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https://www.readbyqxmd.com/read/28635575/-high-risk-obstetrics-in-tertiary-centres-anaesthetist-hybrid-operating-suite-and-obstetric-critical-care-unit
#1
C D van der Marel, A J Eggink, R J Stolker
The frequency of pregnancy-related morbidity has increased over recent decades, as has the number of patients with complex congenital cardiac anomalies reaching fertile age, resulting in an increasing number of high-risk pregnancies. In order to optimalise maternal and foetal outcome in these patients, not only is the availability of optimal in-hospital facilities (e.g. obstetric critical care unit, hybrid operating suite) important, but also a multidisciplinary approach which is mandatory for successful maternal and foetal outcome...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28625241/-efficacy-and-safety-of-intravenous-recombinant-human-brain-natriuretic-peptide-in-patients-with-severe-heart-failure-a-prospective-multicenter-clinical-study
#2
Xue Feng, Yue Wu, Ying Meng, Yizhen Wei
OBJECTIVE: To explore the efficacy and safety of recombinant human brain natriuretic peptide (rhBNP) in the patients with severe heart failure (HF). METHODS: A prospective multicenter study was conducted. Patients whose age > 18 years old, and with the New York Heart Association (NYHA) cardiac function grade over III-IV, acute cardiac insufficiency and the acute exacerbation of chronic cardiac insufficiency admitted to intensive care unit/cardiovascular care unit (ICU/CCU) of 58 Hospitals in China were enrolled...
June 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28618045/clean-catch-urine-collection-time-taken-and-diagnostic-implication-a-prospective-observational-study
#3
Shidan Tosif, Jonathan Kaufman, Patrick Fitzpatrick, Sandy M Hopper, Monsurul Hoq, Susan Donath, Franz E Babl
AIM: Clean catch urine (CCU) collection is commonly used in pre-continent children. CCU can be time-consuming and specimens may be contaminated. Our aim was to determine the time taken for CCU attempts and to describe the success of this method in diagnosing or excluding urinary tract infection. METHODS: Prospective observational study of CCU in pre-continent children aged 2-48 months in the emergency department. Time taken until urine collection, 'successful' (voided and caught), 'missed' (voided not caught) or the procedure 'stopped', were recorded and urine culture results analysed...
June 15, 2017: Journal of Paediatrics and Child Health
https://www.readbyqxmd.com/read/28616570/a-study-of-spectrum-of-rheumatic-heart-disease-in-a-tertiary-care-hospital-in-central-nepal
#4
S Laudari, G Subramanyam
BACKGROUND AND AIMS: Rheumatic heart disease is one of the most common cause for heart failure and associated mortalities/morbidities in the young population in developing countries like Nepal imparting huge familial, social and manpower burden. MATERIALS AND METHODS: This is a hospital based descriptive cross-sectional study during June 2014 to April 2016 over a period of 22 months at College of Medical Sciences-Bharatpur including 235 patients with clinical and/or echocardiographic evidence of definite rheumatic heart disease...
June 2017: IJC Heart & Vasculature
https://www.readbyqxmd.com/read/28615229/cardiac-troponins-and-their-prognostic-importance-in-patients-with-suspected-acute-coronary-syndrome-and-renal-dysfunction
#5
Kai M Eggers, Bertil Lindahl, Juan J Carrero, Marie Evans, Karolina Szummer, Tomas Jernberg
BACKGROUND: Cardiac troponin (cTn) is important for risk assessment in patients with suspected acute coronary syndrome (ACS). cTn concentrations may, however, be affected by renal dysfunction, and the clinical importance of this interrelation is not well established. We investigated the association between cTnT and cTnI (measured with conventional assays and a more sensitive assay) with the estimated glomerular filtration rate (eGFR) and also assessed the ability of cTn to predict the 1-year all-cause mortality...
