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Sepsis protocol

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https://www.readbyqxmd.com/read/100001003/emergency-management-of-sepsis-the-simple-stuff-saves-lives
#1
David Sweet, Julian Marsden, Kendall Ho, Christina Krause, James A Russell
Many emergency departments have implemented sepsis protocols since the 2001 publication of results from the early goal-directed therapy trial, which showed early targeted resuscitation lowers mortality. As part of an attempt to improve clinical and operational outcomes for emergency departments across British Columbia, we reviewed sepsis management literature and considered sepsis protocol implementation in the province’s emergency departments. During the literature review we found that many observational studies confirmed an association between implementation of emergency sepsis protocols and decreased mortality...
May 2012: BC medical journal: BCMJ
https://www.readbyqxmd.com/read/29325521/adjuvant-treatment-of-resectable-biliary-tract-cancer-with-cisplatin-plus-gemcitabine-a-prospective-single-center-phase-ii-study
#2
Alexander R Siebenhüner, Heike Seifert, Helga Bachmann, Burkhardt Seifert, Thomas Winder, Jonas Feilchenfeldt, Stefan Breitenstein, Pierre-Alain Clavien, Roger Stupp, Alexander Knuth, Bernhard Pestalozzi, Panagiotis Samaras
BACKGROUND: Biliary tract cancer (BTC) is a dismal disease, even after curative intent surgery. We conducted this prospective, non-randomized phase II study to evaluate the feasibility and efficacy of cisplatin and gemcitabine as adjuvant treatment in patients with resected BTC. METHODS: Patients initially received gemcitabine 1000 mg/m2 alone on days 1, 8 and 15 every 28-days for a total of six cycles (single agent cohort), and after protocol amendment a combination therapy with gemcitabine 1000 mg/m2 and cisplatin 25 mg/m2 on days 1 and 8 was administered every 21 days for a total of eight cycles (combined regimen cohort)...
January 11, 2018: BMC Cancer
https://www.readbyqxmd.com/read/29316931/nutritional-adequacy-of-a-novel-human-milk-fortifier-from-donkey-milk-in-feeding-preterm-infants-study-protocol-of-a-randomized-controlled-clinical-trial
#3
Alessandra Coscia, Enrico Bertino, Paola Tonetto, Chiara Peila, Francesco Cresi, Sertac Arslanoglu, Guido E Moro, Elena Spada, Silvano Milani, Marzia Giribaldi, Sara Antoniazzi, Amedeo Conti, Laura Cavallarin
BACKGROUND: Fortification of human milk is a standard practice for feeding very low birth weight infants. However, preterm infants often still experience suboptimal growth and feeding intolerance. New fortification strategies and different commercially available fortifiers have been developed. Commercially available fortifiers are constituted by a blend of ingredients from different sources, including plant oils and bovine milk proteins, thus presenting remarkable differences in the quality of macronutrients with respect to human milk...
January 9, 2018: Nutrition Journal
https://www.readbyqxmd.com/read/29316136/transrectal-prostate-biopsy-sepsis-rate-following-reduced-quinolone-antibiotic-prophylaxis-from-six-doses-to-single-dose
#4
Haider K Bangash, Cynthia Hawks, Steve P McCombie, Matthew Brown, Dickon Hayne
BACKGROUND: This study aimed to evaluate the rates of infective complication related to transrectal prostate biopsy (TRPB) as our centre changed its protocol from six doses over 3 days to a single pre-procedure prophylactic dose. METHODS: This prospective cohort study identified infective complication in patients who attended and subsequently underwent TRPB at the time of their one-stop prostate clinic at our public tertiary hospital between August 2011 and April 2017...
January 8, 2018: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/29313710/long-term-outcomes-after-protocolized-sedation-vs-usual-care-in-ventilated-pediatric-patients
#5
R Scott Watson, Lisa A Asaro, James H Hertzog, Lauren R Sorce, Alicia G Kachmar, Leslie A Dervan, Derek C Angus, David Wypij, Martha A Q Curley
RATIONALE: Whether a nurse-implemented goal-directed sedation protocol resulting in more awake yet calm intubated children affects post-discharge functional status, health-related quality of life, or risk for post-traumatic stress disorder is unknown. OBJECTIVES: To compare post-discharge outcomes in children with acute respiratory failure cluster randomized to a sedation protocol or usual care. METHODS: A stratified random sample of 1360 patients from 31 centers in the Randomized Evaluation of Sedation Titration for Respiratory Failure trial was assessed by mail, electronically, and/or telephone six months after intensive care unit discharge...
