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Oxygen, clinical decision making

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https://www.readbyqxmd.com/read/28333829/acute-traumatic-coagulopathy-the-elephant-in-a-room-of-blind-scientists
#1
Michael A Meledeo, Maryanne C Herzig, James A Bynum, Xiaowu Wu, Anand K Ramasubramanian, Daniel N Darlington, Kristin M Reddoch, Andrew P Cap
Acute traumatic coagulopathy (ATC) is the failure of coagulation homeostasis that can rapidly arise following traumatic injury, hemorrhage, and shock; it is associated with higher injury severity, coagulation abnormalities, and increased blood transfusions. ATC has historically been defined by a prolonged prothrombin time (PT), although newer, more informative measurements of hemostatic function have been employed to improve diagnosis and support clinical decision making. The underlying biochemical mechanisms of and best practice therapeutics for ATC remain under active investigation because of its significant correlation to poor outcomes...
March 22, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28331972/safe-sleeping-positions-practice-and-policy-for-babies-with-cleft-palate
#2
Karen Davies, Iain A Bruce, Patricia Bannister, Peter Callery
Guidance recommends 'back to sleep' positioning for infants from birth in order to reduce the risk of sudden infant death. Exceptions have been made for babies with severe respiratory difficulties where lateral positioning may be recommended, although uncertainty exists for other conditions affecting the upper airway structures, such as cleft palate. This paper presents research of (i) current advice on sleep positioning provided to parents of infants with cleft palate in the UK; and (ii) decision making by clinical nurse specialists when advising parents of infants with cleft palate...
March 22, 2017: European Journal of Pediatrics
https://www.readbyqxmd.com/read/28273332/comparison-between-model-predicted-tumor-oxygenation-dynamics-and-vascular-flow-related-doppler-indices
#3
Antonella Belfatto, Ailyn M Vidal Urbinati, Delia Ciardo, Dorella Franchi, Federica Cattani, Roberta Lazzari, Barbara A Jereczek-Fossa, Roberto Orecchia, Guido Baroni, Pietro Cerveri
PURPOSE: Mathematical modeling is a powerful and flexible method to investigate complex phenomena. It discloses the possibility of reproducing expensive as well as invasive experiments in a safe environment with limited costs. This makes it suitable to mimic tumor evolution and response to radiotherapy although the reliability of the results remains an issue. Complexity reduction is therefore a critical aspect in order to be able to compare model outcomes to clinical data. Among the factors affecting treatment efficacy, tumor oxygenation is known to play a key role in radiotherapy response...
March 8, 2017: Medical Physics
https://www.readbyqxmd.com/read/28157275/continuous-cardiotocography-ctg-as-a-form-of-electronic-fetal-monitoring-efm-for-fetal-assessment-during-labour
#4
REVIEW
Zarko Alfirevic, Declan Devane, Gillian Ml Gyte, Anna Cuthbert
BACKGROUND: Cardiotocography (CTG) records changes in the fetal heart rate and their temporal relationship to uterine contractions. The aim is to identify babies who may be short of oxygen (hypoxic) to guide additional assessments of fetal wellbeing, or determine if the baby needs to be delivered by caesarean section or instrumental vaginal birth. This is an update of a review previously published in 2013, 2006 and 2001. OBJECTIVES: To evaluate the effectiveness and safety of continuous cardiotocography when used as a method to monitor fetal wellbeing during labour...
February 3, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28114683/physician-decision-making-and-clinical-outcomes-with-laboratory-polysomnography-or-limited-channel-sleep-studies-for-obstructive-sleep-apnea-a-randomized-trial
#5
Ching Li Chai-Coetzer, Nick A Antic, Garun S Hamilton, Nigel McArdle, Keith Wong, Brendon J Yee, Aeneas Yeo, Rajeev Ratnavadivel, Matthew T Naughton, Teanau Roebuck, Richard Woodman, R Doug McEvoy
Background: The clinical utility of limited-channel sleep studies (which are increasingly conducted at home) versus laboratory polysomnography (PSG) for diagnosing obstructive sleep apnea (OSA) is unclear. Objective: To compare patient outcomes after PSG versus limited-channel studies. Design: Multicenter, randomized, noninferiority study. (Australian New Zealand Clinical Trials Registry: ACTRN12611000926932). Setting: 7 academic sleep centers...
