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Critical care

Erik Hanson-Viana, Mónica González-Rodríguez, Diego García-Vivanco, Mariel González-Calatayud
INTRODUCTION: Popliteal injuries are significant health risk that could induce permanent functional impairment, limb loss, and in some cases death. Currently, there is a controversy about the required treatment between amputation and a limb salvage surgery, which in some cases could cause more prominent functional impairment than the amputation. Different indicators help to predict, in some extent, the risk of amputation, however most of them were described two decades ago. PRESENTATION OF CASE: A patient with a prolonged hot ischemia and in critical conditions, which had no favorable clinical indicators for revascularization is shown and discussed...
June 20, 2018: International Journal of Surgery Case Reports
Margaret L Prust, Clement K Banda, Katie Callahan, Rose Nyirenda, Frank Chimbwandira, Thokozani Kalua, Michael Eliya, Peter Ehrenkranz, Marta Prescott, Elizabeth McCarthy, Elya Tagar, Andrews Gunda
INTRODUCTION: Several models of differentiated care for stable HIV patients on antiretroviral therapy (ART) in Malawi have been introduced to ensure that care is efficient and patient-centered. Three models have been prioritized by the government for a deeper and broader understanding: adjusted appointment spacing through multi-month scripting (MMS); fast-track drug refills (FTRs) on alternating visits; and community ART groups (CAGs) where rotating group members collect medications at the facility for all members...
2018: PloS One
Mariette Marano, Renee Stein, Wei Song, Deesha Patel, Nicole Taylor-Aidoo, Songli Xu, Lamont Scales
Identifying HIV-infected persons who are unaware of their human immunodeficiency virus (HIV) infection status, linking them to care, and reducing health disparities are important national HIV prevention goals (1). Gay, bisexual, and other men who have sex with men (collectively referred to as MSM) accounted for 70% of HIV infection diagnoses in the United States in 2016, despite representing only 2% of the population (2,3). African American or black (black) MSM accounted for 38% of all new diagnoses of HIV infection among MSM (2)...
July 20, 2018: MMWR. Morbidity and Mortality Weekly Report
Nomathemba Chandiwana, Shobna Sawry, Matthew Chersich, Elizabeth Kachingwe, Bulelani Makhathini, Lee Fairlie
Outcomes of HIV-infected children have improved dramatically over the past decade, but are undermined by patient loss to follow-up (LTFU). We assessed patterns of LTFU among HIV-infected children receiving antiretroviral treatment (ART) at a large inner-city HIV clinic in Johannesburg, South Africa between 2005 and 2014.Demographic and clinical data were extracted from clinic records of children under 12 years. Differences between characteristics of children retained in care and LTFU were assessed using Wilcoxon rank sum tests or Pearson χ tests...
July 2018: Medicine (Baltimore)
Andrew R Pines, Aditya Khurana, George M Mastorakos, Kent R Richter, Walker L Asprey
Certain medical schools have begun teaching courses in health systems science (HSS) to train medical students in skills aimed to improve health care in the United States. Although substantial research has been done on the potential benefit of HSS courses, reactions from students have not been reported. In this Invited Commentary, five medical students who have completed the first year of a longitudinal HSS course at the Arizona campus of the Mayo Clinic School of Medicine offer their observations of how early exposure to HSS affected their reactions to subsequent coursework and current events in health care...
July 17, 2018: Academic Medicine: Journal of the Association of American Medical Colleges
Diane K Brown, Ambrose H Wong, Rami A Ahmed
Interprofessional education (IPE) using simulations provides a rich environment for mastery learning and deliberate practice. The debriefing phase is identified as the most valuable by learners, yet investigation into the most effective format for debriefing interprofessional (IP) groups has largely gone unexplored. To determine the best practices in IP simulation debriefing, we compared perceived effectiveness of in-person versus teledebriefing, and single versus IP co-debriefer models according to 404 Debriefing Assessment for Simulation in Healthcare Student-Version (DASH-SV) scores from students in medicine, nursing, and respiratory therapy (n = 135) following three critical care simulations...