June 14, 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/28614421/zero-calcium-score-as-a-filter-for-further-testing-in-patients-admitted-to-the-coronary-care-unit-with-chest-pain
#6
Luis Cláudio Lemos Correia, Fábio P Esteves, Manuela Carvalhal, Thiago Menezes Barbosa de Souza, Nicole de Sá, Vitor Calixto de Almeida Correia, Felipe Kalil Beirão Alexandre, Fernanda Lopes, Felipe Ferreira, Márcia Noya-Rabelo
Background: The accuracy of zero coronary calcium score as a filter in patients with chest pain has been demonstrated at the emergency room and outpatient clinics, populations with low prevalence of coronary artery disease (CAD). Objective: To test the gatekeeping role of zero calcium score in patients with chest pain admitted to the coronary care unit (CCU), where the pretest probability of CAD is higher than that of other populations. Methods: Patients underwent computed tomography for calcium scoring, and obstructive CAD was defined by a minimum 70% stenosis on invasive angiography...
June 12, 2017: Arquivos Brasileiros de Cardiologia
https://www.readbyqxmd.com/read/28601136/psychiatric-aspects-of-lung-disease-in-critical-care
#7
REVIEW
Yelizaveta Sher
Respiratory conditions are some of the most common indications for admission to critical care units. Psychiatric disorders and symptoms are highly comorbid with lung disease. They can occur as a risk factor to lung disease, as a co-occurring condition, as a consequence of a pulmonary condition, or as a treatment side effect either from medications or assistive devices. Patients can experience a myriad of mood, anxiety, and cognitive disorder symptoms and conditions in critical care units. Intensivists and psychiatrists must be aware of the interplay between pulmonary and psychiatric symptoms as well as medication effects and interactions...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28601133/assessment-and-management-of-toxidromes-in-the-critical-care-unit
#8
REVIEW
J J Rasimas, Courtney M Sinclair
The most important diagnostic factor in uncovering a toxic etiology for delirium or critical illness is the clinician's openness to the possibility of its existence. Therefore, a consulting psychiatrist, already prepared to perform the detail-oriented work of sorting out behavioral manifestations of disease, can be a vital asset at the bedside if also attuned to the role of purposeful, accidental, and iatrogenic exposures in the intensive care unit. This article summarizes the presentation, evaluation, and treatment of toxidromes relevant to the work of acute psychosomatic medicine...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28601131/detection-and-management-of-preexisting-cognitive-impairment-in-the-critical-care-unit
#9
REVIEW
Mark A Oldham, Walter Piddoubny, Ryan Peterson, Hochang B Lee
Older adults account for half of intensive care unit (ICU) admissions and ICU days, and approximately 2 in 5 older adults in the ICU have preexisting cognitive impairment (PCI). PCI identification is important for risk stratification and may influence ICU utilization and decision-making surrogacy. PCI is overlooked in more than half of patients without screening; however, screening instruments can identify PCI in less than 5 minutes. Management of PCI in the ICU involves addressing associated neuropsychiatric symptoms...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28593326/intraoperative-infusion-of-dexmedetomidine-for-prevention-of-postoperative-delirium-and-cognitive-dysfunction-in-elderly-patients-undergoing-major-elective-noncardiac-surgery-a-randomized-clinical-trial
#10
Stacie Deiner, Xiaodong Luo, Hung-Mo Lin, Daniel I Sessler, Leif Saager, Frederick E Sieber, Hochang B Lee, Mary Sano, Christopher Jankowski, Sergio D Bergese, Keith Candiotti, Joseph H Flaherty, Harendra Arora, Aryeh Shander, Peter Rock
Importance: Postoperative delirium occurs in 10% to 60% of elderly patients having major surgery and is associated with longer hospital stays, increased hospital costs, and 1-year mortality. Emerging literature suggests that dexmedetomidine sedation in critical care units is associated with reduced incidence of delirium. However, intraoperative use of dexmedetomidine for prevention of delirium has not been well studied. Objective: To evaluate whether an intraoperative infusion of dexmedetomidine reduces postoperative delirium...
