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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/28215029/an-introduction-to-the-pathophysiology-of-aneurysmal-subarachnoid-hemorrhage
#2
REVIEW
Jasper H van Lieshout, Maxine Dibué-Adjei, Jan F Cornelius, Philipp J Slotty, Toni Schneider, Tanja Restin, Hieronymus D Boogaarts, Hans-Jakob Steiger, Athanasios K Petridis, Marcel A Kamp
Pathophysiological processes following subarachnoid hemorrhage (SAH) present survivors of the initial bleeding with a high risk of morbidity and mortality during the course of the disease. As angiographic vasospasm is strongly associated with delayed cerebral ischemia (DCI) and clinical outcome, clinical trials in the last few decades focused on prevention of these angiographic spasms. Despite all efforts, no new pharmacological agents have shown to improve patient outcome. As such, it has become clear that our understanding of the pathophysiology of SAH is incomplete and we need to reevaluate our concepts on the complex pathophysiological process following SAH...
February 18, 2017: Neurosurgical Review
https://www.readbyqxmd.com/read/28214994/cancelled-primary-care-appointments-a-prospective-cohort-study-of-diabetic-patients
#3
Sara McComb, Zhiyi Tian, Laura Sands, Ayten Turkcan, Lingsong Zhang, Shree Frazier, Mark Lawley
Patients scheduled for primary care appointments often cancel or no show. For diabetic patients, nonattendance can affect continuity of care and result in higher emergency department (ED) and hospital use. Nonattendance also impacts appointment scheduling, patient access, and clinic work load. While no show has received significant attention, little research has addressed the prevalence and impact of appointment cancellation. Data on 46,710 appointments for 7586 adult diabetic patients was used to conduct a prospective cohort study examining primary care appointment behavior...
April 2017: Journal of Medical Systems
https://www.readbyqxmd.com/read/28214992/data-mining-in-hiv-aids-surveillance-system-application-to-portuguese-data
#4
Alexandra Oliveira, Brígida Mónica Faria, A Rita Gaio, Luís Paulo Reis
The Human Immunodeficiency Virus (HIV) is an infectious agent that attacks the immune system cells. Without a strong immune system, the body becomes very susceptible to serious life threatening opportunistic diseases. In spite of the great progresses on medication and prevention over the last years, HIV infection continues to be a major global public health issue, having claimed more than 36 million lives over the last 35 years since the recognition of the disease. Monitoring, through registries, of HIV-AIDS cases is vital to assess general health care needs and to support long-term health-policy control planning...
April 2017: Journal of Medical Systems
https://www.readbyqxmd.com/read/28214989/exposure-response-analyses-of-blood-pressure-and-heart-rate-changes-for-methylphenidate-in-healthy-adults
#5
Liang Li, Yaning Wang, Ramana S Uppoor, Mehul U Mehta, Tiffany Farchione, Mitchell V Mathis, Hao Zhu
The aim of the study was to evaluate the exposure-response (E-R) relationships of blood pressure (BP) and heart rate (HR) changes in healthy adults taking methylphenidate (MPH). Intensive time profiles of BP and HR from healthy adults in placebo and MPH treatment arms of seven clinical trials from the FDA internal database were utilized for this analysis. The analysis model contains a circadian component for placebo effect and an E-R component to describe drug effect. Internal validation was performed using goodness-of-fit plots and visual predictive check...
February 18, 2017: Journal of Pharmacokinetics and Pharmacodynamics
https://www.readbyqxmd.com/read/28214925/missed-opportunities-in-neonatal-deaths-in-rwanda-applying-the-three-delays-model-in-a-cross-sectional-analysis-of-neonatal-death
#6
Efua Wilmot, Marcel Yotebieng, Alison Norris, Fidele Ngabo
Objective Administered in a timely manner, current evidence-based interventions could reduce neonatal deaths from infections, intrapartum injuries and complications due to prematurity. The three delays model (delay in seeking care, in arriving at a health facility, and in receiving adequate care), which has been applied to understanding maternal deaths, may be useful for understanding neonatal deaths. We assess the main causes of neonatal deaths in Rwanda and their associated delays. Methods Using a cross-sectional study design, we evaluated data from 2012 from 40 facilities in which babies were delivered...
