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https://www.readbyqxmd.com/read/28213997/echocardiographic-correlates-are-associated-with-in-hospital-mortality-in-trauma-and-burn-patients
#1
Duraid Younan, Russell Griffin, Donald Reiff, Jeffrey Richey, Eric Schinnerer, Jean-Francois Pittet, Ahmed Zaky
BACKGROUND: The role of echocardiographic indices of preload and contractility in predicting outcomes is unknown. We report the association of end diastolic area (EDA) and fractional area of change (FAC) with mortality in a cohort of trauma and burn patients. METHODS: Data on 86 patients admitted to a tertiary care center between July 2013 and July 2015 were reviewed. The association between abnormal EDA and FAC and adverse clinical outcomes was tested using exact logistic regression analysis...
February 9, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28195000/prevention-of-tracheostomy-related-hospital-acquired-pressure-ulcers
#2
Thomas R O'Toole, Natalie Jacobs, Brian Hondorp, Laura Crawford, Lisa R Boudreau, Jill Jeffe, Brian Stein, Phillip LoSavio
Objective To determine if standardization of perioperative tracheostomy care procedures decreased the incidence of hospital-acquired tracheostomy-related pressure ulcers. Methods All patients at least 18 years old who underwent placement of a tracheostomy tube in the operating room from July 1, 2014, through June 30, 2015, were cared for postoperatively through an institutionally adopted quality improvement protocol. This included 4 elements: (1) placement of a hydrocolloid dressing underneath the tracheostomy flange in the postoperative period, (2) removal of plate sutures within 7 days of the tracheostomy procedure, (3) placement of a polyurethane foam dressing after suture removal, and (4) neutral positioning of the head...
February 1, 2017: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/28187799/management-of-intracerebral-hemorrhage
#3
A M Thabet, M Kottapally, J Claude Hemphill
Intracerebral hemorrhage (ICH) is a potentially devastating neurologic injury representing 10-15% of stroke cases in the USA each year. Numerous risk factors, including age, hypertension, male gender, coagulopathy, genetic susceptibility, and ethnic descent, have been identified. Timely identification, workup, and management of this condition remain a challenge for clinicians as numerous factors can present obstacles to achieving good functional outcomes. Several large clinical trials have been conducted over the prior decade regarding medical and surgical interventions...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28182533/the-reality-of-routine-practice-a-pooled-data-analysis-on-chronic-wounds-treated-with-tlc-nosf-wound-dressings
#4
K C Münter, S Meaume, M Augustin, P Senet, J C Kérihuel
OBJECTIVE: A number of randomised controlled trials (RCT) have compared control groups with TLC-NOSF dressings (UrgoStart) on chronic wounds. Our aim was to determine whether the clinical trials' results translate into routine management of such wounds, by pooling the data from real-life observational studies. METHOD: Observational studies, conducted in France and Germany, evaluating current practices in patients suffering from non-selected chronic wounds treated with a TLC-NOSF dressing were identified...
February 2017: Journal of Wound Care
https://www.readbyqxmd.com/read/28174659/making-an-impakt-improving-care-of-chronic-kidney-disease-patients-in-the-community-through-collaborative-working-and-utilizing-information-technology
#5
Gang Xu, Rupert Major, David Shepherd, Nigel Brunskill
Chronic kidney disease (CKD) is a serious long-term condition, which if left untreated causes significant cardiovascular sequele. It is well recognized management of modifiable risk factors, such as blood pressure (BP), can lead to improved long-term outcomes. A novel information technology (IT) solution presents a possible solution to help clinicians in the community identify and manage at risk patients more efficiently. The IMproving Patient care and Awareness of Kidney disease progression Together (IMPAKT) IT tool was used to identify patients with CKD and uncontrolled hypertension in the community...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28168888/cutaneous-sensibility-changes-in-bell-s-palsy-patients
#6
Carlos Andrés Cárdenas Palacio, Francisco Alejandro Múnera Galarza
Objective Bell's palsy is a cranial nerve VII dysfunction that renders the patient unable to control facial muscles from the affected side. Nevertheless, some patients have reported cutaneous changes in the paretic area. Therefore, cutaneous sensibility changes might be possible additional symptoms within the clinical presentation of this disorder. Accordingly, the aim of this research was to investigate the relationship between cutaneous sensibility and facial paralysis severity in these patients. Study Design Prospective longitudinal cohort study...
February 1, 2017: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/28166772/challenges-uncertainties-and-perceived-benefits-of-providing-weekend-allied-health-services-a-managers-perspective
#7
Deb Mitchell, Lisa O'Brien, Anne Bardoel, Terry Haines
BACKGROUND: Health services that operate 7 days per week are under pressure to show the increased cost of providing weekend services can be measured in improved patient outcomes. The evidence for weekend allied health services in acute medical and surgical wards is weak and there is wide variation between the services offered at different hospitals. METHODS: This qualitative study was undertaken during a multi-site stepped wedge randomised controlled trial involving twelve acute medical and surgical wards from two Australian hospitals, in which weekend allied health services were removed before being reinstated with a stakeholder driven model...
