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https://www.readbyqxmd.com/read/29777456/distal-bowel-re-feeding-in-patients-with-proximal-jejunostomy
#1
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/29773516/lymphoedema-management-to-prevent-acute-dermatolymphangioadenitis-in-podoconiosis-in-northern-ethiopia-golbet-a-pragmatic-randomised-controlled-trial
#2
Henok Negussie, Meseret Molla, Moses Ngari, James A Berkley, Esther Kivaya, Patricia Njuguna, Greg Fegan, Abreham Tamiru, Abebe Kelemework, Trudie Lang, Melanie J Newport, Andy McKay, Fikre Enquoselassie, Gail Davey
BACKGROUND: Podoconiosis (also known as endemic, non-filarial elephantiasis) affects about 4 million subsistence farmers in tropical Africa. Poor awareness of the condition and inadequate evidence for the efficacy of treatment mean that no government in an endemic country yet offers lymphoedema management for patients with podoconiosis. Among patients with filarial lymphoedema, trials suggest that limb care is effective in reducing the most disabling sequelae: episodes of acute dermatolymphangioadenitis...
May 14, 2018: Lancet Global Health
https://www.readbyqxmd.com/read/29773297/the-clinical-practice-of-high-flow-nasal-cannula-oxygen-therapy-in-adults-a-japanese-cross-sectional-multicenter-survey
#3
Jiro Ito, Kazuma Nagata, Susumu Sato, Akira Shiraki, Naoki Nishimura, Shinyu Izumi, Ryo Tachikawa, Takeshi Morimoto, Keisuke Tomii
BACKGROUND: High-flow nasal cannula oxygen therapy (HFNC) is widely used mainly in the acute care setting, but limited data are available on real-world practice in adults. The objective of this study was to describe HFNC practices in Japanese adults. METHODS: A retrospective cross-sectional multicenter survey of adult patients receiving HFNC from January through March 2015 was conducted in 33 participating hospitals in Japan. RESULTS: We obtained information on 321 patients (median age, 76; 218 men, 103 women; median estimated PaO2 /FI O2, 178 mm Hg) from 22 hospitals...
May 2018: Respiratory Investigation
https://www.readbyqxmd.com/read/29771731/effect-of-intravenous-dexmedetomidine-during-general-anesthesia-on-acute-postoperative-pain-in-adults-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#4
Xiuqin Wang, Naifu Liu, Jinlong Chen, Zan Xu, Fumei Wang, Chuan Ding
BACKGROUND: Dexmedetomidine has been shown to have an analgesic effect. However, no consensus was reached in previous studies. METHODS: Electronic databases such as PubMed, Embase, and Cochrane Central were searched for relevant randomized controlled trials (RCTs). The relative risk (RR) and weighted mean difference (WMD) were used to analyze the outcomes. Random-effects model was used for meta-analysis. RESULTS: Compared to the normal saline group, patients using dexmedetomidine showed a significantly decreased pain intensity within 6 hours (WMD=-0...
May 16, 2018: Clinical Journal of Pain
https://www.readbyqxmd.com/read/29771700/the-effect-of-iv-amino-acid-supplementation-on-mortality-in-icu-patients-may-be-dependent-on-kidney-function-post-hoc-subgroup-analyses-of-a-multicenter-randomized-trial
#5
Ran Zhu, Matilde J Allingstrup, Anders Perner, Gordon S Doig
OBJECTIVES: We investigated whether preexisting kidney function determines if ICU patients may benefit from increased (2.0 g/kg/d) protein intake. DESIGN: Post hoc, hypothesis-generating, subgroup analysis of a multicenter, phase 2, randomized clinical trial. All analyses were conducted by intention to treat and maintained group allocation. Ninety-day mortality was the primary outcome. SETTING: ICUs of 16 hospitals throughout Australia and New Zealand...
