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Liberation medicine

Gregory A Schmidt, Timothy D Girard, John P Kress, Peter E Morris, Daniel R Ouellette, Waleed Alhazzani, Suzanne M Burns, Scott K Epstein, Andres Esteban, Eddy Fan, Miquel Ferrer, Gilles L Fraser, Michelle Gong, Catherine Hough, Sangeeta Mehta, Rahul Nanchal, Sheena Patel, Amy J Pawlik, Curtis N Sessler, Thomas Strøm, William Schweickert, Kevin C Wilson, Jonathon D Truwit
BACKGROUND: This clinical practice guideline addresses six questions related to liberation from mechanical ventilation in critically ill adults. It is the result of a collaborative effort between the American Thoracic Society (ATS) and American College of Chest Physicians (CHEST). METHODS: A multi-disciplinary panel posed six clinical questions in a Population, Intervention, Comparator and Outcomes (PICO) format. A comprehensive literature search and evidence synthesis was performed for each question, which included appraising the certainty in the evidence (i...
October 20, 2016: American Journal of Respiratory and Critical Care Medicine
Jeffrey L Carson, Gordon Guyatt, Nancy M Heddle, Brenda J Grossman, Claudia S Cohn, Mark K Fung, Terry Gernsheimer, John B Holcomb, Lewis J Kaplan, Louis M Katz, Nikki Peterson, Glenn Ramsey, Sunil V Rao, John D Roback, Aryeh Shander, Aaron A R Tobian
Importance: More than 100 million units of blood are collected worldwide each year, yet the indication for red blood cell (RBC) transfusion and the optimal length of RBC storage prior to transfusion are uncertain. Objective: To provide recommendations for the target hemoglobin level for RBC transfusion among hospitalized adult patients who are hemodynamically stable and the length of time RBCs should be stored prior to transfusion. Evidence Review: Reference librarians conducted a literature search for randomized clinical trials (RCTs) evaluating hemoglobin thresholds for RBC transfusion (1950-May 2016) and RBC storage duration (1948-May 2016) without language restrictions...
October 12, 2016: JAMA: the Journal of the American Medical Association
Alejandro Suarez De La Rica, Fernando Gilsanz, Emilio Maseda
Since the American College of Chest Physicians (ACCP) and the Society of Critical care Medicine (SCCM) published the first consensus definition of syndromes related to sepsis in 1992, the knowledge of epidemiology of sepsis has clearly improved, although no prospective studies have been performed to analyse the incidence of sepsis in general population. There are differences in epidemiologic trends in sepsis between western countries and low-income and middle-income countries. In the United States (US), most of epidemiologic studies have been based on large, administrative databases, reporting an increase in the incidence of severe sepsis over years...
September 2016: Annals of Translational Medicine
David Bernikier, Katia Raetz, David Chaparro, Jessica Delvert, Jean-Christophe Daviet, Jean Yves Salle
OBJECTIVE: HEMIPASS is a post-stroke interdisciplinary mobile home team care, which aims to provide home care services for post-stroke patients. Describe the evolution of HEMIPASS program over the past three years by looking at its level of activities. The hypothesis is that the HEMIPASS program is more in demand by liberal sector than hospital services; indeed, it increases its efficacy over time. MATERIALS/PATIENTS AND METHODS: Retrospective study design conducted from 2013 to 2015, involving all post-stroke patients enrolled in HEMIPASS program during this period...
September 2016: Annals of Physical and Rehabilitation Medicine
Tiphaine Bourseau, Flavie Fremondière, Valérie Dubus, Bénédicte Gohier, Dewi Le Gal, Fabien Cave, Isabelle Richard, Nicolas Lerolle
OBJECTIVE: After critical illness, some survivors experience long-term physical, functional, neurocognitive and/or mental health impairments, which has been termed "Post-Intensive Care syndrome" (PICS) [1]. A specific follow-up is required and many specialized follow-up clinics have been created both abroad and in France. The aim of this study is to evaluate long-term outcomes after critical illness, through the International Classification of Functioning, Disability and Health, and to analyse rehabilitation needs after intensive care unit (ICU) discharge...
September 2016: Annals of Physical and Rehabilitation Medicine
Michal Liber, Moshe Sonnenblick, Gabriel Munter
OBJECTIVE: Elderly patients have a high prevalence of hypernatremia. The aim of this study was to determine demographic and clinical characteristics of the elderly hypernatremic patient hospitalized in the internal medicine ward, and to enhance understanding of the role of ADH secretion in the pathogenesis of hypernatremia. METHODS: Case-control study performed in an Internal Medicine ward in a University affiliated hospital. 33 elderly hypernatremic patients (admission sodium>150 meq/l, age>70) compared to 34 normonatremic patients...