February 18, 2017: Maternal and Child Health Journal
https://www.readbyqxmd.com/read/28214871/restraint-stress-during-pregnancy-rapidly-raises-kynurenic-acid-levels-in-mouse-placenta-and-fetal-brain
#7
Francesca M Notarangelo, Robert Schwarcz
Stressful events during pregnancy adversely affect brain development and may increase the risk of psychiatric disorders later in life. Early changes in the kynurenine (KYN) pathway (KP) of tryptophan (TRP) degradation, which contains several neuroactive metabolites, including kynurenic acid (KYNA), 3-hydroxykynurenine (3-HK), and quinolinic acid (QUIN), may constitute a molecular link between prenatal stress and delayed pathological consequences. To begin testing this hypothesis experimentally, we examined the effects of a 2-h restraint stress on KP metabolism in pregnant FVB/N mice on gestational day 17...
February 18, 2017: Developmental Neuroscience
https://www.readbyqxmd.com/read/28214793/evaluation-of-timing-and-route-of-epinephrine-in-a-neonatal-model-of-asphyxial-arrest
#8
Payam Vali, Praveen Chandrasekharan, Munmun Rawat, Sylvia Gugino, Carmon Koenigsknecht, Justin Helman, William J Jusko, Bobby Mathew, Sara Berkelhamer, Jayasree Nair, Myra H Wyckoff, Satyan Lakshminrusimha
BACKGROUND: Epinephrine administered by low umbilical venous catheter (UVC) or endotracheal tube (ETT) is indicated in neonates who fail to respond to positive pressure ventilation and chest compressions at birth. Pharmacokinetics of ETT epinephrine via fluid-filled lungs or UVC epinephrine in the presence of fetal shunts is unknown. We hypothesized that epinephrine administered by ETT or low UVC results in plasma epinephrine concentrations and rates of return of spontaneous circulation (ROSC) similar to right atrial (RA) epinephrine...
February 18, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28214595/the-impact-of-delayed-infusion-time-in-umbilical-cord-blood-transplantation
#9
R Mitchell, J E Wagner, C Brunstein, Q Cao, D H McKenna, M R Verneris
In umbilical cord blood (UCB) transplantation, UCB units are typically thawed, washed and infused into the patient as rapidly as possible. In some instances, there is a delay in the time from the unit thaw/wash procedure to infusion into the patient. Therefore, we examined the effect of thaw duration time on engraftment outcomes in 567 patients undergoing UCB transplantation. With a range of 32 to 523 minutes, a prolonged thaw duration had no obvious effect on the incidence of neutrophil engraftment or time to recovery...
February 15, 2017: Biology of Blood and Marrow Transplantation
https://www.readbyqxmd.com/read/28214506/comparison-of-the-extent-of-coronary-artery-disease-in-patients-with-versus-without-interatrial-block-and-implications-for-new-onset-atrial-fibrillation
#10
Bryce Alexander, Jimmy MacHaalany, Brandon Lam, Henri van Rooy, Sohaib Haseeb, Adrian Kuchtaruk, Benedict Glover, Antoni Bayés de Luna, Adrian Baranchuk
Interatrial block (IAB) represents delay or block of conduction between the atria. IAB has been shown to predict the development or recurrence of atrial fibrillation (AF) in various clinical scenarios. Few studies have examined the correlation between coronary artery disease and the prevalence of IAB and its impact on AF. The aim of this study was to determine if specific coronary artery lesions (location and number) are associated with the presence of IAB and development of new-onset AF. Retrospective analysis of patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI) to our institution...
