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https://www.readbyqxmd.com/read/29166565/hospital-based-physicians-intubation-decisions-and-associated-mental-models-when-managing-a-critically-and-terminally-ill-older-patient
#1
Shannon Haliko, Julie Downs, Deepika Mohan, Robert Arnold, Amber E Barnato
BACKGROUND: Variation in the intensity of acute care treatment at the end of life is influenced more strongly by hospital and provider characteristics than patient preferences. OBJECTIVE: We sought to describe physicians' mental models (i.e., thought processes) when encountering a simulated critically and terminally ill older patient, and to compare those models based on whether their treatment plan was patient preference-concordant or preference-discordant. METHODS: Seventy-three hospital-based physicians from 3 academic medical centers engaged in a simulated patient encounter and completed a mental model interview while watching the video recording of their encounter...
November 1, 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/29166426/rhinology-future-debates-an-euforea-report
#2
W J Fokkens, C Bachert, M Bernal-Sprekelsen, J Bousquet, M Djandji, A Dorenbaum, D Hakimi-Mehr, S Hendry, C Hopkins, A Leunig, L Mannent, D Mucha, M Onerci, B Pugin, S Toppila-Salmi, P Rowe, S F Seys, S Stimson, A Strzembosz, P W Hellings
The first Rhinology Future Debates was held in Brussels in December 2016, organized by EUFOREA (European Forum for Research and Education in Allergy and Airways diseases). The purpose of these debates is to bring novel developments in the field of Rhinology to the attention of the medical, paramedical and patient community, in a highly credible and balanced context. For the first time in Rhinology, a peer to peer scientific exchange with key experts in the field of rhinology and key medical colleagues from leading industries let to a brainstorming and discussion event on a number of hot issues in Rhinology...
November 22, 2017: Rhinology
https://www.readbyqxmd.com/read/29166342/important-considerations-for-performing-prepectoral-breast-reconstruction
#3
Hani Sbitany
Prepectoral breast reconstruction has emerged as an excellent technique for postmastectomy reconstruction, as it allows for full preservation of a patient's pectoralis major muscle and chest wall function. This reduces pain, eliminates animation deformity, and results in high patient satisfaction. Safely performed prepectoral breast reconstruction requires a careful patient selection process before committing to the procedure, taking into account comorbidities, radiation status, and oncologic criteria such as tumor location and breast cancer stage...
December 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/29166338/use-of-organs-from-hepatitis-c-virus-positive-donors-for-uninfected-recipients-a-potential-cost-effective-approach-to-save-lives
#4
Patrick B Trotter, Dominic M Summers, Ines Ushiro-Lumb, Matthew Robb, J Andrew Bradley, James Powell, Christopher J E Watson, James Neuberger
BACKGROUND: Organs from hepatitis C virus (HCV) seropositive (HCVpos) individuals are seldom used for transplantation because of the risk of disease transmission. Because transmitted HCV is now amenable to effective treatment we estimated the potential impact of using HCVpos deceased donor organs for transplantation. METHODS: The Potential Donor Audit (PDA) of patients (<80years) dying in UK critical care units and the UK Transplant Registry (UKTR) was searched to identify HCVpos potential and proceeding deceased donors...
November 22, 2017: Transplantation
https://www.readbyqxmd.com/read/29166296/emergency-intubations-in-a-high-volume-pediatric-emergency-department
#5
Jen Heng Pek, Gene Yong-Kwang Ong
INTRODUCTION: Resuscitation of critically ill children can be chaotic, and emergency airway management is often fraught with difficulties. This study aimed to characterize the Singaporean landscape of tracheal intubation in a pediatric emergency unit, placing emphasis on safety outcomes, procedural process of care, and provider training. METHODS: A retrospective review of all cases presented to the KK Women's and Children's Hospital from January 2009 to December 2013 with intubation carried out within the pediatric emergency unit was done...
November 21, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29166261/pressure-injury-risk-factors-in-adult-critical-care-patients-a-review-of-the-literature
#6
Jill Cox
Critically ill patients require complex care in a technologically sophisticated environment where they are highly vulnerable to pressure-related injuries. However, pressure injury (PI) development remains a multifactorial phenomenon in critically ill persons; true risk is both pervasive and elusive. The purpose of this comprehensive review of the empirical literature was to examine the risk factors associated with PIs among adult patients admitted to contemporary intensive care units (ICUs). Inclusion criteria stipulated publications were to be peer-reviewed, quantitative studies with a focus on pressure ulcer (PU) risk factors in adult critical care patients published between 2010 and 2016 in which statistical analysis involved multivariate analysis using PU development as the outcome variable...