January 24, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28074789/extracorporeal-membrane-oxygenation-in-severe-influenza-infection-with-respiratory-failure-a-systematic-review-and-meta-analysis
#6
REVIEW
Shashvat Sukhal, Jaskaran Sethi, Malini Ganesh, Pedro A Villablanca, Anita K Malhotra, Harish Ramakrishna
INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) has been extensively used for potentially reversible acute respiratory failure associated with severe influenza A (H1N1) pneumonia; however, it remains an expensive, resource-intensive therapy, with a high associated mortality. This systematic review and meta-analysis aims to summarize and pool outcomes data available in the published literature to guide clinical decision-making and further research. METHODS: We conducted a systematic search of MEDLINE (1966 to April 15, 2015), EMBASE (1980 to April 15, 2015), CENTRAL, and Google Scholar for patients with severe H1N1 pneumonia and respiratory failure who received ECMO...
January 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28071865/the-impact-of-evidence-based-sepsis-guidelines-on-emergency-department-clinical-practice-a-pre-post-medical-record-audit
#7
Bernadine Romero, Margaret Fry, Michael Roche
AIMS AND OBJECTIVES: The aim of this study was to explore the number of patients presenting with sepsis before and after guideline implementation; the impact of sepsis guidelines on triage assessment, Emergency Department management and time to antibiotics. BACKGROUND: Sepsis remains one of the leading causes of mortality and morbidity within hospitals. Globally, strategies have been implemented to reduce morbidity and mortality rates, which rely on the early recognition and management of sepsis...
January 10, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28070916/non-invasive-assessment-of-muscle-oxygenation-may-aid-in-optimising-transfusion-threshold-decisions-in-ambulatory-paediatric-patients
#8
K A Schenkman, D S Hawkins, W A Ciesielski, M Delaney, L S L Arakaki
OBJECTIVE: To assess the potential utility of a novel non-invasive muscle oxygen measurement to determine the presence of muscle hypoxia in patients with anaemia. BACKGROUND: Recent assessment of the risk/benefit ratio of blood transfusion has led to clinical strategies optimising transfusion decisions. These decisions are primarily based on haematocrit (Hct) but not oxygen delivery, the primary function of red blood cells (RBCs). We hypothesised that muscle oxygenation (MOx) would correlate with Hct in patients with anaemia and may be a physiologically relevant determinant of the transfusion threshold...
February 2017: Transfusion Medicine
https://www.readbyqxmd.com/read/28001135/a-survey-of-physicians-attitudes-toward-decision-making-authority-for-initiating-and-withdrawing-va-ecmo-results-and-ethical-implications-for-shared-decision-making
#9
Ellen C Meltzer, Natalia S Ivascu, Meredith Stark, Alexander V Orfanos, Cathleen A Acres, Paul J Christos, Thomas Mangione, Joseph J Fins
OBJECTIVE: Although patients exercise greater autonomy than in the past, and shared decision making is promoted as the preferred model for doctor-patient engagement, tensions still exist in clinical practice about the primary locus of decision-making authority for complex, scarce, and resource-intensive medical therapies: patients and their surrogates, or physicians. We assessed physicians' attitudes toward decisional authority for adult venoarterial extracorporeal membrane oxygenation (VA-ECMO), hypothesizing they would favor a medical locus...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/27999120/the-effect-of-mandible-advancement-splints-in-mild-moderate-and-severe-obstructive-sleep-apnea-the-need-for-sleep-registrations-during-follow-up
#10
Tuula Palotie, Siru Riekki, Antti Mäkitie, Adel Bachour, Sirpa Arte, Leif Bäck
OBJECTIVE AND DESIGN: Our aim was to evaluate the effect of mandible advancement splint (MAS) in mild, moderate, and severe obstructive sleep apnea (OSA). We also determined, if and in which OSA-groups the adequate forward movement in MAS could be quantified without sleep registration for different OSA levels. A retrospective study. SETTINGS: The effect of MAS was measured with clinical methods and by sleep registration. PARTICIPANTS: The series consisted of 103 patients, 75 males and 28 females (mean age 52 years) suffering from mild (32 per cent), moderate (32 per cent), or severe (36 per cent) OSA, who were treated with MAS at Helsinki University Hospital, Finland during the years 2011-2012...
