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Oxygen, clinical decision making

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https://www.readbyqxmd.com/read/29113960/lesion-oxygenation-associates-with-clinical-outcomes-in-premalignant-and-early-stage-head-and-neck-tumors-treated-on-a-phase-1-trial-of-photodynamic-therapy
#1
Peter H Ahn, Jarod C Finlay, Shannon M Gallagher-Colombo, Harry Quon, Bert W O'Malley, Gregory S Weinstein, Ara Chalian, Kelly Malloy, Thomas Sollecito, Martin Greenberg, Charles B Simone, Sally McNulty, Alexander Lin, Timothy C Zhu, Virginia Livolsi, Michael Feldman, Rosemarie Mick, Keith A Cengel, Theresa M Busch
BACKGROUND: We report on a Phase 1 trial of photodynamic therapy (PDT) for superficial head and neck (H&N) lesions. Due to known oxygen dependencies of PDT, translational measurements of lesion hemoglobin oxygen saturation (StO2) and blood volume (tHb) were studied for associations with patient outcomes. METHODS: PDT with aminolevulinc acid (ALA) and escalating light doses was evaluated for high-grade dysplasia, carcinoma-in-situ, and microinvasive carcinomas of the H&N...
November 4, 2017: Photodiagnosis and Photodynamic Therapy
https://www.readbyqxmd.com/read/29082001/derivation-and-validation-of-a-universal-vital-assessment-uva-score-a-tool-for-predicting-mortality-in-adult-hospitalised-patients-in-sub-saharan-africa
#2
Christopher C Moore, Riley Hazard, Kacie J Saulters, John Ainsworth, Susan A Adakun, Abdallah Amir, Ben Andrews, Mary Auma, Tim Baker, Patrick Banura, John A Crump, Martin P Grobusch, Michaëla A M Huson, Shevin T Jacob, Olamide D Jarrett, John Kellett, Shabir Lakhi, Albert Majwala, Martin Opio, Matthew P Rubach, Jamie Rylance, W Michael Scheld, John Schieffelin, Richard Ssekitoleko, India Wheeler, Laura E Barnes
BACKGROUND: Critical illness is a leading cause of morbidity and mortality in sub-Saharan Africa (SSA). Identifying patients with the highest risk of death could help with resource allocation and clinical decision making. Accordingly, we derived and validated a universal vital assessment (UVA) score for use in SSA. METHODS: We pooled data from hospital-based cohort studies conducted in six countries in SSA spanning the years 2009-2015. We derived and internally validated a UVA score using decision trees and linear regression and compared its performance with the modified early warning score (MEWS) and the quick sepsis-related organ failure assessment (qSOFA) score...
2017: BMJ Global Health
https://www.readbyqxmd.com/read/29075482/fluid-resuscitation-practices-in-cardiac-surgery-patients-in-the-usa-a-survey-of-health-care-providers
#3
Solomon Aronson, Paul Nisbet, Martin Bunke
BACKGROUND: Fluid resuscitation during cardiac surgery is common with significant variability in clinical practice. Our goal was to investigate current practice patterns of fluid volume expansion in patients undergoing cardiac surgeries in the USA. METHODS: We conducted a cross-sectional online survey of 124 cardiothoracic surgeons, cardiovascular anesthesiologists, and perfusionists. Survey questions were designed to assess clinical decision-making patterns of intravenous (IV) fluid utilization in cardiovascular surgery for five types of patients who need volume expansion: (1) patients undergoing cardiopulmonary bypass (CPB) without bleeding, (2) patients undergoing CPB with bleeding, (3) patients undergoing acute normovolemic hemodilution (ANH), (4) patients requiring extracorporeal membrane oxygenation (ECMO) or use of a ventricular assist device (VAD), and (5) patients undergoing either off-pump coronary artery bypass graft (OPCABG) surgery or transcatheter aortic valve replacement (TAVR)...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/29071142/the-impact-of-coexisting-sperm-dna-fragmentation-and-seminal-oxidative-stress-on-the-outcome-of-varicocelectomy-in-infertile-patients-a-prospective-controlled-study
#4
Shabieb A Abdelbaki, Jehan H Sabry, Ahmed M Al-Adl, Hanan H Sabry
OBJECTIVES: To study the relationship between sperm DNA fragmentation (SDF) and reactive oxygen species (ROS) levels in infertile patients with varicocele, and to examine the beneficial effect of varicocelectomy and elucidate predictors of improvement after repair. PATIENTS SUBJECTS AND METHODS: We prospectively studied 60 patients with varicocele and abnormal semen variables who attended the outpatient clinic complaining of infertility for ≥12 months. In all, 25 patients (41...
