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Intensive care medicines

Gregory Plotnikoff, Melissa Barber
INTRODUCTION: Single-disorder or single-organ-system clinical practice guidelines are often of limited usefulness in guiding effective management of patients with chronic multidimensional signs and symptoms. The presence of multiple long-standing medical problems in a given patient despite intensive medical effort suggests that addressing systemic core imbalances could complement more narrowly focused approaches. CASE PRESENTATION: A 72-year-old man experiencing longstanding depression, fatigue, irritable bowel syndrome, and chronic pain in the context of additional refractory illnesses was assessed and treated, guided by a system-oriented approach to underlying core imbalances termed functional medicine...
October 14, 2016: Permanente Journal
Gerhard Batz, Michael Dinkel
Echocardiography as an imaging method in anaesthesia and intensive care medicine has enabled a new dimension of hemodynamic monitoring: the direct visualization of the cardiac function and its disruptions. Preconditions for a broad application in this area was the development of mobile, high-definition ultrasonic devices and the origination of focused examination techniques. A successful application of this method requires the respective know-how of the examiner, in order to take relevant decisions and avoid misdiagnoses...
October 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Kanchi Muralidhar, Deepak Tempe, Yatin Mehta, Poonam Malhotra Kapoor, Chirojit Mukherjee, Thomas Koshy, Prabhat Tewari, Naman Shastri, Satyajeet Misra, Kumar Belani
During current medical care, perioperative transesophageal echocardiography (TEE) has become a vital component of patient management, especially in cardiac operating rooms and in critical care medicine. Information derived from echocardiography has an important bearing on the patient's outcome. The Indian Association of Cardiovascular and Thoracic Anaesthesiologists (IACTA) has promoted the use of TEE during routine clinical care of patients undergoing cardiac surgery. An important mission of IACTA is to oversee training and certify anesthesiologists in the perioperative and intensive care use of TEE...
October 2016: Annals of Cardiac Anaesthesia
Prakash Chandra Pandey, Sarita Bajaj, Anubha Srivastava
OBJECTIVE: Snake bite in India is a common medical emergency and an occupational hazard for majority of Indian population especially farmers. Epidemiological data on snake bite from the North India is sparse. Hence we conducted this study to find clinico-epidemiological profile of neuroparalytic snake bite. METHODS: This is a record-based, descriptive study carried out at the Department of Medicine, M.L.N. Medical College and associated Swaroop Rani Nehru Hospital, Allahabad, U...
August 2016: Journal of the Association of Physicians of India
Sarah J Beesley, Eliotte L Hirshberg, Michael J Lanspa
In a recently published issue of Critical Care Medicine, Kar and colleagues investigated glucose management of critically ill patients with type 2 diabetes. In this commentary, we discuss the challenges of investigating glucose control in the critically ill, why so many internally valid studies in this field lead to conflicting results, and the obstacles preventing investigators from reaching a conclusive answer.
September 2016: Annals of Translational Medicine
Kristin L Garlanger, Elena J Jelsing, Jonathan T Finnoff
A 33-year-old elite female runner presented to a tertiary care sports medicine clinic with a 2-year history of progressive anterior thigh and circumferential leg pain with associated foot paresthesias brought on by high-intensity running. She had both external iliac artery vasospasm and chronic exertional compartment syndrome. External iliac artery vasospasm is a rare cause of exertional leg pain, particularly in the running population. This case highlights the unique features of this condition, addresses the multidisciplinary approach that led to the accurate diagnoses, and demonstrates that more than 1 etiology for exertional leg pain can coexist in an athlete...
October 19, 2016: Sports Health
K M Olsson, M Halank, B Egenlauf, D Fistera, H Gall, C Kaehler, K Kortmann, T Kramm, M Lichtblau, A Marra, C Nagel, A Sablotzki, H-J Seyfarth, D Schranz, S Ulrich, M M Hoeper, T J Lange
The 2015 European Guidelines on Diagnosis and Treatment of Pulmonary Hypertension are also valid for Germany. The guidelines contain detailed recommendations for the targeted treatment of pulmonary arterial hypertension (PAH). However, the practical implementation of the European Guidelines in Germany requires the consideration of several country-specific issues and already existing novel data. This requires a detailed commentary to the guidelines, and in some aspects an update already appears necessary. In June 2016, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany...
