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https://www.readbyqxmd.com/read/29444340/antipsychotics-delirium-and-acute-respiratory-distress-syndrome-what-is-the-link
#1
Heather Torbic, Abhijit Duggal
Acute respiratory distress syndrome (ARDS) is an acute inflammatory process that impairs the ability of the lungs to oxygenate and ultimately leads to respiratory failure. Patients who develop ARDS often have prolonged and complicated hospital courses putting them at risk for intensive care unit (ICU) delirium. Patients with ICU delirium often need chemical sedation, mechanical ventilation, prolonged duration of ICU and hospital stays, long-term cognitive impairment, and increased mortality. In a patient with ARDS, ICU delirium further complicates the hospital course and increases the risk of morbidly and mortality...
February 14, 2018: Pharmacotherapy
https://www.readbyqxmd.com/read/29436441/sepsis-thoughtful-management-for-the-non-expert
#2
Robert Tidswell, Mervyn Singer
Sepsis is a common and often devastating medical emergency with a high mortality rate and, in many survivors, long-term morbidity. It is defined as the dysregulated host response to infection resulting in organ dysfunction, and its incidence is increasing as the population ages. However, it is a treatable and potentially reversible condition, especially if identified and treated promptly. A sound understanding of sepsis is crucial for optimal care. Although general guidelines are available for management, here we provide a foundation of understanding to encourage thoughtful, personalised management of sepsis during the acute phase...
February 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/29435847/supportive-care-for-the-head-and-neck-cancer-patient
#3
Sorin Buga, Chandana Banerjee, Jaroslava Salman, Marissa Cangin, Finly Zachariah, Bonnie Freeman
Patients with head and neck cancers (HNC) face multiple psychosocial and physical challenges that require multidisciplinary attention and care throughout their disease process. The psychoemotional symptoms may be triggered by cosmetic disfigurement and/or functional deficits related to the cancer itself or cancer-directed treatments. These physical and emotional symptoms can be demoralizing and require acute and long-term professional assistance throughout a patient's lifespan. HNC remains one of the most challenging cancers to treat due to disfigurement, emotional suffering, social isolation, and loss of self-esteem...
2018: Cancer Treatment and Research
https://www.readbyqxmd.com/read/29435806/critical-west-nile-neuroinvasive-disease
#4
Maximiliano A Hawkes, Ivan D Carabenciov, Eelco F M Wijdicks, Alejandro A Rabinstein
BACKGROUND: Data to guide neurointensivists seeing patients with West Nile Neuroinvasive disease (WNND) are lacking. We present a comparatively large series of patients with WNND admitted to the intensive care unit (ICU) and provide data on their early diagnosis, triage to the ICU and predictors of short-term outcomes. METHODS: We retrospectively identified patients aged ≥ 18 years old with WNND from January 1999 to November 2016. Demographic and clinical data, the modified Rankin Scale at discharge and disposition were collected...
February 12, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29432405/interhospital-transport-of-critically-ill-children-to-picus-in-the-united-kingdom-and-republic-of-ireland-analysis-of-an-international-dataset
#5
Padmanabhan Ramnarayan, Konstantinos Dimitriades, Lynsey Freeburn, Aravind Kashyap, Michaela Dixon, Peter W Barry, Kathryn Claydon-Smith, Allan Wardhaugh, Caroline R Lamming, Elizabeth S Draper
OBJECTIVES: International data on characteristics and outcomes of children transported from general hospitals to PICUs are scarce. We aimed to 1) describe the development of a common transport dataset in the United Kingdom and Ireland and 2) analyze transport data from a recent 2-year period. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Specialist pediatric critical care transport teams and PICUs in the United Kingdom and Ireland...
February 9, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29431027/a-controlled-trial-of-sheng-yu-tang-for-post-hematopoietic-stem-cell-transplantation-leukemia-patients-a-proposed-protocol-and-insights-from-a-preliminary-pilot-study
#6
Tom Fleischer, Tung-Ti Chang, Jen-Huai Chiang, Hung-Rong Yen
Hematopoietic stem cell transplantation has become a well-established treatment for hematologic disorders including acute leukemia. However, long-term survival rates following this procedure are still extremely low, due to posttransplantation relapse, infections, and graft-versus-host disease. We propose that adjunctive Chinese herbal medicine may benefit posttransplantation patients. In preparation for a randomized clinical trial, we conducted a pilot trial. Methods and Analysis: Between September 2015 and June 2017, 18 patients were consecutively enrolled at China Medical University Hospital and followed for up to 1 year...
