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Critical care protocols

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https://www.readbyqxmd.com/read/29147598/dbs-programming-an-evolving-approach-for-patients-with-parkinson-s-disease
#1
REVIEW
Aparna Wagle Shukla, Pam Zeilman, Hubert Fernandez, Jawad A Bajwa, Raja Mehanna
Deep brain stimulation (DBS) surgery is a well-established therapy for control of motor symptoms in Parkinson's disease. Despite an appropriate targeting and an accurate placement of DBS lead, a thorough and efficient programming is critical for a successful clinical outcome. DBS programming is a time consuming and laborious manual process. The current approach involves use of general guidelines involving determination of the lead type, electrode configuration, impedance check, and battery check. However there are no validated and well-established programming protocols...
2017: Parkinson's Disease
https://www.readbyqxmd.com/read/29139552/critical-evaluation-of-the-palm-coein-classification-system-among-women-with-abnormal-uterine-bleeding-in-low-resource-settings
#2
Divya Shubham, Anjali S Kawthalkar
OBJECTIVE: To assess the feasibility of the PALM-COEIN system for the classification of abnormal uterine bleeding (AUB) in low-resource settings and to suggest modifications. METHODS: A prospective study was conducted among women with AUB who were admitted to the gynecology ward of a tertiary care hospital and research center in central India between November 2014 and October 2016. All patients were managed as per department protocols. The causes of AUB were classified before treatment using the PALM-COEIN system (classification I) and on the basis of the histopathology reports of the hysterectomy specimens (classification II); the results were compared using classification II as the gold standard...
November 15, 2017: International Journal of Gynaecology and Obstetrics
https://www.readbyqxmd.com/read/29138206/monitor-ic-study-a-mixed-methods-prospective-multicentre-controlled-cohort-study-assessing-5-year-outcomes-of-icu-survivors-and-related-healthcare-costs-a-study-protocol
#3
Wytske Geense, Marieke Zegers, Hester Vermeulen, Mark van den Boogaard, Johannes van der Hoeven
INTRODUCTION: Due to advances in critical care medicine, more patients survive their critical illness. However, intensive care unit (ICU) survivors often experience long-term physical, cognitive and mental problems, summarised as post-intensive care syndrome (PICS), impacting their health-related quality of life (HRQoL). In what frequency PICS occurs, and to what extent this influences ICU survivors' HRQoL, is mostly unknown. The aims of this study are therefore to study the: (1) 5-year patient outcomes, (2) predictors for PICS, (3) ratio between HRQoL of ICU survivors and healthcare-related costs, and (4) care and support needs...
November 14, 2017: BMJ Open
https://www.readbyqxmd.com/read/29137682/cefepime-induced-neurotoxicity-a-systematic-review
#4
Lauren E Payne, David J Gagnon, Richard R Riker, David B Seder, Elizabeth K Glisic, Jane G Morris, Gilles L Fraser
BACKGROUND: Cefepime is a widely used antibiotic with neurotoxicity attributed to its ability to cross the blood-brain barrier and exhibit concentration-dependent ϒ-aminobutyric acid (GABA) antagonism. Neurotoxic symptoms include depressed consciousness, encephalopathy, aphasia, myoclonus, seizures, and coma. Data suggest that up to 15% of ICU patients treated with cefepime may experience these adverse effects. Risk factors include renal dysfunction, excessive dosing, preexisting brain injury, and elevated serum cefepime concentrations...
November 14, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29135898/acute-illness-protocol-for-urea-cycle-disorders
#5
Lance H Rodan, Saud H Aldubayan, Gerard T Berry, Harvey L Levy
Inborn errors of metabolism (IEMs) are genetic disorders that disrupt enzyme activity, cellular transport, or energy production. They are individually rare but collectively have an incidence of 1:1000. Most patients with IEMs are followed up by a physician with expertise in biochemical genetics (metabolism), but may present outside this setting. Because IEMs can present acutely with life-threatening crises that require specific interventions, it is critical for the emergency physician, internist, and critical care physician as well as the biochemical geneticist to have information on the initial assessment and management of patients with these disorders...