May 15, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29769203/early-and-chronic-dipeptidyl-peptidase-iv-inhibition-and-cardiovascular-events-in-patients-with-type-2-diabetes-mellitus-after-an-acute-coronary-syndrome-a-landmark-analysis-of-the-examine-trial
#6
Abhinav Sharma, Christopher P Cannon, William B White, Yuyin Liu, George L Bakris, William C Cushman, Faiez Zannad
BACKGROUND: Antihyperglycemic therapies may increase the risk of cardiovascular events including hospitalization for heart failure. There is a paucity of data evaluating the cardiovascular safety of antihyperglycemic therapies in the high-risk period following an acute coronary syndrome (ACS). METHODS AND RESULTS: The EXAMINE (Examination of Cardiovascular Outcomes with Alogliptin versus Standard of Care) trial randomized 5380 patients who were 15 to 90 days post ACS to the dipeptidyl dipeptidase-IV (DPP-IV) inhibitor alogliptin versus placebo; mean follow-up was 18 months...
May 16, 2018: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29768487/an-observational-study-the-utility-of-perfusion-index-as-a-discharge-criterion-for-pain-assessment-in-the-postanesthesia-care-unit
#7
Chun-Lin Chu, Yi-You Huang, Ying-Hou Chen, Ling-Ping Lai, Huei-Ming Yeh
Acute post-operative pain can remain untreated if patients cannot express themselves. The perfusion index (PI) may decrease when pain activates sympathetic tone and may increase after analgesics are administered. We evaluated if the perfusion index is a feasible indicator for objectively assessing pain relief in the postanesthesia care unit (PACU) and calculated the changes in PI measurements at the time of discharge from the PACU relative to baseline PI measurements to examine if the PI is a useful criterion for discharging patients from the postanesthesia care unit...
2018: PloS One
https://www.readbyqxmd.com/read/29767833/post-operative-care-of-interventional-therapy-for-40-liver-cancer-patients-with-obstructive-jaundice
#8
De-Ping Tong, Li-Qin Wu, Xiao-Ping Chen, Yi Li
The care of 40 patients with primary liver cancer with obstructive jaundice treated with liver puncture bile drainage or biliary stent implantation was reported. Treated with the interventional therapy, patients were observed closely to identify symptoms of hepatic encephalopathy and pain; diet care was well performed. Bile drainage tube and skin acre were performed carefully. Liver function, bilirubin and other biochemical indicators were monitored; occurrence of bleeding, acute pancreatitis, biliary tract infection, leakage of ascites around drainage tube and other complication were observed with good discharge instruction...
May 16, 2018: European Journal of Cancer Care
https://www.readbyqxmd.com/read/29767829/homeopathy-in-the-age-of-antimicrobial-resistance-is-it-a-viable-treatment-for-upper-respiratory-tract-infections
#9
Alison Fixsen
BACKGROUND:  Acute upper respiratory tract infections (URTIs) and their complications are the most frequent cause of antibiotic prescribing in primary care. With multi-resistant organisms proliferating, appropriate alternative treatments to these conditions are urgently required. Homeopathy presents one solution; however, there are many methods of homeopathic prescribing. This review of the literature considers firstly whether homeopathy offers a viable alternative therapeutic solution for acute URTIs and their complications, and secondly how such homeopathic intervention might take place...
May 2018: Homeopathy: the Journal of the Faculty of Homeopathy
https://www.readbyqxmd.com/read/29767322/management-of-cardiogenic-shock-complicating-myocardial-infarction
#10
REVIEW
Alexandre Mebazaa, Alain Combes, Sean van Diepen, Alexa Hollinger, Jaon N Katz, Giovanni Landoni, Ludhmila Abrahao Hajjar, Johan Lassus, Guillaume Lebreton, Gilles Montalescot, Jin Joo Park, Susanna Price, Alessandro Sionis, Demetris Yannopolos, Veli-Pekka Harjola, Bruno Levy, Holger Thiele
Up to 10% of acute coronary syndromes are complicated by cardiogenic shock (CS) with contemporary mortality rates of 40-50%. The extent of ischemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis in this patient population. Individualized patient risk assessment plays an important role in determining appropriate revascularization, drug treatment with inotropes and vasopressors, mechanical circulatory support, intensive care support of other organ systems, hospital level of care triage, and allocation of clinical resources...
