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https://www.readbyqxmd.com/read/28528465/contrast-induced-nephropathy-cin-of-patients-with-renal-dysfunction-in-ct-examination
#1
Yasuhiro Fukushima, Hitomi Miyazawa, Junpei Nakamura, Ayako Taketomi-Takahashi, Takayuki Suto, Yoshito Tsushima
PURPOSE: To investigate the incidence and risk factors of contrast induced nephropathy (CIN) after contrast enhanced (CE) computed tomography (CT) in patients with renal dysfunction. MATERIALS AND METHODS: Two hundred sixteen inpatients with estimated glomerular filtration rates (eGFR) <60 ml/min/1.73 m(2) underwent CE CT using iodine doses of 420 or 480 mg I/kg. Data of all enrolled patients was collected for baseline serum creatinine level (SCr), post-CE CT SCr within 3 days after CE CT, and conditions considered risk factors for CIN [renal dysfunction, contrast media dose, advanced age, diabetes mellitus, no intravenous hydration, cardiac dysfunction (left ventricular ejection fraction <60%) and intensive-care unit (ICU) admission]...
May 20, 2017: Japanese Journal of Radiology
https://www.readbyqxmd.com/read/28526270/risk-factors-for-urinary-tract-infections-in-geriatric-hospitals
#2
Raphaële Girard, Sylvain Gaujard, Véronique Pergay, Pascal Pornon, Géraldine Martin Gaujard, Laurent Bourguignon
BACKGROUND: Urinary tract infection (UTI) is the most frequent nosocomial infection in geriatric units. An understanding of risk factors for infection may help identify prevention strategies. AIM: Identification of the risk factors for UTI in elderly patients. METHOD: Retrospective analysis of 3 prospective cohorts. All hospitalized patients present in, or admitted to, a geriatric unit from June 1 to June 28, for the years 2009, 2012, and 2015 were included and followed until discharge or until June 30 of the year concerned...
May 16, 2017: Journal of Hospital Infection
https://www.readbyqxmd.com/read/28512772/subspecialty-approach-for-the-management-of-acute-cholecystitis-an-alternative-to-acute-surgical-unit-model-of-care
#3
Sonia Tran, Vincent Choi, Kirsten Hepburn, Nathan Hewitt, Joel Zhou, Daniel L Chan, Michael L Talbot
BACKGROUND: Acute cholecystitis is a common condition. Recent studies have shown an association between creation of an acute surgical unit (ASU) and improved outcomes. This study aimed to evaluate the outcomes of a subspecialty based approach to the management of acute cholecystitis as an alternative to the traditional 'generalist' general surgery approach or the ASU model. METHOD: A 6-year retrospective analysis of outcomes in patients admitted under a dedicated upper gastrointestinal service for acute cholecystitis undergoing emergency laparoscopic cholecystectomy...
May 16, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/28511702/what-is-the-evidence-for-the-management-of-patients-along-the-pathway-from-the-emergency-department-to-acute-admission-to-reduce-unplanned-attendance-and-admission-an-evidence-synthesis
#4
Sarah H Credé, Colin O'Keeffe, Suzanne Mason, Anthea Sutton, Emma Howe, Susan J Croft, Mike Whiteside
BACKGROUND: Globally, the rate of emergency hospital admissions is increasing. However, little evidence exists to inform the development of interventions to reduce unplanned Emergency Department (ED) attendances and hospital admissions. The objective of this evidence synthesis was to review the evidence for interventions, conducted during the patient's journey through the ED or acute care setting, to manage people with an exacerbation of a medical condition to reduce unplanned emergency hospital attendance and admissions...
May 16, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28506413/nasotracheal-prolonged-safe-extubation-in-acute-respiratory-failure-post-thyroidectomy-an-efficacious-technique-to-avoid-tracheotomy-a-retrospective-analysis-of-a-large-case-series
#5
F Ferraro, C Gambardella, D Testa, L Santini, R Marfella, P Fusco, C P Lombardi, A Polistena, A Sanguinetti, N Avenia, G Conzo
BACKGROUND: Acute respiratory failure is a rare life threatening complication following thyroid surgery and its incidence is reported as high as 0.9%. Clinical presentation of severe acute respiratory failure is characterized by dyspnea, inspiratory airways distress, hypoxia and its standard current management is the orotracheal intubation and safe extubation. In case of persistent distress, tracheotomy is mandatory. The Authors, analysing a large acute respiratory failure clinical series, describe an innovative treatment of this severe condition: the nasotracheal prolonged safe extubation...
