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Early goal directed therapy

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https://www.readbyqxmd.com/read/28322310/hormone-therapy-at-early-post-menopause-increases-cognitive-control-related-prefrontal-activity
#1
Romuald Girard, Elise Météreau, Julie Thomas, Michel Pugeat, Chen Qu, Jean-Claude Dreher
Clinical data have been equivocal and controversial as to the benefits to the brain and cognition of hormone therapy (HT) in postmenopausal women. Recent reevaluation of the role of estrogens proposed that HT may effectively prevent the deleterious effects of aging on cognition, and reduces the risks of dementia, including Alzheimer's disease, if initiated early at the beginning of menopause. Yet, little is known about the effects of HT on brain activation related to cognitive control, the ability to make flexible decisions in relation to internal goals...
March 21, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28320242/early-goal-directed-therapy-for-septic-shock-a-patient-level-meta-analysis
#2
(no author information available yet)
Background After a single-center trial and observational studies suggesting that early, goal-directed therapy (EGDT) reduced mortality from septic shock, three multicenter trials (ProCESS, ARISE, and ProMISe) showed no benefit. This meta-analysis of individual patient data from the three recent trials was designed prospectively to improve statistical power and explore heterogeneity of treatment effect of EGDT. Methods We harmonized entry criteria, intervention protocols, outcomes, resource-use measures, and data collection across the trials and specified all analyses before unblinding...
March 21, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28284298/severe-sepsis-and-septic-shock-trials-process-arise-promise-what-is-optimal-resuscitation
#3
REVIEW
Tiffany M Osborn
Between 2014 and 2015, 3 independent, multicenter, randomized controlled trials evaluated early goal-directed therapy (EGDT) in severe sepsis and septic shock: Protocolized Care for Early Septic Shock (ProCESS) from the United States; Australasian Resuscitation in Sepsis Evaluation (ARISE), and Protocolised Management in Sepsis (ProMISe) in the United Kingdom. All 3 trials confirmed that there was no survival benefit of EGDT compared to usual resuscitation. How should we define usual care for sepsis given these study findings? Furthermore, the definition of sepsis has now been updated...
April 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28279695/categorization-of-survival-and-death-after-cardiac-arrest
#4
E A Matthews, J Magid-Bernstein, A Presciutti, A Rodriguez, D Roh, S Park, J Claassen, S Agarwal
BACKGROUND: Most cardiac arrest (CA) patients remain comatose post-resuscitation, prompting goals-of-care (GOC) conversations. The impact of these conversations on patient outcomes has not been well described. METHODS: Patients (n=385) treated for CA in Columbia University ICUs between 2008-2015 were retrospectively categorized into various modes of survival and death based on documented GOC discussions. Patients were deemed "medically unstable" if there was evidence of hemodynamic instability at the time of discussion...
March 6, 2017: Resuscitation
https://www.readbyqxmd.com/read/28275683/colorectal-cancer-liver-metastasis-evolving-paradigms-and-future-directions
#5
REVIEW
Luai R Zarour, Sudarshan Anand, Kevin G Billingsley, William H Bisson, Andrea Cercek, Michael F Clarke, Lisa M Coussens, Charles E Gast, Cristina B Geltzeiler, Lissi Hansen, Katherine A Kelley, Charles D Lopez, Shushan R Rana, Rebecca Ruhl, V Liana Tsikitis, Gina M Vaccaro, Melissa H Wong, Skye C Mayo
In patients with colorectal cancer (CRC) that metastasizes to the liver, there are several key goals for improving outcomes including early detection, effective prognostic indicators of treatment response, and accurate identification of patients at high risk for recurrence. Although new therapeutic regimens developed over the past decade have increased survival, there is substantial room for improvement in selecting targeted treatment regimens for the patients who will derive the most benefit. Recently, there have been exciting developments in identifying high-risk patient cohorts, refinements in the understanding of systemic vs localized drug delivery to metastatic niches, liquid biomarker development, and dramatic advances in tumor immune therapy, all of which promise new and innovative approaches to tackling the problem of detecting and treating the metastatic spread of CRC to the liver...
