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Oxygen, clinical decision making

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https://www.readbyqxmd.com/read/29782079/the-dipep-diagnosis-of-pe-in-pregnancy-study-an-observational-study-of-the-diagnostic-accuracy-of-clinical-assessment-d-dimer-and-chest-x-ray-for-suspected-pulmonary-embolism-in-pregnancy-and-postpartum
#1
Steve Goodacre, Kimberley Horspool, Catherine Nelson-Piercy, Marian Knight, Neil Shephard, Fiona Lecky, Steven Thomas, Beverley J Hunt, Gordon Fuller
OBJECTIVE: To identify clinical features associated with PE diagnosis and determine the accuracy of decision rules and D-dimer for diagnosing suspected PE in pregnant/postpartum women. DESIGN: Observational cohort study augmented with additional cases. SETTING: Emergency departments and maternity units at eleven prospectively recruiting sites and maternity units in the United Kingdom Obstetric Surveillance System (UKOSS). POPULATION: 324 pregnant/postpartum women with suspected PE and 198 pregnant/postpartum women with diagnosed PE...
May 21, 2018: BJOG: An International Journal of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/29734646/evaluation-of-meropenem-pharmacokinetics-in-an-experimental-acute-respiratory-distress-syndrome-ards-model-during-extracorporeal-membrane-oxygenation-ecmo-by-using-a-penp-%C3%AE-lactamase-biosensor
#2
Max Andresen, Joaquin Araos, Kwok-Yin Wong, Yun-Chung Leung, Lok-Yan So, Wai-Ting Wong, Salvador Cabrera, Camila Silva, Leyla Alegria, Alejandro Bruhn, Dagoberto Soto
INTRODUCTION: The use of antibiotics is mandatory in patients during extracorporeal membrane oxygenation (ECMO) support. Clinical studies have shown high variability in the antibiotic concentrations, as well as sequestration of them by the ECMO circuit, suggesting that the doses and/or interval administration used during ECMO may not be adequate. Thus, a fast response sensor to estimate antibiotic concentrations in this setting would contribute to improve dose adjustments. The biosensor PenP has been shown to have a dynamic range, sensitivity and specificity useful for pharmacokinetic (PK) tests in healthy subjects...
May 4, 2018: Sensors
https://www.readbyqxmd.com/read/29676964/advanced-imaging-techniques-in-evaluation-of-colorectal-cancer
#3
Roberto García-Figueiras, Sandra Baleato-González, Anwar R Padhani, Antonio Luna-Alcalá, Ana Marhuenda, Joan C Vilanova, Iria Osorio-Vázquez, Anxo Martínez-de-Alegría, Antonio Gómez-Caamaño
Imaging techniques are clinical decision-making tools in the evaluation of patients with colorectal cancer (CRC). The aim of this article is to discuss the potential of recent advances in imaging for diagnosis, prognosis, therapy planning, and assessment of response to treatment of CRC. Recent developments and new clinical applications of conventional imaging techniques such as virtual colonoscopy, dual-energy spectral computed tomography, elastography, advanced computing techniques (including volumetric rendering techniques and machine learning), magnetic resonance (MR) imaging-based magnetization transfer, and new liver imaging techniques, which may offer additional clinical information in patients with CRC, are summarized...
April 20, 2018: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://www.readbyqxmd.com/read/29537670/impaired-decision-making-and-functional-neuronal-network-activity-in-systemic-lupus-erythematosus
#4
Bei-Bei Wu, Ye Ma, Lei Xie, Jin-Zhuang Huang, Zong-Bo Sun, Zhi-Duo Hou, Rui-Wei Guo, Zhi-Rong Lin, Shou-Xing Duan, Shan-Shan Zhao, Yao-Xie, Dan-Miao Sun, Chun-Min Zhu, Shu-Hua Ma
BACKGROUND: Systemic lupus erythematosus (SLE) is associated with cognitive deficit but the exact neural mechanisms remain unclear. PURPOSE: To explore sequential brain activities using functional magnetic resonance imaging (fMRI) during the performance of a decision-making task, and to determine whether serum or clinical markers can reflect the involvement of the brain in SLE. SUBJECTS: Sixteen female SLE patients without overt clinical neuropsychiatric symptoms and 16 healthy controls were included...
