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https://www.readbyqxmd.com/read/29779296/the-assessment-and-management-of-chest-pain-in-primary-care-a-focus-on-acute-coronary-syndrome
#1
Richard Thomsett, Louise Cullen
BACKGROUND: Chest pain is a common presentation and diagnosis can be challenging. There are many causes for chest pain, including life-threatening conditions such as acute coronary syndrome (ACS), which can prove difficult to diagnose. OBJECTIVE: This article focuses on diagnosis and early management of patients with possible ACS. Key differentials and essential primary care investigations and management are outlined. Hospital-based risk stratification and management are described, providing an outline of what patients can expect if referred to hospital...
May 2018: Australian journal of general practice
https://www.readbyqxmd.com/read/29778885/effects-of-hyperpolypharmacy-and-potentially-inappropriate-medications-pims-on-functional-decline-in-older-patients-discharged-from-acute-care-hospitals
#2
Paolo Fabbietti, Carmelinda Ruggiero, Federica Sganga, Sergio Fusco, Federica Mammarella, Norma Barbini, Laura Cassetta, Graziano Onder, Andrea Corsonello, Fabrizia Lattanzio, Mirko Di Rosa
AIM: To comparatively investigate the effects of hyperpolypharmacy and potentially inappropriate medications (PIMs) on functional decline in older patients after hospital discharge. METHODS: Our series consisted of 733 patients aged ≥65 consecutively enrolled in a multicenter observational longitudinal study. PIMs were defined on the basis of updated versions of Beers and STOPP criteria. The occurrence of functional decline was defined as the loss of independency in at least 1 basic activity of daily living (BADL) from discharge through 3-month follow-up visit...
May 16, 2018: Archives of Gerontology and Geriatrics
https://www.readbyqxmd.com/read/29778659/sepsis-3-septic-shock-criteria-and-associated-mortality-among-infected-hospitalized-patients-assessed-by-a-rapid-response-team
#3
Shannon M Fernando, Peter M Reardon, Bram Rochwerg, Nathan I Shapiro, Donald M Yealy, Andrew J E Seely, Jeffrey J Perry, Douglas P Barnaby, Kyle Murphy, Peter Tanuseputro, Kwadwo Kyeremanteng
BACKGROUND: Rapid Response Teams (RRTs) respond to deteriorating hospitalized patients, and help determine subsequent management, including Intensive Care Unit (ICU) admission. In such patients with sepsis and septic shock, the Sepsis-3 clinical criteria have a potential role in detection, risk-stratification, and prognostication, though their accuracy in comparison to the Systemic Inflammatory Response Syndrome (SIRS)-based septic shock criteria are unknown. We sought to evaluate prognostic accuracy of the Sepsis-3 criteria for in-hospital mortality among infected hospitalized patients with acute deterioration...
May 17, 2018: Chest
https://www.readbyqxmd.com/read/29778434/implementation-of-multimodal-infection-control-and-hand-hygiene-strategies-in-acute-care-hospitals-in-greece-a-cross-sectional-benchmarking-survey
#4
Evangelos I Kritsotakis, Eirini Astrinaki, Argyri Messaritaki, Achilleas Gikas
BACKGROUND: In this first attempt to suggest achievable standards for improvement in hospital infection prevention and control (IPC) in Greece, we assessed main IPC structure and process indicators emphasizing hand hygiene. METHODS: Acute-care hospitals across the country participated in a cross-sectional survey by completing the World Health Organization Hand Hygiene Self-assessment Framework (HHSAF) and by providing hospital-level IPC indicators. RESULTS: Seventeen hospitals completed the survey, comprising 14% of the country's public hospitals...
May 16, 2018: American Journal of Infection Control
https://www.readbyqxmd.com/read/29778331/goal-directed-perfusion-to-reduce-acute-kidney-injury-a-randomized-trial
#5
Marco Ranucci, Ian Johnson, Timothy Willcox, Robert A Baker, Christa Boer, Andreas Baumann, George A Justison, Filip de Somer, Paul Exton, Seema Agarwal, Rachael Parke, Richard F Newland, Renard G Haumann, Dirk Buchwald, Nathaen Weitzel, Rajamiyer Venkateswaran, Valeria Pistuddi
OBJECTIVE: To determine whether a goal-directed perfusion (GDP) strategy aimed at maintaining oxygen delivery (DO2 ) at ≥280 mL·min-1 ·m-2 reduces the incidence of acute kidney injury (AKI). METHODS: This multicenter randomized trial enrolled a total of 350 patients undergoing cardiac surgery in 9 institutions. Patients were randomized to receive either GDP or conventional perfusion. A total of 326 patients completed the study and were analyzed. Patients in the treatment arm were treated with a GDP strategy during cardiopulmonary bypass (CPB) aimed to maintain DO2 at ≥280 mL·min-1 ·m-2 ...