January 25, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28214449/-they-treated-me-like-crap-and-i-know-it-was-because-i-was-native-the-healthcare-experiences-of-aboriginal-peoples-living-in-vancouver-s-inner-city
#11
Ashley Goodman, Kim Fleming, Nicole Markwick, Tracey Morrison, Louise Lagimodiere, Thomas Kerr
There is growing evidence that Aboriginal peoples often experience healthcare inequalities due to racism. However, research exploring the healthcare experiences of Aboriginal peoples who use illicit substances is limited, and research rarely accounts for how multiple accounts of stigma intersect and contribute to the experiences of marginalized populations. Our research aimed to explore the healthcare experiences of Aboriginal peoples who use illicit drugs and or illicit alcohol (APWUID/A) living in Vancouver's inner city...
January 26, 2017: Social Science & Medicine
https://www.readbyqxmd.com/read/28214333/early-and-continued-manual-stimulation-is-required-for-long-term-recovery-after-facial-nerve-injury
#12
Maria Grosheva, Svenja Rink, Ramona Jansen, Habib Bendella, Stoyan P Pavlov, Levent Sarikcioglu, Doychin N Angelov, Sarah A Dunlop
INTRODUCTION: We showed previously that manual stimulation (MS) of vibrissal muscles for 2 months after facial nerve injury (FFA) in rats improves whisking and reduces motor endplate poly-innervation. Here, we asked whether discontinuing or delaying MS after FFA would also lead to similar results. METHODS: Rats were subjected to FFA and received MS for: i) 4 months ("early & continued"), ii) the first but not the last 2 months ("discontinued"), or iii) the last 2 months ("delayed")...
February 18, 2017: Muscle & Nerve
https://www.readbyqxmd.com/read/28214142/-a-case-of-rhinofacial-entomophthoromycosis-in-soudano-sahelian-tropical-climate-in-burkina-faso
#13
S Bamba, V Konsegré, A Zida, I Sangaré, M Cissé, R Beogo, B Diallo, J B Andonaba, R T Guiguemdé
We describe a rhinofacial entomophthoramycosis case in a sexagenarian (65 years old) housewife. She was immunocompetent and resident of Burkina Faso. She consulted both the service of dermatology and the service of stomatology of the Teaching Hospital of Bobo-Dioulasso in February 2016 for a diffuse facial tumefaction evolving over six months. This tumefaction was associated with headaches and a left nasal obstruction. Histological examination of the lesion showed an important and polymorphic inflammatory reaction...
February 14, 2017: Journal de Mycologie Médicale
https://www.readbyqxmd.com/read/28214061/open-physeal-fracture-of-the-distal-phalanx-of-the-hallux-case-study-diagnosis-and-management
#14
Brandon Morris, Scott Mullen, Paul Schroeppel, Bryan Vopat
Open physeal fractures of the distal phalanx of the hallux are the lesser described counterpart to the same fracture of the finger, known by its eponym as a "Seymour fracture". Displaced Salter-Harris phalangeal fractures present with a concomitant nailbed or soft tissue injury. Often these fractures occur in the summer months when open-toe footwear can be worn, however, they may occur indoors as well. Frequently, the injury results from direct axial load of the toe, or "stubbing", which causes the fracture and associated soft tissue injury...
February 6, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28214036/impact-of-filling-gas-on-subharmonic-emissions-of-phospholipid-ultrasound-contrast-agents
#15
Emma Kanbar, Damien Fouan, Charles A Sennoga, Alexander A Doinikov, Ayache Bouakaz
Subharmonic signals backscattered from gas-filled lipid-shelled microbubbles have generated significant research interest because they can improve the detection and sensitivity of contrast-enhanced ultrasound imaging. However, the emission of subharmonic signals is strongly characterized by a temporal dependence, the origins of which have not been sufficiently elucidated. The features that influence subharmonic emissions need to be identified not only to better develop next-generation microbubble contrast agents, but also to develop more efficient subharmonic imaging (SHI) modes and therapeutic strategies...
February 14, 2017: Ultrasound in Medicine & Biology
https://www.readbyqxmd.com/read/28213887/rituals-improve-children-s-ability-to-delay-gratification
#16
Veronika Rybanska, Ryan McKay, Jonathan Jong, Harvey Whitehouse
To be accepted into social groups, individuals must internalize and reproduce appropriate group conventions, such as rituals. The copying of such rigid and socially stipulated behavioral sequences places heavy demands on executive function. Given previous research showing that challenging executive functioning improves it, it was hypothesized that engagement in ritualistic behaviors improves children's executive functioning, in turn improving their ability to delay gratification. A 3-month circle time games intervention with 210 schoolchildren (Mage  = 7...