November 2017: Ostomy/wound Management
https://www.readbyqxmd.com/read/29166210/improving-spiritual-care-in-hospitals-in-the-netherlands-what-do-health-care-chaplains-involved-in-an-action-research-study-report
#7
Joep van de Geer, Anja Visser, Hetty Zock, Carlo Leget, Jelle Prins, Kris Vissers
Health care chaplains participated in a multicenter trial to explore an implementation strategy for the Dutch multidisciplinary guideline for spiritual care. The intervention was concise spiritual care training for hospital staff of departments where patients in curative and palliative trajectories are treated. Data were collected in semistructured interviews with chaplains who acted as trainers, before and after the intervention. Results based on nine preintervention and eleven post-intervention interviews are presented...
November 22, 2017: Journal of Health Care Chaplaincy
https://www.readbyqxmd.com/read/29166131/traditional-chinese-medicine-physicians-insights-into-interprofessional-tensions-between-traditional-chinese-medicine-and-biomedicine-a-critical-perspective
#8
Leanne Chang, Jing Ci Jill Lim
In Singapore, the institutional preference for biomedicine and the cultural importance of traditional Chinese medicine (TCM) have created tensions between the two medical systems and erected barriers to a more collaborative health-care system. This study foregrounds TCM physicians' voice to reveal ideological struggles and power imbalances that underlie the interprofessional tensions and accompanying marginalization of TCM. Through in-depth interviews with 22 TCM physicians in Singapore, this study reveals the incongruences in ideological underpinnings between biomedicine and TCM, reflected in their different worldviews and epistemological approaches to knowledge formation and evaluation...
November 22, 2017: Health Communication
https://www.readbyqxmd.com/read/29165898/thrombocytopenia-associated-multi-organ-failure-secondary-to-hyperglycemic-hyperosmolar-non-ketotic-syndrome-a-case-report
#9
Naile Tufan-Pekkucuksen, Maria Carolina Gazzaneo, Natasha Susana Afonso, Sarah J Swartz, Joseph R Angelo, Poyyapakkam Srivaths
Thrombocytopenia associated multi-organ failure (TAMOF) is a clinical syndrome with features of new onset thrombocytopenia, increased lactate dehydrogenase, and multi-organ failure in critically ill patients. TAMOF can be the initial presentation of an underlying disease process or can develop during the course of illness either during the hospital stay. TAMOF has a high mortality rate if not treated; therefore, early detection is critical. TAMOF has been rarely reported in diabetic ketoacidosis. We are describing the first case of a patient diagnosed with hyperglycemic, hyperosmolar non-ketotic syndrome who developed TAMOF on the third day of his hospital course...
November 22, 2017: Pediatric Diabetes
https://www.readbyqxmd.com/read/29165737/management-of-hemostasis-for-pediatric-patients-on-ventricular-assist-devices
#10
Iki Adachi, Vadim Kostousov, Lisa Hensch, Martin A Chacon-Portillo, Jun Teruya
Ventricular-assist devices (VADs) have seen increased utilization in the pediatric population. Formerly, this therapeutic modality was limited to only the pulsatile VAD, EXCOR (Berlin Heart GmbH). However, the continuous flow VAD devices, HeartMate II (Abbott Inc.) and HeartWare (Medtronic Inc.), are now increasingly used in this population. Postoperatively, VAD patients are acutely anticoagulated using unfractionated heparin, often beginning 24 to 48 hours after VAD placement. Once the patient is stabilized and ready to transition to a lower acuity or outpatient setting, low-molecular-weight heparin or warfarin therapy may be instituted...
November 17, 2017: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/29165692/prognostic-value-of-clinical-vs-pathologic-stage-in-rectal-cancer-patients-receiving-neoadjuvant-therapy
#11
Daniel Delitto, Thomas J George, Tyler J Loftus, Peihua Qiu, George J Chang, Carmen J Allegra, William A Hall, Steven J Hughes, Sanda A Tan, Christiana M Shaw, Atif Iqbal
Background: Neoadjuvant chemoradiation is currently standard of care in stage II-III rectal cancer, resulting in tumor downstaging for patients with treatment-responsive disease. However, the prognosis of the downstaged patient remains controversial. This work critically analyzes the relative contribution of pre- and post-therapy staging to the anticipated survival of downstaged patients. Methods: The National Cancer Database (NCDB) was queried for patients with rectal cancer treated with transabdominal resection between 2004 and 2014...