April 18, 2018: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29778325/tranexamic-acid-for-hyperacute-primary-intracerebral-haemorrhage-tich-2-an-international-randomised-placebo-controlled-phase-3-superiority-trial
#6
Nikola Sprigg, Katie Flaherty, Jason P Appleton, Rustam Al-Shahi Salman, Daniel Bereczki, Maia Beridze, Hanne Christensen, Alfonso Ciccone, Ronan Collins, Anna Czlonkowska, Robert A Dineen, Lelia Duley, Juan Jose Egea-Guerrero, Timothy J England, Kailash Krishnan, Ann Charlotte Laska, Zhe Kang Law, Serefnur Ozturk, Stuart J Pocock, Ian Roberts, Thompson G Robinson, Christine Roffe, David Seiffge, Polly Scutt, Jegan Thanabalan, David Werring, David Whynes, Philip M Bath
BACKGROUND: Tranexamic acid can prevent death due to bleeding after trauma and post-partum haemorrhage. We aimed to assess whether tranexamic acid reduces haematoma expansion and improves outcome in adults with stroke due to intracerebral haemorrhage. METHODS: We did an international, randomised placebo-controlled trial in adults with intracerebral haemorrhage from acute stroke units at 124 hospital sites in 12 countries. Participants were randomly assigned (1:1) to receive 1 g intravenous tranexamic acid bolus followed by an 8 h infusion of 1 g tranexamic acid or a matching placebo, within 8 h of symptom onset...
May 15, 2018: Lancet
https://www.readbyqxmd.com/read/29778317/appropriate-use-of-noninvasive-ischemia-testing-to-guide-revascularization-decision-making-following-acute-st-elevation-myocardial-infarction-in-latin-american-countries-results-from-an-expert-panel-meeting-of-the-international-atomic-energy-agency
#7
I Berrocal, A Peix, F Mut, L J Shaw, G Karthikeyan, E Estrada Lobato, D Paez
Across Latin American and Caribbean countries, cardiovascular disease and especially ischemic heart disease is currently the main cause of death both in men and in women. For most Latin American and Caribbean countries, public and community health efforts aim to define care strategies which are both clinically and cost effective and promote primary and secondary prevention, resulting in improved patient outcomes. The optimal approach to deal with acute events such as ST-elevation myocardial infarction (STEMI) is a matter of controversy; however, there is an expanding role for assessing residual ischemic burden in STEMI patients following primary percutaneous coronary intervention...
May 16, 2018: Revista Española de Medicina Nuclear e Imagen Molecular
https://www.readbyqxmd.com/read/29778236/challenges-in-implementation-of-institutional-protocols-for-patients-with-acute-coronary-syndrome
#8
REVIEW
Atman P Shah, Sandeep Nathan
The diagnosis of acute coronary syndrome (ACS) encompasses ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation ACS (non-STEMI and unstable angina). In recent years, there have been improvements in the rates of death, cardiogenic shock, and recurrent myocardial infarction in patients with ACS, primarily due to the introduction of new pharmacological and interventional therapies, as well as the introduction of and adherence to new treatment guidelines. However, ACS still represents a considerable public health burden...
April 17, 2018: American Journal of Cardiology
https://www.readbyqxmd.com/read/29777926/epidemiology-of-acute-febrile-illness-in-latin-america
#9
REVIEW
José Moreira, Clarisse S Bressan, Patricia Brasil, Andre M Siqueira
BACKGROUND: The causes of acute febrile illness (AFI) in Latin America (LA) are diverse and its complexity increase as the proportion of fever due to malaria decreases as control and new pathogens emerge in the region. In this context, it is important to shed light over the gaps on the epidemiological characteristics and the geographic range for many AFI aetiologies. AIMS: To review studies on community-acquired fever etiology other than malaria in LA, and to highlight knowledge gaps and challenges needing further investigation...