February 1, 2018: Integrative Cancer Therapies
https://www.readbyqxmd.com/read/29430447/mechanisms-involved-in-brain-dysfunction-in-mechanically-ventilated-critically-ill-patients-implications-and-therapeutics
#7
REVIEW
Marc Turon, Sol Fernández-Gonzalo, Candelaria de Haro, Rudys Magrans, Josefina López-Aguilar, Lluís Blanch
Critical illness may lead to significant long-term neurological morbidity and patients frequently develop neuropsychological disturbances including acute delirium or memory impairment after intensive care unit (ICU) discharge. Mechanical ventilation (MV) is a risk factor to the development of adverse neurocognitive outcomes. Patients undergoing MV for long periods present neurologic impairment with memory and cognitive alteration. Delirium is considered an acute form of brain dysfunction and its prevalence rises in mechanically ventilated patients...
January 2018: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29427800/new-insights-into-transmission-of-clostridium-difficile-infection-a-narrative-review
#8
REVIEW
Ana Durovic, Andreas Widmer, Sarah Tschudin Sutter
BACKGROUND: Traditionally, Clostridium difficile has been considered a typical healthcare-associated pathogen - transmitted within healthcare facilities and thus prevented by implementation of standard infection control measures. More recently, this concept has been challenged by studies suggesting a relevant role for community-acquisition of C. difficile. AIMS: To discusses the current literature, compiled during the last decade, reporting on sources of acquisition of C...
February 7, 2018: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/29426299/the-delirium-and-population-health-informatics-cohort-study-protocol-ascertaining-the-determinants-and-outcomes-from-delirium-in-a-whole-population
#9
Daniel Davis, Sarah Richardson, Joanne Hornby, Helen Bowden, Katrin Hoffmann, Maryse Weston-Clarke, Fenella Green, Nishi Chaturvedi, Alun Hughes, Diana Kuh, Elizabeth Sampson, Ruth Mizoguchi, Khai Lee Cheah, Melanie Romain, Abhi Sinha, Rodric Jenkin, Carol Brayne, Alasdair MacLullich
BACKGROUND: Delirium affects 25% of older inpatients and is associated with long-term cognitive impairment and future dementia. However, no population studies have systematically ascertained cognitive function before, cognitive deficits during, and cognitive impairment after delirium. Therefore, there is a need to address the following question: does delirium, and its features (including severity, duration, and presumed aetiologies), predict long-term cognitive impairment, independent of cognitive impairment at baseline? METHODS: The Delirium and Population Health Informatics Cohort (DELPHIC) study is an observational population-based cohort study based in the London Borough of Camden...
February 9, 2018: BMC Geriatrics
https://www.readbyqxmd.com/read/29421293/chronic-ocular-sequelae-of-stevens-johnson-syndrome-in-children-long-term-impact-of-appropriate-therapy-on-natural-history-of-disease
#10
Sayan Basu, Swapna S Shanbhag, Arjun Gokani, Richa Kedar, Chirag Bahuguna, Virender S Sangwan
PURPOSE: To describe the long-term ocular and visual morbidity in children with chronic sequelae of Stevens-Johnson Syndrome (SJS) and visual outcomes of various management strategies. DESIGN: Retrospective comparative case series. METHODS: This study included 568 eyes of 284 children with SJS who presented between 1990 and 2015. Affected eyes either received conservative therapy (n=440) or definitive management (n=128) including lid margin mucous membrane grafting (MMG), prosthetic replacement of the ocular surface ecosystem (PROSE) contact lenses, allogeneic limbal transplantation or keratoprosthesis using an algorithmic approach based on the severity of dryness and cause and extent of corneal damage...