June 7, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28592468/improving-health-care-provider-communication-in-end-of-life-decision-making
#11
Tracey Wilson, Cathy Haut, Bimbola Akintade
Critical care providers are responsible for many aspects of patient care, primarily focusing on preserving life. However, nearly 40% of patients who are admitted to an adult critical care unit will not survive. Initiating a conversation about end-of-life decision-making is a daunting task. Often, health care providers are not trained, experienced, or comfortable facilitating these conversations. This article describes a quality improvement project that identified current views on end-of-life communication in the intensive care unit and potential barriers that obstruct open discussion, and offering strategies for improvement...
2017: AACN Advanced Critical Care
https://www.readbyqxmd.com/read/28592392/code-krishna-an-innovative-practice-respecting-death-dying-and-beyond
#12
Bhalendu Vaishnav, Somashekhar Nimbalkar, Sandeep Desai, Smruti Vaishnav
In moments of grief, human beings seek solace and attempt to discover the meaning of life and death by reaching out to wider and deeper dimensions of existence that stem from their religious, cultural and spiritual beliefs. Conventional patient care fails to consider this vital aspect of our lives. Many hold the view that life and its experiences do not end with death; the body is but a sheath which holds the soul that inhabits it. The use of a protocol-based practice to create a solemn atmosphere around the departed individual can bridge the gap between the materialistic and non-materialistic perceptions of the dimensions of care...
June 6, 2017: Indian Journal of Medical Ethics
https://www.readbyqxmd.com/read/28592358/engineering-waterborne-pseudomonas-aeruginosa-out-of-a-critical-care-unit
#13
Mark I Garvey, Craig W Bradley, Martyn A C Wilkinson, Christina Bradley, Elisabeth Holden
OBJECTIVE: To describe engineering and holistic interventions on water outlets contaminated with Pseudomonas aeruginosa and the observed impact on clinical P. aeruginosa patient isolates in a large Intensive Care Unit (ICU). DESIGN: Descriptive study. SETTING: Queen Elizabeth Hospital Birmingham (QEHB), part of University Hospitals Birmingham (UHB) NHS Foundation Trust is a tertiary referral teaching hospital in Birmingham, UK and provides clinical services to nearly 1 million patients every year...
May 31, 2017: International Journal of Hygiene and Environmental Health
https://www.readbyqxmd.com/read/28584433/critically-ill-obstetric-patients-in-a-general-critical-care-unit-a-5-years-retrospective-study-in-a-public-teaching-hospital-of-eastern-india
#14
Sugata Dasgupta, Tulika Jha, Priyojit Bagchi, Shipti Sradha Singh, Ramprasad Gorai, Sourav Das Choudhury
BACKGROUND: Critical care services are essential for the subset of obstetric patients suffering from severe maternal morbidity. Studies on obstetric critical care are important for benchmarking the issues which need to be addressed while managing critically ill obstetric patients. Although there are several published studies on obstetric critical care from India and abroad, studies from Eastern India are limited. The present study was conducted to fill in this lacuna and to audit the obstetric critical care admissions over a 5 years' period...
May 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28582002/controversies-and-challenges-in-the-management-of-st-elevation-myocardial-infarction-complicated-by-cardiogenic-shock
#15
REVIEW
Byung-Soo Ko, Stavros G Drakos, Frederick G P Welt, Rashmee U Shah
The prognosis in ST-elevation myocardial infarction has improved with coronary care units, revascularization, and anticoagulant strategies; however, cardiogenic shock (CS) remains a highly fatal condition. Controversies remain about optimal pharmacologic therapies, revascularization strategies, the role of mechanical circulatory support (MCS), and evidence-based patient selection. The current informed consent paradigm for clinical trials creates challenges testing treatments in CS patients, who are too ill to consent and require immediate treatment...