November 20, 2017: Journal of the National Cancer Institute
https://www.readbyqxmd.com/read/29165616/work-system-assessment-to-facilitate-the-dissemination-of-a-quality-improvement-program-for-optimizing-blood-culture-use-a-case-study-using-a-human-factors-engineering-approach
#12
Anping Xie, Charlotte Z Woods-Hill, Anne F King, Heather Enos-Graves, Judy Ascenzi, Ayse P Gurses, Sybil A Klaus, James C Fackler, Aaron M Milstone
Background: Work system assessments can facilitate successful implementation of quality improvement programs. Using a human factors engineering approach, we conducted a work system assessment to facilitate the dissemination of a quality improvement program for optimizing blood culture use in pediatric intensive care units at 2 hospitals. Methods: Semistructured face-to-face interviews were conducted with clinicians from Johns Hopkins All Children's Hospital and University of Virginia Medical Center...
November 20, 2017: Journal of the Pediatric Infectious Diseases Society
https://www.readbyqxmd.com/read/29165595/con-the-role-of-diet-for-people-with-advanced-stage-5-ckd
#13
Graham Woodrow
Restriction of dietary protein intake has been used in the management of chronic kidney disease (CKD) for many decades, yet remains controversial, with marked variations in its application in clinical practice. There is extensive literature on the subject, with some expert opinion advocating the use of protein restriction based on the balance of the available evidence. The largest randomized trial of low-protein diets is the Modification of Diet in Renal Disease study. Despite multiple secondary analyses, the essential intention-to-treat analysis failed to demonstrate a benefit in the primary outcome of rate of decline of glomerular filtration rate...
November 17, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/29165510/-the-1-3-%C3%AE-d-glucan-in-critical-adult-patients-as-diagnostic-tool-for-invasive-candida-spp-infection-performance-evaluation
#14
Liliana Donato, Tamara González, Marilena Canales, Paulette Legarraga, Patricia García, Ricardo Rabagliati
BACKGROUND: Invasive fungal infections are important causes of morbimortality in critical patients. Most of these infections are caused by Candida spp. which diagnosis has important limitations. AIM: Initial evaluation of the utility of 1,3-β-D-glucan (BDG) as a diagnostic tool for invasive candida infections in critical patients. PATIENTS AND METHODS: Adult patients over 18 years old, hospitalized in intensive care units for more than five days, with fever > 38 °C of unclear origin and two or more risk factors for invasive Candida spp...
August 2017: Revista Chilena de Infectología: órgano Oficial de la Sociedad Chilena de Infectología
https://www.readbyqxmd.com/read/29164489/antimicrobial-stewardship-opportunities-in-critically-ill-patients-with-gram-negative-lower-respiratory-tract-infections-a-multicenter-cross-sectional-analysis
#15
Kimberly C Claeys, Evan J Zasowski, Trang D Trinh, Abdalhamid M Lagnf, Susan L Davis, Michael J Rybak
INTRODUCTION: Lower respiratory tract infections (LRTIs) are a major cause of morbidity and death. Because of changes in how LRTIs are defined coupled with the increasing prevalence of drug resistance, there is a gap in knowledge regarding the current burden of antimicrobial use for Centers for Disease Control and Prevention (CDC)-defined LRTIs. We describe the infection characteristics, antibiotic consumption, and clinical and economic outcomes of patients with Gram-negative (GN) LRTIs treated in intensive care units (ICUs)...
November 21, 2017: Infectious Diseases and Therapy
https://www.readbyqxmd.com/read/29164170/impact-of-procalcitonin-guided-antibiotic-management-on-antibiotic-exposure-and-outcomes-real-world-evidence
#16
Michael R Broyles
Background: Delayed pathogen identification and nonspecific clinical findings make definitive decisions regarding antibiotics challenging. The stimuli of bacterial toxins and inflammation make procalcitonin (PCT) unique in its ability to differentiate bacterial infection from other causes of inflammation, and thus it is useful for antibiotic management. The objective of our study was to evaluate the impact of a PCT algorithm (PCT-A) on current practice. Methods: A single-center, retrospective cohort study was conducted to evaluate the impact of adding PCT-A to stewardship practices...