November 14, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29135618/pathway-for-the-management-of-hyperglycemia-in-the-cardiac-care-unit
#6
Seyed Hamed Hosseini Dehkordi, Jeanine Albu, Emad F Aziz, Eyal Herzog
Inpatient hyperglycemia has been associated with increased morbidity and mortality in critically ill patients. Optimal control of blood glucose (BG) levels using insulin infusion protocols has been shown to improve clinical outcomes. Protocols have been developed to prescribe a safe and effective rate of insulin infusion for optimal control of BG levels; however, a major obstacle in their implementation is their complexity. We have revised and updated our previously published pathway for the management of hyperglycemia, which introduces the "wheel" concept for insulin dosing...
December 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29130725/-eighth-jes%C3%A3%C2%BAs-culebras-lecture-critical-care-nutrition-and-hyperglycemia-a-close-relationship
#7
Alfonso Mesejo
Critically ill patients show a metabolic response to injury that affects carbohydrate metabolism, causing hyperglycemia and an increase in glycemic variability that makes the critically ill patient susceptible to infection, resulting in morbidity and mortality increase. Also, severe hypoglycemia was detected as a consequence of intensive insulin treatment that provokes deleterious effects in their clinical evolution, so a correct monitoring of plasma glucose would contribute to reduce morbidity and mortality...
October 24, 2017: Nutrición Hospitalaria: Organo Oficial de la Sociedad Española de Nutrición Parenteral y Enteral
https://www.readbyqxmd.com/read/29121287/analgesia-nociception-index-for-the-assessment-of-pain-in-critically-ill-patients-a-diagnostic-accuracy-study
#8
G Chanques, T Tarri, A Ride, A Prades, A De Jong, J Carr, N Molinari, S Jaber
Background: Behavioural pain tools are used in Intensive Care Unit (ICU) patients unable to self-report their pain-intensity but need sustained efforts to educate and train the ICU team because of the subjective nature of these clinical tools. This study measured the validity and performance of an electrophysiological monitoring tool based on the spectral analysis of heart rate variability, the Analgesia Nociception Index (ANI) which varies from 0 (minimal parasympathetic tone, maximal stress-response and pain) to 100 (maximal parasympathetic tone, minimal stress-response and pain)...
October 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29119872/adapting-operational-research-training-to-the-rwandan-context-the-intermediate-operational-research-training-programme
#9
Jackline Odhiambo, Cheryl L Amoroso, Peter Barebwanuwe, Christine Warugaba, Bethany L Hedt-Gauthier
BACKGROUND: Promoting national health research agendas in low- and middle-income countries (LMICs) requires adequate numbers of individuals with skills to initiate and conduct research. Recently, non-governmental organizations (NGOs) have joined research capacity building efforts to increase research leadership by LMIC nationals. Partners In Health, an international NGO operating in Rwanda, implemented its first Intermediate Operational Research Training (IORT) course to cultivate Rwandan research talent and generate evidence to improve health care delivery...
2017: Global Health Action
https://www.readbyqxmd.com/read/29118832/the-impact-of-focused-echocardiography-using-the-focused-intensive-care-echo-protocol-on-the-management-of-critically-ill-patients-and-comparison-with-full-echocardiographic-studies-by-bse-accredited-sonographers
#10
David P Hall, Helen Jordan, Shirjel Alam, Michael A Gillies
Introduction: Focused echocardiography is widely used to assist clinical decision-making in critically ill patients. In the UK, the Focused Intensive Care Echo protocol is recommended by the Intensive Care Society to ensure consistency of approach and guarantee training standards. Concerns remain about the reliability of information attained by non-expert clinicians in focused echocardiography, particularly when this is used to alter clinical management. Methods: A prospective, observational evaluation of 60 consecutive patients undergoing Focused Intensive Care Echo studies in a single ICU...