May 16, 2018: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/29777660/chronic-obstructive-pulmonary-disease-exacerbations-a-need-for-action
#10
Antonio Anzueto, Marc Miravitlles
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality, with exacerbations contributing strongly to the overall severity and burden of disease at the individual level. Many patients with COPD are managed predominantly in the primary care setting; therefore, primary care physicians (PCPs) must have awareness and understanding of the causes, effects, and management of exacerbations in COPD. This review offers practical information regarding how exacerbations are defined in the treatment setting, pathogenic and environmental causes, options for exacerbation treatment and prevention, and suggestions for improving care in the clinic...
May 16, 2018: American Journal of Medicine
https://www.readbyqxmd.com/read/29777566/care-provider-allocation-on-admissions-to-acute-mental-health-wards-the-development-and-validation-of-the-admission-team-score-list
#11
Sjobha R N van den Berg, Barbara Stringer, Roland van de Sande, Stasja Draisma
Currently, support tools are lacking to prioritize steps in the care coordination process to enable safe practice and effective clinical pathways in the first phase of acute psychiatric admissions. This study describes the development, validity, and reliability of an acute care coordination support tool, the Admission Team Score List (ATSL). The ATSL assists in care provider allocation during admissions. Face validity and feasibility of the ATSL were tested in 77 acute admissions. Endscores of filled out ATSL's were translated to recommended team compositions...
May 18, 2018: International Journal of Mental Health Nursing
https://www.readbyqxmd.com/read/29777554/development-and-feasibility-testing-of-an-avatar-based-education-application-for-patients-with-acute-coronary-syndrome
#12
Jintana Tongpeth, Hui Yun Du, Robyn A Clark
AIMS: To develop and evaluate an interactive, avatar-based education application, for improving patients' knowledge of, and response to, ACS symptoms. BACKGROUND: A patient's ability to recognise and respond to the symptoms of acute coronary syndrome (ACS) is imperative for seeking timely medical intervention. Innovative patient education interventions are needed to support patient education and patient self-care. METHODS: Participatory action research methods were used to engage consumers with cardiac and IT experts to develop an avatar-based education application...
May 18, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29777456/distal-bowel-re-feeding-in-patients-with-proximal-jejunostomy
#13
Anand Nagar, Siddharth Mehrotra, Amitabh Yadav, Vivek Mangla, Shailendra Lalwani, Naimish Mehta, Samiran Nundy
BACKGROUND: Patients who have a proximal jejunostomy are difficult to manage because of their high stoma output which results in fluid and electrolyte imbalance with repeated hospital admissions and the necessity for expensive parenteral nutrition (PN). There are few reports on the use of re-feeding of the proximal effluents in this situation. METHODS: We here relate our experience with this manoeuvre in 35 patients between Jan 2010 and Feb 2016 who had stomas less than 120 cm away from the duodenojejunal flexure...
May 18, 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/29777291/growth-of-asymptomatic-intracranial-fusiform-aneurysms-incidence-and-risk-factors
#14
Jusun Moon, Young Dae Cho, Dong Hyun Yoo, Jeongjun Lee, Hyun-Seung Kang, Won-Sang Cho, Jeong Eun Kim, Li Zhang, Moon Hee Han
PURPOSE: Growth of intracranial fusiform aneurysms (IFA) may become clinically problematic through a mass effect or rupture. We investigated the growth rate and factors contributing to growth in asymptomatic untreated IFA. METHOD: As a retrospective review, we assessed patients diagnosed with asymptomatic IFA between August 2000 and September 2014, all untreated. No acute or symptomatic dissecting lesions were considered. Clinical and serial angiographic follow-up data were analyzed, defining growth as expansion > 2 mm in one or more dimensions...
May 18, 2018: Clinical Neuroradiology
https://www.readbyqxmd.com/read/29777245/growth-assessment-and-monitoring-during-childhood
#15
Fabian Yap, Yung Seng Lee, Marion Margaret Hy Aw
Growth is an indicator of the health and nutritional status of infants and children. Health organisations and professionals worldwide advocate monitoring the growth of children with the primary aim of identifying and preventing malnutrition and/or obesity. Growth monitoring should be part of every health care consultation for children. However, physicians during health care consultations are often so busy addressing acute health issues, that they miss the opportunity to monitor the child's growth and provide anticipatory guidance...