2017: Open Forum Infectious Diseases
https://www.readbyqxmd.com/read/29164144/intensive-care-unit-patients-with-lower-respiratory-tract-nosocomial-infections-the-enirris-project
#17
Gennaro De Pascale, Otavio T Ranzani, Saad Nseir, Jean Chastre, Tobias Welte, Massimo Antonelli, Paolo Navalesi, Eugenio Garofalo, Andrea Bruni, Luis Miguel Coelho, Szymon Skoczynski, Federico Longhini, Fabio Silvio Taccone, David Grimaldi, Helmut J F Salzer, Christoph Lange, Filipe Froes, Antoni Artigas, Emili Díaz, Jordi Vallés, Alejandro Rodríguez, Mauro Panigada, Vittoria Comellini, Luca Fasano, Paolo M Soave, Giorgia Spinazzola, Charles-Edouard Luyt, Francisco Alvarez-Lerma, Judith Marin, Joan Ramon Masclans, Davide Chiumello, Angelo Pezzi, Marcus Schultz, Hafiz Mohamed, Menno Van Der Eerden, Roger A S Hoek, D A M P J Gommers, Marta Di Pasquale, Rok Civljak, Marko Kutleša, Matteo Bassetti, George Dimopoulos, Stefano Nava, Fernando Rios, Fernando G Zampieri, Pedro Povoa, Lieuwe D Bos, Stefano Aliberti, Antoni Torres, Ignacio Martín-Loeches
The clinical course of intensive care unit (ICU) patients may be complicated by a large spectrum of lower respiratory tract infections (LRTI), defined by specific epidemiological, clinical and microbiological aspects. A European network for ICU-related respiratory infections (ENIRRIs), supported by the European Respiratory Society, has been recently established, with the aim at studying all respiratory tract infective episodes except community-acquired ones. A multicentre, observational study is in progress, enrolling more than 1000 patients fulfilling the clinical, biochemical and radiological findings consistent with a LRTI...
October 2017: ERJ Open Research
https://www.readbyqxmd.com/read/29164045/factors-related-to-healthcare-service-quality-in-long-term-care-hospitals-in-south-korea-a-mixed-methods-study
#18
Minsung Sohn, Mankyu Choi
Objectives: The environment of long-term care hospitals (LTCHs) is critical to the management of the quality of their services and to patient safety, as highlighted by international studies. However, there is a lack of evidence on this topic in South Korea. This study aimed to examine the factors affecting healthcare quality in LTCHs and to explore the effectiveness of their quality management. Methods: This study used a mixed methods approach with quantitative data collected in a national survey and qualitative data from semi-structured interviews with practice-based managers...
October 2017: Osong Public Health and Research Perspectives
https://www.readbyqxmd.com/read/29164023/type-and-timing-of-rehabilitation-following-acute-and-subacute-spinal-cord-injury-a-systematic-review
#19
REVIEW
Anthony S Burns, Ralph J Marino, Sukhvinder Kalsi-Ryan, James W Middleton, Lindsay A Tetreault, Joseph R Dettori, Kathryn E Mihalovich, Michael G Fehlings
Objectives: The objective of this study was to conduct a systematic review of the literature to address the following clinical questions: In adult patients with acute and subacute complete or incomplete traumatic SCI, (1) does the time interval between injury and commencing rehabilitation affect outcome?; (2) what is the comparative effectiveness of different rehabilitation strategies, including different intensities and durations of treatment?; (3) are there patient or injury characteristics that affect the efficacy of rehabilitation?; and (4) what is the cost-effectiveness of various rehabilitation strategies? Methods: A systematic search was conducted for literature published through March 31, 2015 that evaluated rehabilitation strategies in adults with acute or subacute traumatic SCI at any level...
September 2017: Global Spine Journal
https://www.readbyqxmd.com/read/29163332/clinical-use-of-cerebral-microdialysis-in-patients-with-aneurysmal-subarachnoid-hemorrhage-state-of-the-art
#20
REVIEW
Raimund Helbok, Mario Kofler, Alois Josef Schiefecker, Maxime Gaasch, Verena Rass, Bettina Pfausler, Ronny Beer, Erich Schmutzhard
Objective: To review the published literature on the clinical application of cerebral microdialysis (CMD) in aneurysmal subarachnoid hemorrhage (SAH) patients and to summarize the evidence relating cerebral metabolism to pathophysiology, secondary brain injury, and outcome. Methods: Study selection: Two reviewers identified all manuscripts reporting on the clinical use of CMD in aneurysmal SAH patients from MEDLINE. All identified studies were grouped according to their focus on brain metabolic changes during the early and subacute phase after SAH, their association with mechanisms of secondary brain injury and outcome...
2017: Frontiers in Neurology
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