March 2017: Cellular and Molecular Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28275488/early-management-of-sepsis-with-emphasis-on-early-goal-directed-therapy-ame-evidence-series-002
#6
REVIEW
Zhongheng Zhang, Yucai Hong, Nathan J Smischney, Han-Pin Kuo, Panagiotis Tsirigotis, Jordi Rello, Win Sen Kuan, Christian Jung, Chiara Robba, Fabio Silvio Taccone, Marc Leone, Herbert Spapen, David Grimaldi, Sven Van Poucke, Steven Q Simpson, Patrick M Honore, Stefan Hofer, Pietro Caironi
Severe sepsis and septic shock are major causes of morbidity and mortality in patients entering the emergency department (ED) or intensive care unit (ICU). Despite substantial efforts to improve patient outcome, treatment of sepsis remains challenging to clinicians. In this context, early goal directed therapy (EGDT) represents an important concept emphasizing both early recognition of sepsis and prompt initiation of a structured treatment algorithm. As part of the AME evidence series on sepsis, we conducted a systematic review of all randomized controlled EGDT trials...
February 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28275048/brain-machine-interfaces-from-basic-science-to-neuroprostheses-and-neurorehabilitation
#7
REVIEW
Mikhail A Lebedev, Miguel A L Nicolelis
Brain-machine interfaces (BMIs) combine methods, approaches, and concepts derived from neurophysiology, computer science, and engineering in an effort to establish real-time bidirectional links between living brains and artificial actuators. Although theoretical propositions and some proof of concept experiments on directly linking the brains with machines date back to the early 1960s, BMI research only took off in earnest at the end of the 1990s, when this approach became intimately linked to new neurophysiological methods for sampling large-scale brain activity...
April 2017: Physiological Reviews
https://www.readbyqxmd.com/read/28264831/head-to-head-comparison-of-procalcitonin-and-presepsin-for-the-diagnosis-of-sepsis-in-critically-ill-adult-patients-a-protocol-for-a-systematic-review-and-meta-analysis
#8
Kei Hayashida, Yutaka Kondo, Yoshitaka Hara, Morio Aihara, Kazuma Yamakawa
INTRODUCTION: Early diagnosis and immediate therapeutic intervention, including appropriate antibiotic therapy and goal-directed resuscitation, are necessary to reduce mortality in patients with sepsis. However, a single clinical or biological marker indicative of sepsis has not been adopted unanimously. Although procalcitonin and presepsin are promising biomarkers that can effectively differentiate between sepsis/infection and systemic inflammatory response syndrome of non-infectious origin, little is known about which marker is superior...
March 6, 2017: BMJ Open
https://www.readbyqxmd.com/read/28257071/a-novel-therapy-for-people-who-attempt-suicide-and-why-we-need-new-models-of-suicide
#9
Konrad Michel, Ladislav Valach, Anja Gysin-Maillart
This paper presents a model of suicidal behaviour based on suicide as a goal-directed action, and its implications. An action theoretical model has guided the authors in the development of a brief therapy for individuals who attempt suicide (ASSIP-Attempted Suicide Short Intervention Program). Key elements are an early therapeutic alliance, narrative interviewing, psychoeducation, a joint case conceptualization, safety planning, and regular letters over 24 months. In a randomized controlled trial, ASSIP was highly effective in reducing the risk of suicide reattempts...
March 1, 2017: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/28251511/herpes-simplex-encephalitis-an-update
#10
REVIEW
John W Gnann, Richard J Whitley
PURPOSE OF REVIEW: The goal of this review is to provide an update on current thinking regarding herpes simplex encephalitis (HSE), emphasizing new information about pathogenesis, diagnosis, and immune responses. Specific questions to be addressed are the following: (1) Is there a genetic predisposition to HSE? (2) What clinical approaches have the greatest impact on improving the long-term outcomes in patients with HSE? And (3) are there immune-mediated mechanisms that may account for relapsing HSE? RECENT FINDINGS: Toll-like receptor 3 (TLR 3) plays an important role in innate immune responses, including generation of interferons...
March 2017: Current Infectious Disease Reports
https://www.readbyqxmd.com/read/28123120/-drug-selection-and-treatment-goal-in-osteoporosis-therapy
#11
Mika Yamauchi, Toshitsugu Sugimoto
The goal of treatment for osteoporosis is to reduce the risk of fracture. Achieving effective reductions in the risk of fracture requires evidence-based drug selection and careful consideration of patient background, including concomitant diseases and drug adherence. Selective estrogen receptor modulators(SERM)and active vitamin D3 such as eldecalcitol are well indicated in early menopausal women with no history of fragility fractures. Moreover, elderly individuals with a history of fragility fractures are at high risk of vertebral and hip fractures, so bisphosphonates, denosumab and teriparatide are well indicated in these patients...