January 9, 2018: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29303129/higher-order-multiple-births-in-nigeria-experiences-challenges-and-neonatal-outcomes-in-a-private-health-facility
#6
B Ezenwa, O Oseni, P Akintan, P Aligwekwe, B Chukwukelu, O Fashola, A Ogunmokun, O Odukoya
OBJECTIVES: The aim of this study is to describe the experience and outcome of higher order multiple (HOM) births in a private tertiary health facility in Nigeria. MATERIALS AND METHODS: This was a retrospective review of records of HOM over 3 years in a private tertiary health facility in Nigeria. Relevant data on HOM births were extracted from both the patients' case notes, admission registers and maternity ward and delivery records of the hospital using a predesigned pro forma...
November 2017: Nigerian Journal of Clinical Practice
https://www.readbyqxmd.com/read/29297392/summary-findings-from-a-mixed-methods-study-on-identifying-and-responding-to-maternal-and-newborn-illness-in-seven-countries-implications-for-programs
#7
Danielle Charlet, Allisyn C Moran, Supriya Madhavan
BACKGROUND: There is a lack of systematic information documenting recognition of potentially life-threatening complications and decisions to seek care, as well as reaching care and the specific steps in that process. In response to this gap in knowledge, a multi-country mixed methods study was conducted to illuminate the dynamics driving Delays 1 and 2 across seven countries for maternal and newborn illness and death. METHODS: A common protocol and tools were developed, adapted by each of seven study teams depending on their local context (Ethiopia, India, Indonesia, Nigeria, Tanzania, Uganda, and Nepal)...
December 21, 2017: Journal of Health, Population, and Nutrition
https://www.readbyqxmd.com/read/29296168/glenohumeral-joint-sepsis-after-joint-injection-through-a-new-tattoo
#8
Richard Becker, Sean Haight
We report a case of Propionibacterium acnes septic arthritis of a shoulder following two joint access procedures. Methodical investigation of these two procedures was performed using the Joint Commission root cause analysis matrix, which involved examination of protocols, interviews with technologists and physicians, and inspection of the procedure rooms and equipment. No procedural error or other causal factor for infection was found other than the injection through a five day-old tattoo during the first procedure...
November 2017: Journal of Radiology Case Reports
https://www.readbyqxmd.com/read/29286435/visualization-of-biofilm-formation-in-candida-albicans-using-an-automated-microfluidic-device
#9
Megha Gulati, Craig L Ennis, Diana L Rodriguez, Clarissa J Nobile
Candida albicans is the most common fungal pathogen of humans, causing about 15% of hospital-acquired sepsis cases. A major virulence attribute of C. albicans is its ability to form biofilms, structured communities of cells attached to biotic and abiotic surfaces. C. albicans biofilms can form on host tissues, such as mucosal layers, and on medical devices, such as catheters, pacemakers, dentures, and joint prostheses. Biofilms pose significant clinical challenges because they are highly resistant to physical and chemical perturbations, and can act as reservoirs to seed disseminated infections...
December 14, 2017: Journal of Visualized Experiments: JoVE
https://www.readbyqxmd.com/read/29282483/soluble-trem-1-serum-level-can-early-predict-mortality-of-patients-with-sepsis-severe-sepsis-and-septic-shock
#10
Monika Jedynak, Andrzej Siemiatkowski, Barbara Mroczko, Magdalena Groblewska, Robert Milewski, Maciej Szmitkowski
Early prognostic prediction of sepsis is essential in adjusting therapeutic protocols to prevent deterioration and reduce mortality. We compared the predictive value of the serum concentration of the soluble triggering receptor expressed on myeloid cells 1 (sTREM-1) for 28-day mortality and for the development of severe sepsis or septic shock on the third day with the levels of interleukin (IL)-6, C-reactive protein (CRP) and procalcitonin (PCT). The study was conducted on 85 patients with sepsis. sTREM-1, CRP, PCT and IL-6 concentrations were measured upon study inclusion (day 0) and on days 1, 2, 3 and 5...
