGN A cross-sectional survey of the fecal microbiome was conducted in a tertiary referral, acute-care hospital in Boston, Massachusetts. PARTICIPANTS The study population consisted of adult patients hospitalized in general medical/surgical wards. METHODS Rectal swabs were obtained from patients within 48 hours of hospital admission and screened for MDRO colonization using conventional culture techniques...
September 13, 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28890209/nursing-workload-and-adherence-to-non-pharmacological-measures-in-the-prevention-of-ventilator-associated-pneumonia-a-pilot-study
#7
R Jam, O Hernández, J Mesquida, C Turégano, E Carrillo, R Pedragosa, V Gómez, L Martí, J Vallés, P Delgado-Hito
OBJECTIVE: To analyse whether adherence to non-pharmacological measures in the prevention of ventilator-associated pneumonia (VAP) is associated with nursing workload. METHODS: A prospective observational study performed in a single medical-surgical ICU. Nurses in charge of patients under ventilator support were assessed. VARIABLES: knowledge questionnaire, application of non-pharmacological VAP prevention measures, and workload (Nine Equivalents of Nursing Manpower Use Score)...
September 7, 2017: Enfermería Intensiva
https://www.readbyqxmd.com/read/28888510/improving-the-patient-experience-call-light-intervention-bundle
#8
Jacqueline J Nelson, Beth A Staffileno
PURPOSE: Delays in call light response are a significant patient quality and safety concern. Research on call light interventions and patient outcomes has focused exclusively on adult inpatients. This project examined the impact of increasing staff awareness and workflow redesign to improve the pediatric patient experience and outcomes based on timely response. DESIGN AND METHODS: A quality improvement project was conducted on two pediatric medical surgical units' (31 and 35 beds respectively) at a large Midwest academic medical center with patients' ages from to young adults...
September 2017: Journal of Pediatric Nursing
https://www.readbyqxmd.com/read/28885936/vancomycin-vs-vancomycin-piperacillin-tazobactam-associated-acute-kidney-injury-in-noncritically-ill-patients-at-a-tertiary-care-military-treatment-facility
#9
Caleb W Anderson, Kathy S Cazares, Michael B Lustik, Shivam M Patel, Troy M Denunzio
BACKGROUND: Broad-spectrum antibiotics are often used as initial empiric therapy in patients at risk for infections by multidrug-resistant organisms. Emerging literature and anecdotal reports within Tripler Army Medical Center indicate an increased incidence of vancomycin-associated acute kidney injury when used in combination with piperacillin-tazobactam. This is a retrospective, single-center study comparing the incidence of acute kidney injury in noncritically ill patients receiving either vancomycin or vancomycin in combination with piperacillin-tazobactam in a 206-bed tertiary care military training facility...
September 2017: Military Medicine
https://www.readbyqxmd.com/read/28876570/cohort-study-on-emergency-general-surgery-patients-and-an-observation-unit
#10
M Dickfos, H Ibrahim, A Evans, R Franz
BACKGROUND: Medium-sized, non-trauma hospitals experience many of the same difficulties as tertiary centres do when it comes to managing emergency general surgery patients. However, acute surgical units are not a financially viable option in these hospitals. To improve the care of emergency general surgery patients at one such hospital, a Rapid Assessment Medical Surgical (RAMS) unit was developed to decrease the time to review and increase the efficiency in caring for these patients...
September 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28872034/interest-of-a-medical-surgical-geriatric-unit-in-a-district-hospital-a-retrospective-study
#11
Baptiste Gonnaud, Radia Spiga, Selim Hamache, Patricia Ramboa, Corinne Momplot, Magali Tardy, Régis Gonthier
BACKGROUND: Orthogeriatric units have shown through several studies their effectiveness on reducing the morbidity and mortality after hip fracture. What about other emergency surgeries at the elderly? We evaluated the results of a small medical surgical geriatric unit (UMCG) for all the not sheduled surgeries. METHODS: A retrospective sudy has been done, analyzing management of patients over 75 years after an emergency surgery, between 1(st) January 2013 and 15 February 2014 for the surgical unit, and between 15 February 2014 and 15 April 2014 for the UMCG...
September 1, 2017: Gériatrie et Psychologie Neuropsychiatrie du Vieillissement
https://www.readbyqxmd.com/read/28867778/nurse-perceptions-of-artists-as-collaborators-in-interprofessional-care-teams
#12
Jill Sonke, Virginia Pesata, Jenny Baxley Lee, John Graham-Pole
Increased attention is being given to interprofessional collaboration in healthcare, which has been shown to improve patient satisfaction, patient safety, healthcare processes, and health outcomes. As the arts and artists are being more widely incorporated into healthcare settings throughout the world, professional artists are contributing to interprofessional care teams. A secondary directed content analysis of interviews with 31 nurses on a medical-surgical care unit investigated the roles and impacts of professional artists on the interprofessional care team...
August 30, 2017: Healthcare (Basel, Switzerland)
https://www.readbyqxmd.com/read/28866139/impact-of-caloric-intake-in-critically-ill-patients-with-and-without-refeeding-syndrome-a-retrospective-study
#13
Laura E Olthof, W A C Kristine Koekkoek, Coralien van Setten, Johannes C N Kars, Dick van Blokland, Arthur R H van Zanten
BACKGROUND & AIMS: Refeeding syndrome comprises metabolic disturbances that occur after the reintroduction of feeding after prolonged fasting. Standard care consists of correcting fluid and electrolytes imbalances. Energy intake during refeeding syndrome is heavily debated. This study addresses the effect of caloric intake on outcome during the management of refeeding syndrome. METHODS: A retrospective study among critically ill invasive mechanically ventilated patients admitted for >7 days to a medical-surgical ICU...