February 6, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28158243/long-term-pulse-wave-velocity-outcomes-with-aerobic-and-resistance-training-in-kidney-transplant-recipients-a-pilot-randomised-controlled-trial
#8
Ellen M O'Connor, Pelagia Koufaki, Thomas H Mercer, Herolin Lindup, Eilish Nugent, David Goldsmith, Iain C Macdougall, Sharlene A Greenwood
BACKGROUND: This pilot study examined long-term pulse wave velocity (PWV) and peak oxygen uptake (VO2peak) outcomes following a 12-week moderate-intensity aerobic or resistance training programme in kidney transplant recipients. METHOD: Single-blind, bi-centre randomised controlled parallel trial. 42 out of 60 participants completed a 9-month follow-up assessment (Aerobic training = 12, Resistance training = 10 and usual care = 20). Participants completed 12 weeks of twice-weekly supervised aerobic or resistance training...
2017: PloS One
https://www.readbyqxmd.com/read/28149825/correlations-between-pulmonary-artery-pressures-and-inferior-vena-cava-collapsibility-in-critically-ill-surgical-patients-an-exploratory-study
#9
Stanislaw P Stawicki, Thomas J Papadimos, David P Bahner, David C Evans, Christian Jones
INTRODUCTION: As pulmonary artery catheter (PAC) use declines, search continues for reliable and readily accessible minimally invasive hemodynamic monitoring alternatives. Although the correlation between inferior vena cava collapsibility index (IVC-CI) and central venous pressures (CVP) has been described previously, little information exists regarding the relationship between IVC-CI and pulmonary artery pressures (PAPs). The goal of this study is to bridge this important knowledge gap...
October 2016: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/28149560/glucose-insulin-potassium-correlates-with-hemodynamic-improvement-in-patients-with-septic-myocardial-dysfunction
#10
Won-Young Kim, Moon Seong Baek, Young Shin Kim, Jarim Seo, Jin Won Huh, Chae-Man Lim, Younsuck Koh, Sang-Bum Hong
BACKGROUND: Glucose-insulin-potassium (GIK) demonstrates a cardioprotective effect by providing metabolic support and anti-inflammatory action, and may be useful in septic myocardial depression. The aim of this study was to examine the relationship between GIK and hemodynamic outcomes in septic shock patients with myocardial depression. METHODS: Between October 2012 and March 2014, 45 patients in the intensive care unit who fulfilled the criteria for severe sepsis/septic shock and were treated with GIK were recruited...
December 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28148536/impact-of-rapid-ultrafiltration-rate-on-changes-in-the-echocardiographic-left-atrial-volume-index-in-patients-undergoing-haemodialysis-a-longitudinal-observational-study
#11
Jwa-Kyung Kim, Young Rim Song, GunHa Park, Hyung Jik Kim, Sung Gyun Kim
OBJECTIVE: Optimal fluid management is essential when caring for a patient on haemodialysis (HD). However, if the fluid removal is too rapid, the resultant higher ultrafiltration rate (UFR) disadvantageously promotes haemodynamic instability and cardiac injury. We evaluated the effects of a rapid UFR on changes in the echocardiographic left atrial volume index (LAVI) over a period of time. DESIGN: Longitudinal observational study. SETTING AND PARTICIPANTS: A total of 124 new patients on HD...
February 1, 2017: BMJ Open
https://www.readbyqxmd.com/read/28142133/perioperative-hemodynamic-instability-and-fluid-overload-are-associated-with-increasing-acute-kidney-injury-severity-and-worse-outcome-after-cardiac-surgery
#12
Anja Haase-Fielitz, Michael Haase, Rinaldo Bellomo, Paolo Calzavacca, Anke Spura, Hassina Baraki, Ingo Kutschka, Christian Albert
PURPOSE: The study aimed to investigate patients' characteristics, fluid and hemodynamic management, and outcomes according to the severity of cardiac surgery-associated acute kidney injury (CSA-AKI). METHODS: In a single-center, prospective cohort study, we enrolled 282 adult cardiac surgical patients. In a secondary analysis, we assessed preoperative patients' characteristics, physiological variables, and medication for intra- and postoperative fluid and hemodynamic management and outcomes according to CSA-AKI stages by the Renal risk, Injury, Failure, Loss, End-stage renal disease (RIFLE) classification...
January 31, 2017: Blood Purification
https://www.readbyqxmd.com/read/28138090/standardizing-phlebotomy-job-descriptions
#13
Jim Cook
BACKGROUND: The University of Maryland Medical System, like all other medical systems, is faced with providing the highest quality care in an environment of increased demands and competition for resources. Some responses to this pressure include improved integration, coordination, and efficiency. Laboratory integration has been highlighted by our medical system as a promising area for improvement. Standardization of practices, including job descriptions, is an important step on this journey...
