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Critical care

Ron J Smith
BACKGROUND: Siege, a process of political domination aimed at isolating an entire population, is a unique threat to health-care provision. The aim of this study was to qualitatively examine the effects of the Israeli siege on the practices and systems that underlie health in the Gaza Strip. METHODS: Data were from participant observation between 2009 and 2017, including 20 interviews with doctors and health administrators in non-governmental organisations (NGO), government, and UN sectors...
February 21, 2018: Lancet
Adrien Koeltz, Stephane Lastere, Sylvain Jean-Baptiste
During the 2014-2015 chikungunya outbreak in French Polynesia, 64 patients with confirmed chikungunya virus infection were admitted into intensive care. Sixty-three were nonpregnant adults; 11 had an atypical form, 21 had severe sepsis or septic shock, and 18 died. These findings indicate that critical illness frequently complicates the course of chikungunya virus infection.
April 2018: Emerging Infectious Diseases
Cuirong Zhao, Chao Wang, Chengwu Shen, Qian Wang
China has undertaken waves of healthcare reforms to keep pace with its rapid economic growth. By 2011, universal health insurance coverage was successfully achieved through the creation of a basic social medical insurance system. Growing economic power, extensive government subsidies, and strategies for program implementation are critical to that achievement. However, the breadth and depth of coverage varies considerably across insurance schemes and localities. The disjointed insurance scheme led to inequality in coverage, accessibility, and affordability of medical services, lopsided allocation of health resources, and increasing medical expenditures, and these remain crucial challenges for healthcare insurance coverage...
2018: Drug Discoveries & Therapeutics
Tamara Sussman, Shari Brotman, Heather MacIntosh, Line Chamberland, Judith MacDonnell, Andrea Daley, Jean Dumas, Molly Churchill
It is critical to ensure that long-term care (LTC) homes are sensitive to the needs of lesbian, gay, bisexual, and transgender (LGBT) older adults. However, the extent to which the LTC home sector has adopted recommended strategies is unknown. This qualitative study reports findings from two initiatives: Semi-structured telephone interviews with Canadian LTC home administrators on strategies adopted to support LGBT inclusivity (n = 32), and discussions with participants attending a 2-day meeting on supporting LGBT inclusivity in LTC (n = 25)...
March 19, 2018: Canadian Journal on Aging, la Revue Canadienne du Vieillissement
Hayley B Gershengorn, Carri W Chan, Yunchao Xu, Hanxi Sun, Ronni Levy, Mor Armony, Michelle N Gong
OBJECTIVE: To understand the impact of adding a medical step-down unit (SDU) on patient outcomes and throughput in a medical intensive care unit (ICU). DESIGN: Retrospective cohort study. SETTING: Two academic tertiary care hospitals within the same health-care system. PATIENTS: Adults admitted to the medical ICU at either the control or intervention hospital from October 2013 to March 2014 (preintervention) and October 2014 to March 2015 (postintervention)...
January 1, 2018: Journal of Intensive Care Medicine
Craig M Lilly, Omar Badawi, Xinggang Liu, Gill Christine S, Ilene Harris
OBJECTIVE: To determine whether patients transfused red blood cell (RBC) products according to guideline-specified pretransfusion hemoglobin (Hb) concentrations or for other reasons were more likely to survive their intensive care unit (ICU) stay. DESIGN: An observational study of 375 478 episodes of ICU care, over 5 years, was performed with ICU survival as the primary outcome. Outcomes were analyzed as a function of pretransfusion Hb concentration for groups with distinct transfusion indications while adjusting for potential confounders...
January 1, 2018: Journal of Intensive Care Medicine
Horng-Ruey Chua, Weng-Kin Wong, Venetia Huiling Ong, Dipika Agrawal, Anantharaman Vathsala, Hui-Ming Tay, Amartya Mukhopadhyay
PURPOSE: To evaluate 1-year mortality in patients with septic acute kidney injury (AKI) and to determine association between initial AKI recovery patterns ( reversal within 5 days, beyond 5 days but recovery, or nonrecovery) and chronic kidney disease (CKD) progression. METHODS: Prospective observational study, with retrospective evaluation of initial nonconsenters, of critically ill patients with septic AKI. RESULTS: We studied 207 patients (age, mean [SD]: 64 [16] years, 39% males), of which 56 (27%), 18 (9%), and 9 (4%) died in intensive care unit (ICU), post-ICU in hospital, and posthospitalization, respectively...