October 2016: Deutsche Medizinische Wochenschrift
Michael S Hofman, Rodney J Hicks
(18)F-fluorodeoxyglucose (FDG) PET/CT is a pivotal imaging modality for cancer imaging, assisting diagnosis, staging of patients with newly diagnosed malignancy, restaging following therapy and surveillance. Interpretation requires integration of the metabolic and anatomic findings provided by the PET and CT components which transcend the knowledge base isolated in the worlds of nuclear medicine and radiology, respectively. In the manuscript we detail our approach to reviewing and reporting a PET/CT study using the most commonly used radiotracer, FDG...
October 18, 2016: Cancer Imaging: the Official Publication of the International Cancer Imaging Society
Rae Woong Park
Big data indicates the large and ever-increasing volumes of data adhere to the following 4Vs: volume (ever-increasing amount), velocity (quickly generated), variety (many different types), veracity (from trustable sources). The last decade has seen huge advances in the amount of data we routinely generate and collect in pretty much everything we do, as well as our ability to use technology to analyze and understand it. The routine operation of modern health care systems also produces an abundance of electronically stored data on an ongoing basis as a byproduct of clinical practice...
September 2016: Journal of Hypertension
Ernesto Schiffrin
Clinical practice guidelines, which are systematically developed statements aimed at helping people make clinical, policy-related and system-related decisions, frequently vary widely in quality. A strategy is needed to differentiate among guidelines and ensure that those of the highest quality are implemented. Hypertension Canada provides annually updated standardized recommendations and clinical practice guidelines to detect, treat and control hypertension. The annual, evidence-based recommendations are developed through intense discussion of the clinical implications via a systematic review of the literature followed by critical appraisals of all the new clinical research, taking into account the assessment criteria in the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument that evaluates the process of practice guideline development and the quality of reporting...
September 2016: Journal of Hypertension
Duygu Sönmez Düzkaya, Gülçin Bozkurt, Gülzade Uysal, Tülay Yakut
BACKGROUND: There are few studies in the literature from developing countries regarding the rates of catheter-associated urinary tract infection (CAUTI), which is frequently encountered in pediatric intensive care units (PICUs). AIM: The aim of this study is to evaluate the 2-year rates of CAUTI in a PICU where a CAUTI Prevention Bundle was implemented. DESIGN: This was an interventional prospective study. METHODS: The study was conducted with 390 patients in the PICU of Istanbul Faculty of Medicine, Turkey, from July 2013 to July 2015...
November 2016: Clinical Nurse Specialist CNS
Kim Tran, Chaim Bell, Nathan Stall, George Tomlinson, Allison McGeer, Andrew Morris, Michael Gardam, Howard B Abrams
BACKGROUND: Isolation precautions have negative effects on patient safety, psychological well-being, and healthcare worker contact. However, it is not known whether isolation precautions affect certain hospital-related outcomes. OBJECTIVE: To examine the effect of isolation precautions on hospital-related outcomes and cost of care. DESIGN: Retrospective, propensity-score matched cohort study of inpatients admitted to general internal medicine (GIM) services at three academic hospitals in Toronto, Ontario, Canada between January 2010 and December 2012...
October 17, 2016: Journal of General Internal Medicine
Tae Nyoung Chung, Sun Wook Kim, Je Sung You, Hyun Soo Chung
OBJECTIVE: Tube thoracostomy (TT) is a commonly performed intensive care procedure. Simulator training may be a good alternative method for TT training, compared with conventional methods such as apprenticeship and animal skills laboratory. However, there is insufficient evidence supporting use of a simulator. The aim of this study is to determine whether training with medical simulator is associated with faster TT process, compared to conventional training without simulator. METHODS: This is a simulation study...
March 2016: Clin Exp Emerg Med
Xiang Kong, Yan Kong, Fangyuan Zhang, Tingting Wang, Jin Yan
BACKGROUND: Intrahepatic cholestasis of pregnancy (ICP) is a specific pregnancy-related disorder without standard medical therapies. Ursodeoxycholic acid (UDCA) is the most used medicine, but the efficacy and safety of UDCA remain uncertain. Several meta-analyses had been made to assess the effects of UDCA in ICP. However, the samples were not large enough to convince obstetricians to use UDCA. We conducted a meta-analysis to evaluate the effects and safety of UDCA in patients with ICP, which included only randomized controlled trials (RCTs)...