May 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28489787/a-systematic-review-and-meta-analysis-of-intravenous-glucocorticoids-for-acute-pain-following-total-hip-arthroplasty
#6
Xiuhua Li, Zheng Sun, Chengbing Han, Liangliang He, Baoguo Wang
BACKGROUND: Glucocorticoids are increasingly used perioperatively, principally to prevent postoperative nausea and vomiting (PONV), and acute postoperative pain following total hip arthroplasty (THA). The authors hypothesized that preoperative intravenous glucocorticoids is associated with less pain scores and PONV without increasing the complications after THA. METHODS: Four databases (PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science) were searched with the limitations of randomized controlled trials (RCTs)...
May 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28484983/ischemic-preconditioning-in-the-intensive-care-unit
#7
REVIEW
Maranatha Ayodele, Sebastian Koch
Preconditioning is the premise that controlled preemptive exposure to sub-lethal doses of a stressor and can condition an organism or organ to later withstand a lethal dose. This process relies on marshaling endogenous survival resources that have evolved as part of an organism's evolutionary struggle to overcome at times harsh environmental conditions. This preconditioning response occurs through activation of myriad complex mechanisms that run the gamut from alterations in gene expression to the de novo synthesis and post-translational modification of proteins, and it may occur across exposure to a wide variety of stressors (i...
June 2017: Current Treatment Options in Neurology
https://www.readbyqxmd.com/read/28484421/the-randomized-controlled-strawinski-trial-procalcitonin-guided-antibiotic-therapy-after-stroke
#8
Lena Ulm, Sarah Hoffmann, Darius Nabavi, Marcella Hermans, Bruno-Marcel Mackert, Frank Hamilton, Ingo Schmehl, Gerhard-Jan Jungehuelsing, Joan Montaner, Alejandro Bustamante, Mira Katan, Andreas Hartmann, Stefan Ebmeyer, Christiane Dinter, Jan C Wiemer, Sabine Hertel, Christian Meisel, Stefan D Anker, Andreas Meisel
BACKGROUND: Pneumonia is among the most common acute complications after stroke and is associated with poor long-term outcome. Biomarkers may help identifying stroke patients at high risk for developing stroke-associated pneumonia (SAP) and to guide early treatment. AIMS: This trial investigated whether procalcitonin (PCT) ultrasensitive (PCTus)-guided antibiotic treatment of SAP can improve functional outcome after stroke. METHODS: In this international, multicenter, randomized, controlled clinical trial with blinded assessment of outcomes, patients with severe ischemic stroke in the middle cerebral artery territory were randomly assigned within 40 h after symptom onset to PCTus-based antibiotic therapy guidance in addition to stroke unit care or standard stroke unit care alone...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28480110/point-of-care-testing-in-the-acute-management-of-traumatic-brain-injury-identifying-the-coagulopathic-patient
#9
Yair M Gozal, Christopher P Carroll, Bryan M Krueger, Jane Khoury, Norberto O Andaluz
BACKGROUND: The use of anticoagulants or antiplatelet medications has become increasingly common and is a well-established risk factor for worsening of hemorrhages in trauma patients. The current study addresses the need to investigate the efficacy of point-of-care tests (POC) as an adjunct to conventional coagulation testing in traumatic brain injury (TBI) patients. METHODS: A retrospective review of 190 TBI patients >18 years of age who underwent both conventional and POC testing as part of their admission coagulopathy workup was conducted...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28477230/a-matched-case-control-comparison-of-hospital-costs-and-outcomes-for-knee-replacement-patients-admitted-postoperatively-to-acute-care-versus-rehabilitation
#10
Brian K Tse, Tessa L Walters, Steven K Howard, T Edward Kim, Stavros G Memtsoudis, Eric C Sun, Alex Kou, Lorrie Graham, Robert King, Edward R Mariano
For select total knee arthroplasty (TKA) patients, we have established an alternative pathway to bypass the acute care surgical ward and directly admit patients from the post-anesthesia care unit to on-campus rehabilitation. We retrospectively examined whether this 'fast track' pathway decreased costs and improved patient outcomes. After reviewing records of consecutive primary unilateral TKA patients over a 15-month period, each patient admitted to rehabilitation was matched with a control admitted to the acute care ward...