2017: Clinical Calcium
https://www.readbyqxmd.com/read/28122702/major-publications-in-the-critical-care-pharmacotherapy-literature-in-2015
#12
Adrian Wong, Michael Erdman, Drayton A Hammond, Tara Holt, Jenna M Holzhausen, Michelle Horng, Lori Lynn Huang, Jennifer Jarvis, Bridgette Kram, Shawn Kram, Christine Lesch, Jessica Mercer, Megan A Rech, Ryan Rivosecchi, Brian Stump, Colleen Teevan, Sarah Day
PURPOSE: Recently published practice guidelines and research reports on pharmacotherapy in critical care patient populations are summarized. SUMMARY: The Critical Care Pharmacotherapy Literature Update (CCPLU) Group is composed of over 50 experienced critical care pharmacists who evaluate 31 peer-reviewed journals monthly to identify literature pertaining to pharmacotherapy in critical care populations. Articles are chosen for summarization in a monthly CCPLU Group publication on the basis of applicability and relevance to clinical practice and strength of study design...
January 25, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28120568/long-pentraxin-3-as-a-predictive-marker-of-mortality-in-severe-septic-patients-who-received-successful-early-goal-directed-therapy
#13
Sun Bean Kim, Kyoung Hwa Lee, Ji Un Lee, Hea Won Ann, Jin Young Ahn, Yong Duk Jeon, Jung Ho Kim, Nam Su Ku, Sang Hoon Han, Jun Yong Choi, Young Goo Song, June Myung Kim
PURPOSE: Pentraxin 3 (PTX3) has been suggested to be a prognostic marker of mortality in severe sepsis. Currently, there are limited data on biomarkers including PTX3 that can be used to predict mortality in severe sepsis patients who have undergone successful initial resuscitation through early goal-directed therapy (EGDT). MATERIALS AND METHODS: A prospective cohort study was conducted among 83 severe sepsis patients with fulfillment of all EGDT components and the achievement of final goal...
March 2017: Yonsei Medical Journal
https://www.readbyqxmd.com/read/28074297/-delirium-analgesia-and-sedation-in-intensive-care-medicine-development-of-a-protocol-based-management-approach
#14
A Wolf, R Mörgeli, A Müller, B Weiss, C Spies
Intensive care treatment has long-term consequences that are often not immediately apparent to the health care providers. The combination of muscle weakness, cognitive damage, and psychological disorders is comprised under the term post-intensive care syndrome (PICS). Analgesia and sedation protocols, as well as nonpharmacological preventive and therapeutic approaches, are effective tools for avoiding complications and improving long-term survival. The principle of "early goal-directed therapy" is fundamental...
February 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28067711/early-goal-directed-therapy-for-sepsis-a-novel-solution-for-discordant-survival-outcomes-in-clinical-trials
#15
Andre C Kalil, Daniel W Johnson, Steven J Lisco, Junfeng Sun
OBJECTIVES: Early goal-directed therapy has shown discordant survival outcomes in sepsis studies. We aim to find the reasons for this discordance. DESIGN: Random-effects and Bayesian hierarchical analyses. SETTING: Studies that evaluated early goal-directed therapy. SUBJECTS: Patients with severe sepsis and/or septic shock. INTERVENTIONS: Early goal-directed therapy. MEASUREMENTS AND MAIN RESULTS: A total of 19,998 patients were included in the main analysis: 31 observational (n = 15,656) and six randomized (n = 4,342) studies...
April 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28041551/-haemostatic-resuscitation-in-bleeding-trauma-patients
#16
Jakob Stensballe, Pär I Johansson, Jacob Steinmetz
Trauma haemorrhage is a common reversible cause of death. Haemostatic resuscitation focuses on replacing the lost blood with transfusions equivalent to whole blood as early as possible. In Denmark, the optimal ratio for transfusions in massive bleeding is four packs of red blood cells, four packs of plasma and one pool of platelets (equal to ratio 1:1:1 in USA). Haemostatic resuscitation also includes a restricted use of crystalloids, early tranexamic acid, and a goal-directed transfusion therapy by using viscoelastic haemostatic assays to detect coagulopathy and the need for additional transfusions or pro-haemostatics...