February 5, 2018: American Journal of Ophthalmology
https://www.readbyqxmd.com/read/29420730/clinical-differences-between-men-and-women-undergoing-surgery-for-acute-type-a-aortic-dissection
#11
Tomoaki Suzuki, Tohru Asai, Takeshi Kinoshita
OBJECTIVES: The differences in clinical features, surgical outcome and long-term prognosis between men and women who undergo surgery for Type A aortic dissection are not well known. METHODS: From January 2004 to December 2016, 303 patients, consisting of 147 women and 156 men, underwent surgery for acute Type A aortic dissection at our institution. We compared clinical outcomes between the 2 cohorts. RESULTS: Women were older than men (72...
February 6, 2018: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29420142/the-surprise-question-and-identification-of-palliative-care-needs-among-hospitalized-patients-with-advanced-hematologic-or-solid-malignancies
#12
Kathryn Elizabeth Hudson, Steven Paul Wolf, Gregory P Samsa, Arif H Kamal, Amy Pickar Abernethy, Thomas William LeBlanc
BACKGROUND: Little is known about quality of life (QOL), depression, and end-of-life (EOL) outcomes among hospitalized patients with advanced cancer. OBJECTIVE: To assess whether the surprise question identifies inpatients with advanced cancer likely to have unmet palliative care needs. DESIGN: Prospective cohort study and long-term follow-up. SETTING/SUBJECTS: From 2008 to 2010, we enrolled 150 inpatients at Duke University with stage III/IV solid tumors or lymphoma/acute leukemia and whose physician would not be surprised if they died in less than one year...
February 8, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29417604/effects-of-alcohol-on-the-brain-in-cirrhosis-beyond-hepatic-encephalopathy
#13
Brian C Davis, Jasmohan S Bajaj
Recent advances have led to a greater understanding of how alcohol alters the brain, both in acute stages (intoxication and alcohol withdrawal) and in chronic misuse. This review focuses on the current understanding of how alcohol affects the brain in cirrhosis patients with and without hepatic encephalopathy. Chronic alcohol use is associated with nutritional deficiencies, dementia, cirrhosis, and decompensating events such as hepatic encephalopathy. Direct toxicity on brain tissue, induction of neuro-inflammation, and alcohol's alterations of the gut microbiome are possible mechanisms for the clinical features of hepatic encephalopathy associated with alcohol use...
February 8, 2018: Alcoholism, Clinical and Experimental Research
https://www.readbyqxmd.com/read/29417223/relationship-between-blood-urea-nitrogen-to-creatinine-ratio-at-hospital-admission-and-long-term-mortality-in-patients-with-acute-decompensated-heart-failure
#14
Azusa Murata, Takatoshi Kasai, Yuya Matsue, Hiroki Matsumoto, Shoichiro Yatsu, Takao Kato, Shoko Suda, Masaru Hiki, Atsutoshi Takagi, Hiroyuki Daida
Although elevated blood urea nitrogen (BUN)-to-creatinine (BUN/Cr) ratio at hospital admission has been reported to be associated with poor short-term prognosis, its association to long-term mortality in patients with acute decompensated heart failure (ADHF) remains to be elucidated. Moreover, an additive prognostic value to preexisting renal markers including creatinine and BUN has not been well described. A cohort of 557 consecutive ADHF patients admitted to the cardiac intensive care unit was studied. All cohorts were divided into high and low BUN/Cr ratios according to the median value of BUN/Cr ratio at admission...
February 7, 2018: Heart and Vessels
https://www.readbyqxmd.com/read/29413157/strategies-to-promote-infection-prevention-and-control-in-acute-care-hospitals-with-the-help-of-infection-control-link-nurses-a-systematic-literature-review
#15
REVIEW
Daniel Peter, Michael Meng, Christiane Kugler, Frauke Mattner
BACKGROUND: Infection control link nurses (ICLNs) are important backup personnel for the prevention and control of infections in hospitals. To identify facilitators and barriers for the implementation of and long-term collaboration with ICLNs. METHODS: We conducted a systematic literature review, following the preferred reporting items for systematic reviews and meta-analyses guidelines. Inclusion criteria were defined as description of de novo implementation of an ICLN system, strengthening of an existing ICLN system, or analysis of an ICLN system...