December 20, 2016: European Journal of Orthodontics
https://www.readbyqxmd.com/read/27925054/prone-position-in-patients-with-acute-respiratory-distress-syndrome
#11
Mariano Setten, Gustavo Adrián Plotnikow, Matías Accoce
Acute respiratory distress syndrome occupies a great deal of attention in intensive care units. Despite ample knowledge of the physiopathology of this syndrome, the focus in intensive care units consists mostly of life-supporting treatment and avoidance of the side effects of invasive treatments. Although great advances in mechanical ventilation have occurred in the past 20 years, with a significant impact on mortality, the incidence continues to be high. Patients with acute respiratory distress syndrome, especially the most severe cases, often present with refractory hypoxemia due to shunt, which can require additional treatments beyond mechanical ventilation, among which is mechanical ventilation in the prone position...
October 2016: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/27878797/choosing-wisely-at-the-end-of-life-the-crucial-role-of-medical-indication
#12
Gian Domenico Borasio, Ralf J Jox
At the end of life, several treatments are administered routinely that lack medical indication and may cause significant harm to patients. Examples include artificial hydration and oxygen therapy in the dying phase, as well as enteral nutrition in advanced dementia. Medical indication is defined as the appropriateness of a therapeutic or diagnostic measure in the patient's concrete clinical situation, in light of the best available evidence. The decision about the absence or presence of a medical indication is a core competence of physicians...
2016: Swiss Medical Weekly
https://www.readbyqxmd.com/read/27851839/diagnosis-treatment-and-clinical-management-of-pulmonary-arterial-hypertension-in-the-contemporary-era-a-review
#13
Bradley A Maron, Nazzareno Galiè
Importance: Pulmonary arterial hypertension (PAH) is characterized by severe remodeling of the distal pulmonary arteries, increased pulmonary vascular resistance, and right ventricular dysfunction that promotes heart failure. Once regarded as largely untreatable, evidence-based decision making now guides clinical management of PAH and improves outcomes. However, misconceptions regarding the approach to PAH in the modern era are common and associated with substandard clinical care. Observations: The clinical profile of PAH has changed substantially since its original description...
December 1, 2016: JAMA Cardiology
https://www.readbyqxmd.com/read/27821105/interventions-and-decision-making-at-the-end-of-life-the-effect-of-establishing-the-terminal-illness-situation
#14
MULTICENTER STUDY
C Campos-Calderón, R Montoya-Juárez, C Hueso-Montoro, E Hernández-López, F Ojeda-Virto, M P García-Caro
BACKGROUND: Many 'routine' interventions performed in hospital rooms have repercussions for the comfort of the patient, and the decision to perform them should depend on whether the patient is identified as in a terminal phase. The aim of this study is to analyse the health interventions performed and decisions made in the last days of life in patients with advanced oncological and non-oncological illness to ascertain whether identifying the patient's terminal illness situation has any effect on these decisions...
November 7, 2016: BMC Palliative Care
https://www.readbyqxmd.com/read/27807197/venous-imaging-based-biomarkers-in-acute-ischaemic-stroke
#15
REVIEW
Josep Munuera, Gerard Blasco, María Hernández-Pérez, Pepus Daunis-I-Estadella, Antoni Dávalos, David S Liebeskind, Max Wintermark, Andrew Demchuk, Bijoy K Menon, Götz Thomalla, Kambiz Nael, Salvador Pedraza, Josep Puig
Vascular neuroimaging plays a decisive role in selecting the best therapy in patients with acute ischaemic stroke. However, compared with the arterial system, the role of veins has not been thoroughly studied. In this review, we present the major venous imaging-based biomarkers in ischaemic stroke. First, the presence of hypodense veins in the monophasic CT angiography ipsilateral to the arterial occlusion. Second, the asymmetry of venous drainage in the pathological cerebral hemisphere on CT and MRI dynamic angiography...