June 2017: Arab Journal of Urology
https://www.readbyqxmd.com/read/29061467/an-interactive-simulation-tool-for-patient-specific-clinical-decision-support-in-single-ventricle-physiology
#5
Timothy Conover, Anthony M Hlavacek, Francesco Migliavacca, Ethan Kung, Adam Dorfman, Richard S Figliola, Tain-Yen Hsia
OBJECTIVE: Modeling of single-ventricle circulations has yielded important insights into their unique flow dynamics and physiology. Here we translated a state-of-the-art mathematical model into a patient-specific clinical decision support interactive Web-based simulation tool and show validation for all 3 stages of single-ventricular palliation. METHODS: Via the adoption a validated lumped parameter method, complete cardiovascular-pulmonary circulatory models of all 3 stages of single-ventricle physiology were created within a simulation tool...
September 20, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28981487/oxygen-consumption-in-platelets-as-an-adjunct-diagnostic-method-for-pediatric-mitochondrial-disease
#6
Emil Westerlund, Sigurður E Marelsson, Johannes K Ehinger, Fredrik Sjövall, Saori Morota, Eleonor Åsander Frostner, Anders Oldfors, Niklas Darin, Johan Lundgren, Magnus J Hansson, Vineta Fellman, Eskil Elmér
BACKGROUND: Diagnosing mitochondrial disease (MD) is a challenge. In addition to genetic analyses, clinical practice is to perform invasive procedures such as muscle biopsy for biochemical and histochemical analyses. Blood cell respirometry is rapid and non-invasive. Our aim was to explore its possible role in diagnosing MD. METHODS: Blood samples were collected from 113 pediatric patients, for whom MD was a differential diagnosis. A respiratory analysis model based on ratios (independent of mitochondrial specific content) was derived from a group of healthy controls and tested on the patients...
October 5, 2017: Pediatric Research
https://www.readbyqxmd.com/read/28888156/exploring-the-oxygen-supply-and-demand-framework-as-a-learning-tool-in-undergraduate-nursing-education
#7
Mary Gillespie, Eileen Shackell
In nursing education, physiological concepts are typically presented within a body 'systems' framework yet learners are often challenged to apply this knowledge in the holistic and functional manner needed for effective clinical decision-making and safe patient care. A nursing faculty addressed this learning challenge by developing an advanced organizer as a conceptual and integrative learning tool to support learners in diverse learning environments and practice settings. A mixed methods research study was conducted that explored the effectiveness of the Oxygen Supply and Demand Framework as a learning tool in undergraduate nursing education...
November 2017: Nurse Education in Practice
https://www.readbyqxmd.com/read/28877293/thermodilution-vs-estimated-fick-cardiac-output-measurement-in-clinical-practice-an-analysis-of-mortality-from-the-veterans-affairs-clinical-assessment-reporting-and-tracking-va-cart-program-and-vanderbilt-university
#8
Alexander R Opotowsky, Edward Hess, Bradley A Maron, Evan L Brittain, Anna E Barón, Thomas M Maddox, Laith I Alshawabkeh, Bradley M Wertheim, Meng Xu, Tufik R Assad, Jonathan D Rich, Gaurav Choudhary, Ryan J Tedford
Importance: Thermodilution (Td) and estimated oxygen uptake Fick (eFick) methods are widely used to measure cardiac output (CO). They are often used interchangeably to make critical clinical decisions, yet few studies have compared these approaches as applied in medical practice. Objectives: To assess agreement between Td and eFick CO and to compare how well these methods predict mortality. Design, Setting, and Participants: This investigation was a retrospective cohort study with up to 1 year of follow-up...
October 1, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/28832178/-radiotherapy-of-lung-tumours-in-idiopathic-pulmonary-fibrosis
#9
V Kolek, M Vašáková, M Šterclová, K Cwiertka, D Vrána, A Kudláček, J Skřičková, M Pešek, J Petera
BACKGROUND: This article is a joint statement of the Czech Pneumological and Physiological Society and the Czech Society for Radiation Oncology, Biology and Physics, and reviews current opinions on radiotherapy in patients with idiopathic pulmonary fibrosis (IPF). In general, radiotherapy of lung tumours is associated with risk of radiation pneumonitis (RP); moreover, IPF may be complicated by acute exacerbations (AE-IPF). Both complications may immediately threaten patients lives. MATERIAL AND METHODS: Assessment of individual radiotherapy modalities has shown that conventional radiotherapy is not appropriate, especially in large tumours...