August 2017: J Intensive Care Soc
https://www.readbyqxmd.com/read/29112545/european-guidelines-on-perioperative-venous-thromboembolism-prophylaxis-intensive-care
#11
Jacques Duranteau, Fabio Silvio Taccone, Peter Verhamme, Walter Ageno
: Venous thromboembolism is a common and potentially life-threatening complication that occurs in 4 to 15% of patients admitted to ICUs despite the routine use of pharmacological prophylaxis. We therefore recommend an institution-wide protocol for the prevention of venous thromboembolism (Grade 1B). The routine use of ultrasonographic screening for deep vein thrombosis is not recommended when thromboprophylactic measures are in place (Grade 1B), as the detection of asymptomatic deep vein thrombosis may prompt therapeutic anticoagulation that may increase bleeding risk but has no proven reduction of clinically significant thrombotic events...
November 6, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29112241/periodontal-therapy-for-the-management-of-cardiovascular-disease-in-patients-with-chronic-periodontitis
#12
REVIEW
Chunjie Li, Zongkai Lv, Zongdao Shi, Ye Zhu, Yafei Wu, Longjiang Li, Zipporah Iheozor-Ejiofor
BACKGROUND: There is an association between chronic periodontitis and cardiovascular disease (CVD). However, it is not known whether periodontal therapy could prevent or manage CVD in patients with chronic periodontitis. OBJECTIVES: The objective of this systematic review was to investigate the effects of periodontal therapy in preventing the occurrence of, and management or recurrence of, CVD in patients with chronic periodontitis. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 31 August 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 7), MEDLINE Ovid (1946 to 31 August 2017), Embase Ovid (1980 to 31 August 2017) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL EBSCO) (1937 to 31 August 2017) ...
November 7, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29104765/postnatal-gestational-age-estimation-using-newborn-screening-blood-spots-a-proposed-validation-protocol
#13
Malia S Q Murphy, Steven Hawken, Katherine M Atkinson, Jennifer Milburn, Jesmin Pervin, Courtney Gravett, Jeffrey S A Stringer, Anisur Rahman, Eve Lackritz, Pranesh Chakraborty, Kumanan Wilson
Background: Knowledge of gestational age (GA) is critical for guiding neonatal care and quantifying regional burdens of preterm birth. In settings where access to ultrasound dating is limited, postnatal estimates are frequently used despite the issues of accuracy associated with postnatal approaches. Newborn metabolic profiles are known to vary by severity of preterm birth. Recent work by our group and others has highlighted the accuracy of postnatal GA estimation algorithms derived from routinely collected newborn screening profiles...
2017: BMJ Global Health
https://www.readbyqxmd.com/read/29101946/building-and-maintaining-organizational-infrastructure-to-attain-clinical-excellence
#14
REVIEW
Kelly Lebak, Jason Lane, Richard Taus, Hansol Kim, Michael S Stecker, Michael Hall, Meghan B Lane-Fall, Mark S Weiss
Active maintenance of highly functional teams is critical to ensuring safe, efficient patient care in the non-operating room anesthesia (NORA) suite. In addition to developing collaborative relationships and patient care protocols, individual and team training is needed. For anesthesiologists, this training must begin during residency. The training should be supplemented with continuing education in this field for providers who find themselves working in the NORA space. As NORA continues to grow, robust NORA-specific quality assurance and improvement programs will empower anesthesiologists with the tools they need to best care for these patients...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29095726/high-quality-of-evidence-is-uncommon-in-cochrane-systematic-reviews-in-anaesthesia-critical-care-and-emergency-medicine
#15
Aaron Conway, Zachary Conway, Kathleen Soalheira, Joanna Sutherland
BACKGROUND: The association between the quality of evidence in systematic reviews and authors' conclusions regarding the effectiveness of interventions relevant to anaesthesia has not been examined. OBJECTIVE: The objectives of this study were: to determine the proportion of systematic reviews in which the authors made a conclusive statement about the effect of an intervention; to describe the quality of evidence derived from outcomes in reviews that used the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) working group system for grading the quality of evidence; and to identify review characteristics associated with conclusiveness...