May 16, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29766640/subclinical-inflammation-phenotypes-and-long-term-outcomes-after-pediatric-kidney-transplantation
#11
Michael E Seifert, Megan V Yanik, Daniel I Feig, Vera Hauptfeld-Dolejsek, Elizabeth C Mroczek-Musulman, David R Kelly, Frida Rosenblum, Roslyn B Mannon
The implementation of surveillance biopsies in pediatric kidney transplantation remains controversial. Surveillance biopsies detect subclinical injury prior to clinical dysfunction, which could allow for early interventions that prolong allograft survival. We conducted a single-center retrospective cohort study of 120 consecutive pediatric kidney recipients, of whom 103 had surveillance biopsies ≤ 6 months post-transplant. We tested the hypothesis that subclinical inflammation (borderline or T cell-mediated rejection without clinical dysfunction) is associated with a 5-year composite endpoint of acute rejection and allograft failure...
May 15, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29766275/implementing-cough-reflex-testing-in-a-clinical-pathway-for-acute-stroke-a-pragmatic-randomised-controlled-trial
#12
Makaela Field, Rachel Wenke, Arman Sabet, Melissa Lawrie, Elizabeth Cardell
Silent aspiration is common after stroke and can lead to subsequent pneumonia. While standard bedside dysphagia assessments are ineffective at predicting silent aspiration, cough reflex testing (CRT) has shown promise for identifying patients at risk of silent aspiration. We investigated the impact of CRT on patient and service outcomes when embedded into a clinical pathway. 488 acute stoke patients were randomly allocated to receive either CRT or standard care (i.e. bedside assessment). Primary outcomes included confirmed pneumonia within 3 months post stroke and length of acute inpatient stay...
May 15, 2018: Dysphagia
https://www.readbyqxmd.com/read/29766216/impact-of-angiotensin-converting-enzyme-inhibitors-or-receptor-blockers-on-post-icu-discharge-outcome-in-patients-with-acute-kidney-injury
#13
Etienne Gayat, Alexa Hollinger, Alain Cariou, Nicolas Deye, Antoine Vieillard-Baron, Samir Jaber, Benjamin G Chousterman, Qin Lu, Pierre François Laterre, Xavier Monnet, Michael Darmon, Marc Leone, Bertrand Guidet, Romain Sonneville, Jean-Yves Lefrant, Marie-Céline Fournier, Matthieu Resche-Rigon, Alexandre Mebazaa, Matthieu Legrand
PURPOSE: Acute kidney injury (AKI) is associated with the activation of the renin-angiotensin system. Whether angiotensin-converting enzyme inhibitors (ACEi) or angiotensin-receptor blockers (ARB) improve outcome in patients recovering from AKI remains unexplored. The purpose was to investigate the association between prescription of ACEi/ARB at intensive care unit (ICU) discharge and 1-year outcome in patients recovering from AKI. METHODS: Association between ACEi/ARB and 1-year mortality rate was explored in 1551 patients discharged from 21 European ICUs in an observational cohort...
May 15, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29764273/the-association-between-sequential-organ-failure-assessment-scores-and-mortality-in-patients-with-sepsis-during-the-first-week-the-jseptic-dic-study
#14
Tsuyoshi Nakashima, Kyohei Miyamoto, Toshio Shimokawa, Seiya Kato, Mineji Hayakawa
OBJECTIVE: Predicting prognosis is a complex process, particularly in patients with severe sepsis or septic shock. This study aimed to determine the relationship between the Sequential Organ Failure Assessment (SOFA) scores for individual organs during the first week of admission and the in-hospital mortality in patients with sepsis. METHODS: This study was a post hoc evaluation of the Japan Septic Disseminated Intravascular Coagulation study and included patients admitted to 42 intensive care units in Japan for severe sepsis or septic shock, between January 2011 and December 2013...