February 18, 2017: Child Development
https://www.readbyqxmd.com/read/28213813/waiting-time-variation-in-early-intervention-psychosis-services-longitudinal-evidence-from-the-sepea-naturalistic-cohort-study
#17
James B Kirkbride, Y Hameed, L Wright, K Russell, C Knight, J Perez, P B Jones
PURPOSE: Early Intervention Psychosis [EIP] services have gained traction internationally, but are currently undergoing various forms of reconfiguration. In England, such services are now mandated to ensure 50% of accepted referrals commence care within 14 days, but no empirical evidence exists. We sought to estimate waiting times to EIP services in a large, representative epidemiological cohort in England, and investigate possible reasons for any variation. METHODS: We estimated median waiting time from referral to acceptance by EIP services and investigated whether this varied by clinical, demographic or neighbourhood-level factors, amongst 798 participants, 16-35 years old, presenting to six EIP services over 3...
February 18, 2017: Social Psychiatry and Psychiatric Epidemiology
https://www.readbyqxmd.com/read/28213769/the-patients-experience-of-a-bladder-cancer-diagnosis-a-systematic-review-of-the-qualitative-evidence
#18
REVIEW
Amanda J Edmondson, Jacqueline C Birtwistle, James W F Catto, Maureen Twiddy
PURPOSE: Bladder cancer (BC) is a common disease with disparate treatment options and variable outcomes. Despite the disease's high prevalence, little is known of the lived experience of affected patients. National patient experience surveys suggest that those with BC have poorer experiences than those with other common cancers. The aim of this review is to identify first-hand accounts of the lived experiences of diagnosis through to survivorship. METHOD: This is a systematic review of the qualitative evidence reporting first-hand accounts of the experiences of being diagnosed with, treated for and surviving bladder cancer...
February 17, 2017: Journal of Cancer Survivorship: Research and Practice
https://www.readbyqxmd.com/read/28213670/emerging-genotype-phenotype-relationships-in-patients-with-large-nf1-deletions
#19
REVIEW
Hildegard Kehrer-Sawatzki, Victor-Felix Mautner, David N Cooper
The most frequent recurring mutations in neurofibromatosis type 1 (NF1) are large deletions encompassing the NF1 gene and its flanking regions (NF1 microdeletions). The majority of these deletions encompass 1.4-Mb and are associated with the loss of 14 protein-coding genes and four microRNA genes. Patients with germline type-1 NF1 microdeletions frequently exhibit dysmorphic facial features, overgrowth/tall-for-age stature, significant delay in cognitive development, large hands and feet, hyperflexibility of joints and muscular hypotonia...
February 17, 2017: Human Genetics
https://www.readbyqxmd.com/read/28213522/type-i-interferon-regulated-gene-expression-and-signaling-in-murine-mixed-glial-cells-lacking-signal-transducers-and-activators-of-transcription-1-or-2-or-interferon-regulatory-factor-9
#20
Wen Li, Markus J Hofer, Pattama Songkhunawej, So Ri Jung, Dale Hancock, Gareth Denyer, Iain L Campbell
Type I interferons (IFN-I) are critical in antimicrobial and antitumor defense. Although IFN-I signal via the interferon-stimulated gene factor 3 (ISGF3) complex consisting of STAT1, STAT2 and IRF9, IFN-I can mediate significant biological effects via ISGF3-independent pathways. For example, absence of STAT1, STAT2 or IRF9 exacerbates neurological disease in transgenic mice with CNS-production of IFN-Ι. Here we determined the role of IFN-I-driven, ISGF3-independent signaling in regulating global gene expression in STAT1, STAT2 or IRF9-deficient murine mixed glial cell cultures (MGCs)...
February 17, 2017: Journal of Biological Chemistry
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