August 10, 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28865984/impact-of-surgical-intensive-care-unit-interdisciplinary-rounds-on-interprofessional-collaboration-and-quality-of-care-mixed-qualitative-quantitative-study
#14
Tatiana Urisman, Alberto Garcia, Hobart W Harris
BACKGROUND: Interprofessional collaboration is a key requirement for safe and effective care delivery in the critical care setting. To promote collaboration between care providers, intensive care unit interdisciplinary rounds have been introduced by multiple institutions and subsequent subjective improvements in interprofessional collaboration have been reported. However, only limited data are currently available regarding the impact of these rounds on objective patient care outcomes...
August 30, 2017: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/28858997/virtually-integrated-care-a-new-paradigm-in-patient-care-delivery
#15
Shannon Denney, Elizabeth Miller Evans
Current trends, including an aging population; the impact of the Affordable Care Act; increased complexity and acuity of patient needs; shorter hospital stays; and higher patient expectations have resulted in a significant demand for reconfiguration of the bedside nursing model. The health care system is further complicated by a shortage of highly trained nurses, challenging financial incentive models, and inefficient traditional staffing models. These challenges have increased the urgency for designing a more efficient, cost-effective care delivery model...
October 2017: Nursing Administration Quarterly
https://www.readbyqxmd.com/read/28858955/variability-in-acuity-in-acute-care
#16
Amy L Garcia
OBJECTIVE: This study was designed to describe variable acuity among 1 population of acute care patients. BACKGROUND: Acuity, defined as the individual patient need for nursing care, can inform level of care, nurse staffing, and the nurse-to-patient assignment. Nurse-generated data in the electronic health record can be mined and analyzed for decision support. METHODS: This study used a descriptive, retrospective analysis of repeated measures of acuity generated from 28 739 nursing assessments of 405 consecutive subjects treated for heart failure (HF) in a 455-bed southern hospital...
August 31, 2017: Journal of Nursing Administration
https://www.readbyqxmd.com/read/28858892/evaluation-and-management-of-cytomegalovirus-associated-congenital-hearing-loss
#17
Allison M Dobbie
PURPOSE OF REVIEW: The current article reviews the current literature related to congenital cytomegalovirus (CMV)-related hearing loss. The discussion will focus on the epidemiology, pathogenesis, and clinical presentation of human CMV infection as it pertains to hearing loss. Current methods of CMV diagnosis with a focus on the evolving trend toward broader neonatal screening protocols will also be explored. Discussion of medical, surgical, and audiologic management of the condition will also be addressed...
August 30, 2017: Current Opinion in Otolaryngology & Head and Neck Surgery
https://www.readbyqxmd.com/read/28857892/evaluation-and-management-of-cytomegalovirus-associated-congenital-hearing-loss
#18
Allison M Dobbie
PURPOSE OF REVIEW: The current article reviews the current literature related to congenital cytomegalovirus (CMV)-related hearing loss. The discussion will focus on the epidemiology, pathogenesis, and clinical presentation of human CMV infection as it pertains to hearing loss. Current methods of CMV diagnosis with a focus on the evolving trend toward broader neonatal screening protocols will also be explored. Discussion of medical, surgical, and audiologic management of the condition will also be addressed...
October 2017: Current Opinion in Otolaryngology & Head and Neck Surgery
https://www.readbyqxmd.com/read/28854401/post-icu-psychological-morbidity-in-very-long-icu-stay-patients-with-ards-and-delirium
#19
Farshid R Bashar, Amir Vahedian-Azimi, Mohammadreza Hajiesmaeili, Mahmood Salesi, Behrooz Farzanegan, Seyedpouzhia Shojaei, Reza Goharani, Seyed J Madani, Kivan G Moghaddam, Sevak Hatamian, Hosseinali J Moghaddam, Seyed M M Mosavinasab, Elamin M Elamin, Andrew C Miller
PURPOSE: We investigated the impact of delirium on illness severity, psychological state, and memory in acute respiratory distress syndrome patients with very long ICU stay. MATERIALS AND METHODS: Prospective cohort study in the medical-surgical ICUs of 2 teaching hospitals. Very long ICU stay (>75days) and prolonged delirium (≥40days) thresholds were determined by ROC analysis. Subjects were ≥18years, full-code, and provided informed consent. Illness severity was assessed using Acute Physiology and Chronic Health Evaluation IV, Simplified Acute Physiology Score-3, and Sequential Organ Failure Assessment scores...
August 24, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28853187/time-motion-analysis-of-nursing-work-in-icu-telemetry-and-medical-surgical-units
#20
Elizabeth Schenk, Ruth Schleyer, Cami R Jones, Sarah Fincham, Kenn B Daratha, Karen A Monsen
AIM: This study examined nurses' work, comparing nursing interventions and locations across three units in a United States hospital using Omaha System standardized terminology as the organizing framework. BACKGROUND: The differences in nurses' acute-care work across unit types are not well understood. Prior investigators have used time-motion methodologies; few have compared differences across units, nor used standardized terminology. METHODS: Nurse-observers recorded locations and interventions of nurses on three acute-care units using hand-held devices and web-based TimeCaT(™) software...
August 29, 2017: Journal of Nursing Management
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