May 5, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28473651/how-well-are-we-managing-fragility-hip-fractures-a-narrative-report-on-the-review-with-the-attempt-to-setup-a-fragility-fracture-registry-in-hong-kong
#11
K S Leung, W F Yuen, W K Ngai, C Y Lam, T W Lau, K B Lee, K M Siu, N Tang, S H Wong, W H Cheung
INTRODUCTION: In setting up a disease registry for fragility fractures in Hong Kong, we conducted a retrospective systematic study on the management of fragility hip fractures. Patient outcomes were compared with the standards from our orthopaedic working group and those from the British Orthopaedic Association that runs a mature fracture registry in the United Kingdom. METHODS: Clinical data on fragility hip fracture patients admitted to six acute major hospitals in Hong Kong in 2012 were captured...
May 5, 2017: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
https://www.readbyqxmd.com/read/28466701/care-of-patients-with-dementia-in-an-acute-trauma-and-orthopaedics-unit
#12
Gillian McCorkell, Deirdre Harkin, Victoria McCrory, Mary Lafferty, Vivien Coates
Aim To increase awareness of the needs of patients with dementia in the trauma and orthopaedics unit of one acute hospital, and to collaborate with staff on the unit to identify ways of improving the care experienced by these patients and their families. Method An action research approach was used and three action research cycles were completed. Data were obtained retrospectively for 20 patients with dementia who were admitted to the unit for treatment. Deficiencies in the care of these patients were identified and related to communication, pain management and the recognition of delirium...
May 3, 2017: Nursing Standard
https://www.readbyqxmd.com/read/28460120/post-neonatal-tetanus-in-a-picu-of-a-developing-economy-intensive-care-needs-outcome-and-predictors-of-mortality
#13
Suresh Kumar Angurana, Muralidharan Jayashree, Arun Bansal, Sunit Singhi, Karthi Nallasamy
Objectives: To evaluate pediatric intensive care unit (PICU) needs, outcome and predictors of mortality in post-neonatal tetanus. Materials and methods: Review of 30 consecutive post-neonatal tetanus cases aged 1 months to 12 years admitted to a PICU in north India over a period of 10 years (January 2006 to December 2015). Results: Chronic suppurative otitis media was the commonest portal of entry. All received tetanus toxoid, human tetanus immunoglobulin (HTIG) and appropriate antibiotics; 7 (23...
April 27, 2017: Journal of Tropical Pediatrics
https://www.readbyqxmd.com/read/28459704/a-comparison-of-4-analgesic-regimens-for-acute-postoperative-pain-control-in-breast-augmentation-patients
#14
Pamela Tan, Morgan Sparks Martin, Nina Shank, Leann Myers, Emily Wolfe, John Lindsey, Stephen Metzinger
PURPOSE: Patients undergoing breast augmentation are treated with multiple combinations of medications for pain control including ketorolac, liposomal bupivacaine, bupivacaine, and intravenous and oral narcotics. There is no current consensus on the optimal combination; therefore, all are used at the discretion of the surgeon. METHODS: This was a single-center, retrospective study. The total number of patients included was 132. Comparisons were made between 4 groups: bupivacaine only (B); bupivacaine and liposomal bupivacaine (BL); bupivacaine and liposomal bupivacaine plus intraoperative ketorolac (BLKi); and bupivacaine and liposomal bupivacaine plus postoperative ketorolac (BLKp)...
June 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28459184/embedding-an-enriched-environment-in-an-acute-stroke-unit-increases-activity-in-people-with-stroke-a-controlled-before-after-pilot-study
#15
Ingrid Cm Rosbergen, Rohan S Grimley, Kathryn S Hayward, Katrina C Walker, Donna Rowley, Alana M Campbell, Suzanne McGufficke, Samantha T Robertson, Janelle Trinder, Heidi Janssen, Sandra G Brauer
OBJECTIVES: To determine whether an enriched environment embedded in an acute stroke unit could increase activity levels in acute stroke patients and reduce adverse events. DESIGN: Controlled before-after pilot study. SETTING: An acute stroke unit in a regional Australian hospital. PARTICIPANTS: Acute stroke patients admitted during (a) initial usual care control period, (b) an enriched environment period and (c) a sustainability period...