July 19, 2018: Journal of Interprofessional Care
Ata Mahmoodpoor, Mahsa Medghalchi, Hossein Nazemiyeh, Parina Asgharian, Kamran Shadvar, Hadi Hamishehkar
Purpose: Cucurbita maxima Duchense (C. maxima) has been widely used in China and Mexico as a hypoglycemic plant for controlling blood glucose in diabetic patients. Furthermore, in northwest of Iran, this plant is used traditionally for controlling of diabetes. We examined the effect of C. maxima pulp besides insulin on control of hyperglycemia in diabetic patients admitted to Intensive care unit (ICU). Methods: Twenty critically ill patients who were admitted to the ICU were enrolled in this study. 5g lyophilized powder of C...
June 2018: Advanced Pharmaceutical Bulletin
Constantine Melitas, Mick Meiselman
Obesity, insulin resistance, and metabolic syndrome continue to increase in prevalence. Hypertriglyceridemia is commonly associated and represents a valuable marker of metabolic syndrome. An increase in subcutaneous fat deposition places patients at risk for visceral adipose deposition in sites such as the liver, heart, and pancreas. Pancreatic steatosis in the setting of metabolic syndrome is a rapidly emerging entity whose clinical spectrum remains to be defined. Hypertriglyceridemia is an accepted cause of acute pancreatitis but its role in chronic pancreatic injury remains to be explored...
May 2018: Case Reports in Gastroenterology
Steffen Eychmüller, Sibylle Felber
Anticipation at the end of life - a critical appraisal for the clinical practice Abstract. Advance planning or anticipation in health care is based on prognosis, and that is no more (and no less) than dealing with probabilities. Knowledge about prognostic factors in medicine is needed here, and competencies how to communicate it. In medicine, advance planning is currently more and more regarded as an elementary right as an expression of the implementation of patient autonomy - but what content can or must be discussed and defined? The terminology on the subject of "advance planning" is inconsistent both nationally and internationally...
July 2018: Therapeutische Umschau. Revue Thérapeutique
Nancy C Edwards, Kathryn Smith Higuchi
BACKGROUND: Evidence-based improvements in long-term care (LTC) are challenging due to human resource constraints. AIMS: To evaluate implementation of a multimodal, participatory intervention aimed at improving evidence-based care. METHODS: Using a qualitative descriptive design, we conducted and inductively analyzed individual interviews with staff at midpoint and end-point to identify action plan implementation processes and challenges. The 9-month intervention engaged professional and unregulated staff in an on-site workshop and provided support for their development and implementation of site-specific action plans...
July 18, 2018: Worldviews on Evidence-based Nursing
Bridget L Ryan, Krista Bray Jenkyn, Salimah Z Shariff, Britney Allen, Richard H Glazier, Merrick Zwarenstein, Martin Fortin, Moira Stewart
OBJECTIVES: To determine volumes and rates of multimorbidity in Ontario by age group, sex, material deprivation, and geography. METHODS: A cross-sectional population-based study was completed using linked provincial health administrative databases. Ontario residents were classified as having multimorbidity (3+ chronic conditions) or not, based on the presence of 17 chronic conditions. The volumes (number of residents) of multimorbidity were determined by age categories in addition to crude and age-sex standardized rates...
July 18, 2018: Canadian Journal of Public Health. Revue Canadienne de Santé Publique
Dominic O'Connor, Brian Caulfield, Olive Lennon
PURPOSE: This study aims to (1) summarise and critically evaluate the effects of neuromuscular electrical stimulation (NMES) on indices of health and quality of life (QoL) in adult cancer survivors, (2) assess the safety of NMES as a rehabilitation method in this population, and (3) identify commonly used NMES treatment parameters and describe treatment progression. METHODS: A systematic search of four electronic databases targeted studies evaluating the effects of NMES on physical function, aerobic fitness, muscle strength, body composition, and health-related quality of life (HR-QoL) in adult cancer survivors, published through March 2018...
July 18, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Max J Hilz, Mao Liu, Sankanika Roy, Ruihao Wang
Autonomic dysfunction is common in neuro-critical care patients and may compromise the function of various organs. Among the many diseases causing or being associated with autonomic dysfunction are traumatic brain injury, cerebrovascular diseases, epilepsy, Guillain-Barré syndrome (GBS), alcohol withdrawal syndrome, botulism and tetanus, among many others. Autonomic dysfunction may afflict various organs and may involve hyper- or hypo-activity of the sympathetic or parasympathetic system. In this short overview, we address only a small number of neuro-intensive care diseases with autonomic dysfunction...