April 2018: Annals of the Academy of Medicine, Singapore
https://www.readbyqxmd.com/read/29776804/hemicraniectomy-for-malignant-middle-cerebral-artery-syndrome-a-review-of-functional-outcomes-in-two-high-volume-stroke-centers
#16
Abhi Pandhi, Georgios Tsivgoulis, Nitin Goyal, Muhammad F Ishfaq, Shailesh Male, Efstathios Boviatsis, Jason J Chang, Ramin Zand, Konstantinos Voumvourakis, Lucas Elijovich, Anne W Alexandrov, Marc D Malkoff, Daniel Hoit, Adam S Arthur, Andrei V Alexandrov
BACKGROUND AND PURPOSE: Despite recent landmark randomized controlled trials showing significant benefits for hemicraniectomy (HCT) compared with medical therapy (MT) in patients with malignant middle cerebral artery infarction (MMCAI), HCT rates have not substantially increased in the United States. We sought to evaluate early outcomes in patients with MMCAI who were treated with HCT (cases) in comparison to patients treated with MT due to the perception of procedural futility by families (controls)...
May 15, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29776790/-modern-treatment-of-mesenteric-ischemia
#17
Alexandre Nuzzo, Audrey Huguet, Olivier Corcos
Acute mesenteric ischemia is a highly morbid affliction which requires urgent care. Acute mesenteric ischemia consists in an ischemia injury of the small bowel, secondary to vascular insufficiency, either occlusive (thrombosis, embolism, arterial, venous) or non-occlusive (low flow or vasospasm). Given that the superior mesenteric artery supplies the small bowel as well as the right part of the colon, any ischemic process involving the right colon should be considered an acute mesenteric ischemia until proven otherwise...
May 15, 2018: La Presse Médicale
https://www.readbyqxmd.com/read/29776670/-predictors-of-in-hospital-mortality-in-patients-undergoing-elective-surgery-in-a-university-hospital-a-prospective-cohort
#18
Adriene Stahlschmidt, Betânia Novelo, Luiza Alexi Freitas, Sávio Cavalcante Passos, Jairo Alberto Dussián-Sarria, Elaine Aparecida Félix, Patrícia Wajnberg Gamermann, Wolnei Caumo, Luciana Paula Cadore Stefani
INTRODUCTION: Morbidity and mortality associated with urgent or emergency surgeries are high compared to elective procedures. Perioperative risk scores identify the non-elective character as an independent factor of complications and death. The present study aims to characterize the population undergoing non-elective surgeries at the Hospital de Clínicas de Porto Alegre and identify the clinical and surgical factors associated with death within 30 days postoperatively. METHODOLOGY: A prospective cohort study of 187 patients undergoing elective surgeries between April and May 2014 at the Hospital de Clínicas, Porto Alegre...
May 15, 2018: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/29775092/a-prospective-multi-centre-us-clinical-trial-to-determine-accuracy-of-febridx-point-of-care-testing-for-acute-upper-respiratory-infections-with-and-without-a-confirmed-fever
#19
Nathan I Shapiro, Wesley H Self, Jeffrey Rosen, Stephan C Sharp, Michael R Filbin, Peter C Hou, Amisha D Parekh, Michael C Kurz, Robert Sambursky
BACKGROUND: FebriDx is a 10-minute disposable point-of-care test designed to identify clinically significant systemic host immune responses and aid in the differentiation of bacterial and viral respiratory infection by simultaneously detecting C-reactive protein (CRP) and myxovirus resistance protein A (MxA) from a fingerstick blood sample. FebriDx diagnostic accuracy was evaluated in the emergency room and urgent care setting. METHODS: A prospective, multicentre, observational cohort study of acute upper respiratory tract infections (URIs), with and without a confirmed fever at the time of enrolment, was performed to evaluate the diagnostic accuracy of FebriDx to identify clinically significant bacterial infection with host response and acute pathogenic viral infection...
May 18, 2018: Annals of Medicine
https://www.readbyqxmd.com/read/29775088/an-assessment-of-the-uk-inpatient-care-for-heart-failure-patients-with-diabetes
#20
Lihua Wu, Jackie Cleator, Mamas Mamas, Christi Deaton
BACKGROUND: Diabetes is a common co-morbidity for patients with heart failure. Diabetes as a co-morbidity means that inpatient care should focus on both conditions to maximize the treatment regimen. However, this pressing issue is not widely researched and so it is unclear whether the acute care management needs of these patients are being met. AIMS: (1) To assess the differences in the number of hospital readmissions between patients with heart failure and patients with heart failure-diabetes; (2) to assess the use of integrated care approach for patients with heart failure-diabetes during the index heart failure-related admission; (3) to explore patient experiences of admissions...
May 1, 2018: European Journal of Cardiovascular Nursing
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