January 1, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29760864/3-for-the-price-of-1-teaching-chest-pain-risk-stratification-in-a-multidisciplinary-problem-based-learning-workshop
#15
William D Alley, Cynthia Burns, Nicholas D Hartman, Kim Askew, Simon A Mahler
Introduction: Chest pain is a common chief complaint among patients presenting to health systems and often leads to complex and intensive evaluations. While these patients are often cared for by a multidisciplinary team (primary care, emergency medicine, and cardiology), medical students usually learn about the care of these patients in a fragmented, single-specialty paradigm. The present and future care of patients with chest pain is multidisciplinary, and the education of medical students on the subject should be as well...
May 2018: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29759808/implementation-of-a-clinical-nursing-pathway-for-percutaneous-coronary-intervention-a-prospective-study
#16
Meng Li, Huimin Liu
This study is to evaluate the effect of a clinical nursing pathway (CNP) on the clinical outcomes of the transradial approach for emergency percutaneous coronary intervention (PCI). A total of 118 subjects diagnosed with acute myocardial infarction (AMI) were enrolled in the study. They were randomly divided into a control group receiving conventional nursing and a clinical nursing pathway group. The differences in door-to-balloon time, length of hospital stay, hospitalization cost, postoperative complications, and patient satisfaction with nursing care between the two groups were determined and analyzed statistically...
May 11, 2018: Geriatric Nursing
https://www.readbyqxmd.com/read/29759806/integration-of-post-acute-care-and-hospice-care-in-adult-day-services
#17
Mary Beth Happ, Holly Dabelko-Schoeny, Jiwon Shin
No abstract text is available yet for this article.
May 11, 2018: Geriatric Nursing
https://www.readbyqxmd.com/read/29758059/divergent-humoral-responses-to-23-valent-pneumococcal-polysaccharide-vaccine-in-critically-ill-burn-and-neurosurgical-patients
#18
Scott W Mueller, Laura J Baumgartner, Rob MacLaren, Robert Neumann, Arek J Wiktor, Tyree H Kiser, Gordon Lindberg, Luis Cava, Douglas N Fish, Edward N Janoff
INTRODUCTION: Critically ill hospitalized patients are at increased risk of infection so we assessed the immunogenicity of 23-valent pneumococcal polysaccharide vaccine (PPSV23) administered within six days of injury. METHODS: This prospective observational study compared the immunogenicity of PPSV23 among critically ill burn and neurosurgical patients at a tertiary, academic medical center. Patients received PPSV23 vaccination within six days of ICU admission per standard of care...
2018: PloS One
https://www.readbyqxmd.com/read/29757916/filling-the-gaps-preparing-nurse-practitioners-for-hospitalist-practice
#19
Sharon E Bryant
Over the last 20 years, the emergence of the hospitalist has changed the face of medicine. Hospitalists may serve as either general or specialty-focused providers caring for acutely ill patients in the hospital setting. As the demands and constraints of hospital-specific patient management have continued to grow, an increased need for inclusion of nurse practitioners (NP) into current hospitalist staffing models has occurred. A hospitalist-focused educational model has been developed to better prepare NP students for a variety of hospitalist roles after graduation...
January 2018: Journal of the American Association of Nurse Practitioners
https://www.readbyqxmd.com/read/29756498/construct-validity-and-inter-rater-reliability-of-the-dutch-activity-measure-for-post-acute-care-6-clicks-basic-mobility-form-to-assess-the-mobility-of-hospitalized-patients
#20
Sven Jacobus Gertruda Geelen, Karin Valkenet, Cindy Veenhof
To evaluate the construct validity and the inter-rater reliability of the Dutch Activity Measure for Post-Acute Care "6-clicks" Basic Mobility short form measuring the patient's mobility in Dutch hospital care. First, the "6-clicks" was translated by using a forward-backward translation protocol. Next, 64 patients were assessed by the physiotherapist to determine the validity while being admitted to the Internal Medicine wards of a university medical center. Six hypotheses were tested regarding the construct "mobility" which showed that: Better "6-clicks" scores were related to less restrictive pre-admission living situations (p = 0...
May 12, 2018: Disability and Rehabilitation
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