January 1, 2018: Journal of Intensive Care Medicine
Victoria E Jackson, Helen Hurst, Sandip Mitra
INTRODUCTION: Arteriovenous fistulae remain the gold standard of vascular access in haemodialysis. There is currently no consensus on standardised methods of monitoring arteriovenous fistulae. Assessment techniques and practice remain widely variable. The purpose of this study is to determine whether existing evidence supports physical assessment as an effective tool and a good predictor of arteriovenous fistulae dysfunction to allow for timely intervention and improve outcomes. METHODS: A literature search was performed using CINAHL, PubMed, Medline and BNI databases and relevant search terms...
March 1, 2018: Journal of Vascular Access
Michael F Canarie, Asha N Shenoi
No abstract text is available yet for this article.
2018: Frontiers in Pediatrics
Luisa Flohr, Shaylene Beaudry, K Taneille Johnson, Nicholas West, Catherine M Burns, J Mark Ansermino, Guy A Dumont, David Wensley, Peter Skippen, Matthias Gorges
The pediatric intensive care unit (ICU) is a complex environment, in which a multidisciplinary team of clinicians (registered nurses, respiratory therapists, and physicians) continually observe and evaluate patient information. Data are provided by multiple, and often physically separated sources, cognitive workload is high, and team communication can be challenging. Our aim is to combine information from multiple monitoring and therapeutic devices in a mobile application, the VitalPAD , to improve the efficiency of clinical decision-making, communication, and thereby patient safety...
2018: IEEE Journal of Translational Engineering in Health and Medicine
Sandra Grace, Roger Engel, Ian Jalsion
The Australian chiropractic and osteopathic professions underwent a period of significant transformation between 1960 and 2000. This resulted in an improvement in the views held by the medical profession towards the two professions. However, a recent survey of Australian general practitioners (GPs) reported that a number of GPs still hold negative views towards chiropractors and osteopaths. This paper examines these views from the perspective of critical realism and explores the generative mechanisms that can influence the willingness of health practitioners to collaborate over patient care...
2018: Evidence-based Complementary and Alternative Medicine: ECAM
Rupert Page, Rohit Shankar, Brendan N McLean, Jane Hanna, Craig Newman
Epilepsy is associated with a significant increase in morbidity and mortality. The likelihood is significantly greater for those patients with specific risk factors. Identifying those at greatest risk of injury and providing expert management from the earliest opportunity is made more challenging by the circumstances in which many such patients present. Despite increasing recognition of the importance of earlier identification of those at risk, there is little or no improvement in outcomes over more than 30 years...
2018: Frontiers in Neurology
Joshua T Eggold, Erinn B Rankin
The regulation of erythropoiesis in the bone marrow microenvironment is a carefully orchestrated process that is dependent upon both systemic and local cues. Systemic erythropoietin (EPO) production by renal interstitial cells plays a critical role in maintaining erythropoietic homeostasis. In addition, there is increasing clinical and preclinical data linking changes in EPO and erythropoiesis to altered skeletal homeostasis, suggesting a functional relationship between the regulation of erythropoiesis and bone homeostasis...
March 15, 2018: Bone
Ingrid Zyserman, Deboprosad Mondal, Francisco Sarabia, James H McKerrow, William R Roush, Anjan Debnath
Primary amebic meningoencephalitis (PAM) is a rapidly fatal infection caused by the free-living ameba Naegleria fowleri. PAM occurs principally in healthy children of less than 13 years old with a history of recent exposure to warm fresh water. While as yet not a reportable disease, the Centers for Disease Control and Prevention (CDC) documents a total of 143 cases in the United States. Only four patients have survived. Infection results from water containing N. fowleri entering the nose, followed by migration of the amebae to the brain...