December 27, 2017: Archivum Immunologiae et Therapiae Experimentalis
https://www.readbyqxmd.com/read/29258599/transition-in-care-from-paramedics-to-emergency-department-nurses-a-systematic-review-protocol
#11
Gudrun Reay, Jill M Norris, K Alix Hayden, Joanna Abraham, Katherine Yokom, Lorelli Nowell, Gerald C Lazarenko, Eddy S Lang
BACKGROUND: Effective and efficient transitions in care between emergency medical services (EMS) practitioners and emergency department (ED) nurses is vital as poor clinical transitions in care may place patients at increased risk for adverse events such as delay in treatment for time sensitive conditions (e.g., myocardial infarction) or worsening of status (e.g., sepsis). Such transitions in care are complex and prone to communication errors primarily caused by misunderstanding related to divergent professional perspectives leading to misunderstandings that are further susceptible to contextual factors and divergent professional lenses...
December 19, 2017: Systematic Reviews
https://www.readbyqxmd.com/read/29242417/phase-changing-material-for-therapeutic-hypothermia-in-neonates-with-hypoxic-ischemic-encephalopathy-a-multi-centric-study
#12
Niranjan Thomas, Thangaraj Abiramalatha, Vishnu Bhat, Manoj Varanattu, Suman Rao, Sanjay Wazir, Leslie Lewis, Umamaheswari Balakrishnan, Srinivas Murki, Jaikrishnan Mittal, Ashish Dongara, Y N Prashantha, Somashekhar Nimbalkar
OBJECTIVE: To assess the feasibility and safety of cooling asphyxiated neonates using phase changing material based device across different neonatal intensive care units in India. DESIGN: Multi-centric uncontrolled clinical trial. SETTING: 11 level 3 neonatal units in India from November 2014 to December 2015. PARTICIPANTS: 103 newborn infants with perinatal asphyxia, satisfying pre-defined criteria for therapeutic hypothermia...
December 14, 2017: Indian Pediatrics
https://www.readbyqxmd.com/read/29240754/maternal-death-review-and-outcomes-an-assessment-in-lagos-state-nigeria
#13
Friday Okonofua, Donald Imosemi, Brian Igboin, Adegboyega Adeyemi, Chioma Chibuko, Adewale Idowu, Wilson Imongan
The objective of the study was to investigate the results of Maternal and Perinatal Death Surveillance and Response (MPDSR) conducted in three referral hospitals in Lagos State, Nigeria over a two-year period and to report the outcomes and the lessons learned. MPDRS panels were constituted in the three hospitals, and beginning from January 2015, we conducted monthly MPDSR in the three hospitals using a nationally approved protocol. Data on births and deaths and causes of deaths as identified by the MPDSR panels were collated in the hospitals...
2017: PloS One
https://www.readbyqxmd.com/read/29206765/the-new-york-sepsis-severity-score-development-of-a-risk-adjusted-severity-model-for-sepsis
#14
Gary S Phillips, Tiffany M Osborn, Kathleen M Terry, Foster Gesten, Mitchell M Levy, Stanley Lemeshow
OBJECTIVES: In accordance with Rory's Regulations, hospitals across New York State developed and implemented protocols for sepsis recognition and treatment to reduce variations in evidence informed care and preventable mortality. The New York Department of Health sought to develop a risk assessment model for accurate and standardized hospital mortality comparisons of adult septic patients across institutions using case-mix adjustment. DESIGN: Retrospective evaluation of prospectively collected data...
December 4, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29203977/radical-treatment-of-rectal-cancer-in-elderly-is-feasible-than-feared-results-from-a-tertiary-care-centre
#15
Madhu Muralee, Rajesh Singh, Arun Peter Mathew, Kurian Cherian, K Chandramohan, Paul Augustine, S Roshni, Iqbal Ahamed
The thought of subjecting an elderly patient with rectal cancer to protocol-based neoadjuvant chemoradiation (NACTRT), surgery and adjuvant chemotherapy is sought with fear due to their multiple comorbidities and impaired functional status associated with the process of ageing. Hence, many a times the treatment is compromised and it is a fact that this subgroup of patients is underrepresented in most of the clinical trials. This study was aimed at analysing the perioperative and oncologic outcomes after protocol-based treatment of rectal cancer in the elderly patients, defined here as those with age ≥70 years...