March 14, 2018: Journal of Magnetic Resonance Imaging: JMRI
https://www.readbyqxmd.com/read/29505450/a-device-for-the-quantification-of-oxygen-consumption-and-caloric-expenditure-in-the-neonatal-range
#5
Einav Nachman, Peter Clemensen, Katheryn Santos, Alexis R Cole, Brian D Polizzotti, Grace Hofmann, Kristen T Leeman, Sarah J van den Bosch, John N Kheir
BACKGROUND: The accurate measurement of oxygen consumption (VO2) and energy expenditure (EE) may be helpful to optimize the treatment of critically ill patients. However, current techniques are limited in their ability to accurately quantify these end points in infants due to a low VO2, low tidal volume, and rapid respiratory rate. This study describes and validates a new device intended to perform in this size range. METHODS: We created a customized device that quantifies inspiratory volume using a pneumotachometer and concentrations of oxygen and carbon dioxide gas in the inspiratory and expiratory limbs...
March 1, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29492383/current-indications-for-transplantation-stratification-of-severe-heart-failure-and-shared-decision-making
#6
REVIEW
Darko Vucicevic, Lily Honoris, Federica Raia, Mario Deng
Heart failure (HF) is a complex clinical syndrome that results from structural or functional cardiovascular disorders causing a mismatch between demand and supply of oxygenated blood and consecutive failure of the body's organs. For those patients with stage D HF, advanced therapies, such as mechanical circulatory support (MCS) or heart transplantation (HTx), are potentially life-saving options. The role of risk stratification of patients with stage D HF in a value-based healthcare framework is to predict which subset might benefit from advanced HF (AdHF) therapies, to improve outcomes related to the individual patient including mortality, morbidity and patient experience as well as to optimize health care delivery system outcomes such as cost-effectiveness...
January 2018: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/29472709/splanchnic-nirs-monitoring-in-neonatal-care-rationale-current-applications-and-future-perspectives
#7
REVIEW
Silvia Martini, Luigi Corvaglia
Near infrared spectroscopy (NIRS) provides a non-invasive, continuous monitoring of regional tissue oxygenation. NIRS assessment of neonatal splanchnic oxygenation (SrSO2 ) has gained increasing interest over the last decade, as local hypoxia and ischemia underlie the most feared gut complications in neonates. Current literature provides encouraging evidence in support of SrSO2 reliability in detecting mesenteric hemodynamic changes related to various physiological and pathological conditions in-term and preterm infants...
February 22, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/29410191/regional-cerebral-oxygen-saturation-during-cardiopulmonary-resuscitation-as-a-predictor-of-return-of-spontaneous-circulation-and-favourable-neurological-outcome-a-review-of-the-current-literature
#8
REVIEW
S Schnaubelt, P Sulzgruber, J Menger, K Skhirtladze-Dworschak, F Sterz, M Dworschak
INTRODUCTION: Regional cerebral oxygen saturation (rSO2) can be measured non-invasively even at no- or low-flow states. It thus allows assessment of brain oxygenation during CPR. Certain rSO2 values had been associated with return of spontaneous circulation (ROSC) and neurological outcome in the past. Clear-cut thresholds for the prediction of beneficial outcome, however, are still lacking. METHODS: We conducted a database search to extract all available investigations on rSO2 measurement during CPR...
April 2018: Resuscitation
https://www.readbyqxmd.com/read/29351637/prospective-multicenter-assessment-of-all-cause-mortality-following-surgery-for-adult-cervical-deformity
#9
Justin S Smith, Christopher I Shaffrey, Han Jo Kim, Peter Passias, Themistocles Protopsaltis, Renaud Lafage, Gregory M Mundis, Eric Klineberg, Virginie Lafage, Frank J Schwab, Justin K Scheer, Emily Miller, Michael Kelly, D Kojo Hamilton, Munish Gupta, Vedat Deviren, Richard Hostin, Todd Albert, K Daniel Riew, Robert Hart, Doug Burton, Shay Bess, Christopher P Ames
BACKGROUND: Surgical treatments for adult cervical spinal deformity (ACSD) are often complex and have high complication rates. OBJECTIVE: To assess all-cause mortality following ACSD surgery. METHODS: ACSD patients presenting for surgical treatment were identified from a prospectively collected multicenter database. Clinical and surgical parameters and all-cause mortality were assessed. RESULTS: Of 123 ACSD patients, 120 (98%) had complete baseline data (mean age, 60...