September 15, 2016: Endocrine Practice
Shimon M Glick, Alan Jotkowitz
The recent essay by Schuklenk and Smalling opposing respect for physicians' conscientious objections to providing patients with medical services that are legally permitted in liberal democracies is based on several erroneous assumptions. Acting in this manner would have serious harmful effects on the ethos of medicine and of bioethics. A much more nuanced and balanced position is critical in order to respect physicians' conscience with minimal damage to patients' rights.
September 6, 2016: Journal of Medical Ethics
Chiranjib Chakraborty, Ashish Ranjan Sharma, Garima Sharma, Sang-Soo Lee
Presently, nanotechnology is a multi-trillion dollar business sector that covers a wide range of industries, such as medicine, electronics and chemistry. In the current era, the commercial transition of nanotechnology from research level to industrial level is stimulating the world's total economic growth. However, commercialization of nanoparticles might offer possible risks once they are liberated in the environment. In recent years, the use of zebrafish (Danio rerio) as an established animal model system for nanoparticle toxicity assay is growing exponentially...
2016: Journal of Nanobiotechnology
A M Lenkiewicz, G A Czapski, H Jęsko, A Wilkaniec, W Szypuła, A Pietrosiuk, A M Uszyńska, A Adamczyk
Imbalance between production and scavenging of free radicals and other reactive oxygen species (ROS) is a component of many diseases, but it is especially important in aging-related diseases of the central nervous system. Oxidative stress-induced neuronal dysfunction plays an important role in the pathomechanism of neurodegenerative disorders, including Alzheimer's and Parkinson's disease. Experimental data showed that free radical scavengers may protect the brain against oxidative modifications. The need for efficient and safe antioxidants with therapeutic potential stimulated the rise of interest in the medicinal plant products, which are a rich source of phytochemicals possessing biological activity...
2016: Folia Neuropathologica
Eleftheria Kalogera, Sean C Dowdy
A paucity of data exists regarding traditional perioperative practices (bowel preparation, NPO at midnight, liberal narcotics, PCA use, liberal fluids, prolonged bowel and bed rest). Enhanced Recovery after Surgery (ERAS) is an evidence-based approach to peri-operative care associated with improved outcomes including earlier return of gastrointestinal function, reduced opioid use, shorter hospital stay, and substantial cost reductions with stable complication and readmission rates. Basic principles include patient education, minimizing preoperative fasting, avoiding bowel preparation, preemptive analgesia, nausea/vomiting prophylaxis, perioperative euvolemia, no routine use of drain and nasogastric tubes, early mobilization, oral intake, and catheter removal, non-opioid analgesics, and preemptive laxatives...
September 2016: Obstetrics and Gynecology Clinics of North America
Kristin Wisell, Ulrika Winblad, Sofia Kälvemark Sporrong
BACKGROUND: Reforms in the health-care sector, including the pharmacy sector, can have different rationales. The Swedish pharmacies were prior to 2009 organized in a state-owned monopoly. In 2009, a liberalization of the ownership took place, in which a majority of the pharmacies were sold to private owners. The rationales for this liberalization changed profoundly during the preparatory work, making it probable that other rationales than the ones first expressed existed. The aim of this study was to explore the underlying rationales (not stated in official documents) for the liberalization in the Swedish pharmacy sector, and also to compare the expectations with the perceived outcomes...
2016: BMC Health Services Research
Frances Pheasant-Kelly
This article considers differences between the representation of mutation in science fiction films from the 1950s and the present, and identifies distinctive changes over this time period, both in relation to the narrative causes of genetic disruption and in the aesthetics of its visual display. Discerning an increasingly abject quality to science fiction mutations from the 1970s onwards-as a progressive tendency to view the physically opened body, one that has a seemingly fluid interior-exterior reversal, or one that is almost beyond recognition as humanoid-the article connects a propensity for disgust to the corresponding socio-cultural and political zeitgeist...
August 10, 2016: Medical Humanities
Marek Rudnicki
It is estimated that approximately 20-25 000 polish physicians practice medicine in different countries outside of Poland, enriching medical workforces in their newly elected countries. The composition of this group, known as "Medical Polonia", has been changing from post Second World War emigration, resulting from the war and its political consequences, thru the next large wave of physicians leaving the communist country in 1980's. The last large group of Polish physicians has taken advantage of training opportunities or have started practices in the European Union, having departed Poland permanently or temporarily, after the country joined the European Union in 2004...