December 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29095391/acute-illness-protocol-for-maple-syrup-urine-disease
#16
Lance H Rodan, Saud H Aldubayan, Gerard T Berry, Harvey L Levy
Inborn errors of metabolism (IEMs) are genetic disorders that disrupt enzyme activity, cellular transport, or energy production. They are individually rare but collectively have an incidence of 1:1000. Most patients with IEMs are followed up by a physician with expertise in biochemical genetics (metabolism), but may present outside this setting. Because IEMs can present acutely with life-threatening crises that require specific interventions, it is critical for the emergency medicine physician, pediatrician, internist, and critical care physician as well as the biochemical geneticist to have information on the initial assessment and management of patients with these disorders...
October 31, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29091976/what-s-the-purpose-of-rounds-a-qualitative-study-examining-the-perceptions-of-faculty-and-students
#17
Oliver Hulland, Jeanne Farnan, Raphael Rabinowitz, Lisa Kearns, Michele Long, Bradley Monash, Priti Bhansali, H Barrett Fromme
BACKGROUND: Rounds are a critical activity on any inpatient service, but there is little literature describing the purpose of rounds from the perspective of faculty and trainees in teaching hospitals. OBJECTIVE: To evaluate and compare the perceptions of pediatric and internal medicine attendings and medical students regarding the purpose of inpatient attending rounds. METHODS: The authors conducted 10 semistructured focus groups with attendings and medical students in the spring of 2014 at 4 teaching hospitals...
November 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/29082003/implementing-the-who-safe-childbirth-checklist-lessons-from-a-global-collaboration
#18
REVIEW
Wrg Perry, S Bagheri Nejad, K Tuomisto, N Kara, N Roos, T R Dilip, L R Hirschhorn, I Larizgoitia, K Semrau, M Mathai, N Dhingra-Kumar
The WHO Safe Childbirth Checklist (SCC) was developed to ensure the delivery of essential maternal and perinatal care practices around the time of childbirth. A research collaboration was subsequently established to explore factors that influence use of the Checklist in a range of settings around the world. This analysis article presents an overview of the WHO SCC Collaboration and the lessons garnered from implementing the Checklist across a diverse range of settings. Project leads from each collaboration site were asked to distribute two surveys...
2017: BMJ Global Health
https://www.readbyqxmd.com/read/29074507/systematic-review-of-interventions-for-improving-the-performance-of-community-health-workers-in-low-income-and-middle-income-countries
#19
Madeleine Ballard, Paul Montgomery
OBJECTIVE: To systematically review and critically appraise the evidence for the effects of interventions to improve the performance of community health workers (CHWs) for community-based primary healthcare in low- and middle-income countries. DESIGN: Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS: 19 electronic databases were searched with a highly sensitive prespecified strategy and the grey literature examined, completed July 2016...
October 25, 2017: BMJ Open
https://www.readbyqxmd.com/read/29072885/cardiopulmonary-ultrasound-for-critically-ill-adults-improves-diagnostic-accuracy-in-a-resource-limited-setting-the-africa-trial
#20
Torben K Becker, Chelsea A Tafoya, Maxwell Osei-Ampofo, Matthew J Tafoya, Ross A Kessler, Nikhil Theyyunni, Hussein A Yakubu, Daniel Opuni, Daniel J Clauw, James A Cranford, Chris K Oppong, Rockefeller A Oteng
OBJECTIVE: To assess the effects of a cardiopulmonary ultrasound (CPUS) examination on diagnostic accuracy for critically ill patients in a resource-limited setting. METHODS: Approximately half of the emergency medicine resident physicians at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana, were trained in a CPUS protocol. Adult patients triaged to the resuscitation area of the emergency department (ED) were enrolled if they exhibited signs or symptoms of shock or respiratory distress...
October 26, 2017: Tropical Medicine & International Health: TM & IH
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