January 17, 2018: Neurosurgery
https://www.readbyqxmd.com/read/29237516/utility-of-cardiac-mri-in-paediatric-myocarditis
#10
Alice Hales-Kharazmi, Nina Hirsch, Michael Kelleman, Timothy Slesnick, Shriprasad R Deshpande
BACKGROUND: The diagnostic role of cardiac MRI in myocarditis is evolving, however with extremely limited data in paediatrics. The goal of this study was to assess the utility of cardiac MRI in paediatric myocarditis and present a new prognostic score for risk stratification. METHOD: The present study is a retrospective investigation of children with a clinical diagnosis of myocarditis, including analysis of demographics, clinical presentation, diagnostic studies, including cardiac MRI, and outcomes...
March 2018: Cardiology in the Young
https://www.readbyqxmd.com/read/29189422/extracorporeal-membrane-oxygenation-in-premature-infants-with-congenital-diaphragmatic-hernia
#11
Milenka Cuevas Guamán, Adesola C Akinkuotu, Stephanie M Cruz, Pamela A Griffiths, Stephen E Welty, Timothy C Lee, Oluyinka O Olutoye
Prematurity and low birth weight have been exclusion criteria for extracorporeal membrane oxygenation (ECMO); however, these criteria are not evidence based. With advances in anticoagulation, improved technology, and surgical expertise, it is difficult to deny a potential therapy based on these criteria alone. We report the outcome of three neonates who were ineligible based on traditional criteria but were offered ECMO as a life-saving measure. We highlight the interdisciplinary nature of modern decision-making...
November 14, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29170324/27-the-dipep-diagnosis-of-pe-in-pregnancy-study-can-clinical-assessment-d-dimer-or-chest-x-ray-be-used-to-select-pregnant-or-postpartum-women-with-suspected-pe-for-diagnostic-imaging
#12
Steve Goodacre, Kimberley Horspool, Catherine Nelson-Piercy, Marian Knight, Neil Shephard, Fiona Lecky, Steven Thomas, Beverley Hunt, Gordon Fuller
OBJECTIVE: To determine whether clinical features (in the form of a clinical decision rule) or d-dimer can be used to select pregnant or postpartum women with suspected PE for diagnostic imaging. DESIGN: Observational cohort study augmented with additional cases. SETTING: Consultant-led maternity units participating in the UK Obstetric Surveillance System (UKOSS) and emergency departments and maternity units at eleven prospectively recruiting sites...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29169886/a-potential-diagnostic-pitfall-in-acute-chest-pain-massive-pulmonary-embolism-mimicking-acute-stemi
#13
Ya-Wen Lu, Yi-Lin Tsai, Chun-Chin Chang, Po-Hsun Huang
BACKGROUND: Pulmonary embolism (PE) represents a clinical challenge for clinicians because of nonspecific presentations, including dyspnea, chest pain, and tachycardia. The immediate 12-lead electrocardiogram (ECG) is commonly used to facilitate differential diagnosis of acute chest pain. Although relative rare, massive pulmonary embolism could induce ST segment elevation and mimic acute myocardial infarction. CASE PRESENTATION: We present a challenging scenario that ECG showed ST segment elevation, nevertheless, urgent coronary angiogram revealed non-obstructive coronary artery disease...
March 2018: American Journal of Emergency Medicine
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
#14
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 (St O2 ) 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
#15
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
#16
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
#17
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
#18
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...
February 2018: 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
#19
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
BackgroundDiagnosing 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 noninvasive. Our aim was to explore its possible role in diagnosing MD.MethodsBlood 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...
February 2018: Pediatric Research
https://www.readbyqxmd.com/read/28888156/exploring-the-oxygen-supply-and-demand-framework-as-a-learning-tool-in-undergraduate-nursing-education
#20
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
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