2016: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
Ivana Rešetnik, Dea Baričevič, Diana Batîr Rusu, Klaudija Carović-Stanko, Paschalina Chatzopoulou, Zora Dajić-Stevanović, Maria Gonceariuc, Martina Grdiša, Danijela Greguraš, Alban Ibraliu, Marija Jug-Dujaković, Elez Krasniqi, Zlatko Liber, Senad Murtić, Dragana Pećanac, Ivan Radosavljević, Gjoshe Stefkov, Danijela Stešević, Ivan Šoštarić, Zlatko Šatović
Dalmatian sage (Salvia officinalis L., Lamiaceae) is a well-known aromatic and medicinal Mediterranean plant that is native in coastal regions of the western Balkan and southern Apennine Peninsulas and is commonly cultivated worldwide. It is widely used in the food, pharmaceutical and cosmetic industries. Knowledge of its genetic diversity and spatiotemporal patterns is important for plant breeding programmes and conservation. We used eight microsatellite markers to investigate evolutionary history of indigenous populations as well as genetic diversity and structure within and among indigenous and cultivated/naturalised populations distributed across the Balkan Peninsula...
2016: PloS One
(no author information available yet)
No abstract text is available yet for this article.
June 2016: Annals of Intensive Care
Leah McClimans, Anne Slowther
Philosophers and others have questioned whether or not expertise in morality is possible. This debate is not only theoretical, but also affects the perceived legitimacy of clinical ethicists. One argument against moral expertise is that in a pluralistic society with competing moral theories no one can claim expertise regarding what another ought morally to do. There are simply too many reasonable moral values and intuitions that affect theory choice and its application; expertise is epistemically uniform. In this article, we discuss how similar concerns have recently threatened to undermine expertise in medicine and science...
August 2016: Journal of Medicine and Philosophy
Ruben Herrendorff, Maria Teresa Faleschini, Adeline Stiefvater, Beat Erne, Tatiana Wiktorowicz, Frances Kern, Matthias Hamburger, Olivier Potterat, Jochen Kinter, Michael Sinnreich
Myotonic dystrophy type I (DM1) is a disabling neuromuscular disease with no causal treatment available. This disease is caused by expanded CTG trinucleotide repeats in the 3' UTR of the dystrophia myotonica protein kinase gene. On the RNA level, expanded (CUG)n repeats form hairpin structures that sequester splicing factors such as muscleblind-like 1 (MBNL1). Lack of available MBNL1 leads to misregulated alternative splicing of many target pre-mRNAs, leading to the multisystemic symptoms in DM1. Many studies aiming to identify small molecules that target the (CUG)n-MBNL1 complex focused on synthetic molecules...
August 12, 2016: Journal of Biological Chemistry
Thomas Monks
BACKGROUND: Operational research (OR) is the discipline of using models, either quantitative or qualitative, to aid decision-making in complex implementation problems. The methods of OR have been used in healthcare since the 1950s in diverse areas such as emergency medicine and the interface between acute and community care; hospital performance; scheduling and management of patient home visits; scheduling of patient appointments; and many other complex implementation problems of an operational or logistical nature...
2016: Implementation Science: IS
Eva Schmelzer, Patrick Over, Bruno Gridelli, Jörg C Gerlach
Advancement in thermal three-dimensional printing techniques has greatly increased the possible applications of various materials in medical applications and tissue engineering. Yet, potential toxic effects on primary human cells have been rarely investigated. Therefore, we compared four materials commonly used in thermal printing for bioengineering, namely thermally printed acrylonitrile butadiene styrene, MED610, polycarbonate, and polylactic acid, and investigated their effects on primary human adult skin epidermal keratinocytes and bone marrow mesenchymal stromal cells (BM-MSCs) in vitro...
2016: Journal of Medical and Biological Engineering
Tzipi Weiss, Marci J Swede
ISSUE: The Institute of Medicine identified health care education reform as a key to improving the error prone, costly, and unsatisfying U.S. health care system. It called for health care education that no longer focuses exclusively on the mastery of technical skills but teaches students the human dimensions of care and develops their ability to collaborate with patients and colleagues to alleviate suffering and improve health. When should this educational reform begin, by what frameworks should it be guided, and which methods should it employ are important questions to explore...
May 4, 2016: Teaching and Learning in Medicine
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