January 2017: Journal of Neurology, Neurosurgery, and Psychiatry
https://www.readbyqxmd.com/read/27803369/oxygen-exchange-and-c-reactive-protein-predict-safe-discharge-in-patients-with-h1n1-influenza
#16
B Morton, K Nweze, J O'Connor, P Turton, E Joekes, J D Blakey, I D Welters
BACKGROUND: Pandemic influenza has potential to overwhelm healthcare resources. There is uncertainty over performance of existing triage tools for hospital admission and discharge decisions. AIM: Our aim was to identify clinical criteria that predict safe discharge from hospital and develop a pragmatic triage tool to guide physician decision-making. DESIGN: We retrospectively examined an existing database of patients who presented to the Royal Liverpool University Hospital during the 2010-11 influenza pandemic...
October 18, 2016: QJM: Monthly Journal of the Association of Physicians
https://www.readbyqxmd.com/read/27789215/autophagy-in-the-crosshairs-of-cancer
#17
REVIEW
Heather Graham Hambright, Rita Ghosh
Two prominent features of tumors that contribute to oncogenic survival signaling are redox disruption, or oxidative stress phenotype, and high autophagy signaling, making both phenomena ideal therapeutic targets. However, the relationship between redox disruption and autophagy signaling is not well characterized and the clinical impact of reactive oxygen species (ROS)-generating chemotherapeutics on autophagy merits immediate attention as autophagy largely contributes to chemotherapeutic resistance. In this commentary we focus on melanoma, using it as an example to provide clarity to current literature regarding the roles of autophagy and redox signaling which can be applicable to initiation and maintenance of most tumor types...
February 15, 2017: Biochemical Pharmacology
https://www.readbyqxmd.com/read/27750191/interhospital-transfer-of-children-in-respiratory-failure-a-clinician-interview-qualitative-study
#18
Folafoluwa O Odetola, Renee R Anspach, Yong Y Han, Sarah J Clark
PURPOSE: To investigate the decision making underlying transfer of children with respiratory failure from level II to level I pediatric intensive care unit care. METHODS: Interviews with 19 eligible level II pediatric intensive care unit physicians about a hypothetical scenario of a 2-year-old girl in respiratory failure: RESULTS: At baseline, indices critical to management were as follows: OI (53%), partial pressure of oxygen in arterial blood (Pao2)/Fio2 (32%), and inflation pressure (16%)...
February 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/27723012/poorly-designed-research-does-not-help-clarify-the-role-of-hyperbaric-oxygen-in-the-treatment-of-chronic-diabetic-foot-ulcers
#19
EDITORIAL
Mesut Mutluoglu, Gunalp Uzun, Michael Bennett, Peter Germonpré, David Smart, Daniel Mathieu
Diabetic foot ulcers (DFUs) are one of the most common indications for hyperbaric oxygen treatment (HBOT). The role of HBOT in DFUs is often debated. Recent evidence based guidelines, while recommending its use, urge further studies to identify the patient subgroups most likely to benefit from HBOT. A recent study in Diabetes Care aimed to assess the efficacy of HBOT in reducing the need for major amputation and improving wound healing in patients with chronic DFUs. In this study, patients with Wagner grade 2-4 diabetic foot lesions were randomly assigned to have HBOT (30 sessions/90 min/244 kPa) or sham treatment (30 sessions/90 min/air/125 kPa)...
September 2016: Diving and Hyperbaric Medicine: the Journal of the South Pacific Underwater Medicine Society
https://www.readbyqxmd.com/read/27600806/role-of-donor-hemodynamic-trajectory-in-determining-graft-survival-in-liver-transplantation-from-donation-after-circulatory-death-donors
#20
Daniel J Firl, Koji Hashimoto, Colin O'Rourke, Teresa Diago-Uso, Masato Fujiki, Federico N Aucejo, Cristiano Quintini, Dympna M Kelly, Charles M Miller, John J Fung, Bijan Eghtesad
Donation after circulatory death (DCD)donors show heterogeneous hemodynamic trajectories following withdrawal of life support. Impact of hemodynamics in DCD liver transplant isunclear and objective measures of graft viability would ease transplant surgeon decision making and inform safe expansion of the donor organ pool. This retrospective study tested whether hemodynamic trajectories associated withtransplant outcomes in DCD liver transplantation (n = 87). Using longitudinal clustering statistical techniques we phenotyped DCD donors based on hemodynamic trajectory for both mean arterial pressure (MAP) and peripheral oxygen saturation (SpO2 ) following withdrawal of life support...
September 6, 2016: Liver Transplantation
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