February 2017: Laboratory Medicine
https://www.readbyqxmd.com/read/28134031/factors-that-influence-clinicians-decisions-to-offer-intravenous-alteplase-in-acute-ischemic-stroke-patients-with-uncertain-treatment-indication-results-of-a-discrete-choice-experiment
#14
Aoife De Brún, Darren Flynn, Laura Ternent, Christopher I Price, Helen Rodgers, Gary A Ford, Matthew Rudd, Emily Lancsar, Stephen Simpson, John Teah, Richard G Thomson
Background Treatment with intravenous alteplase for eligible patients with acute ischemic stroke is underused, with variation in treatment rates across the UK. This study sought to elucidate factors influencing variation in clinicians' decision-making about this thrombolytic treatment. Methods A discrete choice experiment using hypothetical patient vignettes framed around areas of clinical uncertainty was conducted with UK-based clinicians. Mixed logit regression analyses were conducted on the data. Results A total of 138 clinicians completed the discrete choice experiment...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28131554/-hereditary-neuropathy-with-liability-to-pressure-palsies-in-childhood-report-of-three-cases
#15
C Bar, F Villéga, C Espil, M Husson, J-M Pedespan, M-F Rouanet
Hereditary neuropathy with liability to pressure palsy (HNPP) is an autosomal dominant neuropathy. It is characterized by recurrent sensory and motor nerve palsies, usually precipitated by minor trauma or compression. Even though rare in childhood, this disorder is probably underdiagnosed given its wide spectrum of clinical symptoms. We review three separate cases of HNPP diagnosed in children with various phenotypes: fluctuating and distal paresthesias disrupting learning at school, cramps related to intensive piano practice, and discrete muscle weakness with no functional complaint...
January 25, 2017: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/28118460/screening-for-obstructive-sleep-apnea-in-adults-evidence-report-and-systematic-review-for-the-us-preventive-services-task-force
#16
REVIEW
Daniel E Jonas, Halle R Amick, Cynthia Feltner, Rachel Palmieri Weber, Marina Arvanitis, Alexander Stine, Linda Lux, Russell P Harris
Importance: Many adverse health outcomes are associated with obstructive sleep apnea (OSA). Objective: To review primary care-relevant evidence on screening adults for OSA, test accuracy, and treatment of OSA, to inform the US Preventive Services Task Force. Data Sources: MEDLINE, Cochrane Library, EMBASE, and trial registries through October 2015, references, and experts, with surveillance of the literature through October 5, 2016. Study Selection: English-language randomized clinical trials (RCTs); studies evaluating accuracy of screening questionnaires or prediction tools, diagnostic accuracy of portable monitors, or association between apnea-hypopnea index (AHI) and health outcomes among community-based participants...
24, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28114696/-quality-of-glaucoma-care-in-the-greater-hamburg-area
#17
S Waibel, C Gesser, M Klemm
Background There is insufficient data on the quality of health services and health-related quality of life of patients with glaucoma. The purpose of this study was to investigate the extent to which the health services for glaucoma patients in the Greater Hamburg area conform to the guidelines set by the German Ophthalmological Society (DOG). Materials and Methods 196 glaucoma patients were offered an interview-administered questionnaire during their inpatient diurnal IOP measurement. The quality of glaucoma care and examinations recommended by the DOG were analysed...
January 23, 2017: Klinische Monatsblätter Für Augenheilkunde
https://www.readbyqxmd.com/read/28114678/revisiting-the-definition-of-bronchopulmonary-dysplasia-effect-of-changing-panoply-of-respiratory-support-for-preterm-neonates
#18
Tetsuya Isayama, Shoo K Lee, Junmin Yang, David Lee, Sibasis Daspal, Michael Dunn, Prakesh S Shah
Importance: Several definitions of bronchopulmonary dysplasia are clinically used; however, their validity remains uncertain considering ongoing changes in the panoply of respiratory support treatment strategies used within neonatal units. Objective: To identify the optimal definition of bronchopulmonary dysplasia that best predicts respiratory and neurodevelopmental outcomes in preterm infants. Design, Setting, and Participants: Retrospective cohort study at tertiary neonatal intensive care units...
January 23, 2017: JAMA Pediatrics
https://www.readbyqxmd.com/read/28109557/does-cutting-a-plaster-window-weaken-its-strength
#19
Nimesh Patel, Lance Wilson, Guy Wansbrough
INTRODUCTION: A plaster window is usually created over a pressure area, or in some cases a wound or suture line. This can relieve pressure at the site, and provide an opportunity to change dressings, check on drainage, and inspect a wound or ulcer. There is concern that this can have an effect on its function to provide fracture stability, and weakens the plaster. The biomechanical effects of windowing on plaster strength were therefore investigated, as it has not previously been reported...
January 16, 2017: Injury
https://www.readbyqxmd.com/read/28107158/human-trafficking-in-areas-of-conflict-health-care-professionals-duty-to-act
#20
Christina Bloem, Rikki E Morris, Makini Chisolm-Straker
Given the significant global burden of human trafficking, the ability of clinicians to identify and provide treatment for trafficked persons is critical. Particularly in conflict settings, health care facilities often serve as the first and sometimes only point of contact for trafficked persons. As such, medical practitioners have a unique opportunity and an ethical imperative to intervene, even in nonclinical roles. With proper training, medical practitioners can assist trafficked persons by documenting human trafficking cases, thereby placing pressure on key stakeholders to enforce legal protections, and by providing adequate services to those trafficked...
January 1, 2017: AMA Journal of Ethics
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