December 26, 2016: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/28027971/host-conditioning-and-rejection-monitoring-in-hepatocyte-transplantation-in-humans
#17
Kyle A Soltys, Kentaro Setoyama, Edgar N Tafaleng, Alejandro Soto Gutiérrez, Jason Fong, Ken Fukumitsu, Taichiro Nishikawa, Masaki Nagaya, Rachel Sada, Kimberly Haberman, Roberto Gramignoli, Kenneth Dorko, Veysel Tahan, Alexandra Dreyzin, Kevin Baskin, John J Crowley, Mubina A Quader, Melvin Deutsch, Chethan Ashokkumar, Benjamin L Shneider, Robert H Squires, Sarangarajan Ranganathan, Miguel Reyes-Mugica, Steven F Dobrowolski, George Mazariegos, Rajavel Elango, Donna B Stolz, Stephen C Strom, Gerard Vockley, Jayanta Roy-Chowdhury, Marilia Cascalho, Chandan Guha, Rakesh Sindhi, Jeffrey L Platt, Ira J Fox
BACKGROUND & AIMS: Hepatocyte transplantation partially corrects genetic disorders and has been associated anecdotally with reversal of acute liver failure. Monitoring for graft function and rejection has been difficult, and has contributed to limited graft survival. Here we aimed to use preparative liver-directed radiation therapy, and continuous monitoring for possible rejection in an attempt to overcome these limitations. METHODS: Preparative hepatic irradiation was examined in non-human primates as a strategy to improve engraftment of donor hepatocytes, and was then applied in human subjects...
December 24, 2016: Journal of Hepatology
https://www.readbyqxmd.com/read/27968811/a-review-of-central-venous-pressure-and-its-reliability-as-a-hemodynamic-monitoring-tool-in-veterinary-medicine
#18
REVIEW
Kristen M Hutchinson, Scott P Shaw
OBJECTIVE: To review the current literature regarding central venous pressure (CVP) in veterinary patients pertaining to placement (of central line), measurement, interpretation, use in veterinary medicine, limitations, and controversies in human medicine. ETIOLOGY: CVP use in human medicine is a widely debated topic, as numerous sources have shown poor correlation of CVP measurements to the volume status of a patient. Owing to the ease of placement and monitoring in veterinary medicine, CVP remains a widely used modality for evaluating the hemodynamic status of a patient...
September 2016: Topics in Companion Animal Medicine
https://www.readbyqxmd.com/read/27958191/wet-or-dry-a-review-of-intravenous-fluid-administration-in-anesthesia-practice
#19
Matthew D'Angelo, R Kyle Hodgen
Fluid therapy has dramatically changed since its early inception nearly 200 years ago. Administration of intravenous fluid (IVF) has evolved from a "drip" technique to the algorithmic approach of the anesthetic fluid plan, and is now moving toward Goal-Directed Fluid Therapy. As the science and culture of fluid management evolves, anesthetists must remain focused on "why" anesthetic fluid matters. The purpose of IVF administration is to support tissue perfusion and maintain euvolemia. As the evidence underlying perioperative practice matures and the science of anesthesia races to meet the evolving demands of surgery, anesthetists must align knowledge generation with the individualized needs of the patient...
January 2017: Annual Review of Nursing Research
https://www.readbyqxmd.com/read/27935782/wet-or-dry-a-review-of-intravenous-fluid-administration-in-anesthesia-practice
#20
Matthew D'Angelo, R Kyle Hodgen
Fluid therapy has dramatically changed since its early inception nearly 200 years ago. Administration of intravenous fluid (IVF) has evolved from a "drip" technique to the algorithmic approach of the anesthetic fluid plan, and is now moving toward Goal-Directed Fluid Therapy. As the science and culture of fluid management evolves, anesthetists must remain focused on "why" anesthetic fluid matters. The purpose of IVF administration is to support tissue perfusion and maintain euvolemia. As the evidence underlying perioperative practice matures and the science of anesthesia races to meet the evolving demands of surgery, anesthetists must align knowledge generation with the individualized needs of the patient...
January 2017: Annual Review of Nursing Research
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