July 18, 2018: Clinical Autonomic Research: Official Journal of the Clinical Autonomic Research Society
Morten Langfeldt Friberg, Leif Rognås
OBJECTIVES: The primary objective was to estimate the incidence of patients in the Central Denmark Region triaged to bypass the local emergency department without being part of a predefined fast-track protocol. The secondary objective was to describe these triage decisions in more detail with regard to the most common diagnoses, incidence of direct referral sorted by the prehospital critical care team (PHCCT) and the destination hospital. DESIGN: Retrospective descriptive study...
July 18, 2018: BMJ Open
Harry Papagoras, Tania Pizzari, Paul Coburn, Kevin Sleigh, Andrew M Briggs
Primary care practitioners play a critical role in supporting return to work (RTW) and minimising the detrimental physical and psychosocial sequelae of unnecessary and prolonged work absence in injured and ill workers. Accurate and consistent certification of capacity is an essential component of this role that has been scrutinised recently given the identified variation in certification practices between and within professions. This Perspective outlines the importance of correct certification of capacity for injured workers and provides a RTW flowchart to support systematised and appropriate certification...
April 2018: Australian Health Review: a Publication of the Australian Hospital Association
Corey W Joseph, Marie L Garrubba, Angela M Melder
Objective Preventable hospital mortality is a critical public health issue, particularly when mortalities are associated with events that are preventable. Mortality and morbidity reviews (MMRs) provide a rigorous, systematic, open, collaborative and transparent review process for clinicians to examine areas of improvement. The aim of the present review was to explore the evidence for best practice when conducting MMRs. Methods Searches of published and grey literature from 2009 to February 2016 were conducted...
June 2018: Australian Health Review: a Publication of the Australian Hospital Association
Moli Paul, Lesley O'Hara, Priya Tah, Cathy Street, Athanasios Maras, Diane Purper Ouakil, Paramala Santosh, Giulia Signorini, Swaran Preet Singh, Helena Tuomainen, Fiona McNicholas
BACKGROUND: Healthcare policy and academic literature have promoted improving the transitional care of young people leaving child and adolescent mental health services (CAMHS). Despite the availability of guidance on good practice, there seems to be no readily accessible, coherent ethical analysis of transition. The ethical principles of non-maleficence, beneficence, justice and respect for autonomy can be used to justify the need for further enquiry into the ethical pros and cons of this drive to improve transitional care...
July 18, 2018: BMC Medical Ethics
Elisabeth Søndergaard, Ruth K Ertmann, Susanne Reventlow, Kirsten Lykke
BACKGROUND: There are few areas of health care where sufficient research-based evidence exists and primary health care is no exception. In the absence of such evidence, the development of assisted support must be based on the opinions and experience of professionals with knowledge of the relevant field. The purpose of this research project is to explore how the nominal group technique can be used to establish consensus by analysing how it supported the development of structured, knowledge-based, electronic health records for preventive child health examinations in Danish general practice...
July 18, 2018: BMC Family Practice
Elizabeth Victor, Laura Guidry-Grimes
BACKGROUND: Caregivers and administrators in long-term facilities have fragile moral work in caring for residents with dementia. Residents are susceptible to barriers and vulnerabilities associated with the most intimate aspects of their lives, including how they express themselves sexually. The conditions for sexual agency are directly affected by caregivers' perceptions and attitudes, as well as facility policies. OBJECTIVE: This article aims to clarify how to approach capacity determinations as it relates to sexual activity, propose how to theorize about patient autonomy in this context, and suggest some considerations for finding an ethically responsible and practically feasible way to respect the sexual rights of this population...
January 1, 2018: Nursing Ethics
Mariana Bertoncelli Tanaka, Ashok Agarwal, Sandro C Esteves
In our society, the number of couples with advanced reproductive age seeking fertility treatment is increasing steadily. While the negative effect of female age on assisted reproductive technology (ART) outcomes is well established, the impact of paternal age needs to be clarified. We reviewed the current literature to determine whether advanced paternal age affects the results of ART and the health of resulting offspring. We found that the published literature is overall supportive of a positive association between advanced paternal age (>40 years) and semen quality deterioration...
July 18, 2018: Panminerva Medica
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