2017: Klinická Onkologie: Casopis Ceské a Slovenské Onkologické Spolecnosti
https://www.readbyqxmd.com/read/28704244/implementation-of-a-standardized-transfusion-protocol-for-cardiac-patients-treated-with-venoarterial-extracorporeal-membrane-oxygenation-is-associated-with-decreased-blood-component-utilization-and-may-improve-clinical-outcome
#10
Christine M Cahill, Neil Blumberg, Amy E Schmidt, Peter A Knight, Amber L Melvin, Howard T Massey, Joseph M Delehanty, Seth B Zebrak, Majed A Refaai
BACKGROUND: Extracorporeal membrane oxygenation supplies oxygenated blood to the body supporting the heart and lungs. Survival rates of 20% to 50% are reported among patients receiving ECMO for cardiac arrest, severe cardiogenic shock, or failure to wean from cardiopulmonary bypass following cardiac surgery. Bleeding is one of the most common complications in ECMO patients due to coagulopathy, systemic anticoagulation, and the presence of large bore cannulas at systemic pressure. Absence of a standardized transfusion protocol in this population leads to inconsistent transfusion practices...
July 10, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28599216/fuzzy-risk-stratification-and-risk-assessment-model-for-clinical-monitoring-in-the-icu
#11
Albion Dervishi
BACKGROUND: The decisions that clinicians make in intensive care units (ICUs) based on monitored parameters reflecting physiological deterioration are of major medical and biomedical engineering interest. These parameters have been investigated and assessed for their usefulness in risk assessment. METHODS: Totally, 127 ICU adult patients were studied. They were selected from a MIMIC II Waveform Database Matched Subset and had continuous monitoring of heart rate, invasive blood pressure, and oxygen saturation...
August 1, 2017: Computers in Biology and Medicine
https://www.readbyqxmd.com/read/28511024/cardiopulmonary-exercise-testing-and-surgery
#12
Paul O Older, Denny Z H Levett
The surgical patient population is increasingly elderly and comorbid and poses challenges to perioperative physicians. Accurate preoperative risk stratification is important to direct perioperative care. Reduced aerobic fitness is associated with increased postoperative morbidity and mortality. Cardiopulmonary exercise testing is an integrated and dynamic test that gives an objective measure of aerobic fitness or functional capacity and identifies the cause of exercise intolerance. Cardiopulmonary exercise testing provides an individualized estimate of patient risk that can be used to predict postoperative morbidity and mortality...
July 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28508270/the-impact-of-combined-cardiopulmonary-exercise-testing-and-spect-myocardial-perfusion-imaging-on-downstream-evaluation-and-management
#13
Georgios Christopoulos, John Bois, Thomas G Allison, Martin Rodriguez-Porcel, Panithaya Chareonthaitawee
OBJECTIVE: The diagnostic yield of combined cardiopulmonary exercise testing (CPET) and myocardial perfusion imaging (MPI) in patients referred for stress testing has received limited study. METHODS: We evaluated consecutive patients who underwent combined CPET-MPI at a single tertiary referral center between 2011 and 2015. An abnormal CPET was defined as any of the following: reduced oxygen consumption, cardiac output impairment, or pulmonary impairment. Normal MPI was defined as the absence of resting or stress perfusion defect...
May 15, 2017: Journal of Nuclear Cardiology: Official Publication of the American Society of Nuclear Cardiology
https://www.readbyqxmd.com/read/28504992/trends-in-perioperative-practice-and-resource-utilization-in-patients-with-obstructive-sleep-apnea-undergoing-joint-arthroplasty
#14
Crispiana Cozowicz, Jashvant Poeran, Ashley Olson, Madhu Mazumdar, Eva E Mörwald, Stavros G Memtsoudis
BACKGROUND: Emerging evidence associating obstructive sleep apnea (OSA) with adverse perioperative outcomes has recently heightened the level of awareness among perioperative physicians. In particular, estimates projecting the high prevalence of this condition in the surgical population highlight the necessity of the development and adherence to "best clinical practices." In this context, a number of expert panels have generated recommendations in an effort to provide guidance for perioperative decision-making...
July 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28501864/first-line-support-by-intra-aortic-balloon-pump-in-non-ischaemic-cardiogenic-shock-in-the-era-of-modern-ventricular-assist-devices
#15
Corstiaan A den Uil, Giorgia Galli, Lucia S Jewbali, Kadir Caliskan, Olivier C Manintveld, Jasper J Brugts, Nicolas M van Mieghem, Mattie J Lenzen, Eric Boersma, Alina A Constantinescu
OBJECTIVES: Little is known about circulatory support in cardiogenic shock (CS) from other causes than the acute coronary syndrome or after cardiotomy. We evaluated the effects of first-line intra-aortic balloon pump (IABP) support in this subpopulation of CS patients. METHODS: A retrospective study was performed in 27 patients with CS from end-stage cardiomyopathy supported firstly by IABP in the years 2011-2016. RESULTS: At 24 h, lactate decreased from 3...