October 2016: Medicine (Baltimore)
Julie C Fitzgerald, Scott L Weiss, Niranjan Kissoon
OBJECTIVE: To review important articles in the field of pediatric shock and pediatric septic shock published subsequent to the Fifth Edition of the Rogers' Textbook of Pediatric Intensive Care. DATA SOURCES: The U.S. National Library of Medicine PubMed ( was searched for combination of the term "pediatric" and the following terms: "sepsis, septic shock, shock, antibiotics, extracorporeal membrane oxygenation, and steroid." The abstract lists generated by these searches were screened for potential inclusion...
September 30, 2016: Pediatric Critical Care Medicine
Xiaoyun Hu, Xiuming Xi, Penglin Ma, Haibo Qiu, Kaijiang Yu, Yaoqing Tang, Chuanyun Qian, Qiang Fang, Yushan Wang, Xiangyou Yu, Yuan Xu, Bin Du
BACKGROUND: The aim of this study is to develop consensus on core competencies required for postgraduate training in intensive care medicine. METHODS: We used a combination of a modified Delphi method and a nominal group technique to create and modify the list of core competencies to ensure maximum consensus. Ideas were generated modified from Competency Based Training in Intensive Care Medicine in Europe collaboration (CoBaTrICE) core competencies. An online survey invited healthcare professionals, educators, and trainees to rate and comment on these competencies...
October 16, 2016: Critical Care: the Official Journal of the Critical Care Forum
Jisha Myalil Lucca, Madhan Ramesh, Gurumurthy Parthasarathi, Dushad Ram
AIMS/OBJECTIVES: Psychotropic drugs are associated with significant short-term and long-term safety issues which may affect patients' mental health, physical health and cost of care. EXPERIMENTAL DESIGNS: This was a prospective study conducted in psychiatry department of a tertiary care hospital. Study included patients of any age and either sex who presented with psychiatric illness as diagnosed by ICD-10 and were receiving at least one psychotropic agent. The study involved both intensive and spontaneous reporting methods to identify ADRs...
March 1, 2016: Psychopharmacology Bulletin
Katherine Fitzgerald, Philip Yates, Jonathan Benger, Adrian Harris
OBJECTIVE: To explore the experience of psychological distress and well-being in emergency medicine (EM) consultants. METHODS: A qualitative, interpretative phenomenological analysis (IPA) study based on 1:1 semistructured interviews with EM consultants working full time in EDs across South West England. Eighteen EM consultants were interviewed across five EDs, the mean (SD) age of participants being 43.17 (5.8) years. The personal meanings that participants attached to their experiences were inductively analysed...
October 13, 2016: Emergency Medicine Journal: EMJ
Gassan Fuad Muady, Haim Bitterman, Arie Laor, Moshe Vardi, Vitally Urin, Nesrin Ghanem-Zoubi
BACKGROUND: Acute reduction in hemoglobin levels is frequently seen during sepsis. Previous studies have focused on the management of anemia in patients with septic shock admitted to intensive care units (ICU's), including aggressive blood transfusion aiming to enhance tissue oxygenation. AIM: To study the changes in hemoglobin concentrations during the first week of sepsis in the setting of Internal Medicine (IM) units, and their correlation to survival. DESIGN: Observational prospective study...
October 13, 2016: BMC Infectious Diseases
E B Carter, M G Tuuli, A O Odibo, G A Macones, A G Cahill
OBJECTIVE: To investigate the association between the number of prenatal visits (PNVs) and pregnancy outcomes in women with gestational diabetes (GDM) and Type 2 diabetes mellitus (DM). STUDY DESIGN: A 4-year prospective cohort study of women with GDM and DM and was conducted. Patients ⩾75th percentile for number of PNVs were compared with those ⩽25th percentile. The primary outcomes were large for gestational age (LGA) with birth weight >90% and neonatal intensive care unit (NICU) admission for >24 h...
October 13, 2016: Journal of Perinatology: Official Journal of the California Perinatal Association
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