April 1, 2017: Clinical Rehabilitation
https://www.readbyqxmd.com/read/28457076/improvement-in-creatinine-clearance-after-open-heart-surgery-in-infants-as-an-early-indicator-of-surgical-success
#16
Amit Dagan, Ovadia Dagan
BACKGROUND: Early surgical correction of congenital heart malformations in neonates and small infants may be complicated by acute kidney injury (AKI), which is associated with higher morbidity and mortality rates, especially in patients who require dialysis. Glomerular filtration rate (GFR) is considered the best measurement of renal function which, in neonates and infants, is highly dependent on heart function. OBJECTIVES: To determine whether measurements of creatinine clearance after open heart surgery in neonates and young infants can serve as an early indicator of surgical success or AKI...
December 2016: Israel Medical Association Journal: IMAJ
https://www.readbyqxmd.com/read/28455097/severity-of-acute-kidney-injury-in-the-post-lung-transplant-patient-is-associated-with-higher-healthcare-resources-and-cost
#17
Albert P Nguyen, Rodney A Gabriel, Eugene Golts, Erik B Kistler, Ulrich Schmidt
OBJECTIVE: Perioperative risk factors and the clinical impact of acute kidney injury (AKI) and failure after lung transplantation are not well described. The incidences of AKI and acute renal failure (ARF), potential perioperative contributors to their development, and postdischarge healthcare needs were evaluated. DESIGN: Retrospective. SETTING: University hospital. PARTICIPANTS: Patients undergoing lung transplantation between January 1, 2011 and December 31, 2015...
February 5, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28450134/variability-in-integrated-cardiothoracic-training-program-curriculum
#18
Elizabeth H Stephens, Dustin M Walters, Amanda L Eilers, Vakhtang Tchantchaleishvili, Andrew B Goldstone, Erin A Gillaspie, Amy Fiedler, Damien J LaPar
BACKGROUND: Development of curricula that appropriately progress a resident from medical school graduate to fully trained cardiothoracic surgeon is a key challenge for integrated cardiothoracic training programs. This study examined variability and perceived challenges in integrated curricula. METHODS: Responses to the 2016 TSDA/TSRA survey that accompanies the annual in-training exam taken by current cardiothoracic surgery residents were analyzed. Standard statistical methods were utilized to examine trends in participant responses...
June 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28444071/reducing-pressure-ulcers-in-patients-with-prolonged-acute-mechanical-ventilation-a-quasi-experimental-study
#19
Cecilia Inés Loudet, María Cecilia Marchena, María Roxana Maradeo, Silvia Laura Fernández, María Victoria Romero, Graciela Esther Valenzuela, Isabel Eustaquia Herrera, Martha Teresa Ramírez, Silvia Rojas Palomino, Mariana Virginia Teberobsky, Leandro Ismael Tumino, Ana Laura González, Rosa Reina, Elisa Estenssoro
Objective: To determine the effectiveness of a quality management program in reducing the incidence and severity of pressure ulcers in critical care patients. Methods: This was a quasi-experimental, before-and-after study that was conducted in a medical-surgical intensive care unit. Consecutive patients who had received mechanical ventilation for ≥ 96 hours were included. A "Process Improvement" team designed a multifaceted interventional process that consisted of an educational session, a pressure ulcer checklist, a smartphone application for lesion monitoring and decision-making, and a "family prevention bundle"...
January 2017: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/28443283/vascular-access-site-for-renal-replacement-therapy-in-acute-kidney-injury-a-post-hoc-analysis-of-the-atn-study
#20
Yue-Harn Ng, Kavitha Ganta, Herbert Davis, V Shane Pankratz, Mark Unruh
BACKGROUND: Acute kidney injury requiring renal replacement therapy (RRT) in the intensive care unit portends a poor prognosis. The decisions regarding dialysis catheter placement is based mainly on physician discretion with little evidence to support the choice of dialysis catheter location. METHODS: The Veterans Affairs/National Institutes of Health Acute Renal Failure Trial Network Study was a multicenter, prospective, randomized trial of intensive vs. less intensive RRT in critically ill patients with AKI...
2017: Frontiers in Medicine
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