February 2018: American Journal of Infection Control
https://www.readbyqxmd.com/read/29413076/application-of-the-seips-model-to-analyze-medication-safety-in-a-crisis-residential-center
#16
Maria L Steele, Brenda Talley, Karen H Frith
PURPOSE: Medication safety and error reduction has been studied in acute and long-term care settings, but little research is found in the literature regarding mental health settings. Because mental health settings are complex, medication administration is vulnerable to a variety of errors from transcription to administration. The purpose of this study was to analyze critical factors related to a mental health work system structure and processes that threaten safe medication administration practices...
February 2018: Archives of Psychiatric Nursing
https://www.readbyqxmd.com/read/29408207/examining-the-epidemiology-and-microbiology-of-clostridium-difficile-carriage-in-elderly-patients-and-residents-of-a-health-care-facility-in-southern-ontario-canada
#17
Gabriella Mallia, Jane Van Toen, Joyce Rousseau, Latha Jacob, Patrick Boerlin, Amy Greer, Devon Metcalf, JScott Weese
BACKGROUND: While Clostridium difficile has been extensively studied in acute care facilities (ACFs), there is limited information about long-term care facilities (LTCFs), despite the high occurrence of putative risk factors (e.g. age, antimicrobial use, healthcare system contact). AIM: To evaluate C. difficile colonization in elderly patients and residents from ACF and its associated LTCF. METHODS: Stool swabs were collected from 884 LTCF and elderly (>65 years) hospital patients...
February 2, 2018: Journal of Hospital Infection
https://www.readbyqxmd.com/read/29407632/what-have-we-learned-from-real-world-noac-studies-in-venous-thromboembolism-treatment
#18
REVIEW
Jan Beyer-Westendorf
Venous thromboembolism (VTE) remains a substantial clinical and health-economic burden worldwide and effective anticoagulant treatment is necessary immediately after VTE is suspected to reduce short- and long-term VTE related morbidity and mortality. For decades, low molecular weight heparin (LMWH), fondaparinux and Vitamin K antagonists (VKAs) have been the standard of anticoagulant therapy for VTE patients but these treatment options had clinically relevant drawbacks and limitations. The introduction of non-VKA oral anticoagulants (NOACs) that specifically inhibit either thrombin or factor Xa have resolved many of these drawbacks because these new compounds exhibit a rapid onset and offset of action, fewer food and drug interactions and a predictable anticoagulant effect...
January 26, 2018: Thrombosis Research
https://www.readbyqxmd.com/read/29405014/-sharing-perspectives-on-home-healthcare
#19
Pi-Shan Hsu, Jui-An Chen, Yu-Tso Chen, Han-Ming Wu, Szu-Ying Lee, Chung-Liang Lai
The baby boom after World War II, coupled with the rapid advances in medical technology and public health, has led to the current rapid aging in the world's population. Countries in Asia are experiencing a faster rate of aging than most other countries around the world. Taiwan is expected to advance from an aged society to a super-aged society in the next 7~10 years. Consequently, the demand for long-term care is increasing. The focus of healthcare has changed from acute to chronic, from disease-oriented to function-oriented and from cure to care...
February 2018: Hu Li za Zhi the Journal of Nursing
https://www.readbyqxmd.com/read/29404575/factors-associated-with-variation-in-long-term-acute-care-hospital-vs-skilled-nursing-facility-use-among-hospitalized-older-adults
#20
Anil N Makam, Oanh Kieu Nguyen, Lei Xuan, Michael E Miller, James S Goodwin, Ethan A Halm
Importance: Despite providing an overlapping level of care, it is unknown why hospitalized older adults are transferred to long-term acute care hospitals (LTACs) vs less costly skilled nursing facilities (SNFs) for postacute care. Objective: To examine factors associated with variation in LTAC vs SNF transfer among hospitalized older adults. Design, Setting, and Participants: We conducted this retrospective observational cohort study of hospitalized older adults (≥65 years) transferred to an LTAC vs SNF during fiscal year 2012 using national 5% Medicare data...
February 5, 2018: JAMA Internal Medicine
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