October 2016: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28577668/characterization-of-hemodynamically-stable-acute-heart-failure-patients-requiring-a-critical-care-unit-admission-derivation-validation-and-refinement-of-a-risk-score
#16
Ismail R Raslan, Paul Brown, Cynthia M Westerhout, Justin A Ezekowitz, Adrian F Hernandez, Randall C Starling, Christopher O'Connor, Finlay A McAlister, Brian H Rowe, Paul W Armstrong, Sean van Diepen
BACKGROUND: Most patients with acute heart failure (AHF) admitted to critical care units (CCUs) are low acuity and do not require CCU-specific therapies, suggesting that they could be managed in a lower-cost ward environment. This study identified the predictors of clinical events and the need for CCU-specific therapies in patients with AHF. METHODS: Model derivation was performed using data from patients in the ASCEND-HF trial cohort (n=7,141), and the Acute Heart Failure Emergency Management community-based registry (n=666) was used to externally validate the model and to test the incremental prognostic utility of 4 variables (heart failure etiology, troponin, B-type natriuretic peptide [BNP], ejection fraction) using net reclassification index and integrated discrimination improvement...
June 2017: American Heart Journal
https://www.readbyqxmd.com/read/28577476/concurrent-intravenous-drug-administration-to-critically-ill-children-evaluation-of-frequency-and-compatibility
#17
Melany Gaetani, Helena Frndova, Winnie Seto, Christopher Parshuram
PURPOSE: To evaluate the frequency of concurrent drug administration and drug-drug incompatibility of concurrently administered drugs in critically ill children based on available references. MATERIALS AND METHODS: We retrospectively evaluated concurrent intravenous drug administration in children admitted to a single centre. Eligible patients included those admitted to the critical care unit for at least 6-hours in the ten-year period ending 30 July 2015 and received two or more IV drug administrations...
May 25, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28576388/safety-and-efficacy-of-prasugrel-and-ticagrelor-in-acute-coronary-syndrome-results-of-a-real-world-multicenter-registry
#18
Manuel Almendro-Delia, Ángel García-Alcántara, M Victoria de la Torre-Prados, Antonio Reina-Toral, José Andrés Arboleda-Sánchez, Michel Butrón-Calderón, Alberto García-Guerrero, Rafael de la Chica-Ruiz Ruano, Rafael Hidalgo-Urbano, Juan C García-Rubira
INTRODUCTION AND OBJECTIVES: The incorporation of the new antiplatelet agents (NAA) prasugrel and ticagrelor into routine clinical practice is irregular and data from the "real world" remain scarce. We aimed to assess the time trend of NAA use and the clinical safety and efficacy of these drugs compared with those of clopidogrel in a contemporary cohort of patients with acute coronary syndromes (ACS). METHODS: A multicenter retrospective observational study was conducted in patients with ACS admitted to coronary care units and prospectively included in the ARIAM-Andalusia registry between 2013 and 2015...
May 30, 2017: Revista Española de Cardiología
https://www.readbyqxmd.com/read/28570379/promoting-evidence-based-practice-at-a-primary-stroke-center-a-nurse-education-strategy
#19
Christina Anne Case
BACKGROUND: Promoting a culture of evidence-based practice within a health care facility is a priority for health care leaders and nursing professionals; however, tangible methods to promote translation of evidence to bedside practice are lacking. OBJECTIVES: The purpose of this quality improvement project was to design and implement a nursing education intervention demonstrating to the bedside nurse how current evidence-based guidelines are used when creating standardized stroke order sets at a primary stroke center, thereby increasing confidence in the use of standardized order sets at the point of care and supporting evidence-based culture within the health care facility...
July 2017: Dimensions of Critical Care Nursing: DCCN
https://www.readbyqxmd.com/read/28570376/research-use-of-nurses-working-in-the-critical-care-units-barriers-and-facilitators
#20
Issa M Hweidi, Loai Issa Tawalbeh, Musa A Al-Hassan, Razan M Alayadeh, Ahmed Mohammad Al-Smadi
BACKGROUND: There is a distinct gap between theory and practice with respect to research use in clinical practice, particularly in critical care units, that could be related to the presence of a number of barriers that hinder the use of research findings. AIMS: The aims of the study were to identify barriers and facilitators to research use as perceived by Jordanian nurses in critical care units and to examine the predictors of research use among those nurses. METHODS: The study used a cross-sectional, correlational design...
July 2017: Dimensions of Critical Care Nursing: DCCN
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