2017: Cardiology
https://www.readbyqxmd.com/read/28459336/an-official-american-thoracic-society-european-society-of-intensive-care-medicine-society-of-critical-care-medicine-clinical-practice-guideline-mechanical-ventilation-in-adult-patients-with-acute-respiratory-distress-syndrome
#16
Eddy Fan, Lorenzo Del Sorbo, Ewan C Goligher, Carol L Hodgson, Laveena Munshi, Allan J Walkey, Neill K J Adhikari, Marcelo B P Amato, Richard Branson, Roy G Brower, Niall D Ferguson, Ognjen Gajic, Luciano Gattinoni, Dean Hess, Jordi Mancebo, Maureen O Meade, Daniel F McAuley, Antonio Pesenti, V Marco Ranieri, Gordon D Rubenfeld, Eileen Rubin, Maureen Seckel, Arthur S Slutsky, Daniel Talmor, B Taylor Thompson, Hannah Wunsch, Elizabeth Uleryk, Jan Brozek, Laurent J Brochard
BACKGROUND: This document provides evidence-based clinical practice guidelines on the use of mechanical ventilation in adult patients with acute respiratory distress syndrome (ARDS). METHODS: A multidisciplinary panel conducted systematic reviews and metaanalyses of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations. RESULTS: For all patients with ARDS, the recommendation is strong for mechanical ventilation using lower tidal volumes (4-8 ml/kg predicted body weight) and lower inspiratory pressures (plateau pressure < 30 cm H2O) (moderate confidence in effect estimates)...
May 1, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28449851/acute-compartment-syndrome
#17
Andrew H Schmidt
Acute compartment syndrome is a well-known complication of tibial fractures, yet it remains difficult to diagnose and the only effective treatment is surgical fasciotomy. Delayed fasciotomy is the most important factor contributing to poor outcomes, and as a result, treatment is biased towards performing early fasciotomy. Current diagnosis of ACS is based on clinical findings and intramuscular pressure (IMP) measurement, and is targeted at identifying safe thresholds for when fasciotomy can be avoided. Since clinical findings are variable and difficult to quantify, measurement of IMP - ideally continuously - is the cornerstone of surgical decision - making...
June 2017: Injury
https://www.readbyqxmd.com/read/28432006/stepwise-use-of-circulatory-support-devices-in-a-patient-refractory-to-cardiopulmonary-resuscitation
#18
Marco Spartera, Richard J Jabbour, Mauro Chiarito, Michele De Bonis, Federico Pappalardo
This case describes the management of a patient admitted to an emergency department with general malaise, who deteriorated into cardiac arrest and refractory to advanced life support measures. After extracorporeal cardiopulmonary resuscitation (eCPR) with veno-arterial extracorporeal membrane oxygenation in association with an Impella 2.5 device, the patient underwent cardiac surgery (tissue aortic valve replacement, coronary artery bypass grafting and implantation of short-term paracorporeal left ventricular assist device)...
September 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28430808/quantification-of-hypoxia-related-gene-expression-as-a-potential-approach-for-clinical-outcome-prediction-in-breast-cancer
#19
Abderrahim El Guerrab, Anne Cayre, Fabrice Kwiatkowski, Maud Privat, Jean-Marc Rossignol, Fabrice Rossignol, Frédérique Penault-Llorca, Yves-Jean Bignon
Breast cancers are solid tumors frequently characterized by regions with low oxygen concentrations. Cellular adaptations to hypoxia are mainly determined by "hypoxia inducible factors" that mediate transcriptional modifications involved in drug resistance and tumor progression leading to metastasis and relapse occurrence. In this study, we investigated the prognostic value of hypoxia-related gene expression in breast cancer. A systematic review was conducted to select a set of 45 genes involved in hypoxia signaling pathways and breast tumor progression...
2017: PloS One
https://www.readbyqxmd.com/read/28387975/insular-and-cingulate-attenuation-during-decision-making-is-associated-with-future-transition-to-stimulant-use-disorder
#20
Jennifer L Stewart, Mamona Butt, April C May, Susan F Tapert, Martin P Paulus
AIMS: To understand processes placing individuals at risk for stimulant (amphetamine and cocaine) use disorder. DESIGN: Longitudinal study. SETTING: University of California, San Diego Department of Psychiatry, CA, USA. PARTICIPANTS: Occasional stimulant users (OSU; n = 184) underwent a baseline clinical interview and a functional magnetic resonance imaging (fMRI) session. On the basis of a follow-up clinical interview completed 3 years later, OSU (n = 147) were then categorized as problem stimulant users (PSU: n = 36; those who developed stimulant use disorders in the interim) or desisted stimulant users (DSU: n = 74; those who stopped using)...
September 2017: Addiction
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