December 2017: Indian Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29202258/the-spice-iii-study-protocol-and-analysis-plan-a-randomised-trial-of-early-goaldirected-sedation-compared-with-standard-care-in-mechanically-ventilated-patients
#16
RANDOMIZED CONTROLLED TRIAL
Yahya Shehabi, Andrew B Forbes, Yaseen Arabi, Frances Bass, Rinaldo Bellomo, Suhaini Kadiman, Belinda D Howe, Colin McArthur, Michael C Reade, Ian Seppelt, Jukka Takala, Steve Webb, Matthew P Wise
BACKGROUND: Sedation strategy in critically ill patients who are mechanically ventilated is influenced by patient-related factors, choice of sedative agent and the intensity or depth of sedation prescribed. The impact of sedation strategy on outcome, in particular when delivered early after initiation of mechanical ventilation, is uncertain. OBJECTIVES: To present the protocol and analysis plan of a large randomised clinical trial investigating the effect of a sedation strategy, in critically ill patients who are mechanically ventilated, based on a protocol targeting light sedation using dexmedetomidine as the primary sedative, termed "early goal-directed sedation", compared with usual practice...
December 2017: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/29201378/time-to-re-think-the-use-of-dobutamine-in-sepsis
#17
Ryota Sato, Michitaka Nasu
Dobutamine is commonly used worldwide and included in the protocol for early goal-directed therapy (EGDT). Since the use of dobutamine in EGDT was reported, it has been considered to be an important component, especially in the treatment of septic patients with myocardial dysfunction. However, it is questionable whether dobutamine improves the mortality of sepsis and septic shock. In three recent randomized controlled trials (ProCESS, ProMISe, and ARISE trials), the frequency of dobutamine use was significantly higher in the EGDT group than in the standard care group, but there were no significant differences in the mortality between the groups...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/29195914/early-fluid-loading-for-septic-patients-any-safety-limit-needed
#18
REVIEW
Yi-Chun Gong, Jing-Tao Liu, Peng-Lin Ma
Early adequate fluid loading was the corner stone of hemodynamic optimization for sepsis and septic shock. Meanwhile, recent recommended protocol for fluid resuscitation was increasingly debated on hemodynamic stability vs risk of overloading. In recent publications, it was found that a priority was often given to hemodynamic stability rather than organ function alternation in the early fluid resuscitation of sepsis. However, no safety limits were used at all in most of these reports. In this article, the rationality and safety of early aggressive fluid loading for septic patients were discussed...
November 8, 2017: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/29192743/can-pancreatic-cancer-be-detected-by-adrenomedullin-in-patients-with-new-onset-diabetes-the-pacanod-cohort-study-protocol
#19
Laura Antolino, Mara La Rocca, Federico Todde, Elena Catarinozzi, Paolo Aurello, Lucilla Bollanti, Giovanni Ramacciato, Francesco D'Angelo
INTRODUCTION: Pancreatic cancer is a leading cause of cancer-related death. Its diagnosis is often delayed and patients are frequently found to have unresectable disease. Patients diagnosed with new-onset diabetes have an 8-fold risk of harboring pancreatic cancer. Adrenomedullin has been claimed to mediate diabetes in pancreatic cancer. New screening tools are needed to develop an early diagnosis protocol. METHODS: Patients aged 45-75 years within 2 years of first fulfilling the ADA criteria for diabetes will be prospectively enrolled in this study...
November 29, 2017: Tumori
https://www.readbyqxmd.com/read/29174462/critical-care-and-personalized-or-precision-medicine-who-needs-whom
#20
Shihab Sugeir, Stephen Naylor
The current paradigm of modern healthcare is a reactive response to patient symptoms, subsequent diagnosis and corresponding treatment of the specific disease(s). This approach is predicated on methodologies first espoused by the Cnidean School of Medicine approximately 2500years ago. More recently escalating healthcare costs and relatively poor disease treatment outcomes have fermented a rethink in how we carry out medical practices. This has led to the emergence of "P-Medicine" in the form of Personalized and Precision Medicine...
November 16, 2017: Journal of Critical Care
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