March 15, 2018: Experimental Parasitology
Raimund Lechner, Thomas Küpper, Markus Tannheimer
INTRODUCTION: History is full of examples of the influence of the mountain environment on warfare. The aim of this article is to identify the main environmental hazards and summarize countermeasures to mitigate the impact of this unique environment. METHODS: A selective PubMed and Internet search was conducted. Additionally, we searched bibliographies for useful supplemental literature and included the recommendations of the leading mountain medicine and wilderness medicine societies...
March 15, 2018: Wilderness & Environmental Medicine
Kimberly Joseph, Sameer Gupta, James Yon, Renee Partida, Lee Cartagena, John Kubasiak, Vanessa Buie, Jared Miller, Dorion Wiley, Kimberly Nagy, Frederic Starr, Andrew Dennis, Matthew Kaminsky, Faran Bokhari
BACKGROUND: Checklists have been advocated to improve quality outcomes/communication in the critical care setting, but results have been mixed. A new checklist process, "TRAUMA LIFE", was implemented in our Trauma Intensive Care Unit (TICU) to replace prior checklists. The purpose of this study was to evaluate the impact of the "TRAUMA LIFE" process implementation on quality metrics and on patient/family communication in the TICU. METHODS: "TRAUMA LIFE" was considered maturely implemented by 2016...
March 9, 2018: American Journal of Surgery
D Díaz-Díaz, M Villanova Martínez, E Palencia Herrejón
OBJECTIVE: To analyze the factors influencing in-hospital mortality among cancer patients admitted to an Intensive Care Unit (ICU). DESIGN: A retrospective observational study was carried out. SETTING: The ICU of a community hospital. PATIENTS: Adults diagnosed with solid or hematological malignancies admitted to the ICU, excluding those admitted after scheduled surgery and those with an ICU stay of under 24h. INTERVENTIONS: Review of clinical data...
March 15, 2018: Medicina Intensiva
Hannah Lee, Jae-Woo Ju, Seung-Young Oh, Jeongsoo Kim, Chul Woo Jung, Ho Geol Ryu
BACKGROUND: Recent reports suggest that not all critically ill patients with delirium share the same consequences. The outcomes of surgical intensive care unit patients with postoperative delirium were evaluated depending on the onset and duration of delirium. METHODS: A total of 527 patients who were admitted from the operating theater and cared for in the surgical intensive care unit for >24 hours were evaluated for delirium using the Confusion Assessment Method for intensive care unit, 3 times a day...
March 15, 2018: Surgery
Sophia Merisier, Caroline Larue, Louise Boyer
BACKGROUND: Problem-based learning is an educational method promoting clinical reasoning that has been implemented in many fields of health education. Questioning is a learning strategy often employed in problem-based learning sessions. AIM: To explore what is known about the influence of questioning on the promotion of clinical reasoning of students in health care education, specifically in the field of nursing and using the educational method of problem-based learning...
March 10, 2018: Nurse Education Today
Yan Zhang, Ricardo S Hattori, Munti Sarida, Estefany C García, Carlos Augusto Strüssmann, Yoji Yamamoto
To shed light on the mechanisms of and interactions of GSD and TSD in pejerrey, we investigated how the transcriptional profiles of amhy and amha are affected by feminizing (17°C) and masculinizing (29°C) temperatures during the critical period of sex determination/differentiation and their relation with the expression profiles of AMH receptor type II (amhrII), gonadal aromatase (cyp19a1a), and 11 beta-hydroxysteroid dehydrogenase 2 (hsd11b2). Careful consideration of the results of this study and all information currently available for this species, including similar analyzes for an intermediate, mixed-sex promoting temperature (25°C), suggests a model for genotypic/temperature-dependent sex determination and gonadal sex differentiation that involves a) cyp19a1a-dependent, developmentally-programmed ovarian development as the default state that becomes self-sustaining in the absence of a potent and timely masculinizing stimulus, b) early, developmentally-programmed amhy expression and high temperature as masculinization signals that antagonize the putative female pathway by suppressing cyp19a1a expression, c) increasing stress response, cortisol, and the synthesis of the masculinizing androgen 11-keto-testosterone via hsd11b2 with increasing temperature that is important for masculinization in both genotypes but particularly so in XX individuals, and d) an endocrine network with positive/negative feedback mechanisms that ensure fidelity of the male/female pathway once started...
March 14, 2018: General and Comparative Endocrinology
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